Annals of surgery
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Nonoperative management (NOM) of rectal cancer after a complete clinical response (cCR) to neoadjuvant therapy is controversial. In this article, we retrospectively reviewed the outcomes of patients managed with selective NOM after a cCR to neoadjuvant treatment and compared these with patients who underwent standard rectal resection with a pathological complete response (pCR). ⋯ Rectal resection was successfully avoided in 81% of patients selected for NOM. When combined with salvage surgery, NOM appears to achieve similar local and distant disease control compared with patients with a pCR treated by rectal resection. Longer follow-up and prospective trials are warranted to evaluate this promising treatment option.
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To identify pressures created by surgical culture and social setting and explore mechanisms for how they might impact operative decision-making. ⋯ Sociopsychological literatures can be linked with decision-making and cognitive capacity theory. When cognitive resources reach their limit during critical and uncertain moments of an operation, the consumption of resources by the pressures of reputation and ego might interfere with the thought processes needed to execute the task at hand. Recognizing the effects of external social pressures may help the surgeon better self-regulate, respond mindfully to these pressures, and prevent surgical error.
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To develop a new international classification of acute pancreatitis severity on the basis of a sound conceptual framework, comprehensive review of published evidence, and worldwide consultation. ⋯ This classification is the result of a consultative process amongst pancreatologists from 49 countries spanning North America, South America, Europe, Asia, Oceania, and Africa. It provides a set of concise up-to-date definitions of all the main entities pertinent to classifying the severity of acute pancreatitis in clinical practice and research. This ensures that the determinant-based classification can be used in a uniform manner throughout the world.
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To evaluate the feasibility of transanal single port surgery in 15 consecutive patients. ⋯ Transanal single port surgery via the SSL is feasible and safe and may become a promising alternative to TEM.
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Documentation of the management of mass casualties in Tahrir Square. ⋯ We describe the pattern of injuries and our management of Tahrir Square mass casualties. We believe that forming multidisciplinary teams of surgeons, anesthesiologists, and nurses was the key to our effective management of such a huge event.