American journal of surgery
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Comparative Study
Admission characteristics of trauma patients in whom delirium develops.
The purpose of this study was to describe the admission characteristics of trauma victims that are predictive of the development of delirium during hospitalization. ⋯ Older patients and alcoholics are at increased risk for delirum. Therapies directed at prevention have the potential to improve care and decrease lengths of stay.
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Comparative Study
Value of repeat cranial computed axial tomography scanning in patients with minimal head injury.
Patients with minimal head injury (MHI) and a cranial computed axial tomography (CAT) scan positive for the presence of intracranial injury routinely undergo a repeat CAT scan within 24 hours after injury. The value of this repeat cranial CAT scan is unclear in those patients who are neurologically normal or improving. ⋯ A persistently normal or improving neurological examination in a patient with MHI appears to exclude the need for neurosurgical intervention and thus a repeat cranial CAT scan.
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There are five types of choledochal cysts, which are anomalies that involve intrahepatic or extrahepatic bile ducts, or both. These lesions are found most frequently in patients who are Asian, female, infants but are recognized with increasing frequency in adults. ⋯ Management of choledochal cysts is successful after their complete removal. Partial cyst resection and internal drainage is less satisfactory because of occasional pancreatitis, cholangitis, and cholangiocarcinoma. Resection of the intrahepatic and intrapancreatic portions of the cysts reduces the risk of cancer even though this risk is low after incomplete cyst excision. Biliary continuity after cyst resection is best established by Roux-Y hepaticojejunostomy.
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Comparative Study
Laparoscopic Roux-en-Y gastric bypass in morbidly obese and super morbidly obese patients.
Our objective was to compare the outcomes after laparoscopic Roux-en-Y gastric bypass (RYGB) in morbidly obese (body mass index [BMI] <50) patients with super morbidly obese (BMI >50) patients. ⋯ Our data demonstrate no significant difference in operative times, complication rates or length of stay between morbidly obese and super morbidly obese patients undergoing laparoscopic RYGB. Laparoscopic RYGB is safe and technically feasible in the super morbidly obese patient population.
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Review Meta Analysis
A review of the literature on octylcyanoacrylate tissue adhesive.
Octylcyanoacrylate is a medical grade topical tissue adhesive that has been approved for closing surgical incisions and traumatic lacerations. We reviewed animal and human studies that evaluated its use for a variety of surgical indications and specialties. We also performed a meta-analysis of all clinical trials using octylcyanoacrylate. ⋯ The current review and metanalysis demonstrate that octylcyanoacrylate can be used successfully in a wide variety of clinical and surgical settings for multiple types of wounds covering most of the surface of the human body. Prior knowledge of the limitations and technical aspects specific to wound closure with octylcyanoacrylate as well as appropriate wound selection and preparation will help ensure optimal results.