Classic Whipple versus pylorus-preserving pancreaticoduodenectomy in the ACS NSQIP.

Background: The classic Whipple operation carries substantial risk of complications. A pylorus-preserving pancreaticoduodenectomy might confer the benefit of decreased perioperative morbidity, but existing data comparing both techniques are inconclusive.

Methods: Using a propensity score model to adjust for potentially confounding differences in patient characteristics, 30-d mortality, operative time, red blood cell transfusion requirements, major complications, and length of hospital stay were compared between both techniques in the American College of Surgeons' National Surgical Quality Improvement Program database.

Personal experience with the Whipple operation: outcomes and lessons learned.

Pancreaticoduodenectomy (PD) has evolved into a safe procedure in major high-volume medical centers. This retrospective outcome review is from a database of 134 consecutive PDs from 1985 through 2002; all of whom underwent resection in a community hospital with a general surgery residency. All resections were performed by senior residents under the supervision of the same attending surgeon (V.

Resident research training conducted in a community hospital general surgery residency program.

Purpose: Research is educationally important for surgical residents. However, little information exists regarding effective methods for teaching residents scientific methodology in a community hospital. This effort describes an effective program conducted in a community hospital for enhancing scientific opportunities of surgical residents.

Sarcoidosis of the pancreas: case report and review of the literature.

Sarcoidosis involving the pancreas is rare. Patients can present with symptoms that mimic pancreatic cancer. We report a case of a male patient with clinical and radiographic findings suggestive of pancreatic cancer as the initial manifestation of sarcoidosis.

Extrapericardial tamponade with herniated omentum after transhiatal esophagectomy.

An unusual complication following transhiatal esophagectomy for lower esophageal carcinoma is reported in which extrapericardial tamponade and profound shock occurred secondary to a herniated section of omentum in the immediate postoperative period. The two-dimensional echocardiogram was nondiagnostic, but the diagnosis was confirmed during reexploration of the abdomen. Anatomic and pathophysiologic considerations of this unusual but life-threatening complication are discussed.

The consequences of a cavalier approach to central venous catheterization.

A cavalier approach on the part of some physicians, and poor research on the part of some equipment manufacturers, has made central venous catheterization more dangerous to the patient than it need be. Here, the relationship between these factors is discussed, with special reference to the fact that central venous catheterization is an invasive surgical operation which should not be taken lightly by its practitioners.

Internal hernia and gangrenous intestine. A rare complication of a femoral--femoral bypass graft.

An unusual case of an internal hernia related to a retropubic femoral-femoral bypass graft is presented. An orifice between the left and right inguinal ligaments and a protruding intraperitoneal portion of the prosthetic graft material resulted in herniation and strangulation of a portion of the small intestine. Technical factors (graft redundancy or misplacement) and natural factors (pulsatile erosion or age elongation) may be implicated.

Primary adenocarcinoma of the appendix. Can preoperative or intraoperative diagnosis be made?

Adenocarcinoma of the appendix is a rare entity with a reported incidence of .03 to .08 per cent.

Total intravenous nutrition with peripherally inserted silicone elastomer central venous catheters.

Long-term indwelling central venous catheters inserted peripherally for total intravenous nutrition have been complicated by thrombophlebitis in most instances. However, experiences with silicone elastomer catheters used in this manner have not been previously reported. In this investigation a crank introducer unit has been developed that has allowed 61-cm silicone elastomer catheters to be placed in the superior vena cava with insertion in the basillic or cephalic vein.