American journal of surgery
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Randomized Controlled Trial Clinical Trial
Supraomohyoid neck dissection in the treatment of T1/T2 squamous cell carcinoma of oral cavity.
Recent studies in patients with previously untreated T1 and T2 squamous cell carcinoma (SCC) of the tongue and floor of the mouth have shown a relationship between tumor thickness, neck metastasis, and survival. Our study was conducted to determine the indication of elective neck dissection in patients with early oral cavity SCC. ⋯ Neck dissection remains mandatory in the early stage of oral SCC, because of better survival rates compared to RA and the poor salvage rate. In particular, patients with tumor thickness > 4 mm treated with RSOND had significant benefit on disease-free survival.
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Clinical Trial
A targeted supradose cisplatin chemoradiation protocol for advanced head and neck cancer.
Hypothesizing that cisplatin (DDP) drug resistance is dose dependent and the radiosensitizing effect of DDP is clinically beneficial, we conducted a chemoradiation protocol using extremely high doses of DDP delivered intra-arterially (IA) to locally advanced head and neck tumors. ⋯ We conclude that the combination of rapid selective delivery of supradose DDP/IV thiosulfate neutralization and concomitant radiotherapy can be safely and effectively applied to patients with advanced head and neck cancer. Preliminary survival analysis indicates that this approach may improve the prognosis for patients with an otherwise devastating disease.
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Comparative Study Clinical Trial Controlled Clinical Trial
Is resection with primary anastomosis following destructive colon wounds always safe?
Resection with primary anastomosis was associated with a 14% anastomotic leak rate in this review of 60 patients with destructive colon wounds. The presence of an underlying medical illness or massive blood transfusion was associated with anastomotic complications. In the high-risk subset of patients who had one or both of these risk factors, the anastomotic leak rate was 42%. ⋯ Ileocolostomies were no safer than colocolostomies. We conclude that resection with anastomosis should not be performed on all patients with destructive colon injuries, as the risk of anastomotic leak is prohibitive in those with either massive blood loss or underlying medical illness. We continue to perform primary anastomosis in healthy patients without excessive blood loss.
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Clinical Trial Controlled Clinical Trial
Octreotide acetate decreases pancreatic complications after pancreatic trauma.
Octreotide acetate (Sandostatin) has been reported to decrease pancreatic related morbidity after pancreatic resections. This study examined the use of octreotide after pancreatic trauma. The charts of all patients treated for pancreatic injuries from June 1988 to February 1992 were reviewed (n = 28). ⋯ No complications were associated with the use of octreotide. In conclusion, pancreatic complications occurred frequently (21%) following pancreatic trauma and resulted in significant morbidity. In this nonrandomized series of patients with equivalent ATI, ISS, and pancreatic grade injuries, the prophylactic use of octreotide was associated with no pancreatic complications and no negative sequelae.
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Early intra-abdominal packing is a lifesaving maneuver for selected patients with major liver injuries. However, the effectiveness of perihepatic packing can be limited by renewed bleeding when laparotomy pads that have become adherent to the injured liver surface are removed. A technique for intra-abdominal packing of complex liver injuries is presented that avoids the bleeding sequelae related to pack removal.