Journal of the American College of Surgeons
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When activated, the nuclear factor (NF)-kappaB pathway is a potent cellular signal that inhibits apoptotic cell death. Pancreatic cancer is resistant to the apoptotic effect of chemotherapy, though it is unclear whether this is an inherent feature or a survival signal engaged in response to chemotherapy. We investigated whether pancreatic cancer cells activate the NF-kappaB pathway in response to chemotherapy and whether inhibition of this response altered the apoptotic efficacy of chemotherapy. ⋯ Part of the apoptotic resistance of pancreatic cancer may be mediated by activation of the NF-kappaB survival pathway in response to chemotherapy. Inhibition of this response may be an important adjunct to increase the efficacy of chemotherapy.
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Comparative Study
Use of a state-wide administrative database in assessing a regional trauma system: the New York City experience.
A successful regional trauma care system should concentrate severely injured patients within trauma centers, and should improve severity-adjusted outcomes. We compared injured patients' outcomes in New York City's level 1 trauma centers and nontrauma centers. ⋯ New York City's trauma system concentrates injured patients in trauma centers on the basis of injury class rather than severity, but does not produce improved adjusted mortality outcomes for injured patients.
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Comparative Study
Prevalence and risk factors for ischemia, leak, and stricture of esophageal anastomosis: gastric pull-up versus colon interposition.
Reports of esophageal anastomotic complications often involve more gastric than colonic reconstructions and are incomplete because of fragmented followup by physicians unfamiliar with the surgical procedure. ⋯ After esophagectomy 10% of patients will develop conduit ischemia or an anastomotic leak and 22% will develop anastomotic stricture. Anastomotic leak and strictures are more common and the strictures are more severe after gastric pull-up compared with colon interposition. Dilatation is a safe and effective treatment.
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Polypropylene mesh used to repair abdominal wall hernias routinely induces dense adhesions if there is direct contact between the mesh and the viscera. Adhesions may lead later to difficult reoperation, intestinal obstruction, or enteric fistula. ⋯ 1) Sepramesh alone reduces polypropylene mesh adhesions by roughly three-quarters. 2) Sepramesh plus Seprafilm nearly eliminates such visceral adhesions. 3) Mesothelial cell coverage of polypropylene mesh confers adhesion resistance.