1,721,179 research outputs found
Postoperative Fever
No full textBackground: Fever is common in surgical patients. The list of potential causes is long and includes many noninfective etiologies.
Causes: Only about 40% of fever episodes in hospitalized patients are caused by infection. Any fever in a surgical patient is a cause for concern. New or continuing fever more than three days after surgery should raise a strong suspicion of persistent illness or a new complication. On rare occasions, these fevers can be attributed to potentially life-threatening occult infections, including acute cholecystitis, antibiotic-related pseudomembranous colitis, systemic candidiasis, or transfusion-related cytomegalovirus disease. A change in the microbiology of postoperative infections has also been noticed, characterized by a greater incidence of infections caused by methicillin-resistant Staphylococcus aureus, by polymicrobial flora, and by fungi.
Treatment: Control of nosocomial infections has become more challenging recently because of widespread bacterial resistance to antibiotics and to more frequent surgical indications in elderly patients at higher risk. Early recognition and appropriate treatment of these infections relieves anxiety, reduces hospital costs, and increases patient survival rates.
Conclusions: The workup and therapy for the individual patient may differ, depending on the underlying disease and clinical appearance and the clinician's suspicion for infection. Subsequent testing should be based on the clinical findings. Perhaps more money is wasted in the evaluation of early postoperative fever than on any other aspect of postoperative care
Chest X-rays Lung Cancer Screening in Cigarette Smokers in the Province of Varese, Italy
No full textNeuromonitoring and Video-assisted Thyroidectomy: A Prospective, Randomized Case-control Evaluation
No full textINTRODUCTION: This study evaluates the role of intraoperative neuromonitoring (IONM) in video-assisted thyroidectomy (VAT) with emphasis given to the identification of recurrent laryngeal nerve (RLN) and external branch of superior laryngeal nerve (EBSLN). METHODS: The study was based on a prospectively randomized series comprising 72 standard VAT gasless approaches. In the control group (N = 36), the laryngeal nerves were identified by 30 degrees 5-mm endoscope magnification solely. The standard technique of the IONM group (N = 36) consisted of localizing and monitoring EBSLN, both vagus and RLNs, before and after thyroid resection to prove nerve integrity. Surgical outcomes were mean operative time, nerve representation, incision length, and morbidity. RESULTS: All procedures were performed successfully. There were no instances of equipment malfunction or interference. No permanent complications occurred in either group. The incidences of temporary RLN injury were 2.7% (1 patient) and 8.3% (3 patients) in the IONM and control group, respectively. The EBSLN was identified better in the IONM group: 83.6% versus 42% (p < 0.05). In the IONM group, a negative electromyography (EMG) response indicated an altered function of RLN and stage thyroidectomy was scheduled. CONCLUSIONS: This is the first VAT series with a standardized IONM technique. The technical feasibility and safety of IONM in selected patients seem acceptable. Neuromonitoring during VAT is effective in providing identification and function of laryngeal nerves. IONM enables surgeons to feel more comfortable with their approach to VAT. A reduction of rates for postoperative complications could not be demonstrated in the present study. Larger series are needed for further evaluation
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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