Annals of surgery
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To identify risk factors associated with readmission for children treated with appendicitis, and to characterize variation in risk-adjusted readmission rates between children's hospitals. ⋯ Significant variation in risk-adjusted readmission rates exists among children's hospitals after treatment of appendicitis, and outliers can be identified at both ends of the performance spectrum. These findings may have important implications for the identification and dissemination of "best practices" from exemplar hospitals.
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To evaluate the effect of laparoscopic sleeve gastrectomy (LSG) on fasting and meal-stimulated release of the gut hormones ghrelin, pancreatic polypeptide (PP), peptide-YY (PYY), glucagon-like peptide-1 (GLP-1), and amylin and of the adipocytokine leptin. ⋯ LSG markedly improved glucose homeostasis and generated significant changes in ghrelin, PP, PYY, GLP-1, amylin, and leptin levels. These multiple hormonal actions may have several beneficial effects on the underlying mechanism of weight loss, demonstrating that LSG could be more than just a restrictive bariatric operation.
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Initial management of severe acute pancreatitis (SAP) is conservative. As a step-up approach, percutaneous catheter drainage (PCD) with saline irrigation is reported to be effective. Factors leading to surgery are unclear. ⋯ PCD reversed sepsis in 62% and avoided surgery in 48% of the patients. Reversal of sepsis within a week of PCD, APACHE II score at first intervention (PCD), and organ failure within a week of the onset of disease could predict the need for surgery in the early course of disease.
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This investigation aimed at exploring the prospects of a cure for persistent medullary thyroid cancer (MTC) stratified by basal calcitonin levels before reoperation and the number of lymph node metastases previously removed at outside facilities. ⋯ With serum calcitonin levels of 1000 pg/mL or lower before reoperation and the previous removal of 5 or fewer lymph node metastases, systematic lymph node dissection seems worthwhile for persistent MTC. These findings will need to be validated in independent series before being adopted more widely as a new standard of care.
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Ileal pouch anal anastomosis (IPAA) is the treatment of choice for chronic, medically refractory mucosal ulcerative colitis, indeterminate colitis, familial adenomatous polyposis (FAP), and a select group of patients with Crohn's disease. ⋯ IPAA is an excellent option for patients with MUC, IC, FAP, and select patients with Crohn's disease.