Sentinel Contributions of US Department of Veterans Affairs Surgeons in Shaping the Face of Health Care.

The vast accomplishments of the US Department of Veterans Affairs (VA) during the past century have contributed to the advancement of medicine and benefited patients worldwide. This article highlights some of those accomplishments and the advantages in the VA system that promulgated those successes. Through its affiliation with medical schools, its formation of a structured research and development program, its Cooperative Studies Program, and its National Surgical Quality Improvement Program, the VA has led the world in the progress of health care.

Appendectomy for appendicitis in patients with a prior ventriculoperitoneal shunt.

Background: Approximately 18,000 cerebrospinal fluid shunts, the majority of which are ventriculoperitoneal, are placed each year in the United States. These patients may develop appendicitis and require surgery. Whether the risk of postoperative complications is increased in these patients is unknown.

Outcome after colectomy for Clostridium difficile colitis.

Purpose: Clostridium difficile colitis is a relatively common entity, yet large series of patients with fulminant C. difficile colitis are infrequently reported. This study was designed to identify risk factors, clinical characteristics, and outcome of patients who required colectomy for fulminant C.

Fulminant Clostridium difficile colitis in a patient with spinal cord injury: case report.

Background: In certain patients with Clostridium difficile colitis (CDC), a life-threatening systemic toxicity may develop despite appropriate and timely medical therapy.

Design: Literature search and case report.

Findings: A 39-year-old man with T10 paraplegia presented with a distended, quiet abdomen following recent treatment with antibiotics for pneumonia.

Spectrum of disease and outcome of complicated diverticular disease.

Background: Diverticular disease is a common entity. The presentation, investigations performed, and management are variable. Our objectives were to assess the presentation, extent of disease, and treatment of a cohort of patients with colonic diverticulitis.

Colon and rectal cancer in the elderly. High incidence of asymptomatic disease, less surgical emergencies, and a favorable short-term outcome.

Background: This is a retrospective study aimed to report short-term outcome among patients age > or =70 years surgically treated for colorectal cancer.

Methods: All patients with the discharge diagnosis of colon and rectal cancer at St. Louis University Hospital from 1992 to 2002 were reviewed.

Ischemic colitis: spectrum of disease and outcome.

Background: The aim of this study was to identify risk factors, clinical characteristics, and outcome of patients with colon ischemia.

Methods: A 10-year (1992-2002) retrospective study was undertaken. Patients were identified from computerized hospital discharge information.

Patterns of disease and surgical treatment among United States veterans more than 50 years of age with ulcerative colitis.

Background: Ulcerative colitis (UC) is a clinical entity that predominantly affects young adults yet large series of middle age or elderly patients with UC are infrequently reported. The aim of this study is to identify patterns of disease, indications for operation, surgical treatment, and outcome of patients more than 50 years of age who required surgery for UC in Department of Veterans Affairs (DVA) Medical Centers.

Methods: A population-based study on all patients in 159 hospitals of the DVA from 1997 to 2001 was carried out.

Colovaginal fistulas. Etiology and management.

Objective: To review the diagnosis and treatment of colovaginal fistulas from various causes.

Data Sources: Papers on colovaginal fistulas were identified using Ovid and PubMed. The search terms used were as follows: colovaginal fistulas, rectovaginal fistulas, diverticular disease and fistulas.

Duodenal reflux produces hyperproliferative epithelial esophagitis--a possible precursor to esophageal adenocarcinoma in the rat.

Esophageal reflux of duodenal contents converts a rat nitrosamine esophageal cancer model from squamous cell carcinoma to adenocarcinoma. Further, there was a tendency for male rats to have a higher incidence of cancer than female rats. However, chemical castration with the gonadotropin-releasing hormone analog leuprolide did not protect male or female animals from developing cancer.

Acute surgical emergencies in inflammatory bowel disease.

Background: Acute surgical emergencies in patients with inflammatory bowel disease may carry a substantial morbidity, but fortunately today, a low mortality. The aim of this review is to delineate the treatment of acute surgical emergencies that occur in patients with ulcerative colitis and Crohn's disease.

Methods: Suitable English language reports were identified using PubMed search.