American journal of surgery
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Comparative Study
Repair of esophageal atresia with tracheoesophageal fistula via thoracotomy: a contemporary series.
A recent series detailing thoracoscopic repair of esophageal atresia with tracheoesophageal fistula (EA/TEF) reported lower complication rates compared with historic controls. This study provides a contemporary cohort of patients repaired via thoracotomy for comparison with the recent large multi-institutional thoracoscopic series. ⋯ Thoracoscopic repair of EA/TEF yielded complication rates similar to this contemporary series; however, trends toward increased anastomotic leaks and greater need for fundoplication were noted. No musculoskeletal sequelae were directly attributable to thoracotomy.
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The objective of our study was to determine the important factors that have influence on the time of sentinel node visualization using intradermal injection of (99m)Tc-antimony sulfide colloid. ⋯ Older age and higher BMI can result in slow sentinel node visualization. Longer interval between biopsy and sentinel node mapping can be associated with rapid sentinel node detection.
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Colon preparation for elective colon resection to reduce surgical site infection (SSI) remains controversial. ⋯ Mechanical bowel preparation alone does not reduce rates of SSI, but oral antibiotic preparation and systemic preoperative antibiotics are superior when compared with systemic antibiotics alone. Additional clinical trials are necessary to define the best combined overall mechanical and oral antibiotic regimen for elective colon surgery.
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Multicenter Study
Local variations in the epidemiology, microbiology, and outcome of necrotizing soft-tissue infections: a multicenter study.
Necrotizing soft-tissue infections (NSTIs) are rare and highly lethal. ⋯ Significant center differences occur in patient populations, etiology, and microbiology of NSTIs, even within a concentrated region. Management should be based on these characteristics given that adjunctive treatments are unproven and variations in outcome are likely because of patient disease at presentation.
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Six percent hetastarch is used as a volume expander but has been associated with poor outcomes. The aim of this study was to evaluate trauma patients resuscitated with hetastarch. ⋯ Because of the detrimental association with renal function and mortality, hetastarch should be avoided in the resuscitation of trauma patients.