The British journal of surgery
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Multicenter Study Comparative Study Observational Study
Surgical complications after open and laparoscopic surgery for perforated peptic ulcer in a nationwide cohort.
Surgery for perforated peptic ulcer (PPU) is associated with a risk of complications. The frequency and severity of reoperative surgery is poorly described. The aims of the present study were to characterize the frequency, procedure-associated risk and mortality associated with reoperation after surgery for PPU. ⋯ Reoperation was necessary in almost one in every five patients operated on for PPU. Laparoscopy was associated with lower risk of reoperation than laparotomy or a converted procedure. However, there was a risk of bias, including confounding by indication.
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Subclinical Cushing's syndrome (SCS) is a condition of biochemical cortisol excess without the classical clinical features of overt hypercortisolism; it may be associated with some consequences of metabolic syndrome. The most appropriate treatment remains controversial. This study aimed to assess the outcomes of adrenalectomy for SCS. ⋯ Laparoscopic adrenalectomy seems to be beneficial in reversing several metabolic effects of hypercortisolism, with a low morbidity rate. However, the heterogeneity and low quality of the available studies preclude definitive recommendations.
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Human factors including stress, repetition, burnout and fatigue are associated with possible sources of error. Objective structured clinical examinations (OSCEs), where examiners concentrate for long periods, would benefit from a human factors approach to see whether these factors affect consistency of examiner behaviour, attitude and marking. Little has been published for OSCEs, in part due to the lack of a validated tool for collecting data in this setting. ⋯ The recognition and further investigation of human factors in OSCEs is needed to improve examiner experience and behaviour in order to influence delivery, candidate experience and quality assurance of these examinations.
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Flap viability after transfer depends on blood flow from the arterial blood supply below the fascia. This study evaluated survival of a pedicle flap with a perforator lateral branch and flow-through blood supply, compared with that of a flap with a flow-end blood supply and perforator terminal branch. ⋯ The flow-through blood supply improved pedicle perforator flap survival. Surgical relevance Perforator flap failure is mainly the result of impaired blood supply, as a flow-end blood configuration is nourished only by the perforator terminal branch of the artery. This work showed that the flow-through blood supply nourished by the perforator lateral branch improved flap survival, with dilatation of collateral vascular anastomoses and increased neoangiogenesis. The use of a flow-through configuration improves perforator flap survival and could therefore minimize morbidity resulting from flap necrosis.
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Multicenter Study Comparative Study Observational Study
Cost-utility analysis of operative versus non-operative treatment for colorectal liver metastases.
Surgical resection of colorectal liver metastases (CRLMs) is the standard of care when possible, although this strategy has not been compared with non-operative interventions in controlled trials. Although survival outcomes are clear, the cost-effectiveness of surgery is not. This study aimed to estimate the cost-effectiveness of resection for CRLMs compared with non-operative treatment (palliative care including chemotherapy). ⋯ Operative treatment of CRLMs yields greater survival than non-operative treatment, and is both more effective and less costly.