Annals of surgery
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This study was designed to examine the effect of morphine administration on the intestinal mucus barrier and determine its direct effect on the virulence and lethality of Pseudomonas aeruginosa, one of the most frequent pathogens to colonize the gut of critically ill patients. ⋯ Morphine administration shifts intestinal P. aeruginosa to express a virulent phenotype and may play a role in its ability to causes lethal gut-derived sepsis in a susceptible host.
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Comparative Study
Short-term outcomes following open versus minimally invasive esophagectomy for cancer in England: a population-based national study.
To compare short-term outcomes of open and minimally invasive esophagectomy (MIE) for cancer. ⋯ Minimally invasive esophagectomy is increasingly performed in the United Kingdom. Although the study confirmed the safety of MIE in a population-based national data, there are no significant benefits demonstrated in mortality and overall morbidity. Minimally invasive esophagectomy is associated with higher reintervention rate. Further evidence is needed to establish the long-term survival of MIE.
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Recent studies have identified an acute traumatic coagulopathy that is present on admission to the hospital and is independent of iatrogenic causes. We have previously reported that this coagulopathy is due to the association of severe injury and shock and is characterized by a decrease in plasma protein C (PC) levels. Whether this early coagulopathy and later propensity to infection, multiple organ failure and mortality are associated with the activation of PC pathway has not been demonstrated and constitutes the aim of this study. ⋯ Acute traumatic coagulopathy occurs in the presence of tissue hypoperfusion and severe traumatic injury and is mediated by activation of the PC pathway. Higher plasma levels of aPC upon admission are predictive of poor clinical outcomes after major trauma. After activation, patients who fail to recover physiologic plasma values of PC have an increased propensity to later nosocomial lung infection.
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The effects of preoperative aspirin use on outcomes of cardiac surgery patients remain uncertain. This study was aimed to evaluate the effect of preoperative aspirin use on major outcomes in cardiac surgery patients. ⋯ Preoperative aspirin therapy is associated with a significant decrease in the risk of major cardiocerebral complications, renal failure, intensive care unit stay and 30-day mortality but does not increase the risk of readmissions in patients undergoing cardiac surgery.
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Comparative Study Controlled Clinical Trial
Pure transvaginal appendectomy versus traditional laparoscopic appendectomy for acute appendicitis: a prospective cohort study.
This report describes the first cohort study comparing pure transvaginal appendectomies (TVAs) to traditional 3-port laparoscopic appendectomies (LAs). ⋯ Pure TVA is a safe and well-tolerated procedure with significantly less pain and faster recovery compared to traditional LA.