Current surgery
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Little published literature describes accurate evaluation and assessment of surgical residents' technical competencies. Work-hour limitations and the proposed changes in training duration challenge our ability to provide core technical competencies, particularly during PGY-1-2. We identified minimally invasive surgery as a particularly challenging competency training area, requiring significant allocation of resident and faculty time and resources, with inconsistent training results. This project evaluated a standardized competency training curriculum in minimally invasive surgery in comparison to existing training. ⋯ The Laparoscopy 101 minimally invasive surgery curriculum (1) p;rovides a structured self-paced curriculum for minimally invasive didactic training that is well accepted by trainees; (2) yields PGY-1 competencies equivalent to PGY-2 who receive training in our department's existing program; and (3) yields significant improvement in PGY-2 minimally invasive surgery competencies. Training effects persist to 6 months without reinforcement. Our observations of PGY-2 performance and competency suggest that this training would best be instituted during PGY-2.
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Diabetes mellitus is the most common metabolic disease. New classifications have recently been proposed by the American Diabetes Association (ADA) and the World Health Organization (WHO). Type 1 (formerly insulin-dependent diabetes mellitus IDDM) is immune-mediated and leads to absolute insulin deficiency. ⋯ There is no consensus on the optimal metabolic management of the diabetic patient during surgery. Several surveys have highlighted the inconsistency with which surgical problems are managed in diabetic patients. The aim of this article is to provide protocols to achieve sensible and practical glycemic control in diabetic patients undergoing surgery.
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To determine the association of the admission white blood cell count in trauma patients with demographics, severity and mechanism of injury, and need for therapeutic intervention. ⋯ Variations in white blood cell count in trauma patients are associated with race and injury severity, but they are not beneficial in predicting the need for volume resuscitation, transfusion, or surgery.
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Review Case Reports
Adult malrotation: a case report and review of the literature.
Midgut malrotation is an anomaly of fetal intestinal rotation that usually presents in the first month of life. It is rare for malrotation to present in adulthood. Symptomatic patients present either acutely with bowel obstruction and intestinal ischemia with a midgut or cecal volvulus, or chronically with vague abdominal pain. ⋯ These symptoms are caused by peritoneal bands first described by Ladd in 1932. These bands run from the cecum to the right lateral abdominal wall. We present a case of malrotation in an adult who presented with chronic abdominal pain.