Hypermagnesaemia causing mesenteric ischaemia and small bowel infarction.

We present a case of mesenteric ischaemia caused by hypermagnesaemia after ingestion of a large oral dose of magnesium citrate, which resulted in smooth muscle relaxation, hypotension and bowel infarction. The patient had a history of chronic bowel dysmotility and renal impairment. On operative exploration, the bowel was noted to have a distinct pattern of ischaemia along its antimesenteric border.

The laparoscopic experience of surgical graduates in the United States.

Background: Although laparoscopic surgery has become widespread during the past decade, no systematic study of the training needs exists. To obtain guidance for planning, we analyzed the national resident operative experience during the past 8 years.

Methods: The laparoscopic experiences of all surgical residents graduating between 1994 and 2001 were subjected to regression analysis.

The decline of training in open biliary surgery: effect on the residents' attitude toward bile duct surgery.

Background: After more than a decade of growth for laparoscopic cholecystectomy and decline in open cholecystectomy, the impact on the training of resident's in other open biliary operations can be analyzed quantitatively.

Methods: The national operative statistics for residents' operations from 1988 to 2001 (data in the public domain) were analyzed by regression analysis to establish trends and to calculate the rate of change. For laparoscopic biliary operations, the changes in laparoscopic and open operations over time and the number of operations per trainee each year were used to measure the growth of a laparoscopic operation and to predict future trends.

Unusual course of right atrial myxoma, masked by acute abdominal pain, and complicated by pulmonary embolus.

In a 17-year-old youth, exploratory laparotomy for acute abdominal pain was complicated by circulatory arrest related to pulmonary embolism. Echocardiography after resuscitation revealed a hitherto "silent" right atrial myxoma, fragmentation of which had blocked the right atrioventricular ostium, causing the pain. Operation was successful.