Abstract:
BACKGROUND:Significant confusion exists about management of blunt carotid injuries (BCI). Currently, three common treatments are being used without significant longterm followup data to demonstrate efficacy. Although heparin has been shown to reduce in-hospital stroke rates, antiplatelet therapy (aspirin and clopidogrel) has emerged as an alternate therapy without proved efficacy; carotid stenting has also been implemented for pseudoaneurysms (13% BCI), but its utility has recently been challenged. This is the first study to assess longterm efficacy of various therapeutic approaches. STUDY DESIGN:Consecutive patients treated and followed at a single regional trauma center over 10 years (1996 to 2005) were reviewed. Outcomes evaluated included cerebral infarction, functional status, and angiographic evolution. RESULTS:One hundred ten patients (11/year) were diagnosed with 133 injuries (23 bilateral). Overall mortality was 26%, with 6% directly attributable to BCI. Angiographic followup was available on 67 injuries (in 50 patients) at a mean of 6 months (range 0.25 to 67 months); 75% remained the same or improved. Clinical followup was available in 55 of 81 patients (68%) who survived to discharge (mean, 34.4 months [range 1 to 109 months]). Of surviving patients receiving antithrombotic therapy, 44% were treated with antiplatelet therapy, 49% with anticoagulation, and 7% with both. No patients experienced cerebral infarction after discharge, and there was no difference in functional outcomes based on the therapy received. Twenty-two endovascular stents were placed (18 for pseudoaneurysms, 4 for extensive dissection). Mean followup on these patients was 29.7 months (range 3 to 94 months). No patients receiving stents experienced periprocedural complications, and one patient with an associated brain injury had a cerebral infarction. CONCLUSIONS:Longterm followup of BCI demonstrates that antithrombotic therapy prevents cerebral infarction; antiplatelet therapy and anticoagulation are equally effective; and carotid stents appear to be safe and effective for lesions that develop pseudoaneurysms or extensive dissections.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Edwards NM,Fabian TC,Claridge JA,Timmons SD,Fischer PE,Croce MAdoi
10.1016/j.jamcollsurg.2006.12.041subject
Has Abstractpub_date
2007-05-01 00:00:00pages
1007-13; discussion 1014-5issue
5eissn
1072-7515issn
1879-1190pii
S1072-7515(07)00085-3journal_volume
204pub_type
杂志文章abstract:BACKGROUND:Intraluminally placed polytetrafluoroethylene grafts are associated with enhanced graft endothelialization and diminished intimal hyperplasia when compared with interposition grafts. This study determined the role of platelet-derived growth factor in intraluminal graft healing. STUDY DESIGN:Thirty dogs unde...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Recent population-based studies have demonstrated that the use of intraoperative cholangiography (IOC) during laparoscopic cholecystectomy (LC) is associated with a decrease in the rate of common bile duct (CBD) injury. The cost implications of a management strategy involving routine IOC use have not been ad...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(02)01806-9
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:The monopolar "Bovie" instrument emits radiofrequency energy that can disrupt the function of other implanted electronic devices through a phenomenon termed electromagnetic interference. The purpose of this study was to quantify the electromagnetic interference occurring on cardiac implantable devices (CIEDs...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2014.03.060
更新日期:2014-09-01 00:00:00
abstract:BACKGROUND:The technique of lymphatic mapping and sentinel lymph node (SLN) biopsy is rapidly becoming the preferred method of staging the axilla of the breast cancer patient. This report describes the impact of postinjection massage on the sensitivity of this surgical technique. STUDY DESIGN:Lymphatic mapping at the ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(00)00771-7
更新日期:2001-01-01 00:00:00
abstract:BACKGROUND:Most studies comparing surgical results of laparoscopic procedures for gastric cancer with open gastrectomies have been conducted based on limited experience. We aimed to compare laparoscopy-assisted distal gastrectomy (LADG) and conventional open distal gastrectomy (ODG) after a protracted learning experien...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.02.028
更新日期:2006-06-01 00:00:00
abstract:BACKGROUND:Surgical patients increasingly have more comorbidities and are of an older age, complicating surgical decision-making in emergent situations. Little is known about surgeons' perceptions of shared decision-making in these settings. STUDY DESIGN:Twenty semi-structured interviews were conducted with practicing...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章,多中心研究
doi:10.1016/j.jamcollsurg.2018.01.008
