Annals of surgery
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Comparative Study
Early aggressive use of fresh frozen plasma does not improve outcome in critically injured trauma patients.
Recent data from Iraq supporting early aggressive use of fresh frozen plasma (FFP) in a 1:1 ratio to packed red blood cells (PRBCs) has led many civilian trauma centers to adopt this resource intensive strategy. ⋯ Early and aggressive use of FFP does not improve outcome after civilian injury. This may reflect inherent differences compared with military injury; however, this practice should be reevaluated.
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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
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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Comparative Study
Posterior retroperitoneoscopic adrenalectomy: preferred technique for removal of benign tumors and isolated metastases.
Posterior retroperitoneoscopic adrenalectomy (PRA) is a minimally invasive approach to removal of the adrenal gland. This anatomically direct approach, popularized by Walz, minimizes dissection and affords early access to the adrenal vein. We report the largest experience to date of PRA in the United States. ⋯ PRA is safe, avoids intra-abdominal adjacent organ mobilization, is unaffected by the presence of intra-abdominal adhesions, and is possible in obese patients. PRA may be the preferred technique for removing benign adrenal tumors and isolated metastases.
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Comparative Study
R1 resection by necessity for colorectal liver metastases: is it still a contraindication to surgery?
To compare long-term outcome of R0 (negative margins) and R1 (positive margins) liver resections for colorectal liver metastases (CLM) treated by an aggressive approach combining chemotherapy and repeat surgery. ⋯ Despite a higher recurrence rate, the contraindication of R1 resection should be revisited in the current era of effective chemotherapy because survival is similar to that of R0 resection.