American journal of surgery
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Pancreatic stone is a rare disease, and it may be associated with obstructive jaundice. We recorded clinical data and accurate images of the pancreatic stone. Whipple operation was performed to relieve the obstructive jaundice. The pancreatic stone is an uncommon entity with obstructive jaundice and may require surgical management if endoscopy or extracorporeal shock wave lithotripsy failed.
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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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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.
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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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An esophageal perforation occurred during an esophagogastroduodenoscopy (EGD). The patient had an episode of retching and forceful vomiting just after an esophageal mucosal biopsy at the gastroesophageal junction. The only clinical feature demonstrated by the patient was neck crepitation after completion of the EGD. ⋯ A unique chest computed tomography scan demonstrated suspension of the esophageal mucosal surface and lumen in a "bull's eye" configuration. A water-soluble esophageal swallow followed by a thin liquid barium swallow demonstrated that the esophageal perforation had sealed. The patient completely recovered with conservative medical therapy of clear liquid diet and antibiotics.