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1.
Chamchad D Horrow JC Nakhamchik L Sauter J Roberts N Aronzon B Gerson A Medved M 《Journal of clinical anesthesia》2011,23(5):361-366
Study Objective
To determine if prophylactic glycopyrrolate prevents bradycardia after spinal anesthesia.Design
Prospective, randomized, double-blinded, placebo-controlled study.Setting
Large university-affiliated community hospital.Patients
81 consecutive term parturients (not in active labor) who were scheduled for elective Cesarean section.Interventions
Parturients received 1.0 to 1.5 L of intravenous Ringer's lactate and either glycopyrrolate 0.4 mg or an equal volume of saline, with caregivers blinded to the immediate sequelae of study drug. Each patient received intrathecal bupivacaine (12 to 14 mg) with morphine sulfate (0.1 to 0.2 mg).Measurements
Continuous heart rate (HR) and blood pressure monitoring occurred for 20 minutes, with the minimum HR recorded for each 5-minute epoch. Heart rates < 60 beats per minute defined bradycardia. Heart rate variability (HRV) analysis occurred offline.Main Results
None of 34 patients administered glycopyrrolate and 6 of 35 (17%) patients receiving saline experienced bradycardia (P = 0.02476). Time domain, frequency domain, and nonlinear and embedded spectrum entropy analyses all reflected the decrease in HRV accompanying administration of glycopyrrolate.Conclusion
Bradycardia after spinal anesthesia occurs commonly. Prophylactic glycopyrrolate may prevent the bradycardia, but not necessarily the hypotension. 相似文献2.
Marilyn W. Butler 《Journal of pediatric surgery》2010,45(2):303-309
Introduction
Pediatric general surgeons volunteering internationally often work independently, some without prior assessment of the needs of those they wish to assist. Consequently, care may be inefficient, duplicated, or misdirected. A study was performed to assess whether a network for pediatric surgery volunteer work exists.Methods
A search of the Internet was performed to determine whether a pediatric surgery network exists. Worldwide pediatric surgery societies were identified and grouped by country according to income. Web sites for medical volunteer organizations were examined for links to a network of pediatric surgery volunteer work.Results
A search of the Internet revealed no pediatric surgery volunteer network. Ninety-seven pediatric surgery societies were identified. Fifty-one of the organizations were identified as residing in low- and middle-income countries. Searching 50 Web sites for these societies revealed no existing pediatric surgery network. Of 45 Web sites for volunteer medical work, 1 surgery networking Web site was identified. Only 4 pediatric general surgery international volunteer opportunities were cited on that Web site.Conclusions
This study demonstrated that no pediatric surgery volunteer network exists. By identifying pediatric surgery organizations in low- and middle-income countries, it is speculated that one might link the surgeons in these regions with those wishing to volunteer their services. 相似文献3.
Chitra N. Sambasivan Karen E. Deveney Katherine T. Morris 《American journal of surgery》2010,199(5):599-603
Background
This study examined outcomes of laparoscopic and open rectal cancer surgery in a community hospital setting.Methods
A community health care system cancer registry was reviewed retrospectively (2004-2007) for rectal cancer patients undergoing surgical treatment. Primary end points were rates of recurrence and survival.Results
Both open and laparoscopic resection groups had similar demographic, treatment, and tumor characteristics. Most patients in the open resection and laparoscopic resection populations experienced no recurrence (79% vs 83%, respectively; P = .5). Overall, the groups had similar mean (88% vs 96%, respectively; P = .4) and disease-free (21 and 23 months, respectively; P = .5) survival.Conclusions
In a community hospital setting, laparoscopic resection of rectal cancer was found to be as safe and effective as open resection in selected patients. 相似文献4.
Hae Ran Yun M.D. Hee Cheol Kim M.D. Ph.D. Woo Yong Lee M.D. Ph.D. Yong Beom Cho M.D. Seong Hyeon Yun M.D. Ph.D. Ho-Kyung Chun M.D. Ph.D. 《American journal of surgery》2009,198(3):354-358
Background
For patients with T3N0M0 colon cancer without known risk factors, the necessity of chemotherapy has no definite consensus.Methods
From 1994 to 2004, we retrospectively analyzed 247 patients who had pathologically confirmed T3N0M0 colon cancer without risk factors.Results
Among the 247 patients, 198 (80.2%) received chemotherapy and 49 (19.8%) underwent surgery alone. The 5-year survival rate was 92.8% for patients with T3N0M0 colon cancer without risk factors. Only chemotherapy increased survival (P = .032) by multivariate analysis. The 5-year survival rates were 85.4% in the surgery-only group and 94.2% in the group that received surgery with chemotherapy. There was no difference in the therapeutic efficacy of 5-fluorouracil, capecitabine, and uracil/tegafur (P = .424) for survival.Conclusion
The results of this study showed that chemotherapy improved the survival of patients with T3N0M0 colon cancer without risk factors. 相似文献5.
