The American surgeon
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The American surgeon · May 2003
Clinical TrialA prospective evaluation of a bedside technique for placement of inferior vena cava filters: accuracy and limitations of intravascular ultrasound.
Our objective was to evaluate the safety and accuracy of a bedside technique for placing vena cava filters with intravascular ultrasonography. We conducted a prospective case series of 36 patients requiring prophylactic vena cava filter placement. Intravascular ultrasound (IVUS) was used to assess the best location for inferior vena cava filter placement. ⋯ In three patients our bedside technique differed from best filter placement by more than 3 cm. Excluding these three patients the difference between best filter placement and bedside technique was 0.92 +/- 0.79 cm. This bedside IVUS technique for placement of inferior vena cava filters is established as safe and accurate; however, knowledge of the limitations involving the technique is important.
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The American surgeon · May 2003
Comparative StudyLaparoscopic adrenalectomy and splenectomy are safe and reduce hospital stay and charges.
The proposed benefits of laparoscopy for certain surgical procedures have been decreased post-operative pain and hospital stay balanced against the proposed deficits of increased costs. We have reviewed our data to evaluate factors associated with patient, procedure, and hospital charges for patients undergoing open versus laparoscopic adrenalectomy and splenectomy during the same time period. Eighty-seven patients underwent adrenalectomy (n = 47) or splenectomy (n = 40) from October 30, 1995 to June 6, 2001 and were retrospectively reviewed. ⋯ We conclude that a laparoscopic approach for adrenalectomy or splenectomy can be accomplished in approximately 95 per cent of patients selected for this procedure. Despite prolonged OR time and increased OR/RR charges the laparoscopic procedures resulted in significantly decreased length of hospital stay and overall patient charges. Laparoscopy is a safe and cost-effective approach and should be strongly considered in patients requiring adrenalectomy or splenectomy.
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The American surgeon · May 2003
Hemodynamic monitoring in the elderly undergoing elective colon resection for cancer.
Controversy surrounds the use of pulmonary artery catheters (PACs). We evaluated the influence of preoperative hemodynamic monitoring and optimization on the outcome in elderly patients undergoing elective resection for colon cancer. We performed a retrospective analysis of all elderly patients (age > 65 years) who had undergone elective colon resection during 1985 to 1995. ⋯ CRI, which was a significant predictor of mortality in the no-PAC group (2.2% mortality for CRI < 10 vs 15.8% for CRI > or = 10; P < 0.001), was insignificant in the PAC group (2.5% mortality for CRI < 10 vs 5% for CRI > or = 10, P = not significant). Although preoperative optimization using PAC was not beneficial in the low-CRI group it resulted in a threefold reduction in mortality (5% vs 15.8%) in the high-CRI group. We conclude that preoperative optimization of cardiovascular function using a PAC is only beneficial in reducing mortality in high-risk (CRI > or = 10) elderly patients undergoing elective colon resection.
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The American surgeon · May 2003
Training fourth-year medical students in critical invasive skills improves subsequent patient safety.
Complications after procedures performed by residents are thought to occur most often early in the first postgraduate year (PGY-1). We evaluated the number of pneumothoraces (PTXs) caused by central venous line insertion (CVLI) by two groups of PGY-1 residents in both the first 3 months of residency and the entire year from 1996 through 2000 to determine the impact of CVLI training on PTX. From 1996 through 1998 fourth-year medical students had no specific training in CVLI and learned on the job as residents. ⋯ The overall yearly decrease for 1999 versus 1996-1998 approached significance (P = 0.06). The introduction of a structured teaching program of CVLI skills appears to have a positive impact in reducing morbidity of PTX. The greatest impact occurs within the first 3 months of the new PGY-1 academic year.