Surgery
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Obese patients (BMI>35) after blunt trauma are at increased risk compared to non-obese for organ dysfunction, prolonged hospital stay, infection, prolonged mechanical ventilation, and mortality. Obesity and non-alcoholic fatty liver disease (NAFLD) produce a low grade systemic inflammatory response syndrome (SIRS) with compromised hepatic blood flow, which increases with body mass index. We hypothesized that obesity further aggravates liver dysfunction by reduced hepatic perfusion following resuscitated hemorrhagic shock (HEM). ⋯ These data suggest that obesity significantly contributes to trauma outcomes through compromised vascular control or through fat-induced sinusoidal compression to impair hepatic blood flow after HEM/RES resulting in a greater hepatic injury. The pro-inflammatory state of NAFLD seen in obesity appears to prime the liver for hepatic ischemia after resuscitated hemorrhagic shock, perhaps intensified by insidious and ongoing hepatic hypoperfusion established prior to the traumatic injury or shock.
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Traumatic diaphragmatic injuries (TDI) are uncommon but associated with substantial morbidity and mortality. We sought to analyze patients with TDI at a large trauma center and associated county coroner to identify characteristics predictive of increased mortality. ⋯ Although TDI may indicate substantive trauma burden in any patient, those with greater ISS and advanced age are at the greatest risk of death.
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Guidelines for the current National Comprehensive Cancer Network recommend radical cholecystectomy, including hepatic resection and portal lymph node (LN) dissection, for patients with early stage gallbladder (GB) cancer. We sought to determine the survival benefit conferred by adequate LN evaluation. ⋯ LN evaluation is a critical component of radical resection for GB cancer. In the absence of LN evaluation, radical resection provides no benefit over cholecystectomy alone.
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In the trauma population, the use of retrievable inferior vena cava filters (RIVCF) is rapidly gaining acceptance in patients at high risk for venous thromboembolism. This study reports the impact of an institutional protocol on retrieval rates of RIVCF at a level I trauma center. ⋯ An institutional protocol for prospective monitoring of RIVCF significantly increases filter retrieval rate.
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Controversy exists regarding the extent of surgical treatment for paratracheal (level VI) lymph nodes in patients with papillary thyroid cancer (PTC). Local recurrence within lymph nodes in the central neck compartment after total thyroidectomy can be difficult to detect and more hazardous to treat surgically. An initial bilateral central lymph node dissection (CLND) can best minimize this risk of local recurrence, if CLND is established as reasonably safe and oncologically justified. ⋯ Lymph node metastases are present in both the ipsilateral and contralateral central lymph node basins in a significant percentage of patients with PTC. Routine bilateral CLND in patients with PTC has the potential to clear metastatic disease without significantly increasing the risk of RLN injury.