Laparoscopic versus open appendectomy: a metaanalysis.

Background: There have been numerous retrospective and uncontrolled series of laparoscopic appendectomy (LA), as well as 16 prospective randomized studies published to date. Although most of these have concluded that the laparoscopic technique is as least as good as open appendectomy (OA), there has been considerable controversy as to whether LA is superior. To help clarify this issue, we performed a metaanalysis of the randomized prospective studies.

Structure, diversity, and repertoire of VH families in the Mexican axolotl.

The Mexican axolotl V(H) segments associated with the Igh C mu and C nu isotypes were isolated from anchored PCR libraries prepared from spleen cell cDNA. The eight new V(H) segments found bring the number of V(H) families in the axolotl to 11. Each V(H) had the canonical structural features of vertebrate V(H) segments, including residues important for the correct folding of the Ig domain.

Appendiceal ultrasonography performed by nonradiologists: does it help in the diagnostic process?

We performed a retrospective study to compare the sensitivity, specificity, predictive value, and diagnostic accuracy of appendiceal ultrasonography performed by unsupervised technicians during the nighttime hours with studies performed during the day by supervised technicians. Fifty-nine percent of the 163 sonographic examinations were done during the day, and 41% were performed at night. The sensitivity during the day (61%) was significantly higher than at night (26%), as was the positive predictive value (93% day, 71% night).

Structure and diversity of the heavy chain VDJ junctions in the developing Mexican axolotl.

The immune capacity of young and adult axolotls (Ambystoma mexicanum) was evaluated by examining the combinatorial and junctional diversity of the VH chain. A large number of VDJ rearrangements isolated from 2.5-, 3.

A multivariate analysis of factors contributing to leakage of intestinal anastomoses.

Background: The study of anastomotic leaks is critically important to surgeons because morbidity and mortality increase many fold in the aftermath of an anastomotic disruption. Previous studies that have attempted to identify significant factors contributing to leakage of intestinal anastomoses used animal models or have analyzed retrospective data using univariate analysis. Our objective was to identify factors contributing to leakage of intestinal anastomoses.

Prognostic importance of scintigraphic left ventricular cavity dilation during intravenous dipyridamole technetium-99m sestamibi myocardial tomographic imaging in predicting coronary events.

Left ventricular (LV) cavity dilation during stress myocardial perfusion imaging has been associated with multivessel disease, and may be an independent prognostic marker in addition to perfusion defects. The present study examines the predictive value for future cardiac events of transient or fixed LV dilation during dipyridamole technetium-99m (Tc-99m) sestamibi single-photon emission computed tomography (SPECT) imaging. The study included 512 consecutive patients who underwent SPECT imaging with Tc-99m sestamibi after dipyridamole infusion.

Economic analyses of phase III cooperative cancer group clinical trials: are they feasible?

Both economic and clinical evaluations of new pharmaceutical agents are important to physicians who practice in the current health care environment. While cooperative cancer groups carry out large-scale phase III clinical evaluations of these agents, few cooperative group studies incorporate economic analyses because of concerns over overburdening of data management, investigators, and statistical center personnel. In this study, we describe the results and operational considerations of one of the first completed economic analyses of a phase III cooperative group trial of the Eastern Cooperative Oncology Group (ECOG).

Vibrio cholerae 01 isolated in the gallbladder of a patient presenting with cholecystitis.

Cholera is a topical infection of the intestinal tract and rarely causes extraintestinal disease. The gallbladder has been proposed to be the reservoir of this organism. We present a patient from Bolivia who developed symptoms of acute cholecystitis and whose bile culture grew Vibrio cholerae 01 El tor.

A new method using neuromagnetic stimulation to measure conduction time within the cauda equina.

Using principles derived from electric field measurements and studies of phrenic nerve in vitro, neuromagnetic stimuli in humans were predicted to excite selective low threshold sites in proximal and distal cauda equina. Physical models, in which induced electric fields were recorded in a segment of human lumbosacral spine immersed in a saline filled tank, supported this prediction. Conclusions from the model were tested and confirmed in normal human subjects.

