Journal of the American College of Surgeons
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Multicenter Study
Wearing surgical attire outside the operating room: a survey of habits of anesthesiologists and surgeons in Israel.
Nurses observe regulations restricting the use of uncovered surgical attire outside the operating room (OR), but there are no guidelines for physicians nor data on their habits in this matter. We assessed physicians' attitudes and behavior about OR attire in non-OR areas. ⋯ Israeli physicians behave differently with regard to wearing OR attire outside the OR. Orthopaedic surgeons and anesthesiologists are more disciplined, and gynecologists are the least observant. Most physicians recognize the importance of establishing strict guidelines of behavior.
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Incidental appendectomy (IA) remains a controversial issue. The role of IA in the nonmanaged-care setting has not been evaluated recently. This study evaluates the cost-benefit of IA based on current third-party reimbursements and reports the incidence of pathology from routine IA during an 18-year period. ⋯ IA can be performed safely during open operation for other bowel pathology. Rate of clinically significant appendiceal pathology is low but not negligible. For patients with third-party payor status, IA can be more broadly performed during open gastrointestinal operation when no additional surgeon reimbursement is obtained.
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Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases.
Surgical resection of isolated hepatic or pulmonary colorectal metastases prolongs survival in selected patients. But the benefits of resection and appropriate selection criteria in patients who develop both hepatic and pulmonary metastases are ill defined. ⋯ Surgical resection of both hepatic and pulmonary colorectal metastases is associated with prolonged survival in selected patients. Patients with a longer disease-free interval between metastases and those with single liver lesions had the best outcomes.
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Randomized Controlled Trial Multicenter Study Comparative Study
A phase 3, randomized, double-blind comparative study of the efficacy and safety of topical recombinant human thrombin and bovine thrombin in surgical hemostasis.
Plasma-derived bovine thrombin is used as a topical agent to improve surgical hemostasis, but development of antibodies to bovine hemostatic proteins has been associated with increased bleeding and thrombotic complications. Recombinant human thrombin could reduce the risk of these complications. ⋯ Results of this trial suggest that rhThrombin has comparable efficacy, a similar safety profile, and is considerably less immunogenic than bovine thrombin when used for surgical hemostasis.
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Multicenter Study Comparative Study
Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection.
Given widespread adoption of the Nuss procedure, prospective multicenter study of management of pectus excavatum by both the open and Nuss procedures was thought desirable. Although surgical repair has been performed for more than 50 years, there are no prospective multicenter studies of its management. ⋯ Anatomically severe pectus excavatum is associated with abnormal pulmonary function. Initial operative correction performed at a variety of centers can be completed safely. Perioperative pain is successfully managed by current techniques.