Current surgery最新文献

{"title":"Effects of Recombinant Activated Factor VII in Traumatic Nonsurgical Intracranial Hemorrhage","authors":"Christopher E. White MD,&nbsp;Amber E. Schrank MD,&nbsp;Toney W. Baskin MD,&nbsp;John B. Holcomb MD","doi":"10.1016/j.cursur.2006.04.013","DOIUrl":"10.1016/j.cursur.2006.04.013","url":null,"abstract":"<div><h3>Objective</h3><p>To determine whether treatment with recombinant activated factor VII (rFVIIa) will prevent progression of bleeding in nonsurgical hemorrhagic traumatic brain injury (TBI).</p></div><div><h3>Methods</h3><p>Chart review from the trauma registry of a level 1 trauma center between January 1, 2002 and December 31, 2004 identified 2 patients who received rFVIIa for progressive hemorrhagic TBI. These patients were given a single dose of rFVIIa (120 mcg/kg) after a repeat head computed tomography (CT) scan showed worsening of intracranial bleeding. Pre-rFVIIa and post-rFVIIa coagulation parameters and postintervention CT scans were performed. A matched convenience sample was drawn from the institution’s trauma registry reflecting similar injury patterns.</p></div><div><h3>Results</h3><p>The 2 patients who received rFVIIa were ages 61 and 79 years; the patients in the matched convenience sample were 57 and 63 years. Both sets of patients comprised 1 man and 1 woman who had suffered blunt trauma, including hemorrhagic TBI, and were matched according to age, gender, and injury severity score (ISS). During their hospital course, repeat CT scans documented worsening of intracranial hemorrhage in both cohorts. In the rFVIIa patients, follow-up CT showed overall improvement of head injury compared with the convenience sample. The rFVIIa patients also saw an appreciable decrease in both prothrombin time (PT) and international normalized ratio (INR).</p></div><div><h3>Conclusions</h3><p>In hemorrhagic TBI, rFVIIa has the potential to limit or even halt the progression of bleeding that would otherwise place growing pressure on the brain. A prospective, randomized multicenter trial is planned to elucidate this hypothesis.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 310-317"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26252031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Porcine Dermal Collagen (Permacol) for Abdominal Wall Reconstruction","authors":"CPT David M. Parker MC,&nbsp;LTC Peter J. Armstrong MC,&nbsp;LTC James D. Frizzi MC,&nbsp;COL James H. North Jr MC","doi":"10.1016/j.cursur.2006.05.003","DOIUrl":"10.1016/j.cursur.2006.05.003","url":null,"abstract":"<div><h3>Objective</h3><p>A review of Eisenhower Army Medical Center’s experience using Permacol (Tissue Science Laboratories, Covington, Georgia) for the repair of abdominal wall defects.</p></div><div><h3>Methods</h3><p>Retrospective review of medical records of patients undergoing abdominal wall reconstruction with Permacol.</p></div><div><h3>Results</h3><p>From July 30, 2003 to February 12, 2005, 9 patients underwent repair of complicated fascial defects with Permacol. Indications for surgery included reoperative incisional hernia repair after removal of a infected mesh (3 patients), reconstruction of a fascial defect after resection of an abdominal wall tumor (2 patients), incisional hernia repair in a patient with a previous abdominal wall infection after a primary incisional hernia repair (1 patient), incisional hernia repair in a patient with an ostomy and an open midline wound (1 patient), emergent repair of incisional hernia with strangulated bowel and multiple intra-abdominal abscesses (1 patient), and excision of infected mesh and drainage of intra-abdominal abscess with synchronous repair of the abdominal wall defect (1 patient).</p><p>At a median follow-up of 18.2 months, 1 recurrent hernia existed after intentional removal of the Permacol. This patient developed an abdominal wall abscess 7 months after hernia repair secondary to erosion from a suture. Overall, 1 patient developed exposure of the Permacol after a skin dehiscence. The wound was treated with local wound care, and the Permacol was salvaged. Despite the presence of contamination (wound classification II, III, or IV) in 5 of 9 patients (56%), no infectious complications occurred.</p></div><div><h3>Conclusion</h3><p>Complex reconstruction of the abdominal wall can be associated with a high complication rate. Placement of a permanent prosthetic mesh in a contaminated field is associated with a high rate of wound infections and subsequent mesh removal. Permacol becomes incorporated by tissue ingrowth and neovascularization. Permacol is a safe and acceptable alternative to prosthetic mesh in the repair of complicated abdominal wall defects.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 255-258"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.05.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145636","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Relationship between Varying Roux Limb Lengths and Weight Loss in Gastric Bypass","authors":"Sukhyung Lee MD,&nbsp;Kirk G. Sahagian DO,&nbsp;John P. Schriver MD","doi":"10.1016/j.cursur.2006.05.001","DOIUrl":"10.1016/j.cursur.2006.05.001","url":null,"abstract":"<div><h3>Background</h3><p>The optimal Roux limb length for gastric bypass is unknown. Therefore, the effect of Roux limb length on weight loss and nutritional deficiency after a Roux-en-Y gastric bypass procedure was studied.