Canadian journal of surgery. Journal canadien de chirurgie
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Randomized Controlled Trial Clinical Trial
Use of desmopressin acetate to reduce blood transfusion requirements during cardiac surgery in patients with acetylsalicylic-acid-induced platelet dysfunction.
To determine whether desmopressin acetate (DDAVP) has the ability to reduce blood loss in patients with a known bleeding tendency. ⋯ DDAVP reduces blood loss during cardiac bypass surgery in patients who have taken acetylsalicylic acid within 7 days before operation.
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To determine predictors of prognostic significance for patients with nonseminomatous testicular cancer (NSTC) who have advanced disease at the time of presentation. ⋯ A symptomatic interval of more than 16 weeks, poor response to initial treatment, bulky retroperitoneal disease, larger volume lung disease and persistently elevated levels of BHCG and AFP were all indicators of poor prognosis.
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To determine the nature of bile duct injuries during laparoscopic cholecystectomy, the treatment of these injuries and patient outcome. ⋯ Proper identification of the pertinent anatomy will prevent the majority of these injuries. Prompt radiographic visualization of the biliary tract is indicated in patients who have pain, jaundice and bile collections postoperatively. A hepaticojejunostomy is the procedure of choice for repair of these bile duct injuries.
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Most patients with spontaneous pneumothorax secondary to bullous emphysema are successfully managed by chest-tube drainage. Occasionally a very large air leak prevents full lung expansion. ⋯ A large bronchopleural fistula was converted to a controlled bronchocutaneous fistula. The authors conclude that when conventional management fails to provide full lung expansion in cases of pneumothorax secondary to bullous emphysema, thoracoscopic intracavitary drainage is useful.
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Comparative Study
Anterior and posterior spinal fusion: comparison of one-stage and two-stage procedures.
To compare postoperative morbidity and length of hospital stay after combined anterior and posterior spinal fusion for patients treated by a one-stage procedure and those treated in two stages, 1 to 2 weeks apart. ⋯ When possible, the one-stage procedure for anterior and posterior spinal fusion is preferred over the two-stage procedure because of a significant reduction in the length of stay in the ICU and in hospital, as well as reduced morbidity. However, this analysis should be interpreted cautiously because of the small number of cases and the variables encountered in treating this type of spinal deformity.