Miyano G Yamataka A Doi T Okawada M Takano Y Kobayashi H Lane GJ Miyano T 《Journal of pediatric surgery》2006,41(5):1025-1028
Purpose
The aim of this study was to assess whether carbon dioxide insufflation (CDI) pneumoperitoneum prevents intraperitoneal adhesions (IPAs).Methods
Laparotomy was performed in 40 8-week-old Lewis rats and their bowels delivered through the wound and manipulated. The rats were divided into 4 groups, namely, those that would have laparotomy (Lp group, n = 15), Lp with CDI (Lp-CDI group, n = 15), Lp and bowel anastomosis (LpBA group, n = 5), and LpBA with CDI (LpBA-CDI group, n = 5). LpBA and LpBA-CDI group rats had 1 cm of ileum excised and end-to-end anastomosis performed. To accelerate IPA formation, all rats then had their bowels heated to 45°C for 40 seconds and 0.5 mL of Lewis rat blood spilled over them. Rats in the control group (n = 5) had Lp alone without heating or blood spillage. Pneumoperitoneum involved insufflating carbon dioxide into the peritoneal cavity through a cannula at the time of final abdominal closure to create pneumoperitoneum to a pressure of 5 mm Hg. All rats had relaparotomy 10 days after surgery and IPAs were assessed blindly using an IPA severity score (IPASS: 0 = no adhesions, 1 = no serosal tears during adhesiolysis, 2 = serosal tears during adhesiolysis, 3 = bowel perforation during adhesiolysis). Only the worst IPA in each rat was scored. Rats were killed after the peritoneum and bowels were excised for histopathology.Results
Pneumoperitoneum resolved in approximately 5 days. There were no associated side effects. The Lp-CDI group had significantly lower IPASS than the Lp group (0.23 ± 0.46 vs 1.07 ± 1.18, P < .05), and the LpBA-CDI group had significantly lower IPASS than the LpBA group (1.50 ± 0.61 vs 2.40 ± 0.55, P < .05). Histopathology showed pneumoperitoneum had no effect on the peritoneum or bowels.Conclusions
Our results suggest that CDI pneumoperitoneum appears to prevent IPA, especially between bowel-bowel IPA. 相似文献6.
Background/Purpose
There have been few studies documenting the effect of subspecialty training on outcomes after appendectomy in children. Some studies have suggested a better outcome in patients managed by pediatric surgeons as compared with general surgeons.Methods
We studied the effect of subspecialty training on clinical outcome and negative appendectomy rate after pediatric appendectomy. Children less than 19 years in Ontario who underwent appendectomy were identified. Outcomes were compared between pediatric and general surgeons. Subanalyses were conducted for the age groups 0 to 5, 6 to 12, and 13 to 18 years.Results
Over 8 years, 24,019 children underwent appendectomy with a preoperative diagnosis of appendicitis. Of these, 21,027 had appendicitis. General surgeons performed 81.2% of the operations. Negative appendectomy rates were 8.3% and 13.4% (P < .0001) in the pediatric and general surgeon groups, respectively. Children operated on by pediatric surgeons were younger (10.5 ± 3.6 vs 12.8 ± 3.8; P < .05), more likely to be perforated (36.6% vs 32.0%; P < .0001), and had a longer postoperative stay (3.8 vs 3.0 days; P < .0001). There was no difference between groups with respect to wound infection or readmission rate when age and perforation status were accounted for.Conclusions
Pediatric surgeons performed significantly fewer negative appendectomies than general surgeons. Although pediatric surgeons kept their patients longer in the hospital, their patients' wound infection and readmission rates were not different from that of the patients of general surgeons. 相似文献7.
