International journal of surgery
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Comparative Study
Larger hepatic metastases are more frequent with N0 colorectal tumours and are associated with poor prognosis: implications for surveillance.
Surgery is the treatment of choice for colorectal cancer liver metastases (CLM). The aim of our study was to analyze which clinical and pathological risk factors can predict recurrence after liver resection. ⋯ We demonstrated a positive correlation between N0 primary tumour and large liver metastases, which have a higher risk of disease recurrence. If validated in larger, independent studies, this study would suggest routine imaging surveillance follow up of even N0 colorectal tumours, until the biology of these tumours is fully understood.
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Evidence suggests that switch from spinal/general anaesthesia (SA/GA) to perianal block (PAB) may prove advantageous for proctologic surgeries. This study evaluates the practicability of this evidence based switch. ⋯ Perianal block is a safe, feasible, reliable, and reproducible mode of anesthesia for ano-rectal surgeries. Its evident efficacy justifies its adoption as anesthesia of choice.
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Comparative Study
Peri-operative blood glucose management in general surgery - a potential element for improved diabetic patient outcomes - an observational cohort study.
Hyperglycaemia impairs many of the physiological processes involved in recovery from surgery but there is limited research on the effect of optimal peri-operative glucose control in diabetic general surgery patients. The objectives of this study were to assess blood glucose management in diabetic general surgical patients and to determine if protocol deviations were associated with adverse outcomes. ⋯ Although not statistically significant, optimal glucose homeostasis according to hospital protocol was associated with a 25.4% reduction in peri-operative complications. We recommend careful blood glucose management according to pre-defined guidelines in all diabetic patients undergoing general surgical procedures.
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Diagnostic evaluation and management of patients with rectus sheath hematoma. A retrospective study.
Rectus sheath hematoma (RSH) is an uncommon cause of acute abdominal pain. It may mimic a wide variety of intraabdominal disorders thus frequently leading to delay in treatment, increased morbidity or even in an unnecessary surgery. ⋯ RSH should be considered in the differential diagnosis of the elderly patients under anticoagulation therapy presenting with acute abdominal pain and a palpable mass. CT is the diagnostic modality of choice. Conservative treatment is feasible in most cases. Early diagnosis is mandatory in order to avoid morbidity or unnecessary surgery. In order to prevent a traumatic RSH, trocar insertion under direct vision during laparoscopic surgery and careful attention in the abdominal administration of LMWH are essential.
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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.