Surgery
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New technologies are available to reduce or prevent retained surgical sponges (RSS), but their relative cost effectiveness are unknown. We developed an empirically calibrated decision-analytic model comparing standard counting against alternative strategies: universal or selective x-ray, bar-coded sponges (BCS), and radiofrequency-tagged (RF) sponges. ⋯ Using currently available data, this analysis provides a useful model for comparing the relative cost effectiveness of existing sponge-tracking strategies. Selecting the best method for an institution depends on its priorities: ease of use, cost reduction, or ensuring RSS are truly "never events." Given medical and liability costs of >$200,000 per incident, novel technologies can substantially reduce the incidence of RSS at an acceptable cost.
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Routine central lymph node dissection (CLND) for papillary thyroid cancer (PTC) at the time of initial thyroidectomy has been advocated with a demonstrated decrease in post-ablation serum thyroglobulin compared to total thyroidectomy alone. Patients now present with central compartment metastatic disease after initial thyroid cancer surgery, or with a diagnosis of PTC after diagnostic lobectomy requiring completion thyroidectomy, and an undissected central compartment. Our aim was to compare the clinical outcomes in patients with PTC who underwent CLND as a secondary event with those having initial CLND. ⋯ This study demonstrates that there is no additional morbidity when CLND is performed as a secondary procedure for patients with PTC. Secondary CLND should be performed in patients with proven central compartment metastatic disease after previous thyroidectomy and can be offered safely as a prophylactic procedure to patients at high risk for central lymph node metastasis when CLND has not been performed at initial primary operation for PTC.
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Malnutrition in gastrointestinal (GI) surgery is associated with increased morbidity. Therefore, careful screening remains crucial to identify patients at risk for malnutrition and consequently postoperative complications. The aim of this study was to evaluate the ability of 3 established score systems to identify patients at risk of developing postoperative complications in GI surgery and to assess the correlation among the score systems. ⋯ The nutrition risk score, nutrition risk index, and bioimpedance analysis correlate with the incidence and severity of perioperative complications in GI surgery. The nutrition risk score was the best score in predicting patients who will develop complications in this study population. The correlation between the individual scores was only moderate, and therefore, they do not necessarily identify the same patients.
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Adiponectin, a key substance in metabolic syndrome, is known to have anti-inflammatory properties. The relationship between adiponectin and sepsis in vivo is unclear. In this study, the possible involvement of adiponectin in polymicrobial sepsis was investigated using adiponectin-knockout (APN-KO) mice that underwent cecal ligation and puncture (CLP) and received the peroxisome proliferator-activated receptor gamma (PPAR-gamma) that increases the plasma adiponectin concentration. ⋯ These results suggest that adiponectin deficiency may cause the high mortality and the high inflammatory cytokine levels in mice with polymicrobial sepsis.