Surgery
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After sphincter-saving operation for rectal cancer, the impact of anastomotic leakage on function has been well studied. The purpose of the present work was to assess the influence of symptomatic and asymptomatic anastomotic leakage on bowel function and health-related quality of life using the Low Anterior Resection Syndrome score and the disease-specific questionnaire European Organization for Research and Treatment of Quality of Life Questionnaire for Colorectal Cancer. ⋯ Symptomatic anastomotic leakage impairs function and quality of life after laparoscopic, sphincter-saving operative intervention for rectal cancer.
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There have been conflicting reports regarding whether the number of rib fractures sustained in blunt trauma is associated independently with worse patient outcomes. We sought to investigate this risk-adjusted relationship among the lesser-studied population of older adults. ⋯ In older patients with trauma, sustaining at least 5 rib fractures is a significant predictor of worse outcomes independent of patient characteristics, comorbidities, and trauma burden.
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Long-term results of large patient cohorts with fecal incontinence treated by sacral neuromodulation are limited. This study shows the long-term results after a mean follow-up of 7.1 years in 325 patients with fecal incontinence treated by continuous sacral neuromodulation. ⋯ Long-term efficacy of sacral neuromodulation can be maintained in about half (52.7%) of all patients screened with sacral neuromodulation for fecal incontinence after a mean follow-up of 7.1 years. Importantly, the quality of life of patients with sacral neuromodulation for fecal incontinence did not differ from the general population.
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Observational Study
Gastrostomy tube placement: An opportunity for establishing patient-centered goals of care.
Surgeons and other health care providers are frequently consulted for gastrostomy tube placement in seriously ill patients at risk of outcomes poorly aligned with patient goals. Palliative care assessments have been recommended to guide decision-making in this setting. We aimed to characterize patient-centered outcomes and define the extent of unmet palliative care need in patients receiving gastrostomy tubes. ⋯ Given high risks of mortality and poor functional outcomes, consideration of gastrostomy tube placement is an appropriate but underutilized trigger for palliative care assessment. This study highlights an untapped opportunity to optimize the goal concordance of treatment in operative intervention.
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Comparative Study
Postconditioning: "Toll-erating" mesenteric ischemia-reperfusion injury?
Postconditioning may prove to be a suitable method to decrease ischemia-reperfusion injury of intestine after mesenteric arterial occlusion. Toll-like-receptor-4 is involved in the pathophysiology of organ damage after ischemia-reperfusion; therefore, the aim of our study was to investigate the effect of postconditioning on the mucosal expression of toll-like-receptor-4. ⋯ Small intestinal ischemia-reperfusion injury in male Wistar rats caused by the occlusion of the superior mesenteric artery was ameliorated by the use of postconditioning, showing a more favorable inflammatory response, which may be attributed to the decreased mucosal expression of toll-like-receptor-4.