The American surgeon
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The American surgeon · Jun 2001
Historical ArticleThe history of the Gold Medal Papers of the Southeastern Surgical Congress: 1960-2000.
Since 1960 at its annual meeting the Southeastern Surgical Congress has selected a varying number of "Gold Medal Papers" to be presented. Customarily a prize is awarded for the first place among the Gold Medal Papers and in some instances a second and third place. ⋯ With the assistance of the Executive Secretary of the Southeastern Surgical Congress a list of the Gold Medal presenters insofar as can be ascertained from the Council minutes is presented. It is unfortunate that all of the names of the Gold Medal Paper presenters have not been preserved.
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Our objective was to evaluate a new technique for the bedside placement of nasoenteral feeding tubes into the duodenum using an external hand-held magnet to maneuver the tube from the stomach to the distal duodenum. We conducted a prospective case series of 20 consecutive patients requiring nasoenteral tube feeding in the intensive care units of a university-affiliated hospital. Twenty patients were entered into the study after the attending physician requested assistance in tube placement. ⋯ There were no complications related to the procedure. Using a novel magnetically guided nasoenteral feeding tube transpyloric tube placement was achieved in 95 per cent of cases with an average procedure time of 9.6 minutes. This new and inexpensive bedside technique will allow prompt and safe initiation of enteral nutrition.
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The American surgeon · May 2001
Randomized Controlled Trial Comparative Study Clinical TrialA comparison between topical and infiltrative bupivacaine and intravenous meperidine for postoperative analgesia after inguinal herniorrhaphy.
The purpose of the present study is to compare postoperative analgesia offered by the simple instillation of local anesthetic on the surgical wound, its infiltration with the same local anesthetic, and the use of an intravenous opioid. Sixty patients were divided into the three analgesia groups to be studied: instillation of local anesthetic (Group I), injection of local anesthetic (Group II), and intravenous opioid (Group III). The pain was quantified using the visual analogue scale. ⋯ We conclude that the instillation of local anesthesia provides analgesia during the immediate postoperative period comparable to local infiltration using the same anesthetic. Both regional analgesia methods are more effective analgesics during the first 6 hours than are intravenous opioids. Furthermore the simple instillation of local anesthetic allows better analgesic evolution of the surgical wound after the first 24 hours considering the lower rate of resulting complications.
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The American surgeon · May 2001
Multicenter StudyIatrogenic and noniatrogenic extrahepatic biliary tract injuries: a multi-institutional review.
Traumatic and iatrogenic extrahepatic biliary tract injuries are rare but may lead to exceedingly morbid complications. Traumatic extrahepatic biliary tract injuries represent less than 1 per cent of all traumatic injuries. Iatrogenic injuries result in 0.2 to 1 per cent of laparoscopic or open cholecystectomies. ⋯ Hepaticojejunostomy has a complication rate of 15 per cent. Minor common duct lacerations are amenable to conservative therapy with oversewing and/or endoscopic retrograde cholangiopancreatography with stent placement. Repair of extrahepatic biliary tract injuries with hepaticojejunostomy at a level of good blood supply remains our gold standard for treatment of more severe injuries and strictures.
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The American surgeon · May 2001
Comparative StudyAre complications of subtotal colectomy with ileorectal anastomosis related to the original disease?
The aim of this study was to compare the morbidity of subtotal colectomy with ileorectal anastomosis performed for colonic inertia, Crohn's disease, familial adenomatous polyposis, and colorectal neoplasia. A retrospective review of all patients who underwent elective colectomy with ileorectal anastomosis between June 1988 and November 1996 was performed. The patients were divided into three groups: Group I, colonic inertia; Group II, Crohn's disease; and Group III, Familial Adenomatous Polyposis or other neoplasia. ⋯ This study failed to identify any differences in either immediate perioperative outcome or morbidity or intermediate-term function in patients undergoing ileorectal anastomosis regardless of diagnosis. The overall rate of small bowel obstruction was 13 per cent with no significant differences among the three groups. Lastly although the anastomotic leak rate was not significantly higher in patients with Crohn's disease it was higher in the group with ileostomy and ileorectal anastomosis, which highlights a potential advantage of performance of this procedure in two stages in selected patients of this patient population.