Surgery
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Review Meta Analysis
An institutional analysis and systematic review with meta-analysis of pneumatic versus hydrostatic reduction for pediatric intussusception.
Intussusception remains a frequent cause of bowel obstruction in children and typically is treated by reduction via enema. Controversy persists regarding the optimal reduction technique to maximize success while minimizing morbidity. ⋯ Pneumatic reduction is more likely to successfully reduce intussusception in children without evidence of increased morbidity. In the context of available expertise, pneumatic reduction should be the method of choice for the treatment of intussusception barring an indication for immediate operative intervention.
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Risk factors for unplanned intubation have been delineated, but details regarding when and why reintubations occur as well as strategies for prevention have not been defined. ⋯ Postoperative sepsis and aspiration/pneumonia account for two thirds of unplanned intubations. Opportunities for management of patients exist for the prevention of this deadly complication.
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Laparoscopic repair of paraesophageal hernia (PEH) has been shown to result in excellent relief of symptoms and improved quality of life (QOL) despite a high radiographically identified recurrence rate. Because there is no uniform definition of PEH recurrence, it is difficult to compare studies reporting on this. This study attempts to introduce consistency to the definition of PEH recurrence based on correlation of symptoms and radiographic findings. ⋯ Our analysis of symptom scores after laparoscopic PEH repair suggests that significant worsening occurs with RRH > 2 cm. Given that there is no consistent description of recurrent PEH, we suggest this as a possible standardized definition. Overall, patients with recurrent PEHs continue to experience excellent QOL and rarely require reoperation.
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We examined whether the data obtained by monitoring central venous oxygen saturation (ScvO2) and/or stroke volume variation (SVV) during hepatectomy, as measured with the FloTrac/Vigileo system, can predict postoperative liver dysfunction. ⋯ Our results suggest that ΔScvO2 and mean SVV can predict postoperative liver dysfunction. When ΔScvO2 and mean SVV exceed 10.2% and 13.6%, respectively, we advocate that adequate attention be paid to postoperative liver dysfunction, and that early intraoperative general circulatory management measures be implemented as needed.
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Few data exist regarding the effectiveness of simulation in resident education in critical care. The purpose of this study was to determine whether multiple-simulation exposure (MSE) or single-simulation exposure (SSE) improved residents' recognition of shock and initial management of the critically ill simulated surgical patient. ⋯ Repeated simulation exposure was more effective than single simulation exposure at improving MCQ performance designed to measure the recognition and management of shock in the critically ill simulated surgical patient. Duration of training did not impact MCQ performance.