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Lisa L Strate, Ian M Gralnek
This guideline provides recommendations for the management of patients with acute overt lower gastrointestinal bleeding. Hemodynamic status should be initially assessed with intravascular volume resuscitation started as needed. Risk stratification based on clinical parameters should be performed to help distinguish patients at high- and low-risk of adverse outcomes. Hematochezia associated with hemodynamic instability may be indicative of an upper gastrointestinal (GI) bleeding source and thus warrants an upper endoscopy...
April 2016: American Journal of Gastroenterology
Mervyn Singer, Clifford S Deutschman, Christopher Warren Seymour, Manu Shankar-Hari, Djillali Annane, Michael Bauer, Rinaldo Bellomo, Gordon R Bernard, Jean-Daniel Chiche, Craig M Coopersmith, Richard S Hotchkiss, Mitchell M Levy, John C Marshall, Greg S Martin, Steven M Opal, Gordon D Rubenfeld, Tom van der Poll, Jean-Louis Vincent, Derek C Angus
IMPORTANCE: Definitions of sepsis and septic shock were last revised in 2001. Considerable advances have since been made into the pathobiology (changes in organ function, morphology, cell biology, biochemistry, immunology, and circulation), management, and epidemiology of sepsis, suggesting the need for reexamination. OBJECTIVE: To evaluate and, as needed, update definitions for sepsis and septic shock. PROCESS: A task force (n = 19) with expertise in sepsis pathobiology, clinical trials, and epidemiology was convened by the Society of Critical Care Medicine and the European Society of Intensive Care Medicine...
February 23, 2016: JAMA: the Journal of the American Medical Association
Richard H Sterns, Marvin Grieff, Paul L Bernstein
Treatment options for hyperkalemia have not changed much since the introduction of the cation exchange resin, sodium polystyrene sulfonate (Kayexalate, Covis Pharmaceuticals, Cary, NC), over 50 years ago. Although clinicians of that era did not have ready access to hemodialysis or loop diuretics, the other tools that we use today-calcium, insulin, and bicarbonate-were well known to them. Currently recommended insulin regimens provide too little insulin to achieve blood levels with a maximal kalemic effect and too little glucose to avoid hypoglycemia...
March 2016: Kidney International
Maureen Moore, Cheguevara Afaneh, Daniel Benhuri, Caroline Antonacci, Jonathan Abelson, Rasa Zarnegar
Gastroesophageal reflux disease (GERD) is a very common disorder with increasing prevalence. It is estimated that up to 20%-25% of Americans experience symptoms of GERD weekly. Excessive reflux of acidic often with alkaline bile salt gastric and duodenal contents results in a multitude of symptoms for the patient including heartburn, regurgitation, cough, and dysphagia. There are also associated complications of GERD including erosive esophagitis, Barrett's esophagus, stricture and adenocarcinoma of the esophagus...
January 27, 2016: World Journal of Gastrointestinal Surgery
Sweyn S Garrioch, Michael A Gillies
PURPOSE OF REVIEW: This review appraises recent evidence and provides clinical guidance on optimal perioperative fluid therapy. RECENT FINDINGS: Choice of perioperative intravenous fluid continues to be the source of much debate. Not all crystalloids are equivalent, and there is growing evidence that balanced solutions are superior to 0.9% saline in many situations. Recent evidence from the critical care population has highlighted risks associated with synthetic colloids; this and the absence of demonstrable benefit in the surgical population make it difficult to recommend their use in the perioperative period...
August 2015: Current Opinion in Critical Care
Amir H Lebastchi, Patricia I Donovan, Robert Udelsman
IMPORTANCE: Locoregional anesthesia, conscious sedation, and exploration via a limited incision have become a well-accepted approach for the treatment of patients with primary hyperparathyroidism with image-localized, presumed single-gland disease. However, to our knowledge, this minimally invasive technique has never been investigated in patients with multigland disease. OBJECTIVE: To extrapolate the technique of locoregional anesthesia, conscious sedation, and exploration via a limited incision to perform minimally invasive bilateral exploration in patients who have multigland hyperplasia...
November 2014: JAMA Surgery
Jai Prakash, Deepansh Dalela, Apul Goel, Divakar Dalela, Manoj Kumar, Satya Narayan Sankhwar, Shiv Narain Kureel
OBJECTIVES: To describe our experience and illustrate the surgical procedure of synchronous bilateral testicular rerouting in high inguinal undescended testes (HIUT) by extending the use of "modified Prentiss maneuver" in bilateral situation, to establish this as a procedure of choice in bilateral HIUT and secondly to demonstrate the length gained by maneuver itself. METHODS: Between January 2011 and December 2012 ten boys (8months-6years) with diagnosis of bilateral HIUT were included in the study...
