Journal of the American College of Surgeons
-
The aim of this study was to identify the ischemic tolerance of the ileum. In microvascular transfer of autologous bowel segments, the most critical factor for survival is ischemic time. In earlier animal studies, the tolerance of ischemic time was shorter for the ileum than for the jejunum, and an ischemic time of <1 hour was suggested for microvascular transfer of the ileum. It was believed that there are more bacteria in the ileum than in the jejunum and therefore autolysis and necrosis will be triggered sooner after the initiation of ischemia. However, in a clinical scenario, the tolerance for ischemic time of the ileum has not yet been clarified. ⋯ Clinically, the ileum segments can tolerate ischemia well within 2 hours. Segmental ileum transfer can be more widely applied in other fields. Care in each step of transfer is mandatory for functional success.
-
The familial risk of abdominal wall hernia (AWH) is largely unknown. In addition, it is unknown whether inguinal hernia (IH), femoral hernia (FH), incisional hernia (INH), epigastric hernia (EH), and umbilical hernia (UH) share familial susceptibility. The aim of this nationwide study was to determine the familial risks of concordant AWH (same disease in proband and exposed relative) and discordant AWH (different disease in proband and exposed relative). ⋯ Family history of surgically treated AWH is an important risk factor for surgical treatment of AWH. The 5 forms of AWH studied share familial susceptibility, but site-specific familial factors might exist. Several spouse risks were increased, suggesting the possibility of a nongenetic contribution to familial risks.
-
Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center. ⋯ Significant disparities in socioeconomic status exist in severely injured pediatric patients treated in the PICU. Disparities were associated with adverse outcomes. These results should inform community and public health efforts to identify the areas and populations at highest risk for violence-related injuries.