Surgical wound morbidity in an austere surgical environment.

Surgical wound morbidity was analyzed for a U.S. military field hospital deployed to the Republic of Haiti in support of Operation New Horizons 1998.

Heterotopic pancreatic tissue obstructing the gallbladder neck: a case report.

Context: Heterotopic pancreatic tissue is defined as pancreatic tissue outside the boundaries of the pancreas that has neither anatomic nor vascular continuity with the pancreas. Heterotopic pancreatic tissue in the gallbladder is uncommon and has rarely been reported to cause symptoms. We report a case of heterotopic pancreatic tissue obstructing the gallbladder neck resulting in cholecystitis.

Reduction of conscious sedation requirements by olfactory stimulation: a prospective randomized single-blinded trial.

Objectives: This study investigated the possibility that olfactory stimulation would decrease sedation needed for colonoscopy and therefore decrease the recovery time needed after conscious sedation.

Materials And Methods: Patients were randomized to receive a cherry-flavoredscent in oxygen flowing at a 4 L per minute rate via nasal cannula or oxygen alone. The scent was provided in a cherry-flavored oil.

Atypical presentation of a retrorectal ancient schwannoma: a case report and review of the literature.

Retrorectal tumors are rare and frequently present either incidentally or with vague symptoms. Schwannomas of the presacral region are one variant described as benign tumors of neurogenic origin. The "ancient degenerative variant" is uncommonly reported.

Internal hernia after laparoscopic gastric bypass surgery: a case report and literature review.

Obesity is becoming more common in the United States, affecting > or = 30% of adults aged 20 years and older. Obesity (body mass index 30) is ranked second only to tobacco use as a preventable cause of death in the United States. Roux-en-Y gastric bypass (RYGBP) is being performed at a rapidly increasing rate, and laparoscopic Roux-en-Y gastric bypass (LRYGBP) surgery is frequently chosen rather than an open approach because of lower morbidity rates.

Enteritis cystica profunda: is trauma the etiology? Interval development in the previously normal ileum: a case report and literature review.

Although well described in the colon, enteritis cystica profunda is an extremely rare lesion of the small intestine with only a few cases documented in English medical literature. It is a benign condition most often associated with Crohn's disease or Peutz-Jeghers syndrome in the adult. It has been described presenting as ileoileal intussusception in the pediatric population.

Ischemic colitis of the ascending colon: a diagnostic and management conundrum.

Ischemic colitis is the most common form of intestinal ischemia. It most commonly involves the left side of the colon presenting with acute onset of abdominal pain followed by bloody diarrhea. Involvement of only the right or ascending colon is an infrequent occurrence.

Bursting strength evaluation in an experimental model of incisional hernia.

Incisional hernias occur in up to 11 per cent of patients undergoing abdominal surgery. Up to 50 per cent of these patients with hernias will require repeat operative procedures. Management of these hernias have focused primarily on tensile strength of the mesh material, have not addressed currently used materials, and have not compared the strength of these repairs with each other.

Laparoscopic appendectomy in patients with a body mass index of 25 or greater: results of a double blind, prospective, randomized trial.

Background: The reported advantages of the laparoscopic approach to appendectomy are shortened hospital stay, less postoperative pain, and earlier return to usual activities (work). However, a prospective, randomized, double-blind trial comparing laparoscopic appendectomy with open appendectomy in active-duty males failed to disclose a benefit of laparoscopic appendectomy with regards to postoperative pain and return to work. The aim of our study was to compare open and laparoscopic appendectomy in overweight patients.

The economic impact of laparoscopic inguinal hernia repair: results of a double-blinded, prospective, randomized trial.

For this study, 66 patients with a preoperative diagnosis of unilateral primary inguinal hernia were randomized to undergo laparoscopic totally extra peritoneal (TEP), laparoscopic transabdominal (TAPP), or open inguinal hernia repair with polypropylene mesh (Lichtenstein type). Both the operative team caring for the patient postoperatively and the patient were blinded to the operative approach by placement of a large dressing covering the abdomen, which was not removed until postoperative day 3. The patients recorded their pain level on a visual analog pain scale daily.

Acute pain and narcotic use does not impair the ability to provide informed consent: evaluation of a competency assessment tool in the acute pain patient.

Patients evaluated in acute pain will often have narcotics withheld until after the patient has been evaluated by a surgeon and has given informed consent. Concern that the patient would have impaired judgment due to narcotic effects often prevents the administration of timely pain relief. The Hopkins Competency Assessment Tool (HCAT) is a validated instrument for both psychiatric and medical patients; it has not been validated to evaluate drug effects on judgment.

The economic impact of early enteral feeding in gastrointestinal surgery: a prospective survey of 51 consecutive patients.

Early postoperative oral feeding has been demonstrated to be safe and not increase postoperative morbidity. There are conflicting reports about its effect on postoperative length of stay. Some patients will fail attempts at early postoperative feeding and may be relegated to a longer postoperative course.

The strictured anastomosis: successful treatment by corticosteroid injections--report of three cases and review of the literature.

Clinically significant anastomotic strictures usually only occur with very low colorectal anastomoses below the level of the peritoneal reflection. The reported rate averages 8 percent and has been attributed to tissue ischemia, localized sepsis, anastomotic leak, proximal fecal diversion, radiation injury, inflammatory bowel disease, and recurrent rectal cancer. Most patients will have symptoms of obstipation, frequent small bowel movements, and bloating.

The incidence of positive peritoneal cytology in colon cancer: a prospective randomized blinded trial.

Many investigators have attempted to explain the suspected increased incidence of port site metastasis in patients undergoing laparoscopic colorectal resections for cancer with animal models in which cancer is simulated by injection of a tumor slurry into the peritoneal cavity. This approach makes the basic assumption that all patients with colorectal malignancies have viable cancer cells freely circulating within the peritoneal cavity. Recent reports in open colorectal resections have conflicting results.