Canadian journal of surgery. Journal canadien de chirurgie
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Tracheostomy is a common surgical procedure, and is increasingly performed in the intensive care unit (ICU) as opposed to the operating room. Procedural knowledge is essential and is therefore outlined in this review. We also review several high-quality studies comparing percutaneous dilational tracheostomy and open surgical tracheostomy. ⋯ Studies comparing early versus late tracheostomy suggest morbidity benefits that include less nosocomial pneumonia, shorter mechanical ventilation and shorter stay in the ICU. However, we discuss the questions that remain regarding the optimal timing of tracheostomy. We outline the potential acute and chronic complications of tracheostomy and their management, and we review the different tracheostomy tubes, their indications and when to remove them.
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Supine anteroposterior chest radiography is an insensitive test for posttraumatic pneumothoraces. Computed tomography often detects pneumothoraces that were not diagnosed on chest radiography (occult pneumothoraces). Whereas the incidence of occult pneumothoraces approximates 5% of all trauma registry patients, this value approaches 15% among injured patients undergoing computed tomography. ⋯ Thoracic ultrasonography, as part of a bedside extended focused assessment with sonography for trauma examination, detects 92%-100% of all pneumothoraces and represents a simple extension of the clinician's physical examination. The final remaining question is whether clinicians can safely omit tube thoracostomy in some patients with occult pneumothoraces concurrent to positive pressure ventilation. This omission would avoid subjecting patients to the 22% risk of major chest tube-related insertional, positional and infective complications.
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Comparative Study
Efficacy of different fixation devices in maintaining an initial reduction for surgically managed distal radius fractures.
Fracture of the distal radius is a common injury. Many treatment options exist for the surgical management of extra-articular and intra-articular distal radius fractures. The best method of treatment for these fractures remains controversial. We sought to examine radiographic outcomes of patients treated with non-spanning external fixator (NSEF), open reduction and internal fixation (ORIF) with locking plates and screws or closed reduction and percutaneous pinning (CRPP) and compare their ability to maintain radiographic parameters over the initial 6-week postoperative period. ⋯ Treatment with ORIF for comminuted, intra-articular distal radius fractures produces good radiographic results with maintenance of surgical radiographic parameters, whereas NSEFand CRPP of less complex fractures also provide good results. This suggests that fracture-specific fixation with CRPP or NSEF are sufficient for certain distal radius fractures.
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Trauma remains a tremendous cause of morbidity and mortality in most countries. The objective of our study was to describe injury from trauma at the major referral hospital in Uganda over a 1-year period. ⋯ Road traffic collisions are the greatest cause of morbidity and mortality from injury in Kampala, Uganda. When comparing data from 1998 and 2005, the spectrum of injury remained similar, but mortality decreased from 7.2% to 2.7%.
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Research is an important mandate for academic surgical divisions. However, there is widespread concern that the current health care climate is leading to a decline in research activity. A University of British Columbia (UBC) academic surgical division attempted to address this concern by strategically recruiting PhD research scientists to prioritize research and develop collaborative research programs. The objective of our study was to determine whether this strategy resulted in increased research productivity. ⋯ Strategic recruitment resulted in increased and sustained research productivity. Interactions between research scientists and clinicians resulted in successful program grant funding support. These results have implications for sustaining the research mission within academic departments of surgery.