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1.
Manuel Díez Tomás Ratia María José Medrano José María Mugüerza M. Rosario San Román Carlos Medina Ángel Rodríguez María Isabel Sánchez-Seco Cristina Vera Raúl Díaz Pilar Franco Javier Granell 《Cirugía espa?ola》2011,(6):386
Introduction
The relationship between the intra-operative concentration of parathyroid hormone (IOPTH) and the long-term outcome of patients intervened due to primary hyperparathyroidism (PHPT).Patients and methods
A prospective observational study was performed with 120 patients. Three determinations were made of PTH in blood: baseline, when the diseases gland was located, and 10 minutes after its extirpation. The calcium, PTH and vitamin D (25-OH-D3) levels were measured during follow up.Results
A decrease in IOPTH > 50% was observed in 96 (80%) patients, and the post-extirpation value returned to the normal range (Group I), in 18 (15%) a decrease of > 50% but the final value remained higher than normal (Group II) and in 6 (5%) the decrease was < 50% (Group III). Persistent PHPT was detected during follow up in 6 patients (5%): one in Group I (1%), 3 (16.7%) in II and 2 (33.3%) in group III (P < .001). The risk of persistent PHPT was higher in Group II (odds ratio: 19; 95% CI: 1.85-194) and in Group III (odds ratio: 47; 95% CI: 3.53-639). There were no cases of recurrent PHPT. A normal calcium with an increased PTH was detected in 20 patients of Group I (20.8%), 11 (61.1%) in II and 3 (50%) in III (P < .001). These patients had a lower concentration of post-operative vitamin D (17 ng/ml, range: 24; compared to 28 ng/ml, range: 21) (P = .008) and higher frequency of hypovitaminosis D (70.6% compared to 26.2%) (P>.001).Conclusion
The risk of persistent PHPT is higher when the IOPTH decreases more than 50% but still remains high. 相似文献2.
Jordi Pujol Gebelli Amador García Ruiz de Gordejuela Anna Casajoana Badía Lluis Secanella Medayo Andrew Vicens Morton Carles Masdevall Noguera 《Cirugía espa?ola》2011,(6):356
Introduction
Laparoscopic Gastric Plication is a new technique derived from sleeve gastrectomy. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. The results of the first cases where this technique has been applied in this hospital are presented.Methods
A review was made of patients operated on in our hospital between November 2009 and December 2010. Plication of the gastric greater curvature was performed under general anaesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probe as a guide. The results of the morbidity, mortality and weight loss are presented.Results
A total of 13 patients were operated on (7 women). The maximum body mass index (BMI) varied between 37.11 kg/m2 and 51.22 kg/m2 at the time of the operation. The most frequently found morbidity was nausea and vomiting. Two patients required further surgery due intractable vomiting and total dysphagia; in one the plication unfolded, and in the second it was converted into vertical gastrectomy.Conclusions
Laparoscopic Gastric Plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is a reproducible and reversible technique with results and indications still to be validated. 相似文献3.
Daniel Serralta De Colsa Irene Arjona Medina Andrés García-Marín Jorge Martín-Gil Maria Dolores Pérez-Díaz Fernando Turégano Fuentes 《Cirugía espa?ola》2009,85(6):348-353
Introduction
Ischaemic colitis (IC) is the most common form of bowel ischaemia and is often under-diagnosed.Objectives
To report the results obtained in patients with IC who required surgical intervention in our Hospital, and to evaluate the predictive factors of mortality.Methods
The data were obtained from the Gregorio Marañon Hospital CI database. The demographic and clinical characteristics, diagnostic methods, surgical techniques employed and mortality were analysed statistically, using the χ2 and Student t test.Results
One-hundred and one patients with CI were operated on between 1991 and 2006. The majority of them had cardiovascular histories and 35 cases were diagnosed during their hospital stay due to another cause. The signs and the symptoms were non-specific in 40% of the cases. Total morbidity and mortality was 39.6% and 41.6% respectively. In the post-operative IC cases, the death rate increased to 68% (p<0.01); 93% of the patients who died had transmural necrosis during the surgery (p<0.05) and 69% had a metabolic acidosis.Conclusions
The death rate in patients with IC that requires surgery is high, particularly if the diagnosis is made in the post-operative period after surgery for another cause, or if there is evidence of transmural necrosis during the intervention. Early diagnosis is the best tool to improve these results. 相似文献4.
