Journal of the American College of Surgeons
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Randomized Controlled Trial Comparative Study Clinical Trial
Surgical morbidity and mortality among American Indian and Alaska Native veterans: a comparative analysis.
Few studies have examined surgical risk factors and outcomes in American Indians and Alaska Natives (AI/ANs). My colleagues and I sought to determine if prevalence of preoperative risk factors for morbidity and mortality differed between male AI/AN and Caucasian surgical patients, and to determine if AI/ANs had an increased risk of surgical morbidity or mortality. ⋯ Our results add postoperative mortality to health disparities experienced by AI/ANs. Future research should be conducted to identify other factors that contribute to this disparity.
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Randomized Controlled Trial Comparative Study Clinical Trial
Pain after anterior mesh hernia repair.
The results of a randomized clinical trial comparing the Lichtenstein procedure, mesh plug repair, and the Prolene Hernia System provided a database for analyzing chronic pain after anterior mesh hernia repair to determine the characteristics and identify risk factors. ⋯ Chronic pain after anterior mesh hernia repair is determined by younger age and stronger pain directly after the operation. Especially in patients with chronic neuropathic pain, its intensity is aggravated when numbness is present and the number of words to describe pain increases.
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Randomized Controlled Trial Clinical Trial
Magnetic resonance cholangiopancreatography accurately detects common bile duct stones in resolving gallstone pancreatitis.
There is controversy about the optimal method to detect common bile duct (CBD) stones in patients with mild resolving gallstone pancreatitis. The aim of this study was to evaluate magnetic resonance cholangiopancreatography (MRCP) in detecting choledocholithiasis in this group of patients. ⋯ Patients with resolving gallstone pancreatitis and a negative MRCP do not need preoperative ERCP or IOC. Only patients with a positive MRCP will require preoperative ERCP.
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The impact of lymphovascular invasion (LVI) on postmastectomy locoregional relapse (LRR) and its use in guiding locoregional therapy in node-negative breast cancer are unclear. This study evaluates the association of LVI with relapse and survival in a cohort of women with early-stage breast cancer. ⋯ LVI is an adverse prognostic factor for relapse and survival in node-negative patients treated with mastectomy and systemic therapy. LVI, in combination with age older than 50 years, premenopausal status, grade III histology, or estrogen receptor-negative disease, identified patient subsets with 7-year LRR risks of approximately 15% to 20%. Prospective research is required to define the role of adjuvant radiotherapy in these patients.
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My colleagues and I compared trauma patient demographics and outcomes between two time periods in the last 10 years in our Level I trauma center to evaluate the impact of the marked evolution in trauma care and determine additional opportunities for improvement. ⋯ Over the past decade, more older, severely injured patients have been admitted to our Level I trauma center. Overall mortality among these higher acuity patients has increased, with a marked shift in attributable mortality to CNS injury and away from late sepsis and multiple organ failure. This highlights the need for continued efforts to identify optimal management strategies for severe brain injury. Additional areas for improvement include enhancement of our regional trauma network and injury prevention initiatives.