The Thermal Signature of Wound Healing.

Background: Despite major efforts in prevention, surgical site infections (SSIs) remain a burden on patients and the healthcare system and are associated with significant morbidity. SSIs are one of the costliest healthcare-associated infections. The diagnosis of SSIs is based mainly on clinical assessment, which may result in a delay in detection.

The First Study Evaluating the Safety of Pre-Surgery Administration of Metformin in Patients with Colorectal and other Gastrointestinal Cancers and Effect on Cancer Stem Cells.

Background: The cancer stem cell (CSC) hypothesis of tumor genesis suggests that unlike most cancer cells within tumor CSC resist chemotherapy and can regenerate various cell types in tumor thereby causing relapse. Hence drugs that selectively target CSC may offer great promise for cancer therapy especially when combined with chemotherapy. Current treatment options for colorectal cancer (CRC) and other gastrointestinal (GI) tumors rely on combination of surgical resection, cytotoxic and targeted drugs.

Value of an interactive phone application in an established enhanced recovery program.

Purpose: An interactive mobile phone application was added to an established Enhanced Recovery After Surgery (ERAS) program to determine the impact on ERAS compliance as well as clinical outcomes.

Methods: We identified patients undergoing elective colorectal surgery enrolled in our ERAS program from February 2017 to July 2018. Patients enrolled in a phone application were compared with those not enrolled in terms of age, sex, diagnosis, operative approach, bowel preparation, oral intake and solid food intake, ERAS pathway adherence, and clinical outcomes.

Longer Operative Time and Intraoperative Blood Transfusion Are Associated with Postoperative Anastomotic Leak after Lower Gastrointestinal Surgery.

Anastomotic leak after lower gastrointestinal surgery is a complication with potential for high morbidity, mortality, and increased costs. A single-institution retrospective chart review was performed on all patients who underwent lower gastrointestinal surgery between June 2009 and June 2013. Fifty-seven variables were included in our analysis and their association with postoperative anastomotic leak was examined.

Adenoma detection rate metrics in colorectal cancer surveillance colonoscopy.

Background: A target goal for screening adenoma detection rate (S-ADR) of ≥ 25% has been set to define high-quality colonoscopy performance. However, there is no current accepted target goal for ADR in colorectal cancer (CRC) surveillance. This makes quality assessment challenging when physicians perform cancer surveillance colonoscopy but minimal screening procedures.

Effect of protected research time on ABSITE scores during general surgery residency.

Background: Objective - To determine whether residents with one or more years of dedicated research time (Research Residents, RR) improved their ABSITE scores compared to those without (Non-Research Residents, N-RR).

Methods: A retrospective review of general surgery residents' ABSITE scores from 1995 to 2016 was performed. RR were compared to N-RR.

Common side closure type, but not stapler brand or oversewing, influences side-to-side anastomotic leak rates.

Background: Anastomotic leak (AL) increases costs and cancer recurrence. Studies show decreased AL with side-to-side stapled anastomosis (SSA), but none identify risk factors within SSAs. We hypothesized that stapler characteristics and closure technique of the common enterotomy affect AL rates.

Repair of a colonoscopic perforation of the rectum with transanal endoscopic microsurgery.

Iatrogenic colonic perforations are relatively uncommon but serious complications of diagnostic and therapeutic colonoscopies. Transanal endoscopic microsurgery (TEM) is an useful approach to the rectum and may be used for repair of a rectal perforation during colonoscopy. A 56-year-old male had an iatrogenic perforation of the rectum during a routine follow-up colonoscopy repaired by TEM with an uneventful and rapid recovery.

Antithrombin in the treatment of burn trauma.

Antithrombin (AT) is a natural anticoagulant with anti-inflammatory properties that has demonstrated value in sepsis, disseminated intravascular coagulation and in burn and inhalation injury. With high doses, AT may decrease blood loss during eschar excision, reducing blood transfusion requirements. There are no human randomized, placebo-controlled studies, which have tested the true benefit of this agent in these conditions.

Cleft lift procedure for pilonidal disease: technique and perioperative management.

Pilonidal disease is a common condition affecting young patients. It is often disruptive to their lifestyle due to recurrent abscesses or chronic wound drainage. The most common surgical treatment, "cystectomy," removes useful tissue unnecessarily and does not address the etiology of the condition.

Radiographic staging practices of newly diagnosed colorectal cancer vary according to medical specialty.

Background: Since 2008, multiple guidelines have endorsed incorporation of chest CT in the radiographic staging assessment of newly diagnosed colorectal cancer (CRC). Radiographic staging practices performed after CRC is detected have not been studied.