</p></div><div><h3>Methods</h3><p>From September 2000 to February 2004, 165 Roux-en-Y gastric bypass surgeries were performed at William Beaumont Army Medical Center. One-year follow-ups were completed on 97 patients. Roux limbs varied from 100 cm to 150 cm, based on the patient’s body mass index (BMI). Roux limb lengths were compared with 1-year changes in absolute weight, BMI, and nutritional levels.</p></div><div><h3>Results</h3><p>In the 97 patients, average age at the time of surgery was 44 years (range, 20-63). Average BMI was 46.7 ± 6.6 kg/m² before surgery and 30.9 ± 5.8 kg/m² at 1-year follow-up. Average absolute weight loss at 1 year was 43.7 ± 12.8 kg. A statistically significant linear relationship existed between Roux limb length and reductions in BMI and absolute weight. No relationship existed between Roux limb length and changes in nutrient levels.</p></div><div><h3>Conclusion</h3><p>A linear relationship exists between Roux limb length and 1-year weight loss.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 259-263"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.05.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatobiliary Cystadenoma: A Case Report and a Review of the Literature","authors":"John G. Carson MD,&nbsp;Sergio Huerta MD,&nbsp;John A. Butler MD","doi":"10.1016/j.cursur.2006.03.001","DOIUrl":"10.1016/j.cursur.2006.03.001","url":null,"abstract":"<div><h3>Background</h3><p>Hepatic cystic lesions are rare; however, their management and treatment is dependent on early recognition and diagnosis.</p></div><div><h3>Methods</h3><p>In this report, the authors discuss a 72-year-old woman who presented to their clinic for treatment of a hepatocystadenoma.</p></div><div><h3>Results</h3><p>The history, physical examination, and diagnostic modalities lead to surgical intervention despite an unclear diagnosis.</p></div><div><h3>Conclusions</h3><p>This case illustrates an unusual hepatic lesion in which the diagnosis was not known until the time of laparotomy. However, diagnostic modalities were important in establishing the need for surgical intervention. The authors offer a pertinent review of the literature and discuss current treatment modalities.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 285-289"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.03.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Meckel’s Diverticulitis: A Rare Etiology of an Acute Abdomen During Pregnancy","authors":"Sergio Huerta MD ,&nbsp;Andrew Barleben MD ,&nbsp;Michael A. Peck MD ,&nbsp;Ian L. Gordon MD","doi":"10.1016/j.cursur.2006.02.009","DOIUrl":"10.1016/j.cursur.2006.02.009","url":null,"abstract":"<div><p>Perforated Meckel’s diverticulum (MD) is a rare complication of pregnancy. Its diagnosis, however, must be considered in all cases of intra-abdominal disease, as its presentation is similar to appendicitis. Prompt diagnosis and appropriate treatment is imperative in these cases due to the high rate of perforation leading to fetal and maternal morbidity and mortality. The usual lesion affecting a patient with MD and a review of the literature on other unusual causes of an acute abdomen in pregnancy is presented in the following report.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 290-293"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.02.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Measurement!","authors":"John A. Weigelt MD (Editor-in-Chief, Current Surgery)","doi":"10.1016/j.cursur.2006.04.012","DOIUrl":"10.1016/j.cursur.2006.04.012","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Page 243"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26147410","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perspectives on Being a Mom and a Surgical Trainee. Juggling these Roles?","authors":"Rachel Greenup MD","doi":"10.1016/j.cursur.2006.04.002","DOIUrl":"10.1016/j.cursur.2006.04.002","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 297-298"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Program Information Form (PIF)—Are You Ready?","authors":"Ellie Gray","doi":"10.1016/j.cursur.2006.03.003","DOIUrl":"10.1016/j.cursur.2006.03.003","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 300-301"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.03.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Triune","authors":"Edwina S. Baskin-Bey MD","doi":"10.1016/j.cursur.2006.04.003","DOIUrl":"10.1016/j.cursur.2006.04.003","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 298-299"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26145572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Periampullary Carcinoid Tumor in a Woman with Neurofibromatosis","authors":"Lauren Buck MD,&nbsp;W. Brian Perry MD,&nbsp;Melanie L. Richards MD","doi":"10.1016/j.cursur.2006.04.014","DOIUrl":"10.1016/j.cursur.2006.04.014","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 4","pages":"Pages 252-254"},"PeriodicalIF":0.0,"publicationDate":"2006-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.014","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26147412","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}