Endoscopic retrograde cholangiopancreatography in a general surgery training program.

Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most complex procedures performed by endoscopists. ERCP has been performed primarily by gastroenterologists. There have been no reports in the literature regarding ERCP training within the framework of a general surgery residency program.

Endoscopic evaluation of the postoperative stomach.

The endoscopic assessment of the postoperative stomach is one of the most challenging areas in endoscopy. This is a function of the plurality of disease entities and anatomic variations with which the endoscopist must be familiar in order to interpret the findings in this setting. At the same time, the diagnostic and therapeutic use of endoscopy in the postoperative environment is magnified because of the opportunity it provides to achieve information and relieve disability in situations of inherently significant morbidity.

Progressive intracranial aneurysmal disease in a child with progressive hemifacial atrophy (Parry-Romberg disease): case report.

Intracranial aneurysms are uncommon in children, and their presence often leads to suspicion of a systemic connective tissue disorder. We describe the case of a young male patient with progressive hemifacial atrophy (Parry-Romberg disease) and multiple intracranial aneurysms, a previously undescribed association, and propose that a neural crest defect may be the underlying abnormality in this patient. At age 5 years, the patient was treated for a giant aneurysm of the left cavernous carotid artery with carotid ligation in the neck and a superficial temporal artery-middle cerebral artery bypass.

Cost-effectiveness of laparoscopic cholecystectomy.

This study retrospectively evaluated the cost-effectiveness of laparoscopic cholecystectomy compared to open cholecystectomy in a single university-affiliated community hospital. The medical records of all patients that underwent laparoscopic cholecystectomy during 1990 and open cholecystectomy during 1989 in one hospital were reviewed. Hospital stay, hospital charges, surgeons' and anesthesiologists' fees were determined.

Delayed gallstone abscess following laparoscopic cholecystectomy.

Delayed infectious complications following elective laparoscopic cholecystectomy have not been well delineated in the medical literature. Irretrievable spillage of gallbladder contents at the time of laparoscopic cholecystectomy is not rare, and has generally been felt to be of little consequence, particularly in the nonacute setting. The case presented documents an instance of delayed gallstone abscess formation after elective laparoscopic cholecystectomy.

Moyamoya disease: the disorder and surgical treatment.

Objective: To discuss the clinical features of moyamoya disease, the studies that aid in diagnosing this disorder, and the reported outcomes of surgical treatment.

Design: We review the manifestations of moyamoya disease in children and adults and the recent reports of the various surgical procedures.

Material And Methods: Moyamoya disease is a chronic cerebrovascular disorder in which stenosis of the major arteries of the circle of Willis at the base of the skull progresses to occlusion.

Surgical endoscopy fellowships. What difference do they make?

This study was conducted to evaluate the career impact of a formalized surgical endoscopy fellowship. Sixteen surgeons who have completed this training were surveyed via questionnaire. Twelve individuals were found to be in teaching settings, 10 had academic appointments, and 12 had published in the endoscopic and gastrointestinal literature.

Acute superior vena cava syndrome after central venous catheter placement.

Most cases of superior vena cava (SVC) syndrome are secondary to malignant disease and subacute in their presentation. Acute cases of SVC syndrome have been described, with the majority of these being precipitated by thrombosis after central venous catheterization. The authors report a case of acute SVC syndrome after central venous catheter placement, which was not due to thrombosis, but rather caused by a catheter occluding a previously subclinical stenosis of the SVC.

Colonoscopic indirect lymphangiography in a canine model.

Colorectal malignancies metastasize most frequently to mesenteric lymph nodes. Preoperative staging of these nodes by current modalities is problematic. This study evaluates the feasibility of indirect mesenteric lymphangiography as a colonoscopic technique in a canine model.

Bleeding after endoscopic sphincterotomy as an underestimated entity.

Hemorrhage is the most frequent complication of endoscopic sphincterotomy, with a reported incidence of 2 to 9 per cent. Previous reports have generally defined this complication clinically, leaving the issue of occult bleeding after sphincterotomy essentially unaddressed. Seventy-five serial sphincterotomies were reviewed to further assess this complication.

Endoscopic retrograde hemorrhoidal sclerotherapy using 23.4% saline: a preliminary report.

Historically, injection sclerotherapy has had a prominent role in the treatment of symptomatic hemorrhoids. Concern over sclerosant-related morbidity and dissatisfaction with anoscopic injection techniques has limited the application of this modality in the United States. This study reports an initial evaluation of 23.

Tract formation following percutaneous endoscopic gastrostomy in an animal model.

Complications of percutaneous endoscopic gastrostomy (PEG) have often been related to the application of excessive traction to the gastrostomy tube in an attempt to achieve immediate juxtaposition of the gastric and abdominal walls. Recent clinical reviews have suggested that complication rates can be reduced by avoiding such traction and leaving a longer tract between these structures. Laboratory evaluation of tract development has been lacking.

A simple method of infundibular retraction during laparoscopic cholecystectomy.

Laparoscopic excision of the gallbladder has rapidly become a preferable technique for treating patients with symptomatic cholelithiasis. To date, new developments in instrumentation have hardly been able to keep pace with the rising popularity of this method. The use of techniques applied to other areas of endoscopy may be useful when adapted to laparoscopic surgery.

Endoscopy in gastric malignancy.

Gastric cancer remains, in most parts of the world, a disease of advanced presentation and associated resistantly high mortality. To date, fiberoptic endoscopy has yet to change this seemingly inexorable fact. Nevertheless, endoscopy plays a vital role in the evaluation and diagnosis of the gastric cancer patient and provides palliative options to patients suffering from advanced disease that may not respond to other modalities.

Cognitive effort in modality retrieval by young and older adults.

A secondary task methodology was used to determine whether the retrieval of modality information is more cognitively effortful for older adults than younger ones. Young (M age = 20 years) and older (M age = 68 years) adults were asked to learn a mixed modality (auditory and visual) list of nouns. During recall of words and modality, subjects were asked to respond to a randomly presented light signal.

Emergency housing for frail older adults.

The emergency housing program described provides immediately available beds in private homes for homeless, impaired elderly adults. Clients receive 24-hour care for two to four weeks while permanent housing arrangements are made. Compared to traditional programs for the homeless, the emergency program saved money and provided more positive social support.

Cerebral aneurysms in childhood and adolescence.

In this study, 24 aneurysms occurring in 23 patients under the age of 18 years (mean 12 years) are analyzed. The male:female ratio was 2.8:1, and the youngest patient was 3 months old.

Corneal crystals, myopathy and nephropathy: a new syndrome?

A case with ocular (corneal crystals and retinal pigment epithelial mottling), muscle (oropharyngeal and hand weakness and atrophy), and renal (proteinuria and hypertension) abnormalities is described. We believe that this represents a previously unrecognized syndrome.