Arch Surg Chicago
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Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field. ⋯ Previous interventions (excisional biopsy, incomplete dissection) in the regional basin that drain a melanoma site prior to definitive surgical procedures significantly increase the risk of melanoma recurrence in the surgical field, and they should be avoided. Fine-needle aspiration and sentinel node biopsy, performed with strict surgical oncologic techniques, are safe with regard to failure in the surgical field.
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Comparative Study
Correlation of central venous and arterial blood gas measurements in mechanically ventilated trauma patients.
Central venous blood gas (VBG) measurements of pH, PCO2, and base excess can be substituted for the same values obtained from an arterial blood gas (ABG) analysis in mechanically ventilated trauma patients, obviating the need for arterial puncture. ⋯ Central venous and arterial PCO2, pH, and base excess values correlate well, but their LOAs represent clinically significant ranges that could affect management. Although VBGs cannot be substituted for ABGs in mechanically ventilated trauma patients during the initial phases of resuscitation, clinically reliable conclusions can be reached with VBG analysis.
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Antecolic duodenojejunostomy prevents delayed gastric emptying (DGE) after a pylorus-preserving Whipple (ppW) procedure better than retrocolic duodenojejunostomy. ⋯ We recommend antecolic duodenjejunostomy in patients undergoing a ppW procedure regardless of their diagnosis.
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A majority of trauma patients with known seizure disorder with seizure activity were noncompliant with their medications, normal neurologic examination findings would predict negative results of head computed tomography (CT) scans, and the yield of CT scans would be insufficient to justify their routine use. ⋯ Neurologic examination is an unreliable predictor of intracranial injury in patients with seizure disorder. In trauma patients with seizure activity, the yield of CT scans in finding unsuspected intracranial abnormalities justifies its routine use regardless of prior history.
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Comparative Study
Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit.
Serum bicarbonate (HCO(3)) measurement may accurately and reliably be substituted for the arterial base deficit (BD) assay in the surgical intensive care unit (ICU). ⋯ Serum HCO(3) provides equivalent information to the arterial BD and may be used as an alternative predictive marker or guide to resuscitation. Low HCO(3) levels should prompt immediate metabolic acidosis evaluation and management.