Journal of the American College of Surgeons
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Randomized Controlled Trial Multicenter Study Clinical Trial
Fibrin sealant reduces the duration and amount of fluid drainage after axillary dissection: a randomized prospective clinical trial.
Patients who have axillary dissections during lumpectomy or modified radical mastectomy for breast carcinoma accumulate serosanguinous fluid, potentially resulting in a seroma. Currently accepted practice includes insertion of one or more drains for fluid evacuation. This multicenter, randomized, controlled, phase II study was undertaken to evaluate whether a virally inactivated, investigational fibrin sealant is safe and effective when used as a sealing agent to reduce the duration and volume of serosanguinous fluid drainage and to determine the dose response of this effect. ⋯ Application of fibrin sealant following axillary dissection at the time of lumpectomy or modified radical mastectomy can significantly decrease the duration and quantity of serosanguinous drainage. The viral safety of the product was also supported.
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Several authors have showed that bedside insertion of inferior vena cava filters (IVCF) is feasible and cost effective, with the additional benefit of not having to transport a critically ill patient to the operating room or radiology department. The objective of this study was to examine our experience of 158 IVCF insertions at the bedside in the intensive care unit. ⋯ Our results demonstrate the safety and efficacy of IVCF insertion at the bedside in the ICU. This method offers less resource use and more safety for critically ill patients, avoiding the hazards of intrahospital transport.
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Because T2 carcinoma of the gallbladder that invades perimuscular connective tissue without extension beyond serosa or into the liver has a hope for longterm survival, we attempted to clarify significant prognostic factors with respect to tumor- and surgery-related variables. ⋯ Results suggest that radical surgery is the treatment of choice for patients with T2 carcinoma of the gallbladder. The presence of lymph node metastasis, perineural invasion, or both suggests the necessity of additional treatment after radical surgery.
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Randomized Controlled Trial Comparative Study Clinical Trial
Comparison of pulmonary function and postoperative pain after laparoscopic versus open gastric bypass: a randomized trial.
Impairment of pulmonary function is common after upper abdominal operations. The purpose of this study was to compare postoperative pulmonary function and analgesic requirements in patients undergoing either laparoscopic or open Roux-en-Y gastric bypass (GBP). ⋯ Laparoscopic gastric bypass resulted in less postoperative suppression of pulmonary function, decreased pain, improved oxygenation, and less atelectasis than open gastric bypass.