Annals of surgery
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Comparative Study
The LEGS score: a proposed grading system to direct treatment of chronic lower extremity ischemia.
To prospectively compare the Lower Extremity Grading System (LEGS)-derived "recommended treatment" to the actual treatment performed and to analyze LEGS intergrader scoring consistency by comparing blinded scoring results between physician graders. ⋯ A reproducible scoring system to guide the treatment of patients with chronic lower extremity ischemia is possible. While systems like the LEGS score may have potential clinical application, their use as a treatment standardization tool for future prospective outcomes comparisons between open and endovascular surgery will be essential.
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Comparative Study
Evolution of staged versus primary closure of gastroschisis.
Since the introduction of a preformed silo to the authors' practice in 1997, there has been a decrease in primary closure of gastroschisis. To clarify the impact of this change, the authors reviewed their results over the past 10 years. ⋯ A lower incidence of infection and complications related to abdominal compartment syndrome has made staged closure of gastroschisis more common in the authors' practice. While it has resulted in a longer hospital stay, staged closure decreases the risk of long-term bowel dysfunction and need for reoperation.
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Comparative Study
Complex blunt aortic injury or repair: beneficial effects of cardiopulmonary bypass use.
To compare the outcomes and associated morbidity in patients with blunt aortic injury (BAI) repaired using cardiopulmonary bypass versus no bypass. Special consideration is given to the influence of bypass in the outcome of complex injuries or repair circumstances. ⋯ With the use of cardiopulmonary bypass in the repair of BAI, the incidence of paraplegia/paresis has fallen. While patients with typical injuries and uncomplicated repair can expect good results with either technique, cardiopulmonary bypass provides significant advantages in the repair of those with CI/R. With the use of bypass, no CI/R patient developed paraplegia, while all CI/R patients experienced paraplegia before bypass use. Although others have reported the importance of clamp time, in this series clamp time appeared largely to be a surrogate variable for complexity of injury.
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To describe a novel in vitro human tissue-based angiogenic model that can predict an individual tumor's response to antiangiogenic drugs. ⋯ Epothilone B may be an effective antiangiogenic agent in a variety of tumor types. The authors speculate that this in vitro model might provide useful information to the clinician on the effect of specific antiangiogenic agents on individual tumors. This may be particularly useful in patients with tumors that, as a group, are unresponsive to treatment with antineoplastic agents.
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To study the effects of peritoneal resuscitation from hemorrhagic shock. ⋯ Despite the restoration of MAP with blood and saline infusions, progressive vasoconstriction and compromised intestinal blood flow occurs following HS/CR. Hyperosmolar PR during CR maintains intestinal blood flow and endothelial function. This is thought to be a direct effect of hyperosmolar solutions on the visceral microvessels. The addition of PR to a CR protocol prevents the splanchnic ischemia that initiates systemic inflammation.