American journal of surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized trial of short versus long tubes in adhesive small-bowel obstruction.
Many cases of acute adhesive small-bowel obstruction (SBO) can be successfully treated with intestinal tube decompression. There is considerable controversy, however, regarding whether a short nasogastric tube (NGT) or a long nasointestinal tube (LT) is the best method of intestinal tube decompression. ⋯ Patients with adhesive SBO can safely be given a trial of tube decompression upon hospital admission. There was no advantage of one type of tube over the other in patients with adhesive SBO.
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The American College of Surgeons recommends minimum patient volumes for trauma centers and surgeons. Those numbers, however, are largely based on results from studies of surgical (but not trauma) relationships between volume and outcome. ⋯ These results support the regionalization of trauma care by affirming that increased per-surgeon experience in the treatment of seriously injured patients is associated with improved outcomes and help define the minimum experience needed to achieve normative survival. Prospective study of the relationship between volume and survival and other outcomes is required.
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As cardiac complications constitute the principal cause of early and late morbidity and mortality after the surgical treatment of abdominal aortic aneurysm (AAA), a prospective study was planned to evaluate the effects of revascularization of coronary arteries on survival after AAA repair during early and long-term follow-up periods. ⋯ The results of this study emphasize the importance of coronary artery revascularization for early, and especially for late, survival after AAA repair.
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We devised a method for performing pylorus-preserving gastrectomy (PPG) with radical lymph node dissection without compromising pyloric blood flow, based on vascular anatomical evaluation of 210 celiac angiograms. The origin of the infrapyloric artery was variable, but consistently supplied blood flow to the pylorus and the posterior wall of the antrum. ⋯ When the infrapyloric artery originated from the right gastroepiploic artery (type B, 12%), the right gastroepiploic artery was divided distal to the infrapyloric artery origin and the short right gastroepiploic artery remnant was skeletonized of lymph nodes. We have used this technique to perform PPG on 25 patients with early gastric cancer in the middle third of the stomach with minimal morbidity and no mortality.
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There exists a growing interest in intraoperative radiation therapy as a treatment modality for large-bowel cancer. Since such therapy could interfere with wound repair, we investigated its effects on early healing of colonic anastomoses. ⋯ High-dose intraoperative radiation therapy delays the healing of colonic anastomoses; it transiently reduces strength, probably as a result of a diminished accumulation of collagen.