International journal of surgery
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Mortality and morbidity in trauma remain a major problem in developing countries. Organized emergency response systems for transfer of trauma patients to hospitals are absent and the consequent delays could cause significant complications. ⋯ Transfer and delay in admission to a tertiary care center does not affect in-hospital mortality of trauma patients in a setting with no emergency response system. This may be due to self selection of patients who survive long enough to reach the hospital.
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Surgery is increasingly becoming an integral part of public health and health systems development worldwide. Such surgical care should be provided at the same type and level in both urban and rural settings. However, provision of essential surgery in remote and rural areas of developed as well as low and middle income countries remains totally inadequate and poses great challenges. ⋯ The best means of bringing surgical care to rural dwellers is yet to be clearly determined. However, modern surgical techniques integrated with the strategy as outlined by the World Health Organization can be brought to rural areas through specially organized camps. Sophisticated surgery can thus be performed in a high-volume and cost-effective manner, even in temporary settings. However, provision of essential surgery to rural and remote areas can only partly be met both in developed and in low and middle income countries and it will take years to solve the problem of unmet surgical needs in these areas.
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Comparative Study
Emergency laparoscopic cholecystectomy in an unselected cohort: a safe and viable option in a specialist centre.
Patients presenting acutely with symptomatic gallstone-related disease have historically had their laparoscopic cholecystectomy (LC) deferred due to perceived increased operative risks in the acute setting, particularly conversion to open surgery. The aim of this study was to compare morbidity and mortality between unselected cohorts of patients undergoing elective and 'emergency' LC in a District General Hospital. ⋯ When performed by specialist laparoscopic surgeons, LC in the acute setting is safe with mortality and morbidity rates, including conversion to open surgery, comparable to elective LC.
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Enhanced recovery after surgery (ERAS) pathways has been shown to minimize the duration of hospital stay. The aim of this study was to identify which factors have the greatest impact at reducing the length of stay within an enhanced recovery programme. ⋯ Lower ASA grade, use of epidurals and avoidance of regular oral opiates are associated with an earlier discharge in an ERAS programme.
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Neurocysticercosis (NCC) is caused by the larval form of the pork tapeworm Taenia solium and is the commonest parasitic infestation of the central nervous system. NCC is usually managed medically but in some instances surgery is required. Magnetic resonance imaging (MRI) and computed tomography (CT) are often able to provide the diagnosis of NCC in most patients with intraventricular and parenchymal cysts but in patients with hydrocephalus without any cysts, the diagnosis is confirmed by the presence of cysticercal antibodies in the serum. ⋯ For incompletely excised cysts and cysts or granulomas in locations such as the spinal cord, medical treatment with steroids and albendazole is recommended. Hydrocephalus is treated with a ventriculo-peritoneal shunt but shunts in these patients suffer from frequent obstructions and require multiple revisions. The outcome for patients with intraventricular and parenchymal cysts is usually good but for those with hydrocephalus associated with cisternal or racemose cysts and with cysticercotic meningitis, the mortality is high.