Annals of surgery
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Of 193 patients with penetrating wounds of the neck, 76 had only surgical exploration; 57 had only nonsurgical exploration including one or more of the following: arteriography, bronchoscopy, laryngoscopy, esophagoscopy, and contrast-swallow esophagogram; and 60 had both surgical and nonsurgical exploration. Eighty-six patients were wounded by gunshot, 108 by stabbing. Presenting signs and symptoms were an unreliable method of predicting presence or absence of injury. ⋯ Financial cost of a negative surgical exploration was $3185, while for four-vessel cerebral arteriography with panendoscopy it was $3492. More studies need to be done, particularly concerning venography and esophagoscopy. However, considering the fact that surgical exploration should by no means be considered 100% accurate, the data in this study support the fact that arteriography with panendoscopy represents an equally safe and acceptable method of exploration of penetrating wounds of the neck for stable patients without specific signs and symptoms of injury and can be expected to result in a reduced number of negative surgical explorations and their associated morbidity as well as a reduced length of hospital stay, although at a slightly higher financial cost when compared to mandatory surgical exploration.
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Comparative Study Clinical Trial
What causes center effects in kidney transplantation.
Results in 195 renal transplants were compared for two distinct patient populations, those from the out-of-town surrounding rural region and those from the local large metropolitan center. The 1-year cadaver kidney survival was strikingly higher in the group from out-of-town (62% vs. 43%, p less than 0.001). This was partially due to better patient survival in the out-of-town patients. ⋯ Other relevant factors were not different between the two groups. This strong dialysis center effect, which exerts a major influence on the subsequent likelihood of success, derives from some factor related to the derivation of the recipient. In addition to its possible implications for patient care, further study of this phenomenon would also be useful with regard to recent interest on the part of government and other third-party payment groups in transplant center results.
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This study represents the personal experience of a general surgeon in 70 cases of penetrating injuries of the heart. Eighteen patients with no signs of life on admission were subjected to a thoracotomy on the stretcher with a mortality of 94%. ⋯ In the author's opinion, percardiocentesis has no place in the diagnosis or treatment of cardiac injuries. Particular attention has been paid to the management of coronary artery injuries and the high incidence of air embolism in certain patients.
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Nearly 30% of patients with Crohn's disease requiring operative treatment have severe peripheral lymphopenia. The surgical significance of this finding had not been previously determined. One hundred fifty-eight patients with Crohn's disease admitted for resection of the diseased bowel were studied. ⋯ Also, lymphopenic patients were more likely to require separate resections of the diseased bowel and more than one anastomosis. Postoperative follow-up revealed that patients with preoperative lymphopenia had a markedly higher incidence of symptomatic recurrences within 3 years of operation (67 vs. 36%, p less than 0.01). It appears that the preoperative peripheral lymphocyte count may be used as an indicator of disease severity and prognosis in patients with Crohn's disease.