Annals of surgery
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Multicenter Study
Treatment evolution in high-risk congenital diaphragmatic hernia: ten years' experience with diaphragmatic agenesis.
The objective of this study was to evaluate the impact of newer therapies on the highest risk patients with congenital diaphragmatic hernia (CDH), those with agenesis of the diaphragm. ⋯ There has been a change in the management of infants with CDH with less frequent use of ECMO and a greater use of iNO in high-risk patients with a potential improvement in survival. However, the mortality, hospital length of stay, and morbidity in agenesis patients remain significant.
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Comparative Study
Serologic markers of brain injury and cognitive function after cardiopulmonary bypass.
To examine the association between biochemical markers of brain injury (MBI) and the inflammatory response in relation to neurocognitive deficiency (NCD) after cardiopulmonary bypass (CPB). ⋯ NSE and tau are better associated with NCD and less influenced by cardiotomy suction compared with S-100beta. Inflammatory and oxidative stress is associated with NCD post-CPB.
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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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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.