American journal of surgery
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Randomized Controlled Trial Clinical Trial
A prospective, randomized trial limiting perioperative red blood cell transfusions in vascular patients.
Patients undergoing major arterial reconstruction have traditionally been transfused with red blood cells to keep hemoglobin concentrations above 10 g/dL in order to prevent anemia-induced myocardial ischemia. There are no data to support this practice. The hypothesis that vascular patients will tolerate a hemoglobin concentration of 9 g/dL was examined. ⋯ A lower hemoglobin concentration was tolerated without adverse clinical outcome. Patients did not compensate for anemia by increased myocardial work, but by increasing O2 extraction in the peripheral tissues.
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Randomized Controlled Trial Comparative Study Clinical Trial
Influence of blunt needles on surgical glove perforation and safety for the surgeon.
Round-tipped blunt needle (BN) may decrease the risk of needlestick injuries and hand contamination. We prospectively determined the incidence of glove perforations in emergency abdominal procedures and the efficacy of BN in increasing the safety for surgeons. ⋯ The risk of glove perforation is sevenfold greater if SN are used. Blunt needles reduce sharp injuries and improve safety for surgeons.
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Randomized Controlled Trial Clinical Trial
Effect of patient position upon success in placing central venous catheters.
There is little consensus regarding the most efficient or the safest method by which to place a central venous catheter (CVC). ⋯ The bump position improves the likelihood of successful central venous catheter placement. No more than three needle passes ought to be attempted.
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Randomized Controlled Trial Comparative Study Clinical Trial
Results of a prospective, randomized trial of surgery versus thrombolysis for occluded lower extremity bypass grafts.
The purpose of this study was to prospectively evaluate the treatment of patients with occluded lower extremity bypass grafts, comparing surgical revascularization with catheter-directed thrombolysis. ⋯ Proper catheter positioning currently limits the potential of catheter-directed thrombolysis for lower extremity bypass graft occlusion. Patients with graft occlusion > 14 days have a significantly better outcome when treated surgically, with a new bypass being the best surgical option. However, in patients with acute limb ischemia (< 14 days) successful thrombolysis of occluded lower extremity bypass grafts improves limb salvage and reduces the magnitude of the planned surgical procedure. Patients with occluded prosthetic grafts suffer more major morbid events compared with occluded autogenous grafts.
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Randomized Controlled Trial Clinical Trial
Drainage is unnecessary after elective liver resection.
A prospective, randomized trial was performed to determine if intra-abdominal drainage catheters are necessary after elective liver resection. ⋯ In the first 50 consecutive resections performed since the conclusion of this trial, only 4 patients (8%) have required subsequent percutaneous drainage. We conclude that abdominal drainage is unnecessary after elective liver resection.