Elective Lumbar Spine Surgery Leads to the Development of Chronic Pancreatitis and Pancreatic Pseudocyst: A Case Report and Literature Review.

The occurrence of pancreatitis shortly after elective lumbar spine surgery in an adult is rare. We report a case of a 63-year-old female who developed, for the first time, acute pancreatitis within three days of elective lumbar (L) spine surgery that was performed for degenerative disk disease without significant deformity (i.e.

Impact of a Novel Surgical Wound Protection Device on Observed versus Expected Surgical Site Infection Rates after Colectomy Using the National Surgical Quality Improvement Program Risk Calculator.

Background: Surgical site infection (SSI) remains a persistent and morbid problem in colorectal surgery. A novel surgical device that combines barrier surgical wound protection and continuous surgical wound irrigation was evaluated in a cohort of elective colorectal surgery patients. A retrospective analysis was performed comparing rates of SSI observed in a prospective cohort study with the predicted rate of SSI using the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) Risk Calculator.

A Novel Wound Retractor Combining Continuous Irrigation and Barrier Protection Reduces Incisional Contamination in Colorectal Surgery.

Background: Surgical site infection (SSI) remains a persistent and morbid problem in colorectal surgery. Key to its pathogenesis is the degree of intraoperative bacterial contamination at the surgical site. The purpose of this study was to evaluate a novel wound retractor at reducing bacterial contamination.

Treatment of pancreatic and periampullary cancers at a community hospital: successful application of tertiary care treatment standards.

Background. The treatment of pancreatic cancer and other periampullary neoplasms is complex and challenging. Major high-volume cancer centers can provide excellent multidisciplinary care of these patients but almost two-thirds of pancreatic cancer patients are treated at low volume centers.

Establishing a rural surgery training program: a large community hospital, expert subspecialty faculty, specific goals and objectives in each subspecialty, and an academic environment lay a foundation.

Purpose: Although there is great interest in providing training for surgical residents who are interested in practicing in a rural environment, guidelines for creating a curriculum are nonexistent.

Methods: A 1-year clinical fellowship designed for PGY4s with an interest in practicing in a rural or subspecialty-sparse environment was designed. Elements of this fellowship include blocks of time on subspecialty services as well as general surgery.

Colorectal surgical specimen lymph node harvest: improvement of lymph node yield with a pathology assistant.

Introduction: Adequate lymph node harvest from colorectal cancer specimens has become a standard of care, influencing both staging and survival. To improve lymph node harvests at our hospital, a pathology assistant was trained to meticulously harvest lymph nodes from colorectal cancer specimens. An analysis of trends in lymph node harvests over time is presented.

Predicting unresectability in pancreatic cancer patients: the additive effects of CT and endoscopic ultrasound.

Background: A standardized method for predicting unresectability in pancreatic cancer has not been defined. We propose a system using CT and endoscopic ultrasound (EUS) to assess patients for unresectable pancreatic cancers.

Methods: Radiologic and surgical data from 101 patients who underwent exploration/resection for pancreatic cancer were reviewed.

Surgical intervention and understanding of diseases of the stomach and duodenum.

The stomach and duodenum are organs of complex physiology and cell biology. Neoplastic disease of these organs represents a difficult surgical challenge, and gastric and duodenal cancer mortality rates remain high despite advances in surgical technique, perioperative care, and adjuvant therapy. True "cures" elude the surgeon all too often.

Acute abdomen with colonic necrosis induced by Kayexalate-sorbitol.

Colonic necrosis is an unusual complication after treatment of hyperkalemia with sodium polystyrene sulfonate (SPS, Kayexalate) in sorbitol. To increase awareness of this complication, we report a case of necrosis of the transverse colon in a patient given oral and rectal SPS-sorbitol for hyperkalemia. Colonic necrosis was manifested as an acute abdomen within 24 hours of initial administration.

Large cystic pancreatic neoplasms: pathology, resectability, and outcome.

Background: Cystic pancreatic neoplasms may be benign, premalignant, or malignant. These lesions may remain asymptomatic for long periods and can be quite large at the time of presentation.

Methods: A retrospective analysis was used to determine whether preoperative evaluation can predict pathology and determine resectability and outcome.

Cystadenomas of the pancreas: is enucleation an adequate operation?

Objective: The objective was to determine whether surgical enucleation of mucinous cystadenoma of the pancreas is a safe and adequate operation.

Summary Background Data: Mucinous cystadenomas of the pancreas are premalignant cystic lesions. Resection is the preferred treatment but often requires a pancreatoduodenectomy or a distal pancreatectomy with or without a splenectomy.

Increased mediastinal pressure and decreased cardiac output during laparoscopic Nissen fundoplication.

Background: Laparoscopic Nissen fundoplication (LNF) is gaining popularity. Although the hemodynamic effects of the typical pneumoperitoneum have been studied, the additional consequences of the hiatal dissection necessary for LNF have not.

Methods: Seven female pigs were anesthetized, intubated, and ventilated with a volume ventilator and hemodynamic and mechanical pressure monitoring devices were placed.

Adenocarcinoma of the ampulla of Vater. A 28-year experience.

Objective: The aim of this study were to review the experience with adenocarcinoma of the ampulla of Vater at The Johns Hopkins Hospital and to determine what factors influenced the long-term outcome in these patients.

Summary Background Data: Adenocarcinoma of the ampulla of Vater is the second most common periampullary malignancy. However, most series have relatively small numbers.