Improving surgeon wellness: The second victim syndrome and quality of care.

Improving quality of care logically involves optimizing the duty-readiness and well-being of the healthcare provider. Medical errors and poor outcomes adversely impact the involved providers, especially surgeons, as well as the patients and their families. Unfortunately our current system does little to support these "second victims" who experience various degrees of emotional and psychological stresses including confusion, loss of confidence, and debilitating anxiety.

Elucidating the origin of the ExbBD components of the TonB system through Bayesian inference and maximum-likelihood phylogenies.

Uptake of ferric siderophores, vitamin B12, and other molecules in gram-negative bacteria is mediated by a multi-protein complex known as the TonB system. The ExbB and ExbD protein components of the TonB system play key energizing roles and are homologous with the flagellar motor proteins MotA and MotB. Here, the phylogenetic relationships of ExbBD and MotAB were investigated using Bayesian inference and the maximum-likelihood method.

Continuing promise 2009--assessment of a recent pediatric surgical humanitarian mission.

Purpose: Surgical organizations have begun to focus their efforts on providing humanitarian assistance in international communities. Most surgeons do not have previous international experience and lack an understanding of what is expected and what care they can provide. The unknown factors include case types, patient volume, postoperative care, and equipment.

Nonoperative closure of persistent gastrocutaneous fistulas in children with 2-octylcyanoacrylate.

Unlabelled: A persistent gastrocutaneous fistula (pGCF) is an all-too-common complication following removal of a gastrostomy tube (GT) in a child and is associated with significant morbidity. The most common initial methods to manage pGCF include local would care and occlusion techniques. Failure of this approach is followed by surgical excision of the fistula tract and closure of the gastrostomy under general anesthesia.

Laser epilation is a safe and effective therapy for teenagers with pilonidal disease.

Unlabelled: Pilonidal disease (PD) is a frustrating condition because of a recurrence rate as high as 30%. Hair insertion is the essential cause of the disease. Therefore, hair removal with shaving is a part of many postoperative regimens.

The interaction between endothelium-derived relaxing factor (EDRF) and eicosanoids in the regulation of the mesenteric microcirculation.

Locally produced eicosanoids and endothelium-derived factors are believed to be the mediators of vascular tone of various vascular beds including the mesentery. Using a small vessel isometric myograph which allows direct measurement of microvascular reactivity, the interaction of eicosanoids and endothelium-derived relaxing factor (EDRF) in regulating vascular tone of mesenteric microcirculation of the rat was characterized. The microvascular response to various vasoactive agents before and after inhibition of prostacyclin production with indomethacin (INDO, 5 microM) and inhibition of EDRF synthesis with N omega-nitro-L-arginine methyl ester (L-NAME, 50 microM) was compared.

Identification of dopamine1A receptors in the rat small intestine.

Dopamine receptors have been localized to several tissues outside the central nervous system including the kidney and mesenteric vessels. To determine if there are dopamine1 receptors within the small intestine, homogenates of the antimesenteric halves of the entire jejunum and ileum of adult rats were prepared and competitive inhibition studies and Scatchard analysis were performed at room temperature using 125I-SCH 23982 and SCH 23390. The specific binding of 125I-SCH 23982 to the intestinal tissue homogenates was rapid, saturable with ligand concentration, and reversible.

Successful splenorenal shunt for emergent control of variceal bleeding in a small child.

A 8.6-kg, 10-month-old boy with idiopathic cavernous transformation of the portal vein developed variceal hemorrhage refractory to nonoperative management. A distal splenorenal shunt was performed while the bleeding was controlled with balloon tamponade.

Laparoscopic cholecystectomy in pediatric patients.

Laparoscopic cholecystectomy has gained increasing application as an operative approach for adults with gallbladder disease. We assessed the safety and feasibility of this technique in five pediatric patients with symptomatic cholelithiasis, two of whom had sickle cell disease. With several technical modifications, we found that laparoscopic cholecystectomy was safe and effective in children.

Thymolipoma: computed tomographic appearances.

The computed tomographic (CT) appearances of a thymolipoma are described in a 5 1/2-year-old girl. The location and CT appearances of the tumor appear to be specific for the diagnosis of thymolipoma.

The preoperative use of iodine solution in thyrotoxic patients prepared with propranolol. Is it necessary?

Despite the numerous reports documenting the safety and efficacy of the use of propranolol, a selective beta-adrenergic blocker, as the sole agent for preoperative preparation of a hyperthyroid patient, many surgeons continue to add a solution containing iodine to the treatment regimen. The rationale for the concomitant use of iodine solution and propranolol is that the iodine solution reduces the amount of propranolol required to make the patient symptomatically euthyroid and that iodine administration reduces the vascularity of the gland, thereby minimizing intraoperative blood loss. To ascertain the validity of these beliefs, we retrospectively reviewed our experience with 42 consecutive hyperthyroid patients who underwent subtotal thyroidectomy.

Postnephrectomy pseudoaneurysm with arteriovenous fistula.

Sonography detected a paraaortic pulsatile tubular mass in a patient 10 years after "stump" nephrectomy, which was subsequently confirmed as a renal artery-renal vein fistula by computed tomography, angiography, and laparotomy.

Gallstones. When to observe, when to treat.

Although observation is the best form of therapy for patients with asymptomatic gallstones, surgical management offers the least risk and greatest benefit to patients with symptomatic disease. This is particularly true of patients with diabetes and patients over 60 years of age. Dissolution therapy may play a major role in the treatment of symptomatic cholesterol gallstones in the future, but at present the most effective approach remains early cholecystectomy.

Evaluation of absorbable polyglycolic acid mesh as a wound support.

The ideal wound-support material would reinforce a wound early in the healing process when intrinsic wound strength is the weakest, yet disappear over time, preventing many of the untoward late effects seen with currently utilized nonabsorbable materials. This study was designed to evaluate the effectiveness of a newly designed absorbable material, polyglycolic acid mesh (Dexon), as a buttress for abdominal wounds closed under moderate tension. Young male rats (n = 211) were divided into three experimental groups.

Morphological observations of mineralizing pericardium cardiac grafts.

Pericardial patch grafts were implanted in the hearts of young sheep for periods ranging from two to 120 days. Explants seven to 21 days old revealed the formation of a "pseudoneointima" (PNI) on the blood contacting surface of the pericardium. The PNI was more heavily mineralized than the pericardium.

Gastroesophageal reflux in the infant with cystic fibrosis.

The association of gastroesophageal reflux and its sequelae in the infant with cystic fibrosis has gone virtually unnoticed. Eight of 40 newly diagnosed infants with cystic fibrosis seen over a 24 month period had significant gastroesophageal reflux, characterized by vomiting (7 infants), recurrent pneumonia (7 infants), and failure to thrive (4 infants). Gastroesophageal reflux was demonstrated by a combination of barium swallow, scintiscan, manometry, and esophagoscopy.

Vascular rings and slings: long-term follow-up of pulmonary function.

Between 1968 and 1983, 54 patients underwent surgery for symptomatic aortic arch and pulmonary artery anomalies at St Christopher's Hospital for Children. Presenting symptoms included stridor, wheeze, apnea, recurrent pulmonary infections, or dysphagia. Diagnosis was established with chest roentgenogram, bronchoscopy, barium esophagram, and arteriography.

Congenital cardiac anomalies associated with the DiGeorge syndrome: a neonatal experience.

The DiGeorge syndrome is a rare congenital abnormality of absent of hypoplastic thymus and parathyroid glands. Thirty neonates who had cardiac lesions and the DiGeorge syndrome are reviewed. The early mortality for 10 neonates undergoing palliative procedures was 80%.