Arch Surg Chicago
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Burn injury typically elicits a hypermetabolic response characterized by increased energy expenditure and muscle protein catabolism. ⋯ These findings demonstrate the association of severe fever with further increase in energy expenditure and muscle protein catabolism in otherwise hypermetabolic burned children. This suggests a possible metabolic benefit in attenuating fever in such patients.
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Duodenal-preserving resection of the head of the pancreas (DPRHP) and pancreas head resection with segmental duodenectomy (PHRSD) can be alternatives to standard pancreaticoduodenectomy for benign periampullary lesions. ⋯ Duodenal-preserving resection of the head of the pancreas is recommended first for a benign or low-grade, early malignant pancreatic head lesion; PHRSD can be an option for a lesion of the ampullary-parapapillary duodenal area as well as the pancreatic head. Duodenal-preserving resection of the head of the pancreas can be converted to PHRSD if ischemia of the second portion of the duodenum occurs. We found benign periampullary lesions could be conservatively treated with DPRHP and PHRSD, which could substitute for classic pancreaticoduodenectomy.
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Early burn wound excision modulates the hypermetabolic response in severe pediatric burn injuries. ⋯ Early burn wound excision is a safe therapeutic approach that modulates the hypermetabolic response after burn injury. It was superior to the conservative treatment of silver sulfadiazine and delayed excision, and it should be considered when treating all severe full-thickness burns.
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Multicenter Study
Patient outcomes in academic medical centers: influence of fellowship programs and in-house on-call attending surgeon.
There are very few data on characteristics or policies that improve patient outcomes in academic medical institutions. We were interested in 2 such policies or characteristics that are commonly implemented in academic centers: an in-house on-call attending physician policy and the existence of postgraduate medical education. ⋯ An in-house on-call attending surgeon policy is not associated with improved outcomes. In contrast, presence of a trauma and surgical critical care fellowship program, a potential surrogate marker for an institution that is committed to this specialty interest, is associated with improved outcomes for critically injured patients. An investment in advanced postgraduate medical education has potential benefits in patient care and outcomes.
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Comparative Study
Decrease of collagen deposition in wound repair in type 1 diabetes independent of glycemic control.
Type 1 and type 2 diabetes mellitus and glycemic control influence wound healing in humans. ⋯ Collagen deposition in acute wounds is impaired in type 1 diabetes, possibly due to a decreased fibroblast proliferation. In type 2 diabetes, collagen deposition is normal. Glycemic control does not influence collagen deposition in acute wound repair in type 1 or in type 2 diabetes mellitus.