The American surgeon
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The American surgeon · Mar 2007
Case ReportsAsymptomatic intussusception of the appendix secondary to endometriosis.
This is a report of a 47-year-old woman with an asymptomatic clinical presentation of appendiceal intussusception secondary to endometriosis. Initially discovered during routine colonoscopy as a submucosal mass, it was ultimately diagnosed after surgical resection by pathology findings. The theories regarding the pathogenesis of appendiceal intussusception are reviewed and discussed here.
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The American surgeon · Mar 2007
Case ReportsRemoval of a large spherical foreign object from the rectum using an obstetric vacuum device: a case report.
Reports of retained rectal foreign bodies are increasingly common worldwide. It is likely that any surgeon practicing at a major medical center will encounter this type of case, and thus, should be familiar with both surgical and nonsurgical management options. ⋯ Low-lying objects can usually be extracted in the emergency room transanally, whereas high-lying foreign bodies may require anesthesia and laparotomy. We report an experience using an obstetric vacuum device to extract a high-lying foreign body from the rectum.
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The American surgeon · Feb 2007
"Shift work" improves survival and reduces intensive care unit use in seriously injured patients.
We assessed whether a trauma service model with an emphasis on continuity of care by using "shift work" will improve trauma outcomes and cost. This was a case-control cohort study that took place at a university-affiliated Level I trauma center. All patients (n=4283) evaluated for traumatic injuries between May 1, 2002 and April 30, 2004 were included. ⋯ On multivariate analysis, factors affecting mortality and LOS included age, initial vital signs, injury type, and ISS. Overall, the two trauma service models resulted in similar outcomes. Although multivariate analysis revealed that treatment period did not affect mortality, our study revealed improved patient survival and reduction in LOS and cost for the severely injured in Period II.
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Maintenance of Certification (MOC) is the most recent stage in the evolution of specialty board certification. Driven by increasing concerns over the quality and safety of medical care, MOC represents a change in the frequency and the nature of the requirements of existing recertification. ⋯ The focus of these assessments is for improvement rather than judgment. The extent to which MOC succeeds will reflect surgeons' ability to improve the quality of care through voluntary efforts.