International journal of surgical investigation
-
Int. J. Surg. Investig. · Jan 2001
Comparative StudyPitfalls and complication avoidance associated with transthoracic endoscopic sympathectomy for primary hyperhidrosis (analysis of 2200 cases).
Transthoracic endoscopic sympathectomy (TES) has been already a standard method for the treatment of primary hyperhidrosis. There are rare reports about possibly encountered problems during TES. Therefore, we present our experience in treating palmar and axillary hyperhidrosis and discuss the resoluble methods of potential problems during and after TES. ⋯ Potential complications may happen during and after TES. But nearly all endoscopic sympathectomy could be achieved if surgeons acknowledge possible anatomic variation and has ability to overcome pleural adhesions.
-
Int. J. Surg. Investig. · Jan 2000
Randomized Controlled Trial Clinical TrialPostoperative intramuscular dextromethorphan injection provides pain relief and decreases opioid requirement after modified radical mastectomy.
Narcotics are still the therapeutic mainstay for postoperative pain relief. However, many unwanted side effects are accompanied. NMDA antagonists have been demonstrated to produce analgesic and antihyperalgesic effects, moreover, to possess potentiated effect of narcotics on postoperative pain management. ⋯ Postoperative DM I.M. injection provided an analgesic effect and reduced meperidine requirement after MRM.
-
Int. J. Surg. Investig. · Jan 2000
ReviewPeri-operative nutritional support: controversies and debates.
Malnutrition continues to be a significant problem in patients undergoing surgery. The relationship between a poor nutritional status and subsequent post-operative morbidity and mortality is well recognised. It is logical, therefore, that malnourished patients should be given nutritional supplementation in the peri-operative period. However, the benefits of this approach have been debated and as we enter the new millennium there are many questions regarding then role of peri-operative nutritional support that remain unanswered. ⋯ Patients most likely to benefit from peri-operative nutritional support can be defined. Enteral nutritional support has advantages over parenteral nutrition and the administration of key nutrients has clinical benefits.
-
Disseminated intravascular coagulation (DIC) is a severe and complex coagulopathy resulting from excessive thrombin formation. Although there is a final common pathway, consumption coagulopathy and multiple organ failure (MOF), the early pathophysiology differs depending on the underlying disease. ⋯ Damaged vascular endothelial cells overproduce plasminogen activator inhibitor 1, which, with excess production of thrombin, leads to fibrnolysis-suppressive DIC and fibrin formation in the microvasculature. These changes characterize the septic coagulopathy, which is often complicated by MOF; however, a bleeding tendency is relatively rare. The platelet count and fibrinogen/fibrin degradation products are most useful for the diagnosis of septic DIC. However, since the specificity is not sufficient with these screening tests, other tests including molecular markers should be added. Since endothelial damage plays an important role in the pathophysiology in septic DIC, treatment should be focused not only on abnormal coagulopathy but also on vascular damage. Protease inhibitors and antithrombin III are both effective treatments for DIC. Although heparin is a standard drug for the treatment of DIC, the use of heparin is not recommended in case of septic DIC.
-
Int. J. Surg. Investig. · Jan 2000
Randomized Controlled Trial Comparative Study Clinical TrialShort-term symptomatic outcome and quality of life after laparoscopic versus open Nissen fundoplication: a prospective randomized trial.
Laparoscopic operation has replaced conventional operation in the treatment of reflux disease. This change has been mostly based on excellent results from highly experienced antireflux surgeons rather than on randomized clinical trials. ⋯ LNF and ONF are effective methods in the operative treatment of GERD in short-term and result in a significant improvement in patients gastrointestinal symptoms and quality of life.