Journal of the American College of Surgeons
-
The American College of Surgeons (ACS) has collected comprehensive data about surgical residents for the past 12 years and has published an annual report, the Longitudinal Study of Surgical Residents. In 1994, the ACS and the American Medical Association (AMA) agreed to collaborate in collecting data about surgical residents. We report the analysis of these data for residents enrolled in graduate medical education (GME) in surgery during the 1993 to 1994 academic year. ⋯ Surgical GME enrollment has been stable since 1982, and graduates of general surgery residencies are increasingly likely to enroll in advanced specialty residency programs.
-
Since the inception of the Charity Hospital Tumor Registry in 1948, 80 cases of malignant melanoma in blacks were treated at the Tulane University School of Medicine, Department of Surgery. Among black people, melanoma occurs on acral dermal sites. The histologic type is primarily acrallentiginous melanoma (ALM), found on acral, volar-subungual skin and junctional mucocutaneous sites. ⋯ Black females have a higher rate of extracutaneous melanoma than black men or white men and women, which accounts for a distinct negative impact on survival rates among black women with melanoma. In addition, the worst prognosis of melanoma among black women is not entirely related to delays in diagnosis, as has been suggested, but to their higher rates of extracutaneous melanoma.
-
Randomized Controlled Trial Multicenter Study Clinical Trial
Prevention of postoperative abdominal adhesions by a sodium hyaluronate-based bioresorbable membrane: a prospective, randomized, double-blind multicenter study.
Postoperative abdominal adhesions are associated with numerous complications, including small bowel obstruction, difficult and dangerous reoperations, and infertility. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) was developed to reduce formation of postoperative adhesions. The objectives of our prospective study were to assess the incidence of adhesions that recurred after a standardized major abdominal operation using direct laparoscopic peritoneal imaging and to determine the safety and effectiveness of HA membrane in preventing postoperative adhesions. ⋯ This study represents the first controlled, prospective evaluation of postoperative abdominal adhesion formation and prevention after general abdominal surgery using standardized, direct peritoneal visualization. In this study, HA membrane was safe and significantly reduced the incidence, extent, and severity of postoperative abdominal adhesions.
-
Significant changes occurred over a 4.5-year period in the causes, diagnosis, and treatment of arterial injuries associated with skeletal fractures of the extremities. ⋯ Arterial injuries associated with fractures increasingly result from penetrating trauma and carry a much lower risk of amputation than injuries from blunt trauma. Physical examination can accurately detect 100 percent of the arterial injuries requiring repair. Minimal arterial abnormalities seen on arteriograms may be safely followed up by observation.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Comparative clinical study of port-closure techniques following laparoscopic surgery.
Recently, a number of laparoscopic port-closure techniques have been reported to avoid the complications associated with the port closure after laparoscopic surgery. To evaluate these port-closure techniques, we compared seven new laparoscopic port-closure techniques with the standard technique of a hand-sutured closure. ⋯ The Carter-Thomason device is our preferred method for the closure of port sites after laparoscopic surgery.