Loading…

Prevention of Overwhelming Postsplenectomy Infection in Thalassemia Patients by Partial Rather Than Total Splenectomy

Objective We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present wi...

Full description

Saved in:
Bibliographic Details
Published in:Canadian Journal of Surgery 2007-10, Vol.50 (5), p.382-386
Main Authors: Sheikha, Anwar K., MD, Salih, Ziyan T., MD, Kasnazan, Kalandar H., MB, ChB, Khoshnaw, Mohammad K., MB, ChB, Al-Maliki, Talal, MB, BS, Al-Azraqi, Tarek A., MB, BS, Zafer, Mubarak H., MB, BS
Format: Article
Language:English
Subjects:
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by
cites
container_end_page 386
container_issue 5
container_start_page 382
container_title Canadian Journal of Surgery
container_volume 50
creator Sheikha, Anwar K., MD
Salih, Ziyan T., MD
Kasnazan, Kalandar H., MB, ChB
Khoshnaw, Mohammad K., MB, ChB
Al-Maliki, Talal, MB, BS
Al-Azraqi, Tarek A., MB, BS
Zafer, Mubarak H., MB, BS
description Objective We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present with pneumococcal septicemia. Pneumococcal vaccine given before surgery is a well-established preventive measure. Methods In this study, we compared 2 populations of patients from Iraq and Saudi Arabia, both of whom underwent splenectomy for thalassaemia. All patients from Saudi Arabia were given a preoperative pneumococcal vaccine and underwent total splenectomy after about 4 weeks. Unfortunately, this vaccine was not available for the Iraqi patients. Partial splenectomy was offered to many of these patients as a protective measure against this fatal complication. Results A significant difference was found between the total splenectomy fatalities in the 2 groups. There were 5 deaths in the 30 enrolled Iraqi patients over 4 years. One death over a 12-year period was reported in the 22 patients from Saudi Arabia. Partial splenectomy was associated with a dramatic reduction of mortality in the Iraqi patients. None of the 12 patients died during a follow-up period of 4 years. Conclusions Pneumovax is a powerful prophylactic tool against overwhelming postsplenectomy infection in patients with thalassaemia and should be used whenever available. In poor or problematic countries with limited health resources, partial rather than total splenectomy could offer an alternative measure to avoid this fatal complication.
doi_str_mv 10.1016/S0008-428X(07)50111-6
format article
fullrecord <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2386178</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A169960695</galeid><els_id>1_s2_0_S0008428X07501116</els_id><sourcerecordid>A169960695</sourcerecordid><originalsourceid>FETCH-LOGICAL-e515t-d2145dc78eec3193381c0bfa71acbdefaeb3f88a3aa1d6d567780cf5e978eea83</originalsourceid><addsrcrecordid>eNptklFv0zAQxyMEYmXwEUARDxN7yLDrxnFeJk0Tg0oTq-iQeLOuzqXxcOwudsr67XG2sbZo8oOt8-_-Z9_9k-Q9JSeUUP55TggR2WQsfn0ixXFOKKUZf5GM6ESIbMwoeZmMnpCD5I33N4RQwibl6-SACsIoZ-Uo6WcdrtEG7Wzq6vRqjd2fBk2r7TKdOR_8yqBFFVy7Sae2jqeB1Da9bsCA99hqSGcQdNTw6WITz13QYNIfEBrsBiyyLsTIfCv1NnlVg_H47nE_TH5efLk-_5ZdXn2dnp9dZpjTPGTVmE7yShUCUTFaMiaoIosaCgpqUWENuGC1EMAAaMWrnBeFIKrOsRxSQLDD5PRBd9UvWqxUfGQHRq463UK3kQ603L-xupFLt5ZjJjgtBoGjR4HO3fbog2y1V2gMWHS9l1zkrChzEsGP_4E3ru9s_JykZV7mEy6KCGUP0BIMSm1rF4uqZexKrO0s1jqGzygvS054mW9F93i10rdyFzp5BoqrirNRz6oe7yVEJuBdWELvvZzOv--zRztsg2BC453pBxf4ffDDbqefWvzPadtRYJz3WmMnldFWKzC_cYN-2y3px5LIe3sP1iXFvbc5-wtcBOwV</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>195954687</pqid></control><display><type>article</type><title>Prevention of Overwhelming Postsplenectomy Infection in Thalassemia Patients by Partial Rather Than Total Splenectomy</title><source>PubMed Central(OpenAccess)</source><creator>Sheikha, Anwar K., MD ; Salih, Ziyan T., MD ; Kasnazan, Kalandar