Archives of Surgery最新文献

{"title":"Image of the month-quiz case.","authors":"Peter J Kneuertz, Midhun Malla, David P Cosgrove, Joseph M Herman, Ihab R Kamel, Jean-Francois H Geschwind, Andrew M Cameron, Timothy M Pawlik","doi":"10.1001/archsurg.2011.1505a","DOIUrl":"10.1001/archsurg.2011.1505a","url":null,"abstract":"","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 10","pages":"973"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"32399379","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"About this journal.","authors":"","doi":"10.1001/archsurg.147.9.792","DOIUrl":"https://doi.org/10.1001/archsurg.147.9.792","url":null,"abstract":"","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"792"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.147.9.792","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31588899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Influence of resident involvement on trauma care outcomes.","authors":"Marko Bukur,&nbsp;Matthew B Singer,&nbsp;Rex Chung,&nbsp;Eric J Ley,&nbsp;Darren J Malinoski,&nbsp;Daniel R Margulies,&nbsp;Ali Salim","doi":"10.1001/archsurg.2012.1672","DOIUrl":"https://doi.org/10.1001/archsurg.2012.1672","url":null,"abstract":"<p><strong>Hypothesis: </strong>Discrepancies exist in complications and outcomes at teaching trauma centers (TTCs) vs nonteaching TCs (NTCs).</p><p><strong>Design: </strong>Retrospective review of the National Trauma Data Bank research data sets (January 1, 2007, through December 31, 2008).</p><p><strong>Setting: </strong>Level II TCs.</p><p><strong>Patients: </strong>Patients at TTCs were compared with patients at NTCs using demographic, clinical, and outcome data. Regression modeling was used to adjust for confounding factors to determine the effect of house staff presence on failure to rescue, defined as mortality after an in-house complication.</p><p><strong>Main outcome measures: </strong>The primary outcome measures were major complications, in-hospital mortality, and failure to rescue.</p><p><strong>Results: </strong>In total, 162 687 patients were available for analysis, 36 713 of whom (22.6%) were admitted to NTCs. Compared with patients admitted to TTCs, patients admitted to NTCs were older (52.8 vs 50.7 years), had more severe head injuries (8.3% vs 7.8%), and were more likely to undergo immediate operation (15.0% vs 13.2%) or ICU admission (28.1% vs 22.8%) (P < .01 for all). The mean Injury Severity Scores were similar between the groups (10.1 for patients admitted to NTCs vs 10.4 for patients admitted to TTCs, P < .01). Compared with patients admitted to TTCs, patients admitted to NTCs experienced fewer complications (adjusted odds ratio [aOR], 0.63; P < .01), had a lower adjusted mortality rate (aOR, 0.87; P = .01), and were less likely to experience failure to rescue (aOR, 0.81; P = .01).</p><p><strong>Conclusions: </strong>Admission to level II TTCs is associated with an increased risk for major complications and a higher rate of failure to rescue compared with admission to level II NTCs. Further investigation of the differences in care provided by level II TTCs vs NTCs may identify areas for improvement in residency training and processes of care.</p>","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"856-62"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.1672","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30913665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Failure to rescue from residents?","authors":"Matthew J Martin","doi":"10.1001/archsurg.2012.1802","DOIUrl":"https://doi.org/10.1001/archsurg.2012.1802","url":null,"abstract":"","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"862-3"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.1802","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30913666","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative breast magnetic resonance imaging: a solution looking for a problem: comment on \"selective preoperative magnetic resonance imaging in women with breast cancer\"a solution looking for a problem.","authors":"Sharon S Lum","doi":"10.1001/archsurg.2012.1679","DOIUrl":"https://doi.org/10.1001/archsurg.2012.1679","url":null,"abstract":"","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"839-40"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.1679","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30912639","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of open operation for aortoiliac occlusive disease after failed endovascular therapy.","authors":"Rachel C Danczyk,&nbsp;Erica L Mitchell,&nbsp;Bryan D Petersen,&nbsp;James Edwards,&nbsp;Timothy K Liem,&nbsp;Gregory J Landry,&nbsp;Gregory L Moneta","doi":"10.1001/archsurg.2012.1649","DOIUrl":"https://doi.org/10.1001/archsurg.2012.1649","url":null,"abstract":"<p><strong>Objectives: </strong>To compare patient outcomes of primary open operation for aortoiliac occlusive disease (AIOD) with those of secondary open operations for failed endovascular therapy (ET) of AIOD.