Journal of the American College of Surgeons
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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.
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Multicenter Study Comparative Study
Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers.
A large outcome study of laparoscopic gastric bypass has not been done because of difficulty in differentiating between open and laparoscopic procedures in the absence of a specific ICD-9 procedural code for the laparoscopic operation. The University HealthSystem Consortium (UHC) clinical database recently added a specific procedural code for laparoscopic gastric bypass. The goal of this study was to compare the use and outcomes of laparoscopic versus open gastric bypass at academic centers. ⋯ This nationwide analysis of academic medical centers between 2004 and 2006 showed that bariatric surgery has shifted to a predominately laparoscopic approach. In addition, laparoscopic gastric bypass is as safe as open gastric bypass and is considerably associated with a lower 30-day morbidity.
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Acute liver failure after major surgical procedures is associated with a high risk of multiple organ failure, including acute renal failure. The optimal time to initiate renal replacement therapy for acute renal failure is controversial because of the poor overall clinical outcomes. ⋯ The mortality rate in postoperative patients with acute liver failure-associated acute renal failure was very high. Earlier initiation of renal replacement therapy, based on the predialysis blood urea nitrogen level, with continuous venous-venous hemofiltration might provide a better ICU survival rate.