Journal de chirurgie
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Journal de chirurgie · Apr 2001
Comparative Study[The precautionary principle: advantages and risks].
The extension of the precautionary principle to the field of healthcare is the social response to two demands of the population: improved health safety and the inclusion of an informed public in the decision-making process. The necessary balance between cost (treatment-induced risk) and benefit (therapeutic effect) underlies all healthcare decisions. An underestimation or an overestimation of cost, i.e. risk, is equally harmful in public healthcare. ⋯ In the field of health and healthcare, the State must undertake actions based on fully open and undisguised decision-making and provide complete information to the public. A pplication of the precautionary principle requires much discernment because the final outcome can be beneficial or harmful, depending on the way it is implemented. The precautionary principle, and its applications, must be precise and detailed within a well-defined framework.
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Journal de chirurgie · Dec 2000
Practice Guideline Comparative Study Guideline[Guidelines of the SFAR (Société Française d'Anesthésie et de Réanimation). Antibiotic combinations or monotherapy in surgery and surgical intensive care. Extracts relating to the "visceral surgery" conference of experts].
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The decision to perform damage control laparotomy in a critically injured patients depends on the risk of life-threatening coagulopathy. The main decision criteria are: presence of concomitant injuries, patient history, shock, transfusion volume, hypothermia and acidosis. The aim of surgery is to achieve satisfactory hemostasis, limit peritoneal thermal loss, and perform physiological restoration as rapidly as possible in the intensive care unit. ⋯ Injuries to the intestine and the urinary tract are sutures, stapled or drained. If the skin borders cannot be reapproximated because of excessive abdominal tension, a wall prosthesis should be used to avoid abdominal compartment syndrome. Reoperation is a dangerous procedure in the immediate postoperative period but must be proposed later for reexploration or damage repair.
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Acute mesenteric ischemia is an infrequent abdominal emergency. The 90% mortality of this affection is related to a delayed diagnosis. The mesenteric ischemia and the mesenteric infarction are two different pathologic stages characterized by two different treatment and prognosis. ⋯ The purpose of the angiography is diagnostic and therapeutic. The aim of surgery in case of mesenteric ischemia is to restore a normal vascularisation. In spite of this attitude the prognosis of this affection remain poor.