Laparoscopic common duct exploration in 90-bed rural hospital.

Laparoscopic common bile duct exploration (LCBDE) is an effective procedure when endoscopic retrograde cholangiopancreatography is not available. From January 2004 until December 2009, 1254 patients presented with biliary tract disease. Laparoscopic cholecystectomy was attempted in 1240 (98%) cases and completed in 1232 (98%) cases.

Threats to rural surgery.

Background: Rural surgery is a subject that often is discussed but little has been done to address the problems of rural surgery. With a decreased interest in broad-based general surgery, an aging population (especially in rural America), an aging population of general surgeons who are retiring early, surgical care in rural North America is approaching a crisis.

Methods: An internet search was performed to analyze the problems in rural surgery.

Clinical and economic outcomes of oral linezolid versus intravenous vancomycin in the treatment of MRSA-complicated, lower-extremity skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus.

Background: Resistant bacteria often complicate the management of skin and soft tissue infections of the lower extremities. This open-label study compared oral linezolid and intravenous vancomycin for management of complicated skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA).

Methods: Patients aged 18 years or older with proven MRSA-related complicated skin and soft-tissue infections requiring surgical intervention were randomized to receive oral linezolid (n=30) or intravenous vancomycin (n=30) for 7 to 21 days.

Practicing surgeons lead in quality care, safety, and cost control.

Objective: To report the experiences of 66 surgical specialists from 15 different hospitals who performed 43 CPT-based procedures more than 16,000 times.

Summary Background Data: Surgeons are under increasing pressure to demonstrate patient safety data as quantitated by objective and subjective outcomes that meet or exceed the standards of benchmark institutions or databases.

Methods: Data from 66 surgical specialists on 43 CPT-based procedures were accessioned over a 4-year period.

Impact of level III verification on trauma admissions and transfer: comparisons of two rural hospitals.

Purpose: To study the impact of Level III verification and other changes in rural hospitals on trauma delivery and to examine factors affecting transfer to a Level I trauma center.

Setting: Two rural Kentucky hospitals and a Level I trauma center.

Method Of Review: Concurrent review of all trauma patients in 1988 and re-review of the same parameters in 1995.

Operative cholangiography.

The value of operative cholangiography in the management of biliary tract disease has been questioned. To better define the role of cholangiography, we reviewed 579 consecutive cholecystectomies done by 1 group of surgeons in a small rural practice over 8 years. Cholangiography demonstrated unsuspected common bile duct disease in 5% of the procedures, while 12% of the patients were spared an unnecessary choledochotomy after a normal cholangiogram was obtained.

Postoperative percutaneous choledochoscopy.

Postoperative percutaneous choledochoscopy (PC) is becoming an important aid to surgeons in the diagnosis and treatment of complex biliary tract disease. The authors retrospectively examined the results of 27 PCs performed on 22 patients at the University of Louisville Affiliated Hospitals from 1980 to 1987. Indications for PC included: suspected choledocholithiasis stricture, sclerosing cholangitis, and cholangiocarcinoma.

Management of malignant ascites.

The management of malignant ascites is a significant clinical problem. Although most of the patients who have this complication develop have rather significantly limited life expectancy rates, they may be successfully palliated if appropriate steps are taken to provide them with the proper therapy. All of the aforementioned treatment modalities, specifically intracavitary radiotherapy, radioactive colloids, intracavitary chemotherapy, peritoneovenous shunting and immunotherapy have distinct advantages and limitations.

Responsiveness of metastatic basal-cell carcinoma to chemotherapy. A case report.

Basal cell carcinoma normally causes major morbidity only by direct extension of the tumor into adjacent tissues. Occasionally the tumor will metastasize to distant sites such as the lungs, the bones, regional lymph nodes, and the abdominal viscera. Over 100 cases of this disseminated disease are reported in the literature.

Evaluation of management of the emergency right hemicolectomy.

To evaluate the morbidity and mortality attending emergency resection of the right colon, we studied retrospectively 119 consecutive patients from two major centers, particularly examining the role of delayed anastomosis (initial ileostomy with subsequent ileocolic anastomosis). Emergency right colectomy was defined as an operative procedure in which partial resection of the terminal ileum and total or partial resection of the cecum and/or ascending colon were necessary before the colon could be evacuated and prepared as might be the case in elective resection. Ninety patients underwent primary anastomosis; hospital mortality and morbidity were 26 and 11%, respectively.

Post-traumatic intestinal obstruction.

The roentgenographic and pathologic findings in three patients with delayed post-traumatic intestinal obstruction are described. The pertinent literature also is reviewed to delineate the variable pathophysiology of the clinical phenomenon. As a result of the increasing incidence of blunt trauma in our society, the problem of occult intra-abdominal injury resulting in subsequent clinical disease always should be considered in the differential diagnosis of patients presenting later with intestinal complaints.