Journal of the American College of Surgeons
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Percutaneous dilational tracheostomy (PDT) is becoming a widely accepted technique that has replaced open tracheostomy (OT) in many hospitals. One of the remaining relative contraindications is morbid obesity. There are no published case series of its use in this patient population. We reviewed our experience with PDT in the morbidly obese and compared it to OT in this patient population. Our hypothesis is that PDT and OT have a similar frequency of adverse events. ⋯ PDT is a safe procedure to perform on morbidly obese patients.
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A two- or three-step procedure is mandatory for restorative proctocolectomy in patients presenting with severe or acute colitis complicating inflammatory bowel disease (IBD). The aim of this study was to analyze the feasibility of a total laparoscopic approach for consecutive subtotal colectomy (STC) and secondary ileal pouch-anal anastomosis (IPAA). ⋯ Our study suggests that a total laparoscopic approach is feasible and safe in inflammatory bowel disease patients with acute or severe colitis, not only for STC but also for IPAA after STC, with no mortality and an acceptable morbidity rate.
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Bullet-proof vests and helmets protect from harm in combat and military engagements. The use of armor against shrapnel has been studied, yet little has been documented as to how they protect from high velocity gunshots. This study aims to describe the medical consequences of high velocity firearm injuries and to differentiate between patients injured while using protective wear and those injured unprotected. ⋯ Body armor has a protective effect on victims of high velocity gunshot wounds; lower rates of head, brain, chest, and abdominal injuries are seen. In addition, armor reduces the severity of injuries to the chest and the abdomen.
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Comparative Study
Risk factors for anastomotic leakage after surgery for colorectal cancer: results of prospective surveillance.
Anastomotic leakage in operations for colorectal cancer not only results in morbidity and mortality, but also increases the risk of local recurrence and worsens prognosis. So a better understanding of risk factors for developing anastomotic leakage in colorectal cancer surgery is important to surgeons. The aim of this study was to determine the incidence and risk factors for clinical anastomotic leakage after elective surgery for colorectal cancer. ⋯ Preoperative steroid use, longer duration of operation, and contamination of the operative field were independent risk factors for developing clinical anastomotic leakage after elective resection for colorectal cancer. Surgeons should be aware of such high-risk patients, which would help them to decide whether to create a diversion stoma during surgery.
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Multicenter Study Comparative Study
Surgical resection of hepatic and pulmonary metastases from colorectal carcinoma.
Patients with hepatic and pulmonary metastases from colorectal cancer (CRC) may benefit from aggressive surgical therapy. We examined the longterm outcomes of patients who underwent both lung and liver resections for colorectal metastases over a 10-year period. ⋯ An aggressive multidisciplinary surgical approach should be undertaken for recurrent CRC metastases. In selected patients, serial metastasectomy for recurrent metastatic disease is safe and results in excellent longterm survival after CRC resection.