Annals of surgery
-
Review
Validation of the riboleukogram to detect ventilator-associated pneumonia after severe injury.
We hypothesized that circulating leukocyte RNA profiles or “riboleukograms” detect ventilator-associated pneumonia after blunt trauma. ⋯ Our results validate those described in a pilot study, confirming that riboleukograms are associated with the development of VAP days prior to clinical diagnosis. Similarly, a riboleukogram predictive model tested on a larger cohort of 158 patients was better than chance at predicting VAP days prior to clinical diagnosis.
-
Randomized Controlled Trial Comparative Study
Portal-systemic encephalopathy in a randomized controlled trial of endoscopic sclerotherapy versus emergency portacaval shunt treatment of acutely bleeding esophageal varices in cirrhosis.
In patients with cirrhosis and bleeding esophageal varices, there is a widespread belief that control of bleeding by portal-systemic shunts is compromised by a high incidence of shunt-related portal-systemic encephalopathy (PSE). This important issue was examined by a randomized controlled trial that compared emergency and long-term endoscopic sclerotherapy (EST) to emergency direct portacaval shunt (EPCS) in patients with cirrhosis and acute variceal hemorrhage. ⋯ In contrast to EST, EPCS permanently controlled variceal bleeding, resulted in significantly greater long-term survival, and was followed by a relatively low (15%) incidence of PSE. These results were facilitated by rigorous, frequent, and lifelong follow-up that included regular counseling on dietary protein restriction and abstinence from alcohol, and by long-term patency of the portacaval shunt in 98% of patients. Furthermore, these results call into question the practice of avoiding portacaval shunt because of fear of PSE, and thereby foregoing the lifesaving advantage achieved by surgical control of bleeding. (clinicaltrials.gov NCT00690027).
-
Studies have reported potential underuse of surgical resection in black patients with nonmetastatic colorectal cancer. Our objective was to determine the independent, adverse effect of race on surgical resection, controlling for tumor location, comorbidity, and socioeconomic/insurance status. ⋯ Black race is a powerful, independent predictor of underuse of surgery in rectal cancer patients living in poverty. It is incumbent on the gastroenterology/surgical community to determine whether misperceptions about rectal surgery or barriers to successfully navigating multidisciplinary, rectal cancer care may account for these disparities.
-
To determine event free survival (EFS) of children with Wilms tumor (WT) and metastatic liver disease at diagnosis. ⋯ Liver metastasis at diagnosis is not an adverse prognostic factor for stage IV metastatic FH WT.
-
Simultaneous pancreas-kidney transplantation (SPK) is a procedure which frees the diabetic patient with end-stage nephropathy from dialysis and daily insulin injections. The purpose of this study is to report long-term outcomes of this procedure, and describe surgical and medical complications. ⋯ Diabetic patients with end-stage renal failure have a poor prognosis without transplantation. Transplantation with SPK provides a marked extension of the patient's life and freedom from insulin injections. Enteric drainage is currently the surgical technique of choice. SPK transplantation should be considered the treatment of choice in this patient population.