Annals of surgery
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Comparative Study
Accurate localization and surgical management of active lower gastrointestinal hemorrhage with technetium-labeled erythrocyte scintigraphy.
There is disagreement over the reliability of technetium Tc 99m (99mTc)-labeled erythrocyte scintigraphy in the localization of active lower gastrointestinal hemorrhage. A previous study at The New York Hospital-Cornell Medical Center that showed a superior sensitivity for localization of scintigraphy versus angiography in surgical patients led the authors to emphasize scintigraphy as the diagnostic test of first choice in the clinical diagnostic algorithm. The authors hypothesized that tagged erythrocyte scintigraphy can be used accurately as the primary diagnostic modality in localizing acute bleeding and guiding surgical intervention. ⋯ When performed correctly and interpreted conservatively, scintigraphy is a useful and safe means of guiding segmental resection, and should be the primary tool used in the diagnosis of patients with active lower gastrointestinal bleeding.
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The authors evaluate surgeon-performed ultrasound in determining the need for operation in patients with possible cardiac wounds. ⋯ Surgeon-performed ultrasound is a rapid and accurate technique for diagnosing hemopericardium. Delay times from admission to operating room are minimized when the surgeon performs the ultrasound examination.
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Randomized Controlled Trial Clinical Trial
Beta-blockade lowers peripheral lipolysis in burn patients receiving growth hormone. Rate of hepatic very low density lipoprotein triglyceride secretion remains unchanged.
The purpose of this study was to determine the effect of propranolol on peripheral lipolysis in massively burned children during treatment with recombinant human growth hormone (rhGH), and to ascertain whether decreased free fatty acid availability for re-esterification would alter the hepatic rate of secretion of triglycerides (TGs) bound to very low density lipoproteins (VLDLs). ⋯ The administration of propranolol to burned children receiving rhGH is safe, has salutary cardiovascular effects, decreases the release of FFA from adipose tissue and increases the efficiency of the liver in secreting fatty acids as VLDL TGs.
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An analysis was performed to evaluate early patterns of recurrence and survival in patients undergoing laparoscopic-assisted colectomies for primary colorectal cancer. Thirty-nine patients are available with a minimum of 24 months postoperative follow-up. ⋯ In this group of patients undergoing laparoscopic-assisted colectomies for primary colorectal malignancy, no adverse patterns of recurrence or decreased survival has been noted at 2-year follow-up when compared with standard open colorectal cancer surgery statistics. Prospective randomized studies with long-term follow-up will be required to better define the potential benefits and adverse effects of laparoscopic surgery for colorectal malignancy.
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The authors define the role of palliative pancreaticoduodenectomy in patients with pancreatic carcinoma. ⋯ Pancreaticoduodenectomy can be performed with a similar perioperative morbidity and mortality and only a minimal increase in hospital stay when compared with traditional surgical palliation. Pancreaticoduodenectomy with postoperative chemotherapy and radiation therapy is associated with improved long-term survival when compared with patients treated with surgical bypass. These data support the role of palliative pancreaticoduodenectomy in patients with pancreatic carcinoma and with local residual disease.