World journal of surgery
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World journal of surgery · Mar 1998
Use of the scalp as a donor site for large burn wound coverage: review of 150 patients.
The characteristics of rapid wound healing and multiple harvest capacity make the scalp an important donor site when dealing with large and deep burn wounds. This paper reports the results of a retrospective analysis of 150 patients treated for large burn wounds. ⋯ Use of a scalp graft also carried a low risk of complications, with only four (2.7%) major complications including three cases (2.0%) of visible alopecia and one case (0.7%) of hair transplantation. There were no hypertrophic scars, even in the patient who had the largest number (11) of repeat harvests.
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World journal of surgery · Feb 1998
ReviewSelective gut decontamination in intensive care and surgical practice: where are we?
Selective decontamination of the digestive tract (SDD) has been widely studied in the intensive care setting. Despite the publication of more than 50 controlled trials, it remains a controversial subject, with widely disparate views on the role of SDD. ⋯ Most individual studies have shown no effect on mortality, but meta-analyses suggest a 10% overall reduction in mortality. Despite the large number of publications to date, there remain several aspects worthy of further study.
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World journal of surgery · Feb 1998
Review Comparative StudyNutritional support and infection: does the route matter?
Questions regarding the effects of the route of nutrition began to surface shortly after the introduction of total parenteral nutrition (TPN). Although TPN has become a life-saving therapy for patients who cannot tolerate enteral nutrition, it is not the panacea it was hoped to be. ⋯ These effects do not appear to be due solely to prevention to malnutrition, as the infectious complications develop early after injury or illness. However, the lack of understanding of the mechanisms does not negate the fact that in many clinical studies the enteral route of nutrition is superior to the parenteral route in terms of reducing infectious complications in critically ill or injured patients.
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World journal of surgery · Feb 1998
ReviewReflex sympathetic dystrophy: model of a severe regional inflammatory response syndrome.
The systemic inflammatory response syndrome (SIRS) and acute reflex sympathetic dystrophy syndrome (RSD) share clinical signs of severe inflammation, a protracted course, and a similar problem of impaired oxygen utilization. The difference is that SIRS patients have these signs and symptoms systemically and are severely ill in the intensive care unit (ICU), whereas acute RSD patients are in good health and their problems are limited to one extremity. Both conditions seem to be the result of an exaggerated inflammatory response. ⋯ It is hypothesized that this situation is exquisitely suitable for studying the pathophysiology of severe inflammatory responses in humans. Only a few patients are required to perform studies of, for example, oxygen metabolism and cytokine or oxygen radical production. Assessment methods may be utilized, such as nuclear magnetic resonance spectroscopy, which cannot easily be performed in ICU patients.