The American surgeon
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Left pancreatic traumas (LPTs) are rare but serious lesions occurring in 1 to 6 per cent of abdominal trauma patients and mainly resulting from blunt traumas. LPT severity is primarily dependent on the associated injuries and secondarily related to main pancreatic duct injury responsible for complications: acute pancreatitis, pseudocysts, pancreatic fistulas, or abscesses. The guidelines for blunt LPT management can be presented as follows. ⋯ However, in such cases, spleen-preserving distal pancreatectomy remains the treatment of choice. Pancreatic ductal lesions resulting from LPT have to be diagnosed early to avoid late complications. Distal pancreatectomy remains the treatment of choice in case of severe pancreatic ductal lesions because the role of ERCP stenting and endoscopic techniques needs further evaluation.
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The American surgeon · Jan 2011
Comparative StudyStatins and the bariatric patient: characterization and perioperative effects of statin therapy in the gastric bypass patient.
In surgical patients, statins have been shown to have beneficial effects independent of the lipid-lowering properties. Statin use has not been well studied in the bariatric patient. The objective of this study was to characterize the use of statins in the bariatric surgery patient and compare outcomes, including complications, weight loss, and changes in comorbidities. ⋯ The statin group was more likely to report resolution in HLD (27.5 vs 9.5%, P = 0.004), but not DM, HTN, or OSA. In summary, there are differences in bariatric patients who take statins compared with their counterparts. Statins with gastric bypass may improve resolution of HLD, which may eventually alter long-term cardiac risk in these patients.
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The American surgeon · Jan 2011
Comparative StudyDoes use of intraoperative irrigation with open or laparoscopic appendectomy reduce post-operative intra-abdominal abscess?
To date, no study shows a decrease in postoperative abscess with the use of irrigation during appendectomy. Postoperative abscess rate for laparoscopic and open appendectomy is 3.3 and 2.6 per cent. The purpose of this study is to determine if irrigation at appendectomy decreases the postoperative intra-abdominal abscess rate. ⋯ Thirteen patients developed postoperative abscess: 11 with irrigation, two without irrigation. Ten of 13 patients who developed abscess were perforated; nine with irrigation and one without. These results suggest routine use of intraoperative irrigation for appendectomies does not prevent intra-abdominal abscess formation, adds extra costs, and may be avoided.
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The American surgeon · Jan 2011
Comparative StudyComparison of blood transfusion free pancreaticoduodenectomy to transfusion-eligible pancreaticoduodenectomy.
Even though the surgical techniques and perioperative care have improved, blood transfusions are still often required for the patients undergoing pancreaticoduodenectomy (PD). But complications from blood transfusions, poor prognosis of blood transfused patients, cost, and availability of blood products demand transfusion free (TF) surgery in the PD patients. The purpose of this study is to compare clinical outcome of TF pancreaticoduodenectomy with transfusion-eligible (TE) PD. ⋯ The results of statistical analysis between TF and TE group showed that there were no statistical differences in intraoperative data and postoperative outcomes, except preoperative hemoglobin levels, type of operations, and transfusion amount. To our best knowledge, this is the first successful PD program in selected patients as a series of operations without blood transfusion. TF PD can be done successfully in selected patients without severe complications.
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The American surgeon · Jan 2011
A policy of dedicated follow-up improves the rate of removal of retrievable inferior Vena Cava Filters in trauma patients.
Retrievable Inferior Vena Cava Filters (IVCF) for prophylaxis against pulmonary embolus have been associated with low rates of removal. Strategies for improving the rates of retrieval have not been described. We hypothesized that a policy of dedicated follow-up would achieve a higher rate of filter removal. ⋯ On multivariate analysis young age and trauma patient status were independent predictors of filter removal. A policy of dedicated follow-up of patients with IVCFs can achieve significantly higher rates of filter removal than have been previously reported. Similar policies should be adopted by all centers placing retrievable IVCFs to maximize retrieval rates.