Surgery
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Obesity is a national epidemic. Prior studies of the impact of body mass index (BMI) on surgical outcomes from cervical endocrine procedures have come from high-volume, single institutions. Our study characterizes the 30-day clinical and economic outcomes in patients with high BMI from a multi-institutional database. ⋯ Patients with high BMI seem to require operations of greater duration and sustain more morbidity after cervical endocrine procedures than patients with normal BMI, but these differences may not be clinically significant. Thyroidectomy and parathyroidectomy can be performed safely, with appropriate surgical decision making.
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Little is known about the longer term status of pain or the factors associated with pain-related outcome in patients after polytrauma. The current study evaluated the prevalence and severity of pain at least 2 years after injury compared with preinjury status using several pain scores in a Swiss cohort of survivors of blunt polytrauma. ⋯ Our study shows a high rate of longer term pain in survivors of polytrauma and important differences in the type and sensitivity of the standard pain measures investigated. Given the potential impact of these findings, international guidelines for the assessment of pain in polytraumatized patients are needed.
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The Japanese herbal medicine Tokishakuyaku-san (TJ-23) has been used to treat neurodegenerative, immune, and respiratory tract diseases, as well as many gynecologic disorders, with few adverse effects. This study investigated the effect of TJ-23 on alloimmune responses in a murine model of cardiac allograft transplantation. ⋯ TJ-23 induced hyporesponsiveness to fully allogeneic cardiac allografts and generated CD4(+) CD25(+) regulatory cells in our model.
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Review Meta Analysis
Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis.
The use of antibiotics alone in the treatment of uncomplicated acute appendicitis has been controversial. The present report is based on a systematic review and meta-analysis of existing studies that compared antibiotics treatment to appendectomy in patients with uncomplicated acute appendicitis. ⋯ In some cases, antibiotic treatment may fail, and there is a risk of recurrence. However, surgically treated patients, including those with the potential for spontaneous resolution and those with a normal appendix, are subjected to the risks of operative morbidity and mortality. Antibiotic therapy incurs significantly fewer complications. Prospective randomized studies are urgently needed to conclusively define the roles of appendectomy and antibiotic treatment in the management of uncomplicated acute appendicitis.