Víctor Valentí José Luis Hernández-Lizoain Fernando Martínez Regueira Aurora Gil Pablo Martí Gabriel Zozaya Álvaro Bueno Nicolás Pedano Jorge Arredondo M. Carmen Beorlegui Javier Álvarez-Cienfuegos 《Cirugía espa?ola》2009,86(6):351-357
Introduction
The impact of neoadjuvant treatment on the postoperative complications in stomach cancer is a subject of controversy. The aim of this study is to analyse the post-surgical morbidity and mortality in a group of patients who were treated using a chemoradiotherapy protocol before surgery, as well as to identify the possible risk factors that may be associated with the development of complications.Material and methods
Patients diagnosed with locally advanced gastric adenocarcinoma between June 2005 and June 2008 were operated on in our Centre after having followed a preoperative chemoradiotherapy protocol. Data on postoperative morbidity and mortality were collected retrospectively and the dependent variables associated with the patients, the type of intervention and the tumour characteristics were analysed.Results
A total of 40 patients were evaluated. The overall morbidity and mortality was 32.5% (13 patients) and 2.5% (1 patient), respectively. The most frequent complications were pneumonia in 12.9% and sepsis due to the catheter in 9.7% of the patients. The risk factors for the development of complications were the body mass index (BMI 25 kg/m2) and the inclusion of the pancreas and/or spleen in the resection.Conclusions
Preoperative treatment with chemoradiotherapy in patients with locally advanced stomach cancer does not increase the incidence of post-surgical complication. The preoperative condition of the patient (BMI) and extending the surgery to the spleen and pancreas are prognostic factors of early postoperative complications. 相似文献5.
Z. Dahami F. Barjani O. Saghir R. Ben Elkhaiat M.S. Moudouni I. Sarf 《Journal de chirurgie》2009,146(6):549-552
Objective
Our aim was to evaluate the outcome of transurethral resection of prostate (TURP) and inguinal hernia repair performed in a single session.Methods
Data was obtained retrospectively for 31 patients (mean age 65 years) who underwent simultaneous TURP and inguinal hernia repair. Most patients had lower urinary tract symptoms related to BPH such as acute urinary retention, recurrent bladder retention, or severe dysuria. Twenty-one patients had simple inguinal hernia and ten had large inguinoscrotal hernia. Operations were performed in 23 patients under spinal anesthesia. Bassini's operation was the most common herniorrhaphy technique (23 patients).Results
We observed good outcomes in 86% of the patients. The morbidity rate was 10.7%, the mean postoperative stay was 3.6 days (2–6 days). There was no recurrence of inguinal hernia.Conclusion
Combining TURP and inguinal hernia repair in one session decreases the number of procedures and anesthesias, hospital stay, and thus direct health costs and does not result in an increase in operative or postoperative morbidity. 相似文献6.
