Archives of surgery (Chicago, Ill. : 1960)
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Randomized Controlled Trial Comparative Study
Occlusive vs gauze dressings for local wound care in surgical patients: a randomized clinical trial.
To compare effectiveness and costs of gauze-based vs occlusive, moist-environment dressing principles. ⋯ The occlusive, moist-environment dressing principle in the clinical surgical setting does not lead to quicker wound healing or less pain than gauze dressings. The lower costs of less frequent dressing changes do not balance the higher costs of occlusive materials. Trial Registration trialregister.nl Identifier: 56264738.
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Randomized Controlled Trial Multicenter Study
Definitive risk factors for anastomotic leaks in elective open colorectal resection.
Anastomotic leaks following elective colorectal resections increase morbidity, mortality, and the need for additional interventions. An accurate understanding of risk factors would potentially reduce anastomotic leaks and/or allow appropriate selection of patients for diverting stomas. ⋯ Significant risk factors for anastomotic leaks include low preoperative serum albumin level, steroid use, male sex, and increased duration of surgery. Appreciation of risk factors provides a rational basis for temporary diversion.
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Randomized Controlled Trial
Spinal vs general anesthesia for laparoscopic cholecystectomy: interim analysis of a controlled randomized trial.
To compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy in healthy patients. ⋯ Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery.
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Randomized Controlled Trial
Randomized clinical trial of small-incision and laparoscopic cholecystectomy in patients with symptomatic cholecystolithiasis: primary and clinical outcomes.
To evaluate the primary and clinical outcomes in laparoscopic and small-incision cholecystectomy. ⋯ No differences in primary clinical outcome measures were found between laparoscopic and small-incision cholecystectomy in this randomized trial with emphasis on methodologic quality and generalizability. The gold standard status of laparoscopic cholecystectomy is questionable. Trial Registration isrctn.org Identifier: ISRCTN67485658.
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Randomized Controlled Trial
Hypertonic resuscitation of hypovolemic shock after blunt trauma: a randomized controlled trial.
The leading cause of late mortality after trauma is multiple organ failure syndrome, due to a dysfunctional inflammatory response early after injury. Preclinical studies demonstrate that hypertonicity alters the activation of inflammatory cells, leading to reduction in organ injury. The purpose of this study was to evaluate the effect of hypertonicity on organ injury after blunt trauma. ⋯ Although no significant difference in ARDS-free survival was demonstrated overall, there was benefit in the subgroup of patients requiring 10 U or more of packed red blood cells in the first 24 hours. Massive transfusion may be a better predictor of ARDS than prehospital hypotension. The use of HSD may offer maximum benefit in patients at highest risk of ARDS.