Arch Surg Chicago
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Comparative Study Clinical Trial
Cytoreductive surgery and intraperitoneal chemohyperthermia for peritoneal carcinomatosis arising from gastric cancer.
The most common cause of palliative resection and recurrence in gastric cancer is peritoneal seeding. This study evaluates the efficacy of intraperitoneal chemohyperthermia after cytoreductive surgery in patients with peritoneal carcinomatosis arising from gastric cancer. ⋯ An aggressive management strategy combining intraperitoneal chemohyperthermia with cytoreductive surgery is effective for patients with peritoneal carcinomatosis arising from gastric cancer. In highly selected patients (good general status, resectable primary tumor, resectable peritoneal carcinomatosis), this therapy may result in long-term survival.
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Comparative Study
Inpatient hospital admission and death after outpatient surgery in elderly patients: importance of patient and system characteristics and location of care.
Surgery at different outpatient care locations in the higher-risk elderly (age >65 years) population is associated with similar rates of inpatient hospital admission and death. ⋯ This study represents an initial effort to demonstrate the risk associated with outpatient surgery in a large, diverse population of elderly individuals.
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Comparative Study
Predictive factors for successful laparoscopic splenectomy in patients with immune thrombocytopenic purpura.
Younger patients with immune thrombocytopenic purpura (ITP) and high preoperative platelet counts successfully respond to laparoscopic splenectomy (LS). ⋯ A successful response to LS for ITP is expected in patients younger than 50 years and in those with preoperative platelet counts greater than 70 x 10(3)/microL. These factors can be incorporated into an equation that yields a splenectomy prediction score, which predicts the success of LS for ITP.
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Comparative Study
Oxygen transport dynamics after resuscitation with a conjugated hemoglobin solution.
Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP), a hemoglobin-based oxygen carrier, is effective in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage but may be less effective in off-loading oxygen at the tissue level. ⋯ Pyridoxalated hemoglobin polyoxyethylene conjugate is at least as effective as shed blood in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage. There is a disproportionately low contribution from plasma to oxygen consumption, which suggests that PHP may act as an oxygen sink in moderate anemia.
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Population-based hospital data indicate that African American patients undergo major lower extremity (LE) amputation 2 to 3 times more frequently than white patients. Some have attributed this to a lack of access to LE revascularization procedures by African American patients. To determine the likelihood that racial disparities in amputation rates are related to treatment choice, this study examines rates of primary amputation (major amputation without any previous attempt at revascularization) and repeat amputation. ⋯ The racial disparity at the study institution was primarily due to African American patients undergoing repeat major amputation at a significantly higher rate than whites.