Robotic Sigmoidectomy of a Rare Instance of Sigmoid Colon Duplication in an Elderly Patient: A Case Report.

Duplication of the alimentary tract is a rare malformation that can occur in any portion of the gastrointestinal tract. Rarely diagnosed in adulthood, it is usually an incidental finding due to non-specific gastrointestinal symptoms. Approximately 80% of cases are diagnosed in infants less than two years old.

Sample selection in the face of design constraints: Use of clustering to define sample strata for qualitative research.

Objective: To sample 40 physician organizations stratified on the basis of longitudinal cost of care measures for qualitative interviews in order to describe the range of care delivery structures and processes that are being deployed to influence the total costs of caring for patients.

Data Sources: Three years of physician organization-level total cost of care data (n = 156 in California) from the Integrated Healthcare Association's value-based pay-for-performance program.

Study Design: We fit total cost of care data using mixture and K-means clustering algorithms to segment the population of physician organizations into sampling strata based on 3-year cost trajectories (ie, cost curves).

Double Application of TA-90 B Four-Row AutoSuture(c) Stapling Instrument: A Safe, Effective Method of Staple-line Production Indicated by Follow-up GI Series.

BACKGROUND: Controversy continues, concerning the best method of isolating upper and lower gastric pouches in Roux-Y gastric bypass. This paper reports a technique used from August 1991 through May 1996, in which there was a double application of the TA-90 B Four-Row AutoSuture Stapling Instrument to form the proximal gastric pouch. Because of a significant staple-line failure rate historically, many are separating the pouches.

Delayed hemorrhage following endoscopic retrograde sphincterotomy for choledocholithiasis.

To define the clinical significance of delayed postsphincterotomy hemorrhage, we reviewed 476 consecutive ERCP procedures performed over a three-year period. Of 250 patients who underwent endoscopic sphincterotomy (ES), five (2%) developed postprocedure hemorrhage, two of whom had immediate, self-limited bleeding that resolved after endoscopic injection of epinephrine and did not require transfusion. The other three had delayed hemorrhage characterized by: onset 20-48 hr after the procedure, melena without hematemesis as the index clinical manifestation of bleeding, and atraumatic balloon extraction of common duct stones.