American journal of surgery
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Missed injuries can lead to delays. In the rural environment, where patients are frequently seen in multiple hospitals prior to reaching the trauma center, different problems arise. ⋯ Transferred patients with blunt injury have the highest risk for missed injury. Delayed transports and prior examination may contribute to complacency. All trauma patients must be repeatedly evaluated thoroughly, and all diagnostic studies reviewed for adequacy.
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This overview on glutamine, cancer and its therapy discusses some of the in vitro and in vivo work on glutamine and tumor growth, and summarizes animal and human data on the potential benefits of glutamine in the tumor-bearing host receiving radiation or chemotherapy. ⋯ Further prospective randomized trials are needed to demonstrate the safety and efficacy in humans undergoing radiation and chemotherapy.
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Randomized Controlled Trial Clinical Trial
Effect of patient position upon success in placing central venous catheters.
There is little consensus regarding the most efficient or the safest method by which to place a central venous catheter (CVC). ⋯ The bump position improves the likelihood of successful central venous catheter placement. No more than three needle passes ought to be attempted.
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Comparative Study
A cost-minimization analysis of laparoscopic cholecystectomy versus open cholecystectomy.
Earlier economic analyses have evaluated charges but not costs, and have not considered the cost of production losses associated with open and laparoscopic cholecystectomy. This study attempted to accomplish an economic evaluation of open versus laparoscopic cholecystectomy from the point of view of society. ⋯ From the point of view of society, laparoscopic cholecystectomy was a cost-saving strategy if at least 68 patients were operated on yearly. However, with regard to hospital costs, open cholecystectomy was less expensive than laparoscopic cholecystectomy.
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Intraoperative inadvertent perforation of the rectum is a potentially avoidable complication of abdominoperineal resection (APR). Although widely thought to be detrimental, the impact of inadvertent perforation on outcome has not been conclusively determined, especially after controlling for potential confounding variables. The objective of this study was to determine if inadvertent perforation of the rectum during APR for rectal cancer is an independent risk factor for the adverse outcomes of local recurrence and/or death. ⋯ Inadvertent perforation of the rectum during APR is associated with increased local recurrence and decreased 5-year survival. The detrimental implications of inadvertent perforation during APR mandates meticulous avoidance.