Annals of surgery
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The main objective of this study was to investigate the potential use of circulating microRNAs (miRNAs) as biomarkers of colorectal (CR) adenomas. ⋯ Plasma miRNAs are reliable, noninvasive, and inexpensive markers for CR adenomas. This miRNA panel warrants study in larger cohorts. Plasma-based assays could provide better screening compliance compared to fecal occult blood or endoscopic screening.
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Comparative Study
Improved outcomes of bile duct injuries in the 21st century.
The objectives of this analysis were to compare the outcomes of bile duct injuries by specialist over time and the role of management timing and biliary stents. ⋯ Almost all bile leaks and many bile duct injuries can be managed successfully by endoscopists. Selected proximal injuries can be treated by interventional radiologists with modest success. Outcomes of bile duct injuries are best with surgical management and in patients who are stented for more than 6 months.
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Comparative Study
Comparison of outcomes for open abdominal aortic aneurysm repair and endovascular repair in patients with chronic renal insufficiency.
This study investigates whether this practice is supported by multicenter prospectively collected data. ⋯ Contrary to current practice, and despite the use of contrast, EVAR should be the first choice in patients with moderate renal dysfunction if they have the appropriate anatomy. Higher threshold for AAA repair with either OPEN or EVAR should be applied in patients with severe renal dysfunction because postoperative complications were significantly high with either approach.
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"The elderly" is an often used but poorly defined descriptor of surgical patients. Investigators have used varying subjectively determined age cutoffs to report outcomes in the elderly. We set out to use objective outcomes data to determine the "at-risk" elderly population. ⋯ Mortality risk for major gastrointestinal surgical resections starts increasing at 50 years of age, and at 75 years of age, it starts increasing very rapidly. The optimum age of 68.5 years predicts mortality with the best combination of sensitivity and specificity. These ages should be used to standardize outcome data and focus perioperative resources to improve outcomes.
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To evaluate the effect of surgical delay on the outcomes of patients with adhesive small bowel obstruction (ASBO). ⋯ Early operative intervention for patients with ASBO is associated with a significant survival benefit, lower incidence of local and systemic complications, and shorter hospitalization.