Study Objective
To evaluate retrospectively serum albumin concentrations as well as morbidity and mortalitiy of abdominal surgical patients who -if hypoalbuminemic- did not receive human albumin solutions versus those who did receive such solutions.Design
Retrospective observational study.Setting
Academic community hospital.Measurements
The records of 76 consecutive patients who had undergone elective abdominal surgery were reviewed. Preoperative and postoperative serum albumin concentrations up to the seventh day after surgery were recorded. Morbidity and mortality were followed until the time of discharge from the hospital.Results
38 patients who received albumin replacement if they were hypoalbuminemic versus 38 patients who did not receive albumin replacement showed no significant difference in cumulative (P < 0.52) or individual postoperative complications (infections P < 0.35, cardiovascular complications P < 1.0, organ failure P < 0.67, thromboembolic incidents P < 0.26), and mortality (P < 0.47).Conclusions
Postoperative serum albumin concentration had no correlation with postoperative morbidity. There is no justification for perioperative albumin replacement in abdominal cancer surgical patients. 相似文献8.
Limpert JN Limpert PA Weber TR Bower RJ Trimble JA Micelli A Keller MS 《Journal of pediatric surgery》2003,38(6):924-927
Purpose
The aim of this study was to determine the outcome of extremely low-birth-weight infants (ELBW) requiring surgical interventions for the complications of prematurityMethods
One hundred eighty-seven consecutive infants with a birth weight less than 1,000 g treated over a 5-year period were reviewed. Outcome variables included number and types of surgical procedures; length of stay; survival rate and; pulmonary, neurologic, and gastrointestinal morbidity.Results
Surgical interventions were required in 66 (35%) infants (group S) weighing less than 1,000 g at birth (33% necrotizing enterocolitis/bowel perforation, 36% patent ductus arteriosus, 56% other). Overall mortality rate for group S infants was 23% compared with 22% for those not requiring surgery (group NS; P > .05). Mortality rate rose to 38% for those infants undergoing procedures for necrotizing enterocolitis/bowel perforation (P < .05). Although neurologic and pulmonary morbidity for the entire population were high, there was no difference in their incidence between surgical and nonsurgical groups (29% v 26% and 44% v 65%, group S v group NS, respectively; P > .05).Conclusions
These data suggest an improving outcome for ELBW infants. Common associated morbidities of prematurity do not appear adversely affected by surgical interventions supporting an aggressive approach to the care of these infants at the extreme of life. 相似文献9.
Fariba Navid Catherine A. Billups Andrew M. Davidoff JoAnn Harper Sheri L. Spunt 《Journal of pediatric surgery》2009,44(10):1965-1971
Background
Predictors of outcome have not been established for pediatric visceral and body wall nonrhabdomyosarcoma soft tissue sarcomas (NRSTS).Methods
The study used a retrospective review of clinical features and outcome of 61 patients with visceral and body wall NRSTS evaluated at our institution between March 1962 and December 1999.Results
Median age at diagnosis was 9.9 years (range, birth to 17.4 years). Tumors were greater than 5 cm in 43 (70%), high grade in 33 (54%), invasive in 25 (41%), and metastatic at presentation in 14 (23%) patients. Visceral tumors (n = 27) were more likely than body wall tumors (n = 34) to be greater than 5 cm (93% vs 53%; P < .001) and invasive (70% vs 18%; P < .001) and were less likely to be resected at diagnosis (44% vs 85%; P = .001). Estimated 10-year event-free survival (EFS) and overall survival (OS) for the entire cohort were 45.5% ± 6.9% and 56.8% ± 6.7%, respectively. The 10-year EFS and OS were better for patients with body wall sites than for those with visceral sites (61.8% ± 8.5% and 67.5% ± 8.2% vs 24.2% ± 9.4% and 43.0% ± 10.3%; P = .004 and P = .004). The 10-year estimated cumulative incidence (CI) of local recurrence was higher for patients with visceral sites than for those with body wall sites (64.3% ± 9.8% vs 26.5% ± 7.7%; P = .004), whereas CI of distant recurrence was similar for the 2 sites (15.2% ± 7.2% vs 23.5% ± 7.4%; P = .39).Conclusions
Pediatric patients with visceral NRSTS are more likely to have invasive, large, and unresectable tumors compared to those with body wall tumors. More than two thirds of visceral NRSTS recur locally, and fewer than half of patients with visceral tumors survive. 相似文献10.
