American journal of surgery
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Morbid obesity continues to increase in the United States, which accounts for the increase in bariatric procedures performed. After these patients experience massive weight loss, many are left with a redundant pannus that poses physical limitations and psychosocial disturbances. An increasing proportion of bariatric patients are returning for body-contouring procedures. ⋯ Post-bariatric patients who have sustained significant weight loss report subjective improvement after panniculectomy. Even though this population has experienced significant weight loss, they are still at an increased risk for postoperative complications. Maximal reduction in BMI should be stressed to these patients in order to reduce their risk of complications following panniculectomy.
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Our current trauma triage system uses patient and scene variables within a 3-tiered trauma response system. Our purpose was to evaluate the accuracy of the current system and to identify the most reliable variables for trauma triage. ⋯ A simplified triage system using only highly predictive variables can safely decrease the high rate of overtriage of trauma patients.
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Intra-abdominal hypertension affects multiple organ systems. Current measurement standard requires supine positioning, which jeopardizes patient safety by increasing the risk for ventilator-associated pneumonia. This study evaluated the relationship between intra-abdominal pressure (IAP) and head-of-bed (HOB) positioning in critically ill intubated patients. ⋯ There is a significant, positive association between IAP and HOB positioning in critically ill patients. Clinically relevant changes in IAP occur at HOB increases >20 degrees.
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Guidelines regarding bowel preparation exist for the adult but not the pediatric population. Our aim was to evaluate the bowel preparation practices, including antibiotic usage for elective colorectal operations in children. ⋯ There is a wide variation in bowel preparation practices in children. A prospective, randomized trial would be helpful to identify the role of oral antibiotics and optimal duration of intravenous antibiotics in this population.
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Randomized Controlled Trial
Polyethylene glycol versus sodium phosphate mechanical bowel preparation in elective colorectal surgery.
The type of mechanical bowel preparation (MBP) used before elective colorectal surgery remains controversial. ⋯ SP, coupled with ertapenem antibiotic prophylaxis, may improve outcomes and reduce SSIs in patients undergoing elective colorectal surgery when compared with PEG coupled with cefotetan antibiotic prophylaxis.