International journal of surgery
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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.
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As with any technology-driven field, laparoscopic surgery has made tremendous progress in recent years. Since the performance of first laparoscopic cholecystectomy by Prof Dr Med Erich Mühe of Böblingen, Germany 1985, this procedure has overtaken open cholecystectomy as the treatment of choice in cholelithiasis. However due to the cost incurred thereof and surgical training needed, open cholecystectomy is still performed on a very large scale in most parts of the third world countries. We tried to modify the conventional cholecystectomy to a minimal access approach (with minimal required infrastructure) to suit majority of patients with cholelithiasis in lieu of cost and morbidity. ⋯ These results confirm that mini-lap cholecystectomy by our modified approach is safe, feasible and has lesser morbidity and postoperative pain as compared to conventional open cholecystectomy. The technique is cost effective, easy to practice and can benefit majority of patients who otherwise cannot afford the laparoscopic surgery. Hence it can serve as an alternative to the gold standard laparoscopic cholecystectomy with almost comparable results.
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Severe blast injuries of large tyres are similar to those resulting from landmine explosions with neither thermal nor chemical effects. Little has been written about the destructive nature of these blasts. ⋯ The high energy produced by large tyre blasts may cause severe injuries leading to high morbidity and mortality. Preventive occupational methods should be adopted and implemented at the work place.