Effectiveness of nuclear cardiology training guidelines: a comparison of trainees with experienced readers.

Background: To evaluate the effectiveness of published nuclear cardiology training guidelines, the diagnostic accuracy of image interpretation by nuclear cardiology trainees was compared with that of experienced nuclear cardiologists.

Methods And Results: The accuracy of three experienced nuclear cardiologists and three trainees with level II experience following Society of Nuclear Medicine/American College of Cardiology/American Society of Nuclear Cardiology guidelines in the interpretation of 114 exercise 99mTc-labeled sestamibi single-photon emission computed tomographic imaging studies was evaluated. Studies were selected randomly and included patients with less than 5% likelihood of coronary artery disease, as well as patients with angiographically demonstrated single and multivessel disease.

Effect of catheter diameter on resting pressures in anal fissure patients.

Purpose: Controversy exists as to whether fissure patients have elevated resting pressures when compared with control patients. The diameter of manometry catheters used in past studies varies widely (1.5-25 mm) and may have contributed to differences observed in resting pressures.

Colonoscopic bowel preparations--which one? A blinded, prospective, randomized trial.

Unlabelled: For the past decade peroral, orthograde, polyethylene glycol-electrolyte lavage solutions (PEG-ELS) have been the preferred bowel-cleansing regimens before diagnostic and therapeutic procedures on the colon and rectum. The large volume and unpalatibility of these solutions may lead to troubling side effects and poor patient compliance.

Purpose: This study was undertaken to determine which of various colon-cleansing methods before colonoscopy would provide greater patient acceptance while maintaining similar or improved effectiveness and safety.

Endoscopic treatment of postoperative hemorrhage from a stapled colorectal anastomosis.

We present the sixth reported case of endoscopic electrocoagulation to successfully treat postoperative hemorrhage from a stapled colorectal anastomosis. A literature review revealed 17 patients with postoperative hemorrhage from a combined total of 775 patients (1.8 per cent) after stapled colorectal anastomosis requiring blood transfusion and/or emergency surgery.

Spontaneous ureterocolic fistula: a rare complication of colonic diverticular disease.

Spontaneous ureterocolic fistula is rare and usually caused by urinary calculi. We present the fifth reported case of spontaneous ureterocolic fistula caused by diverticular disease of the colon. Review of these cases revealed a preponderance of women (3:1 ratio), with mean age of 77 years.

Abdominal wall recurrence after laparoscopic colectomy for colon cancer.

Background: Although rare, abdominal wall recurrences after laparoscopic surgery for cancer have been increasing at an alarming rate as the range and sheer number of laparoscopic surgical procedures have increased. Overall, 13 case reports of abdominal wall cancer recurrence after laparoscopic surgery have been published.

Methods And Results: We present the fourth known case of abdominal wall recurrence after laparoscopic colectomy involving a patient with a TNM stage III (T3, N2, M0) colon cancer.

Gallstone shrapnel contamination during laparoscopic cholecystectomy.

The fate of lost gallstones in the peritoneal cavity following laparoscopic cholecystectomy is unknown. We report a case of microabscesses and granuloma formation in the peritoneal cavity and abdominal wall caused by infected gallstone shrapnel due to rupture of the gallbladder during extraction.

Accuracy of viscera slide detection of abdominal wall adhesions by ultrasound.

Viscera slide is the normal, longitudinal movement of the intraabdominal viscera caused by respiratory excursions of the diaphragm. By detecting areas of restricted viscera slide, ultrasonic imaging was used to identify anterior abdominal wall adhesions prior to laparotomy or laparoscopy. Transcutaneous ultrasound examination was performed on 110 patients.

Efficacy of albumin supplementation in the surgical intensive care unit: a prospective, randomized study.

Objective: To determine the efficacy of supplemental 25% albumin in reducing morbidity and mortality rates in the surgical intensive care unit (ICU).

Design: Prospective, randomized, unblinded clinical study.

Setting: Surgical ICU in a community hospital.