Journal of the Medical Association of Thailand = Chotmaihet thangphaet
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Acute (open abdomen) and late (ventral hernia) abdominal wall defects are difficult surgical problems requiring appropriate management for acceptable results. Several methods of abdominal wall reconstruction in these patients have been introduced with varying outcomes. Components separation method (CSM) is an autologous tissue repair that has been employed for such situations with satisfaction by many investigators. The authors have adopted this method of abdominal wall repair or reconstruction and used it in our patients with difficult abdominal wall problems since May 2005. The aim of the present study was to examine results of treatment of patients with large abdominal wall defects by CSM at our institution. A brief demonstration of surgical techniques and discussion of the related issues were also made. ⋯ CSM is a good alternative for management of difficult abdominal wall problems, especially in situations that employment of prosthetic mesh may be inappropriate. Its advantages are avoidance of prosthetic mesh and low risk of infection in potentially infected environment. It is versatile in various abdominal wall problems even in large abdominal wall defects. CSM is recommended when associated enteric fistula, ileostomy, colostomy closure, or other potentially infected procedures are simultaneously performed.
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Randomized Controlled Trial
A prospective placebo-controlled study on the efficacy of onion extract in silicone derivative gel for the prevention of hypertrophic scar and keloid in median sternotomy wound in pediatric patients.
New topical treatments studied in adults have been published to be potentially effective in the treatment of hypertrophic scar and keloids. There is still no study in Thai children. ⋯ Onion extract in silicone derivative gel can significantly decreased the incidence of hypertrophic scar from median sternotomy wound in pediatric patients. Keloid did not show statistically significant differences in both groups.
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Randomized Controlled Trial Comparative Study
Comparison the incidence of emergence agitation between sevoflurane and desflurane after pediatric ambulatory urologic surgery.
To compare the incidence and severity of emergence agitation, recovery profile, and adverse events between desflurane and sevoflurane anesthesia in unpremedicated pediatric ambulatory urologic surgery patients. ⋯ The occurrence of EA and adverse events between sevoflurane and desflurane were not different, except that the overall of intraoperative respiratory events was higher in desflurane group.
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Ornithine transcabamylase (OTC) deficiency is the most common and severe form of abnormal urea synthesis. It can result in hyperammonemia, severe neurologic manifestation, brain edema, and early death. Rapid removal of ammonia by hemodialysis can decrease mortality and morbidity in the patients with severe increase of ammonia levels. ⋯ Continuous venovenous hemofiltration (CVVH) is increasingly used as an alternative for HD, but performing CVVH in a neonate can be problematic due to small body size and difficult vascular access. The authors reported a successful CVVH using umbilical vein as a vascular access site for ammonia removal in a neonate with OTC deficiency with progressive elevation of plasma ammonia. Technical problems, pitfalls in performing the CVVH, and how the authors overcame the problems are discussed.
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To evaluate the effectiveness of the uterine compression suture (B-Lynch and modified B-Lynch suture) in avoiding hysterectomy in cases ofpostpartum hemorrhage and in eliminating the need for surgical intervention to arrest bleeding. ⋯ The present study showed that the B-Lynch suture is an effective and safe surgical option for treatment of intractable postpartum hemorrhage with no apparent adverse outcomes. The procedure should be taught to any physician who deals with parturition and should be applied as standard protocol for the management of PPH in the operating room.