Impact of laparoscopic cholecystectomy on resident training: fifteen years later.

Laparoscopic cholecystectomy was first introduced to our surgical community in 1989. In 1993, McKellar reviewed the impact of laparoscopic cholecystectomy on 1 specific surgical training program. Fifteen years later, the authors reexamined the implications of laparoscopic surgery on resident competency with both open and laparoscopic biliary procedures.

Ecthyma gangrenosum in a patient with toxic epidermal necrolysis.

Toxic epidermal necrolysis and Stevens-Johnson syndrome are a spectrum of disease characterized by a delayed hypersensitivity reaction that involves the skin and mucous membranes and typically is associated with either recent upper respiratory infection or with certain medications. Ecthyma gangrenosum is a rare necrotizing vasculitis that most commonly affects immunocompromised and burn patients and is often a sequela of Pseudomonas aeruginosa bacteremia. The cutaneous lesions of ecthyma gangrenosum are characterized by an erythematous halo surrounding a dark gray or black nodule.