World journal of surgery
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The planning and development of trauma care systems in India has yet to gain attention and priority from the government, even though trauma is a major public health problem. Several efforts are under way to improve the delivery of trauma care for the injured. Guidelines for Essential Trauma Care has proved to be an ideal tool with which to begin the process of development for building a national system for the care of the injured in one of the most populous countries in the world, and one with a high burden of trauma deaths and disability. This article focuses on the impact of the Guidelines for Essential Trauma Care in efforts for improvement of the system in India.
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World journal of surgery · Jun 2006
One-stage sigmoid colon resection for perforated sigmoid diverticulitis (Hinchey stages III and IV).
Guidelines for the treatment of complicated sigmoid diverticulitis recommend Hartmann's procedure or anastomosis with protective colostomy for Hinchey stage III diverticulitis and Hartmann's procedure only for Hinchey stage IV diverticulitis. We evaluated the outcome of patients with perforated sigmoid diverticulitis Hinchey III/IV undergoing one-stage colon resection and primary anastomosis without protective colostomy. ⋯ One-stage sigmoid resection and primary anastomosis can be performed safely in nearly 90% of all patients with perforated sigmoid diverticulitis (Hinchey III/IV) by surgeons of different training levels. Patients with immunosuppression, chronic renal failure, liver cirrhosis, or previous organ transplantation or complex cardiovascular reconstructive procedures have a significantly increased risk of dying after sigmoid resection for perforated diverticulitis.
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In recent decades liver resection has become a safe procedure, mainly because of better patient selection. Despite this progress, however, outcomes of hepatectomy in cirrhotic patients with portal hypertension are still uncertain. The aim of this study was to elucidate early and long-term outcomes of liver resection in these patients. ⋯ Portal hypertension should not be considered an absolute contraindication to hepatectomy in cirrhotic patients. Child-Pugh A patients with portal hypertension have short- and long-term results similar to patients with normal portal pressure.
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World journal of surgery · Jun 2006
Randomized Controlled Trial Multicenter Study Comparative StudyAppendectomy versus antibiotic treatment in acute appendicitis. a prospective multicenter randomized controlled trial.
Appendectomy has been the treatment for acute appendicitis for over 120 years. Antibiotic treatment has occasionally been used in small uncontrolled studies, instead of operation, but this alternative has never before been tried in a multicenter randomized trial. ⋯ Acute non-perforated appendicitis can be treated successfully with antibiotics. However, there is a risk of recurrence in cases of acute appendicitis, and this risk should be compared with the risk of complications after appendectomy.
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World journal of surgery · Jun 2006
Clinicopathological characteristics and long-term outcome in patients with distant metastases from differentiated thyroid cancer.
Distant metastases are seen in a minority of patients with differentiated thyroid carcinoma (DTC) but account for most of its disease-specific mortality. Studies on the long-term outcome of patients with distant metastases are controversial. ⋯ We conclude that complete resection of the thyroid gland at diagnosis and high-dose adjuvant radioactive iodine are associated with improved survival in patients with metastatic DTC.