H., MB, ChB ; Khoshnaw, Mohammad K., MB, ChB ; Al-Maliki, Talal, MB, BS ; Al-Azraqi, Tarek A., MB, BS ; Zafer, Mubarak H., MB, BS</creator><creatorcontrib>Sheikha, Anwar K., MD ; Salih, Ziyan T., MD ; Kasnazan, Kalandar H., MB, ChB ; Khoshnaw, Mohammad K., MB, ChB ; Al-Maliki, Talal, MB, BS ; Al-Azraqi, Tarek A., MB, BS ; Zafer, Mubarak H., MB, BS</creatorcontrib><description>Objective We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present with pneumococcal septicemia. Pneumococcal vaccine given before surgery is a well-established preventive measure. Methods In this study, we compared 2 populations of patients from Iraq and Saudi Arabia, both of whom underwent splenectomy for thalassaemia. All patients from Saudi Arabia were given a preoperative pneumococcal vaccine and underwent total splenectomy after about 4 weeks. Unfortunately, this vaccine was not available for the Iraqi patients. Partial splenectomy was offered to many of these patients as a protective measure against this fatal complication. Results A significant difference was found between the total splenectomy fatalities in the 2 groups. There were 5 deaths in the 30 enrolled Iraqi patients over 4 years. One death over a 12-year period was reported in the 22 patients from Saudi Arabia. Partial splenectomy was associated with a dramatic reduction of mortality in the Iraqi patients. None of the 12 patients died during a follow-up period of 4 years. Conclusions Pneumovax is a powerful prophylactic tool against overwhelming postsplenectomy infection in patients with thalassaemia and should be used whenever available. In poor or problematic countries with limited health resources, partial rather than total splenectomy could offer an alternative measure to avoid this fatal complication.</description><identifier>ISSN: 0008-428X</identifier><identifier>EISSN: 1488-2310</identifier><identifier>DOI: 10.1016/S0008-428X(07)50111-6</identifier><identifier>PMID: 18031639</identifier><identifier>CODEN: CJSUAX</identifier><language>eng</language><publisher>Canada: CMA Impact Inc</publisher><subject>Adolescent ; Adult ; Analysis ; Anemia ; Care and treatment ; Child ; Child, Preschool ; Dosage and administration ; Female ; Follow-Up Studies ; Health aspects ; Humans ; Infections ; Male ; Medical research ; Original ; Pneumococcal vaccine ; Preventive medicine ; Prospective Studies ; Retrospective Studies ; Spleen ; Splenectomy ; Splenectomy - adverse effects ; Splenectomy - methods ; Splenectomy - mortality ; Surgery ; Surgical Wound Infection - etiology ; Surgical Wound Infection - prevention &amp; control ; Survival Rate ; Thalassemia ; Thalassemia - surgery</subject><ispartof>Canadian Journal of Surgery, 2007-10, Vol.50 (5), p.382-386</ispartof><rights>Canadian Medical Association</rights><rights>COPYRIGHT 2007 CMA Impact Inc.</rights><rights>Copyright Canadian Medical Association Oct 2007</rights><rights>2007 Canadian Medical Association</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386178/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC2386178/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18031639$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Sheikha, Anwar K., MD</creatorcontrib><creatorcontrib>Salih, Ziyan T., MD</creatorcontrib><creatorcontrib>Kasnazan, Kalandar H., MB, ChB</creatorcontrib><creatorcontrib>Khoshnaw, Mohammad K., MB, ChB</creatorcontrib><creatorcontrib>Al-Maliki, Talal, MB, BS</creatorcontrib><creatorcontrib>Al-Azraqi, Tarek A., MB, BS</creatorcontrib><creatorcontrib>Zafer, Mubarak H., MB, BS</creatorcontrib><title>Prevention of Overwhelming Postsplenectomy Infection in Thalassemia Patients by Partial Rather Than Total Splenectomy</title><title>Canadian Journal of Surgery</title><addtitle>Can J