Surgical malpractice in California: res judicata.

Medical negligence claims are of increasing concern to surgeons. Although noneconomic damage awards in California are limited by the Medical Injury Compensation Reform Act (MICRA) law to $250,000, the total amount of such settlements can increase significantly based on claims for economic damages. We reviewed negligence litigation involving California surgeons to determine outcomes and monetary awards through retrospective review of surgical malpractice cases published in a legal journal.

Duodenal adenocarcinoma: why the extreme rarity of duodenal bulb primary tumors?

Adenocarcinoma of the small bowel accounts for only one per cent of all gastrointestinal malignancies. Duodenal adenocarcinoma accounts for half of all small bowel adenocarcinomas. The duodenum is divided into four segments: D1 (proximal horizontal 5 cm beginning with the 3-cm duodenal bulb), D2 (descending), D3 (distal horizontal), and D4 (ascending).

Senior residents as teaching assistants during laparoscopic cholecystectomy in the 80-hour workweek era: effect on biliary injury and overall complication rates.

Purpose: The resident as teaching assistant (TA) in the operating room is an important role in the maturation of surgical trainees. One concern in the current 80-hour workweek era is that current senior residents (SRs) are unprepared to serve as TAs, potentially leading to higher complication rates and a significant increase in the length of operations. The aim of this study was to analyze whether SRs serving as TAs during laparoscopic cholecystectomy (LC) resulted in an adverse effect on complication rates in the 80-hour workweek era.

Choledochoduodenostomy as the biliary-enteric bypass of choice for benign and malignant distal common bile duct strictures.

Choledochoduodenostomy (including hepaticoduodenostomy) for common bile duct (CBD) strictures has been underused because of concerns regarding postoperative duodenal fistula and cholangitis attending the so-called "sump syndrome." An institutional retrospective review of 55 consecutive choledochoduodenostomy procedures for CBD strictures from 1995 to 2011 was performed to examine its suitability as the biliary-enteric bypass procedure of choice. There were 30 male (55%) and 25 female (45%) patients with a mean age of 49 years (range, 13 to 73 years).

The unequal distribution of parathyroid neoplasms in male patients.

There is a known lesser incidence of primary hyperparathyroidism and parathyroid neoplasms in male patients. Any difference in the anatomic distribution between males and females has not been documented. Review of our institutional experience with 125 pathologically confirmed parathyroid adenomas (119) or carcinomas (six) from 2000 through 2012 was conducted.

Laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy achieve comparable weight loss at 1 year.

Laparoscopic sleeve gastrectomy has gained popularity as a weight loss surgical option for morbidly obese patients. Although initial studies have shown weight loss and comorbidity resolution comparable to those after laparoscopic Roux-en-Y gastric bypass (RYGB), many of these studies are limited by the small patient size. Thus, the purpose of this study was to compare the outcomes of laparoscopic sleeve gastrectomy and laparoscopic RYGB.

Effect of socioeconomic status on surgery for pancreatic adenocarcinoma.

Survival for pancreatic cancer remains poor. Surgical resection remains the only chance for cure. The intent of this study was to investigate the role of socioeconomic status (SES) on resection rates for pancreatic adenocarcinoma.

Early laparoscopic cholecystectomy for mild gallstone pancreatitis: time for a paradigm shift.

HYPOTHESIS Patients with mild gallstone pancreatitis may undergo an early laparoscopic cholecystectomy (LC) within 48 hours of hospital admission without awaiting the normalization of pancreatic and liver enzyme levels. This may decrease the hospital stay without increasing morbidity or mortality and may minimize the unnecessary use of endoscopic retrograde cholangiopancreatography. DESIGN A retrospective review.

Preoperative serum albumin but not prealbumin is an excellent predictor of postoperative complications and mortality in patients with gastrointestinal cancer.

Preoperative serum albumin level is well recognized as a general predictor of adverse surgical outcomes in patients with gastrointestinal (GI) malignancy. Whether serum albumin or prealbumin levels can better predict postoperative surgical complications and death remains unknown. A retrospective review of 641 consecutive patients operated nonemergently for GI malignancies between January 1, 1997, and July 31, 2008, disclosed that 104 patients (16.

Fluorescence in situ hybridization and K-ras analyses improve diagnostic yield of endoscopic ultrasound-guided fine-needle aspiration of solid pancreatic masses.

Objectives: Endoscopic ultrasound (EUS)-guided fine-needle aspiration (FNA) is the main diagnostic modality for pancreatic mass lesions. However, cytology is often indeterminate, leading to repeat FNAs and delay in care. Here, we evaluate whether combining routine cytology with fluorescence in situ hybridization (FISH) and K-ras/p53 analyses improves diagnostic yield of pancreatic EUS-FNA.

Staining for p53 and Ki-67 increases the sensitivity of EUS-FNA to detect pancreatic malignancy.

Aim: To investigate whether tumor marker staining can improve the sensitivity of endoscopic ultrasound-guided fine needle aspiration (EUS-FNA) to diagnose pancreatic malignancy.

Methods: Patients who underwent EUS-FNA were retrospectively identified. Each EUS-FNA specimen was evaluated by routine cytology and stained for tumor markers p53, Ki-67, carcinoembryonic antigen (CEA) and CA19-9.