Estela Membrilla-Fernández David Parés Francisco Alameda Marta Pascual Ricard Courtier María José Gil Gabriel Vallecillo Pere Fusté Miguel Pera Luis Grande 《Cirugía espa?ola》2009,85(6):365-370
Introduction
Anal intraepithelial neoplasia is a precursor condition of squamous anal carcinoma. The groups at risk of this lesion are patients with anogenital condylomata, cervical dysplasia, human immunodeficiency virus infection and, in general, patients with HPV infection. The aim of this study was to analyse the results of a diagnostics protocol of Anal Intraepithelial Neoplasia in high risk population using anal cytology.Patients and method
The protocol is based on a visit in the outpatient department, clinical interview, physical examination and anal cytology evaluated by Bethesda criteria. The cross-sectional observational study was designed to study the anal smear results and their relationship with risk factors.Results
A total of 64 patients were included from January 2005 to December 2006. In the overall series, 25 patients have been diagnosed with abnormal anal cytology: 9 atypical squamous cells of undetermined significance (ASCUS), 15 low-grade and 1 high-grade squamous intraepithelial lesions. There were no significant associations between abnormal cytology results and the presence of anal condyloma (p=0.22). Neither were there statistical associations found with high risk-HPV infection (p=0.84), HIV infection (p=0.98) or tobacco use (p=0.14).Conclusions
Our diagnostic protocol of anal intraepithelial neoplasia revealed 25% of patients with pre-invasive lesions of squamous anal cancer. 相似文献7.
Harari A Mitmaker E Grogan RH Lee J Shen W Gosnell J Clark O Duh QY 《Annals of surgical oncology》2011,18(6):1717-1722
Background
Standard preoperative imaging for primary hyperparathyroidism usually includes sestamibi scanning (MIBI) and ultrasound (US). In a subset of patients with a positive MIBI and a negative US, we hypothesize that the parathyroid adenomas are more likely to be located posteriorly in the neck, where anatomically they are more difficult to detect by US.Methods
We retrospectively reviewed the records of 661 patients treated for primary hyperparathyroidism between 2004 and 2009 at a tertiary referral center. We included patients who for their first operation had a MIBI that localized a single lesion in the neck and an US that found no parathyroid adenoma. We excluded patients with persistent or recurrent hyperparathyroidism, and patients with MIBIs that were negative, that had more than one positive focus, or that had foci outside of the neck. Sixty-six cases were included in the final analysis.Results
A total of 54 patients (83%) had a single adenoma, 4 (6%) had double adenomas, and 7 (11%) had hyperplasia. Thirty-three patients (51%) had a single upper gland adenoma; 19 of these (58%) were posteriorly located upper gland adenomas (PLUGs). PLUGs occurred more often on the right side than on the left (P = 0.048, Fisher’s test). PLUGs were also larger than other single adenomas (mean 1.85 vs. 1.48 cm, P = 0.021, t-test). Seventy-six percent of patients successfully underwent a unilateral or focused exploration. Six patients (9%) had persistent disease, which is double our group’s overall average (4–5%).Conclusions
Primary hyperparathyroid patients with preoperative positive MIBI and negative US are more likely to have PLUGs. 相似文献8.
Wouter P. Kluijfhout Toni Beninato Frederick Thurston Drake Menno R. Vriens Jessica Gosnell Wen T. Shen Insoo Suh Chienying Liu Quan-Yang Duh 《World journal of surgery》2016,40(12):2964-2969
Background
Primary hyperparathyroidism is the most common manifestation of multiple endocrine neoplasia type 1 (MEN1). Guidelines advocate subtotal parathyroidectomy (STP) or total parathyroidectomy with autotransplantation due to high prevalence of multiglandular disease; however, both are associated with a significant risk of permanent hypoparathyroidism. More accurate imaging and use of intraoperative PTH levels may allow a less extensive initial parathyroidectomy (unilateral clearance, removing both parathyroids with cervical thymectomy) in selected MEN1 patients with primary hyperparathyroidism.Methods
We performed a retrospective cohort study at a high-volume tertiary medical center including patients with MEN1 and primary hyperparathyroidism, who underwent STP or unilateral clearance as their initial surgery from 1995 to 2015. Unilateral clearance was offered to patients who had concordant sestamibi and ultrasound showing a single enlarged parathyroid gland. For both the groups, we compared rates of persistent/recurrent disease and permanent hypoparathyroidism.Results
Eight patients had unilateral clearance and 16 had STP. Subtotal parathyroidectomy patients were younger (37 vs 52 years). One patient in each group had persistent disease. One (13 %) unilateral clearance and five (31 %) STP patients had recurrent hyperparathyroidism after a mean follow-up of 47 and 68 months (p = 0.62). No unilateral clearance patients and two of 16 SPT patients had permanent hypoparathyroidism (p = 0.54).Conclusions
Some MEN1 patients with primary hyperparathyroidism who have concordant localizing studies may be selected for unilateral clearance as an alternative to STP. For appropriately selected MEN1 patients, unilateral clearance can achieve similar results as STP and has no risk of permanent hypoparathyroidism, and may facilitate possible future reoperations.9.
