Journal of the American College of Surgeons
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Comparative Study
Operative management and outcomes of traumatic lung resection.
To analyze the presentation, injury patterns, and outcomes among a large cohort of patients requiring lung resection for trauma, and to compare outcomes stratified by the extent of resection. ⋯ Lung resection is infrequently required for traumatic injury, but carries substantial associated morbidity and mortality. The extent of lung resection is an independent predictor of hospital mortality, even after exclusion of patients with severe associated injuries. The worst outcomes were seen after complete pneumonectomy.
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Because herniorrhaphy failure and complication rates appear proportional to the number of previous repairs, multiply recurrent hernias (MRH) represent a formidable challenge. We sought to determine the safety and efficacy of open preperitoneal retrofascial mesh repair of MRH. ⋯ Open preperitoneal retrofascial mesh repair resulted in an effective herniorrhaphy with low perioperative morbidity in patients with MRH. Smoking cessation appears to be important in minimizing infectious complications. Given the technical challenge, surgical care of patients with MRH may be best provided in referral centers with interest and expertise in complex hernia repairs.
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Left hepatic trisectionectomy is the most extended hepatic resection. To date, few data are available on longterm outcomes after this operation. ⋯ Left trisectionectomy provides acceptable survival rates in both locally advanced primary hepatobiliary malignancies and large metastatic liver tumors. Despite major progress in surgical technique and perioperative management, left trisectionectomy is still associated with higher operative mortality and morbidity than less-extensive resections. Because selection criteria for this type of procedure are not clearly defined, particular attention should be focused on the oncologic benefits when considering this operation.
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Comparative Study
An ethanol protocol to prevent alcohol withdrawal syndrome.
Alcohol withdrawal syndrome (AWS) occurs in dependent patients during the initial period of sudden onset abstinence. It is usually manifested by mild symptoms such as disorientation, agitation, and tachycardia, but, if untreated, can lead to severe confusion, seizures, and even cardiovascular collapse. Prevention of AWS has been shown to improve morbidity and mortality and shorten hospital and ICU stays. We examined the efficacy of ethanol as a method of prophylaxis. ⋯ Intravenous ethanol is a viable option for AWS prophylaxis when administered in a systematic protocol.
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Identification of correlates of contemporary US medical graduates' surgical career plans can provide insights about the emerging surgical workforce composition and inform future recruitment efforts. ⋯ Contemporary graduates planning surgical careers represent a relatively narrow spectrum of US medical graduates, and those planning general-surgery careers differ in numerous ways from those planning surgical-specialty careers. Targeted efforts are warranted to recruit US medical graduates qualified to meet the nation's future health-care needs and advance the profession of surgery.