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Varut Lohsiriwat
Anorectal emergencies refer to anorectal disorders presenting with some alarming symptoms such as acute anal pain and bleeding which might require an immediate management. This article deals with the diagnosis and management of common anorectal emergencies such as acutely thrombosed external hemorrhoid, thrombosed or strangulated internal hemorrhoid, bleeding hemorrhoid, bleeding anorectal varices, anal fissure, irreducible or strangulated rectal prolapse, anorectal abscess, perineal necrotizing fasciitis (Fournier gangrene), retained anorectal foreign bodies and obstructing rectal cancer...
July 14, 2016: World Journal of Gastroenterology: WJG
Shyam Varadarajulu, Ji Young Bang, Bryce S Sutton, Jessica M Trevino, John D Christein, C Mel Wilcox
BACKGROUND & AIMS: Although surgery is the standard technique for drainage of pancreatic pseudocysts, use of endoscopic methods is increasing. We performed a single-center, open-label, randomized trial to compare endoscopic and surgical cystogastrostomy for pancreatic pseudocyst drainage. METHODS: Patients with pancreatic pseudocysts underwent endoscopic (n = 20) or surgical cystogastrostomy (n = 20). The primary end point was pseudocyst recurrence after a 24-month follow-up period...
September 2013: Gastroenterology
T C Fabian, K A Kudsk, M A Croce, L W Payne, E C Mangiante, G R Voeller, L G Britt
During a 42-month period, 65 patients sustaining pancreatic injuries were treated. They were randomized on alternate days (two separate trauma teams) to receive sump (S) or closed suction (CS) drainage. Twenty-eight patients were randomized to S and 37 to CS; there were six early deaths, which precluded drainage analysis, leaving 24 evaluable S patients and 35 CS patients. Penetrating wounds occurred in 71% and blunt in 29%. No significant differences appeared between the groups with respect to age, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), or grade of pancreatic injury...
June 1990: Annals of Surgery
Mark L Venturi, Christopher E Attinger, Ali N Mesbahi, Christopher L Hess, Katherine S Graw
The use of sub-atmospheric pressure dressings, available commercially as the vacuum-assisted closure (VAC) device, has been shown to be an effective way to accelerate healing of various wounds. The optimal sub-atmospheric pressure for wound healing appears to be approximately 125 mm Hg utilizing an alternating pressure cycle of 5 minutes of suction followed by 2 minutes off suction. Animal studies have demonstrated that this technique optimizes blood flow, decreases local tissue edema, and removes excessive fluid from the wound bed...
2005: American Journal of Clinical Dermatology
C Justinger, M K Schilling
The most common complications after abdominal surgery - wound infections and the development of incisional hernia - are associated with the opening and closing of the abdominal wall. Depending on the selection of patients, wound infection rates of up to 19 % and hernia rates of up to 38 % are reported. Based on a summary of the actual literature, the abdominal wall should be closed with continuous slowly absorbable sutures with a suture length to wound length ratio of over 4 using small stitches. While antiseptic suture material may help to reduce wound infections after abdominal incision, preventing the development of incisional hernia is still a unsolved problem...
December 2011: Zentralblatt Für Chirurgie
A C Lord, R Hompes, A Venkatasubramaniam, S Arnold
Management of the open abdomen has advanced significantly in recent years with the increasing use of vacuum assisted closure (VAC) techniques leading to increased rates of fascial closure. We present the case of a patient who suffered two complete abdominal wall dehiscences after an elective laparotomy, meaning primary closure was no longer possible. She was treated successfully with a VAC system combined with continuous medial traction using a Prolene(®) mesh. This technique has not been described before in the management of patients following wound dehiscence...
January 2015: Annals of the Royal College of Surgeons of England
Simon C Blackburn, Michael P Stanton
The peritoneum is commonly encountered in abdominal surgery. The development and rotation of the primitive gut tube lead to the normal adult arrangement of the peritoneal cavity, which forms bloodless planes allowing the retroperitoneal portions of the bowel to be safely mobilised. The arrangement of the peritoneum also forms spaces in which infected fluid or pus can collect. The microcirculation of peritoneal fluid is now well understood, and the large absorptive surface of the peritoneum can be exploited in peritoneal dialysis...
December 2014: Seminars in Pediatric Surgery
Olivier Mimoz, Jean-Christophe Lucet, Thomas Kerforne, Julien Pascal, Bertrand Souweine, Véronique Goudet, Alain Mercat, Lila Bouadma, Sigismond Lasocki, Serge Alfandari, Arnaud Friggeri, Florent Wallet, Nicolas Allou, Stéphane Ruckly, Dorothée Balayn, Alain Lepape, Jean-François Timsit
BACKGROUND: Intravascular-catheter-related infections are frequent life-threatening events in health care, but incidence can be decreased by improvements in the quality of care. Optimisation of skin antisepsis is essential to prevent short-term catheter-related infections. We hypothesised that chlorhexidine-alcohol would be more effective than povidone iodine-alcohol as a skin antiseptic to prevent intravascular-catheter-related infections. METHODS: In this open-label, randomised controlled trial with a two-by-two factorial design, we enrolled consecutive adults (age ≥18 years) admitted to one of 11 French intensive-care units and requiring at least one of central-venous, haemodialysis, or arterial catheters...
November 21, 2015: Lancet
Rachael Williams, Juvonda Hodge, Walter Ingram
BACKGROUND: Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) result in epidermal sloughing and mucositis. There are no published guidelines for intubation and early tracheostomy in this patient population. METHODS: A retrospective chart review of 40 patients admitted from 2010 to 2015 with SJS and TEN was conducted. Descriptive statistics and significance were calculated. RESULTS: Of the 43% of patients who underwent early tracheostomy, 100% had oral involvement while the initial total body surface area (TBSA) was 70% or more in 41% of patients (P < ...
April 2016: American Journal of Surgery
K S Gurusamy, K Samraj
BACKGROUND: Between 5% and 11% of people undergoing cholecystectomy have common bile duct stones. Open common bile duct exploration is an important operation when endoscopic retrograde cholangio-pancreatography fails or when expertise for laparoscopic common bile duct exploration is not available. The optimal method for performing open common bile duct exploration is unclear. OBJECTIVES: The aim is to assess the benefits and harms of primary closure versus routine T-tube drainage in open common bile duct exploration for common bile duct stones...
2007: Cochrane Database of Systematic Reviews
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