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October 2016 - July 1920

Decade

Year

Issue

June 1, 2011, Vol 146, No. 6, Pages 630-765

Original Article

Early Postoperative Outcomes After Pancreaticoduodenectomy in the Elderly

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Arch Surg. 2011;146(6):715-723. doi:10.1001/archsurg.2011.115

Incidence and Risk Factors of Venous Thromboembolism in Colorectal SurgeryDoes Laparoscopy Impart an Advantage?

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Arch Surg. 2011;146(6):739-743. doi:10.1001/archsurg.2011.127
Invited Critique

Sometimes Less Is MoreComment on “Effect of Incomplete Parathyroidectomy Preserving Entire Parathyroid Glands on Renal Graft Function”

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Arch Surg. 2011;146(6):710-710. doi:10.1001/archsurg.2011.111

Angiographic Intervention in Patients With a Suspected Visceral Artery Pseudoaneurysm Complicating Pancreatitis and Pancreatic Surgery

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Arch Surg. 2011;146(6):647-652. doi:10.1001/archsurg.2011.11
ObjectiveTo assess the clinical effectiveness of angiography and transcatheter intervention in patients suspected of visceral artery pseudoaneurysm complicating pancreatitis and pancreatic surgery.DesignRetrospective study.SettingUniversity hospital.PatientsA total of 51 patients who underwent mesenteric angiography for a suspected visceral artery pseudoaneurysm following pancreatitis or pancreatic surgery from 1978 to 2010 were included in this study. There were 39 men and 12 women. The mean age was 66 years (range, 21-89 years) at the time of the angiography. Data on patients' demographics, medical history, angiographic findings, treatment, and outcomes were recorded. Of these 51 patients, 27 had acute pancreatitis, 22 had pancreatic cancer, and 2 experienced pancreatic trauma. Embolization was performed for patients with a pseudoaneurysm. One patient was treated with a stent graft.Main Outcome MeasuresThe technical success rate of the intervention, the 24-hour and 30-day rebleeding rates, and the 24-hour and 30-day mortality rates were calculated. A multivariate analysis was performed to determine the factors associated with survival following angiography.ResultsOf the 51 patients studied, 23 had a visceral artery pseudoaneurysm involving the gastroduodenal (7 patients), hepatic (5 patients), splenic (5 patients), and other arteries (7 patients). The technical success rate of the intervention (ie, embolization or exclusion with a Stent graft) was 100%. The 24-hour and 30-day rebleeding rates were 4% and 17%, respectively. The 24-hour and 30-day mortality rates were 0% and 9%, respectively. For the 27 patients who had a negative angiographic finding, the 24-hour and 30-day rebleeding rates were 0% and 11%, respectively, and the 24-hour and 30-day mortality rates were 4% and 21%, respectively. The requirement of a large number of blood products prior to angiography was associated with poor outcome.ConclusionEmbolization was highly effective in treating a pseudoaneurysm complicating pancreatitis and pancreatic surgery. The hemodynamic status at the time of angiography determines overall survival.

The Vulnerable Stage of Dedicated Research Years of General Surgery ResidencyResults of a National Survey

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Arch Surg. 2011;146(6):653-658. doi:10.1001/archsurg.2011.12
ObjectiveTo characterize the demographics and attitudes of US general surgery residents performing full-time research.DesignCross-sectional national survey administered after the 2008 American Board of Surgery In-Service Training Examination.SettingTwo hundred forty-eight residency programs.ParticipantsGeneral surgery residents.InterventionSurvey administration.Main Outcomes MeasuresA third of categorical general surgery residents interrupt residency to pursue full-time research. To our knowledge, there exist no comprehensive reports on the attitudes of such residents.ResultsFour hundred fifty residents performing full-time research and 864 postgraduate year 3 (PGY-3) clinical residents completed the survey. Thirty-eight percent of research residents were female, 53% were married, 30% had children, and their mean age was 31 years. Residency programs that were academic, large, and affiliated with fellowships had proportionally more research residents compared with other programs. Research and PGY-3 residents differed (P < .05) on 10 survey items. Compared with PGY-3 residents, research residents were less likely to feel they fit well in their program (86% vs 79%, respectively), that their program had support structures if they struggled (72% vs 64%), or that they could turn to faculty (71% vs 65%). They were more likely to feel training was too long (21% vs 30%) and that surgeons must be specialty trained (55% vs 63%). In multivariate analyses, research residents believed surgical training was too long (odds ratio, 1.36) and they fit in less well at their programs (odds ratio, 0.71) (P < .05).ConclusionsCompared with PGY-3 residents, research residents report less satisfaction with important aspects of training, suggesting this is a vulnerable stage. Interventions could be targeted to facilitate support and better integration into the mainstream of surgical education.

