American journal of surgery
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The time required for air leak resolution after chest trauma is not well described. Based on an institutional review of posttraumatic air leaks our hypothesis was that video-assisted thoracic surgery (VATS) for persistent posttraumatic air leak would decrease chest tube days and length of stay compared with nonoperative management. ⋯ In patients otherwise ready for discharge VATS reduces chest tube days and length of stay when used to treat persistent posttraumatic air leak.
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Clinical Trial
Routine preoperative lymphoscintigraphy is not necessary prior to sentinel node biopsy for breast cancer.
This prospective study was performed to ascertain the added benefit of lymphoscintigraphy to a standard method of intraoperative lymphatic mapping and sentinel node biopsy for breast cancer. ⋯ Preoperative lymphoscintigraphy adds little additional information to intraoperative lymphatic mapping, and its routine use is not justified.
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Severe injury is often complicated by the development of sepsis and the adult respiratory distress syndrome. Since the outcome from severe injury also correlates with changes in monocyte human leukocyte antigen (HLA)-DR expression in such patients, the present study aimed to determine whether or not there was a relationship between monocyte HLA-DR expression and indicators of early pulmonary dysfunction. ⋯ The degree of intrapulmonary shunting observed following severe trauma correlates with the failure of circulating monocytes to re-express HLA-DR antigen, and this may provide some insights into the early events that result in the adult respiratory distress syndrome after major injury.
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We use a loop ileostomy for temporary fecal diversion because of ease of technical construction and assumed low complication rate. Here, we review our complications of loop ileostomy and takedown using three techniques of closure. ⋯ Loop ileostomy and takedown are associated with low rates of serious complications (5% or less). As such, we continue to advocate use of loop ileostomy as a diversion procedure. Closure by enterotomy suture is preferred over resection. However, if resection is required, closure by stapled anastomosis is preferred over suture anastomosis.