Annals of surgery
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Comparative Study
Cultured skin substitutes reduce donor skin harvesting for closure of excised, full-thickness burns.
Comparison of cultured skin substitutes (CSS) and split-thickness skin autograft (AG) was performed to assess whether donor-site harvesting can be reduced quantitatively and whether functional and cosmetic outcome is similar qualitatively in the treatment of patients with massive cutaneous burns. ⋯ The requirement for harvesting of donor skin for CSS was less than for conventional skin autografts. These results suggest that acute-phase recovery of patients with extensive burns is facilitated and that complications are reduced by the use of CSS together with conventional skin grafting.
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To investigate a possible association with plasma platelet activating factor acetylhydrolase (PAF-AH) gene mutation with the risk of abdominal aortic aneurysm (AAA). ⋯ The genetic mutation of plasma PAF-AH gene appear to be an independent risk factor for AAA. Our findings need to be confirmed in a larger, prospective study including patients from different populations.
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To evaluate the effect of recurrent nerve dissection on the incidence of recurrent laryngeal nerve injury (RLNI) and to analyze the performance of individual surgeons. ⋯ Recurrent nerve dissection significantly reduces the risk of RLNI. Extensive dissection facilitates visual control of nerve integrity during resection and is therefore superior to a more limited exposure of the nerve. Quality control can improve the global outcome and identify the variability in individual performance. This cannot be eliminated by merely confronting surgeons with comparative data; hence, it is important to search for the underlying causes.
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To identify the incidence and outcomes of emergent and semiemergent intubations in hospitalized trauma patients with cervical fractures and/or dislocations treated with halo fixation. ⋯ A significant number of trauma patients treated with halo fixation ultimately require an in-hospital emergent or semiemergent intubation. Given the difficulty and potential lethality associated with these intubations, heightened vigilance regarding the airway is warranted. The authors recommend that early tracheostomy be considered in patients with a history of cardiac disease, especially when a high Injury Severity Score is present. Older patients (older than 60 years) are more at risk for arrest-related death and may also benefit from early tracheostomy.
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To analyze the association between pre- and perioperative factors and pouch-related septic complications (PRSC) in ulcerative colitis (UC) and in familial adenomatous polyposis (FAP) after ileal pouch-anal anastomosis (IPAA). ⋯ Pouch-related septic complications occur as late complications and should therefore be considered in regular, specific long-term follow-up examinations. The authors identified significant risk factors for PRSC specific to patients with UC and FAP; these must be considered for each individual surgical strategy.