Financial Contribution of Residents When Billing as "Junior Associates" in the "Surgical Firm".

Objective: There is an increasing number of proposals to change the way Graduate Medical Education is funded. This study attempts to estimate the potential financial contribution of surgical residents using an alternative funding mechanism similar to that used by law firms, which would allow surgery departments to bill for resident activity as "junior associates."

Methods: Following 24 residents over a period of 12 weeks, we were able to estimate the annual revenue that they generated from operating room procedures, independent consultations, patient management, and minor procedures using Medicare reimbursement rates.

Ligation of superior mesenteric vein and portal to splenic vein anastomosis after superior mesenteric-portal vein confluence resection during pancreaticoduodenectomy - Case report.

Unlabelled: 62 year old Caucasian female with pancreatic head mass abutting the superior mesenteric vein (SMV) presented with fine needle aspiration biopsy confirmed diagnosis of ductal adenocarcinoma. CT scan showed near complete obstruction of portal vein and large SMV collateral development. After 3 months of neoadjuvant therapy, her portal vein flow improved significantly, SMV collateral circulation was diminished.

Patient variables impacting hospital costs from 2008 to 2010.

Background: Studying the variables associated with the increased costs of health care provides valuable insight.

Methods: A review and analysis of the pertinent variables and information collected for 118.3 million hospital admissions recorded as Nationwide Inpatient Samples database was done for the years 2008 to 2010.

A single center experience with retrievable IVC filters.

Objective: To evaluate retrievable IVC filters in our institution and assess their retrieval following a well-structured follow up program.

Design: Retrospective cohort study.

Materials: The medical records of patients implanted with retrievable IVC filters were reviewed.

Femoral artery complications after cardiac catheterization: a study of patient profile.

Background: Femoral artery complications after cardiac catheterization range from simple events to severe complications requiring invasive techniques or surgery with significant economic costs. This study evaluated early femoral arterial complications from percutaneous arterial access during diagnostic and interventional cardiac catheterizations in an era of widespread use of closure devices and intense anticoagulation.

Methods: Patients undergoing percutaneous cardiac catheterization via the femoral artery between August 2005 and December 2005 were identified using an ICD-9 patient database.

Changes in inferior vena cava filter placement over the past decade at a large community-based academic health center.

Objective: A significant increase in the frequency of inferior vena cava (IVC) filter placement at our large community-based academic health center led us to evaluate changes in indications, devices, and providers over the past decade.

Methods: A single-center retrospective review of all filter placements was performed comparing 76 patients in 1995 with 470 patients in 2005. Demographic data, provider data, filter type, and indications for placement were tabulated.

Contemporary outcomes for carotid endarterectomy at a large community-based academic health center.

The North American Symptomatic Carotid Endarterectomy Trial (NASCET) and Asymptomatic Carotid Atherosclerosis Study (ACAS) demonstrated the efficacy of carotid endarterectomy (CEA), but these studies were published 15 and 11 years ago, respectively. We hypothesized that present clinical results of CEA have improved compared with those reported by NASCET/ACAS. Every patient having CEA from January 1999 through December 2003 was reviewed as part of a continuous quality-assurance program.

Intentional coverage of a main renal artery during endovascular juxtarenal aortic aneurysm repair in symptomatic high-risk patients.

Purpose: To describe the efficacy and morbidity of intentionally covering a main renal artery during symptomatic juxtarenal endovascular aneurysm repair (EVAR).

Case Reports: Two patients with symptomatic juxtarenal abdominal aortic aneurysm (AAA) were felt to be at prohibitive risk for open repair. Each underwent EVAR with intentional coverage of 1 main renal artery to achieve adequate proximal hemostatic seal.

Positron-emission tomography as a prognostic tool for early-stage lung cancer.

Background: Positron-emission tomography (PET) shows tissue metabolic activity in the form of the standard uptake value (SUV). This study examines the prognostic value of the SUV for early-stage lung cancer.

Methods: A retrospective review of 187 patients undergoing PET for potential lung cancer.

Diagnosis of total internal carotid occlusions with duplex ultrasound and ultrasound contrast.

