Canadian journal of surgery. Journal canadien de chirurgie
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Societal, technologic, organizational and educational developments during the past 10 years have brought about increasing promises for change in the graduate medical education of cardiac and thoracic surgeons. These changes effectively lengthened training to 8'years and created a double standard for the education of a thoracic surgeon. A task force mandated by the Royal College of Physicians and Surgeons of Canada nucleus committees in both cardiac and thoracic surgery and with the support of the Canadian Society of Cardiovascular and Thoracic Surgeons studied the problem and made the following recommendation: cardiac surgery and thoracic surgery should each become a primary specialty with its own nucleus committee. ⋯ Each specialty could also be entered after completion of full training in general surgery. The task force also urged the development of a curriculum to guide educational objectives in each specialty. These changes will produce a flexible, shorter, more focused program for cardiac and thoracic surgeons for both university and community settings.
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The authors review the principles of reconstructive surgery for lower limb salvage after severe lower limb trauma to determine factors that have been used as decision-making criteria for limb salvage or amputation in severe lower extremity injuries and the methods of reconstruction and their outcome. The use of scoring systems and their value in acute decision making (primary amputation or limb salvage) are described. ⋯ It is essential for the physician to make a good initial decision on the need for primary amputation or limb salvage. A multidisciplinary approach is fundamental to successful salvage.
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Clinical Trial
The role of extracorporeal shock-wave lithotripsy in the treatment of symptomatic cholelithiasis.
To determine the effectiveness of extracorporeal shock-wave lithotripsy (ESWL) and adjuvant bile-salt therapy for the treatment of symptomatic cholelithiasis. ⋯ ESWL with bile salts as treatment for symptomatic cholelithiasis is not recommended for routine use.
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Review Comparative Study
Diagnostic peritoneal lavage versus abdominal computed tomography in blunt abdominal trauma: a review of prospective studies.
To determine whether abdominal computed tomography (CT) or diagnostic peritoneal lavage (DPL) should be used in the evaluation of hemodynamically stable patients with blunt abdominal trauma and equivocal findings on physical examination. ⋯ DPL should be performed if there are no contraindications and no associated injuries that would be better delineated by CT, in which case abdominal CT is indicated.
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Comparative Study
Laparoscopic appendectomy versus open appendectomy: retrospective assessment of 200 patients.
To compare laparoscopic appendectomy (LA) with traditional methods as the primary treatment for acute appendicitis. ⋯ LA is a safe and viable treatment alternative for acute appendicitis. Prospective randomized studies are needed to confirm its potential advantages.