</p><p><strong>Design: </strong>A retrospective cohort study was performed analyzing demographic characteristics, comorbidities, and outcomes.</p><p><strong>Setting: </strong>Affiliated Veterans Affairs Hospital from January 1, 1998, through March 31, 2010.</p><p><strong>Patients: </strong>Patients who underwent primary open operation for AIOD or secondary open operation for failed ET of AIOD.</p><p><strong>Main outcome measures: </strong>Overall survival and limb salvage.</p><p><strong>Results: </strong>Primary open operations (n = 153) were 67 aortobifemoral grafts (43.8%), 38 axillobifemoral grafts (24.8%), and 48 femoral-femoral grafts (31.4%). Secondary open operations (n = 35) were 28 aortobifemoral grafts (80.0%), 5 axillobifemoral grafts (14.3%), and 2 femoral-femoral grafts (5.7%). Mean (SD) 5-year survival was 48.2% (5.6%) and 66.8% (10.0%), respectively, for patients undergoing primary vs secondary open surgery for AIOD (P = .01). There were 7 amputations during a mean follow-up of 3 years, all in the primary open surgery group.</p><p><strong>Conclusions: </strong>Despite a higher proportion of coronary artery disease and a 20% conversion of claudication to critical limb ischemia after failed ET for AIOD, survival was longer in patients undergoing secondary vs primary open surgery. Patients who underwent open surgery after failed ET for AIOD did not require amputation. Failed ET for AIOD does not lead to worse outcomes for patients undergoing open surgery for AIOD.</p>","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"841-5"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.1649","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30912640","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Could the endo-first strategy really be better?","authors":"Jason T Lee","doi":"10.1001/archsurg.2012.2021","DOIUrl":"https://doi.org/10.1001/archsurg.2012.2021","url":null,"abstract":"sion. Danczyk et al 1 hypothesized that failed endovascular AIOD procedures lead to worse outcomes when converted to open surgery and review their 12-year experience. To my surprise, and I suspect somewhat to theirs, this turns out not to be the case. In fact, survival and outcomes of the secondary open operations are actually better than those of primary open operations (5-year survival, 67% vs 48%). Although there may be numerous explanations for this observation that the authors acknowledge is counterintuitive, one of the takeaway messages of this article is that secondary open conversion after failed AIOD endovascular treatment is at least not worse. Unlike failed infrainguinal endovascular interventions that often lead to higher rates of amputation, failed endovascular AIOD treatments were not associated with this. To answer the question I pose in the title, this article providescompellingevidencethatforinflowdisease,endovascular interventions should be the preferred initial route. In terms of patency, durability, patient comfort, and physician comfort, iliac stenting is at least as good as, if not better than, aortofemoral bypass. We now have evidencethat,evenifthereissomefearoflong-termconsequencesfromiliacstentingshoulditfail,theopenconversion is not worse than initial primary open operations. The endo-first, and many times an endo-second and endo-third, approach for AIOD is justified for most patients, and this strategy, even if it fails, is not hurting patients or their long-term outcomes.","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"846"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.2021","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30912641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What you hear is what you get.","authors":"Julie Ann Freischlag","doi":"10.1001/archsurg.2012.2168","DOIUrl":"https://doi.org/10.1001/archsurg.2012.2168","url":null,"abstract":"","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"795"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.2168","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30912755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preoperative imaging of pulmonary metastases in patients with melanoma: implications for minimally invasive techniques.","authors":"Travis B Kidner,&nbsp;Jeong Yoon,&nbsp;Mark B Faries,&nbsp;Donald L Morton","doi":"10.1001/archsurg.2012.1667","DOIUrl":"https://doi.org/10.1001/archsurg.2012.1667","url":null,"abstract":"<p><strong>Hypothesis: </strong>Preoperative imaging underestimates the number of pulmonary melanoma metastases. Although thoracoscopic resection is less invasive than resection via thoracotomy, it does not allow manual palpation of the lung to identify any metastases not visible on the preoperative scan or at the time of resection.