Current surgery最新文献

{"title":"Low-Dose Dopamine: A Physiologically Based Review","authors":"Paul J. Schenarts MD,&nbsp;Scott G. Sagraves MD,&nbsp;Michael R. Bard MD,&nbsp;Eric A. Toschlog MD,&nbsp;Claudia E. Goettler MD,&nbsp;Mark A. Newell MD,&nbsp;Michael F. Rotondo MD","doi":"10.1016/j.cursur.2005.08.008","DOIUrl":"10.1016/j.cursur.2005.08.008","url":null,"abstract":"<div><h3>Background</h3><p>In an attempt to prevent or alter the course of acute renal failure, many surgeons continue to use low-dose dopamine. This article critically reviews the physiologic reasons why low-dose dopamine is not clinically efficacious.</p></div><div><h3>Methods</h3><p>A critical review of English language literature.</p></div><div><h3>Results</h3><p>The effect of dopamine on renal blood flow remains controversial. If dopamine does increase renal blood flow, the vascular anatomy of the kidney would limit its effectiveness. Rather than improving renal function, dopamine has been shown to impair renal oxygen kinetics, inhibit feedback systems that protect the kidney from ischemia, and may worsen tubular injury. Dopamine has not been proven useful in the prevention or alteration of the course of acute renal failure as a result of heart failure, cardiac surgery, abdominal aortic surgery, sepsis, and transplantation. Dopamine has been associated with multiple complications involving the cardiovascular, pulmonary, gastrointestinal, endocrine, and immune systems.</p></div><div><h3>Conclusions</h3><p>Based on the anatomy and physiology of the kidney, low-dose dopamine would not be expected to improve renal failure and this has been demonstrated by the lack of efficacy in clinical trials.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 219-225"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.08.008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073366","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":"Nonoperative Management of Liver Gunshot Injuries","authors":"Kelly A. Garrett MD (Guest Reviewers),&nbsp;Steven C. Stain MD (Guest Reviewers),&nbsp;Carl Rosati MD (Guest Reviewers)","doi":"10.1016/j.cursur.2005.12.004","DOIUrl":"10.1016/j.cursur.2005.12.004","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 169-173"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.12.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073482","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":"","authors":"Nikhil Jaik MD","doi":"10.1016/j.cursur.2005.12.013","DOIUrl":"https://doi.org/10.1016/j.cursur.2005.12.013","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Page 174"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.12.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"137288914","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":"Determining and Interpreting the Accuracy of a Test","authors":"Ram Nirula MD,&nbsp;Karen Brasel MD","doi":"10.1016/j.cursur.2005.12.016","DOIUrl":"10.1016/j.cursur.2005.12.016","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 190-193"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.12.016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073484","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":"Pancreatic Sarcoidosis: Unusual Presentation Resembling a Periampullary Malignancy","authors":"Manuel Caceres MD,&nbsp;M. Shirin Sabbaghian,&nbsp;Rebecca Braud,&nbsp;Saree Wilks,&nbsp;Michael Boyle MD","doi":"10.1016/j.cursur.2005.06.011","DOIUrl":"10.1016/j.cursur.2005.06.011","url":null,"abstract":"<div><p>Sarcoidosis involving the pancreas is a rare occurrence. Isolated cases of localized or diffuse involvement of the pancreas have been reported in the literature. The preoperative diagnosis of this entity is a clinical challenge, and surgical intervention is usually needed to make a definitive diagnosis.</p><p>We report a patient that presents with a preoperative evaluation suggestive of cholangiocarcinoma. Surgical management involved pancreaticoduodenectomy, which revealed pancreatic sarcoidosis with regional lymph node involvement.</p><p>An extensive literature review of sarcoidosis of the pancreas is provided, which cites all reported cases in which the presentation warranted surgical intervention.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 179-185"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.06.011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073485","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":"Risk Scoring in Perioperative and Surgical Intensive Care Patients: A Review","authors":"Seetharaman Hariharan MD ,&nbsp;Andrew Zbar FRCS","doi":"10.1016/j.cursur.2006.02.005","DOIUrl":"10.1016/j.cursur.2006.02.005","url":null,"abstract":"<div><h3>Purpose</h3><p>Assessing the risk and predicting the outcome of surgery, trauma, and surgical intensive care is an important aspect of perioperative practice. There have been attempts to devise and validate many scoring systems to predict the prognosis of patients having a similar severity of illness. This article reviews some of the commonly used systems with respect to their development, strengths, and limitations.</p></div><div><h3>Sources</h3><p>Published literature describing risk assessment scores and physiologic scoring systems for preoperative assessment, trauma, and surgical intensive care patients.</p></div><div><h3>Principal findings</h3><p>Risk scores used in preoperative evaluation assist the clinician in optimizing the patient before, during, and after surgery. Scoring systems applied in intensive care units are useful as guidelines rather than accurate predictors of prognosis for individual patient. Many models are used for audit purposes, and some are used as performance measures and quality indicators of a unit; however, both utilities are controversial because of poor adjustment of these systems to case-mixtures.</p></div><div><h3>Conclusions</h3><p>Risk assessment scores may assist in the perioperative risk evaluation with respect to organ systems. Prognostication of critically ill patients belonging to a category of illness may be done using physiological scoring systems taking into account the difference in the case-mix of the particular unit.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 226-236"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.02.