The Vulnerable Stage of Dedicated Research Years of General Surgery ResidencyResults of a National Survey

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Arch Surg. 2011;146(6):653-658. doi:10.1001/archsurg.2011.12

Early vs Interval Appendectomy for Children With Perforated Appendicitis

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Arch Surg. 2011;146(6):660-665. doi:10.1001/archsurg.2011.6
ObjectiveTo compare the effectiveness and adverse event rates of early vs interval appendectomy in children with perforated appendicitis.DesignNonblinded randomized trial.SettingA tertiary-referral urban children's hospital.PatientsA total of 131 patients younger than 18 years with a preoperative diagnosis of perforated appendicitis.InterventionsEarly appendectomy (within 24 hours of admission) vs interval appendectomy (6-8 weeks after diagnosis).Main Outcome MeasuresTime away from normal activities (days). Secondary outcomes included the overall adverse event rates and the rate of predefined specific adverse events (eg, intra-abdominal abscess, surgical site infection, unplanned readmission).ResultsEarly appendectomy, compared with interval appendectomy, significantly reduced the time away from normal activities (mean, 13.8 vs 19.4 days; P < .001). The overall adverse event rate was 30% for early appendectomy vs 55% for interval appendectomy (relative risk with interval appendectomy, 1.86; 95% confidence interval, 1.21-2.87; P = .003). Of the patients randomized to interval appendectomy, 23 (34%) had an appendectomy earlier than planned owing to failure to improve (n = 17), recurrent appendicitis (n = 5), or other reasons (n = 1).ConclusionsEarly appendectomy significantly reduced the time away from normal activities. The overall adverse event rate after early appendectomy was significantly lower compared with interval appendectomy.Trial Registrationclinicaltrials.gov Identifier: NCT00435032

Neuronal Differentiation of Human Adipose Tissue–Derived Stem Cells for Peripheral Nerve Regeneration In Vivo

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Arch Surg. 2011;146(6):666-674. doi:10.1001/archsurg.2011.148

Impact of Antiviral Therapy on the Survival of Patients After Major Hepatectomy for Hepatitis B Virus–Related Hepatocellular Carcinoma

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Arch Surg. 2011;146(6):675-681. doi:10.1001/archsurg.2011.125

Comparative Analysis of Resection and Liver Transplantation for Intrahepatic and Hilar CholangiocarcinomaA 24-Year Experience in a Single Center

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Arch Surg. 2011;146(6):683-689. doi:10.1001/archsurg.2011.116

Endoscopic Excision of Large Colorectal Polyps as a Viable Alternative to Surgical Resection

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Arch Surg. 2011;146(6):690-696. doi:10.1001/archsurg.2011.126

Hilar CholangiocarcinomaTumor Depth as a Predictor of Outcome

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Arch Surg. 2011;146(6):697-703. doi:10.1001/archsurg.2011.122

Effect of Incomplete Parathyroidectomy Preserving Entire Parathyroid Glands on Renal Graft Function

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Arch Surg. 2011;146(6):704-710. doi:10.1001/archsurg.2011.138

Minimally Invasive Esophagectomy Provides Equivalent Oncologic Outcomes to Open Esophagectomy for Locally Advanced (Stage II or III) Esophageal Carcinoma

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Arch Surg. 2011;146(6):711-714. doi:10.1001/archsurg.2011.146

Pancreatic Endocrine Tumors With Major Vascular Abutment, Involvement, or Encasement and Indication for Resection

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Arch Surg. 2011;146(6):724-732. doi:10.1001/archsurg.2011.129

Early-Stage Gallbladder Cancer in the Surveillance, Epidemiology, and End Results DatabaseEffect of Extended Surgical Resection

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Arch Surg. 2011;146(6):734-738. doi:10.1001/archsurg.2011.128
Review

Bariatric Surgery as a Novel Treatment for Type 2 Diabetes MellitusA Systematic Review

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Arch Surg. 2011;146(6):744-750. doi:10.1001/archsurg.2011.134
Special Feature

Image of the Month—Quiz Case

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Arch Surg. 2011;146(6):755-755. doi:10.1001/archsurg.2011.124-a

Image of the Month—Diagnosis

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Arch Surg. 2011;146(6):756-756. doi:10.1001/archsurg.2011.124-b

Image of the Month—Quiz Case

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Arch Surg. 2011;146(6):757-757. doi:10.1001/archsurg.2011.137-a

Image of the Month—Diagnosis

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Arch Surg. 2011;146(6):758-758. doi:10.1001/archsurg.2011.137-b

Image of the Month—Quiz Case

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Arch Surg. 2011;146(6):759-759. doi:10.1001/archsurg.2011.140-a

Image of the Month—Diagnosis

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Arch Surg. 2011;146(6):760-760. doi:10.1001/archsurg.2011.140-b
Research Letters

Dynamic Parietal Closure: Initial Experience of an Original Parietal Closure Procedure for Treatment of Abdominal Wound Dehiscence

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Arch Surg. 2011;146(6):762-764. doi:10.1001/archsurg.2011.112
Correspondence

“Unnecessary” Postmastectomy Radiation Therapy

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Arch Surg. 2011;146(6):764-765. doi:10.1001/archsurg.2011.131

“Unnecessary” Postmastectomy Radiation Therapy—Reply

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Arch Surg. 2011;146(6):765-765. doi:10.1001/archsurg.2011.132
From JAMA

Better Than the Lungs We Are Taking Out

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Arch Surg. 2011;146(6):645-646. doi:10.1001/archsurg.2011.123
Resident's Forum

An Alternative Pancreatic Anastomosis Following Pancreaticoduodenectomy

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Arch Surg. 2011;146(6):752-754. doi:10.1001/archsurg.2011.133
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