World journal of surgery
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World journal of surgery · Sep 2012
Antibiotics as first-line therapy for acute appendicitis: evidence for a change in clinical practice.
Randomized studies have indicated that acute appendicitis may be treated by antibiotics without the need of surgery. However, concerns have been raised about selection bias of patients in such studies. Therefore, the present study was aimed to validate previous findings in randomized studies by a full-scale population-based application. ⋯ This population-based study confirms previous results of randomized studies. Antibiotic treatment can be offered as the first-line therapy to a majority of unselected patients with acute appendicitis without medical drawbacks other than the unknown risk for long-term relapse, which must be weighed against the unpredicted but well-known risk for serious major complications following surgical intervention.
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World journal of surgery · Sep 2012
Overall distribution of trauma-related deaths in Berlin 2010: advancement or stagnation of German trauma management?
Trauma is the leading cause of death among children, adolescents, and young adults. The latest data from the German Trauma Registry reveals a constant decrease in trauma mortality, indicating that 11.6 % of all trauma patients in 2010 died in hospital. Notably, trauma casualties dying before admission to hospital have not been systematically surveyed and analyzed in Germany. ⋯ Polytrauma is the leading cause of death, followed by severe traumatic brain injury (sTBI). The temporal analysis of traumatic death indicates a shift from the classic "trimodal" distribution to a new "bimodal" distribution. Besides advances in road safety, prevention programs and improvement in trauma management-especially the pre-hospital phase-have the potential to significantly improve the survival rate after trauma.
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World journal of surgery · Sep 2012
Postoperative adverse outcomes in surgical patients with dementia: a retrospective cohort study.
Dementia patients often present with coexisting medical conditions and potentially face higher risk of complications during hospitalization. Because the general features of postoperative adverse outcomes among surgical patients with dementia are unknown, we conducted a nationwide, retrospective cohort study to characterize surgical complications among dementia patients compared with sex- and age-matched nondementia controls. ⋯ These findings have specific implications for postoperative care of dementia patients regarding complications that are difficult to diagnose in their initial stages. Acute renal failure, pneumonia, septicemia, stroke, and urinary tract infection are the top priorities for prevention, early recognition, and intervention of postoperative complications among surgical patients with dementia. Further efforts are needed to determine specific protocols for health care teams serving this population.
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World journal of surgery · Sep 2012
Comparative StudyTrauma care and case fatality during a period of frequent, violent terror attacks and thereafter.
From September 1999 through January 2004 during the second Intifada (al-Aqsa), there were frequent terror attacks in Jerusalem. We assessed the effects on case fatality of introducing a specialized, intensified approach to trauma care at the Hebrew University-Hadassah Hospital Shock Trauma Unit (HHSTU) and other level I Israeli trauma units. This approach included close senior supervision of prehospital triage, transport, and all surgical procedures and longer hospital stays despite high patient-staff ratios and low hospital budgets. Care for lower income patients also was subsidized. ⋯ Sustained reductions in trauma unit CFRs followed introduction of a specialized, intensified approach to trauma care.
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World journal of surgery · Sep 2012
Surgical outcome of liver transection by the crush-clamping technique combined with Harmonic FOCUS™.
New energy devices are constantly being introduced for all types of surgery, including liver surgery. These devices help surgeons perform operations. Meanwhile, intraoperative blood loss is a concern of liver surgeons. Various methods to reduce intraoperative bleeding during liver resection have been reported. There are some reports that the use of energy devices was effective for liver transection. Recently, the Harmonic FOCUS™ (HF), an ultrasonically activated device, was developed. The shape of the HF is similar to that of Kelly forceps. Hepatectomy can be performed by the clamp-crushing method using the HF instead of Kelly forceps. We obtained good results of liver resection with the HF, and report these outcomes in this study. ⋯ The crush-clamping method combined with the HF is effective for liver transection. Liver resection can be performed quickly using this method.