Journal of the American College of Surgeons
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Dialysis patients develop nonocclusive mesenteric ischemia (NOMI) at an increased rate. Previous studies have associated atherosclerosis and hemodialysis-induced hypotension as inciting factors for NOMI development. A retrospective review of 29 of 1,370 longterm hemodialysis patients who developed NOMI from January 1992 to December 1997 was performed. The NOMI patients were compared with a similar profile of hemodialysis patients to identify risk factors for the development of NOMI and for outcomes assessment. ⋯ NOMI occurs at an increased rate in hemodialysis patients. Identification of patients at high risk for NOMI and dose monitoring of filtration rates may impact on the high mortality of this disease.
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Staphylococcus aureus is a frequent cause of infection and bacteremia in the postoperative patient. Unfortunately, there have been no prospective studies evaluating these patients, so the incidence of complications, subsequent treatment algorithms, and prognosis remain undefined. The objectives of this prospective study of postoperative Staphylococcus aureus bacteremia (SAB) were to define the primary sources of bacteremia and to identify the common complications of SAB in the postoperative setting. ⋯ SAB in the postoperative setting is often a severe disease with high morbidity and mortality. A thorough diagnostic evaluation is indicated in surgical patients with S. aureus bacteremia to ensure the early detection of metastatic infections such as infective endocarditis and to define foci such as mediastinitis re quiring surgical intervention.
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Since its first description in 1948, total pelvic exenteration has been a surgical option for the treatment of locally advanced rectal cancer in selected patients. During these 50 years, it has remained a formidable procedure with high mortality and substantial morbidity. This report describes the results of total pelvic exenteration for rectal cancer in terms of post-operative mortality, morbidity, and longterm survival in patients with locally advanced primary and recurrent rectal cancer. ⋯ Total pelvic exenteration now can be performed with low mortality rates, but the morbidity remains high. In the treatment of primary rectal cancer, good survival (64%) can be achieved, but results are dismal for the treatment of recurrent disease. We suggest better selection of patients for this procedure, especially as a treatment for recurrent rectal cancer.
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Pyramidal surgical residency programs, in which more residents are enrolled than can complete the program, have gradually declined in number in recent years. In 1996, the Residency Review Committee for Surgery established a policy that the number of residents appointed to a program must be consistent with the number who will complete the program. Even so, there is still attrition in the ranks of surgical residents, some of whom hold undesignated preliminary positions and have no guarantee of a position that will lead to completion of the program. This study examined the 1993 entering cohort of surgical residents to determine the rate of attrition as of 1998. ⋯ The attrition rate from surgical GME is low, and most residents who drop out reenter GME in another specialty. Of concern is the high rate of attrition of African-American men who are United States or Canadian graduates. The highest rate of attrition, by far, is in the group of international medical graduates, many of whom are likely to have held undesignated preliminary positions.