***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE To examine the effectiveness of fibrin sealants as supportive treatment to improve hemostasis and decrease the incidence of bile leakage and intra-abdominal collection s. DESIGN Prospect i ve , controlled , quasiexperimental study . SETTING Tertiary referral center , University Hospital Reina Sofía . PATIENTS A total of 115 patients ( 58 in the control group and 57 in the collagen sponge group ) scheduled for conventional hepatectomies . INTERVENTIONS Patients were distributed into groups for major and minor hepatectomies with or without application of a carrier-bound collagen sponge on the raw surface of the liver . MAIN OUTCOME MEASURES The main outcome measures were postoperative mortality , incidence and severity of postoperative surgical complications , and length of hospital stay . The secondary outcome measures were postoperative drainage output volume , transfusion requirements , and changes in biochemical parameters ( hemoglobin , bilirubin , alanine aminotransferase , and platelet levels ) . RESULTS The fibrin sealant after major liver resection was effective for decreasing drainage volume ( mean [ SD ] volume , 1124.7 [ 842.8 ] mL in the control group and 691.2 [ 499.5 ] mL in the collagen sponge group ; P = .007 ) with a higher volume of output by drain each postoperative day in the control patients ( P = .003 ) ; postoperative blood transfusion requirements ( 18.9 % vs 7.0 % , respectively ; P = .04 ) ; moderate to severe postoperative complications ( 21 % vs 8 % , respectively ; P = .03 ) ; and mean ( SD ) hospital stay ( 12.6 [ 6.7 ] vs 9.6 [ 5.1 ] days , respectively ; P = .03 ) . CONCLUSION The use of a new carrier-bound collagen sponge after major liver resection may be recommended because of its clinical and cost-savings effectiveness A system has been constructed to evaluate the design , implementation , and analysis of  r and omized control trials ( RCT ) . The degree of quadruple blinding ( the r and omization process , the physicians and patients as to therapy , and the physicians as to ongoing results ) is considered to be the most important aspect of any trial . The analytic techniques are scored with the same emphasis as is placed on the control of bias in the planning and implementation of the studies . Description of the patient and treatment material s and the measurement of various controls of quality have less weight . An index of quality of a RCT is proposed with its pros and cons . If published papers were to approximate these principles , there would be a marked improvement in the quality of r and omized control trials . Finally , a reasonable st and ard design and conduct of trials will facilitate the interpretation of those with conflicting results and help in making valid combinations of undersized trials Overwhelming evidence shows the quality of reporting of r and omised controlled trials ( RCTs ) is not optimal . Without transparent reporting , readers can not judge the reliability and validity of trial findings nor extract information for systematic review s. Recent method ological analyses indicate that inadequate reporting and design are associated with biased estimates of treatment effects . Such systematic error is seriously damaging to RCTs , which are considered the gold st and ard for evaluating interventions because of their ability to minimise or avoid bias . A group of scientists and editors developed the CONSORT ( Consoli date d St and ards of Reporting Trials ) statement to improve the quality of reporting of RCTs . It was first published in 1996 and up date d in 2001 . The statement consists of a checklist and flow diagram that authors can use for reporting an RCT . Many leading medical journals and major international editorial groups have endorsed the CONSORT statement . The statement facilitates critical appraisal and interpretation of RCTs . During the 2001 CONSORT revision , it became clear that explanation and elaboration of the principles underlying the CONSORT statement would help investigators and others to write or appraise trial reports . A CONSORT explanation and elaboration article was published in 2001 alongside the 2001 version of the CONSORT statement . After an expert meeting in January 2007 , the CONSORT statement has been further revised and is published as the CONSORT 2010 Statement . This up date improves the wording and clarity of the previous checklist and incorporates recommendations related to topics that have only recently received recognition , such as selective outcome reporting bias . This explanatory and elaboration document-intended to enhance the use , underst and ing , and dissemination of the CONSORT statement-has also been extensively revised . It presents the meaning