J David Richardson

..Decisions made within the next few years will likely decide the future of general surgery as a specialty...

..The treatment of esophageal perforation remains controversial, particularly in terms of the type of operative therapy. This report analyzed results of an aggressive treatment protocol...

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..Delayed laparoscopic evacuation of these collections prevents bile peritonitis and decreases inflammatory response and avoiding early operation, which has been implicated in increased death from hemorrhage...

..A high level of suspicion must be maintained when evaluating all potential laryngotracheal injury patients irrespective of the mechanism of injury...

..The authors evaluated a statewide experience to assess the effect of age on resource utilization and outcomes for this common disease...

..As laparoscopic techniques for elective splenectomy become more common, the changing indication for splenectomy has important ramifications for surgical education and training...

..The necessity of an abdominal operative intervention further amplifies this effect. Trauma and cirrhosis is, in fact, a deadly duo...

..In Kentucky, pediatric solid organ injuries are usually managed nonoperatively in both trauma and nontrauma centers, but trauma centers cared for fewer isolated solid organ injuries...

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..This integration positively impacts patient flow and resident work hours without altering patient outcomes or direct hospital cost...

..The presence of contrast extravasation is highly associated with the need for pelvic embolization in patients with pelvic fractures, but its absence does not exclude the need for pelvic angiography...

..Changing a line within 24 hours may not be sufficient to reduce the risk of CLBSI. Every effort should be made to adhere to proper sterile technique while placing central venous catheter...

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..Additionally, many patients arrive moribund and care provided is likely to be futile. We sought to examine the impact of these situations on TC mortality...

..A higher rate of liver-related mortality was seen in the PED population. Overall, PED patients seemed to sustain fewer liver related complications necessitating invasive procedures despite similar injury patterns...

..However, most information on C. difficile colitis is from large tertiary-care medical centers. Whether the community hospital experience is similar to that of large referral centers is unknown...

..Nevertheless, during the same period, the number of verified trauma centers has significantly increased. This study assesses the economic drive behind this dichotomy...

..Primary repair of HVI is preferred although no survival disadvantage is seen in other forms of repair in marginally stable patients. Definitive repair at the initial operation decreases complications...

..Our acute care surgeon (ACS) group aggressively treats complications of penetrating chest trauma with VATS, and our results suggested that the early use of VATS by ACS should be expanded...

..Our faculty includes surgeons with both broad-based and narrowly focused practices. In light of duty-hour restrictions and proposed changes in surgical training, we assessed the results of this model over an extended period...

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..Although many institutions have been individually affected by shortages of NS providing care to injured patients, data on regional changes in NS availability and the effect on patient care are limited...

..This review assesses the outcome of operative and nonoperative management of liver injury after blunt trauma...

..Since the majority of such patients have multicavitary injuries that require prior operation and are commonly coagulopathic, caution should be exercised when deciding whether to proceed with thoracotomy based solely on chest tube output...

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..To review the literature on the use of video-assisted thoracoscopic surgery for the diagnosis and treatment of intrathoracic injuries...

..To elucidate the cause of posttraumatic empyema, preoperative bronchoalveolar lavage (BAL)/sputum cultures obtained from patients with posttraumatic empyema were compared with cultures obtained at the time of decortication...

..Furthermore, all charts reviewed by the author presented an opportunity to compare actual patient data with that obtained from an administrative data set. This report also examines the author's attempts at improving outcome...

..This study was undertaken to evaluate outcomes with open repair and TEVAR for BTAI...

..We examined mesenteric lymph flow and proinflammatory constituents to determine whether DPR-stabilized interstitial compartment function could explain improved outcomes...

..The data support a conclusion that surgeons perceive they are not represented in a realistic manner with the insurance companies and the government when their core issues are decided...

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..This is thought to be a direct effect of hyperosmolar solutions on the visceral microvessels. The addition of PR to a CR protocol prevents the splanchnic ischemia that initiates systemic inflammation...

..Imatinib mesylate has been shown to decrease the density of tumor cells without causing inflammation or necrosis. Current studies are evaluating the usefulness of adjuvant therapy after primary surgical resection...

..Thus patients with facial fractures should be treated with the same caution as patients with significant blunt head trauma...

..There is evidence that supports a current undersupply of general surgeons with a potential for worsening workforce shortages in the future. This article examines this potential shortage along with its causes and possible consequences...

..Such treatment preserved esophageal function and was accomplished with relatively low morbidity and mortality...

..Focused abdominal sonography for trauma (FAST) is an unreliable method for assessing intra-abdominal injury in patients with seat belt marks...

..Tracheobronchial injuries are relatively uncommon, and few data are available on the long-term effects of their treatment...

..Five of the patients have been followed a mean of six years and remain well. Esophagectomy is a safe and appropriate treatment option in the setting of recurrent and end stage achalasia...

..The long-term success of bariatric operations for weight reduction has been well documented, but their potential effects on the risk of esophageal cancer have not been evaluated...

..This procedure offers a much more physiologic approach to certain duodenal problems than a gastric jejunojejunostomy...

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..It has been our experience during the last decade that VATS is a safe, reliable, and effective alternative to conventional open thoracic surgery...

..A continuum of the prospective evaluation process is required by the RRC-S and other surgical specialties to ensure that requisite surgical volume is maintained throughout the entire 5 years of clinical surgery...