Surgery
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We sought to obtain unbiased estimates of open cholecystectomy outcomes in a population-based cohort of elderly patients during the immediate prelaparoscopic era. ⋯ This study provides an unbiased assessment of open cholecystectomy outcomes necessary for future comparisons of open and laparoscopic cholecystectomy in elderly patients. Estimates of the excess mortality rates associated with CBDE provide a benchmark for assessing the outcomes of alternative strategies for managing common duct stones during laparoscopic cholecystectomy. Findings regarding the rates of retained or recurrent common bile duct stones in patients undergoing simple cholecystectomy and IOC challenge widespread beliefs about the limited clinical importance of unsuspected common duct stones, at least in the elderly population, and are relevant to the debate about routine IOC.
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Most patients undergoing coronary artery bypass surgery receive homologous blood transfusions despite the availability of multiple pharmacologic and blood salvage conservation strategies. ⋯ Because major determinant of homologous blood transfusion during coronary bypass surgery is the predictable and unavoidable dilution of a small red cell mass that occurs when instituting cardiopulmonary bypass, adherence to defined transfusion criteria alone is a simple, safe, and effective strategy for decreasing blood product utilization.
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Elevations in levels of the pancreatic enzymes amylase and lipase occur frequently after trauma. The purpose of this prospective study was to examine the incidence of these enzyme elevations in patients suffering blunt trauma, their natural history, and their relationship to posttraumatic pancreatitis. ⋯ After blunt trauma 17% of patients displayed persistent pancreatic enzyme elevations, but the majority remained asymptomatic despite enteral feeding. Retroperitoneal injury may identify patients at risk for pancreatitis. Patients with isolated head injuries should be fed enterally.
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The experience at Loyola University Chicago was retrospectively reviewed to evaluate survival and functional outcome after single lung transplantation (SLT) and bilateral lung transplantation (BLT). ⋯ Patients who undergo BLT have significantly better postoperative pulmonary function than those who undergo SLT. On the basis of the study there was a trend toward better survival with BLT.