Purpose
Recurrent gastroesophageal reflux disease (GERD) after gastroesophageal surgery is a troublesome problem. Reoperative surgery often is complicated by adhesions and recurrence. Radiofrequency ablation or energy delivery (RF or the Stretta procedure) is a new method for treating GERD. This study is the first report describing the use of the Stretta procedure in pediatric patients.Methods
Six patients who underwent previous gastroesophageal surgery presented with recurrent GERD. Medical records were reviewed and the severity of reflux graded using a modified scoring system. All underwent RF and were graded for GERD at 6 months postprocedure.Results
Mean operating time was 80 ± 12 minutes. Mean age at initial operation was 12 ± 4 years and for the RF, 18.0 ± 3.4 years. All patients were discharged as outpatients. Early complications occurred in one child with self-resolving acute gastric distension. Five of 6 patients were completely asymptomatic at 3 months after the procedure, and 3 stopped anti secretory agents. One patient was improved but still symptomatic and needed a redo fundoplication. Another required a repeat application of RF 10 months after the initial one. Mean GERD score pre-Stretta was 5.2 ± 1.0, which improved to 1.6 ± 1.9 at 6 months postprocedure (P < .05; paired t test).Conclusions
Use of RF treatment of the lower esophageal sphincter is a potentially successful modality to treat recurrent GERD in children. Long-term follow-up is required. 相似文献11.
Emily T. Durkin Dennis P. Lund Herbert Chen Rebecca S. Sippel 《Journal of pediatric surgery》2010,45(6):1142-1146
Purpose
Little information exists regarding the optimal surgical treatment of pediatric primary hyperparathyroidism. We hypothesized that primary hyperparathyroidism in children, in the absence of a family history, is caused by single-gland disease and is amenable to minimally invasive parathyroidectomy (MIP).Methods
We reviewed the records of individuals younger than 25 years who underwent parathyroidectomy in a prospectively collected database at a single tertiary hospital from 2003 to 2009.Results
Twenty-five patients were identified, with a mean (SD) age of 19 (3.7) years. Sixty percent had single-gland disease (n = 15). Familial disease was present in 6 patients. All of the children younger than 18 years without a family history of disease (9/9) were found to have a single-gland disease (P < .001). Seventy-eight percent of patients without a family history were successfully treated without a bilateral exploration. Average length of stay was less than 1 day with no complications or recurrences.Conclusions
Primary hyperparathyroidism in patients younger than 18 years without a family history was uniformly caused by single-gland disease. Minimally invasive parathyroidectomy was successful in these patients and avoided the morbidity of bilateral exploration. We recommend MIP be used in pediatric patients at large referral centers with prior successful institutional experience with the technique. 相似文献12.
Introduction
Over the last ten years, ultrasound became standard procedure in the intensive care unit (ICU).Study design
A national survey to evaluate the use of this technique in French ICUs.Methods
Three hundred and twenty-seven units were contacted from the listing of the Société de réanimation de langue française (SRLF). A survey containing 20 questions addressing the availability, the training for, and the use of ultrasound was sent to the ICUs. Collection of data took place over a period of three months.Results
We received 132 completed surveys out of the 327 sent out (40%). Seventy-nine percent of the public community and private centers and 94% of the university centers had an available device in the unit. Forty percent of the units carried out five to ten examinations per week. Seventy-two percent had staff trained in echocardiography. Fifty-five percent used association of monitoring techniques for the haemodynamic assessment of patients with shock. Only 73% carried out formalized reports after examination. In more than 80%, the echocardiograph was also used for the evaluation of other organs.Conclusion
Ultrasound, and particularly echocardiography, has taken on a more prominent role in the routine assessment of critically ill patients. The availability of equipment and of training has increased over the last ten years, but the demand for training in this area remains strong. This French survey confirms this technique became the “extension of the hand” of the intensivist in ICU. 相似文献13.
