Journal of the American College of Surgeons
-
Multicenter Study
Wearing surgical attire outside the operating room: a survey of habits of anesthesiologists and surgeons in Israel.
Nurses observe regulations restricting the use of uncovered surgical attire outside the operating room (OR), but there are no guidelines for physicians nor data on their habits in this matter. We assessed physicians' attitudes and behavior about OR attire in non-OR areas. ⋯ Israeli physicians behave differently with regard to wearing OR attire outside the OR. Orthopaedic surgeons and anesthesiologists are more disciplined, and gynecologists are the least observant. Most physicians recognize the importance of establishing strict guidelines of behavior.
-
Incidental appendectomy (IA) remains a controversial issue. The role of IA in the nonmanaged-care setting has not been evaluated recently. This study evaluates the cost-benefit of IA based on current third-party reimbursements and reports the incidence of pathology from routine IA during an 18-year period. ⋯ IA can be performed safely during open operation for other bowel pathology. Rate of clinically significant appendiceal pathology is low but not negligible. For patients with third-party payor status, IA can be more broadly performed during open gastrointestinal operation when no additional surgeon reimbursement is obtained.
-
Outcomes after resection of synchronous or metachronous hepatic and pulmonary colorectal metastases.
Surgical resection of isolated hepatic or pulmonary colorectal metastases prolongs survival in selected patients. But the benefits of resection and appropriate selection criteria in patients who develop both hepatic and pulmonary metastases are ill defined. ⋯ Surgical resection of both hepatic and pulmonary colorectal metastases is associated with prolonged survival in selected patients. Patients with a longer disease-free interval between metastases and those with single liver lesions had the best outcomes.
-
Ischemic bowel remains a critical problem, resulting in up to 80% mortality. Acute lung injury, a common complication after intestinal ischemia/reperfusion (I/R), might be responsible for such a high mortality rate. Our previous studies have shown that administration of a novel vasoactive peptide adrenomedullin (AM) and its binding protein (AMBP-1) reduces the systemic inflammatory response in rat models of both hemorrhage and sepsis. It remains unknown whether administration of AM/AMBP-1 has any protective effects on intestinal I/R-induced acute lung injury. We hypothesized that administration of AM/AMBP-1 after intestinal I/R prevents acute lung injury through downregulation of proinflammatory cytokines. ⋯ AM/AMBP-1 can be developed as a novel treatment to attenuate acute lung injury after an episode of gut ischemia. The protective effect of AM/AMBP-1 appears to be mediated through downregulation of proinflammatory cytokines.
-
Acute liver failure after major surgical procedures is associated with a high risk of multiple organ failure, including acute renal failure. The optimal time to initiate renal replacement therapy for acute renal failure is controversial because of the poor overall clinical outcomes. ⋯ The mortality rate in postoperative patients with acute liver failure-associated acute renal failure was very high. Earlier initiation of renal replacement therapy, based on the predialysis blood urea nitrogen level, with continuous venous-venous hemofiltration might provide a better ICU survival rate.