Annals of surgery
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To review current knowledge of hemorrhagic shock and reperfusion injury. ⋯ It is unlikely that a single treatment modality or "magic bullet" will be able to substantially block such a complex regulated process unless performed before feedback mechanisms known to be in place. Ongoing translational research will inevitably have a major impact on patient care.
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To obtain precise information on the optimal time window for surgical antimicrobial prophylaxis. ⋯ When cefuroxime is used as a prophylactic antibiotic, administration 59 to 30 minutes before incision is more effective than administration during the last half hour.
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Inguinal hernias are very common disorders, especially in men, with inguinal herniorrhaphy being one of the most frequently performed general surgical procedures in men. Theoretically, obesity might increase the risk of groin hernia by increasing intra-abdominal pressure. The objective of the present study was to investigate whether overweight and obesity in middle age could significantly predict future groin hernia in men. ⋯ In a large community-based sample of middle-aged men overweight and obesity were associated with a lower risk for groin hernia during an extended follow-up. Obesity, in comparison with normal weight, reduced the risk of groin hernia by 43%. A reduced risk of groin hernia was also noted in heavy smokers. Obviously, hernia may be more easily detected in lean men but a true protective effect cannot be excluded.
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To estimate the importance of center and provider effect and its implication on the estimation of treatment effect in surgical randomized controlled trials. ⋯ Provider and center effects play a significant role in the estimation of treatment effect of large randomized controlled surgical trials. Not accounting for such effects may lead to biased estimates and misleading conclusions. These effects should be accounted for in the design and analysis of such trials.
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Comparative Study
Comparative study of portal vein embolization versus portal vein ligation for induction of hypertrophy of the future liver remnant using a mini-pig model.
The extent of hepatectomies is limited by the functional reserve of the remnant liver. The introduction of preoperative portal vein occlusion techniques to induce a preoperative hyperplasia of the future liver remnant has reduced the risk of postoperative liver failure. However, it has remained a matter of debate whether partial portal vein embolization (PVE) or suture ligation of the portal branches during exploration is the preferred technique. We compared both techniques under standardized experimental conditions in a large animal model by means of effectiveness and pathophysiologic differences. ⋯ Both PVL and PVE are able to induce hypertrophy of the future liver remnant. In comparison, PVE is the more effective technique to increase the future liver remnant. This is due to a more effective, durable occlusion of the portal branches. Formation of collaterals between occluded and nonoccluded liver parts seems to be the cause of inferior regeneration in the ligation group.