American journal of surgery
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Randomized Controlled Trial
Prospective randomized trial of paravertebral block for patients undergoing breast cancer surgery.
The goal of the current study was to evaluate the effect of regional anesthesia using paravertebral block (PVB) on postoperative pain after breast surgery. ⋯ PVB significantly decreases postoperative pain up to 3 hours after breast cancer surgery.
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The authors present a case of a huge right inguinal bulge that was referred as a right inguinal hernia. At surgery, it was confirmed to be a giant lipoma of the spermatic cord. A description of the case, pictures of clinical appearance and operative specimen, and a short literature review are presented.
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The impact of long-term preoperative glucose control on short-term surgical complications is unclear. We investigated whether preoperative hemoglobin A1c (HA(1c)) levels correlated with the risk of postoperative complications. ⋯ Although our data show an increased risk of surgical complications in diabetics, there was no detectable correlation between risk of complication and HA(1c) level. This suggests that poor long-term glucose control may not play a major role in determining short-term surgical morbidity.
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Since 1994, the National Surgical Quality Improvement Program (NSQIP) has become a tool for the study of outcomes in surgery. Through carefully designed studies, patient risk factors, structures, and processes of care and their impact on various outcomes were carefully described within many specialties and subspecialties of surgery. "Fifteen years of NSQIP" is a celebration of the work of Shukri Khuri and his colleagues during this time frame. By summarizing their extensive contributions, a perspective is given as to the impact and breadth of their observations and recommendations on quality improvement for specific operations in various specialties under various conditions. A total of 128 articles published in the peer-reviewed literature dealing mostly with findings from the Veterans Affairs (VA) hospital system are summarized.
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Exsanguination from hepatic trauma is exacerbated by the lethal triad of acidosis, coagulopathy, and hypothermia. We evaluated the application of a modified chitosan dressing in a hypothermic coagulopathic model of grade V liver injury. ⋯ Modified chitosan dressings provide simple rapid treatment of life-threatening liver injuries.