Annals of surgery
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Comparative Study
Survival and changes in comorbidities after bariatric surgery.
To evaluate survival rates and changes in weight-related comorbid conditions after bariatric surgery in a high-risk patient population as compared with a similar cohort of morbidly obese patients who did not undergo surgery. ⋯ Bariatric surgery appears to increase survival even in the high-risk, Medicare population, both for individuals aged 65 and older and those disabled and under 65. In addition, the diagnosed prevalence of weight-related comorbid conditions declined after bariatric surgery relative to a control cohort of morbidly obese patients who did not undergo surgery.
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Skin graft survival and healing requires rapid restoration of blood flow to the avascular graft. Failure or delay in the process of graft vascularization is a significant source of morbidity and mortality. One of the primary regulators of blood flow and vessel growth is nitric oxide (NO). The secreted protein thrombospondin-1 (TSP1) limits NO-stimulated blood flow and growth and composite tissue survival to ischemia. We herein demonstrate a role for TSP1 in regulating full thickness skin graft (FTSG) survival. ⋯ TSP1 through CD47 limits skin graft survival. Blocking TSP1 binding or suppressing CD47 expression drastically increases graft survival. The therapeutic applications of this approach could include burn patients and the broader group of people requiring grafts or tissue flaps for closure and reconstruction of complex wounds of diverse etiologies.
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Meta Analysis
The rupture rate of large abdominal aortic aneurysms: is this modified by anatomical suitability for endovascular repair?
There are no precise estimates of the rate of rupture of large abdominal aortic aneurysms (AAA). There is recent suspicion that anatomic suitability for endovascular repair may be associated with a decreased risk of AAA rupture. ⋯ Rupture rates of large AAAs reported in different studies are highly variable. There is emerging evidence that patients anatomically suitable for endovascular repair have lower rupture rates.
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Preoperative portal vein embolization (PVE) is used clinically to prevent postoperative liver insufficiency. The current study examined the impact of portal vein embolization on liver resection. ⋯ PVE is a safe and effective procedure in inducing liver hypertrophy to prevent postresection liver failure due to insufficient liver remnant.
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Randomized Controlled Trial
Randomized trial of division versus nondivision of the short gastric vessels during laparoscopic Nissen fundoplication: 10-year outcomes.
Although laparoscopic Nissen fundoplication is an effective procedure for the treatment of gastroesophageal reflux, in some patients it is followed by troublesome side effects, such as dysphagia, abdominal bloating, and inability to belch. It has been claimed that dividing the short gastric blood vessels during laparoscopic Nissen fundoplication minimizes the risk of these problems. We have previously reported the 6-month and 5-year outcomes from a randomized trial, which have shown no advantages after division of these vessels. In this study, we determined the longer-term (10 years) outcomes from this trial. ⋯ The 10-year clinical outcomes from this trial have shown no benefit for division of the short gastric vessels during laparoscopic Nissen fundoplication.