Journal of the American College of Surgeons
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Because T2 carcinoma of the gallbladder that invades perimuscular connective tissue without extension beyond serosa or into the liver has a hope for longterm survival, we attempted to clarify significant prognostic factors with respect to tumor- and surgery-related variables. ⋯ Results suggest that radical surgery is the treatment of choice for patients with T2 carcinoma of the gallbladder. The presence of lymph node metastasis, perineural invasion, or both suggests the necessity of additional treatment after radical surgery.
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Level II trauma centers may be verified (1999, American College of Surgeons Committee on Trauma) with an on-call operating room team if the performance-improvement program shows no adverse outcomes. Using queuing and simulation methodology, this study attempted to add a volume guideline. ⋯ Trauma centers performing fewer than six operations between 11:00 PM and 7:00 AM per year could conserve resources by using an immediately available on-call team, with responses monitored by the performance-improvement program.
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The sentinel node is the first regional lymph node to receive tumor cells that metastasize through the lymphatic channel from a primary tumor. The tumor status of the sentinel node should reflect the tumor status of the entire regional node basin. Sentinel lymph node dissection (SLND) has recently been investigated for use in patients with early breast carcinoma to avoid the sequelae of complete axillary lymph node dissection (ALND). Published studies of SLND in breast cancer patients identify marked variations in technique, and there are few guidelines for credentialing surgeons to perform SLND. ⋯ The majority of surgeons in the United States use similar technique for SLND breast cancer. But, there was marked variation in the number of SLND cases validated by an ALND before performing SLND only.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial.
Impairment of pulmonary function is common after upper abdominal operations. The purpose of this study was to compare postoperative pulmonary function and analgesic requirements in patients undergoing either laparoscopic or open Roux-en-Y gastric bypass (GBP). ⋯ Laparoscopic gastric bypass resulted in less postoperative suppression of pulmonary function, decreased pain, improved oxygenation, and less atelectasis than open gastric bypass.