August 2014: Journal of Pediatric Surgery
Harman M Bruins, Erik Veskimae, Virginia Hernandez, Mari Imamura, Molly M Neuberger, Philip Dahm, Fiona Stewart, Thomas B Lam, James N'Dow, Antoine G van der Heijden, Eva Compérat, Nigel C Cowan, Maria De Santis, Georgios Gakis, Thierry Lebret, Maria J Ribal, Amir Sherif, J Alfred Witjes
CONTEXT: Controversy exists regarding the therapeutic value of lymphadenectomy (LND) in patients undergoing radical cystectomy (RC) for muscle-invasive bladder cancer (MIBC). OBJECTIVE: To systematically review the relevant literature assessing the impact of LND on oncologic and perioperative outcomes in patients undergoing RC for MIBC. EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, the Cochrane Central Register of Controlled Trials, and the Latin American and Caribbean Center on Health Sciences Information (LILACS) were searched up to December 2013...
December 2014: European Urology
Binula N Wickramarachchi, Goswin Y Meyer-Rochow, Kim McAnulty, John V Conaglen, Marianne S Elston
INTRODUCTION: Approximately 5% of all abdominal computed tomography (CT) and magnetic resonance imaging (MRI) scans reveal an adrenal incidentaloma. Although most adrenal incidentalomas are benign non-functioning adenomas, lesions may be hormonally active and/or malignant. The aim of this study was to determine adherence to recommended international guidelines and potential influencing factors when an adrenal incidentaloma is identified in routine clinical practice. METHODS: A retrospective study was performed of all CT and MRI reports from December 2009 to December 2011 using a key phrase search to identify patients with an incidental adrenal lesion...
June 2016: ANZ Journal of Surgery
Xiao-Ping Chen, Zhi-Yong Huang, Josef W Y Lau, Bi-Xiang Zhang, Zhi-Wei Zhang, Yi-Fa Chen, Wan-Guang Zhang, Peng Zhu, Binhao Zhang
BACKGROUND AND PURPOSE: Internationally, postoperative pancreatic fistula (POPF) remains a leading cause of morbidity and mortality after pancreaticoduodenectomy (PD). In order to reduce the incidence of POPF, a number of technical modifications for pancreato-enteric anastomosis after PD have been proposed. In 1995, we established a new technique with transpancreatic transverse U-sutures for end-to-end invaginated pancreaticojejunostomy after a PD, and the preliminary results were quite encouraging...
December 2014: Annals of Surgical Oncology
Giovanni Alei, Piero Letizia, Lavinia Alei, Francesco Massoni, Serafino Ricci
OBJECTIVES: To describe and report on our variant of penile corporoplasty, the ‘double-breasted’ corporoplasty, with penoscrotal and infrapubic access not requiring circumcision. The medicolegal aspects of treatment are also discussed. PATIENTS AND METHODS: Between February 1995 and October 2012, double-breasted corporoplasty was performed in 93 patients with congenital ventral penile curvature. Preoperative assessment comprised RigiScan monitoring, prostaglandin E1 injection with photographic documentation and measurement of penile angulation, administration of the International Index of Erectile Function-5 (IIEF-5) questionnaire, and biothesiometry up until 5 years ago when it was substituted with the Genito Sensory Analyser for testing sensitivity...
June 2014: BJU International
Jean Marc Regimbeau, David Fuks, Karine Pautrat, Francois Mauvais, Vincent Haccart, Simon Msika, Muriel Mathonnet, Michel Scotté, Jean Christophe Paquet, Corinne Vons, Igor Sielezneff, Bertrand Millat, Laurence Chiche, Hervé Dupont, Pierre Duhaut, Cyril Cossé, Momar Diouf, Marc Pocard
IMPORTANCE: Ninety percent of cases of acute calculous cholecystitis are of mild (grade I) or moderate (grade II) severity. Although the preoperative and intraoperative antibiotic management of acute calculous cholecystitis has been standardized, few data exist on the utility of postoperative antibiotic treatment. OBJECTIVE: To determine the effect of postoperative amoxicillin plus clavulanic acid on infection rates after cholecystectomy. DESIGN, SETTING, AND PATIENTS: A total of 414 patients treated at 17 medical centers for grade I or II acute calculous cholecystitis and who received 2 g of amoxicillin plus clavulanic acid 3 times a day while in the hospital before and once at the time of surgery were randomized after surgery to an open-label, noninferiority, randomized clinical trial between May 2010 and August 2012...
July 2014: JAMA: the Journal of the American Medical Association
P Marco Fisichella, Marco G Patti
BACKGROUND: The topic of "when and what" for gastroesophageal reflux disease (GERD) procedures centers on the correct indications for antireflux surgery gleaned from a thorough preoperative evaluation (the "when") and on the right antireflux operation to perform once the ideal candidate is identified (the "what"). AIMS: The goals of this evidence-based review are the following: (1) to identify the key indications for surgery and predictors of good outcomes in the initial evaluation of patients with symptoms of GERD; (2) to describe the operations for GERD in the armamentarium of the general surgeon and their indications, as well as the technical elements of the operation; and (3) to describe the optimal surgical treatment of GERD and obesity when the two diseases coexist...
