Abstract:

A number of patients undergoing major surgery have an associated high morbidity leading to a long stay in the intensive care unit. This group of patients can be regarded as high risk, as their mortality rate is in the region of 20 to 30%.The high-risk patient is likely to have at least one of the characteristics listed in Table 1. Perioperative cardiac morbidity remains the leading cause of postoperative mortality. Although we can now support patients through the early phase of shock, trauma or other life-threatening illness, some will go on to develop progressive failure of one or more vital organs. In this article, we review some of the current processes of care that may improve outcomes in these surgical patients, as improving patient outcome is the purpose of medical care.

Authors:

Z. P Khan, F.R.C A R.T.; Spychal, M.D., F.R.C.S.; J. S. Pooni, M.R.C.P., F.R.C.A City Hospital,B~Ngham, England, UK

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Abstract:

Revascularization of the coronary or lower extremity circulation ideally requires an autologous conduit. The saphenous vein is the most commonly used graft. Minimally invasive surgical techniques for harvesting of the greater saphenous vein (GSV) are gaining popularity. With better instruments, critical evaluation of techniques and longer follow-up of patients, the outcome of such vein harvesting is improving. An increasing number of authors are reporting a variety of techniques with reduction in wound complications compared to conventional surgery.

Authors:

Aziz Benbrahim M.D., Hospital of St. Raphael; Walter Kwass, M.D., F.A.C.S., Hospital of St. Raphael And Yale-New Haven Hospita;l Antoine Ferneini, M.D., F.A.C.S., Hospital of St. Raphael, New Haven, CT, Raghu S. Savalgi, M.D., F.R.C.S., Ph.D. University of Connecticut, Storrs, CT

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Abstract:

While surgical infections are seemingly a heterogeneous group of disease entities, there are several common features that permit a general approach to their diagnosis and management. These properties include: the polymicrobial nature of the flora in most infections, the association of the infection with some underlying pathological process, and appropriate treatment often includes both broad-spectrum antimicrobial therapy and some surgical or radiological intervention to promote eradication of the infection. For the purpose of this review, intra-abdominal infection will be used as the prototypical surgical infection because it embodies many of the general features of most infections.

Authors:

Ian D. McGilvray, M.D., Ori D. Rotstein, M.D., F.R.C.S.C., University of Toronto, Toronto, Canada

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