JAMA surgery
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Recently, preoperative lung cancer staging has evolved to include endobronchial ultrasonography-guided transbronchial needle aspiration (EBUS-TBNA) biopsies of the hilar and mediastinal lymph nodes, but the feasibility and usefulness of the procedure have not been well studied in the veteran population. ⋯ A preoperative lung cancer staging strategy that includes EBUS-TBNA seems to be safe and effective in a veteran population, resulting in a low rate of nontherapeutic operations because of occult N2 nodal disease.
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Inadvertent carotid sheath insertion during central venous catheter placement could lead to serious complications. ⋯ Inadvertent carotid artery sheath placement during attempted central venous cannulation for pulmonary artery catheter insertion mandates catheter removal and repair of the carotid artery puncture site. The closure device permits percutaneous repair of the carotid artery expeditiously. Our experience showed this treatment modality to be as safe and effective as operative repair.
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Comparative Study
Outcomes of laparoscopic vs open repair of primary ventral hernias.
More primary ventral hernias (PVHs) are being repaired using the technique of laparoscopic ventral hernia repair (LVHR). Few studies exist comparing the outcomes of LVHR with the outcomes of open ventral hernia repair (OVHR) for PVHs. We hypothesize that LVHR of PVHs is associated with fewer surgical site infections (SSIs) but more hernia recurrences and more clinical cases of bulging (bulging not associated with recurrence or seroma). ⋯ Compared with OVHR of PVHs, LVHR of PVHs is associated with fewer SSIs but more clinical cases of bulging and with the risk of developing a port-site hernia. Further study is needed to clarify the role of LVHR of PVHs and to mitigate the risk of port-site hernia and bulging.
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Multicenter Study
Successful nonoperative management of the most severe blunt renal injuries: a multicenter study of the research consortium of New England Centers for Trauma.
Severe renal injuries after blunt trauma cause diagnostic and therapeutic challenges for the treating clinicians. The need for an operative vs a nonoperative approach is debated. ⋯ Hemodynamically stable patients with a grade IV or V BRI were safely managed nonoperatively. Nonoperative management failed for only 6.5% of patients owing to renal-related injuries, and three-fourths of the entire population retained their kidneys.
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With the technical success of tension-free inguinal herniorrhaphy, chronic groin pain has far surpassed recurrence as the most common long-term complication. ⋯ This represents the largest series of laparoscopic retroperitoneal triple neurectomies for treatment of inguinodynia. The rate of successful intervention was better than reported for standard triple neurectomy and open extended triple neurectomy. The procedure allows access proximal to all potential sites of peripheral neuropathy and overcomes many of the limitations of open triple neurectomy. In the absence of recurrence or meshoma, it is the preferred technique for definitive management of chronic inguinal neuralgia.