International journal of surgery
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The safety of the patient and its importance in a surgical setting is well recognised. However, in the literature far less emphasis is placed upon the safety of the surgeon and his/her team. This review discusses the risks to which a surgeon is exposed, including blood-borne pathogens, radiation exposure, biomechanical stresses and fatigue, and the adverse effects of diathermy fumes. Strategies addressing these risks are presented and recommendations to improve surgical team safety are offered.
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An overview of intra-abdominal sepsis is necessary at this time with new experimental studies, scoring systems and audits on management outcomes. The understanding of the pathophysiology of the peritoneum in the manifestation of surgical sepsis and the knowledge of the source of pathogenic organisms which reach the peritoneal cavity are crucial in the prevention of intra-abdominal infection. Inter-individual variation in the pattern of mediator release and of end-organ responsiveness may play a significant role in determining the initial physiological response to major sepsis and this in turn may be a key determinant of outcome. The ability to identify the presence of peritoneal inflammation probably has the greatest influence on the final surgical decision. The prevention of the progression of sepsis is by early goal-directed therapy and source control. Recent advances in interventional techniques for peritonitis have significantly reduced the morbidity and mortality of physiologically severe complicated abdominal infection. In the critically ill patients there is some evidence that the prevention of gut mucosal acidosis improves outcome. The aim of this review is to ascertain why intra-abdominal sepsis remains a major clinical challenge and how a better understanding of the pathophysiology may enable its prevention and better management. ⋯ Electronic searches of the medline (PubMed) database, Cochrane library, and science citation index were performed to identify original published studies on intra-abdominal sepsis and the current management. Relevant articles were searched from relevant chapters in specialized texts and all included.
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According to characteristic of anatomical structure of calcaneus and sinus tarsi approach, the minimally invasive plate for treatment of displaced intra-articular calcaneal fractures had been designed. Here we aimed to review the effect of this treatment. Forty intra-articular calcaneal fractures in 38 patients from September 2006 to September 2008 were treated with percutaneous plate via sinus tarsi approach under the monitoring of C-shaped arms. ⋯ Maryland foot score demonstrated that excellent result was achieved in 32 cases, good in 6 cases, fair in 2 cases, and the excellent and good rate was 95%. Postoperative complications were not found in all fractured feet. Our results suggest that this minimally invasive sinus tarsi approach with new designed plate and screw fixation technique for the treatment of intra-articular calcaneal fractures can not only obtain the satisfactory outcomes, but also can effectively prevent surgical complications.
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A prevailing perception regarding night time surgery is that the probability of complications may be higher due to decreased availability of support staff, surgeon fatigue and other logistical factors. However there is little data supporting this notion in hip fracture surgery and we studied this in the context of Inter-trochanteric fractures fixed with dynamic hip screws (DHS). ⋯ Outcomes in terms of adequacy of fixation, post-operative complications and post-operative 30-day mortality are comparable to routine day time surgery while offering the benefits of early fixation and mobilization to the patient. This also has a positive impact on the financial burden on this population as early fixation translates into decreased length of stay and reduced cost of treatment.
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BACKGROUDS: Diagnosing penetrating diaphragmatic rupture (PDR) is a challenging aspect of managing thoracoabdominal injuries due to the lack of a typical clinical presentation. The mortality from PDR is variable and center-specific. In this study, we identified the incidence and clinical presentation of PDR at our institution and analyzed the factors that affected the length of hospital stay and mortality. ⋯ Overlooking diaphragmatic rupture in patients with thoracoabdominal penetrating injury is not infrequent. A high index of suspicion is important for making the diagnosis. A high-grade PDR and associated lung injury prolonged the length of hospital stay. Profound hemorrhagic shock and associated physical decompensation have an impact on mortality.