and rationale for each new and up date d checklist item providing examples of good reporting and , where possible , references to relevant empirical studies . Several examples of flow diagrams are included . The CONSORT 2010 Statement , this revised explanatory and elaboration document , and the associated website ( www.consort-statement.org ) should be helpful re sources to improve reporting of r and omised trials BACKGROUND AND OBJECTIVES Postoperative wound seromas are a frequent and troublesome occurrence after mastectomy . Recent reports have suggested the efficacy of topical sclerosants at reducing their formation . METHODS A prospect i ve , r and omized , double-blinded trial was performed to examine the effect of intraoperatively administered topical tetracycline on the occurrence of postoperative mastectomy seromas .  Thirty-two women were r and omized to the control arm ( normal saline ) and 30 women to the tetracycline arm . In the treatment group , 100 ml ( 2 g ) of tetracycline solution was administered topically to the chest wall and skin flaps prior to skin closure . The control group received an equal volume of normal saline . Patients were monitored for the development of postoperative wound seroma . RESULTS There were no significant differences between groups regarding total volume of closed suction drainage , numbers of patients leaving hospital with drains in place , or duration of catheter drainage . Seroma formation 2 weeks postoperatively was greater in the tetracycline group than the control group ( 53 % vs. 22 % , P = 0.01 ) . There were no differences between groups regarding the degree of postoperative pain , wound infection , or seroma formation 1 month postoperatively . CONCLUSIONS Topical tetracycline is not effective at preventing post-mastectomy wound seromas BACKGROUND Electrocautery has been postulated as a factor in the risk of seroma formation after mastectomy . METHODS Eighty consecutive mastectomies in 74 patients were r and omly assigned to dissection of the mastectomy flaps with either scalpel ( n = 38 ) or electrocautery ( n = 42 ) . Total volume of fluid output through drains and aspirated from seromas was recorded . Other factors investigated included the type of drain utilized , estimated blood loss , and complications . RESULTS Seromas developed in 16 wounds in the electrocautery group compared with 5 in the scalpel group ( 38 % and 13 % , respectively ; P = 0.01 ) . Other factors with an independent risk for seroma included use of Jackson-Pratt drains compared with Blake drains ( P = 0.006 ) , and lower estimated blood loss ( P = 0.006 ) . No differences in characteristics of patients or in other complications were noted . CONCLUSIONS Use of electrocautery to create skin flaps in mastectomy reduced blood loss but increased the rate of seroma formation Abstract Background : Seromas and impaired shoulder function are well-known complications after modified radical mastectomy for breast cancer . Early postoperative physiotherapy is a common treatment to avoid shoulder dysfunction . The aim of this study was to evaluate if the frequency of postoperative seromas could be reduced , without increasing shoulder dysfunction , by delayed postoperative shoulder exercises . Methods : In a prospect i ve study 163 patients with breast cancer undergoing modified radical mastectomy  were r and omized to physiotherapy starting on postoperative day 1 or day 7 . Patients were seen by the surgeons and the physiotherapists during hospital stay and in the outpatient department . Seromas and other complications were registered by the surgeons . The physiotherapists instructed the patients pre- and postoperatively and assessed shoulder function . Results : There was a significantly higher incidence of postoperative seromas in the group of patients that started physiotherapy postoperative day 1 ( 38 % ) compared to the group that started physiotherapy postoperative day 7 ( 22 % ) ( p<0.05 ) . There was no significant difference between the groups in the late outcome of shoulder function . Conclusion : The incidence of seromas after modified radical mastectomy for breast cancer is reduced by delaying shoulder exercises one week postoperatively . Earlier postoperative physiotherapy is not necessary to avoid impaired shoulder function BACKGROUND This study was design ed to determine the effectiveness of Hemaseel APR fibrin sealant versus conventional drain placement in the prevention of seromas after breast procedures . METHODS A prospect i ve , r and omized , controlled study of subjects who were r and omized into control ( drain ) and experimental ( fibrin ) groups was conducted . RESULTS Analysis of 82 patients showed similarly matched groups . Seroma formation rate was 45.5 % in the control group