Surgery
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The adverse effects of blood transfusion after cancer surgery have been recently challenged in older anemic persons or those with substantial intraoperative blood loss. We hypothesized that intraoperative blood transfusions continue to adversely impact short-term cancer surgery outcomes regardless of age or preoperative hematocrit levels. ⋯ The present study shows that intraoperative blood transfusion adversely impacts short-term operative cancer surgery outcomes across all age groups and in those with low to normal hematocrit levels. These findings provide insightful implications on the patterns of blood transfusion during cancer surgery that deserve further investigation.
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The objectives of our study were to determine the association between age and postoperative outcomes after emergency surgery for diverticulitis and to identify risk factors for postoperative mortality among elderly patients. ⋯ Advanced age is an independent risk factor for death after emergency surgery for diverticulitis, with mortality being greatest among elderly patients who experience certain postoperative complications. Prevention of these complications should form the cornerstone of initiatives designed to lower the mortality associated with emergency surgery in elderly patients.
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Intraductal papillary mucinous neoplasms of the pancreas are defined as mucin-producing neoplasms arising in the main pancreatic duct (main duct type), its major branches (branch duct type), or in both (mixed type). Intraductal papillary mucinous neoplasms of the pancreas can occur as a single collection of cysts or as multifocal lesions. While subtypes of intraductal papillary mucinous neoplasms of the pancreas are well described in literature, little is known about the importance of multifocal intraductal papillary mucinous neoplasms of the pancreas. This study evaluated the clinicopathologic characteristics of patients with surgically resected, multifocal intraductal papillary mucinous neoplasm of the pancreas. ⋯ Most multifocal intraductal papillary mucinous neoplasms of the pancreas involve the main pancreatic duct and synchronously its major side branches (mixed type). Patients with multifocal intraductal papillary mucinous neoplasm of the pancreas present at an older age compared to patients with single cystic pancreatic neoplasm. The risk of harboring malignancy-nearly 60% in the present study-seems to be increased in patients with multifocal intraductal papillary mucinous neoplasms of the pancreas compared to single lesions.
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The assessment and treatment of trauma patients begins in the prehospital environment. Studies have validated the shock index as a correlate for mortality and the identification of shock in trauma patients. We investigated the use of the first shock index obtained in the prehospital environment and the first shock index obtained upon arrival in the trauma center as correlates for other outcomes to evaluate its usefulness as a triage tool. ⋯ A prehospital shock index for trauma correlates with measures of hospital resource use and mortality. A prospective study is needed to determine the use of this measure as a triage tool.
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For pancreatic cancer, complete macroscopic resection in combination with chemotherapy is the only potentially curative treatment. Many patients present with locally advanced cancers deemed unresectable. We sought to assess the results of exploration after neoadjuvant therapy for locally advanced possibly unresectable pancreatic cancer. ⋯ In locally advanced, unresectable pancreatic cancer, R0/R1 resections can be achieved in up to 40% of patients who undergo operation after neoadjuvant therapy. In these cases, survival rates are similar to those observed for initially resectable pancreatic cancer.