Adoption of a policy in favor of early laparoscopic cholecystectomy will result in better patient quality of life and substantial savings to the Canadian health care system.
The incidence of hypothyroidism following TL is low, and a significant proportion of individuals who become biochemically hypothyroid will demonstrate only a transient elevation in their TSH levels. As well, individuals with LI, or GC formation, within their resected thyroid lobe may be at increased risk for post-TL hypothyroidism.
The desmoid tumors (DTs) are unusual soft-tissue tumors that have a propensity for aggressive local growth and may develop during, or soon after pregnancy. Pregnancy-associated DTs are uncommon and optimal management of this tumor has yet to be defined. Currently, controversy centers on the timing of surgical resection and is influenced by the potential for tumor growth and the effects of a gravid uterus. A review of current literature in which DTs were managed either during pregnancy or in the postpartum period, was carried out. Surgical resection of these tumors has been performed successfully both during and soon after delivery, and the role of postpartum radiotherapy, chemotherapy and other medical intervention remains controversial. Management of DTs diagnosed during pregnancy is complex and treatment must be individualized.
Background: Today's acute care surgery (ACS) service model requires multiple handovers to incoming attending surgeons and residents. Our objectives were to investigate current handover practices in Canadian hospitals that have an ACS service and assess the quality of handover practices in place.
Methods:We administered an electronic survey among ACS residents in 6 Canadian general surgery programs.Results: Resident handover of patient care occurs frequently and often not under ideal circumstances. Most residents spend less than 5 minutes preparing handovers. Clinical uncertainty owing to inadequate handover is most likely to occur during overnight and weekend coverage. Almost one-third of surveyed residents rate the overall quality of the handovers they received as poor.
Conclusion:Handover skills must be taught in a systematic fashion. Improved resident communication will likely decrease loss of patient information and therefore improve ACS patient safety.
Various strategies to manage a hepatic artery injury have been described, ranging from ligation to complex vascular reconstruction. In hemodynamically stable patients, arterial transposition using the splenic artery is a feasible method to ensure adequate arterial supply to the liver and biliary tract.
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