Latest Articles
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Meta Analysis
Fuel utilization in neoplastic disease: implications for the use of nutritional support in cancer patients.
Tumor cell metabolism and the whole-body response to tumor metabolic activity produces a complex derangement, including alterations in carbohydrate oxidation with futile cycling and changes in gluconeogenesis and lipid utilization. An interplay between circulating hormones, lymphocyte-mediated cytokines, and tumor growth factors complicates fuel metabolism in these individuals. ⋯ Therefore, it is impossible to determine the validity of the results. Furthermore, it is possible that some of the detrimental effects of TPN observed in earlier studies were secondary to the inappropriate use of large glucose loads in cancer patients.
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To critically assess original studies evaluating the role of preoperative pulmonary function testing in predicting postoperative outcomes. ⋯ Preoperative pulmonary function testing helps clinicians to make decisions on management of lung resection candidates. Although many studies of patients before abdominal surgery have focused on the utility of preoperative pulmonary function testing, methodologic difficulties undermine the validity of their conclusions. The impact of testing on care of other preoperative patients is even less clear because of poor study design and insufficient data. Therefore, further investigation is necessary before a consensus can be reached on the role of preoperative pulmonary function testing in evaluating patients before all surgical procedures except lung resection.
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Despite numerous controlled clinical trials, the indications for parenteral nutritional support of cancer patients undergoing chemotherapy remain controversial. The results of the published trials have therefore been subjected to meta-analysis. ⋯ In summary, for the patients in trials to date, TPN was associated with net harm. Routine use of TPN in patients undergoing chemotherapy should be strongly discouraged, and trials involving specific groups of patients or modifications in TPN should be undertaken with caution.
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Advances in therapy · Mar 1990
Meta AnalysisReduction of infectious morbidity with uterine stapling device.
Due to the recent development of absorbable surgical staples, application of gynecologic stapling methods has expanded to the field of obstetrics. Several studies have been published presenting the results of utilization of a novel hysterotomy and uterine stapling device for cesarean section (Poly CS-57, U. S. ⋯ Four studies fulfilled several criteria, including use of proper controls. A total of 383 patients were included in these studies with an infection rate of 6.4% (12/187) versus 16.3% (32/196) for the stapled and non-stapled (traditional sutured) group, respectively (p less than 0.001). The individual investigations attributed the decreased infection rate to reductions in blood loss and incisional hematoma formation and decreased reactivity of copolymer absorbable staples.