The Modified Lithotomy: A Surgical Position for Lower Extremity Wound Care Procedures in Super Morbidly Obese Patients. A Case Study.

Unlabelled: Operative positioning of morbidly obese patients presents unique challenges and can cause complications, especially when the operative field involves the proximal lower extremity or genitoperineal region.

Purpose: The purpose of this case study was to describe a modified lithotomy operative positioning technique that has helped the authors improve care of these patients.

Methods: Double-layer, foam padding at least 4 inches thick is secured to the top and sides of 2 small rolling preparation tables using 3-inch silk tape to create "lithotomy" leg holders, the operating table is raised appropriately, the abducted legs are placed onto the padded prep tables, and the footboard is carefully lowered to provide access to the groin and medial thighs.

Site fidelity in space use by spider monkeys (Ateles geoffroyi) in the Yucatan peninsula, Mexico.

Animal home ranges may vary little in their size and location in the short term but nevertheless show more variability in the long term. We evaluated the degree of site fidelity of two groups of spider monkeys (Ateles geoffroyi) over a 10- and 13-year period, respectively, in the northeastern Yucatan peninsula, Mexico. We used the Local Convex Hull method to estimate yearly home ranges and core areas (defined as the 60% probability contour) for the two groups.

Partial splenectomy prevents splenic sequestration crises in sickle cell disease.

Purpose: Acute splenic sequestrations (SSs) are potentially fatal complications in sickle cell disease (SCD). Total splenectomies in young patients may predispose them to a higher risk of overwhelming infections, whereas partial splenectomy may maintain immunocompetence. We present our series of partial splenectomies in patients with multiple SS episodes.

Effect of Dakin's solution on components of a dermal equivalent.

Background: The use of Dakin's solution on open wounds remains controversial in clinical practice. Here we investigated the effect of Dakin's solution on collagen degradation and fibroblast migration using a dermal equivalent.

Materials And Methods: Acid solubilized or neutralized collagen was combined with four dilutions of Dakin's solution (0.

Factors in fellowship selection: effect of services and fellows.

Purpose: General Surgery residents are increasingly pursuing fellowships. We examine whether perceived subspecialty content, dedicated services, and fellows impact fellowship choices.

Methods: Specialty content was assessed through a survey linking 228 operations to 9 content areas.

Adding insult to injury: neck exploration for penetrating pediatric neck trauma.

Penetrating neck injuries are uncommon in children, and management involves mandatory exploration of the neck. This results in a number of unnecessary operations. Adult experience is moving towards selective exploration.

Instability of fellowship intentions during general surgery residencies.

Purpose: To determine whether PGY-1 future fellowship preferences are stable during progression through residency.

Methods: Residents who took the American Board of Surgery In-Training Examination (ABSITE) were surveyed about fellowships. Three data files were created: categorical and nondesignated preliminary trainees at all postgraduate years (PGY); categorical PGY-1 and chief residents; and individual categorical residents with paired PGY-1 and PGY-5 responses.

Changing demographics of residents choosing fellowships: longterm data from the American Board of Surgery.

Background: After completing general surgery residency, surgeons may seek focused additional education or fellowships. Longterm data describing the characteristics of residents selecting fellowships are lacking. Credible data could inform decisions about surgical education paradigms and workforce planning.

Gastric electrical stimulation for children with intractable nausea and gastroparesis.

Purpose: Gastric electrical stimulation (GES) has been performed in adults as a treatment of refractory nausea and vomiting in patients who have failed medical treatment, but has not been used in children.

Methods: Nine patients with chronic nausea and vomiting with a mean age of 14 years were evaluated for temporary GES. All 9 patients subsequently underwent placement of a temporary followed by permanent GES device.

Recombinant factor VIIa as an adjunct in nonoperative management of solid organ injuries in children.

Background: Ongoing bleeding after blunt solid organ injury in children may require invasive therapy in the form of either angiographic or operative control. We report our experience in the use of a procoagulant, recombinant activated factor VII (rFVIIa), for controlling persistent bleeding in blunt abdominal trauma in children.

Methods: After institutional review board approval, the records of 8 children with blunt abdominal trauma, persistent bleeding, and managed nonoperatively with rFVIIa were reviewed.

Intra-community infanticide and forced copulation in spider monkeys: a multi-site comparison between Cocha Cashu, Peru and Punta Laguna, Mexico.

We describe two cases of infanticide, two suspected infanticides, and a forced copulation by familiar resident males in two populations of wild spider monkeys (Ateles belzebuth chamek and A. geoffroyi yucatanensis). These are the first known infanticides and forced copulation in spider monkeys.

See one, do one, be competent in one? Resident rotations broaden the perceived scope of general surgery.

Purpose: To compare the scope of general surgery as perceived by general surgery program directors (PDs) nationally and our residents (RES), and to assess the effect of clinical rotation assignments on resident perception.

Methods: A background questionnaire and survey document drawn from the Resident Operative Report submitted by finishing residents to the American Board of Surgery (ABS) was sent to our general surgery residents. Respondents categorized 309 items as procedures with which a finishing resident should be competent (A), familiar (B), or neither (C).

Face, content, and construct validities of inanimate intestinal anastomoses simulation.

Purpose: Surgical simulation modules for "open" surgery are limited and not well studied or validated. Available simulation modules use either synthetic material, which is convenient but may not mimic what is observed or felt in the operating room, or live animal laboratories, which can simulate human tissue but are costly and not readily available. An intestinal anastomosis simulation was devised with thawed porcine intestine.

Primary laparoscopic repair of high imperforate anus in neonatal males.

Purpose: The standard approach to males with high imperforate anus has been a staged procedure starting with a descending colostomy, then posterior sagittal anorectoplasty with colostomy closure after 3 months. Recently, a minimally invasive approach to the repair of high imperforate anus has been described in infants after colostomy. We describe 6 newborn males with high imperforate anus successfully repaired laparoscopically as a primary, single-stage procedure.

Molecular analysis of inflammatory markers in trauma patients at risk of postinjury complications.

Background: Genetic differences associated with individual's immune responses appear to be a major contributing factor to the development of trauma- induced sepsis. Thus, effective treatment of sepsis requires the identification of the patients who are at increased risk for sepsis.

Methods: Sixty-eight patients, of which the majority had an injury severity score >15, and 118 controls from the same geographic region were genotyped.

Intragroup lethal aggression in wild spider monkeys.

We report the first evidence of intragroup coalitionary aggression leading to the death of a wild young adult male spider monkey. During a long-term study of a well-habituated community at the Otoch Ma'ax Yetel Kooh reserve in Yucatan, Mexico, a young adult male sustained severe injuries repeatedly between January and March 2002. On 1 April 2002 the same male was the victim of an intragroup attack by at least one adult male that resulted in his death.

Acute, subacute, and chronic cervical lymphadenitis in children.

Lymphadenopathy refers to any disease process involving lymph nodes that are abnormal in size and consistency. Lymphadenitis specifically refers to lymphadenopathies that are caused by inflammatory processes. Cervical lymphadenopathy is a common problem in the pediatric age group and is largely inflammatory and infectious in etiology.