The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of...The foundation of evidence-based medicine is critical analysis and synthesis of the best data available concerning a given health problem. These factual data are accessible because of the availability on the Internet of web tools specialized in research for scientific publications. A bibliographic database is a collection of bibliographic references describing the documents indexed. Such a reference includes at least the title, summary (or abstract), a set of keywords, and the type of publication. To conduct a strategically effective search, it is necessary to formulate the question - clinical, diagnostic, prognostic, or related to treatment or prevention - in a form understandable by the research engine. Moreover, it is necessary to choose the specific database or databases, which may have particular specificity, and to analyze the results rapidly to refine the strategy. The search for information is facilitated by the knowledge of the standardized terms commonly used to describe the desired information. These come from a specific thesaurus devoted to document indexing. The most frequently used is MeSH (Medical Subject Heading). The principal bibliographic database whose references include a set of describers from the MeSH thesaurus is Medical Literature Analysis and Retrieval System Online (Medline), which has in turn become a subpart of a still more vast bibliography called PubMed, which indexes an additional 1.4 million references. Numerous other databases are maintained by national or international entities. These include the Cochrane Library, Embase, and the PASCAL and FRANCIS databases.
Angiomyxoma is a rare but aggressive mesenchymal tumor. It commonly develops in the pelvis, perineum and groin and is more common in females. Angiomyxoma characteristically has a high incidence of local recurrence. The o...Angiomyxoma is a rare but aggressive mesenchymal tumor. It commonly develops in the pelvis, perineum and groin and is more common in females. Angiomyxoma characteristically has a high incidence of local recurrence. The only treatment of recurrence is surgical re-excision. We report a case of recurrent aggressive angiomyxoma, which was only incompletely resected.
This work aims to define a strategy for the management of polytrauma based on findings from a review of the recent literature. After a definition of terminology, we address the modes of injury, pathophysiology, and the d...This work aims to define a strategy for the management of polytrauma based on findings from a review of the recent literature. After a definition of terminology, we address the modes of injury, pathophysiology, and the different phases in the management of polytrauma. We assess the results of current management of polytrauma in developed countries and stress the need for improvement in trauma systems and therapeutic interventions in order to achieve better results.
BACKGROUND: Among the various bariatric procedures, laparoscopic Roux-en-Y gastric bypass (LRYGBP) is widely considered to be the gold standard. However, a majority of bariatric surgeons in France do not perform LFYGBP,...BACKGROUND: Among the various bariatric procedures, laparoscopic Roux-en-Y gastric bypass (LRYGBP) is widely considered to be the gold standard. However, a majority of bariatric surgeons in France do not perform LFYGBP, perhaps because of its reputation as a technically demanding procedure with a long learning curve. This study evaluates the outcomes and the learning curve for the first 50 LFYGBP performed by one surgeon in a French non-university hospital. MATERIAL AND METHOD: Between April 2007 and February 2009, we performed our first 50 cases of LRYGBP. Surgical outcomes and the learning curve were measured by prospective criteria including length of stay, operative time, complications, percentage weight loss and reduction of obesity-related co-morbidities. RESULTS: The mean patient age was 41.8+/-9.8 years. The mean BMI was 47.7+/-7.1 kg/m(2). The mean operative time was 146+/-51 minutes and the mean hospital stay was 5.3+/-1.4 days. Three cases (6%) were converted to open surgery. Early complications occurred in 4% and late complications occurred in 6%. The average follow-up was 6.3+/-1.3 months. Overall excess weight loss was 39.5, 50, 62, and 63% at 3, 6, 9, and 12 months. CONCLUSION: LRYGBP can be performed with acceptable morbidity and short-term results, even during the early phase of a surgeon's learning curve. It is a feasible procedure for bariatric surgeons with previous experience in gastric banding.
