The Journal of surgical research
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Wound and anastomotic healing is considered to be delayed in patients with obstructive jaundice. The study was designed to find out whether the healing of experimental suction blister wounds, skin collagen synthesis, and serum procollagen levels are affected by obstructive jaundice, and if biliary drainage may cause any alterations in these processes. ⋯ Healing of an experimental blister wound is not disturbed by obstructive jaundice. The decreased baseline skin collagen synthesis is partly restored by the resolution of jaundice. The results indicate that cell protein synthesis is disturbed earlier than cell dynamics in obstructive jaundice. The elevated serum PIIINP levels, which are most likely to be related to early fibrosis in liver, decreased after drainage.
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This study was designed to evaluate temporal trends in the use and type of operative and non-operative interventions in the management of diverticulitis. ⋯ There was a minimal increase in the frequency of diverticulitis admissions over time. A rise in percutaneous drainage procedures was associated with a decrease in emergency operative interventions. The proportion of patients undergoing colostomy remained stable, and there does not seem to be a significant increase in the use of one-stage procedures for diverticulitis.
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In this study, we investigated the ability of protamine sulfate, at sub-bactericidal dosing, to interfere with the in vivo virulence of Pseudomonas aeruginosa (PAO1) during burn wound infection. ⋯ Our results suggest that: (1) local injection of sub-bactericidal doses of protamine sulfate reduces the virulence of P. aeruginosa; (2) this effect is due to interference with the systemic rather than local spread of P. aeruginosa; and (3) local application of protamine sulfate may have potential as supportive therapy for prevention of systemic P. aeruginosa infection in severely burned patients.
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The extensive changeover in residents that occurs every July in university-affiliated hospitals has been postulated to result in impaired delivery of patient care as new house staff are less experienced and unfamiliar with hospital-specific systems (the "July phenomenon"). To assess the impact of this process on patient safety, we examined the incidence and sources of medical error and adverse outcomes on a pediatric general surgery service during the final month of an academic year and the first month of the subsequent academic year. ⋯ Resident changeover at the completion of an academic year did not result in an increased number of medical errors or adverse outcomes, indicating that effective systems are in place to prevent the "July phenomenon."
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Clavicular pseudoarthrosis is a rare condition, the management of which should not be underestimated because it requires re-operations and causes serious morbidity or even a lifelong handicap. ⋯ A single operation was adequate in seven cases; two operations were adequate in four cases and three operations were adequate in one case. Fractures healed properly in 11 cases, but in some cases mild-to-moderate symptoms still persisted post-operatively. The results of 13 patients who underwent various surgical procedures show that a reconstruction plate should be the first choice of osteosynthesis, followed by a dynamic-compression plate, and a semitubular plate should be the last choice. To conclude, with this kind of treatment of clavicular pseudoarthrosis, we achieved a high degree of patient satisfaction, as well as objective improvements in status reports.