The American surgeon
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The American surgeon · Jan 2003
ReviewA targeted approach for antiangiogenic therapy of metastatic human colon cancer.
The realization that the growth and spread of tumors are dependent on angiogenesis has created new avenues of research designed to help us to better understand cancer biology and to facilitate the development of new therapeutic strategies. However, the process of angiogenesis consists of multiple sequential and interdependent steps with a myriad of positive and negative regulators of angiogenesis being involved. ⋯ In addition, specific integrins such as alphavbeta3 and alpha5beta1 mediate endothelial cell survival and have been shown to be overexpressed on the endothelium of colon cancer. These angiogenic mediators thus serve as targets for therapy of metastatic colon cancer and have shown promise in preclinical trials.
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Traumatic abdominal wall hernia (TAWH) can occur after blunt trauma and can be classified into low- or high-energy injuries. Low energy injuries occur after impact on a small blunt object. High-energy injuries are sustained during motor vehicle accidents or automobile versus pedestrian accidents. ⋯ Hernias following low-energy injuries can be repaired after local exploration through an incision overlying the defect. TAWHs following high-energy trauma should undergo exploratory laparotomy through a midline incision. The defect should be repaired primarily and prosthetics avoided because of the high incidence of postoperative infection.
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The American surgeon · Jan 2003
Two decades of student career choice at the University of Florida: increasingly a lifestyle decision.
Recently, there has been a decrease in the number of graduating U. S. medical students entering surgical residency. Therefore the purpose of this study was to examine student career choice over the last two decades (1982-2002) at the University of Florida. ⋯ A disproportionately low number of graduating female medical students are entering surgical residency. By one measure of academic performance the quality of female graduates entering lifestyle-friendly specialty residencies is superior to that of students entering surgical residency. Lifestyle issues are increasingly important in student career choice decisions.
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The American surgeon · Dec 2002
Clinical TrialOral antibiotics in the management of perforated appendicitis in children.
After appendectomy for perforated appendicitis children have traditionally been managed with intravenous broad-spectrum antibiotics for 5 to 10 days and then until fever and leukocytosis have resolved. We prospectively evaluated a protocol of hospital discharge on oral antibiotics when oral intake is tolerated-regardless of fever or leukocytosis-in a consecutive series of 80 children between one and 15 years of age who underwent appendectomy (38 open and 42 laparoscopic) for perforated appendicitis. At discharge subjects began a 7-day course of oral trimethoprim/sulfamethoxazole and metronidazole. ⋯ Among the 66 children who were discharged on oral antibiotics without having had an inpatient infectious complication there were three wound infections (4.4%). None of these patients had a fever or leukocytosis at discharge. We conclude that after appendectomy for perforated appendicitis children may be safely discharged home on oral antibiotics when enteral intake is tolerated regardless of fever or leukocytosis.
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The American surgeon · Dec 2002
Comparative StudyDay for night: should we staff a trauma center like a nightclub?
Most trauma services throughout the country are staffed on a fixed-call rotational basis. Staff is deployed in a linear fashion when trauma often occurs in a skewed sporadic fashion resulting in large fluctuations in volume, injury severity, and mechanism of injury. Medical error and increased mortality have been associated with certain admission times. ⋯ Six comparisons were performed: 1) morning versus night admission; 2) weekday versus weekend admission; 3) least busy day (Tuesday) versus busiest day (Sunday) admission; 4) weeknight versus weekend night admission; 5) in cases of penetrating trauma, morning versus night admission; and 6) in cases of blunt trauma, morning versus night admission. None of the six comparisons showed a significant difference in mortality. There was no significant difference in ISS-matched mortality related to fixed trauma call staffing.