Arch Surg Chicago
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To assess clinician use and acceptance of RET proto-oncogene mutation testing in multiple endocrine neoplasia, type 2 (MEN 2) family members. ⋯ Genetic screening for RET proto-oncogene mutations in MEN 2 is a powerful diagnostic tool that enables prophylactic thyroidectomy to be performed in RET mutation-positive patients at an earlier stage of the disease process than does traditional biochemical screening.
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Comparative Study Clinical Trial
Evaluation of diagnostic peritoneal lavage in stable patients with gunshot wounds to the abdomen.
Diagnostic peritoneal lavage (DPL) is used to diagnose intra-abdominal injury in patients with stab wounds and blunt trauma. Because exploratory celiotomy is routinely performed on patients with gunshot wounds to the abdomen, DPL is rarely employed. However, several studies have questioned routine exploration and have drawn attention to the associated morbidity of negative celiotomy. Diagnostic peritoneal lavage is an easily performed and inexpensive test that may be useful in this situation. ⋯ Clinical judgment is highly accurate in separating patients with tangential gunshot wounds to the abdomen from those with intra-abdominal injury but may miss patients with intra-abdominal hemorrhage. Diagnostic peritoneal lavage is highly predictive of the presence of intra-abdominal injury. The return of gross blood on aspiration or a lavage red blood cell count greater than 10 x 10(9)/L should prompt an urgent celiotomy. Missed injuries are rare and most likely to be bowel perforations. Diagnostic peritoneal lavage is an objective test that may augment clinical judgment in selecting hemodynamically stable patients with potential tangential gunshot wounds for observation and is especially useful in identifying intra-abdominal hemorrhage.
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The concept of multiple organ failure and related abnormalities was first developed in the 1970s. Multiple organ failure became evident when the support systems in intensive care units were able to keep patients alive long enough for multiple organ problems to develop in them. ⋯ These trials have had either limited success or negative results, despite considerable evidence for efficacy or protection by such agents in experimental animals and in studies of normal human volunteers. I believe a major reason for these negative results has been the use of general entry criteria for the trials rather than the treatment of specific diseases or injuries.
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Randomized Controlled Trial Comparative Study Clinical Trial
Laparoscopic vs open appendectomy. Prospective randomized study of outcomes.
To compare open appendectomy (OA) with laparoscopic appendectomy (LA) for length of the operation, complications, postoperative pain control, length of hospitalization, postdischarge recovery time, and hospital charges. ⋯ Laparoscopic appendectomies and OAs are comparable for complications, postoperative pain control, length of hospitalization, and recovery time. Patients who underwent an OA had a shorter operative time and lower operating room and hospital charges. Laparoscopic appendectomy does not offer any proved benefits compared with the open approach for the routine patient with acute appendicitis.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparing preincisional with postincisional bupivacaine infiltration in the management of postoperative pain.
To determine if preemptive local anesthesia yields better postoperative pain control than infiltration of local anesthetic at the time of wound closure. ⋯ Based on the theory of "dorsal horn hypersensitivity," several clinical trials have shown significant improvement in pain control with preincisional infiltration of local anesthetic. Our results indicate that pain was no better controlled with preincisional infiltration than with postincisional infiltration of bupivacaine, raising the question of the benefit of preemptive anesthesia at the local level in long-term postoperative care.