American journal of surgery
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Surgical excision remains the primary and only potentially curative treatment for melanoma. Although current guidelines recommend excisional biopsy as the technique of choice for evaluating lesions suspected of being primary melanomas, other biopsy types are commonly used. We sought to determine the impact of biopsy type (excisional, shave, or punch) on outcomes in melanoma. ⋯ Both shave and punch biopsies demonstrated a significant risk of finding residual tumor in the WLE, with pathologic upstaging of the WLE. Punch biopsy also led to a larger mean WLE area compared with other biopsy types. However, biopsy type did not impact SLNB accuracy or results, tumor recurrence, or disease-specific survival (DSS). Punch and shave biopsies, when used appropriately, should not be discouraged for the diagnosis of melanoma.
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Comparative Study
Chitosan based advanced hemostatic dressing is associated with decreased blood loss in a swine uncontrolled hemorrhage model.
The purpose of this study was to compare standard gauze (SG) and advanced hemostatic dressings in use by military personnel in a no-hold model. ⋯ XG demonstrated shorter application time and decreased secondary blood loss in comparison with both SG and CG. These differences may be of potential benefit in a care-under-fire scenario.
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Little is known about the reliability of data collected by abstractors without professional medical training. This investigation sought to determine the level of agreement among untrained volunteer abstractors as part of a study to evaluate the risk assessment of venous thromboembolism in patients who have undergone trauma. ⋯ The performance of volunteers showed outstanding inter-rater reliability; however, limitations of interpretation can influence reliability.
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Trauma patients are at risk for the development of venous thromboembolism (VTE). The purpose of this study was to validate the Risk Assessment Profile (RAP) as a tool for stratifying the risk of VTE. ⋯ The RAP score is highly associated with VTE in trauma patients regardless of mechanism of injury and is a valid risk assessment tool.
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The investigators present a series of adults with severe acute respiratory distress syndrome (ARDS) who were treated with extracorporeal membrane oxygenation (ECMO) at a regional referral center. ⋯ ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate.