The American surgeon
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The American surgeon · Feb 2005
Admission preoperative glucose is predictive of morbidity and mortality in trauma patients who require immediate operative intervention.
Although there have been reports in the surgical literature regarding the negative effects of preoperative hyperglycemia on outcome, the impact of elevated preoperative serum glucose levels in trauma patients is unknown. Our objectives were to determine whether preoperative hyperglycemia was associated with a greater morbidity and mortality in trauma patients who underwent surgical intervention upon admission. Prospective data was collected on 252 consecutive nondiabetic trauma patients admitted for > or =3 days who went directly to the OR from the resuscitation area. ⋯ Patients with elevated serum glucose had a significantly greater incidence of infection, HLOS, ILOS, and mortality matched per age and ISS. Elevated serum glucose on admission is an accurate predictor of postoperative infection, HLOS, ILOS, and mortality. A randomized prospective trial evaluating the impact of preoperative glucose control is warranted.
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The American surgeon · Feb 2005
Effects of pneumatic dilation and myotomy on esophageal function and morphology in patients with achalasia.
Only two treatment modalities-pneumatic dilation and Heller myotomy-promise long-term relief from dysphagia and regurgitation in patients with achalasia. The objective of this study was to determine whether both options differ in their effects on esophageal function, morphology, and improvement in symptoms. Eighty-nine patients diagnosed with achalasia between January 1980 and December 2002 at a single center were enrolled in this study. ⋯ Morphologic changes, assessed by the diameter of the esophageal corpus, were also more pronounced after surgical therapy (P > 0.05). Both options will lead to an immediate and significant improvement in symptoms, although the two treatment modalities did not differ in their subjective results. As only objective findings, such as those obtained by manometry and the timed barium swallow, have proven relevance for the assessment of long-term results, surgical therapy is the superior and more effective treatment option in patients with achalasia.
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The American surgeon · Jan 2005
Comparative StudyA comparison of continuous renal replacement therapy to intermittent dialysis in the management of renal insufficiency in the acutely III surgical patient.
Acute renal failure (ARF) occurs in 10 per cent to 23 per cent of intensive care unit patients with mortality ranging from 50 per cent to 90 per cent. ARF is characterized by an acute decline in renal function as measured by urine output (UOP), serum creatinine, and blood urea nitrogen (BUN). Causes may be prerenal, intrarenal, or postrenal. ⋯ CRRT results in an enhancement of renal function with improved creatinine clearance at the time of dialysis discontinuation. CRRT provides better control of azotemia while preserving hemodynamic stability in patients undergoing renal replacement therapy. Prospective randomized controlled studies and larger sample sizes are needed to further evaluate these modalities.
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The American surgeon · Dec 2004
Preoperative lymphoscintigraphy and internal mammary sentinel lymph node biopsy do not enhance the accuracy of lymphatic mapping for breast cancer.
Lymphoscintigraphy (LS) may identify sentinel lymph nodes (SLNs) outside the axilla. Biopsy of these nodes could improve the accuracy of lymphatic mapping (LM) for breast cancer (BC) if a significant number of tumor-positive extra-axillary sentinel nodes are identified. To address this, we evaluated the impact of the use of preoperative LS and biopsy of axillary and internal mammary SLNs in women with BC. ⋯ LM identified IM sentinel nodes in 6 of these 10 patients, but none were involved with tumor. Preoperative lymphoscintigraphy and biopsy of internal mammary sentinel nodes do not enhance the accuracy of lymphatic mapping for breast cancer. Omitting lymphoscintigraphy reduces the complexity and cost of lymphatic mapping without compromising the identification of tumor-positive sentinel nodes.
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The American surgeon · Dec 2004
Apoptosis and necrosis in the development of acute lung injury after hemorrhagic shock.
Acute lung injury can be a complication of hemorrhagic shock. Mechanisms of injury include neutrophil-derived inflammatory products that induce necrosis within the lung. Recent data has shown apoptosis, in addition to necrosis, as a pathway leading toward acute lung injury in shock models. ⋯ Acute lung injury is a complex pathophysiologic process. Apoptosis in cells (neutrophils, macrophages, alveolar cells) is induced within the lung after hemorrhagic shock. The role of apoptosis in pulmonary dysfunction after hemorrhagic shock has yet to be determined.