Objective
To evaluate compliance with clinical guidelines on prophylactic antibiotic usage in gastro-intestinal surgery.Material and methods
The medical charts of one hundred consecutive patients undergoing surgery in the last 6 months of 2006 were analysed as to determine whether the use of prophylactic antibiotics was indicated. Compliance with the prophylactic antibiotic guidelines of the Toulouse teaching hospitals and the Société Française d’Anesthésie et de Réanimation (SFAR) was examined; cases were analyzed by the criteria of the Haute Autorité en Santé for indication, type of antibiotic, time of administration, and duration of treatment.Results
Antibiotic prophylaxis was prescribed in 58% of patients; there was an 85% compliance rate with the indication. Of those receiving antibiotic prophylaxis, the choice of antibiotic was appropriate in 82.8%, but the timing of administration was in compliance in only 39.7%. Duration of antibiotic administration was excessive in 5 cases. The overall rate of compliance with guidelines was 42%.Conclusion
Prophylactic antibiotic guidelines were inadequately applied, especially regarding the timing of administration. Further systemic progress is needed to achieve compliance with guidelines and documentation of administration; such evaluations must be repeated on regular basis. 相似文献10.
Schaapveld M Jorna FH Aben KK Haak HR Plukker JT Links TP 《American journal of surgery》2011,202(5):590-597
Background
Parathyroid carcinoma is a rare malignancy and generally is diagnosed after surgery for primary hyperparathyroidism. Lack of a preoperative diagnosis and ill-considered surgical planning with its impact on survival are ill-described.Methods
In a retrospective population-based cohort study the clinical features, treatment, recurrences, and survival of 41 parathyroid cancer patients are reported and compared with characteristics of patients with primary hyperparathyroidism.Results
Patients with parathyroid carcinoma had significantly higher serum parathyroid hormone and calcium levels compared with patients with primary hyperparathyroidism. Nineteen patients (46%) had a palpable neck mass. A parathyroid hormone level more than 3 times the upper normal limits was suspicious and levels more than 10 times carried a positive predictive value of 84% for carcinoma. Ten-year recurrence-free and disease-specific survival rates were 71% and 79%, respectively.Conclusions
Parathyroid hormone levels of more than 3 times upper normal limits, palpable neck mass, and profound hypercalcemia are suspicious signs of carcinoma necessitating surgical exploration by an experienced surgeon. 相似文献11.
Francisco Sánchez-Bueno Jezabel Fernández-Carrión Gloria Torres Salmerón Rocío García Pérez Pablo Ramírez Romero Matilde Fuster Quiñonero Pascual Parrilla 《Cirugía espa?ola》2011,(7):439
Introduction
We present a series of 146 cases of hepatic trauma (HT) treated in our hospital over a period of 8 yearsm (2001-2008), and comparing it with a previous series of 92 cases (1977-1984).Material and method
The mean age in the current series was 28.6 years and the majority were male. The closed traumas were mainly penetrating, with the most frequent cause being road traffic accidents.Results
The American Association for the Surgery of Trauma (AAST) classification was used to evaluate the grade of the hepatic injury. Associated abdominal and /or extra-abdominal injuries were seen in 79.5% of the patients, with the most frequent being chest trauma, compared to bone fractures in the previous series. The most common associated intra-abdominal injury was the spleen in both series. The most used diagnostic technique in the current series was abdominal CT. Simple peritoneal puncture and lavage (PLP) were the most used examinations used in the previous series. Non-surgical treatment (NST) was given in 98 cases and the surgery was indicated in the remaining 48. In the previous series, 97.8% of patients were operated on. In the current series, on the 15 patients with severe liver injuries, 5 right hepatectomies, 2 segmentectomies and 6 packing compressions were performed, with the remaining two dying during surgery due to hepatic avulsion. The overall mortality was 3.4%, being 1% in the NST group and 8.3% in the surgical patients. In the previous series, the overall mortality was 29.3%.Conclusions
The key factor for using NST is to control haemodynamic stability, leaving surgical treatment for haemodynamically unstable patients. 相似文献12.
