Annals of surgery
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Hypertrophic burn scars produce significant morbidity, including itching, pain, stiffness, and contracture, but best management practices remain unclear. We present the largest study to date that examines long-term impact of laser therapies, a potentially transformative technology, on scar remodeling. ⋯ For the first time, ever, in a large prospective study, laser therapies have been shown to dramatically improve both the signs and symptoms of hypertrophic burn scars, as measured by objective and subjective instruments. Laser treatment of burn scars represents a disruptive innovation that can yield results not previously possible and may displace traditional methods of operative intervention.
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Randomized Controlled Trial Comparative Study
The HYSLAR trial: a prospective randomized controlled trial of the use of a restrictive fluid regimen with 3% hypertonic saline versus lactated Ringers in patients undergoing pancreaticoduodenectomy.
This study was designed to determine whether the volume and type of fluid administered for pancreaticoduodenectomy impacts postoperative outcomes. ⋯ A moderately restrictive fluid regimen with HYS resulted in a statistically significant 25% reduction in complications when adjusted for age, weight, and pancreatic texture.
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To investigate the relationship between trauma center volume and outcome. ⋯ Increased trauma center volume was associated with increased survival, more ventilator-free days, and less severe organ failure. Trauma system planning and implementation should avoid unnecessary duplication of services.
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Comparative Study
Primary hyperparathyroidism with negative imaging: a significant clinical problem.
To compare the outcomes for patients undergoing parathyroidectomy for primary hyperparathyroidism by imaging results. ⋯ Nonlocalization of abnormal glands preoperatively is not associated with a decreased surgical cure rate for primary hyperparathyroidism. Referral for surgical evaluation should be based on biochemical diagnosis rather than localization by imaging.
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Disease severity, not operative approach, drives organ space infection after pediatric appendectomy.
This study examines patient and operative factors associated with organ space infection (OSI) in children after appendectomy, specifically focusing on the role of operative approach. ⋯ This model suggests that disease severity, not operative approach, as previously suggested, drives OSI development in children. Although 88% of appendectomies in this population were performed laparoscopically, these findings support utilization of the surgeon's preferred surgical technique and may help guide postoperative counsel in high-risk children.