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:The outcomes after elective surgery in patients with cirrhosis have not been well studied. STUDY DESIGN:We used the Nationwide Inpatient Sample (NIS) to identify all patients undergoing elective surgery for four index operations (cholecystectomy, colectomy, abdominal aortic aneurysm repair, and coronary art...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.09.006
更新日期:2009-01-01 00:00:00
abstract:BACKGROUND:Recurrent hepatocellular carcinoma (RHCC) after curative resection is a major challenge for hepatic surgeons. A better understanding of the clonal origin of RHCC will help clinicians design personalized therapy and assess postoperative outcomes. The current study was performed to determine the clonal origin ...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.07.402
更新日期:2013-12-01 00:00:00
abstract::The preoperative diagnosis of inflammatory aneurysms of the abdominal aorta (IAAA) is seldom made, yet knowledge of its presence would be an aid to the surgeon. A heightened awareness of the variety of clinical presentations of IAAA should prompt the clinician to consider this entity in the differential diagnosis of b...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-06-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to determine the overall survival (OS) of patients with resectable gastric cancer treated with preoperative chemoradiation therapy and gastrectomy. STUDY DESIGN:The medical records of patients with gastric adenocarcinoma presenting to our institution (January 1995 to August 201...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2015.04.004
更新日期:2015-07-01 00:00:00
abstract:BACKGROUND:Triage decision correctness for children in motor vehicle crashes can be affected by occult injuries. There is a need to develop a transfer score (TS) metric for children that can help quantify the likelihood that an injury is present that would require transfer to a trauma center (TC) from a non-TC, and imp...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.09.018
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Cirrhosis as an independent predictor of poor outcomes in trauma patients was identified in 1990. We hypothesized that the degree of preinjury hepatic dysfunction is, by itself, an independent predictor of mortality. STUDY DESIGN:The trauma registry at our Level I trauma center was queried for all ICD-9 cod...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2006.08.001
更新日期:2006-12-01 00:00:00
abstract:BACKGROUND:Metabolic syndrome (MetS) increases cardiovascular risk and is associated with poor patient outcomes. We hypothesized that MetS confers an increased risk of morbidity and mortality in severely injured trauma patients. STUDY DESIGN:We performed a retrospective review of trauma patients from 2014 through 2018...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2019.09.009
更新日期:2020-01-01 00:00:00
abstract:BACKGROUND:Our goal was to identify factors that can be targeted during medical education to encourage a career in surgery. STUDY DESIGN:We conducted a cross-sectional survey of first and fourth year classes in a Liaison Committee on Medical Education-accredited medical school. Students scored 19 items about perceptio...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2005.02.033
更新日期:2005-06-01 00:00:00
abstract:BACKGROUND:Single-site laparoscopy (SSL) attempts to further reduce the surgical impact of minimally invasive surgery. However, crossed instruments and the proximity of the endoscope to the operating instruments placed through one single site leads to inevitable instrument or trocar collision. We hypothesized that a no...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2010.10.009
更新日期:2011-03-01 00:00:00
abstract:BACKGROUND:In the western literature, controversy exists regarding the operative management of carcinoma of the stomach. Still debated are the extent of gastric resection, the role of splenectomy, and the significance of lymphadenectomy. STUDY DESIGN:We performed a retrospective study of 646 consecutive patients who u...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-11-01 00:00:00
abstract:BACKGROUND:There is increasing interest in surgical outcomes. The Patient Safety in Surgery (PSS) Study database was examined about thyroid and parathyroid procedures to determine risk factors for adverse outcomes and outcomes rates. Relative outcomes performance for the Veterans Affairs (VA) and private-sector populat...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2007.02.073
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND:Enthusiasm for radiofrequency ablation (RFA) therapy for patients with unresectable hepatocellular carcinoma (HCC) has increased. The data for recurrence after RFA for patients with HCC is not well documented. The purpose of this study was to evaluate tumor recurrence patterns after RFA in patients with unre...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/S1072-7515(03)00750-6
更新日期:2003-11-01 00:00:00
