Surgery
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Comparative Study
The palliative benefit of aggressive surgical intervention for both hepatic and mesenteric metastases from neuroendocrine tumors.
Metastatic neuroendocrine tumors (NETs) can present with complications of gastrointestinal tract obstruction or ischemia and carcinoid syndrome (CS). The purpose of this study was to assess whether aggressive surgical intervention of metastatic NETs provides effective palliation from these symptoms. ⋯ Surgical resection is highly effective in relieving symptoms of intestinal obstruction and ischemia. Hepatic cytoreduction seems to enhance the ability to control the symptoms of carcinoid syndrome. A surgically aggressive approach in patients with metastatic NETs provides effective palliation in carefully selected patients.
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More elderly trauma patients are identified with preinjury use of clopidogrel, aspirin, or warfarin (CAW). The purpose of this study was to determine whether preinjury CAW use was an important predictor of mortality in patients aged >or=50 years with blunt, hemorrhagic brain injury (HBI). ⋯ Preinjury CAW use in older blunt, HBI patients is not associated with increased mortality. Age was a significant predictor of mortality independent of CAW use.
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Despite a lack of level I evidence, endovascular stent grafting is frequently used for the treatment of blunt thoracic aortic injury. The purpose of this study is to compare the outcomes between open and endovascular repair of traumatic rupture of the thoracic aorta. ⋯ There were no significant differences with respect to morbidity or mortality between these 2 groups. These data suggest that ER is at least as safe as OR for blunt aortic injury.
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All hospitals are required to perform quality assurance activities. Many risk adjustment methodologies have been developed, and many medical centers use 1 or more than 1 risk adjustment program in an attempt to characterize their outcomes better rather than simply assessing unadjusted outcome statistics. The University HealthSystem Consortium (UHC) and American College of Surgeons-National Surgical Quality Improvement Program (NSQIP) both produce risk-adjusted outcome data. Our institution recognized a large disparity between our UHC and NSQIP risk-adjusted mortality. The purpose of this study was to attempt to discover the cause of that disparity. ⋯ We found significant differences in the reporting of both comorbidities and outcomes between our medical center's submissions to UHC and NSQIP in a consecutive series of patients. This may be at least partially responsible for the difference in the risk-adjusted mortality for our institution, as reported by UHC and NSQIP.
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Surgeons continue to search for the ideal prosthetic material to repair complex abdominal wall hernias. Recently, a new biologic material was introduced into the surgeon's arsenal. The purpose of this study is to review a single institution's experience with the use of human acellular dermal matrix (HADM [AlloDerm]) for repair of hernias. ⋯ HADM is a suitable prosthesis for repair of complex and routine abdominal wall defects. This bioprosthesis can incorporate into contaminated tissue without becoming infected. Eventration occurs when HADM is utilized as a fascial replacement rather than as a reinforcement.