World journal of surgery
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World journal of surgery · Jan 2014
A straight left heart border: a new radiological sign of a hemopericardium.
Detection of a cardiac injury in a stable patient after a penetrating chest injury can be difficult. Ultrasound of the pericardial sac may be associated with a false negative result in the presence of a hemothorax. A filling in of the left heart border inferior to the pulmonary artery, called the straight left heart border (SLHB), is a radiological sign on chest X-ray that we have found to be associated with the finding of a hemopericardium at surgery. The aim of the present study was to determine if this was a reliable and reproducible sign. ⋯ The straight left heart border is a newly described radiological sign that was highly significant in predicting the presence of a hemopericardium and should alert the clinician to a possible occult cardiac injury.
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World journal of surgery · Jan 2014
Thyroid lobectomy for papillary thyroid cancer: long-term follow-up study of 1,088 cases.
Total thyroidectomy is well accepted as initial surgery for papillary thyroid cancer (PTC), but the extent of the thyroidectomy remains a matter of controversy. This study was designed to investigate the long-term clinical outcome of PTC patients who had undergone thyroid lobectomy and to elucidate the indications of lobectomy as initial surgery. ⋯ The long-term clinical outcome of the PTC patients who had been treated by lobectomy without RAI ablation was excellent. Based on the above results, we concluded that lobectomy is a valid alternative to total thyroidectomy for the treatment of PTC patients who are younger than aged 45 years, whose tumor diameter is 40 mm or less, and who do not have clinical lymph node metastasis or extrathyroidal invasion.
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World journal of surgery · Jan 2014
Clinical outcomes after unplanned extubation in a surgical intensive care population.
Clinical outcome after unplanned extubation (UE) in patients admitted to the surgical intensive care unit (SICU) has not been fully investigated. In this study we assessed in-hospital mortality of patients with UE and determined whether UE is a predictor of in-hospital mortality. Finally, we sought to identify predictors of reintubation after UE in mechanically ventilated patients in the SICU. ⋯ Our results indicated that although patients with UE had high in-hospital mortality, UE was not directly associated with in-hospital mortality. Reintubation, chronic neurologic disease, emergency operation, and higher APACHE II score were related to increased in-hospital mortality. A low RASS score, a low PaO2/FiO2 ratio, and long MV duration before UE were related to reintubation after UE.
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World journal of surgery · Jan 2014
Factors influencing surgeons' intraoperative leadership: video analysis of unanticipated events in the operating room.
The achievement of surgical goals and the successful functioning of operating room (OR) teams are dependent on leadership. The attending surgeon is a team leader during an operation, with responsibility for task accomplishment by the clinical team. This study examined surgeons' leadership behaviors during surgical procedures, with particular reference to the effect of intraoperative events on leadership. ⋯ Overall, surgeons engaged in the same leadership behaviors throughout the course of an operation unless they were dealing with an unanticipated event. Surgeons appeared to adopt a "one size fits all" leadership style approach regardless of the team or situation. Additionally, surgeons seemed to limit their intraoperative leadership focus to other surgeons rather than to the wider OR team.
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World journal of surgery · Jan 2014
Intrathoracic anastomotic leakage after gastroesophageal cancer resection is associated with reduced long-term survival.
Most likely because of low statistical power, no previous studies have shown any significant association between long-term survival and anastomotic leakage in patients who have undergone gastroesophageal cancer resection. ⋯ This nationwide study confirms that patients experiencing anastomotic leakage after gastroesophageal cancer resection have a significantly lower long-term survival, even following full recovery after the leakage.