The American surgeon
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The American surgeon · Feb 2008
Randomized Controlled TrialDoes single, low-dose preoperative dexamethasone improve outcomes after colorectal surgery based on an enhanced recovery protocol? Double-blind, randomized clinical trial.
Preoperative single, high-dose methylprednisolone administration improves postoperative outcomes after colonic surgery. Several randomized studies, including major surgeries, assessed various high-dose steroid regimens; however, evidence about the effect of administration of lower doses on postoperative outcomes in colorectal surgery is not available. The aim of the present study is to determine whether the administration of a single, low dose of dexamethasone before surgery would confer an outcome advantage after colorectal surgery. ⋯ C-reactive protein and Interleukin-6 levels increased significantly postoperatively in each group (P < 0.05), but there were no differences between groups when compared (P > 0.05). There were also no significant differences between pain scores, bowel functions, mobilization, hospital stay, complication rates, and readmission rates between the two groups (P > 0.05). Preoperative 8 mg dexamethasone administration has no significant effect on reducing postoperative inflammatory response and also does not improve outcomes of colorectal surgery.
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Portal hypertension resulting from cirrhosis was one of the biggest challenges faced by general surgeons up until the past two decades. The management of portal hypertensive variceal hemorrhage has undergone dramatic changes during this period. Endoscopic variceal ligation and transjugular intrahepatic portosystemic shunts are currently used with great success. ⋯ However, the need for surgical intervention has become a rarity. The success of liver transplantation has ensured that portal hypertension is cured permanently and one does not often see the critically ill and decompensated patient with cirrhosis on the surgical service. A review of the current treatment options in this very ill patient population is the primary focus of this article.
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Venous thromboembolism (VTE) includes deep vein thrombosis and pulmonary embolus and is a significant cause of morbidity and mortality in injured patients. Absolute risk factors for VTE development are poorly defined. This study aimed to elucidate and evaluate risk factors in a large, population-based trauma registry. ⋯ Hospital length of stay was doubled by VTE. The VTE rate at trauma centers was higher, which was expected, given the complexity of patients treated and higher ISS. Patients with ISS greater than 15, need for operation, spinal cord injuries, lower extremity fractures, and certain thoracic injuries are at risk for VTE.
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The American surgeon · Dec 2007
Case ReportsBullet embolus to the heart after gunshot wound to the neck: a case report.
A 43-year-old woman presented with gunshot wounds to the neck, chest, and left thigh. Computed tomography of the neck and chest with intravenous contrast revealed a left common carotid pseudoaneurysm and a foreign body in the right atrium. ⋯ At median sternotomy, the intracardiac foreign body could not be located using fluoroscopy. The foreign body (bullet) was subsequently removed in the cardiac catheterization laboratory using a percutaneous transvenous basket extraction through a right femoral vein cutdown.