Abstract:
INTRODUCTION:Pharmacological prophylaxis for early seizures following traumatic brain injury (TBI) is a recommendation in the Brain Trauma Foundation Guidelines. However, several studies have challenged the efficacy and safety of this practice, resulting in varied practice across centers around the world. The purpose of the present study was to compare the incidence of early clinical seizures following TBI, between two large centers, a US Center that practises routine seizure prophylaxis and a Chinese Center that does not use seizure prophylaxis following TBI. PATIENTS AND METHODS:This was a prospective observational study including an urban level I trauma center in the USA and a large hospital in Shenzhen, China. At the US Center, all patients received seizure prophylaxis with levetiracetam. At the Chinese Center, no seizure prophylaxis was given. All patients with blunt TBI and positive computed tomography findings for epidural hematoma, subdural hematoma, subarachnoid hemorrhage, intracerebral hemorrhage or diffuse axonal injury were included. Patients who died within 24 h of admission were excluded. The study population was monitored daily for clinical seizures for the first 7 post-injury days. Data collected included demographics, mechanism of injury, vital signs upon arrival, injury severity and emergency interventions. Primary outcome was the incidence of early seizures, defined as those occurring within 7 days of injury. RESULTS:A total of 522 patients were included in the analysis: 272 patients at the US Center who received seizure prophylaxis and 250 patients at the Chinese Center who did not receive prophylaxis. Overall, 3.7% of patients who received seizure prophylaxis developed early seizures, compared to 2.8% of patients who did not receive any prophylaxis (p = 0.573). Decompressive craniectomy was associated with the highest incidence of early seizure (9.2%). In this subgroup, the seizure rate was 10.4% in the prophylaxis group and 7.1% in the no-prophylaxis group (p = 0.738). Patients with admission GCS < 9 had an overall early seizure incidence of 7.0%: 4.3% in the prophylaxis group and 14.3% in the no-prophylaxis group (p = 0.062). Analysis of the subgroup with isolated blunt TBI showed an incidence of early seizures of 3.4% in the prophylaxis group versus 2.4% in the no-prophylaxis group (p = 0.593). Further analyses of outcomes according to head AIS 3, 4 and 5 showed no significant difference in the seizure rate between the two groups: head AIS 3: 6.1% in the prophylaxis group versus 2.6% in the no-prophylaxis group, p = 0.329; head AIS 4: 0 versus 2.7%, p = 0.302; head AIS 5: 8.7 versus 4.0%, p = 0.601. CONCLUSIONS:The present study failed to show any benefit of routine early seizure prophylaxis following blunt TBI. This practice should be reexamined in a large randomized clinical study.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Khor D,Wu J,Hong Q,Benjamin E,Xiao S,Inaba K,Demetriades Ddoi
10.1007/s00268-017-4373-0subject
Has Abstractpub_date
2018-06-01 00:00:00pages
1727-1732issue
6eissn
0364-2313issn
1432-2323pii
10.1007/s00268-017-4373-0journal_volume
42pub_type
杂志文章abstract:BACKGROUND:It has been reported that the paraesophagogastric devascularization with esophageal transection procedure, also known as the modified Sugiura procedure, was effective in the treatment of variceal bleeding. However, it was not widely accepted by other surgeons because of the high rate of rebleeding, complicat...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-014-2478-2
更新日期:2014-08-01 00:00:00
abstract::There are many concepts of risk and prognostic factor analysis for differentiated thyroid cancer. The prognostic role of lymph node metastases in follicular thyroid cancer (FTC), however, is still controversial. We performed a retrospective trial in 186 patients with FTC (124 women, 62 men; mean follow-up 5.5 years) q...
journal_title:World journal of surgery
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doi:10.1007/s00268-002-6668-y
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abstract:BACKGROUND:The appropriate surgical approach for hepatocellular carcinoma (HCC) patients of Child-Pugh class B is unclear. The aim of this study was to clarify the prognostic factors after hepatectomy in Child-Pugh class B patients and to delineate the selection criteria for hepatectomy. METHODS:One hundred fifty pati...
journal_title:World journal of surgery
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doi:10.1007/s00268-010-0929-y
更新日期:2011-04-01 00:00:00
abstract::With limited resources and the current concerns about using animals for research purposes, the needs must be clear when setting up trauma and sepsis experiments for pharmacologic interventions. Such interventions are performed typically for four reasons: (1) to study the pathophysiologic role of certain mediators (whi...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900077
更新日期:1996-05-01 00:00:00
abstract:BACKGROUND:Few details of the clinical features of hepatocellular carcinoma (HCC) developing extrahepatic recurrence after a curative resection have been published. The purpose of this study was to clarify the clinicopathologic findings of patients with HCC who experienced extrahepatic metastases. METHODS:Clinicopatho...
