Journal of the American College of Surgeons
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Before extended hepatectomy of five or more segments, the remnant liver volume (RLV) is usually calculated as a ratio of RLV to total liver volume (RLV-TLV) and must be >20% to 25%. This method can lead to compare parts of normal liver parenchyma to others compromised by biliary or vascular obstruction or by portal vein embolization. Extrapolating from living-donor liver transplantation, we hypothesized that RLV to body weight ratio (RLV-BWR) could accurately assess the functional limit of hepatectomy. ⋯ RLV-BWR was more specific than RLV-TLV in predicting postoperative course after extended hepatectomy. Patients with an anticipated RLV < or = 0.5% of body weight are at considerable risk for hepatic dysfunction and postoperative mortality.
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Randomized Controlled Trial
Preliminary report of a prospective, randomized trial of underwater seal for spontaneous and iatrogenic pneumothorax.
Management of pneumothorax has traditionally been tube thoracostomy and -20 cm H2O suction. The purpose of our study was to determine if underwater seal in iatrogenic and spontaneous pneumothoraces is safe and efficacious and if small-caliber chest tubes are appropriate for routine use in pneumothorax. ⋯ Early underwater seal appears to be safe for treating iatrogenic and spontaneous pneumothoraces. It can achieve comparable frequencies of early chest tube removal and avoidance of operation compared with traditional management. A larger, multi-institutional study should be performed to demonstrate that pneumothorax treatment can effectively incorporate small-caliber tubes and underwater seal.
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The role of data and safety monitoring boards (DSMBs) in clinical research in acute trauma resuscitation is not well documented. Many of the difficulties conducting acute resuscitation research are exacerbated because multiinstitutional studies are needed to adequately power such research. ⋯ Based on our experience as members of the study DSMB and on a review of the literature, we recommend a strong role for DSMBs in multicenter trials in acute resuscitative care.
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The aging population of the United States results in increasing numbers of surgical operations on elderly patients. This study observed aging related to morbidity, mortality, and their risk factors in patients undergoing major operations. ⋯ Although several risk factors for postoperative morbidity and mortality increase with age, increasing age itself remains an important risk factor for postoperative morbidity and mortality.