It remains a significant technical challenge for duplex ultrasound to accurately differentiate between total and near total internal carotid artery (ICA) occlusions. We have evaluated the efficacy of an ultrasound contrast agent combined with improved imaging techniques in patients with suspected carotid artery occlusions. Patients identified by conventional duplex ultrasound between January and August 2003 as having a possible ICA occlusion were eligible for study.

Size and location of thrombus in intact and ruptured abdominal aortic aneurysms.

Purpose: This study compared the volume and morphology of intraluminal thrombus (ILT) in intact and ruptured abdominal aortic aneurysms (AAAs).

Methods: ILT volume in 67 intact AAAs and in 31 ruptured AAAs was assessed by using computed tomography (CT) angiography to measure the major and minor diameter of the outer wall and lumen of AAA as outlined by contrast at multiple sites. ILT thrombus morphology was recorded by AutoCAD 2000 software.

Lysyl oxidase expression in bronchogenic carcinoma.

Background: Lysyl oxidase catalyzes a key step in the cross-linking of collagen and elastin in the extracellular matrix. Recent studies have documented differential lysyl oxidase expression in the stromal reaction to colon, breast, prostate, and lung cancer. The present study was undertaken to test the hypothesis that lysyl oxidase mRNA and protein expression decrease with advancing tumor stage in patients with bronchogenic carcinoma.

Duplex ultrasound recognition of spontaneous carotid dissection--a case report and review of the literature.

Spontaneous dissection of the internal carotid artery is an uncommon entity with a variable clinical presentation. A high index of suspicion is required to make the diagnosis, and prompt diagnosis and treatment with anticoagulation are essential for improved patient outcomes. Duplex ultrasound provides a safe and reliable imaging modality for early diagnosis and follow-up.

Nitric oxide-releasing biopolymers inhibit thrombus formation in a sheep model of arteriovenous bridge grafts.

Objectives: Nitric oxide (NO), produced by normal vascular endothelial cells, reduces platelet aggregation and thrombus formation. NO-releasing biopolymers have the potential to prolong vascular graft and stent patency without adverse systemic vasodilation.

Methods: 5-mm polyurethane vascular grafts coated with a polymer containing the NO-donor dialkylhexanediamine diazeniumdiolate were implanted for 21 days in a sheep arteriovenous bridge-graft model.

Lysyl oxidase expression in a rat model of arterial balloon injury.

Objective: Traditional therapies for arteriosclerotic disease often fail as a result of an exaggerated fibroproliferative response (recurrent stenosis) at the site of the intervention. Lysyl oxidase, secreted by activated vascular smooth muscle cells and fibroblasts, catalyzes a key step in the cross-linking and stabilization of collagen and elastin in the vascular wall. We hypothesized that lysyl oxidase messenger RNA (mRNA) and protein expression are time-dependent and precede collagen accumulation and luminal narrowing after arterial balloon injury in the rat.

Gastrointestinal complications following infrarenal endovascular aneurysm repair.

Gastrointestinal complications are known to occur after open elective aortic aneurysm repair. This leads to increased morbidity, mortality, length of stay, and hospital costs. The authors hypothesize a change in the character and/or frequency of early postoperative gastrointestinal complications after endovascular aneurysm repair as compared to open abdominal aortic repair.

Hypothermia is an independent predictor of mortality in ruptured abdominal aortic aneurysms.

Hypothermia is known to significantly increase mortality in trauma patients, but the effect of hypothermia on outcomes in ruptured abdominal aortic aneurysms (RAAA) has not been evaluated. The authors reviewed their experience from 1990 to 1999 in 100 consecutive patients who presented with RAAA and survived at least to the operating room for surgical treatment. There were 70 men and 30 women, with a mean overall age of 74 +/-8 years.

Reliability of extracranial carotid artery duplex ultrasound scanning: value of vascular laboratory accreditation.

Objectives: The purpose of this study was to evaluate the reliability of carotid duplex ultrasound scanning performed by nonaccredited vascular laboratories and to assess the clinical effect on patient management.