Francisco J. Morera-Ocón Eugenia Hernández-Montes Juan C. Bernal-Sprekelsen 《Cirugía espa?ola》2009,86(6):358-362
Introduction
Intestinal invagination in the adult is an uncommon condition, often manifested by non-specific chronic or sub-acute symptoms. In the majority of occasions there is an organic lesion. There are currently no large patient series published in the literature to help define the management of these patients.Material and method
A review of case series published in the Spanish literature. A data base of patients over 15 years old was designed. Data was extracted from national clinical cases using Internet resources. Our own recent clinical case is added.Results
A series of 30 adults with intestinal invagination was obtained (29 cases from the review and one own). The median age was 45 years (19–84 years) and 17/30 (57%) were males. A total of 27/30 patients had abdominal pain and 8/30 (28%) cases had established intestinal obstruction. The preoperative diagnosis of invagination was made in 25/30 (83%) of patients. The invaginations were; enteroenteric, 61%; colocolic, 12%; enterocolic, 21%; and gastrojejunal, 6%. A total of 85% of the invaginations were associated with a proliferative lesion and 43% of the latter were malignant.Conclusions
The diagnosis of invagination in the adult is usually made preoperatively. There are no data to support intestinal resection without performing a reduction. Resection must be the norm and the presence of lymph nodes is no argument to perform large resections. 相似文献13.
Melanie L. Richards Geoff B. Thompson M.D. David R. Farley M.D. Clive S. Grant M.D. 《American journal of surgery》2008,196(6):937-943
Background
Reoperative parathyroidectomy (R-PTX) in primary hyperparathyroidism (1HPT) has increased failure rates and morbidity. This study evaluated R-PTX during the era of minimal-access PTX with intraoperative parathyroid hormone (IOPTH) monitoring.Methods
Two thousand sixty-five patients with 1HPT who underwent PTX were assessed for R-PTX. Preoperative studies, operative findings, and outcomes were evaluated.Results
Two hundred twenty-eight patients underwent 236 R-PTX procedures. Imaging performed included sestamibi (89%), ultrasound (US; 56%), computed axial tomography/magnetic resonance imaging (5%), and selective venous sampling (1%). Sestamibi was more sensitive than US (84% vs 68%). Curative surgery was performed in 89% of patients. IOPTH was 99% sensitive. There was no relationship between cure and the following parameters: preoperative calcium or PTH levels, persistent or recurrent disease, or use of IOPTH. Solitary gland disease and a single previous operation were associated with increased likelihood of cure (P = .06). Hypoparathyroidism was decreased using IOPTH monitoring (2% vs 9%). One patient had recurrent laryngeal nerve palsy.Conclusions
R-PTX can be performed effectively with minimal complications. IOPTH is an accurate predictor of cure and may decrease the frequency of permanent hypoparathyroidism. 相似文献14.
