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131.
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Ritenour CW 《The Canadian journal of urology》2012,19(2):6158-6159
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Porter CK Faix DJ Shiau D Espiritu J Espinosa BJ Riddle MS 《Clinical infectious diseases》2012,55(7):915-922
Background.?The US Centers for Disease Control and Prevention estimates 20.9 million norovirus infections annually in the United States. Although the acute disease burden is sizeable, emerging data suggest norovirus may be associated with chronic gastrointestinal problems. We identified known outbreaks in US military recruits and used the Defense Medical Encounter Database (DMED) to identify the risk of new onset functional gastrointestinal disorders (FGD) and gastroesophageal reflux disease (GERD). Methods.?Subjects reporting for care of acute gastroenteritis (AGE) at a military treatment clinic during 3 known norovirus outbreaks were identified. Each AGE subject was matched with up to 4 subjects with unrelated medical encounters. Medical encounter data were analyzed for the duration of military service time (or a minimum of 1 year) to assess for incident FGD or GERD. Relative risks were calculated using regression models. Results.?We identified 1718 subjects from 3 outbreaks. After controlling for important demographic covariates, the incidence of constipation, dyspepsia, and GERD was approximately 1.5-old higher (P?.01) in AGE-exposed subjects than matched subjects. We also noted variability in outcome incidence across outbreaks. Conclusions.?It appears that the risk of dyspepsia, constipation, and GERD are higher among those who have AGE during a confirmed norovirus outbreak. Although these findings need confirmation, they suggest that dysmotility may result subsequent to these infections. If confirmed, the costs and morbidity associated with the chronic consequences of norovirus should be considered. 相似文献
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Sajida Ahad Chad Gonczy Vriti Advani Stephen Markwell Imran Hassan 《Surgical endoscopy》2013,27(6):1865-1871
Background
By virtue of the benefits associated with minimally invasive approaches, laparoscopic splenectomy (LS) is believed to have better patient-related outcomes compared to open splenectomy (OS). However, there are limited data directly comparing the two techniques.Methods
Patients who underwent elective LS and OS between 2005 and 2010 were identified from the public use file of the ACS-NSQIP database using the Current Procedural Terminology codes 38120 and 38100. Patients who had concomitant procedures were excluded. Because of the nonrandom assignment of surgical techniques, a selection bias could have been responsible for the differences in patient outcomes. Therefore, patient characteristics and comorbidities that were available and could have been potential confounders were compared and regression analysis was performed to determine independent risk factors associated with serious and overall morbidity as well as mortality.Results
During the study period 1,644 and 851 patients underwent LS and OS, respectively. Compared to patients who underwent LS, patients who had OS had a longer median length of hospital stay (3 vs. 6 days, P < 0.0001) and higher incidences of serious (7 vs. 17 %, P < 0.0001) and overall morbidity (12 vs. 25 %, P < 0.0001) and mortality (1.4 vs. 3.3 %, P = 0.02). However, there were certain significant differences in the characteristics and comorbidities of the patients that could have confounded outcomes. On regression analysis, OS was not associated with higher mortality (OR = 1.43, 95 % CI 0.7–2.7, P = 0.28) but was associated with higher serious morbidity (OR = 1.8, 95 % CI 1.4–2.3, P = 0.001) and overall morbidity (OR = 2.0, 95 % CI 1.6–2.4, P = 0.0001).Conclusion
After adjusting for available confounders, patients who underwent LS had lower morbidity and similar mortality rates. Although certain confounders such as previous surgical history, underlying pathology, and spleen size could still have potentially influenced outcomes, the data suggest that patient outcomes after LS are excellent and when technically possible a minimally invasive technique should be the preferred approach for splenectomy. 相似文献139.
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Masayuki Nakamori MD PhD Krzysztof Sobczak PhD Araya Puwanant MD Steve Welle PhD Katy Eichinger DPT Shree Pandya DPT Jeannne Dekdebrun MS Chad R. Heatwole MD Michael P. McDermott PhD Tian Chen MA Melissa Cline PhD Rabi Tawil MD Robert J. Osborne PhD Thurman M. Wheeler MD Maurice S. Swanson PhD Richard T. Moxley III MD Charles A. Thornton MD 《Annals of neurology》2013,74(6):862-872