Methods: We retrospectively reviewed concordance of findings of carotid duplex ultrasound scanning between laboratories accredited by the Intersocietal Commission for Accreditation of Vascular Laboratories and nonaccredited laboratories in 174 patients with asymptomatic disease referred to tertiary care community hospitals for surgical evaluation for carotid endarterectomy (CEA) between January 2001 and December 2002, and evaluated changes in clinical management made on the basis of repeat examinations.

Results: Concordant findings were noted in 171 of 348 arteries (49%), predominantly those with minimal or mild disease (114 arteries; 67%).

Duplex ultrasound imaging with an ultrasound contrast agent: the economic alternative to CT angiography for aortic stent graft surveillance.

The use of endovascular stent graft repair for aortic aneurysmal disease has become increasingly common, with the added requirement for close postoperative surveillance to detect the presence of endoleaks or graft migration. The most commonly used technique for surveillance is computed tomography (CT) angiography, with the need for intravenous contrast posing 1 limitation in those patients with renal dysfunction and the cost of this testing presenting an economic limitation. Early results of duplex imaging in the authors' Vascular Laboratory using an intravenous ultrasound contrast agent have shown sensitivity and specificity equivalent to those of CT angiography, with no evidence of any related morbidity.

Relationship of residual intraluminal to intrathrombotic pressure in a closed aneurysmal sac.

Purpose: This study was undertaken to determine the relationship of residual intraluminal aneurysmal sac pressure (ILASP) to intrathrombic aneurysm sac pressure (ITASP) and to define the relationship between abdominal aorta aneurysm (AAA) size (anteroposterior or transverse diameter), volume of intraluminal thrombus, and residual ITASP.

Methods: We measured ILASP and ITASP after proximal aortic neck and distal iliac clamping by placing angiocatheters into the lumen and thrombus of an excluded aneurysm sac in 41 consecutive patients. Simultaneously, mean blood pressure was recorded and aneurysm sac pressure ratio was calculated.

Transrenal fixation of endovascular stent-grafts for infrarenal aortic aneurysm repair: mid-term results.

Purpose: We evaluated mid-term results of a single-center consecutive series of endovascular stent-grafts implanted for aortic aneurysm repair with transrenal fixation, to determine clinical outcome, aneurysm anatomy, renal artery patency, and renal complications.

Methods: Modular stent-grafts were placed with transrenal fixation in 37 patients between November 1998 and July 2000. Follow-up evaluation included clinical examination, laboratory evaluation of serum creatine concentration, computed tomographic angiography, and renal duplex scanning.

Efficacy of ultrasound scan contrast agents in the noninvasive follow-up of aortic stent grafts.

Objective: Computed tomographic angiography (CTA) is currently the most commonly used technique for postoperative surveillance to detect endoleaks after endovascular stent graft repair of abdominal aortic aneurysms. We have evaluated the efficacy of duplex ultrasound scan with the addition of an ultrasound scan contrast agent in documenting endoleaks and compared these results with CTA.

Methods: Conventional duplex ultrasound scan with color Doppler imaging (CDI) was first done as part of routine postoperative surveillance.

American College of Cardiology/American Heart Association preoperative assessment guidelines reduce resource utilization before aortic surgery.

Background: Methods used for evaluation of cardiac risk before noncardiac surgery vary widely. We evaluated the effect over time on practice and resource utilization of implementing the American College of Cardiology/American Heart Association Guidelines on Preoperative Risk Assessment.

Methods: We compared 102 historical control patients who underwent elective abdominal aortic surgery (from January 1993 to December 1994) with 94 consecutive patients after guideline implementation (from July 1995 to December 1996) and 104 patients in a late after guideline implementation (from July 1, 1997, to September 30, 1998).

Simultaneous stent-graft repair of thoracic and infrarenal abdominal aortic aneurysms.

Purpose: To describe a technique for concomitant endovascular stent-graft repair of thoracic and infrarenal abdominal aortic aneurysms.

Case Report: A 68-year-old man was found to have concomitant thoracic and abdominal aortic aneurysms. Both of the aneurysms were excluded successfully in one procedure using Talent stent-grafts.