World journal of surgery
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World journal of surgery · Jan 2012
Review Meta AnalysisDexamethasone for prevention of postoperative nausea and vomiting in patients undergoing thyroidectomy: meta-analysis of randomized controlled trials.
Postoperative nausea and vomiting (PONV) is a common complication after thyroidectomy. Steroids effectively reduce nausea, pain, and inflammation; therefore, preoperative administration of steroids ought to improve these surgical outcomes. ⋯ A single preoperative administration of dexamethasone reduced the incidence of PONV and analgesic requirements in patients undergoing thyroidectomy. Prophylactic use of steroids for patients undergoing thyroidectomy is safe and should be considered for routine clinical practice.
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World journal of surgery · Jan 2012
Impact of advanced age on outcomes following damage control interventions for trauma.
Damage control (DC) strategy has significantly contributed to mortality reduction in massively bleeding and critically injured trauma victims. However, there is a lack of literature validating the effectiveness of this approach in the elderly population. ⋯ The mortality rate for elderly trauma patients undergoing DC is excessive at 29%. Despite the significant burden of injury and the massive transfusion requirement, most of the elderly patients subjected to DC survived and experienced in-hospital morbidity measures comparable to those of the younger patients. Our results provide further support for damage control intervention in severely injured elderly patients.
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World journal of surgery · Jan 2012
Risk factors and outcome of intra-abdominal hypertension in patients with severe acute pancreatitis.
Intra-abdominal hypertension (IAH) is common in patients with severe acute pancreatitis (SAP). The aim of the present study was to investigate the risk factors of IAH in SAP patients and assess the prognosis of SAP combined with IAH. ⋯ The significant risk factors for IAH in patients with SAP include 24 h fluid balance (first day), number of fluid collections, and serum calcium level. Additionally, IAH is associated with extremely poor prognosis, evidenced by high rates of mortality, morbidity, and the need for invasive interventions.
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World journal of surgery · Jan 2012
Randomized Controlled Trial Multicenter StudyGhrelin agonist TZP-101/ulimorelin accelerates gastrointestinal recovery independently of opioid use and surgery type: covariate analysis of phase 2 data.
Delayed recovery of gastrointestinal (GI) motility is a common complication following surgery. TZP-101/ulimorelin is a macrocyclic peptidomimetic ghrelin receptor agonist with GI promotility effects that significantly accelerates time to recovery of GI motility compared to placebo following partial colectomy. It is also well tolerated. The objectives of this analysis were to identify predictors of GI motility recovery in patients undergoing partial colectomy and to evaluate whether these factors affect ulimorelin acceleration of GI recovery. ⋯ Two factors, type of surgery and total opioid use, independently modified times to recovery of GI motility following partial large bowel resection surgery. Acceleration of recovery of GI motility by ulimorelin was independent of these factors.
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World journal of surgery · Jan 2012
Comparative StudyEvidence-based selective application of transhiatal esophagectomy in a high-volume esophageal center.
Transthoracic esophagectomy (TTE) with lymphadenectomy represents the gold standard of operative approaches to esophageal cancer. The TTE procedure carries significant operative risk, particularly in patients with co-morbidities, and the possible oncologic benefit of a mediastinal lymph node dissection in certain subgroups of patients with esophageal cancer is controversial. Transhiatal esophagectomy (THE), which avoids a thoracotomy, may reduce morbidity and mortality below levels seen with TTE, and there is no proof from randomized studies of any oncologic inferiority to TTE in patients with early tumors. Accordingly, the selective use of THE has increased in our high-volume center in recent years, and this study audits that experience over the last decade ⋯ Transhiatal esophagectomy has a role in a pragmatic individualized approach to esophageal cancer. As an alternative to a standardized en bloc transthoracic esophagectomy, the transhiatal approach may be suitable for patients with predicted node-negative cancers or those with resectable disease who are not candidates for TTE because of co-morbidity.