American journal of surgery
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Randomized Controlled Trial Comparative Study
The impact of central line simulation before the ICU experience.
This study was designed to evaluate whether resident performance of placing central lines improved after simulation training on newly available partial-task simulators. ⋯ Simulation for central line placement using a partial-task simulator does positively impact resident performance.
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Current surgical training provides little opportunity for surgeons to recognize and manage intraoperative stress before it affects performance and compromises patient safety. We explored the perceived need for structured stress training and propose an intervention design that may be acceptable and appropriate. ⋯ There is a need for structured training in management of intraoperative stress. Surgeons would welcome a simulation-based intervention to enhance performance and patient safety.
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Early diagnosis is the main factor to improve the outcome of acute mesenteric ischemia (AMI). The goal of this study was to assess the correlation of the D-dimer test and biphasic computed tomography (CT) with mesenteric CT angiography for the diagnosis of AMI. ⋯ In the setting of early diagnosis of AMI, the D-dimer test may improve our ability to diagnose patients in whom we cannot use multidetector row CT with CT angiography.
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Vena caval injury is a rare but serious complication of laparoscopic surgery, and often requires conversion to an open procedure. The current study investigated whether a vena caval injury could be repaired with a chitosan dressing laparoscopically. ⋯ Use of the chitosan-based hemostatic dressing is a simple and reliable technique to control serious hemorrhage from IVC injury during laparoscopic surgery.
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The ideal prosthetic material for ventral hernia repair has yet to be described. Each prosthetic material has unique advantages and disadvantages in terms of tissue ingrowth, adhesion formation, and shrinkage profiles. Polyester-based mesh has shown minimal shrinkage and excellent tissue ingrowth in animal models. However, the macroporous, braided nature of this material has raised several concerns regarding the incidence of infections, fistulas, and bowel obstructions. We have reviewed our experience with polyester-based mesh for the repair of ventral hernias. ⋯ This study shows that in this complex group of patients, polyester mesh placed during ventral hernia repair results in acceptable infection rates, and no direct bowel complications or fistulas. Given the macroporous nature of the mesh, each case of infection was treated successfully with local wound measures or partial mesh resection. Polyester-based meshes with an anti-adhesive barrier appear safe for intraperitoneal placement.