Y Fuhrer F Bayoumeu S Boileau B Dousset B Foliguet MC Laxenaire 《Annales fran?aises d'anesthèsie et de rèanimation》1996,15(8):1162-1167
Objectives
To determine the quality of blood salvaged and processed during Caesarean section with a cell-saver.Study design
Laboratory study.Patients
The study included 20 patients of ASA physical class 1 or 2 undergoing a scheduled Caesarean section.Methods
A separate suction device was used from the beginning of surgery until the delivery of the fetus, to remove most of the amniotic fluid coming from the surgical field. Thereafter using an Haemolite 2Plus™ (Haemonetics), the blood was separated and washed with 2 L of normal saline solution. Blood quality was assessed through detection of fetal cells and measuring out of alpha-fetal-protein, tissue factor. A Kleihauer test was also performed.Results
Cell-saver processing removed most of alpha-fetalprotein and tissue factor while fetal cells were rarely seen. The Kleihauer test could not be performed because of haemolized blood samples. However, the results were very heterogeneous and after washing some salvaged units contained very high concentrations of alpha-fetal-protein or tissue factor.Conclusions
These preliminary results show that intra-operative autologous transfusion is not fully safe during Caesarean sections. In addition, there is an immunological risk if a significant part of fetal red blood cells are reinfused into maternal circulation. Therefore, additional studies are needed to better assess this risk. 相似文献15.
I. Klempa M.D. U. Frei M.D. P. Röttger M.D. M. Schneider M.D. K. M. Koch M.D. 《World journal of surgery》1984,8(4):540-544
Recurrence of hyperparathyroidism (HPT) following total parathyroidectomy and autotransplantation (APTX) has been reported before. However, no data about the time interval between grafting and relapse and about morphology were given. Only 1 case of primary hyperparathyroidism with APTX has been extensively analyzed. We have performed autotransplantation in 42 patients with HPT due to chronic renal failure. Implanted parathyroid tissue showed typical chief cell hyperplasia. Within 4–33 months, 6 patients developed recurrent HPT with serum iPTH levels being highest in venous blood of the grafted arm. Grafts had to be removed. Although only 20–40 mg of parathyroid tissue had been implanted, removed grafts weighed from 0.9 to 3.1 g. Explanted grafts were examined by light and electron microscopy. The size and DNA content of nuclei were determined. In all cases the explanted material showed a distinct invasive growth into the adjacent connective tissue and muscles and in 2 cases mitotic figures were demonstrated, a finding resembling malignant neoplasia of the parathyroid. From our clinical and morphological observations we draw the following conclusions:
- Surgical treatment of renal hyperparathyroidism by PTX + Auto-TX unforeseeably may result in very accelerated growth of grafted tissue.
- Because of invasive growth there exists the risk of uncontrolled spread of parathyroid tissue.
- Graft removal may turn out to be difficult and possibly necessitate repeated and extensive surgery.
- Before the observed phenomenon is totally understood, we no longer recommend PTX + Auto-TX as an alternative to subtotal PTX in the surgical treatment of renal hyperparathyroidism.
16.
Background
The authors studied a cohort of 154 patients with unilateral vocal cord paresis following thyroidectomy, analyzing the pathogenesis, symptomatology, spontaneous evolution, and management of this complication.Objective
This retrospective study distinguished between vocal cord paresis due to recurrent laryngeal nerve injury or due to injury of the cricoarytenoid articulation. We assessed the influence multiple variables on therapeutic management. The results and complications of currently-employed surgical techniques to remedy unilateral vocal cord paresis were defined.Patients and methods
Injury to the recurrent laryngeal nerve was the cause of vocal cord paresis in 98% of cases; injury to the cricoarytenoid articulation accounted for only 2% of cases. When the recurrent laryngeal nerve had not been actually transected, spontaneous recovery of vocal cord function occurred in 36% of cases. No spontaneous recovery was noted when the nerve had been divided. The interval to recovery of cord function ranged from 2 to 15 months (median: 4 months). Spontaneous recovery of vocal cord function had occurred in 90% of these patients by the 9th postoperative month. Three factors significantly influenced the decision to perform a median transposition of the injured vocal cord: known transection of the recurrent laryngeal nerve, the interval to consultation with an ENT specialist, and the severity of dysphonia. Medial transposition of the injured vocal cord resulted in an immediate improvement in the quality of voice and speech with no major complications.Conclusion
Unilateral vocal cord paresis occurring after thyroidectomy is not always symptomatic and is not uniformly due to injury of the recurrent laryngeal nerve. Management does not always require surgical reintervention. The practical and medico-legal consequences of these injuries are discussed. 相似文献17.
