World journal of surgery
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World journal of surgery · Jun 2009
Randomized Controlled TrialPreoperative fasting of 2 hours minimizes insulin resistance and organic response to trauma after video-cholecystectomy: a randomized, controlled, clinical trial.
Studies showing the improvement of insulin sensitivity by reducing the term of preoperative fasting are mostly done in patients undergoing major operations. More information about the role of shortened preoperative fasting in perioperative metabolism is needed for such elective minor/moderate abdominal procedures as laparoscopic cholecystectomy. We investigated the influence of a carbohydrate-rich drink given 2 h before laparoscopic cholecystectomy on insulin resistance and the metabolic response to trauma. ⋯ Abbreviation of the period of preoperative fasting and administration of a carbohydrate beverage diminishes insulin resistance and the organic response to trauma.
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World journal of surgery · Jun 2009
Comparative StudyImpact of surgical training on incidence of surgical site infection.
Despite availability of other training forms, tutorial assistance cannot be entirely replaced in surgical education. Concerns exist that tutorial assistance may lead to an increased rate of surgical site infection (SSI). The purpose of the present study was to investigate whether the risk of SSI is higher after surgery with tutorial assistance than after surgery performed autonomously by a fully trained surgeon. ⋯ Surgical training does not lead to higher SSI rate if trainees are adequately supervised and interventions are carefully selected. Although other forms of training are useful, tutorial assistance in the operating room continues to be the mainstay of surgical education.
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World journal of surgery · Jun 2009
Intrahepatic cholangiocarcinoma: prognostic factors after surgical resection.
Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor. The resectability rate is low because at the time of diagnosis this disease is frequently beyond the limits of surgical therapy. Curative resection (R0) is the most effective treatment and the only therapy associated with prolonged disease-free survival. Based on the gross appearance of the tumor the Liver Cancer Study Group of Japan (LCSGJ) defined three types: mass-forming type (MF), periductal infiltrating type (PI), intraductal growth (IG) type. The prognostic significance of gross type has been demonstrated in Eastern countries, but this issue has not been clarified in Western countries. The aim of this study was to identify the prognostic factors for survival in a group of patients submitted to surgical resection for ICC. ⋯ Curative resection of ICC is the only therapy that can achieve long-term survival. The best results were observed in patients who underwent R0 resection for MF tumors without lymph node metastases or vascular invasion. Important predictive factors related to poor survival are MF + PI macroscopic tumor type, lymph node metastases, and vascular invasion. In these patients, other therapeutic approaches (i.e., adjuvant or neoadjuvant therapy) should be evaluated to improve results.
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World journal of surgery · Jun 2009
Effect of preoperative hyperfibrinogenemia on recurrence of colorectal cancer without a systemic inflammatory response.
Disorders in the blood coagulation system are often associated with malignancy. Patients with colorectal cancer (CRC) have been shown to have abnormal data for various coagulation tests. ⋯ Hyperfibrinogenemia is clinically relevant in tumor recurrence before a systemic inflammatory response and thus can be a useful predictor of recurrence in the preinflammatory stage of CRC.
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World journal of surgery · Jun 2009
Biography Historical ArticleAn early observation on the anatomy of the inguinal canal and the etiology of inguinal hernias by Petrus Camper in the 18th century.
The famous Dutch medical doctor Petrus Camper (1722-1789) was appointed professor of anatomy and surgery at the University of Franeker, Amsterdam, and Groningen. As Praelector Anatomiae of the Amsterdam Guild of Surgeons, he gave public anatomy lessons in the Anatomy theatre in Amsterdam. During the mid 18th century he performed dissections on corpses of children and adults to investigate the anatomy and etiology of inguinal hernias. ⋯ His anatomical studies and perfect, self-drawn illustrations contributed to a better understanding of the anatomy of the inguinal canal, on the national as well as international level. Camper's "Icones Herniarum" is his most widely known work on inguinal hernias and included a series of outstanding anatomical illustrations. Petrus Camper should be considered one of the pioneers in the field of inguinal hernias.