November 2014: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Jun-Bin Yuan, Min-Feng Chen, Lin Qi, Yuan Li, Yang-Le Li, Cheng Chen, Jin-bo Chen, Xiong-Bing Zu, Long-Fei Liu
OBJECTIVE: To prospectively study the surgical strategies and clinical efficacy of laparoendoscopic single-site (LESS) inguinal lymphadenectomy compared with conventional endoscopic inguinal lymphadenectomy for the management of inguinal nodes. PATIENTS AND METHODS: A total of 12 patients with squamous cell carcinoma of the penis who underwent penectomy between February and July 2013 were enrolled in the study. All 12 patients underwent bilateral inguinal lymphadenectomy (LESS inguinal lymphadenectomy in one limb and conventional endoscopic inguinal lymphadenectomy in the other) with preservation of the saphenous vein...
April 2015: BJU International
Lars Sjöström, Markku Peltonen, Peter Jacobson, Sofie Ahlin, Johanna Andersson-Assarsson, Åsa Anveden, Claude Bouchard, Björn Carlsson, Kristjan Karason, Hans Lönroth, Ingmar Näslund, Elisabeth Sjöström, Magdalena Taube, Hans Wedel, Per-Arne Svensson, Kajsa Sjöholm, Lena M S Carlsson
IMPORTANCE: Short-term studies show that bariatric surgery causes remission of diabetes. The long-term outcomes for remission and diabetes-related complications are not known. OBJECTIVES: To determine the long-term diabetes remission rates and the cumulative incidence of microvascular and macrovascular diabetes complications after bariatric surgery. DESIGN, SETTING, AND PARTICIPANTS: The Swedish Obese Subjects (SOS) is a prospective matched cohort study conducted at 25 surgical departments and 480 primary health care centers in Sweden...
June 11, 2014: JAMA: the Journal of the American Medical Association
Michael Berger, Oliver Muensterer, Carroll M Harmon
The use of eponyms in medicine has a long and captivating tradition, which applies to pediatric surgery as well. Unfortunately, even though these eponyms are widely used, oftentimes the fascinating personalities and lives behind these names remain unrecognized or underappreciated, especially among residents, fellows and younger-generation pediatric surgeons. Therefore, in this article, we review 15 names that are frequently used as eponyms in modern pediatric surgery and hereby enlighten the personalities behind them...
January 2014: Pediatric Surgery International
Anne Rowan-Legg
Constipation is a common childhood problem, with both somatic and psychological effects. The etiology of paediatric constipation is likely multifactorial, and seldom due to organic pathology. Children benefit from prompt and thorough management of this disorder. The goal of treatment is to produce soft, painless stools and to prevent reaccumulation of feces. Education, behavioural modification, daily maintenance stool softeners and dietary modification are all important components of therapy. Fecal disimpaction may be necessary at the outset of treatment...
December 2011: Paediatrics & Child Health
(no author information available yet)
Male circumcision is a common procedure, generally performed during the newborn period in the United States. In 2007, the American Academy of Pediatrics (AAP) formed a multidisciplinary task force of AAP members and other stakeholders to evaluate the recent evidence on male circumcision and update the Academy's 1999 recommendations in this area. Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks and that the procedure's benefits justify access to this procedure for families who choose it...
September 2012: Pediatrics
Jacek Szopinski, Stanislaw Dabrowiecki, Stanislaw Pierscinski, Marek Jackowski, Maciej Jaworski, Zbigniew Szuflet
BACKGROUND: The Shouldice method and other tissue-based techniques are still acknowledged to be acceptable for primary inguinal hernia repair according to the European Hernia Society guidelines. Desarda's technique, presented in 2001, is an original hernia repair method using an undetached strip of external oblique aponeurosis. This randomized trial compared outcomes after hernia repair with Desarda (D) and mesh-based Lichtenstein (L) techniques. METHODS: A total of 208 male patients were randomly assigned to the D or L group (105 vs...
May 2012: World Journal of Surgery
Xavier Serra-Aracil, Jordi Bombardo-Junca, Juan Moreno-Matias, Anna Darnell, Laura Mora-Lopez, Manuel Alcantara-Moral, Isidro Ayguavives-Garnica, Salvador Navarro-Soto
BACKGROUND: The prevalence of terminal parastomal hernia (PH) after colostomy placement may be as high as 50%. The effect of the PH may range from discomfort to life-threatening complications. Surgical procedures for repairing PH are difficult to perform and present a high-failure rate. OBJECTIVE: To reduce the incidence of PH by implanting a lightweight mesh in the sublay position. MATERIAL AND METHODS: Randomized, controlled, prospective study...
April 2009: Annals of Surgery
2016-03-13 12:15:51
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