Manabu Okada Yoshihiro Tominaga Takayuki Yamamoto Takahisa Hiramitsu Shunji Narumi Yoshihiko Watarai 《World journal of surgery》2016,40(3):595-599
Background
Reoperative parathyroidectomy (RPTX) because parathyroid glands have been missed is frequently required in patients with secondary hyperparathyroidism (SHPT). The usual locations of these missed glands in patients with SHPT are yet to be fully elucidated.Methods
We retrospectively investigated the locations of missed glands in 165 patients who underwent RPTX for persistent or recurrent SHPT at our institution from August 1982 to July 2014. At our institution, total parathyroidectomy with forearm autograft is the routine operative procedure for SHPT. We also routinely resect the thymic tongue.Results
Of 165 patients, 82 underwent initial parathyroidectomy at our institution (Group A), and the remaining 83 underwent initial parathyroidectomy at other institutions (Group B). A total of 239 parathyroid glands were resected (Group A, 93; Group B, 146). Missed glands were most commonly located in the mediastinum (Group A, 22/93) and the thymic tongue (Group B, 31/146).Conclusions
In patients with persistent or recurrent SHPT, ectopic parathyroid glands are frequently located in the mediastinum and thymic tongue. Therefore, resecting the thymic tongue during the initial operation may reduce the need for RPTX.18.
David Costa Navarro Montiel Jiménez Fuertes Juan Carlos Medina Álvarez Luis Requena Meana Elena Jimeno Lecina Kenji Inaba Eugenio Herrero José Antonio Velasco 《Cirugía espa?ola》2009,86(6):363-368
Introduction
Although there is ample evidence on the importance of having good protocols for Trauma patient care, a teaching system for the personnel involved in this care is needed.Methods
The aim is to describe how we have organised the care for this type of patient in Torrevieja Hospital by creating a Trauma Surgery Unit, a Trauma Committee and a Trauma Team. We also describe how we have developed training in order to ensure personnel get the knowledge and skills to care for these patients correctly (Trauma Surgery Course).Results
We prospectively describe the results. Seventy-nine patients were attended to and 38% had sustained combined multiple injuries, 35% isolated thoracic trauma, 15% combined thorax and abdomen, and 12% abdomen. The most frequent cause of trauma was traffic accident, closely followed by stab wounds. Trauma team activation was made in 27 cases. Overall mortality rate was 8.8%. During this period of time, 5 editions of the course have been given and 29.5% of the target personnel have already participated in them.Conclusions
We conclude by highlighting the importance of having adequate protocols for treating these patients and the correct means for teaching the personnel. 相似文献19.
Leah Candell Michael J. Campbell Wen T. Shen Jessica E. Gosnell Orlo H. Clark Quan-Yang Duh 《World journal of surgery》2014,38(1):88-91
Background
The goal of this study was to review a single institution’s experience using intraoperative ultrasound-guided (ioUSG) methylene blue dye injection for the localization and removal of enlarged parathyroid glands in patients with primary hyperparathyroidism and a history of previous neck surgery.Methods
We performed a retrospective review of nine consecutive patients who underwent reoperative parathyroidectomy using ioUSG methylene blue dye injection.Results
All patients had successful resolution of their hyperparathyroidism, with at least a 50 % decrease in intraoperative parathyroid hormone level after resection. One patient had transient recurrent laryngeal nerve paresis. There were no permanent recurrent laryngeal nerve injuries or cases of permanent hypoparathyroidism.Conclusions
Blue dye injection is a safe and effective method of localizing diseased parathyroid glands in the reoperative neck. 相似文献20.
Kevin Shepet BS Amal Alhefdhi MD Reid Usedom BS Rebecca Sippel MD FACS Herbert Chen MD FACS 《Annals of surgical oncology》2013,20(7):2256-2260