Laparoscopic splenectomy (LS) has become the standard approach to splenectomy for benign and malignant hematologic diseases despite a paucity of high-level evidence. The procedure requires expertise in laparoscopic surgi...Laparoscopic splenectomy (LS) has become the standard approach to splenectomy for benign and malignant hematologic diseases despite a paucity of high-level evidence. The procedure requires expertise in laparoscopic surgical techniques and meticulous dissection of the spleen. Management should include a preoperative radiologic assessment to measure splenic volume and to detect the presence of accessory splenic tissue; the patient should undergo preoperative vaccination against meningococcal, pneumococcal, and Haemophilus influenzae type B infections. Prophylactic antibiotics are used in the perioperative period as well as prophylactic anticoagulation therapy which may be continued long-term in high-risk patients. LS is associated with a low morbidity and mortality; when compared to laparotomy, it reduces the length of hospital stay and improves the quality of life by decreasing postoperative ileus and pain. There are a variety of laparoscopic approaches; the hand-assisted technique and newer coagulating devices have facilitated the operative technique leading to increasing acceptance of laparoscopy as the preferred approach - even in patients with malignant hematologic disease and/or massive splenomegaly.
Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly...Esophageal perforation during nasogastric tube insertion is a very unusual occurrence. In this case report, radiologic images revealed a right-sided aortic arch with a right-sided thoracic aorta. This anatomical anomaly probably contributed to the complication and necessitated a modified approach to the surgical repair.
AIM OF THE STUDY: We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. PATIENTS AND METHOD...AIM OF THE STUDY: We analyse aspects of re-operative abdominal surgery in an economically disadvantaged environment with respect to indications, operative findings, treatment modalities, and outcomes. PATIENTS AND METHODS: Retrospective chart review over a seven-year period of patients requiring re-operative surgery during the same hospitalization or within 30 days of initial surgery. RESULTS: During the study period, 7714 laparotomies were performed. Two hundred and seventy-seven (3.6%) required re-operation; of these, 238 charts (86%) were able to be reviewed. The decision for operative re-intervention was made mainly on the basis of clinical findings. Postoperative peritonitis (50.8%), adhesive bowel obstruction (23.9%), and intestinal fistula (10.9%) were the main indications for re-intervention. Complications occurred in 35% and included postoperative infection (n=70, 33%) and abdominal wall dehiscence (n=37, 15.5%). Mortality was 18% and increased significantly when the initial operative procedure was for peritonitis and re-operation was due to septic complications. CONCLUSION: In an economically disadvantaged environment, the re-operation rate after an abdominal surgery does not seem to be higher than that seen in series from developed countries, although there may be factors which bias this observation. The mortality rate for cases with postoperative peritonitis is high, but operative re-intervention based on clinical findings is still considered the favored strategy in our environment. Results may improve with better material medical conditions.
AIM OF THE STUDY: Many of the treatments proposed for trans-sphincteric and suprasphincteric anal fistulas are complex and often associated with permanent damage to the sphincter mechanism. In this study, we evaluate the...AIM OF THE STUDY: Many of the treatments proposed for trans-sphincteric and suprasphincteric anal fistulas are complex and often associated with permanent damage to the sphincter mechanism. In this study, we evaluate the long-term stability of fistula closure using fibrin glue. MATERIALS AND METHODS: Forty-five consecutive patients (mean age 41.5) underwent this procedure. Follow-up was obtained from all patients and their primary care physicians by January 1, 2008. RESULTS: Mean follow-up was 67 months. All recurrences occurred in the first six months after the initial fibrin glue injection procedure; there were no late recurrences. CONCLUSION: Long-term follow-up confirmed the safety, efficacy and durability of fibrin glue fistula closure.
INTRODUCTION: Sleeve gastrectomy as an isolated procedure is a new option in bariatric surgery. The aim of this study was to evaluate its short and medium term (2 years) results in a multicenter setting. MATERIALS: This...INTRODUCTION: Sleeve gastrectomy as an isolated procedure is a new option in bariatric surgery. The aim of this study was to evaluate its short and medium term (2 years) results in a multicenter setting. MATERIALS: This is a retrospective study including 446 patients undergoing surgery in 14 teaching, private, and public hospitals. RESULTS: The immediate post-operative course were uneventful in 83.3% of patients. Minor complications occurred in 10.9% of patients and major complications in 5.3%. Suture line leaks occurred in 4.3% of the whole series. There was no mortality and the rate of reoperation was 2%. Overall mean weight loss after two years was 32 kg and the mean excess weight loss was 62%. Weight loss was significantly greater in non super-obese patients (p=0.0003). CONCLUSIONS: This study confirms the feasibility of sleeve gastrectomy in a multicenter setting; it is efficacious at two years as an isolated bariatric procedure for non super-obese patients. It is possible that an additional second-stage procedure may be necessary for super-obese patients.