American journal of surgery
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Despite successful initial resuscitation, septic shock frequently evolves into multiple system organ failure (MSOF) and death. Since blood lactate levels can reflect the degree of cellular derangements, we examined the relation between serial blood lactate levels and the development of MSOF, or mortality, in patients with septic shock. ⋯ In patients with septic shock, serial determinations of blood lactate levels are good predictors of the development of MSOF an death. In this respect, the duration of lactic acidosis is more important than the initial lactate value. Although a number of factors may contribute to hyperlactatemia, these observations are compatible with a direct role of prolonged tissue hypoxia in the development of complications following septic shock.
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Randomized Controlled Trial Clinical Trial
Drainage is unnecessary after elective liver resection.
A prospective, randomized trial was performed to determine if intra-abdominal drainage catheters are necessary after elective liver resection. ⋯ In the first 50 consecutive resections performed since the conclusion of this trial, only 4 patients (8%) have required subsequent percutaneous drainage. We conclude that abdominal drainage is unnecessary after elective liver resection.
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Surgical management of distal duodenal pathology is challenging because of the duodenum's retroperitoneal location and its shared blood supply with the pancreas. For infra-ampullary pathology, surgical treatment may include local excision, pancreaticoduodenectomy, or pancreas-sparing duodenectomy (PSD). ⋯ Pancreas-sparing duodenectomy is a safe and effective treatment in patients with distal duodenal benign neoplasms or trauma, and PSD appears to have limited effectiveness for malignant distal duodenal pathology.
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This paper addresses the current status of General Surgery, the direction in which it is moving, and how to prepare for future changes. The paper points out that, since the predicted effects of new technology on the practice of General Surgery are more technical complexity, decreasing invasiveness, and fewer traditional operations, the consequences for the training of surgeons, the division of responsibilities among specialists, and the organization of surgical care will be substantial. In light of the current difficulty in dealing with the stresses within General Surgery, the paper discusses how changes in residency training and an increased use of Fellowships will enable the specialty to handle such disruptive changes in the future.
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Since the role of a hiatal hernia in the pathophysiology of gastroesophageal reflux disease (GERD) has not been fully elucidated, we studied the effects of hiatal hernias on the function of the lower esophageal sphincter (LES) and esophageal acid clearance. ⋯ Among patients with proven GERD, those with a small hiatal hernia and those with no hiatal hernia had similar abnormalities of LES function and acid clearance. In patients with larger hiatal hernias, however, the LES was shorter and weaker, the amount of reflux was greater, and acid clearance was less efficient. Consequently, the degree of esophagitis was worse in the presence of a large hiatal hernia.