Objective: To evaluate radiographic staging practices for newly diagnosed CRC between gastroenterologists versus non-gastroenterologists.

Enterocolic fistula due to a rectal stent: Case report and literature review.

Introduction: Self-expanding metal stents (SEMS) are successfully being used to acutely relieve obstructing colorectal cancers; yet, their use does not come without complications.

Presentation Of Case: We present a case in which a patient with a recurrent obstructing sigmoid carcinoma underwent colonic stenting for acute decompression. Two months after stent placement, an enterocolic fistula formed from erosion of the upper end of the stent.

Systems-based practice: learning the concepts using a teamwork competition model.

Background: Systems-based practice (SBP) is a core competency of the Accreditation Council for Graduate Medical Education (ACGME) that must be integrated into residency training. We sought to develop a method to improve resident understanding using a teamwork competition model.

Methods: The residents were given a pretest to assess their understanding of SBP followed by a didactic lecture.

Management of chronic intractable constipation in children.

Background: Chronic intractable constipation (CIC) is a debilitating disease that is challenging to manage. Treatment options in children include medications, enemas, and surgical management in selected cases.

Method: We reviewed medical records of pediatric patients diagnosed as having CIC at Tufts Medical Center from 2005 to 2012.

Strangulated ileostomy evisceration following lateralizing mesh repair of parastomal hernia.

Parastomal hernia formation and ostomy prolapse are relatively common complications of intestinal ostomy construction. Underlay mesh placement with lateralization of the stoma limb appears to be the method of repair with the lowest recurrence rate. Prophylaxis of new stomas with mesh is advocated by many authors.

Management of pediatric patients with refractory constipation who fail cecostomy.

Background: Antegrade continence enema (ACE) is a recognized therapeutic option in the management of pediatric refractory constipation. Data on the long-term outcome of patients who fail to improve after an ACE-procedure are lacking.

Purpose: To describe the rate of ACE bowel management failure in pediatric refractory constipation, and the management and long term outcome of these patients.

Intraoperative small bowel length measurements and analysis of demographic predictors of increased length.

Few studies have measured small bowel length (SBL) in live humans and many textbooks base their "normal" SBL values on cadaver data. Here, we present a series of intraoperative SBL measurements and analyze predictors of increased length. SBL from ligament of Treitz to ileocecal valve was measured in patients undergoing laparotomy for colorectal resection.

Perineal reconstruction with local flaps: technique and results.

Background: Wide excision of perineal lesions, often including the entire anal canal, may be necessary for benign and malignant conditions. Closure of these large defects is challenging, especially when continence is a goal. The aim of this study was to assess our experience with local flap closure of large perineal defects.

Perforated peptic ulcer in an adolescent girl.

A perforated peptic ulcer in a child is a rare entity. Severe abdominal pain in an ill-appearing child with a rigid abdomen and possibly with signs of shock is the typical presenting feature of this life-threatening complication of peptic ulcer disease. We present a case of a 14.

The digital rectal examination scoring system (DRESS).

Purpose: Assessment of anal sphincter tone is a critical part of anorectal examination, yet no standardized, quantifiable method for describing anal sphincter tone on digital rectal examination exists. We developed a novel scoring system for anal sphincter tone using a scale of 0 to 5 for both resting pressure and squeeze pressure. The score ranges from 0 = no discernable pressure to 5 = extremely tight and 3 = normal.

Topical tacrolimus for parastomal pyoderma gangrenosum: a report of two cases.

Pyoderma gangrenosum (PG) is an idiopathic, ulcerative, inflammatory dermatologic condition that occurs in patients with systemic diseases such as inflammatory bowel disease (IBD). This inflammatory skin disorder is presumably caused by an autoimmune mechanism and the diagnosis is one of exclusion. PG is not a common condition but it is thought to account for approximately 50% of chronic parastomal ulcers.

Accuracy of colonoscopic localization.

Background: The objective of this study was to evaluate the accuracy of preoperative colonoscopic localization of colonic lesions. Localization of the colonic lesion plays a key role in determining the type of operation a patient may require. Inaccurate localization may result in removal of the wrong segment of colon and/or a change in the operation performed.

Premature red blood cells have decreased aggregation and enhanced aggregability.

Preterm infants are highly susceptible to ischemic damage. This damage is most obvious in the brain, retina, and gastrointestinal tract. Studies focusing on the rheological properties of premature red blood cells (pRBCs) have consistently shown minimal or no RBC aggregation.