Evidence-Based Workflows for Thyroid and Parathyroid Surgery.

A need exists to reduce care variations by standardizing the practice of thyroid and parathyroid surgery. During the course of a year, a task force developed algorithms representing decision points and workflows based on American Thyroid Association guidelines and three internal studies of surgical practices in the Northern and Southern California Regions of Kaiser Permanente conducted in collaboration with Health Information Technology Transformation & Analytics (HITTA).

The power of the National Surgical Quality Improvement Program--achieving a zero pneumonia rate in general surgery patients.

The National Surgical Quality Improvement Program (NSQIP) of the American College of Surgeons provides risk-adjusted surgical outcome measures for participating hospitals that can be used for performance improvement of surgical mortality and morbidity. A surgical clinical nurse reviewer collects 135 clinical variables including preoperative risk factors, intraoperative variables, and 30-day postoperative mortality and morbidity outcomes for patients undergoing major surgical procedures. A report on mortality and complications is prepared twice a year.

Effects of laparoscopic vs laparotomy treatment of E. coli peritonitis on hemodynamic responses in a porcine model.

Background: Laparoscopic surgery is being used now for increasingly diverse clinical applications, including diagnosis and treatment of appendicitis and bacterial peritonitis. However, some concerns and controversies exist regarding the effectiveness of laparoscopic irrigation of the abdominal cavity compared with that achieved during laparotomy. Of no less importance is concern that establishing a CO(2) pneumoperitoneum in patients with cardiopulmonary insufficiency or endotoxemic shock may compromise hemodynamic function.

Entrapment and obstruction of the esophagus from thoracic spine hyperextension-dislocation injury.

We have reported a unique case of esophageal entrapment and obstruction from a thoracic spine hyperextension-dislocation injury after a motor vehicle crash. Because the risk for esophageal injury is not typically associated with thoracic spine injury, a heightened sensitivity for developing symptoms and signs is at least necessary. As with any injury to the gastrointestinal tract, optimal therapy requires resuscitation and prompt operative intervention.

Cardiopulmonary effects of the laparoscopic pneumoperitoneum in a porcine model of adult respiratory distress syndrome.

Background: Increasingly, laparoscopy is being used in critically ill patients in whom there is a question of intra-abdominal sepsis. We examine the cardiopulmonary effects of laparoscopy in a porcine model of adult respiratory distress syndrome (ARDS).

Methods: Domestic pigs (n = 12) underwent saline lung lavage and subsequent surgical abdominal exploration using either laparoscopy or conventional laparotomy.

Hemodynamic effects of the laparoscopic pneumoperitoneum during sepsis in a porcine endotoxic shock model.

Objective: The authors compared the hemodynamic effects of laparoscopic intervention with conventional laparotomy in an endotoxic shock model in the pig.

Summary Background Data: Laparoscopic techniques are being applied more frequently to severely ill patients to evaluate potential abdominal sources of sepsis. Although hemodynamic effects of laparoscopy are minimal in healthy patients, recent studies have shown more significant changes in patients with chronic cardiopulmonary disease.

Generation of monoclonal antibodies against soluble human T cell receptor polypeptides.

One approach to the diagnosis and therapy of T cell-mediated diseases is to develop reagents specific for T cell receptor (TcR) variable (V) regions. To date, however, TcR expressed on the surface of antigen-specific T lymphocytes have proven to be poorly immunogenic. As a result, few monoclonal antibodies (mAb) recognizing human variable regions are available.

Kappa and lambda light chain composition of antibody to the capsular polysaccharide of Haemophilus influenzae type b.

Concentrations of total immunoglobulins bearing kappa and lambda light chains were measured in the sera of 215 healthy white children aged 6 months to 10 years. Both kappa and lambda concentrations increased with age. However, the concentration of immunoglobulins bearing kappa light chains increased at a greater rate than those bearing lambda light chains (P = .

Magnetite albumin microspheres: a new MR contrast material.

A superparamagnetic MR contrast agent was synthesized by incorporating 150-250-A particles of magnetite (Fe3O4, Fe2O3) in 1-5 microns human serum albumin microspheres. Magnetite albumin microspheres (MAM) target almost exclusively to the reticuloendothelial system after IV administration, are stable in vitro and in vivo, and possess a long shelf life. The agent has a large magnetic susceptibility effect that selectively reduces T2 with little effect on T1.

Intrafissural fat: CT correlation with chest radiography.

A small collection of supradiaphragmatic fat is occasionally present invaginating into the inferior aspect of the major interlobar fissure. In a review of 212 computed tomography (CT) scans obtained in the immediate supradiaphragmatic region, 39 cases demonstrated some degree of this intrafissural fat collection either unilaterally or bilaterally. On lateral chest radiographs, the intrafissural fat corresponded to a sharply marginated triangular density, the base of which abutted the anterior diaphragmatic surface and the apex of which tapered into the major fissure.

Pulse sequence optimization for MR imaging using a paramagnetic hepatobiliary contrast agent.

Paramagnetic agents enhance contrast between tissues in magnetic resonance (MR) imaging by altering tissue relaxation times. The effect of these changes on MR image intensity depends in part on the choice of operator-controlled pulse sequence parameters. With the newly described paramagnetic hepatobiliary contrast agent, iron(III) ethylenebis-(2-hydroxyphenylglycine), Fe(EHPG)-, an in vivo experimental analysis of pulse sequence optimization was performed on the rat.

Iron-EHPG as an hepatobiliary MR contrast agent: initial imaging and biodistribution studies.

The paramagnetic metal complex iron(III) ethylenebis-(2-hydroxyphenylglycine) [Fe(EHPG)-] is an effective hepatobiliary contrast agent for liver enhancement in magnetic resonance (MR) imaging. The intravenous administration of 0.2 mmol/kg of Fe(EHPG)- to rats yields a 200% increase in the signal intensity of the liver when using a T1-weighted inversion recovery pulse sequence on a 1.