Annals of surgery
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Primary duodenal gastrinomas are now recognized as a common etiology for patients with sporadic Zollinger Ellison Syndrome (ZES); however, the clinical and pathologic features of this condition and long-term outcome after operation are not well characterized. ⋯ Duodenal gastrinomas in patients with sporadic ZES are frequently small, most commonly located in the proximal duodenum, and associated with regional lymph node metastases in 60%. Disease-free survival is lower for patients with regional lymph node metastases suggesting that a more systematic lymphadenectomy to extirpate occult disease may be indicated in this group.
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Randomized Controlled Trial Clinical Trial
Improved net protein balance, lean mass, and gene expression changes with oxandrolone treatment in the severely burned.
To determine the effects of the anabolic agent oxandrolone on muscle protein and gene expression in severely burned children. ⋯ Oxandrolone improves protein net balance and lean mass in the severely burned. These changes are associated with increased gene expression for functional muscle proteins.
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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 review all admissions (age > 13) to three surgical patient care centers at a single academic medical center between January 1, 1995, and December 6, 1999, for significant surgical adverse events. ⋯ This study demonstrates no rational link between the tort system and the reduction of adverse events. Sixty-three percent of contributing causes to adverse events were undetected by current medical review processes. Adverse events occur at the interface between different systems or disciplines and result from multiple failures. Indemnity costs per hospital day vary dramatically by patient care center (range $3.60-97.60 US dollars a day). The regionalization of healthcare is in jeopardy from the burden of high indemnity payments.