Advances in surgery
-
Advances in surgery · Jan 2005
ReviewThe pharmacologic modulation of the hypermetabolic response to burns.
Patients with burns less than 40% TBSA do not have catabolism unless sepsis develops. Those with burns more than 40% TBSA always experience catabolism, which causes metabolic derangements that persist for at least 1 year after the injury in most body tissues. The accomplishments of the past decade have placed us in the midst of an exciting paradigm shift from what used to be a primary concern (ie, mortality) to areas that are more likely to enhance the quality of life of burn survivors. ⋯ Exogenous, continuous low-dose insulin infusion, beta-blockade with propranolol, and the use of the synthetic testosterone analogue oxandrolone are the most cost-effective and least toxic therapies to date. These greatly assist therapeutic minimization of the loss of lean body mass and linear growth delay and are effective in burned patients with and without sepsis. Adverse effects, cost benefits, and the ease of administration and monitoring must be examined when considering the possibility of their use.
-
Advances in surgery · Jan 2004
Review Comparative StudySurgical therapy for hepatocellular carcinoma.
-
Advances in surgery · Jan 2002
ReviewThe role of epidural analgesia and anesthesia in surgical outcomes.
Recent clinical evidence suggests that EAA used in combination with general anesthesia has a beneficial effect on surgical outcome compared with general anesthesia and systemic analgesia. Those complications with clear evidence of a reduced incidence in prospective, randomized studies are shown in Table 2. The benefits are greatest in high-risk patients who receive thoracic epidural blockade with local anesthetic agents. Besides reducing the incidence of certain major complications, the adjunctive use of EAA reduces ICU care, hastens recovery, and has cost savings.
-
Robotic surgery has indeed arrived. The approved device in the United States, the Intuitive Surgical System's daVinci System, is installed in about 80 hospitals worldwide. That number is rising rapidly. ⋯ Most of them are also convinced that when they can see better and manipulate tissue better, the outcomes for their patients are better. Is robotic surgery right for you? The answer is complex and has a myriad of elements. This author would suggest that a great start in determining the answer would be to try the current systems and keep track of both the literature and the technical evolution regarding these systems as time progresses.
-
Nonoperative treatment is best for hemodynamically stable patients with blunt liver injuries and in selected patients with penetrating injuries. However, most patients with penetrating injuries require early surgical intervention to control life-threatening hemorrhage or manage associated injuries. ⋯ In patients with persistent hemorrhage that cannot be controlled by surgical means, immediate transfer to the angiography suite for selective embolization may be a lifesaving alternative. Surgeons should not hesitate to operate on a patient for complications, but many of these can be managed by delayed, less-invasive procedures such as angiography, CT-guided drainage of collections, laparoscopy, or endoscopic retrograde cholangiopancreatography.