The Journal of surgical research
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Comparative Study
The role of laparoscopy in the management of malrotation.
Malrotation is currently treated via the Ladd's procedure. Many surgeons feel this operation should be performed using the open approach to facilitate adhesion development, thus decreasing the risk for volvulus. However, little comparative data exist on the relative merits of laparoscopy for this operation. Therefore, we have analyzed our experience with the open and laparoscopic Ladd's procedure. ⋯ A laparoscopic Ladd's procedure should be the initial approach in patients with malrotation in the absence of volvulus. We encourage a low threshold for conversion to an open approach if there is any concern about volvulus/orientation. This may decrease morbidity for patients who are found at operation to have a low risk of recurrent volvulus.
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Comparative Study
Despite the increasing use of nonoperative management of firearm trauma, shotgun injuries still require aggressive operative management.
The energy dissipation between gunshot and shotgun blasts is very different. Injuries from shotgun blasts vary depending on the distance of the victim from the shooter, the choke of the shotgun, the pellet load, and the wad of the ammunition. We postulated that gunshot and shotgun blasts create different injury patterns that dictate different treatment plans. ⋯ Although the injury severity was similar, injuries from shotguns required more operations and resource utilization. Shotgun blasts can create impressive superficial injuries as well as significant deep organ damage. An aggressive operative approach to managing shotgun trauma is advantageous.
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Previously, we have shown that cutaneous wounds in mid-gestational (E15) mice heal in a scarless manner with decreased procollagen 1 and increased procollagen 3 production compared with wounds in late-gestational (E18) mice, which heal with scars. The aim of the current work was to determine whether E15 and E18 fibroblasts respond to stimulation in culture with differential procollagen expression, suggesting they may preserve their phenotype in vitro. Further, we wanted to determine if fetal fibroblast gene expression patterns persisted in tissue culture. We measured expression of procollagen types 1alpha1 and 3 in response to TGF-beta1 stimulation. We theorized that E15 fibroblasts would respond with a pattern of procollagen that would contribute to a more easily remodeled collagen. ⋯ Our results from this in vitro work demonstrate a differential pattern of gene expression for procollagen 1alpha1 and 3 in E15 and E18 fibroblasts in response to TGF-beta1. E15 cells showed decreased expression of procollagen 1alpha1, while E18 cells showed increased procollagen 1alpha1 and decreased procollagen 3 expression. These patterns of expression in E15 cells are suggestive of increased type 3 to 1 collagen ratio seen in scarless fetal wounds. Interestingly, treatment of either E15 or E18 cells with TGF-beta1 significantly decreased procollagen 3 expression by 48 h, yet this was more profound in E15 groups. This suggests that after 24 h, E15 cells may transition towards an E18 phenotype and corresponding signaling.
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Very few quality indicators of care exist for surgical procedures. These may be used to both score the quality of care received, and as a method of improving the quality of care delivered (quality improvement initiatives). ⋯ This Delphi process has used the best available evidence, along with a consensus methodology employing the opinion of experts in the field, to identify 18 quality indicators for patients undergoing hepatic resection for metastatic colorectal cancer. These indicators will provide a means for benchmarking quality of care among surgeons, institutions, and health regions.
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To retrospectively evaluate the diagnostic performance and clinical utility of magnetic resonance imaging (MRI) in pregnant patients suspected of having acute appendicitis, when an ultrasound study generated an inconclusive result. ⋯ MRI represents a useful diagnostic test for acute appendicitis in pregnant women, and decreases the need for an emergency operation. Its high negative predictive value makes MRI useful for ruling out appendicitis in pregnant patients who have an inconclusive ultrasound. However, the low sensitivity observed in this study suggests that MRI, like other imaging modalities, is not perfect, and may miss an acute appendicitis diagnosis. Thus, future prospective clinical study of MRI as a diagnostic test for the evaluation of women who present with acute abdominal pain and possible appendicitis during pregnancy is warranted.