American journal of surgery
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Randomized Controlled Trial Multicenter Study
Safety and hemostatic effect of recombinant activated factor VII in cirrhotic patients undergoing partial hepatectomy: a multicenter, randomized, double-blind, placebo-controlled trial.
Coagulopathy caused by cirrhosis may contribute to excessive bleeding during hepatectomy. We evaluated the hemostatic effect and safety of recombinant factor VIIa (rFVIIa) in cirrhotic patients undergoing partial hepatectomy. ⋯ Using blood loss as a transfusion trigger, the efficacy of rFVIIa in reducing the requirement for RBC transfusion was not established in this study. No safety concerns were identified.
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Randomized Controlled Trial Comparative Study
Lecture versus standardized patient interaction in the surgical clerkship: a randomized prospective cross-over study.
Medical schools increasingly are incorporating the standardized patient (SP) interaction as a teaching and testing modality to prepare students for United States Medical Licensing Examination Step 2 Clinical Skills. Although SP interactions provide a safe environment in which to practice clinical skills, little is known about medical students' perceptions of the instructional SP interaction in comparison with the classic didactic lecture. We hypothesized that students would enjoy and value an instructional SP interaction more than a didactic lecture, and that this perception would be enhanced if the lecture immediately preceded the instructional SP interaction. ⋯ The classic lecture format not only is enjoyed and valued as a learning tool more by our surgical clerkship students than the instructional SP interaction, but having a lecture just before an SP interaction increased perceived enjoyment and value of the SP interaction and enhanced performance on the SP checklist. These data suggest that educators can improve student perceptions and attitudes surrounding the instructional SP interaction by using strategically timed lectures.
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Maintaining sufficient blood flow to the gastric tube after a subtotal esophagectomy for esophageal cancer is crucial for decreasing esophagogastric anastomotic leakage. ⋯ This practical supercharge technique reduces leakage during esophageal anastomosis.
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The feasibility and accuracy of sentinel lymph node (SLN) biopsy examination for breast cancer patients with clinically node-negative breast cancer after neoadjuvant chemotherapy (NAC) have been investigated under the administration of a radiocolloid imaging agent injected intradermally over a tumor. In addition, conditions that may affect SLN biopsy detection and false-negative rates with respect to clinical tumor response and clinical nodal status before NAC were analyzed. ⋯ The SLN identification rate and false-negative rate were similar to those in nonneoadjuvant studies. The SLN biopsy examination accurately predicted metastatic disease in the axilla of patients with tumor response after NAC and clinical nodal status before NAC. This diagnostic technique, using an intradermal injection of radiocolloid, may provide treatment guidance for patients after NAC.