journal_title:World journal of surgery
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doi:10.1007/s00268-008-9613-x
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abstract:BACKGROUND:Transient postthyroidectomy hypocalcemia occurs in up to 30% of patients. We evaluated the effect of vitamin D deficiency on postthyroidectomy hypocalcemia. METHODS:Data were collected prospectively between January 2006 and March 2009. A total of 166 consecutive total thyroidectomies were analyzed regarding...
journal_title:World journal of surgery
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doi:10.1007/s00268-010-0872-y
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abstract::In some patients, bile ducts of segments 2 and 3 (B2 and B3) run caudally to the umbilical portion of the left portal vein (UP)--an infraportal course. We aimed to evaluate the frequency and clinical implications of this variation. Between January 1992 and October 2000, 108 patients underwent resection for hilar chola...
journal_title:World journal of surgery
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doi:10.1007/s00268-002-6544-9
更新日期:2002-12-01 00:00:00
abstract::Leiomyomas and leiomyosarcomas are derived from smooth muscle tissues. Smooth muscle cells also surround the blood vessels that supply the alimentary tract. These cells have at times been said to contribute to the formation of smooth muscle tumors in the alimentary canal. With such an abundance of smooth muscle, there...
journal_title:World journal of surgery
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doi:10.1007/s002689910063
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abstract::Burn patients develop a number of physiologic alterations among which is a markedly increased metabolic rate. Other metabolic changes include an increased rate of glucose production and utilization, a decreased rate of lipid metabolism, and an increased rate of both protein catabolism and anabolism. These alterations ...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02067118
更新日期:1992-01-01 00:00:00
abstract::The value of surgical resection for patients with chronic pancreatitis has been debated on account of persistent symptoms and the morbidity of the operative procedure, both immediate and delayed. This paper explores the consequence of pancreatoduodenectomy in 175 patients with chronic pancreatitis who were operated on...
journal_title:World journal of surgery
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abstract::Adenocarcinomas of the esophagogastric junction (AEG) are now recognized as a separate tumor entity with increasing incidence. The aim of the present study was to evaluate whether positron emission tomography (PET) using the glucose analog F-18-fluorodeoxyglucose (FDG) can be used for metabolic characterization of thi...
journal_title:World journal of surgery
pub_type: 杂志文章
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更新日期:2003-09-01 00:00:00
abstract::The goal of fluid resuscitation in the burn patient is maintenance of vital organ function at the least immediate or delayed physiological cost. To optimize fluid resuscitation in severely burned patients, the amount of fluid should be just enough to maintain vital organ function without producing iatrogenic pathologi...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
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更新日期:1992-01-01 00:00:00
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journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-005-0471-5
更新日期:2006-07-01 00:00:00
abstract::The lack of sufficient suitable human donor lungs for the many patients requiring pulmonary transplantation as life-saving therapy for end-stage lung diseases has generated extensive interest in cross-species lung transplantation. Ethical concerns and those of animal rights advocates have prompted studies of nonprimat...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/s002689900332
更新日期:1997-11-01 00:00:00
abstract::Frequently, several multiple abdominal reexplorations are needed in patients with acute necrotizing hemorrhagic pancreatitis (ANP) or with persistent intraabdominal sepsis (PIAS). Residual undrained necrotic and septic foci lead to multiple organ failure. To provide wide-open drainage of the abdominal cavity, since 19...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/BF01658968
更新日期:1991-01-01 00:00:00
abstract::Patients with short bowel syndrome (SBS) receiving total parenteral nutrition (TPN) have a high incidence of catheter-related sepsis, one of its major complications. The aim of this study was to correlate the length of remaining small bowel (RSB) with septic episodes related to the central venous catheter in a group o...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s002680010274
更新日期:2000-12-01 00:00:00
abstract:BACKGROUND:Vibrio vulnificus infection can progress rapidly in skin or soft tissue, and it is potentially life-threatening. The purpose of the present study was to explore the predictors of mortality in patients with V. vulnificus infections of skin or soft tissue. METHODS:The medical records of 119 consecutive patien...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0455-y
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Unrecognized reduction of blood supply to intestinal organs is associated with significant postoperative morbidity in abdominal surgery. The aim of this study was to determine whether--in the absence of hypovolemia--intestinal hypoperfusion as a result of blood flow redistribution occurs after abdominal surg...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-010-0560-y