Andrew G. Shuman Payam Entezami Nancy E. Wallace Jeremy M.G. Taylor Norman D. Hogikyan 《Otolaryngology--head and neck surgery》2010,143(3):353-360
Objective
This study was designed to 1) describe the demographics and 2) determine the efficacy of a head and neck cancer screening program to optimize future programs.Study Design
Database analysis plus chart review.Setting
Tertiary care academic medical center.Subjects and Methods
After Institutional Review Board approval, we reviewed our 14-year experience (1996-2009) conducting a free annual head and neck cancer screening clinic. Available demographic and clinical data, as well as clinical outcomes, were analyzed for all participants (n = 761). The primary outcome was the presence of a finding suspicious for head and neck cancer on screening evaluation.Results
Five percent of participants had findings suspicious for head and neck cancer on screening evaluation, and malignant or premalignant lesions were confirmed in one percent of participants. Lack of insurance (P = 0.05), tobacco use (P < 0.001), male gender (P = 0.03), separated marital status (P = 0.03), and younger age (P = 0.04) were the significant demographic predictors of a lesion suspicious for malignancy. Patients complaining of a neck mass (P < 0.001) or oral pain (P < 0.001) were significantly more likely to have findings suspicious of malignancy. A high percentage (40%) was diagnosed with benign otolaryngologic pathologies on screening evaluation.Conclusion
A minority of patients presenting to a head and neck cancer screening clinic will have a suspicious lesion identified. Given these findings, to achieve maximal potential benefit, future head and neck cancer screening clinics should target patients with identifiable risk factors and take full advantage of opportunities for education and prevention. 相似文献14.
15.
Dejan Ignjatovic Kristine Aasland Stale Sund Milan Spasojevic 《American journal of surgery》2010,200(2):270-5058
Aim
To determine the effect of a single dose of bevacizumab on adhesion formation in the rat cecum abrasion model.Methods
The cecum and parietal peritoneum of 38 male Wistar rats were abraded to promote adhesion formation. The rats were randomized into 2 groups: group 1 received bevacizumab (2.5 mg/kg) intraperitoneally, and group 2 received saline. On day 30 animals were killed, adhesions scored, and histopathological samples taken.Results
There was no wound dehiscence; there were 2 incision hernias (5.3%), 1 per group. Thirty-seven animals developed adhesions (97.4%). Adhesion grade and severity scores were significantly different between groups 1 and 2 at 2.7:1.6 (P = .018) and 3.8:2.7 (P = .007), respectively. There was no difference in adhesion square area (27.7:25.0%; P = .16), location (P = 1.00), or number (2.1:1.3; P = .06). Histopathology confirmed the statistical difference between groups (P = .049), and a highly significant correlation between results was shown (r = .758; P = .0001).Conclusion
A single dose of intraperitoneal bevacizumab significantly reduces grade and severity of abdominal adhesions in the cecum abrasion rat model. 相似文献16.
Jamie Wagner D.O. Judy C. Boughey M.D. Betsy Garrett P.A-C. Gildy Babiera M.D. Henry Kuerer M.D. Funda Meric-Bernstam M.D. Eva Singletary M.D. Kelly K. Hunt M.D. Lavinia P. Middleton M.D. Isabelle Bedrosian M.D. 《American journal of surgery》2009,198(3):387-391
Background
Optimal surgical management of patients with invasive lobular carcinoma (ILC) who undergo neoadjuvant chemotherapy (NAC) is unknown. We evaluated optimal margin distance and local recurrence (LR) rates for these patients.Methods
Ninety-three (30%) of 311 patients with ILC received NAC. We examined margin status, residual disease after re-excision, and clinical outcomes.Results
Margin positivity rates after the final operative procedure were similar between the NAC and surgery-first group (P > .05). The proportion of patients, stratified by margin status, who were taken back for re-excision was not different between the 2 groups, and, similarly, there were no differences in frequency of residual disease (all P > .05). At a median follow-up of 3.1 years, 1 patient in the NAC group and 2 in the surgery-first group developed LR (P = 1.0).Conclusions
Patients with ILC who have undergone NAC and have margins >1 mm have a low probability of residual disease and LR. 相似文献17.
