Journal of the American College of Surgeons
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Comparative Study
TRISS methodology: an inappropriate tool for comparing outcomes between trauma centers.
The TRISS methodology has been used for comparison of survival outcomes between trauma centers. The purpose of this study was to evaluate the role of TRISS in comparing outcomes between a small and a large trauma center and evaluate its usefulness in various groups of patients. ⋯ The TRISS methodology is not a reliable tool for comparing outcomes between trauma centers and has an unacceptably high misclassification rate in patients with severe trauma.
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Resuscitation with Lactated Ringer's solution after hemorrhagic shock in rats has been shown to cause early cellular injury in the lung. We hypothesized that the use of energy substrates, such as ketone bodies, in the resuscitation fluids would protect against this injury. As markers of cellular injury we measured the induction of apoptotic cell death and the expression of Intracellular Adhesion Molecule-1 (ICAM-1). ⋯ Substitution of lactate with ketone bodies in the resuscitation fluid attenuates the expression of cellular injury markers in the lung.
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The number of laparoscopic pancreatic resections reported in the surgical literature has been remarkably low. Few substantive data are available concerning current indications and outcomes after laparoscopic pancreatectomy. The purpose of this article is to review the recent indications, complications, and outcomes after laparoscopic pancreatic resection. ⋯ This represents the largest single-institution experience with laparoscopic pancreatic resection. The considerable morbidity rate is comparable to recently published open series, and is likely inherent in pancreatic surgery, rather than the technical approach. Laparoscopic pancreatic surgery resulted in shorter hospital stays and appears to be safe for benign diseases.
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There has been a tremendous increase in interest on quality of life in surgical research. An increase in interest does not necessarily translate into better research. This study evaluates surgical articles that claim to measure or make some conclusion on quality of life. ⋯ Despite the emphasis on quality of life outcomes, a substantial number of studies made errors in conceptually defining quality of life and in use of quality of life instruments. Researchers and journal reviewers need to be better versed on the techniques of quality of life research.