Surgery
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Although previously examined, the potential relationship between preoperative biliary drainage (PBD), intraoperative bile culture (IBC), and postoperative morbidity and mortality rate for pancreatic surgery remains unclear. ⋯ PBD predisposes to a positive IBC. Patients with a positive IBC have a clinically important increased risk of developing both infectious complications and wound infection after pancreatic surgery.
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"Fast-track" surgery, involving multimodal care, improves efficiency and short-term outcomes in patients undergoing bowel resection. The sustainability of the benefits and the "drag" effect on non-participating surgeons through changed nursing and resident practice is undetermined. ⋯ Implementation of a new practice pattern in a shared environment leads to improved outcomes for patients of other surgeons within the same environment. Dissemination and cross-pollination of new methods through resident, nurse, and case manager practice pattern modification creates a favorable force for change and this impact is sustained over a 3-year period.
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Controlled Clinical Trial
Serum interleukin-15 level is a useful predictor of the complications and mortality in severe acute pancreatitis.
In severe acute pancreatitis, multiple organ dysfunction syndrome and infectious complications are contributors to high mortality. Interleukin (IL)-15 is a novel cytokine that shares many biologic properties with IL-2. Serum IL-15 levels have not yet been determined in SAP. ⋯ Serum IL-15 level is a useful predictor of the complications (especially organ dysfunction) and mortality in severe acute pancreatitis.
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Comparative Study
Early discharge after nonoperative management for splenic injuries: increased patient risk caused by late failure?
With increasing experience and knowledge about nonoperative management of splenic injury (NOMSI), patients are being discharged early and possibly placed at risk for late failure of NOMSI and its associated complications. To evaluate if blunt trauma patients managed by NOMSI can be safely discharged early, because failure after the third day from injury occurs infrequently and is not associated with added morbidity. ⋯ Late failure occurs infrequently, unpredictably, and almost always in patients who are still in the hospital for associated injuries. In-hospital observation beyond the third day after injury is not necessary for most patients with splenic injury, who have no other reason to remain hospitalized.
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Although aggressive fluid hydration prevents a decrease in renal cortical perfusion (RCP) during laparoscopic donor nephrectomy, excess fluid is deleterious. We assessed whether goal-directed fluid administration, based on hemodynamic measures, would maintain RCP during pneumoperitoneum with less fluid loading. ⋯ A goal-directed strategy during pneumoperitoneum allows for tailored fluid administration and maintains RCP with lower volumes of intravenous fluid.