Surgical technology international
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Review Comparative Study
Management of infection in the surgical patient: an update.
Management of severe surgical infections remains difficult and requires a multifaceted approach. In this review, we briefly summarise our approach to surgical infection, concentrating on the underlying pathological processes of intraabdominal infection. Two promising new therapies--activated protein C (ACP) and stress-dose hydrocortisone--are reviewed as adjunctive management in treatment of patients with septic shock.
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During recent years, a rapid progress in the area of minimally invasive heart surgery has been seen. In addition to operations through smaller incisions and those without a complete median sternotomy, minimally invasive in cardiac surgery also means--and this might be even more important--performing the operation without cardiopulmonary bypass (CPB). ⋯ However, discussion continues regarding whether off-pump coronary artery bypass (OPCAB) techniques allow the same (or better) outcomes in long-term graft patency, myocardial damage, and associated morbidity compared with the classic operation done on CPB. That is one of the reasons the German insurance companies still do not accept OPCAB techniques as a viable alternative for surgical coronary revascularization, although the avoidance of CPB appears to have the greatest potential to minimize procedural costs and, consequently, provide economic benefit.
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The use of microsurgical techniques has significantly altered the management of lower extremity trauma. Indications for amputation or salvage continue to change, as microsurgical transplants have become more commonplace. ⋯ The historically high rate of complications of these procedures and the fact that the resultant limb is never completely normal has led some to the conclusion that severely traumatized limbs should not be salvaged. In order to evaluate our own results in light of these considerations we have reviewed our most recent experience with this difficult problem.
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From its inception in 1911, the topic of spinal fusion has seemingly been shrouded in controversy. In that year, Dr. Russell Hibbs performed the first human spinal fusion on a patient with spinal tuberculosis. ⋯ The debate over spinal fusions is manifold to this date. The literature is replete with differing opinions regarding the indications, techniques and outcomes of spinal fusions. The topic is further compounded by the fact that the specifics of a spinal fusion are often distinct to the area of the spine fused.