Articles: surgery.
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The pharmacokinetic variables of drug clearance and volume of distribution are usually corrected for body weight or surface area. Only recently have the relationships which exist between body size, physiologic function and pharmacokinetic variables been evaluated in the obese population. These effects are not widely known, and data on this and the effects of bariatric surgical procedures are scantily documented in the surgical literature. ⋯ Drugs whose distribution is restricted to LBM should utilize a loading dose based on ideal body weight (IBW). For those drugs which distribute freely into adipose tissue, the loading dose should be based on total body weight (TBW). Adjustment of the maintenance dose depends on clearance rates. In a few cases dosage adjustment depends on pharmacodynamic data, since drug clearance does not conform to these recommendations, for reasons which remain to be defined. Following bariatric surgery, in the absence of delayed gastric emptying or uncontrolled diarrhea, drug absorption rates are usually comparable to the non-operated patient.
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Reconstructive surgery for critical leg ischaemia (CLI) increased in both hospital- and population-based patient samples over 12 years. In the referral centre amputation numbers were unchanged over this period, although amputation carried out for patients with CLI decreased from 58 to 35 per cent. ⋯ Amputation rates as a measure of the efficacy of an arterial reconstruction policy should be used only on a population basis. The analysis is skewed by selection bias in referral centres.
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Tidsskr. Nor. Laegeforen. · Jan 1996
[Increasing use of cesarean section, even in developing countries].
At Kaziba hospital in rural Zaire, the frequency of deliveries by Caesarean section rose from 6.2% in 1971 to 12% in 1992, and the fraction of repeated sections rose from 17% to 49%. During the same period, the overall maternal mortality decreased from 0.3% to 0.12%, and deaths connected with Caesarean section from 3.2% to 0.7%, but still the risk of dying remained 13 times higher for births by Caesarean section compared with vaginal deliveries. The frequency of vacuum deliveries was halved during the period, and mean birth weight decreased by about 100 g. ⋯ Operations carried out by persons other than physicians were complicated by wound infections at a higher rate (20.8%) than those carried out by experienced doctors (11.2%). In areas with a poorly developed health system, a high rate of Caesarean section represents a hazard to maternal health. The need for knowledge about alternative methods like vaginal extraction, symphyseotomy and active management of labour is underlined.
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More than half of Cambodia's nine million people are under 17 years of age, but there are no certified paediatric surgeons. On a mission sponsored by CARE Australia and the International Federation of Surgical Colleges, Paddy A Dewan investigated the surgical care of Cambodia's children.