Annals of surgery
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Multicenter Study
Hepatic resection for noncolorectal nonendocrine liver metastases: analysis of 1,452 patients and development of a prognostic model.
To determine the utility of hepatic resection (HR) in the treatment of patients with noncolorectal nonendocrine liver metastases (NCNELM). ⋯ HR for NCNELM is safe and effective, with outcomes mainly dependent on primary tumor site and histology. For individual patients, a statistical model based on key prognostic factors could validate the indication for hepatic resection by predicting long-term survivals.
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We recently reported increased CD4 CD25 T regulatory (Treg) activity after burn injury in mice. This study sought to determine if Tregs mediate the reduction in TH1-type immunity after serious injury in man and if Treg function is altered by injury. ⋯ We demonstrate for the first time that human Tregs are increased in potency after severe injury. Most significantly, Tregs are important mediators of the suppression of T cell activation and the reduction in TH1 cytokine production found after injury.
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To evaluate the effect of an intensivist-model of critical care delivery on the risk of death following injury. ⋯ Care in an intensivist-model ICU is associated with a large reduction in in-hospital mortality following trauma, particularly in elderly patients who might have limited physiologic reserve and extensive comorbidity. That the effect is greatest in trauma centers and in units led by surgical intensivists suggests the importance of content expertise in the care of the critically injured. Injured patients are best cared for using an intensivist-model of dedicated critical care delivery, a criterion that should be considered in the verification of trauma centers.
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To assess the feasibility and safety of selective nonoperative management in penetrating abdominal solid organ injuries. ⋯ In the appropriate environment, selective nonoperative management of penetrating abdominal solid organ injuries has a high success rate and a low complication rate.
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To compare outcomes of appendectomy in an Acute Care Surgery (ACS) model to that of a traditional home-call attending surgeon model. ⋯ In patients with acute appendicitis, the presence of an in-house acute care surgeon significantly decreased the time to operation, rupture rate, complication rate, and hospital length of stay. The ACS model appears to improve outcomes of acute appendicitis compared with a TRAD home-call model. This study supports the efficacy and efficiency of the ACS model in the management of surgical emergencies.