Annals of surgery
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To review all admissions (age > 13) to three surgical patient care centers at a single academic medical center between January 1, 1995, and December 6, 1999, for significant surgical adverse events. ⋯ This study demonstrates no rational link between the tort system and the reduction of adverse events. Sixty-three percent of contributing causes to adverse events were undetected by current medical review processes. Adverse events occur at the interface between different systems or disciplines and result from multiple failures. Indemnity costs per hospital day vary dramatically by patient care center (range $3.60-97.60 US dollars a day). The regionalization of healthcare is in jeopardy from the burden of high indemnity payments.
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Randomized Controlled Trial Clinical Trial
Improved net protein balance, lean mass, and gene expression changes with oxandrolone treatment in the severely burned.
To determine the effects of the anabolic agent oxandrolone on muscle protein and gene expression in severely burned children. ⋯ Oxandrolone improves protein net balance and lean mass in the severely burned. These changes are associated with increased gene expression for functional muscle proteins.
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To describe a novel in vitro human tissue-based angiogenic model that can predict an individual tumor's response to antiangiogenic drugs. ⋯ Epothilone B may be an effective antiangiogenic agent in a variety of tumor types. The authors speculate that this in vitro model might provide useful information to the clinician on the effect of specific antiangiogenic agents on individual tumors. This may be particularly useful in patients with tumors that, as a group, are unresponsive to treatment with antineoplastic agents.
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Comparative Study
Complex blunt aortic injury or repair: beneficial effects of cardiopulmonary bypass use.
To compare the outcomes and associated morbidity in patients with blunt aortic injury (BAI) repaired using cardiopulmonary bypass versus no bypass. Special consideration is given to the influence of bypass in the outcome of complex injuries or repair circumstances. ⋯ With the use of cardiopulmonary bypass in the repair of BAI, the incidence of paraplegia/paresis has fallen. While patients with typical injuries and uncomplicated repair can expect good results with either technique, cardiopulmonary bypass provides significant advantages in the repair of those with CI/R. With the use of bypass, no CI/R patient developed paraplegia, while all CI/R patients experienced paraplegia before bypass use. Although others have reported the importance of clamp time, in this series clamp time appeared largely to be a surrogate variable for complexity of injury.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective randomized trial of carotid endarterectomy with polytetrafluoroethylene versus collagen-impregnated dacron (Hemashield) patching: late follow-up.
To compare the late clinical outcome and incidence of recurrent stenosis after carotid endarterectomy (CEA) with polytetrafluoroethylene (PTFE) versus Hemashield patching. ⋯ PTFE patching was superior to Hemashield in lowering the incidence of postoperative ipsilateral strokes and late recurrent stenosis.