American journal of surgery
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As medicinal and recreational marijuana use broadens across the United States, knowledge of its effects on the body will become increasingly important to all health care providers, including surgeons. ⋯ The primary components in the cannabis plant, tetrahydrocannabinol (THC) and cannabidiol (CBD), have been made available in numerous forms and formulations to treat multiple medical conditions, and recreational access to marijuana is increasing. Of particular importance to the surgeon may be their effects on prolonging intestinal motility, decreasing inflammation, increasing hunger, mitigating pain, and reducing nausea and vomiting. Perioperative use of medicinal or recreational marijuana will become increasingly prevalent, and the surgeon should be aware of the positive and negative effects of these cannabinoids.
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Microvascular invasion (MVI) has recently been reported to be an independent prognostic factor in patients with hepatocellular carcinoma (HCC). This study compared the outcomes of adjuvant transarterial chemoembolization (A-TACE) after hepatic resection (HR) in patients with HCC involving MVI. ⋯ A-TACE may improve postoperative outcomes for MVI-HCC patients, especially those with tumor diameter >5 cm or multinodular tumors.
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The purpose of this study was to determine the impact of the incision used for specimen extraction on wound infection during laparoscopic colorectal surgery. ⋯ A RLQ/LLQ extraction site is associated with the most reduced risk of wound infection in laparoscopic colorectal surgery.
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Randomized Controlled Trial
A randomized double blinded study to determine the effectiveness of utilizing intraperitoneal bupivacaine: Does it reduce postoperative opioid use following laparoscopic appendectomy?
Improving postoperative pain control may lead to improved outcomes including decreased opioid use, shorter hospital stays, and improved patient satisfaction. This study examined the effects of instilling intraperitoneal bupivacaine following laparoscopic appendectomy. ⋯ This prospective, randomized, double-blinded, placebo-controlled study enrolled subjects with acute appendicitis undergoing laparoscopic appendectomy. Subjects were randomized to receive either bupivacaine or normal saline intraperitoneally at the close of surgery. In the bupivacaine group, pain scores at 1 h were improved and inpatient postoperative opioid use was less.
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We hypothesized that medical experts would concur the American College of Surgeons/Association for Surgical Education Medical Student Simulation-based Surgical Skills Curriculum ("ACS/ASE Curriculum") could be used to teach and assess Entrustable Professional Activities (EPAs). ⋯ The ACS/ASE Curriculum lays the framework for implementing select EPAs into medical student education. Experts recommended increased time for skills training with incorporation of the modules into the first three years of medical education, with assessments planned in the third to fourth years.