Surg</addtitle><description>Objective We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present with pneumococcal septicemia. Pneumococcal vaccine given before surgery is a well-established preventive measure. Methods In this study, we compared 2 populations of patients from Iraq and Saudi Arabia, both of whom underwent splenectomy for thalassaemia. All patients from Saudi Arabia were given a preoperative pneumococcal vaccine and underwent total splenectomy after about 4 weeks. Unfortunately, this vaccine was not available for the Iraqi patients. Partial splenectomy was offered to many of these patients as a protective measure against this fatal complication. Results A significant difference was found between the total splenectomy fatalities in the 2 groups. There were 5 deaths in the 30 enrolled Iraqi patients over 4 years. One death over a 12-year period was reported in the 22 patients from Saudi Arabia. Partial splenectomy was associated with a dramatic reduction of mortality in the Iraqi patients. None of the 12 patients died during a follow-up period of 4 years. Conclusions Pneumovax is a powerful prophylactic tool against overwhelming postsplenectomy infection in patients with thalassaemia and should be used whenever available. In poor or problematic countries with limited health resources, partial rather than total splenectomy could offer an alternative measure to avoid this fatal complication.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Analysis</subject><subject>Anemia</subject><subject>Care and treatment</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Dosage and administration</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Health aspects</subject><subject>Humans</subject><subject>Infections</subject><subject>Male</subject><subject>Medical research</subject><subject>Original</subject><subject>Pneumococcal vaccine</subject><subject>Preventive medicine</subject><subject>Prospective Studies</subject><subject>Retrospective Studies</subject><subject>Spleen</subject><subject>Splenectomy</subject><subject>Splenectomy - adverse effects</subject><subject>Splenectomy - methods</subject><subject>Splenectomy - mortality</subject><subject>Surgery</subject><subject>Surgical Wound Infection - etiology</subject><subject>Surgical Wound Infection - prevention &amp; control</subject><subject>Survival Rate</subject><subject>Thalassemia</subject><subject>Thalassemia - surgery</subject><issn>0008-428X</issn><issn>1488-2310</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><recordid>eNptklFv0zAQxyMEYmXwEUARDxN7yLDrxnFeJk0Tg0oTq-iQeLOuzqXxcOwudsr67XG2sbZo8oOt8-_-Z9_9k-Q9JSeUUP55TggR2WQsfn0ixXFOKKUZf5GM6ESIbMwoeZmMnpCD5I33N4RQwibl6-SACsIoZ-Uo6WcdrtEG7Wzq6vRqjd2fBk2r7TKdOR_8yqBFFVy7Sae2jqeB1Da9bsCA99hqSGcQdNTw6WITz13QYNIfEBrsBiyyLsTIfCv1NnlVg_H47nE_TH5efLk-_5ZdXn2dnp9dZpjTPGTVmE7yShUCUTFaMiaoIosaCgpqUWENuGC1EMAAaMWrnBeFIKrOsRxSQLDD5PRBd9UvWqxUfGQHRq463UK3kQ603L-xupFLt5ZjJjgtBoGjR4HO3fbog2y1V2gMWHS9l1zkrChzEsGP_4E3ru9s_JykZV7mEy6KCGUP0BIMSm1rF4uqZexKrO0s1jqGzygvS054mW9F93i10rdyFzp5BoqrirNRz6oe7yVEJuBdWELvvZzOv--zRztsg2BC453pBxf4ffDDbqefWvzPadtRYJz3WmMnldFWKzC_cYN-2y3px5LIe3sP1iXFvbc5-wtcBOwV</recordid><startdate>20071001</startdate><enddate>20071001</enddate><creator>Sheikha, Anwar K., MD</creator><creator>Salih, Ziyan T., MD</creator><creator>Kasnazan, Kalandar H., MB, ChB</creator><creator>Khoshnaw, Mohammad K., MB, ChB</creator><creator>Al-Maliki, Talal, MB, BS</creator><creator>Al-Azraqi, Tarek A., MB, BS</creator><creator>Zafer, Mubarak H., MB, BS</creator><general>CMA Impact Inc</general><general>CMA Impact, Inc</general><general>Canadian Medical Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>ISN</scope><scope>3V.