American journal of surgery
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No papers have heretofore documented histological studies of cases involving the inflammation of resected gallbladder or examined surgical difficulties on the basis of pathological findings. ⋯ The judgment using the scores was satisfactory in terms of the simplicity of evaluating the technical difficulties associated with each patient and the ease of obtaining information for each factor. The quantification of technical difficulty using the scores is useful for preoperative prediction of which patients will have difficulties in gallbladder dissection and the conversion to OC in LC. Our results suggest that the consideration of technical difficulties is important for conducting safe operations with avoiding intraoperative complications.
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Randomized Controlled Trial Clinical Trial
Prevention of deep abdominal complications with omentoplasty on the raw surface after hepatic resection. The French Associations for Surgical Research.
Several methods have been suggested to treat the hepatic raw surface after resection. Among these, omentoplasty (OP) has been employed occasionally but there are no clinical studies that clearly demonstrate its usefulness. ⋯ OP on the raw surface after hepatic resection lowers the rate of all complications related to DAC (except biliary leaks) and their severity (repeat operations and death) but not significantly so. OP is not recommended as a routine measure to complete elective hepatic resections.
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Acute respiratory distress syndrome (ARDS) remains a significant cause of morbidity and mortality in surgical intensive care unit patients. A relatively predictable sequence of pathophysiologic events occur in the lung, which involve inflammatory mediators and neutrophils. The characteristic radiographic findings of ARDS may mimic ventilator-associated pneumonia (VAP), making the diagnosis of VAP difficult. ⋯ The use of bronchoscopy with bronchoalveolar lavage and quantitative cultures can differentiate local and systemic inflammatory response to injury or blood loss from invasive bacterial pneumonia. Basing antibiotic therapy solely on the results of quantitative cultures is safe, because quantitative cultures identify VAP in less than half the patients with clinical evidence of pneumonia. Empiric therapy should be based on the microbiology of the intensive care unit rather than the results of the Gram stain.
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Review
Multifactorial analyses in the diagnosis of pneumonia arising in the surgical intensive care unit.
The diagnosis of ventilator-associated pneumonia in the surgical intensive care unit continues to be problematic. The majority of intensive care units use clinical criteria based on chest x-ray; fever; leukocytosis; alterations in the pulse oximeter observations; the need to alter modes and amounts of ventilatory support; and more specific microbiologic studies, such as appropriate sputum, Gram stain, and culture to identify pneumonia. Diagnosing pneumonia based on clinical criteria alone is often difficult and inaccurate, which may lead to inappropriate use and choice of antibiotics. ⋯ Furthermore, those results that return positive are often too late to dictate the need for, or direction of, therapy. Our use of a "pneumonia grid" may help identify patients likely to have a poor outcome. Until a readily available and cost-effective diagnostic study for pneumonia is developed, clinical criteria remain vital in routine practice.
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Comparative Study
Lumpectomy margins, reexcision, and local recurrence of breast cancer.
The diagnosis of breast cancer is often made by excisional biopsy without margin assessment for mammographic findings or palpable masses. Many patients treated with breast conservation undergo reexcision to obtain clear margins although the relationship between clear margins and local recurrence remains controversial. ⋯ Clear excision margins are facilitated by preoperative diagnosis by fine-needle cytology. For patients with nonnegative margins, reexcision was more commonly performed in young patients with small tumors diagnosed by spot localization biopsy. The relationship of local recurrence to margins and reexcision was not statistically significant. Estrogen receptor negative tumors with nonnegative margins had a significantly higher rate of local recurrence than estrogen receptor negative tumors with clear margins and estrogen receptor positive tumors regardless of margin status.