The Surgical clinics of North America
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Patients with chronic colitis from inflammatory bowel disease (IBD) have an increased risk of colorectal cancer (CRC). Previously, to ameliorate this, prophylactic total colectomy was offered to patients who had chronic ulcerative colitis (UC); however, research has identified less invasive management options through better understanding of the pathogenesis of cancer in chronic inflammation, a more uniform histologic diagnosis by pathologists, and proper surveillance colonoscopy techniques. This article reviews the pathogenesis of neoplasia in IBD, and then reviews the risk factors for CRC in IBD, surveillance guidelines and their limitations, surveillance techniques, ileal pouch dysplasia, and chemoprevention. Although data for CRC risk in Crohn's disease (CD) are not as extensive, it has been suggested that the risks are comparable to UC.
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The primary method of improving outcome from traumatic brain injury is through avoiding secondary insults to the injured brain. Although surgery is important, most management is critical care. ⋯ With modern monitoring systems, a physiologic-based approach is increasingly applicable, allowing focused treatment for intracranial hypertension and ischemia. It is important to balance and integrate the care of the injured brain into the overall care of the polytrauma patient.
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Surg. Clin. North Am. · Feb 2007
ReviewAdvancing injury prevention and trauma care in North America and globally.
Injury is a major global health problem. This article reviews ways in which the toll from injury can be lowered through the spectrum of injury control, including surveillance, prevention, and trauma care. There is room for improvement in the application of scientifically based, proved interventions at all points in the spectrum in all countries. The greatest attention is needed in low- and middle-income countries, however, where most of the world's people live, where injury rates are higher, and where few injury control activities have yet been undertaken.
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Despite improved education and prevention initiatives, trauma remains the leading cause of death in children. A variety of preventative measures have been developed to decrease the morbidity and mortality, and the financial burden on the health care system. This article discusses injury prevention strategies, issues in prehospital care, and key points of initial resuscitation. In addition, the major injury patterns are described with attention paid to the diagnosis and management of patients with multiple traumatic injuries.
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Surg. Clin. North Am. · Feb 2007
ReviewDamage control in trauma: laparotomy wound management acute to chronic.
Damage control surgery is fundamental to operative trauma care. Prophylactic application of open abdomen techniques has led to avoidance of a great deal of the organ dysfunction associated with abdominal compartment syndrome. Surgeons are learning about management of large open abdominal wounds. ⋯ The acute use of vacuum wound may provide for early secondary closure. There is less study focused on optimal definitive reconstructive techniques. Further study in all of these areas will lead to improved outcomes.