Journal of the American College of Surgeons
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Income inequality in the United States has been increasing in recent decades. It is unclear whether income inequality has an independent effect on health outcomes, or whether it simply correlates with increasing levels of poverty. The goal of this study was to evaluate whether income inequality is significantly associated with US county health care expenditures and health care use. ⋯ Income inequality is independently associated with higher health care expenditures and more health care use, with increases in both potentially discretionary procedures and in potentially preventable admissions.
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Except in Budd-Chiari syndrome, alternative drainage pathways have been described rarely. The aim was to describe the alternative collaterals pathways due to tumor hepatic vein (HV) confluence obstruction and its impact in the setting of liver resection. ⋯ Development of collateral pathways is not fortuitous and depends on the number of HVs involved and pre-existing accessory veins. The increased blood loss observed in patients with collaterals leads to consider specific vascular clamping.
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Patients with phlegmonous appendicitis can be managed nonoperatively, yet debate continues about the need for interval appendectomy (IA), given the low risk of recurrence or neoplasm. We sought to determine for which patient age interval appendectomy is cost-effective. ⋯ Interval appendectomy should be considered in patients younger than 34 years of age.