Articles: surgery.
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Normal facial movement is required for chewing, swallowing, speaking, and protecting the eye. Bell's palsy causes most cases of acute, unilateral facial palsy; infection with herpes simplex virus (HSV) type 1 may be its major cause. Varicella zoster virus (VZV) reactivation (Ramsay Hunt syndrome) is less common, but may appear without skin lesions in a form indistinguishable from Bell's palsy. ⋯ Facial nerve decompression surgery for Bell's palsy and herpes zoster oticus has experienced varying levels of enthusiasm over the years. Recent work implies that early, extensive decompression of the nerve through a middle fossa craniotomy may benefit patients at high risk for persistent deficits. However, until this procedure is subjected to a rigorous, controlled trial comparing it with maximal medical therapy, it is difficult to justify the very high costs and risk.
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To review the strategies for identification and subsequent management of high-risk patients that have been proposed to reduce perioperative morbidity and mortality. ⋯ In patients who are about to undergo major intra-abdominal surgery, preoperative cardiopulmonary exercise testing is an excellent predictor of risk in the postoperative period. No other test is able to offer such a comprehensive preoperative risk evaluation for an operative patient.
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Tramadol is a unique analgesic offering moderate, dose-related pain relief through its action at multiple sites. In contrast to pure opioid agonists, it has a low risk of respiratory depression, tolerance and dependence. ⋯ It may have advantages in paediatric and day-case surgery and as an adjunct in local anaesthetic techniques. This review provides an evidence-based account of the role of tramadol in modern practice.
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The technique or approach of damage control surgery in trauma is not new; packing liver injuries has been an accepted treatment strategy for some time. What is new is the realization that an abbreviated laparotomy, or completion of only the essential portions of the operation, is often the best treatment for the patient as a whole. Recent developments include strategies in the operating room and the intensive care unit to manage patients undergoing trauma laparatomy, including prevention of hypothermia, methods to accurately assess resuscitation status with right ventricular catheters and measurements of end-organ perfusion, and recognition of abdominal compartment syndrome, with emphasis on prevention.
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Introduction. Intra-Arterial Hepatic Chemotherapy (IAHC) based on floxuridine (FUdR) infusion is an effective treatment for hepatic metastases from colorectal cancer. A percutaneously implanted intra-arterial device may overcome the surgical stress of the laparotomic placement allowing an increase in the number of patients treated by IAHC. ⋯ Conclusions. Surgically implanted indwelling catheters for IAHC present lower incidence of device-related complications than percutaneous transaxillary implanted catheters. In spite of its irreversibility and significant biological costs, surgical implant is still advised when laparotomy has to be performed for other contextual procedures, such as colorectal or hepatic resection, while percutaneous transaxillary catheter placement is indicated for palliative or neoadjuvant IAHC.