</scope><scope>4T-</scope><scope>4U-</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8FQ</scope><scope>8FV</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AN0</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9-</scope><scope>K9.</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M3G</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>Q9U</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20071001</creationdate><title>Prevention of Overwhelming Postsplenectomy Infection in Thalassemia Patients by Partial Rather Than Total Splenectomy</title><author>Sheikha, Anwar K., MD ; Salih, Ziyan T., MD ; Kasnazan, Kalandar H., MB, ChB ; Khoshnaw, Mohammad K., MB, ChB ; Al-Maliki, Talal, MB, BS ; Al-Azraqi, Tarek A., MB, BS ; Zafer, Mubarak H., MB, BS</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-e515t-d2145dc78eec3193381c0bfa71acbdefaeb3f88a3aa1d6d567780cf5e978eea83</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Analysis</topic><topic>Anemia</topic><topic>Care and treatment</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Dosage and administration</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Health aspects</topic><topic>Humans</topic><topic>Infections</topic><topic>Male</topic><topic>Medical research</topic><topic>Original</topic><topic>Pneumococcal vaccine</topic><topic>Preventive medicine</topic><topic>Prospective Studies</topic><topic>Retrospective Studies</topic><topic>Spleen</topic><topic>Splenectomy</topic><topic>Splenectomy - adverse effects</topic><topic>Splenectomy - methods</topic><topic>Splenectomy - mortality</topic><topic>Surgery</topic><topic>Surgical Wound Infection - etiology</topic><topic>Surgical Wound Infection - prevention &amp; control</topic><topic>Survival Rate</topic><topic>Thalassemia</topic><topic>Thalassemia - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Sheikha, Anwar K., MD</creatorcontrib><creatorcontrib>Salih, Ziyan T., MD</creatorcontrib><creatorcontrib>Kasnazan, Kalandar H., MB, ChB</creatorcontrib><creatorcontrib>Khoshnaw, Mohammad K., MB, ChB</creatorcontrib><creatorcontrib>Al-Maliki, Talal, MB, BS</creatorcontrib><creatorcontrib>Al-Azraqi, Tarek A., MB, BS</creatorcontrib><creatorcontrib>Zafer, Mubarak H., MB, BS</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>Gale In Context: Canada</collection><collection>ProQuest Central (Corporate)</collection><collection>Docstoc</collection><collection>University Readers</collection><collection>Nursing &amp; Allied Health Database</collection><collection>Health &amp; Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>Canadian Business &amp; Current Affairs Database</collection><collection>Canadian Business &amp; Current Affairs Database (Alumni Edition)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>British Nursing Database</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>Consumer Health Database (Alumni Edition)</collection><collection>ProQuest Health &amp; Medical Complete (Alumni)</collection><collection>Family Health Database (Proquest)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>PML(ProQuest Medical Library)</collection><collection>CBCA Reference &amp; Current Events</collection><collection>Nursing &amp; Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>ProQuest Central Basic</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Canadian Journal of Surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Sheikha, Anwar K., MD</au><au>Salih, Ziyan T., MD</au><au>Kasnazan, Kalandar H., MB, ChB</au><au>Khoshnaw, Mohammad K., MB, ChB</au><au>Al-Maliki, Talal, MB, BS</au><au>Al-Azraqi, Tarek A., MB, BS</au><au>Zafer, Mubarak H., MB, BS</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevention of Overwhelming Postsplenectomy Infection in Thalassemia Patients by Partial Rather Than Total Splenectomy</atitle><jtitle>Canadian