American journal of surgery
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Hormone replacement therapy increases the number and quality of grafts recovered from brain-dead organ donors. Arginine vasopressin (AVP) has also been shown to have beneficial effects. The aim of this study was to determine the effect of AVP on recovery rates. ⋯ The use of AVP with hormone replacement therapy is independently associated with an increased rate of organ recovery. This strategy should be universally adopted in the management of donors progressing to neurologic death.
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A minimum of 12 lymph nodes has been endorsed as a quality measure to confirm node-negative colon cancer, but its relevance to early-stage rectal cancer is unclear. ⋯ Five-year overall survival improved as the number of sampled nodes increased. A thorough lymphadenectomy should routinely be performed to optimize staging and to improve survival of patients with early-stage rectal cancer.
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Rib fractures occur in 10% of injured patients, are associated with morbidity and mortality, and frequently necessitate intensive care unit (ICU) care. A scoring system that identifies the risk for respiratory failure early in the evaluation process may allow early intervention to improve outcomes. The aim of this study was to test the hypothesis that a scoring system based on initial clinical findings can identify patients with rib fractures at greatest risk for morbidity and mortality. ⋯ A simple scoring system predicts the likelihood that patients will require mechanical ventilation and prolonged courses of care. A score of 7 or 8 predicted increased risk for mortality, admission to the ICU, and intubation. A score > 5 predicted a longer length of stay and a longer period of ventilation. This scoring system may assist in the earlier implementation of treatment strategies such epidural anesthesia, ventilation, and operative fixation of fractures.
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Open abdomen management applies to a variety of traumatic and inflammatory abdominal conditions. One complication of this technique is inability to achieve primary closure of the abdominal wall. The aim of this study was to determine if the number of abdominal reexplorations influences the success of abdominal closure. ⋯ Greater than 4 reoperations is significantly associated with failure of the primary fascia closure. Efforts to obtain closure should be undertaken within 4 reoperations.