The American surgeon
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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.
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The American surgeon · Apr 2003
Randomized Controlled Trial Clinical TrialThe use of intraperitoneal bupivacaine to decrease the length of stay in elective laparoscopic cholecystectomy patients.
This prospective, double-blind, randomized, and placebo-controlled study evaluates the effectiveness of intraperitoneal bupivacaine in decreasing the length of stay for elective laparoscopic cholecystectomy patients. Seventy-seven patients undergoing elective laparoscopic cholecystectomy before noon at a single institution and by a single group of surgeons were entered into the study. The pharmacy randomly assigned each patient to one of four study groups (control, predissection, postdissection, and both). ⋯ There was no statistical difference between the predissection, postdissection, and both groups regarding same-day discharge. Therefore, these groups were combined for comparison against the control group. The study found that patients receiving bupivacaine at any time during the surgery were more likely to go home the same day as their procedure (79% vs 43%, respectively: P < 0.02).
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The American surgeon · Apr 2003
Case ReportsPneumatosis cystoides intestinalis with free intraperitoneal air: a case report.
Pneumatosis cystoides intestinalis (PCI) is a rare disorder of the medical management and clinical outcome of which largely depend on the severity of its clinical manifestation. A limited number of cases have been reported in the literature although it is suggested that the true incidence of this disorder is higher than observed in clinical practice. This is the case of a 76-year-old woman with a past medical history of Crohn's disease found to have PCI. ⋯ Her symptoms resolved gradually over several days. The patient was discharged home in stable condition tolerating a regular diet and was doing well at follow-up. The sole finding of free air with PCI does not mandate exploratory laparotomy.
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The American surgeon · Apr 2003
Case ReportsAnisakiasis of the colon presenting as bowel obstruction.
Anisakiasis is a disease caused by human infection by the Anisakis larvae, a marine nematode found in raw or undercooked fish. With the increased popularity of eating sushi and raw fish (sashimi) in the United States infection with anisakis is expected to rise. We present the first reported case in the United States of intestinal anisakiasis presenting as a bowel obstruction. ⋯ If the larvae have invaded the intestine or the stomach wall diagnosis and cure occur with endoscopic or surgical removal if evidence of obstruction or perforation is found. The incidence of anisakiasis in the United States is unknown but will likely continue to increase with the popularity of eating sashimi. This case is meant to demonstrate another possible cause for bowel obstruction in the patient who has just eaten raw or undercooked fish.