Journal of Surgery</jtitle><addtitle>Can J Surg</addtitle><date>2007-10-01</date><risdate>2007</risdate><volume>50</volume><issue>5</issue><spage>382</spage><epage>386</epage><pages>382-386</pages><issn>0008-428X</issn><eissn>1488-2310</eissn><coden>CJSUAX</coden><abstract>Objective We aimed to evaluate the protective role of partial versus total splenectomy against sepsis in patients with thalassaemia when other preventive measures are not available. Overwhelming postsplenectomy infection is a serious complication of splenectomy in these patients, and most present with pneumococcal septicemia. Pneumococcal vaccine given before surgery is a well-established preventive measure. Methods In this study, we compared 2 populations of patients from Iraq and Saudi Arabia, both of whom underwent splenectomy for thalassaemia. All patients from Saudi Arabia were given a preoperative pneumococcal vaccine and underwent total splenectomy after about 4 weeks. Unfortunately, this vaccine was not available for the Iraqi patients. Partial splenectomy was offered to many of these patients as a protective measure against this fatal complication. Results A significant difference was found between the total splenectomy fatalities in the 2 groups. There were 5 deaths in the 30 enrolled Iraqi patients over 4 years. One death over a 12-year period was reported in the 22 patients from Saudi Arabia. Partial splenectomy was associated with a dramatic reduction of mortality in the Iraqi patients. None of the 12 patients died during a follow-up period of 4 years. Conclusions Pneumovax is a powerful prophylactic tool against overwhelming postsplenectomy infection in patients with thalassaemia and should be used whenever available. In poor or problematic countries with limited health resources, partial rather than total splenectomy could offer an alternative measure to avoid this fatal complication.</abstract><cop>Canada</cop><pub>CMA Impact Inc</pub><pmid>18031639</pmid><doi>10.1016/S0008-428X(07)50111-6</doi><tpages>5</tpages></addata></record>
fulltext fulltext
identifier ISSN: 0008-428X
ispartof Canadian Journal of Surgery, 2007-10, Vol.50 (5), p.382-386
issn 0008-428X
1488-2310
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_2386178
source PubMed Central(OpenAccess)
subjects Adolescent
Adult
Analysis
Anemia
Care and treatment
Child
Child, Preschool
Dosage and administration
Female
Follow-Up Studies
Health aspects
Humans
Infections
Male
Medical research
Original
Pneumococcal vaccine
Preventive medicine
Prospective Studies
Retrospective Studies
Spleen
Splenectomy
Splenectomy - adverse effects
Splenectomy - methods
Splenectomy - mortality
Surgery
Surgical Wound Infection - etiology
Surgical Wound Infection - prevention & control
Survival Rate
Thalassemia
Thalassemia - surgery
title Prevention of Overwhelming Postsplenectomy Infection in Thalassemia Patients by Partial Rather Than Total Splenectomy
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-24T16%3A20%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prevention%20of%20Overwhelming%20Postsplenectomy%20Infection%20in%20Thalassemia%20Patients%20by%20Partial%20Rather%20Than%20Total%20Splenectomy&rft.jtitle=Canadian%20Journal%20of%20Surgery&rft.au=Sheikha,%20Anwar%20K.,%20MD&rft.date=2007-10-01&rft.volume=50&rft.issue=5&rft.spage=382&rft.epage=386&rft.pages=382-386&rft.issn=0008-428X&rft.eissn=1488-2310&rft.coden=CJSUAX&rft_id=info:doi/10.1016/S0008-428X(07)50111-6&rft_dat=%3Cgale_pubme%3EA169960695%3C/gale_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-e515t-d2145dc78eec3193381c0bfa71acbdefaeb3f88a3aa1d6d567780cf5e978eea83%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=195954687&rft_id=info:pmid/18031639&rft_galeid=A169960695&rfr_iscdi=true