Journal of the American College of Surgeons
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The role of leptin in mediating calcium-related metabolic processes is not well understood. ⋯ Our results suggest a role for the parathyroid gland in regulating leptin production. Genetic contributions from the leptin pathway might predispose to hyperparathyroidism.
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Phenylephrine can be used to treat postoperative hypotension after renal transplantation. However, its effect on the renal allograft is unknown. We evaluated the safety and efficacy of this approach. ⋯ Although there is a brief association between phenylephrine administration and a slower rate of transplanted kidney recovery, there is no clinically or statistically significant impaired outcome in the phenylephrine group at time of discharge. Administration of phenylephrine to support low blood pressure after renal transplant appears safe.
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Data revealed that our urban, academic, safety net medical center was a high outlier for postoperative venous thromboembolism (VTE). Our goal was to implement and determine the efficacy of a standardized intervention for reducing postoperative VTE complications. ⋯ A patient care program, emphasizing early postoperative mobilization along with mandatory VTE risk stratification and commensurate electronic prophylaxis recommendations, significantly reduced the likelihood of VTE complications among our patients.
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The incidence of community-acquired Clostridium difficile (CACD) is increasing in the United States. Many CACD infections occur in the elderly, who are predisposed to poor outcomes. We aimed to describe the epidemiology and outcomes of CACD in a nationally representative sample of Medicare beneficiaries. ⋯ Nearly half of the Medicare beneficiaries admitted with CACD have no recent antibiotic exposure. High mortality and readmission rates suggest that the burden of C difficile on patients and the health care system will increase as the US population ages. Additional efforts at primary prevention and eradication might be warranted.
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The aim of this study was to compare outcomes of patients who sustained burn and ostensible inhalation injuries while on home oxygen therapy with those suffering equivalent injuries via other mechanisms. ⋯ Injury secondary to smoking on home oxygen therapy is a perennial problem, and guidelines for prescribing home oxygen therapy for smokers should be reassessed. Despite underlying lung disease, patients in our series did as well as patients without COPD who sustained similar injuries.