Arch Surg Chicago
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Randomized Controlled Trial Clinical Trial
Prophylaxis with oral granisetron for the prevention of nausea and vomiting after laparoscopic cholecystectomy: a prospective randomized study.
Laparoscopic cholecystectomy is associated with a relatively high incidence of postoperative nausea and vomiting when no prophylactic antiemetic is given. This study assesses the efficacy and safety of oral granisetron hydrochloride for the prevention of nausea and vomiting after laparoscopic cholecystectomy. ⋯ Preoperative oral granisetron in doses higher than 2 mg is effective for the prevention of nausea and vomiting after laparoscopic cholecystectomy.
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Abdominal wall tumors, though clinically similar, have varying degrees of biological behavior. ⋯ Abdominal wall tumors demonstrate a broad spectrum of biological behavior. Desmoids and DFSP are a local problem. High grade, size at or above 5 cm, and deep location predict distant failure and tumor-related mortality for patients with STS. Complete surgical resection is the recommended treatment approach to achieve local control. Stratification by prognostic factors will facilitate selection of patients with STS for adjuvant systemic therapies.
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Since the early 1990s, the laparoscopic technique has been increasingly used for the treatment of perforated peptic ulcer. It is important to validate a risk scoring system that can stratify patients into various risk groups before comparing the treatment outcome of laparoscopic repair against that of conventional open surgery. The scoring system should be able to predict the likelihood of mortality and morbidity. Boey score and APACHE II (Acute Physiology and Chronic Health Evaluation II) score may be of use in patient stratification. ⋯ The APACHE II score may be a useful tool for stratifying patients into various risk groups, and the Boey score might select appropriate patients for laparoscopic repair.
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Abbreviated thoracotomy, a damage-control strategy, improves survival in patients with metabolic exhaustion. ⋯ Abbreviated thoracotomy is a useful strategy in the treatment of severe chest trauma. Its use in situations of metabolic exhaustion or planned reexploration may increase patient survival rates by expediting transfer of the patient from the operating room to the ICU, where homeostasis can be restored.
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Recent use of minimally invasive techniques to evaluate the chest and abdomen in patients with penetrating thoracoabdominal trauma has led to the discovery of many occult diaphragm injuries. Surgical repair of these injuries is relatively straightforward. However, diagnosis can be difficult, and the natural history of these injuries is controversial. By developing a penetrating diaphragm injury model, the ultrasonographic characteristics and natural history of this injury can be better understood. ⋯ We developed a penetrating diaphragm injury model with high and low risk of herniation. Ultrasonography may prove to be an important diagnostic adjunct in evaluating diaphragm injuries with and without herniation. Moreover, since the "protected" diaphragm injuries in our model healed spontaneously, a role may exist for the nonoperative treatment of diaphragm injuries in clinical practice. This pig model may prove useful in further defining future management and repair techniques for such injuries.