American journal of surgery
-
Virtual reality (VR) simulation is a rapidly proliferating adjunct of surgical training. Numerous devices have evolved as educational tools in a variety of fields. Whether these tools can be used for validation of physicians' skills has yet to be determined. The objective of this study was to determine whether the GI Mentor (Simbionix, Lod, Israel) flexible endoscopy simulator construct could distinguish experienced endoscopists from beginners. ⋯ The G1 Mentor VR colonoscopy construct appears valid. Significant performance differences were shown between the experienced and beginner cohorts. The beginner participants in this study were all physicians with some degree of endoscopic experience. Therefore, the G1 Mentor distinguished endoscopists of varying experience and exposure. Further validation studies are needed to evaluate the breadth of programs inherent to this simulator and to determine whether it may be used in the future for qualification and certification purposes.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Clinical and economic outcomes of oral linezolid versus intravenous vancomycin in the treatment of MRSA-complicated, lower-extremity skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus.
Resistant bacteria often complicate the management of skin and soft tissue infections of the lower extremities. This open-label study compared oral linezolid and intravenous vancomycin for management of complicated skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA). ⋯ Clinical outcomes were significantly better with linezolid than with vancomycin. Additionally, linezolid was associated with reduced length of stay and outpatient charges.
-
Hepatic portal venous gas is an unusual entity associated with a variety of abdominal catastrophes. There is usually a grave prognosis when hepatic portal venous gas is associated with ischemic bowel disease. We reported a 57-year-old man with hepatic portal venous gas associated with extensive infarction of the jejunum and a concomitant perforation at a site in the terminal ileum leading to two operations performed 24 hours apart. Progressive ischemia and infarction after the initial laparotomy resulted in massive resection of the small bowel. ⋯ When hepatic portal venous gas associated with ischemic bowel disease is encountered, coexistence of other abdominal condition with no relation to ischemic segment should be considered.
-
Comparative Study
Comparison of one-stage resection and anastomosis of acute complete obstruction of left and right colon.
Although acute obstruction of the right colon is usually handled by primary anastomosis following resection, many surgeons are reluctant to offer one-stage resection and anastomosis to patients with obstructive lesions of the left colon. The aim of the study is to compare the immediate result of one-stage resection and anastomosis for patients with acute complete obstruction of the right colon versus left colon. ⋯ This experience suggests that an anastomosis can be performed as safely in patients with acute obstruction of the left colon as in those with acute obstruction of the right colon. Mortality following resection and anastomosis is actually lower in left than right colonic obstruction. Neither intraoperative irrigation nor routine subtotal colectomy was found to be necessary in patients with acute colonic obstruction. Intraoperative decompression should be considered in left and also right colonic obstruction prior to the anastomosis following colonic resection.
-
Comparative Study
A cumulative analysis of an individual surgeon's early experience with elective open abdominal aortic aneurysm repair.
Several studies have reviewed the role of hospital and surgeon case volumes in determining early mortality after elective open abdominal aortic aneurysm (AAA) repair. Few, however, have analyzed this relationship at the individual surgeon level. The purpose of this study was to display the usefulness of a unique statistical tool as a form of an ongoing practice audit. ⋯ The cumulative sum failure method provides a tool whereby a surgeon can prospectively audit his practice and recognize trends in performance before their recognition by standard statistical tools.