Arch Surg Chicago
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Randomized Controlled Trial Comparative Study Clinical Trial
Occlusion of hepatic blood inflow for complex central liver resections in cirrhotic patients: a randomized comparison of hemihepatic and total hepatic occlusion techniques.
Intermittent occlusion of hepatic blood inflow by means of a hemihepatic or total hepatic occlusion technique is essential for reducing operative blood loss. Central liver resection to preserve more functioning liver parenchyma is mandatory for centrally located liver tumors in patients with cirrhosis, but it requires a longer overall hepatic ischemic time because of a wide transection plane. No controlled comparison has been performed for the 2 techniques in these operations. ⋯ Intermittent hemihepatic and total occlusion of hepatic blood inflow are safe in cirrhotic patients with an overall ischemic time of greater than 60 minutes. However, for complex liver resections with an estimated liver transection plane of greater than 60 cm(2), hemihepatic occlusion of blood inflow, if feasible, may be recommended in cirrhotic patients to reduce operative blood loss and the incidence of blood transfusion under our defined occlusion time.
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The power of servant leadership to transform health care organizations for the 21st-century economy.
Physician leadership is emerging as a vital component in transforming the nation's health care industry. Because few physicians have been introduced to the large body of literature on leadership and organizations, we herein provide a concise review, as this literature relates to competitive health care organizations and the leaders who serve them. ⋯ In contrast, outside the health care sector, service industries have repeatedly demonstrated that transformational, situational, and servant leadership styles are most successful in energizing human resources within organizations. This optimization of intellectual capital is further enhanced by transforming organizations into adaptable learning organizations where traditional institutional hierarchies are flattened and efforts to evoke change are typically team driven and mission oriented.
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Candida peritonitis (CP) is generally considered to be a severe disease, but its impact on outcome in critically ill patients remains unknown. ⋯ These results confirm the severity of CP in ICU patients and emphasize the prognostic value of direct examination of peritoneal fluid for Candida in this context.