Journal of the American College of Surgeons
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The aim of this study was to assess whether pancreatoduodenectomy (PD) and en bloc mesenterico-portal resection (PD+VR) could be performed with primary venous reconstruction, avoiding a vascular graft. In addition, the short-term surgical outcomes of this approach were compared with a standard PD (PD-VR). ⋯ Pancreatoduodenectomy with VR and primary venous anastomosis avoids the need for a graft and has comparable postoperative morbidity with PD-VR. However, it is associated with an increased operative time, higher intraoperative blood loss, and, for pancreatic ductal adenocarcinoma, a higher rate of positive resection margins compared with PD-VR.
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The acute coagulopathy of trauma has been identified as a critical determinant of outcomes. Antifibrinolytic agents have recently been demonstrated to improve outcomes. This prospective study was designed to assess coagulopathy in trauma patients using thromboelastography. ⋯ In this prospective analysis, hyperfibrinolysis on thromboelastography developed in approximately 10% of patients and was considerably more likely to require massive transfusion. Hyperfibrinolysis was a strong independent predictor of mortality. Additional evaluation of the role of thromboelastography-directed antifibrinolytic therapies is warranted.
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Relatively little is known or understood about the nature of complications that occur during a surgical procedure. Definitions, classification, and documentation are substantive challenges to comprehensive event capture. We hypothesized that our prospective complication database (ie, Surgical Activity Tracking System) would supplement traditional sources of intraoperative complication reporting. ⋯ Our prospective complication tracking system identified a considerable number of complications that were not available in either the operative report or discharge summary. The number of unreported adverse events varied greatly by category, suggesting opportunities for improvement in both complication identification and tracking.
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Percutaneous needle biopsy has the potential to provide a preoperative diagnosis of breast cancer, which helps to optimize surgical planning; however, its use remains an area of unexplained clinical variation. The purposes of this study were to perform a statewide assessment of diagnostic biopsy methods for women diagnosed with breast cancer and to evaluate the impact of biopsy method on the quality of breast cancer surgery. ⋯ The quality of breast cancer surgery as measured by initial margin status, total number of operations, and axillary evaluation improved with preoperative PNB; however, the use of PNB varied considerably. The potential impact of PNB on the quality of patient care and health care costs is substantial. Emphasis should be placed on understanding the barriers to the use of preoperative PNB and developing strategies to expand its use in the management of breast cancer.
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We have shown that administration of heparin-binding EGF (epidermal growth factor)-like growth factor (HB-EGF) protects the intestines from experimental necrotizing enterocolitis (NEC). We have also demonstrated that systemically administered mesenchymal stem cells (MSC) can engraft into injured intestines. This study investigated the effects of HB-EGF on MSC in vitro, and whether MSC and HB-EGF can act synergistically to prevent NEC in vivo. ⋯ Heparin-binding EGF-like growth factor and MSC act synergistically to reduce injury and improve survival in experimental NEC.