abstract:BACKGROUND:Procedure-related complications contribute to 1-year mortality in patients with perforated ulcers. Natural orifice translumenal endoscopic surgery (NOTES) might offer a new repair approach. STUDY DESIGN:Swine were randomized to laparoscopic or NOTES repair. Laparoscopic gastrotomy creation (1 cm) was follow...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2009.11.014
更新日期:2010-04-01 00:00:00
abstract:BACKGROUND:Computed tomography is commonly used to rule out intra-abdominal injury (IAI) in children, despite associated cost and radiation exposure. Our purpose was to derive a prediction rule to identify children at very low risk for IAI after blunt abdominal trauma (BAT) for whom a CT scan of the abdomen would be un...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2016.12.041
更新日期:2017-04-01 00:00:00
abstract::Difficult pelvic operations for malignancy or complex benign conditions can be associated with extensive blood loss. Religious beliefs that preclude transfusion and the known risks of homologous blood have prompted investigators to seek alternatives to transfusion. We used the Haemonetics-V50 Cell Separator (Haemoneti...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1994-04-01 00:00:00
abstract:BACKGROUND:This study was undertaken to report our experience with major vascular injuries in gynecologic laparoscopy in order to specify the circumstances under which they occurred, the means of diagnosis, the risk factors, and the means for prevention. STUDY DESIGN:Retrospective case review study. RESULTS:Seventeen...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1997-11-01 00:00:00
abstract:BACKGROUND:The value of frozen sections in the intraoperative examination of sentinel nodes (SN) remains controversial. Accurate frozen sections will spare those patients with node metastasis from a second procedure to complete the axillary dissection. We examined our own experience with intraoperative examination of S...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2008.06.341
更新日期:2008-11-01 00:00:00
abstract:BACKGROUND:We examine the technique of combining percutaneous transluminal angioplasty and secondary intravascular stent deployment with femorofemoral bypass graft in patients with bilateral aortoiliac occlusive disease. STUDY DESIGN:Retrospective review. RESULTS:During the 5-year period from June 1988 to October 199...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:In the present study we evaluated gastrointestinal motility after gastrectomy of a new pylorus-preserving technique that is becoming a popular operation for early stage carcinoma of the stomach. STUDY DESIGN:Using strain-gauge force transducers we studied gastrointestinal motility in control dogs, dogs afte...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:
更新日期:1995-12-01 00:00:00
abstract:BACKGROUND:Many surgeons believe that primary fascial closure with mesh reinforcement should be the goal of abdominal wall reconstruction (AWR), yet others have reported acceptable outcomes when mesh is used to bridge the fascial edges. It has not been clearly shown how the outcomes for these techniques differ. We hypo...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2013.08.015
更新日期:2013-12-01 00:00:00
abstract:BACKGROUND:Type or lack of insurance may affect access to care, treatment, and outcomes. We evaluated trends for surgical management of all peripheral arterial disease (PAD) in-hospital admissions by insurer status in New York State. STUDY DESIGN:Statewide Planning and Research Cooperative System (SPARCS) data were ob...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2012.05.033
更新日期:2012-09-01 00:00:00
abstract:BACKGROUND:Small bowel obstruction (SBO) represents roughly 15% of admissions by general surgeons. Management of SBO relies heavily on provider judgment, including decisions on how long to try nonsurgical management and whether to use a laparoscopic or open approach when surgery is needed. Given the subjective nature o...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2017.11.006
更新日期:2018-06-01 00:00:00
abstract:INTRODUCTION:An effective strategy to manage acute pain while minimizing opioid exposure is needed for injured patients. In this trial, we aimed to compare two multimodal pain regimens (MMPR) in minimizing opioid exposure and relieving acute pain in a busy, urban trauma center. METHODS:This was an unblinded, pragmatic...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/j.jamcollsurg.2020.12.014
更新日期:2020-12-29 00:00:00
abstract:BACKGROUND:Rests of thyroid tissue within the thyrothymic area are relatively common and might be of clinical importance. The purpose of this study is to define the incidence and anatomy of thyroid tissue located in the line of the thyrothymic ligament, referred to here as "rests." STUDY DESIGN:Prospective descriptive...
journal_title:Journal of the American College of Surgeons
pub_type: 杂志文章
doi:10.1016/s1072-7515(02)01319-4
更新日期:2002-11-01 00:00:00