Annals of surgery
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Randomized Controlled Trial Multicenter Study Comparative Study
A prospective, randomized, double-blind, placebo-controlled multicenter trial comparing early (7 day) corticosteroid cessation versus long-term, low-dose corticosteroid therapy.
To compare outcomes with early corticosteroid withdrawal (CSWD) and chronic low dose corticosteroid therapy (CCS). ⋯ Early CSWD, compared with CCS, is associated with an increase in BCAR primarily because of mild, Banff 1A, steroid-sensitive rejection, yet provides similar long-term renal allograft survival and function. CSWD provides improvements in cardiovascular risk factors (triglycerides, NODAT requiring insulin, weight gain). Tacrolimus/MMF/antibody induction therapy allows early CSWD with results comparable to long-term low dose (5 mg/d) prednisone therapy.
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Comparative Study
Long-term outcomes with ileal pouch-anal anastomosis and Crohn's disease: pouch retention and implications of delayed diagnosis.
To assess long-term outcomes after ileal pouch-anal anastomosis (IPAA) in Crohn's disease (CD). ⋯ For CD patients with IPAA, when the diagnosis is established preoperatively or immediately following surgery, pouch loss rates are low and functional results are favorable. Outcomes in patients with delayed diagnosis are worse but half retain their pouch at 10 years with good functional outcomes.
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Multicenter Study Comparative Study
Experience with "sports hernia" spanning two decades.
Athletic pubalgia (AP) is a leading cause of athlete loss from competitive sports. Commonly misnamed "sports hernia," AP is a set of pelvic injuries involving the abdominal and pelvic musculature outside the ball-and-socket hip joint and on both sides of the pubic symphysis. Prospective studies show that timely intervention and appropriate repair of selected injuries results in greater than 95% success. ⋯ Better understanding and recognition of the injuries has led to more satisfactory care and returned many athletes to successful careers, which has had a major impact on modern sport.
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Comparative Study
Race and surgical outcomes: it is not all black and white.
Studies using Medicare data have suggested that African American race is an independent predictor of death after major surgery. We hypothesized that the apparent adverse effect of race on surgical outcomes is due to confounding by comorbidity, not race itself. ⋯ African American race is associated with greater comorbidity and cardiac/renal complications but is not an independent predictor of perioperative mortality after general surgery. Efforts to improve postoperative outcomes in African Americans should focus on reducing the need for emergency surgery and improving perioperative management of comorbid conditions.
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Comment Letter
The technique of reconstruction after total gastrectomy.