The British journal of surgery
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Multicenter Study Observational Study
Combined effect of therapeutic strategies for bleeding injury on early survival, transfusion needs and correction of coagulopathy.
The combined effects of balanced transfusion ratios and use of procoagulant and antifibrinolytic therapies on trauma-induced exsanguination are not known. The aim of this study was to investigate the combined effect of transfusion ratios, tranexamic acid and products containing fibrinogen on the outcome of injured patients with bleeding. ⋯ A high platelet or plasma to RBC ratio, and use of tranexamic acid were associated with a decreased need for massive transfusion and increased survival in injured patients with bleeding. Early normalization of coagulopathy was not seen for any transfusion ratio, or for use of tranexamic acid or fibrinogen products.
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Comparative Study
Indications for major hepatectomy and combined procedures for advanced gallbladder cancer.
The clinical impact of major hepatectomy for advanced gallbladder cancer is currently unclear. ⋯ Major hepatectomy combined with portal vein resection or pancreatoduodenectomy, if necessary, may be considered in the treatment of advanced gallbladder cancer, especially in selected patients without liver metastasis or hepatic arterial invasion.
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The effect of anastomotic leakage on oncological outcomes after total mesorectal excision (TME) is controversial. This study aimed to assess the influence of symptomatic and asymptomatic anastomotic leakage on oncological outcomes after laparoscopic TME. ⋯ Symptomatic anastomotic leakage is a risk factor for disease recurrence in patients with rectal adenocarcinoma.
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RCTs testing surgical interventions can change clinical practice. The adequate reporting of surgical trials is an important issue. ⋯ The quality of reporting in surgical trials has improved in the past decade. Overall quality, however, remains suboptimal, particularly in relation to details regarding surgical interventions and management.
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Several studies have demonstrated an association between immediate autologous or implant-based breast reconstruction and a reduced incidence of lymphoedema. However, few of these have ocused specifically on whether the reconstruction method affects the development of lymphoedema. The study evaluated the potential impact of breast reconstruction modality on the incidence of lymphoedema. ⋯ The method of breast reconstruction may affect subsequent development of lymphoedema.