World journal of surgery
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World journal of surgery · Sep 2014
Partnership for sustainability in cardiac surgery to address critical rheumatic heart disease in sub-Saharan Africa: the experience from Rwanda.
Rheumatic heart disease (RHD) in the developing world results in critical disability among children, adolescents, and young adults-marginalizing a key population at its peak age of productivity. Few regions in sub-Saharan Africa have independently created an effective strategy to detect and treat streptococcal infection and mitigate its progression to RHD. ⋯ This strategy provides a reliable and consistent model of sophisticated specialty care delivery; inclusive of patient-centered cardiac surgery, mentorship, didactics, skill transfer, and investment in a sustainable cardiac program to address critical RHD in sub-Saharan Africa.
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World journal of surgery · Sep 2014
Impact of ATLS training on preventable and potentially preventable deaths.
Multiple trauma continues to have a high incidence worldwide. Trauma is the leading cause of death among people between the ages of 10 and 40. The Advanced Trauma Life Support (ATLS) is the most widely accepted method for the initial control and treatment of multiple trauma patients. It is based on the following hypothesis: The application of the ATLS program may reduce preventable or potentially preventable deaths in trauma patients. ⋯ Well-founded protocols such as the ATLS can help provide the preparation health professionals need. In our hospital environment, ATLS training has helped to reduce preventable or potentially preventable mortality among trauma patients.
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World journal of surgery · Sep 2014
Comparative StudyCorrelation between preoperative imaging and intraoperative risk assessment in the prediction of postoperative pancreatic fistula following pancreatoduodenectomy.
Prediction of postoperative pancreatic fistula (POPF) can be carried out with the intraoperative assessment of pancreatic consistency (PC) and via pancreatic duct width (iPDW). Preoperative computed tomography (CT) calculated pancreatic remnant volume (PRV) and duct width (rPDW) have also been shown to offer useful information about the risk of POPF. ⋯ Preoperative CT-based and intraoperative gland risk assessments offer comparable predictive information on the risk of POPF after pancreatoduodenectomy. These results imply that accurate POPF risk estimation can be carried out in the preoperative setting to opt for improved patient selection into relevant research protocols and the availability of surgical expertise and techniques.
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World journal of surgery · Sep 2014
Audit on preoperative fasting of elective surgical patients in an African academic medical center.
Preoperative fasting is a requisite before anesthesia. The main reason for preoperative fasting is to reduce gastric volume and acidity and thus decrease the risk of pulmonary aspiration. However, preoperative fasting is usually prolonged beyond the recommended time for various reasons. Despite the many adverse effects of prolonged fasting, patients sometimes fasted for a prolonged time when surgery was delayed for different reasons at the University of Gondar Hospital. The aim of this study was to assess the duration of preoperative fasting for elective surgery. ⋯ Most patients fasted from both food (92 %) and fluid (95 %) longer than the fasting time recommended by the AAGBI, ASA, RCOA, and RCN fasting guidelines. Anesthetists, surgeons, and nurses need to revise operation lists every day in the operating theatres and resuscitate the patients when surgery is delayed for various reasons. A preoperative fasting guideline should be developed and implemented in the University of Gondar Hospital.
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World journal of surgery · Sep 2014
High pre-operative urinary norepinephrine is an independent determinant of peri-operative hemodynamic instability in unilateral pheochromocytoma/paraganglioma removal.
Peri-operative hemodynamic instability (HDI) may increase peri-operative morbidity in pheochromocytoma/paraganglioma (PPGL) patients. ⋯ High pre-operative urinary NE was an independent tumor-related factor for peri-operative HDI and significantly correlated with sustained intra-operative hypertension and post-operative hypotension.