American journal of surgery
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Comparative Study
Effect of human pancreatic juice and bile on the tensile strength of suture materials.
Several suture materials are used for pancreatojejunal anastomosis. In this study, we tested the durability of these suture materials in human pancreatic juice and bile. ⋯ We found that polidioxanone was the strongest suture material in pancreatic juice.
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Hemoperfusion with PMX-F (polymyxin B covalently immobilized on fibers) has been reported to be safe and effective for patients with septic shock. However, the molecular mechanism of this usefulness is not yet clear. The purpose of this study was to evaluate whether the expression of CD14, human leukocyte antigen (HLA)-DR on monocytes, and the expression of CD16, CD11b/CD18 on neutrophils, are altered in septic patients according to the severity, and whether PMX-F treatment affects the clinical parameters and the expression of leukocyte surface antigen expression. ⋯ We showed that the surface antigens, HLA-DR on monocytes and CD16 on granulocytes, are extremely decreased in patients with septic shock, and that PMX-F treatment is effective for beneficially increasing the surface antigen expression on leukocytes. This therapy might be a new strategy for helping patients recover from immunoparalysis in septic conditions.
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Most existing residency evaluation tools were constructed to evaluate the Accreditation Council for Graduate Medical Education (ACGME) competencies. ⋯ Our locally developed tool demonstrated high reliability and construct validity for 4 of 6 ACGME competencies. The correlation between factors suggests overlap between competencies.
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There are five types of choledochal cysts, which are anomalies that involve intrahepatic or extrahepatic bile ducts, or both. These lesions are found most frequently in patients who are Asian, female, infants but are recognized with increasing frequency in adults. ⋯ Management of choledochal cysts is successful after their complete removal. Partial cyst resection and internal drainage is less satisfactory because of occasional pancreatitis, cholangitis, and cholangiocarcinoma. Resection of the intrahepatic and intrapancreatic portions of the cysts reduces the risk of cancer even though this risk is low after incomplete cyst excision. Biliary continuity after cyst resection is best established by Roux-Y hepaticojejunostomy.
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A litigation crisis exists in this country, and it may be better understood through analysis of lawsuits. Verdict summary analysis has been used for this purpose. ⋯ The study of skin cancer suits may help develop risk management and prevention strategies.