Minerva chirurgica
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We aim to assess which group of patients with blunt or penetrating chest trauma will benefit from emergency thoracotomy (ET) and have a good functional outcome. ⋯ Patients most likely to benefit from ET are those with penetrating chest injury, signs of life at scene or on arrival in the ED or pericardial tamponade. Hospitals should develop specific guidelines for emergency thoracotomy for patients with penetrating trauma, pericardial tamponade and witnessed cardiac arrest, as they are most likely to benefit from ET with improved chances of survival and good neurological outcome.
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Comparative Study
Reimbursement for tissue reconstruction by pedicled and free flaps across five European countries. The importance of autologous breast reconstruction.
Case payment mechanisms have become the principle means of remunerating hospitals in many countries. We analysed the reimbursement for different types of autologous tissue transfer in five European countries. ⋯ International data for the benchmarking and refinement of a national compensation system can be a useful instrument in identifying ways of improving each system. Across a spectrum of European countries, reimbursement for the reconstruction of the breast and other body parts was analysed and characteristics were identified. As rationalisation of healthcare becomes widespread in European countries, the need for individualised reimbursement which correlates accordingly is becoming ever more important.
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Patients prefer minimally invasive procedures with fast recovery, minimal pain and good cosmesis. Single-port cholecystectomy may decrease the need for narcotic pain medication and thus shorten recovery. Outcome-based evidence for this procedure is still being assembled. ⋯ In this small study, there is a statistically significant difference in narcotic use during the initial hospital stay was measured between the two groups. After the initial ten cases, the operative time for single-port cholecystectomy approximated the standard four-port cholecystectomy. Prospective randomized controlled trials are necessary to investigate differences in outcomes between the two approaches.
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Randomized Controlled Trial Comparative Study
Bupivacaine 0.5% versus ropivacaine 0.75% wound infiltration to decrease postoperative pain in total thyroidectomy, a prospective controlled study.
Control of postoperative pain is one of the most important concerns for both the patients and the surgical team. In this regard the efficacy of wound infiltration with local analgesia and the most proper drugs to be used are not settled. We conducted our study trying to investigate this point in a prospective randomized double blinded manner. ⋯ The benefit of local wound infiltration with local analgesia in decreasing postoperative pain is limited to a short period after surgery in which the use of ropivacaine 0.75% is recommended over pubivaccaine 0.5%.
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Comparative Study
Wedge resection versus lobectomy for T1N0 non-small cell lung cancer.
Advances in imaging techniques and screening protocols can detect more small lung cancers. Controversy exists regarding surgical management of these small tumors. ⋯ We found poorer outcome for wedge resection compared to lobectomy. We believe that caution should be used when suggesting the use of wedge resection as intentional limited resection for patients with small non-small cell lung cancer who may otherwise tolerate lobectomy. Two randomized trials comparing limited resection and lobectomy are ongoing in Japan and in United States: they will better clarify the role of limited resection, especially segmentectomy, in the treatment of T1aN0 tumors. Wedge resection may remain a valid option for compromised patients.