Articles: cations.
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Review Meta Analysis
Meta-analysis of prophylactic mesh to prevent parastomal hernia.
Rates of parastomal hernia following stoma formation remain high. Previous systematic reviews suggested that prophylactic mesh reduces the rate of parastomal hernia; however, a larger trial has recently called this into question. The aim was to determine whether mesh placed at the time of primary stoma creation prevents parastomal hernia. ⋯ Mesh placed prophylactically at the time of stoma creation reduced the rate of parastomal hernia, without an increase in mesh-related complications.
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Randomized Controlled Trial
Gender-Based Differences in Surgical Residents' Perceptions of Patient Safety, Continuity of Care and Well-Being: An Analysis from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) Trial.
Little is known about gender differences in residency training experiences and whether duty hour policies affect these differences. Using data from the Flexibility in Duty Hour Requirements for Surgical Trainees (FIRST) trial, we examined gender differences in surgical resident perceptions of patient safety, education, health and well-being, and job satisfaction, and assessed whether duty hour policies affected gender differences. ⋯ Gender differences exist in perceptions of surgical residency. These differences vary across cohorts and can be influenced by duty hour policies.
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Intraneural perineuriomas are rare, benign lesions produced by the neoplastic proliferation of perineurial cells. They typically present in adolescents and affect nerves of the limbs. In our experience, we have not encountered a single case of classic intraneural perineurioma at an intradural location. ⋯ Based on our study, the occurrence of classic intraneural perineuriomas intradurally is exceedingly rare, if at all present. This may be related to the paucity of perineurial cells at the nerve root level and reciprocal interactions between neuroglial cells at the central-to-peripheral transition zones.
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Endovascular treatment of acutely ruptured aneurysms requires the administration of antiplatelet and/or anticoagulant medication to prevent thrombosis. For patients who require an external ventricular drain (EVD) insertion to treat hydrocephalus stemming from aneurysm subarachnoid hemorrhage (aSAH), the administration of the medication may increase risk of hemorrhage in patients. It has become a practice for neurosurgeons to insert EVDs in patients with aSAH before endovascular treatment. However, the benefits and risks of this practice have not been fully assessed. The aim of this study was to compare and quantify the hemorrhagic risks associated with endovascular treatment of patients with sSAH before and after EVD. ⋯ EVD-related hemorrhage risk may increase with administration of antiplatelet and/or anticoagulant medication for endovascular treatment of ruptured aneurysms in aSAH patients.
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Distinction between inflammation secondary to surgery, especially coronary artery bypass graft with cardiopulmonary bypass (CPB), and inflammation due to infection is difficult in surgical intensive care unit (ICU) patients. Development of biomarkers of infection could help clinicians in the early identification and thus treatment of sepsis in these patients. We compared the time course of the neutrophil CD64 index, a high affinity immunoglobulin FC γ receptor I whose expression is increased in bacterial infection, in 39 patients undergoing cardiac surgery with CPB and 11 patients admitted to the ICU with severe sepsis or septic shock. ⋯ Nevertheless, combination of low CD64 index with low CRP concentrations on day 1 ruled out sepsis except in three patients. There were no correlations between the CD64 index and cytokine levels (tumor necrosis factor [TNF]-α, interferon [IFN]γ, interleukin [IL]-6, IL-10, IL-8, IL-12) measured in subpopulations. In conclusion, CD64 index only in combination with CRP concentrations could be used to discriminate inflammation due to surgery from that due to infection in this particular population.