Arch Surg Chicago
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Patients with hepatic metastases often develop obstruction of the intrahepatic inferior vena cava (IVC), known as IVC syndrome. This obstruction is debilitating due to the development of ascites and anasarca. ⋯ The debilitation of IVC syndrome due to ascites and anasarca can be considerably palliated by placement of transfemoral percutaneous stents.
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To examine the hypothesis that the futility of short-term care for trauma patients requiring emergency operation can be determined based on the number of units of blood transfused and associated risk factors. ⋯ Although mortality among critically injured patients requiring operation and massive blood transfusion can be correlated with independent risk factors, discontinuation of short-term care cannot be justified based on the need for massive blood transfusion of up to 68 units.
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Collis gastroplasty is indicated when tension-free fundoplication is not possible. Few studies have described the physiological results of this procedure, and no studies have evaluated outcomes of the endoscopic approach. ⋯ Collis gastroplasty allows a tension-free fundoplication to be performed to correct a shortened esophagus. It results in an effective antireflux mechanism but can be complicated by the presence of acid-secreting gastric mucosa proximal to the intact fundoplication and a loss of distal esophageal motility. These patients require close objective follow-up and maintenance acid-suppression therapy.
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To compare the effect of staffing with general surgeons vs trauma specialists on patient outcome at a trauma center. ⋯ Transitions in staffing afforded the opportunity to examine patient outcomes by surgeon specialization and frequency of call. In our sample, 12 well-trained surgeons taking call less frequently managed a trauma service as efficiently as a group of 4 trauma specialists, without any differences in morbidity and mortality.
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Although cardiac valve procedures are being performed more frequently in the elderly, long-term functional outcomes have not been well characterized. ⋯ Although greater resource expenditure is required for the initial perioperative convalescence, octogenarians can be expected to have an excellent functional outcome and long-term performance status after cardiac valve surgery.