American journal of surgery
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Bile duct injuries remain one of the most devastating injuries during laparoscopic cholecystectomy. Few studies target surgeons who have experienced bile duct injuries for their insight, their perspective, and their suggestions concerning this problem. ⋯ General surgeons in British Columbia have a one in two chance of experiencing a bile duct injury in their career. There were more injuries in surgeons who had already been in practice for 10 years at the time of introduction of laparoscopic cholecystectomy. The injuries are likely to occur despite high volumes of procedures and increased experience. The incidence of bile duct injuries does not seem to be different in surgeons who perform routine cholangiography and most surgeons feel that cholangiography would have little effect on injury incidence. Surgeons tend to have patient-centered concerns after injury and little concern for medicolegal issues. The majority of surgeons felt that these injuries could not be anticipated and as such it is an inherent risk of this procedure.
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Classic teaching is that narcotic analgesia in the setting of an acute abdomen can alter physical examination findings and should therefore be withheld until after a surgeon's examination. ⋯ It is common for emergency medicine physicians to medicate acute abdomen patients prior to surgical evaluation. Numerous significant study limitations and design flaws were found that question the validity of the four clinical trials supporting this practice. Because many physicians base their clinical decisions on these trials, a careful analysis of their shortcomings, as well as our own personal experiences and practice recommendations, is discussed.
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Comparative Study
Comparison of carbon dioxide and iodinated contrast for cavography prior to inferior vena cava filter placement.
The use of iodinated contrast in the critically ill trauma patient has been associated with the development of acute renal failure. The low incidence of nephrotoxicity associated with carbon dioxide (CO(2)) makes it an ideal contrast agent for cavography. However, the use of CO(2) has been limited, because reportedly it underestimates the diameter of the inferior vena cava (IVC). ⋯ Based on these data, it was determined that CO(2) cavagrams accurately reflect the diameter of the IVC and the anatomy of the renal veins. Additionally, CO(2) cavagrams can be safely performed in the intensive care unit during bedside placement of IVC filters.
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Comparative Study
Functions of the splenic remnant after subtotal splenectomy for treatment of severe splenic injuries.
To evaluate the clinical and laboratory characteristics of patients submitted to subtotal splenectomy during the immediate and late postoperative period. ⋯ We conclude that subtotal splenectomy is a good surgical alternative for serious distal spleen lesion or when the main splenic pedicle is injured.
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The need to control high costs of running operating rooms while providing for timely patient care led us to assess the time wasted in the operating room (OR). ⋯ Continuous surveillance on OR suite-patients' prompt care, repeated evaluation, and wise staff deployment-could maximize OR efficiency.