American journal of surgery
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Recent data suggest that the type of resuscitation fluid used to treat hemorrhagic shock contributes to cellular dysfunction ⋯ Cellular damage results from hemorrhagic shock. The use of resuscitation fluids decreases apoptosis during shock.
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An ongoing environment of reimbursement lagging behind escalating expenses has led physicians to explore new sources of revenue. The goal of physician-hospital ventures is to create a valuable entity that benefits patients, physicians, and the hospital. Physicians may choose to invest in healthcare facilities to improve patient care and obtain increased control over daily operations. ⋯ Physicians and management should invest time in developing a shared vision of the future before beginning contract negotiations. Successful partnering requires transparency and stepwise building of trust. The greatest gain in joint ventures arises when both sides become active owners, rather than passive investors.
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Comparative Study
Routine ilioinguinal nerve excision in inguinal hernia repairs.
Chronic inguinal neuralgia is one of the most significant complications following inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed as a means to avoid this complication. The purpose of this report is to evaluate the long-term outcomes of neuralgia and paresthesia following routine ilioinguinal nerve excision compared to nerve preservation. ⋯ Routine ilioinguinal neurectomy is associated with a significantly lower incidence of postoperative neuralgia compared to routine nerve preservation with similar severity scores in each group. There is a trend towards increased incidence of subjective paresthesia in patients undergoing routine neurectomy at 1 month, but there is no significant increase at any other end point in time. When performing Lichtenstein inguinal hernia repair, routine ilioinguinal neurectomy is a reasonable option.
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Rhabdomyolysis accounts for up to 28% of the causes of posttraumatic acute renal failure requiring dialysis. Clinically significant rhabdomyolysis is poorly characterized biochemically and difficult to diagnose. ⋯ An algorithm for testing at-risk surgical patients was developed and may aid in the early diagnosis of clinically significant rhabdomyolysis.
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Comparative Study
Selective clinical management of anterior abdominal stab wounds.
The optimal management of clinically stable patients with anterior abdominal stab wounds (AASWs) is debated. We implemented a protocol of serial clinical assessments to determine the need for laparotomy. The purpose of this study was to determine whether the approach is safe and effective. ⋯ Patients sustaining AASWs who present without hypotension, evisceration, or peritonitis may be managed safely under a protocol of serial clinical evaluations. This approach should be compared with LWE/DPL in a prospective, randomized multicenter trial.