Predictors of efficacy and health resource utilization in treatment of complicated intra-abdominal infections: evidence for pooled clinical studies comparing tigecycline with imipenem-cilastatin.

Background: Duration of intravenous (IV) treatment, surgical/radiologic interventions for infection control, and hospital length of stay (LOS) are important cost considerations in complicated intra-abdominal infections (cIAIs).

Methods: Data were pooled from two multinational, double-blind studies conducted in hospitalized adults with cIAIs who were randomized (1:1) to receive tigecycline (100 mg IV initial dose then 50 mg IV every 12 h) or imipenem-cilastatin (500 mg IV every 6 h) for 5 to 14 days in order to assess tigecycline safety and efficacy. This report focuses on developing predictors of cure and health care resource utilization, including the need for repeat surgical/radiologic interventions, duration of IV antibiotic therapy, and hospital LOS.

Creation of clinical research databases in the 21st century: a practical algorithm for HIPAA Compliance.

Background: Enforcement of the Health Insurance Portability and Accountability Act (HIPAA) began in April, 2003. Designed as a law mandating health insurance availability when coverage was lost, HIPAA imposed sweeping and broad-reaching protections of patient privacy. These changes dramatically altered clinical research by placing sizeable regulatory burdens upon investigators with threat of severe and costly federal and civil penalties.

Patient outcomes after axillary lymph node dissection for breast cancer: use of postoperative continuous local anesthesia infusion.

Background: Although considered a safe surgical procedure, axillary lymph node dissection (ALND) is associated with postoperative numbness, paresthesias, pain, and muscle weakness. Despite meticulous surgical technique and the absence of long thoracic or thoracodorsal nerve injury, the risk of these complications are reported as great as 35% to 50%, with a subset of patients developing chronic pain syndromes.

Methods: Female patients (n = 27) undergoing Level I-II ALND for breast cancer were recruited.

Integrating information technologies as tools for surgical research.

Background: Surgical research is dependent upon information technologies. Selection of the computer, operating system, and software tool that best support the surgical investigator's needs requires careful planning before research commences.

Materials And Methods: This manuscript presents a brief tutorial on how surgical investigators can best select these information technologies, with comparisons and recommendations between existing systems, software, and solutions.

Web-based minimally invasive surgery training: competency assessment in PGY 1-2 surgical residents.

Objectives: Little published literature describes accurate evaluation and assessment of surgical residents' technical competencies. Work-hour limitations and the proposed changes in training duration challenge our ability to provide core technical competencies, particularly during PGY-1-2. We identified minimally invasive surgery as a particularly challenging competency training area, requiring significant allocation of resident and faculty time and resources, with inconsistent training results.

Evaluation of face-mounted binocular video display for laparoscopy: outcomes of psychometric skills testing and surgeon satisfaction.

Objectives: Improved digital video cameras and high-resolution video displays have greatly enhanced laparoscopic surgery. However, the size and distance of the video display and the location of the monitor continue to be impediments in laparoscopy, providing unsatisfactory operative visualization and causing the development of neck and back strain in surgeons performing long procedures. The purpose of this study was to evaluate the use of a face-mounted binocular high-resolution video display by means of standardized measurements of laparoscopic skill, and to compare procedure speed and surgeon satisfaction with the binocular display, open operative visualization, and standard laparoscopic monitor views.

An Internet-based tool for evaluating third-year medical student performance.

Background: Shortened non-primary care medical school clerkships have increased time pressures for accurate assessment of student knowledge, skills, and attitudes. Paper-based student evaluations suffer from low response rates, inefficient data acquisition and analysis, and difficulty obtaining input from multiple evaluators. This project describes the development of a Web-based model for evaluating third-year medical student performance, improving evaluation response rates, and including multiple evaluators' input.

Clinical outcomes and fiscal consequences of bilateral neck exploration for primary idiopathic hyperparathyroidism without preoperative radionuclide imaging or minimally invasive techniques.

Background: Radionuclide imaging-directed, minimally invasive parathyroid operation is promoted in the surgical literature and public domain as the fastest, most successful, and cheapest means of treating primary idiopathic hyperparathyroidism. The validity of these claims is unproven. This study reviews the treatment outcome results of a large series of patients treated with standard parathyroid operation without preoperative localization studies.

Pro- and antiinflammatory cytokine production after radiofrequency ablation of unresectable hepatic tumors.

Background: Experience using radiofrequency ablation (RFA) for treating unresectable hepatic malignancies is expanding, with promising outcomes and fewer complications compared with cryotherapy.

Study Design: This study examined systemic inflammatory responses after RFA as measured by the appearance of postoperative symptoms and cytokine production. Seventeen patients (11 men, 6 women) aged 40 to 85 years (mean 64.

Hepatic artery embolization for control of symptoms, octreotide requirements, and tumor progression in metastatic carcinoid tumors.

Hepatic artery embolization (HAE) has been utilized for treatment of advanced hepatic carcinoid metastases, with promising symptom palliation and tumor control. Our institution employs transcatheter HAE using Lipiodol/Gelfoam for treatment of carcinoid hepatic metastases, and this report presents our experience with twenty-four patients, examining symptom control, quality-of-life, octreotide dependence, and tumor progression. Twenty-four (11 male, 13 female, mean age = 59.

Sequential dermal-peritumoral radiocolloid injection for sentinel node biopsy for breast cancer: the University of Florida experience.

Although sentinel lymph node (SLN) biopsy is rapidly becoming the standard of care for small breast cancers the optimal radiocolloid injection technique remains controversial. We report our experience with sequential dermal-peritumoral radiocolloid injection that takes advantage of both techniques. One hundred eighteen patients with clinical stage T(is), T1, T2 and N0 breast cancer underwent SLN biopsy at the University of Florida.

Transanal excision of locally advanced rectal cancers downstaged using neoadjuvant chemoradiotherapy.

Background: Our institution has previously demonstrated a survival advantage conferred by preoperative neoadjuvant therapy for locally advanced rectal cancers. We now report our results using transanal excision as definitive surgical therapy in a selected group of patients who experienced significant downstaging of T3 rectal cancers after neoadjuvant therapy.

Study Design: Seventy-four patients diagnosed with locally advanced (T3) rectal cancers were treated with neoadjuvant chemoradiotherapy.

Duodenal perforation with an inferior vena cava filter: an unusual cause of abdominal pain.

The insertion of inferior vena cava (IVC) filters results in device migration at rates that exceed 50% in some studies, although the clinical significance of migration remains in question. These filters can also erode or penetrate the IVC wall, injuring adjacent retroperitoneal and abdominal structures. The risk of erosion or perforation is estimated to be as much as 25%, although clinical symptoms are observed far less frequently in patients with these complications.

Role of radiation therapy in the treatment of resectable rectal adenocarcinoma.

The purpose of this study is to review the role of radiation therapy in the treatment of resectable rectal adenocarcinoma. Selection criteria, treatment techniques, and results are discussed.