Use of clinical triage criteria decreases monitored care bed utilization in gallstone pancreatitis.

Admission indicators for monitored care in gallstone pancreatitis have been lacking. Recently, we established three criteria for admission to intensive care unit or step down versus ward beds: (1) concomitant cholangitis, (2) heart rate >110 beats/min, and (3) blood urea nitrogen >15 mg/dL. The purpose of this study was to determine whether these criteria would be effective in decreasing monitored care bed utilization without adversely affecting outcomes.

Solid pseudopapillary neoplasm of the pancreas: a rare and atypically aggressive disease among male patients.

Solid pseudopapillary neoplasm (SPN) of the pancreas is uncommon, has low metastatic potential, typically afflicts young females, and expresses progesterone receptors. In the rare male patient, its biologic behavior may be more aggressive and lethal. A retrospective case series analysis and literature review of SPN was performed to compare its clinical behaviors in males and females.

Acute care surgery performed by sleep deprived residents: are outcomes affected?

Background: The Institute of Medicine recently recommended further reductions in resident duty hours, including a 5-h rest time for on-call residents after 16 h of work. This recommendation was purportedly intended to better protect patients against fatigue-related errors made by physician trainees. Yet no data are available regarding outcomes of operations performed by surgical trainees working without rest beyond 16 h in the current 80-h workweek era.

Early cholecystectomy safely decreases hospital stay in patients with mild gallstone pancreatitis: a randomized prospective study.

Objective: We hypothesized that laparoscopic cholecystectomy performed within 48 hours of admission for mild gallstone pancreatitis, regardless of resolution of abdominal pain or abnormal laboratory values, would result in a shorter hospital stay.

Summary Of Background Data: Although there is consensus among surgeons that patients with gallstone pancreatitis should undergo cholecystectomy to prevent recurrence, the precise timing of laparoscopic cholecystectomy for mild disease remains controversial.

Methods: Consecutive patients with mild pancreatitis (Ranson score View Article and Find Full Text PDF

Narrowing the gap: early and intermediate outcomes after percutaneous coronary intervention and coronary artery bypass graft procedures in California, 1997 to 2006.

Objective: Percutaneous coronary intervention is increasingly used to treat multivessel coronary artery disease. Coronary artery bypass graft procedures have decreased, and as a result, percutaneous coronary intervention has increased. The overall impact of this treatment shift is uncertain.

Extreme aggressiveness and lethality of gastric adenocarcinoma in the very young.

Objective: To determine whether very young patients with gastric adenocarcinoma as compared with older patients with the disease have a biologically more aggressive form of the disease, presenting at an advanced stage and conferring unusually poor perioperative and long-term outcomes.

Design, Setting, And Patients: A 15-year, single-institution, retrospective review and analysis of demographic and outcomes data for 350 patients diagnosed with gastric adenocarcinoma.

Main Outcome Measures: Histologic features, frequency of stage IV disease, frequency of curative gastric resection, postoperative mortality, and long-term survival in very young and older patient groups.

The value of endoscopic ultrasonography in predicting resectability and margins of resection for periampullary tumors.

Cure of pancreatic head and other periampullary neoplasms continues to be infrequent and is unattainable unless clear surgical margins are achieved during Whipple pancreaticoduodenectomy. Endoscopic ultrasonography (EUS) is a relatively recent gastrointestinal tumor imaging modality and may be superior to other techniques used in locoregional staging. We hypothesized that EUS can accurately predict not only tumor resectability, but also negative resection margins with Whipple resection.

Total bilirubin is a useful predictor of persisting common bile duct stone in gallstone pancreatitis.

Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP.

Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek.

Background: Considerable concern has been raised about the effects of restricted duty hours on surgical training. However, to our knowledge, the effect of the 80-hour resident workweek on operative outcomes after laparoscopic cholecystectomy has not been well studied.

Objective: To compare the rates of bile duct injury and overall complications after laparoscopic cholecystectomy before and after the institution of the duty-hour restriction.

Early cholecystectomy for mild to moderate gallstone pancreatitis shortens hospital stay.

Background: The timing of cholecystectomy in gallstone pancreatitis remains controversial. We hypothesized that in patients with mild to moderate gallstone pancreatitis (three or fewer Ranson's criteria), performing early cholecystectomy before resolution of laboratory or physical examination abnormalities would result in shorter hospitalization, without adversely affecting outcomes.

Study Design: An observational study consisting of a retrospective and a prospective group was conducted.

Gallstone pancreatitis: a benign disease in Hispanics.

Little is known about ethnic differences among patients with gallstone pancreatitis in the United States. The purpose of this study was to compare Hispanic and non-Hispanic patients with gallstone pancreatitis with regard to severity of disease, level of care required, length of hospital stay, and clinical outcomes. A retrospective cohort study of 198 consecutive patients with gallstone pancreatitis was performed from 2003 to 2005.

En bloc resection of the duodenum for locally advanced right colon adenocarcinoma.

Direct invasion of colorectal adenocarcinoma into adjacent structures occurs frequently, but only rarely is the duodenum involved. This study was undertaken to assess the safety and efficacy of en bloc resection of locally advanced right colon carcinoma invading the duodenum. A retrospective review of 49 patients with locally advanced colon cancer, surgically managed between 2000 and 2005, was performed.