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073367","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":"24 Hours On-Call and Acute Fatigue No Longer Worsen Resident Mood Under the 80-Hour Work Week Regulations","authors":"Michael Kiernan MD ,&nbsp;Joseph Civetta MD ,&nbsp;Christine Bartus MD ,&nbsp;Stephen Walsh SCD","doi":"10.1016/j.cursur.2006.03.002","DOIUrl":"10.1016/j.cursur.2006.03.002","url":null,"abstract":"<div><h3>Purpose</h3><p>Studies in on-call residents have shown that mood is worsened by fatigue as indicated by increased scores on measures of depression, anxiety, confusion, and anger using the Profile of Mood States (POMS). In prior sleep deprivation studies, mood has been shown to be more affected than either cognitive or motor performances. The purpose of this study was to examine the effect of the 80-hour work week regulations on resident mood in general and in a post-call period (PC).</p></div><div><h3>Methods</h3><p>Institutional Review Board approval was obtained to survey the residents and publish the results. POMS is a 65-item adjective questionnaire that includes subscales for measuring tension-anxiety, anger-hostility, depression-dejection, vigor-activity, fatigue-inertia, and confusion-bewilderment, with the summation of the scales forming a total mood disturbance score. Surgical residents were tested at a 9 <span>am</span> didactic curriculum session (9 <span>am</span> has been shown to correlate with the nadir of performance). Residents were tested after nights off call (NOC) or after PC. Time asleep in the preceding 24 hours and other demographic data were also collected. Acute fatigue (AF) was defined as &lt;4 hours sleep. The two-sample <em>t</em>-test and linear regression were used to assess differences between groups.</p></div><div><h3>Results</h3><p>A total of 123 standardized POMS mood questionnaires were administered on 4 occasions to 51 surgical residents, 35 men and 16 women at levels PGY-1 through PGY-5. Overall, 33 tests (27%) were taken after PC and 90 (73%) were taken after NOC. Acute fatigue residents had a mean sleep time of 2.2 (+/−1.5) hours, whereas rested (R) residents had a mean sleep time of 6.7 (+/−2.2) hours (whether PC or NOC). No statistical differences in mean values of vigor, anger, depression, concentration, fatigue, tension, or total score were observed between PC and NOC or between AF and R residents. There was no significant relationship between acute sleep deprivation and total mood disturbance, whether PC or NOC. In linear relationships, NOC total score and hours slept had r² = 0.01 (<em>p</em> = 0.44), whereas PC total score and hours slept had r² = 0.07 (p = 0.14).</p></div><div><h3>Conclusion</h3><p>Although POMS was given 4 times, only 27% were PC, which reflects our 1 in 4 night in-house coverage. In contrast to earlier studies, resident mood, as measured by POMS, is no longer related to PC/NOC or acute fatigue. Previous studies have shown that loss of sleep was associated with declining mood. The lack of such a relationship in this study may be related to the new regulations. It has been assumed that people can adapt to chronic sleep loss but have a harder time coping with the effects of acute sleep deprivation. If, however, the new regulations have relieved chronic sleep deprivation, then a well-rested resident can periodically cope with the effects of acute sleep de","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 237-241"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.03.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073368","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":"Minimally Invasive Surgery: Training in Resident Education","authors":"Fernando A. Herrera Jr. MD (Guest Reviewers),&nbsp;David W. Easter MD (Guest Reviewers)","doi":"10.1016/j.cursur.2005.12.012","DOIUrl":"10.1016/j.cursur.2005.12.012","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 166-169"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.12.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073481","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":"Henry Drysdale Dakin: More Than His Solution","authors":"Combiz Rezayat MD,&nbsp;Warren D. Widmann MD,&nbsp;Mark A. Hardy MD","doi":"10.1016/j.cursur.2006.04.009","DOIUrl":"10.1016/j.cursur.2006.04.009","url":null,"abstract":"","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 194-196"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.009","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073364","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":"Iatrogenic Entrapment: Femoro-popliteal Vein Bypass Graft","authors":"Manzoor Abbas MS, FVES,&nbsp;B. Patrice Mwipatayi MMed, FRACS,&nbsp;Donna Angel RN,&nbsp;Elvie Haluszkiewicz MIT,&nbsp;Kishore Sieunarine FRCS, FRACS","doi":"10.1016/j.cursur.2005.08.012","DOIUrl":"10.1016/j.cursur.2005.08.012","url":null,"abstract":"<div><p>A rare cause of occlusive vascular disease is the “Popliteal Artery Entrapment Syndrome.” The most common cause of this problem is abnormal position of the popliteal artery caused by abnormal migration of the medial head of the gastrocnemius. An acquired form can occur because of tunneling defects by inadvertent placement of venous bypass graft medial to the medial head of the gastrocnemius muscle.</p><p>We present 2 cases of iatrogenic entrapment of the femoropopliteal bypass graft. Investigations revealed compression of the graft with extension of the knee. Both cases were treated surgically. Intraoperatively there was evidence of compression of the graft between the tendons of the semitendinosus and the gracilis muscles and the medial head of the gastrocnemius muscle. Treatment involved division of the medial head of the gastrocnemius in 1 patient, and in the other, the tendons of gracilis and semitendinosus were divided. No compression of the graft was noted postoperatively by noninvasive test. No significant mobility issues caused by the division of muscle or the tendons were present in the postoperative period.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 3","pages":"Pages 202-206"},"PeriodicalIF":0.0,"publicationDate":"2006-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2005.08.012","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26073486","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}