The American surgeon
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The American surgeon · May 2011
Comparative StudyLaparoscopic approach to adrenalectomy: review of perioperative outcomes in a single center.
Laparoscopic expertise increases the volume of adrenalectomies at referral centers. We report our 10-year experience with laparoscopic adrenalectomy. All laparoscopic adrenalectomies at a single institution were prospectively recorded in a surgical outcomes database. ⋯ Patients with pheochromocytomas had the longest operative times, highest estimated blood loss, and highest American Society of Anesthesiologists scores (218.2 minutes, 128 mL, 3.0; P < 0.004). Laparoscopic adrenalectomy is safe and effective. Removal of pheochromocytomas is more challenging and may be more appropriate for referral to a specialized center for optimal outcomes.
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The American surgeon · May 2011
Comparative StudyIncidence, risk factors, and outcomes for atrial arrhythmias in trauma patients.
The purpose of this study is to determine the incidence, risk factors, and outcomes after the development of an atrial arrhythmia (AA) in trauma patients admitted to the intensive care unit (ICU). We performed a retrospective study of more than 7 years of trauma patients admitted to the ICU at an urban, academic Level I trauma center. Patients with AA, defined as atrial fibrillation, atrial flutter, or paroxysmal supraventricular tachycardia, were compared with patients without AA. ⋯ AA occurs in 6 per cent of trauma patients admitted to the ICU. Developing an AA is an independent risk factor for mortality after trauma. Beta-blocker therapy was associated with decreased mortality in trauma patients with AA.
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The American surgeon · May 2011
Comparative StudyBenefits of laparoscopy: does the disease condition that indicated colectomy matter?
The benefits of laparoscopic (LC) over open colectomy (OC) have been well characterized for a variety of conditions. Whether the relative benefits of LC differ for different conditions has not been previously investigated. The aim of this study was to identify whether there are differences in benefits of LC for colon cancer (CC), Crohn's disease (CD), and diverticular disease (DD). ⋯ In the LC group, patients with DD presented less postoperative complications (P = 0.009). LC results in reduced LOS and EBL with similar complications rates when compared with OC. The benefits of LC are more pronounced in DD when compared with CD and CC.
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The American surgeon · May 2011
Seatbelt triad: severe abdominal wall disruption, hollow viscus injury, and major vascular injury.
The triad of seatbelt-related severe abdominal wall disruption, hollow viscus injury, and distal abdominal aortic injury after a motor vehicle collision is uncommon. We present a small case series involving those three clinical features with the goal of preventing a future missed diagnosis of the distal abdominal aortic injury in particular.
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The American surgeon · May 2011
Comparative StudyTransumbilical laparoscopic-assisted appendectomy: an extracorporeal single-incision alternative to conventional laparoscopic techniques.
Recently the use of a single umbilical incision to perform an appendectomy has been described. The purpose of this study was to review our initial experience with transumbilical laparoscopic-assisted appendectomy (TULAA) in the pediatric population. A retrospective review of all pediatric patients treated for appendicitis over a 10-month period was performed. ⋯ The technique described is cost-effective, because it does not use any special laparoscopes, trocars, or staplers. When performed as described in this study, only a single trocar and a standard laparoscopic setup are required. Cases of advanced appendicitis may require additional trocars or "conversion" to conventional laparoscopic techniques.