World journal of surgery
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World journal of surgery · Apr 2012
Clinicopathological profile, airway management, and outcome in huge multinodular goiters: an institutional experience from an endemic goiter region.
Huge goiters are common in iodine-deficient endemic regions. They are of concern to the surgeons because of the anticipated risk of difficult dissection and increased chances of surgical complications. Similarly, they are of concern to the anesthesiologists because of anticipated intubation-related difficulties and post-thyroidectomy tracheomalacia. In the present study we aimed to present our experience of managing goiters based on their gross weight, highlighting their clinicopathological profile, perioperative airway-related difficulties, and management of surgical morbidity. ⋯ Long-standing huge goiters are common in iodine-deficient endemic areas. The majority of patients have symptomatic or clinicoradiological evidence of airway involvement. The incidence of RSE, airway deformity, intubation difficulty, and tracheomalacia is high with huge goiters. The surgery is technically demanding with greater associated chances of injury to native structures. Malignancy influences the presentation and outcome in smaller goiters. In centers with experienced endocrine surgeons and dedicated anesthetists, huge goiters can be successfully managed with minimal short-term and long-term morbidity.
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World journal of surgery · Apr 2012
Modification of the Trauma and Injury Severity Score (TRISS) method provides better survival prediction in Asian blunt trauma victims.
The objective of the present study was to identify logistic regression models with better survival prediction than the Trauma and Injury Severity Score (TRISS) method in assessing blunt trauma (BT) victims in Japan and Thailand. An additional aim was to demonstrate the feasibility of probability of survival (Ps) estimation without respiratory rate (RR) on admission, which is often missing or unreliable in Asian countries. ⋯ For better prediction of Ps, the actual number of the AY should be used as an explanatory variable instead of the coded value (used by the TRISS method). The logistic regression model using the ISS, AY, and coded values of SBP, GCS, and RR estimates the best prediction. Information about RR seems to be unimportant for survival prediction in BT victims in Asian countries.
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World journal of surgery · Apr 2012
Pilot testing of a population-based surgical survey tool in Sierra Leone.
The prevalence of surgical diseases in low income countries is thought to be very large, but to date no population-based survey has documented the need. The Surgeons OverSeas Assessment of Surgical Need (SOSAS) is a survey tool programmed for use with iPads to measure the prevalence of surgical conditions. ⋯ Pilot testing of SOSAS showed that a population-based survey measuring the prevalence of surgical disease could be undertaken in a low income country. It is recommended that SOSAS be used with a larger sample size to calculate the prevalence of surgical disease in low income countries.
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World journal of surgery · Apr 2012
Randomized Controlled Trial Comparative StudyComparison of dexamethasone with ondansetron or haloperidol for prevention of patient-controlled analgesia-related postoperative nausea and vomiting: a randomized clinical trial.
Patient-controlled analgesia (PCA) with parenteral opioids is associated with a high incidence of postoperative nausea and vomiting (PONV). The aim of the present study was to compare the efficacy of dexamethasone plus haloperidol with dexamethasone plus ondansetron for the prevention of PCA-related PONV. Patients who received dexamethasone alone were used as controls. ⋯ The incidences of total PONV in the first 24 h in groups DH (35%) and DO (30%) were significantly lower than those of group D (57%) (p < 0.05 for each comparison). The differences between groups DH and DO were insignificant. The incidence of PONV was significantly smaller in the DH and DO groups than predicted by the patients’ underlying risks. Pain scores, sedation scores, and recovery times were similar among the three study groups, and no clinically relevant prolongation of the electrocardiographic QTc interval was observed in any patient. conclusions: Dexamethasone 5 mg with either haloperidol 2 mg or ondansetron 4 mg provides a better antiemetic effect than dexamethasone 5 mg alone in patients receiving postoperative morphine PCA.
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World journal of surgery · Apr 2012
Utility of drain fluid amylase measurement on the first postoperative day after pancreaticoduodenectomy.
Early detection of pancreatic fistula (PF) may improve the outcome after pancreaticoduodenectomy, and exclusion of PF may allow earlier drain removal and accelerate recovery. The aim of the present study was to evaluate the relationship between drain fluid amylase on the first postoperative day (DFA(1)) and PF. ⋯ Drain fluid amylase on the DFA(1) after pancreaticoduodenectomy stratifies patients according to likelihood of developing a PF.