The American surgeon
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The American surgeon · Sep 2002
Multicenter Study Comparative StudyIs bariatric surgery safe in academic centers?
Contemporary outcomes of bariatric surgery are not well defined. Our aim was to document the outcomes of bariatric surgery on the basis of surgeon caseload and affiliation. We analyzed prospectively collected Florida-wide hospital discharge data. ⋯ We conclude that outcomes of bariatric surgery in high-risk patients are similar among academic and community-based surgeons. Academic surgeons undertake bariatric surgery in high-risk patients more frequently than community-based surgeons, which underlies their increased complication rate. These prospectively collected data reflect surgical outcomes more accurately than clinical series and will impact our practice of bariatric surgery.
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Maintaining adequate cerebral perfusion is important in the treatment of patients with closed head injury. Placement of an intracranial pressure (ICP) monitor is necessary to determine both ICP and the cerebral perfusion pressure and serves as a guide to the contemporary management of traumatic brain injury. Insertion of such monitoring devices historically has been performed by neurosurgeons, but others including general (trauma) surgeons have successfully inserted simple ICP monitors. ⋯ The low complication rate associated with this procedure was similar for neurosurgeons and non-neurosurgeons. We believe that insertion of simple parenchymal ICP monitors should be considered a core skill for trauma surgeons and should be included in surgical residency training. Insertion of ICP monitors by non-neurosurgeons is a potential method of improving the care of patients with brain injury in geographic areas that are underserved by neurosurgeons.
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The American surgeon · Sep 2002
Seprafilm reduces adhesions to polypropylene mesh and increases peritoneal hydroxyproline.
Polypropylene mesh is an effective and widely used material in repairing abdominal wall defects, but it causes dense adhesions when in contact with abdominal viscera directly. As a consequence of this process intestinal obstruction and enterocutaneous fistula may develop. The purpose of the present study was to determine whether Seprafilm, a bioresorbable translucent membrane, reduces abdominal visceral adhesions to polypropylene mesh and whether Seprafilm has any effects on peritoneal tissue hydroxyproline levels. ⋯ The abdominal cavity was evaluated for adhesion formation, and peritoneal biopsies were taken for the measurement of tissue hydroxyproline levels at the 14th day. The use of Seprafilm resulted in significant reduction in the adhesion formation (P = 0.002) and a significant increase in peritoneal hydroxyproline level (P < 0.0001). These findings demonstrate that the increase of peritoneal hydroxyproline levels caused by Seprafilm might play a role on the antiadhesive effects of Seprafilm.