更新日期:2010-09-01 00:00:00
abstract:BACKGROUND:The benefit of bullae ablation for the management of primary spontaneous pneumothorax (PSP) has been established. However, various modalities for bullae ablation have been reported from different centers. OBJECTIVE:The present study aimed to assess whether endoloop ligation of bullae was as effective as sta...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-009-9928-2
更新日期:2009-05-01 00:00:00
abstract::The metabolic changes in cancer cachexia appear to be mediated by a complex network of proinflammatory cytokines, neuroendocrine hormones, neurotransmitters, eicosanoids, and tumor-derived factors produced by the body in response to the tumor and by the tumor itself. The relative importance of these various mediator p...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
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更新日期:2000-06-01 00:00:00
abstract::Nuss described a minimally invasive technique for correcting pectus excavatum in children. A curved stainless-steel bar is inserted behind the sternum through the chest cavity with the convex surface face down, then rotated 180 degrees to elevate the sternum and correct the deformity. The procedure gained wide accepta...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-002-6519-x
更新日期:2002-10-01 00:00:00
abstract::We analyzed clinical features and genetic alterations in the noncancerous and cancerous biliary lesions obtained from pancreaticobiliary maljunction (PBM) patients. Gallbladder (GB) and bile duct (BD) lesions were obtained surgically from 36 patients with PBM, and polymerase chain reaction (PCR) methods were used to e...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-001-0187-0
更新日期:2002-01-01 00:00:00
abstract::Abdominal infections are treated by resuscitation, abdominal drainage, control of the source of infection, and antimicrobial agents. Ideally, antimicrobial therapy is active against expected pathogens, safe and effective in clinical trials, inexpensive, and unlikely to promote drug resistance. Numerous single-agent an...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
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更新日期:1998-02-01 00:00:00
abstract::Endoscopic management of upper gastrointestinal bleeding has been expanded from a purely diagnostic role to a therapeutic role in many patients. In addition to controlling active bleeding, it is an option in a patient who is clinically at a high risk of rebleeding, or in patients who have peptic ulcers with visible ve...
journal_title:World journal of surgery
pub_type: 杂志文章,评审
doi:10.1007/BF02067057
更新日期:1992-11-01 00:00:00
abstract:BACKGROUND:The impact of time to readmission (TTR) on post-discharge mortality has not been well examined. We sought to define the impact of TTR on postoperative mortality after liver or pancreas surgery. METHODS:A retrospective cohort analysis of liver and pancreas surgical patients was conducted using 2013-2015 Medi...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-4766-8
更新日期:2019-01-01 00:00:00
abstract::Inflammatory breast cancer (IBC) is the most aggressive form of locally advanced breast cancer. It can be diagnosed based on a clinical or pathologic basis. We evaluated the usefulness of (18)F-fluorodeoxyglucose-positron emission tomography (FDG-PET) scans for diagnosing and staging IBC. We retrospectively reviewed t...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-003-6893-z
更新日期:2003-10-01 00:00:00
abstract:BACKGROUND:Trauma contributes more than ten percent of the global burden of disease. Initial assessment and resuscitation of trauma patients often requires rapid diagnosis and management of multiple concurrent complex conditions, and errors are common. We investigated whether implementing a trauma care checklist would ...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-016-3759-8
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Management of critically ill patients is challenging in a low-resource setting. In Rwanda, peritonitis is a common surgical condition where patients often present late, with advanced disease. We aim to describe critical care management of patients with peritonitis in Rwanda. METHODS:Data were collected at a...
journal_title:World journal of surgery
pub_type: 杂志文章
doi:10.1007/s00268-018-4598-6
更新日期:2018-10-01 00:00:00
abstract::The first laparoscopic Nissen fundoplication was performed 20 years ago. Surgical management of gastroesophageal reflux disease (GERD) should be offered only to appropriately studied and selected patients, with the ultimate aim of improving the well-being of the individual, the "quality of life." The choice of fundopl...
journal_title:World journal of surgery
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更新日期:2011-07-01 00:00:00
abstract::The novel trend toward focused parathyroidectomy requires precise preoperative localization of the parathyroid adenoma in patients with primary hyperparathyroidism (PHPT). The present study evaluated the impact of hybrid single photon emission computed tomography/computed tomography (SPECT/CT), using 99mTc-sestamibi (...
journal_title:World journal of surgery
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doi:10.1007/s00268-005-7849-2
更新日期:2006-01-01 00:00:00