Background
The role of B-type natriuretic peptide (BNP) concentration in predicting cardiac dysfunction has been extensively investigated in many clinical conditions. Little is known, however, about its relationships with hemodynamic parameters from right heart catheterization in patients undergoing liver transplant surgery.Methods
We retrospectively evaluated 525 patients who underwent liver transplantation. Hemodynamic variables from a Swan-Ganz catheter and BNP concentrations were measured 1 hour after induction of general anesthesia. Patients were stratified by quintiles of BNP concentrations. Univariate and multivariate logistic regression analysis were used to identify hemodynamic parameters associated with BNP ≥ 135 pg/mL, a cutoff point for the 5th quintile.Results
Univariate analysis showed that factors significantly associated with BNP ≥ 135 pg/mL included model for end-stage liver disease (MELD) score, diastolic blood pressure, mean pulmonary artery pressure, pulmonary capillary wedge pressure (PCWP), cardiac index, right ventricular end-diastolic volume index (RVEDVI), systemic vascular resistance index, pulmonary vascular resistance index (PVRI), and right ventricular stroke work index. Multivariate analysis revealed that MELD score (odds ratio [OR] = 1.059, P < .001), PCWP (OR = 1.116, P = .026), RVEDVI (OR = 1.010, P = .009), and PVRI (OR = 1.009, P = .002) were independent determinants of BNP ≥ 135 pg/mL.Conclusions
Severity of liver disease, preload dependent hemodynamic parameters, and pulmonary vascular resistance were found to be significantly associated with increased BNP concentration, reinforcing the utility of BNP as a marker of cardiac strain and ventricular volume overload in liver failure patients undergoing liver transplant surgery. 相似文献18.
Roaten JB Partrick DA Nydam TL Bensard DD Hendrickson RJ Sirotnak AP Karrer FM 《Journal of pediatric surgery》2006,41(12):2013-2015
Background
Traumatic injuries are a major cause of morbidity and mortality in children. The purpose of the present study was to determine the incidence of nonaccidental trauma (NAT) and to compare the outcomes of accidental trauma (AT) patients with NAT patients at a large pediatric trauma center.Methods
A retrospective chart review of 6186 trauma patients younger than 18 years evaluated during the period of 1996 to 2004.Results
During the period of study, NAT accounted for 7.3% (n = 453) of trauma evaluations (n = 6186). Compared to AT, the NAT patient was younger, 12 vs 76 months (P < .05); were more severely injured, injury severity score 18 vs 9 (P < .05); and required both longer intensive care unit stay, 2 vs 1 day (P < .05), and overall hospital stay, 6 vs 3 days (P < .05). Craniotomy was required in 4.4% of NAT patients compared with 2.7 % of AT patients (P < .05). Abdominal exploration was necessary in 3.5% of NAT patients compared to 1.6% of AT patients. The mortality rate for NAT was 9.7% compared to 2.2% for AT (P < .05).Conclusions
The surgeon caring for children must appreciate the high incidence of NAT with its increased morbidity and mortality relative to AT patients. A surgical evaluation should be performed promptly in NAT patients because of their frequent need for emergent intervention. 相似文献19.
Miltiadis A. Lalountas Konstantinos D. Ballas Christos Skouras Christos Asteriou Theodoros Kontoulis Dimitrios Pissas Apostolos Triantafyllou Athanasios K. Sakantamis 《American journal of surgery》2010,200(1):118-123
Objectives
The aim of this study was to compare the effectiveness of atorvastatin with the sodium hyaluronate/carboxymethylcellulose (HA/CMC, Seprafilm; Genzyme; Genzyme Biosurgery Corporation, Cambridge, MA) in preventing postoperative intraperitoneal adhesion formation in rats.Methods
Sixty Wistar rats underwent a laparotomy, and adhesions A were induced by cecal abrasion. The animals were divided into 4 groups: group 1, control A; group 2, (A + atorvastatin); group 3, (A + HA/CMC), and group 4, (A + atorvastatin + HA/CMC). The atorvastatin (groups 2 and 4) and HA/CMC (groups 3 and 4) were administered intraperitoneally before the abdominal wall was closed. After 14 days, adhesions were classified by 2 independent surgeons.Results
The adhesion scores (mean ± standard deviation) for groups 1, 2, 3, and 4 were 2.93 ± .59, 1.85 ± 1.07, 1.80 ± .86, and 1.93 ± .70, respectively. The differences in adhesion scores among all 3 preventive groups (groups 2, 3, and 4) were statistically significant when compared with the control group (P = .005, P = .002, and P = .009, respectively).Conclusions
These data suggest that atorvastatin, administered intraperitoneally, is as effective as HA/CMC without an expectable additive effect in preventing postoperative adhesions in rats. 相似文献20.
Austin MT Leys CM Feurer ID Lovvorn HN O'Neill JA Pinson CW Pietsch JB 《Journal of pediatric surgery》2006,41(1):182-186