</p><p><strong>Design: </strong>Retrospective review of a prospectively maintained database.</p><p><strong>Setting: </strong>Tertiary referral center.</p><p><strong>Patients: </strong>A total of 170 patients who underwent preoperative computed tomography of the chest, followed within 30 days by thoracotomy for resection of pulmonary metastatic melanoma.</p><p><strong>Main outcome measures: </strong>Number of pathology-confirmed pulmonary metastases detected by preoperative chest computed tomography vs intraoperative manual palpation.</p><p><strong>Results: </strong>The mean age of the patients was 49.5 years at initial diagnosis of melanoma and 57.1 years at diagnosis of pulmonary metastases; 69% of patients were male. A total of 334 pulmonary metastases were resected; the mean lesion size was 2.0 cm (range, 0.1-14.0 cm). In 49 of 190 pulmonary resections (26%), manual palpation of the subpleural parenchyma revealed lesions not identified during preoperative imaging. The rate of 5-year overall survival was 33%.</p><p><strong>Conclusions: </strong>Preoperative imaging underestimates the number of pulmonary lesions in patients with metastatic melanoma. Because incomplete resection of metastatic disease is associated with worse outcomes, we recommend caution when considering a minimally invasive approach for the resection of pulmonary metastatic melanoma.</p>","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"871-4"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.1667","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30913670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Detection of colon cancer metastases with fluorescence laparoscopy in orthotopic nude mouse models.","authors":"Rhiana S Menen,&nbsp;Sharmeela Kaushal,&nbsp;Cynthia S Snyder,&nbsp;Mark A Talamini,&nbsp;Robert M Hoffman,&nbsp;Michael Bouvet","doi":"10.1001/archsurg.2012.704","DOIUrl":"https://doi.org/10.1001/archsurg.2012.704","url":null,"abstract":"<p><strong>Objective: </strong>To improve detection of colon cancer metastases using fluorescence laparoscopy (FL).</p><p><strong>Design: </strong>An orthotopic mouse model of human colon cancer was established by intracecal injection of HCT-116 human colon cancer cells expressing green fluorescent protein into 12 mice. One group modeled early disease and the second modeled late metastatic disease. For the early-disease model, 2 weeks after implantation, 6 mice underwent 2 modalities of laparoscopy: bright field laparoscopy (BL) and FL. The number of metastases identified within each of the 4 abdominal quadrants was recorded with both laparoscopy modalities. This process was repeated in the late-metastatic disease group 4 weeks after implantation. All animals were then humanely sacrificed and imaged using open fluorescence laparoscopy (OL) as a positive control to identify metastases.</p><p><strong>Setting: </strong>Basic science laboratory.</p><p><strong>Participants: </strong>Twelve female, 6-week-old nude mice.</p><p><strong>Interventions: </strong>Detection of tumor foci by FL compared with BL.</p><p><strong>Main outcome measures: </strong>Number of tumors identified in each quadrant. RESULTS Fluorescence laparoscopy enabled superior visualization of colon cancer metastases compared with BL in the early (P = .03) and late (P = .002) models of colon cancer. Compared with OL, BL was significantly inferior in the early (P = .04) and late (P < .001) groups. Fluorescence laparoscopy was not significantly different from OL in the early (P = .85) or late (P = .46) group. Thus, FL allowed identification of micrometastases that could not be distinguished from surrounding tissue using BL.</p><p><strong>Conclusions: </strong>The use of FL enables identification of metastases that could not be visualized using standard laparoscopy. This report illustrates the important clinical potential for FL in the surgical treatment of cancer.</p>","PeriodicalId":8298,"journal":{"name":"Archives of Surgery","volume":"147 9","pages":"876-80"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1001/archsurg.2012.704","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30913671","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}