The European journal of surgery = Acta chirurgica
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Multicenter Study Comparative Study
Are routine preoperative chest radiographs useful in general surgery? A prospective, multicentre study in 3959 patients. Association des Chirurgiens de l'Assistance Publique pour les Evaluations médicales.
To find out which patients about to undergo general or gastrointestinal operations could have the routine preoperative posteroanterior chest radiograph omitted. ⋯ Preoperative chest radiographs should be routine for patients about to undergo general and gastrointestinal operations with three or more risk factors, and done selectively for patients with one or two. Routine preoperative films are unnecessary for patients with no risk factors.
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To study the influence of suture technique on healing of midline laparotomy wounds. ⋯ Suture technique affects both early and late wound complications. The rate of incisional hernia is lower if the suture length: wound length ratio is 4 or more. However, a high ratio should not be achieved by suturing with a stitch length of 5 cm or more as this is associated with an increase in the rate of wound infection.
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To report our experience with percutaneous dilatational tracheostomy. ⋯ Percutaneous dilatational tracheostomy is a simple, safe and cost effective technique for inserting a tracheal cannula.
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Comparative Study
Laparoscopic compared with open appendicectomy for acute appendicitis: a prospective study.
To assess the benefits of laparoscopic appendicectomy over open appendicectomy and to evaluate the impact of the severity of appendicitis and of peritonitis on the advantages of the laparoscopic approach. ⋯ Hospital stay and wound infection rates were significantly lower after laparoscopic appendicectomy. With the exception of the wound infection rate, the variables studied may differ depending on the severity of the appendicitis and the presence of peritonitis. Result of comparative studies should be carefully interpreted when the two groups are not stratified for these features.
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It has been hypothesised that failure of the gut is an important pathophysiological phenomenon of the generalised inflammatory response that leads to the multiple organ dysfunction syndrome (MODS). Abnormal colonisation, infections of gut origin, bacterial translocation are all signs of gut failure that have been implicated in the pathogenesis of MODS. ⋯ In other patients, however, this relationship is not so clear and it seems that these phenomena may reflect a failure of the host's immune and mechanical defence systems and are epiphenoma of critical illness. The causal relation between those phenomena and the development of MODS are complex and need further clarification.