The British journal of surgery
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Although currently available surgical scoring systems have good outcome predictive power, their use is often limited by complexity and their non-dynamic nature. The aim of this study was to develop and test a risk adjustment for general surgical audit which is both simple and dynamic, while preserving a high predictive power for surgical morbidity. ⋯ A simple dynamic model for surgical morbidity has been developed which is comparable to previously published surgical scoring systems in terms of predictive power. This risk adjustment tool can be incorporated into the existing audit system, enabling comparison of surgical unit performance.
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There have been few comprehensive studies relating to the life-threatening or fatal complications of antireflux surgery. ⋯ Laparoscopic fundoplication was associated with more life-threatening complications than open fundoplication. This may compromise the advantages of the laparoscopic technique.
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Over the past 10 years xenotransplantation has generated much interest in the hope that it will enable us to overcome the current lack of human organ donors. This review examines the evolution and current therapeutic strategies that have been developed to overcome the predominant problem of graft rejection. ⋯ Despite the considerable advances that have been made in molecular biological techniques, xenograft rejection cannot be prevented without significant immunosuppression and toxic side-effects. The problem of delayed rejection, in particular, will probably be very difficult to overcome, although some of the difficulties associated with hyperacute rejection have been resolved. The potential risk of porcine endogenous retrovirus transmission has generated much debate recently, but it is likely that some of the important issues relating to xenotransplantation will never be resolved until carefully regulated clinical trials are allowed to begin.
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The association between raised levels of homocysteine, fibrinogen and lipoprotein (a), and the presence of pre-existing intimal hyperplasia (IH) in vein has not been assessed. The positive association between such hyperplasia and graft failure following infrainguinal arterial reconstruction, and between lipoprotein (a) and graft failure, is disputed. The influence of homocysteine on outcome has not been investigated prospectively. ⋯ Hyperhomocysteinaemia is associated with peripheral vascular disease and the development of pre-existing IH in vein, which itself is associated with vein graft failure.