American journal of surgery
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Angioembolization is an effective adjunct in the management of high-grade renal injuries not surgically treated. However, in some cases, the bleeding may stop spontaneously, without the need for embolization. The aim of this study was to define the characteristics of patients who need angioembolization for high-grade blunt renal injuries (BRIs). ⋯ In patients with BRIs, discontinuity of Gerota's fascia and pararenal hematoma expansion seemed to be associated with the need for angioembolization. Early angioembolization should be considered in patients with severe associated trauma with BRIs.
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The specialty of trauma/critical care is relatively new and is currently in a state of evolution as we now face not only a shortage of surgeons but also an alarmingly increasing number of well-trained surgeons who are unwilling to provide emergency care. Regionalization of both trauma and emergency surgical care nationwide is on the horizon and will require major changes in our surgical training programs. However, careers in trauma/critical care and emergency surgery can offer a controlled lifestyle, challenging cases that cross over many disciplines, and a rich field for scientific investigation.
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Current evidence-based guidelines provide recommendations for prophylaxis and treatment of venous thromboembolism (VTE) in a variety of surgical patients. ⋯ Pharmacologic and mechanical approaches are available for VTE prophylaxis, including low-dose unfractionated heparin, low-molecular-weight heparin, vitamin K antagonists, fondaparinux, intermittent pneumatic compression devices, and graduated compression stockings. Permanent inferior vena cava filters are not recommended for primary VTE prophylaxis, although they do have a role in the prevention of pulmonary embolism in patients with recent VTE who cannot have surgery delayed. Retrievable inferior vena cava filters are under investigation for primary VTE prophylaxis in trauma patients. New anticoagulants that inhibit factor Xa and thrombin will soon be available for the prevention and treatment of VTE in surgical patients.
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An 83-year-old man reported falling and bumping his right lateral forehead on the ground 3 weeks previously. Physical examination revealed a soft, reddish swelling on the lateral forehead. Computed tomography confirmed a hematoma of the right lateral forehead. ⋯ Doppler echo showed pulsation of the swelling, which disappeared with compression of the anterior branch of the superficial temporal artery (STA). Surgical exploration was performed, and the pseudoaneurysm was resected. Pathological findings confirm a pseudoaneurysm.
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Randomized Controlled Trial Comparative Study
Fundamentals of laparoscopic surgery simulator training to proficiency improves laparoscopic performance in the operating room-a randomized controlled trial.
The purpose of this study was to assess whether training to proficiency with the Fundamentals of Laparoscopic Surgery (FLS) simulator would result in improved performance in the operating room (OR). ⋯ This study clearly demonstrates the educational value of FLS simulator training in surgical residency curricula.