American journal of surgery
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Comparative Study Clinical Trial
A comparison of thoracic CT and abdominal CT for the identification of thoracic blunt trauma.
In light of current trends to limit radiation exposure and costs, as well as increased traffic safety, computed tomography (CT) may have decreasing value for evaluating patients with blunt trauma. The authors examined the utility of chest x-ray and abdominal CT for identifying clinically significant thoracic blunt trauma. ⋯ Clinically significant injuries can be identified with abdominal CT and chest x-ray, safely allowing reductions in radiation exposure, hospital stays, and costs by limiting the use of thoracic CT.
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A minimum of 12 lymph nodes has been endorsed as a quality measure to confirm node-negative colon cancer, but its relevance to early-stage rectal cancer is unclear. ⋯ Five-year overall survival improved as the number of sampled nodes increased. A thorough lymphadenectomy should routinely be performed to optimize staging and to improve survival of patients with early-stage rectal cancer.
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Hormone replacement therapy increases the number and quality of grafts recovered from brain-dead organ donors. Arginine vasopressin (AVP) has also been shown to have beneficial effects. The aim of this study was to determine the effect of AVP on recovery rates. ⋯ The use of AVP with hormone replacement therapy is independently associated with an increased rate of organ recovery. This strategy should be universally adopted in the management of donors progressing to neurologic death.
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Most trauma centers incorporate mechanistic criteria (MC) into their algorithm for trauma team activation (TTA). We hypothesized that characteristics of the crash are less reliable than restraint status in predicting significant injury and the need for TTA. ⋯ Improper restraint is an independent predictor of necessitating TTA in this single-institution study.
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Clostridium difficile-associated infection (CDI) can have varying severity from asymptomatic carriage to fulminant colitis. Its incidence and virulence in North America are increasing. The increase in virulence is associated with emergence of the highly toxigenic North American pulsed field gel electrophoresis-1 strain. ⋯ Another major risk factor is hospitalization. The spectrum of CDI ranges from asymptomatic carriers to fulminant disease. Although asymptomatic carriers require no treatment, fulminant disease carries a substantial mortality regardless of management strategy.