and 36.8 % in the fibrin glue group ( P = 0.43 ) . The rate of wound complications was similar . Aspirate volumes were significantly greater in the fibrin glue group . Drain placement saved patients > 366 US dollars over fibrin glue . CONCLUSIONS Although use of fibrin sealant result ed in a nonsignificant decrease in seroma formation rate compared with that of drain placement , the higher cost involved , cumbersome technique , and higher aspirate volumes tend to indicate that there is no advantage to using fibrin glue over drain placement with the technique described BACKGROUND Seroma formation frequently occurs in patients who have undergone axillary lymphadenectomy . The aim of the study was to evaluate the effect of fibrin glue in the prevention of seroma formation after axillary lymphadenectomy . MATERIAL S AND METHODS Hundred fifty-nine breast cancer patients about to undergo quadrantectomy or mastectomy plus axillary lymphadenectomy were enrolled in the study and r and omized into two groups . Fibrin glue spray applied to the axillary fossa plus placement of closed suction drainage were used in 80 patients ( group A ) ; placement of closed suction drainage was only used in 79 patients ( group B ) . RESULTS Group A patients showed a slight advantage with regard to the mean duration of axillary drainage placement ( 4.5 + /- 1.3 days in group A vs. 5.1 + /- 1.6 days in group B ) and number of seroma aspirations ( 6.3 + /- 1.1 in group A vs. 6.7 + /- 1.2 in group B ) . No statistically significant differences were observed between the two groups of patients regarding the mean volume of total axillary drainage and of total seroma volume . CONCLUSIONS The use of fibrin glue does not prevent seroma formation and does not reduce seroma magnitude and duration . The costs of the product involved do not justify its routine use in patients undergoing axillary dissection Fibrin as a tissue sealant has been used since the turn of the century for hemostasis . The development of cryoprecipitate and the result ant availability of higher concentrations of fibrinogen have led to a resurgence of interest in this material . Fibrin glue has since been shown to be effective for numerous applications throughout the field of surgery . Animal studies have shown fibrin glue to be effective at reducing drain output after mastectomy . Human studies , however , have been equivocal . Our objectives were to determine whether the use of fibrin glue would decrease lymphatic drainage after modified radical mastectomy and subsequently reduce time to drain removal . A prospect i ve r and omized trial was conducted consisting of 27 women . All women received modified radical mastectomy .  At the completion of the mastectomy they were r and omized to receive either st and ard closure or the application of fibrin glue before st and ard closure . Patients were then monitored for daily drain output , time to drain removal , and wound complications . A total of 14 women received fibrin glue  and 13 received  no glue . Those patients receiving fibrin glue had a significantly higher average drain output than patients who did not receive glue ( 1308 vs 754 cm3 ; P = 0.012 ) . Time to drain removal was also increased by 4 days , although this did not reach statistical significance . The overall complication rate was higher for the fibrin glue group , although again , this did not reach significance . The application of fibrin glue significantly increased drain total drain output after modified radical mastectomy . Time to drain removal was increased as was the complication rate . On the basis of these data fibrin glue can not be recommended for routine use in modified radical mastectomy BACKGROUND The extended latissimus dorsi is a workhorse flap and plays an important role in breast reconstruction . Unfortunately , seromas at the flap donor site are a frustrating problem complicating many procedures . The purpose of this study was to evaluate the efficacy of a combination of fibrin sealant ( Quixil ; Johnson & Johnson , Langhorne , Pa. ) and limited quilting sutures at reducing seroma formation . METHODS This was a prospect i ve , double-blinded , clinical trial under a single surgeon . Twenty-six patients were enrolled in the study , and all were followed up for a period of 6 months . The patients were r and omized to receive either quilting sutures only ( group 1 ) or a combination of Quixil sealant and marginal quilting sutures ( group 2 ) . RESULTS The incidence of seroma was 23.1 percent in group 1 and 7.7 percent in group 2 ( odds 
    Output:
    
FG did not influence the incidence of postoperative seroma , the mean volume of seroma , wound infections , complications and the length of hospital stays in people undergoing breast cancer surgery .