American journal of surgery
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Our institution initiated the implementation of the Surviving Sepsis Campaign guidelines in 2006. We hypothesize that the addition of a surgical intensivist improved results more than the implementation of the guidelines alone. ⋯ Implementation of evidence-based guidelines decreased LOS and decreased cost in our surgical intensive care unit. By adding the expertise of a surgical intensivist, we reduced LOS, cost, and relative risk of death even further than using the guidelines alone.
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Splenic infarction is rare in inflammatory diseases of the pancreas, although the spleen and its vessels have an intimate relation with the pancreas. Most reported cases are of focal infarction, and treatment is mostly conservative. The authors report a case of diffuse splenic infarction in a 17-year-old boy with severe acute pancreatitis who presented with massive upper gastrointestinal bleeding and was treated with splenectomy.
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Preoperative steroid use has been associated with increased postoperative complications. We sought to establish these risks using data from the National Surgical Quality Improvement Program (NSQIP). ⋯ Previous concerns related to surgical risks in patients on chronic steroid regimens appear valid. These results may assist in counselling patients regarding the increased risk of surgery. They may also help the surgeon plan and modify the procedure if possible.
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Controlled Clinical Trial
Sensitivity of detection of radiofrequency surgical sponges: a prospective, cross-over study.
A retained surgical sponge is a serious medical error that results in negative patient outcomes. Radiofrequency (RF) technology has recently been introduced to evaluate for the presence of a retained sponge. The aim of this study was to evaluate the sensitivity and specificity of the detection of surgical sponges embedded with an RF chip through the torsos of subjects of varying body habitus, including the morbidly obese. ⋯ The sensitivity and specificity of RF sponge technology are much higher than published reports of surgical counts or published findings of intraoperative radiographs for retained sponges.