Journal of the American College of Surgeons
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Intensive insulin therapy to maintain serum glucose levels between 80 and 110 mg/dL has previously been shown to reduce mortality in the critically ill; recent data, however, have called this benefit into question. In addition, maintaining uniform, tight glucose control is challenging and resource demanding. We hypothesized that, by use of a protocol, tight glucose control could be achieved in the surgical trauma intensive care unit (STICU), and that improved glucose control would be beneficial. ⋯ Improvements in glucose control in the ICU can be achieved by using a protocol for intensive insulin therapy. In our ICU, this was temporally associated with a significant reduction in mortality.
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Fate of the remnant pancreas after resection of noninvasive intraductal papillary mucinous neoplasm.
The risk of local recurrence in the pancreatic remnant after resection of noninvasive intraductal papillary mucinous neoplasm (IPMN) is not well defined. ⋯ Patients who have undergone resection for noninvasive IPMN require indefinite surveillance because local recurrences may be identified several years from the initial operation and be resected while still noninvasive. Although the risk of local recurrence appears to increase in the setting of positive margins, the majority of patients with positive margins have not developed local recurrence. Negative margins should be the goal of the operation when achievable with partial pancreatectomy, but the risk of local recurrence is not high enough to mandate total pancreatectomy for microscopic positive margins.
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Academic medical centers are faced with increasing volumes, higher acuity, and, as a consequence, capacity issues. These affect operating room (OR) use and patient throughput, with negative impact on finances and patient and physician satisfaction. We evaluated our experiences in dealing with OR efficiency at a time of maximum hospital capacity and occupancy. ⋯ Academic medical centers face occupancy issues that are not likely to go away and will have an impact on OR volume and productivity. To improve the situation in a short-term fashion, a multidisciplinary approach involving several strategies will be needed.
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The influence of increased body mass index (BMI) on morbidity and mortality in critically injured trauma patients has been studied, with conflicting results. The objective of this study was to investigate the relationship between stratified BMI and outcomes in blunt injured patients. ⋯ This is the largest study to date evaluating the relationship between BMI and outcomes in critically injured trauma patients. Increasing BMI increases morbidity while having no proved influence on mortality.
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Neutrophils are thought to play pivotal roles in eliminating pathogens, and they have also been implicated in end organ dysfunction associated with systemic inflammatory response syndrome (SIRS). Because modulating neutrophil survival and function has been proposed as a therapy for sepsis, it remains critical to determine under which circumstances modulating neutrophil function is efficacious. The aim of this study was to investigate whether sustaining the presence of neutrophils activated by hemorrhagic shock (HEM) would be disadvantageous during subsequent sepsis, ie, inflammation plus infection, or systemic inflammation without infection. ⋯ Whether effects of prolonged survival of hemorrhage-primed neutrophils are beneficial or detrimental is determined by the nature of the second insult. During sepsis, prolonging neutrophil survival is beneficial, enhancing antimicrobial activity. Alternatively, during inflammation without infection, increased organ damage by long-lived neutrophils is detrimental.