American journal of surgery
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Randomized Controlled Trial Comparative Study
Modern wound care for the poor: a randomized clinical trial comparing the vacuum system with conventional saline-soaked gauze dressings.
A clinical randomized trial was performed to determine whether a simple homemade wound vacuum-dressing system (HM-VAC) is a feasible alternative to the use of conventional saline-soaked gauze dressings (WET) for the treatment of complex wounds in a resource-poor hospital. ⋯ The HM-VAC should be considered in underdeveloped countries to provide modern management for complex wounds because healing is significantly faster compared with conventional wound care. Although the HM-VAC is more costly than the conventional approach, it is probably affordable for most resource-poor hospitals.
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Hepatic artery pseudoaneurysm is a rare and potentially fatal complication of laparoscopic cholecystectomy that often presents with abdominal pain, anemia, hemobilia, and liver function elevations. The authors report a case of hepatic artery pseudoaneurysm diagnosed by abdominal computed topography in a 54-year-old man who had undergone laparoscopic cholecystectomy the previous month. Definitive treatment was angiography with embolization.
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Current recommendations for victims of penetrating trauma include prompt transportation to a trauma center. It remains unclear whether field intubation allows for improvements in mortality rate. ⋯ Victims of penetrating trauma who require any airway management have a high mortality rate. The cause of this difference awaits further prospective investigation.
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We evaluated contemporary outcomes of open thoracic aortic surgery at a Veterans Affairs (VA) medical center affiliated with a major academic aortic program and examined the predictive value of 2 established cardiac risk models. ⋯ Good outcomes can be achieved when thoracic aortic surgery is performed at an experienced VA center. The cardiac risk models we examined overpredicted operative mortality.
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The US military forces developed and implemented the Joint Theater Trauma System (JTTS) and Joint Theater Trauma Registry (JTTR) using US civilian trauma system models with the intent of improving outcomes after battlefield injury. ⋯ JTTS initiatives contributed to improved survival after battlefield injury. The JTTS has set the standard of trauma care for the modern battlefield using contemporary systems-based methodologies.