American journal of surgery
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After resuscitation from hemorrhagic shock, intestinal microvessels constrict leading to impaired mucosal blood flow. This occurs despite restoration of central hemodynamics. We review studies on the use of peritoneal dialysis fluid as an adjunct treatment in amelioration of this gut hypoperfusion. ⋯ DPR enhances organ blood flow to organs incited in the pathogenesis of multiple organ failure and improves survival after severe hemorrhage and CR.
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Despite recent significant improvement in outcome, children undergoing surgery for correction of congenital heart defects have a persistent and troublesome mortality rate and incidence of neurologic complications. Recent data suggest that some congenital heart defects are associated with abnormal brain development and with low cerebral blood flow. We hypothesized that some children with congenital heart disease have an abnormally low baseline (preoperative) cerebral oxygen saturation (ScO2). ⋯ Baseline ScO2 is lower in patients with left-to-right shunt physiology. Postoperative saturation is lower in patients with left-to-right shunt physiology and in cyanotic patients. Low baseline ScO2 predicts perioperative mortality in children with congenital heart disease. Measurement of ScO2 preoperatively will provide additional information for parent counseling, and preoperative optimization of ScO2 may improve outcome.
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Comparative Study
Formal training in advanced surgical technologies enhances the surgical residency.
Surgeons have been consistently instructed to use better tools by which to improve upon a patient's medical care. Since the first laparoscopic cholecystectomy, the desire for advanced surgical technologies has continued. This surgical breakthrough has been one of many changes in modern surgical and medical therapy that now represents the standard of care. The aim of this article is to examine the changes in surgical technologies that occurred in the past 15 years, evaluate the possible solutions that have been discussed and formally present the results of a formal training rotation in advanced surgical technologies at the University of Louisville, Department of Surgery. ⋯ The number of demands impacting medical education have never been this numerous or complex. The rapid advances in science, systems, and information technology provide numerous advances in surgical training that continue to be the requirement and responsibility of general surgical training. The cultural changes in surgery include the team approach to provide services in surgical technologies, focus on the aging population, and outcomes assessment. The learning curve, for any and all of these procedures, is inevitably steep, and traditional resident training too often focuses on the more conventional procedures done in routine rotations. The need for formal training in advanced surgical technologies continues to be of utmost importance in these rapidly evolving times.
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Decompensated hemorrhagic shock is often refractory to resuscitation, and we show here that it is associated with loss of vascular tone in skeletal muscle precapillary arterioles. We tested the hypothesis that microvascular derangements in the skeletal muscle, intestinal, and renal microcirculation systems would be reversed by initial hypertonic saline-dextran infusion. ⋯ Despite return of cardiac output to greater than baseline levels, muscle, intestinal, and renal microvascular blood flows remained significantly depressed. Hypertonic saline and/or dextran did not improve these deficits.
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Surgical training in the United Kingdom and Europe is in transition given the pressure to decrease the number of workweek hours and the numbers of years in training. To achieve this shortened training in the United Kingdom, the primary component will be the foundational education, which will last for 2 years, with the second year perhaps counting toward specialist training. ⋯ During the foundation period there is exists the question of assessment, so this might be a natural point at which to preselect these students. This article considers psychometric assessment as a methodology of preselecting surgeons and considers objective assessment as a possibility during the foundational education period.