Local and national trends in general surgery residents' operative experience: do work hour limitations negatively affect case volume in small community-based programs?

The goals of this study were to analyze the impact of work hour restrictions on the operative case volume at a small community-based general surgery residency training program and compare changes with the national level. Annual national resident case log data from Accreditation Council for Graduate Medical Education (ACGME) website and case logs of graduating Easton Hospital residents (years 2002-2009) were used for analysis. Weighted average change in total number of cases in our institution was -1.

Predictors of fatal outcome after colectomy for fulminant Clostridium difficile Colitis: a 10-year experience. dr.markelov@gmail.com.

Surgical treatment of fulminant Clostridium difficile colitis has high mortality rates. Identification of a set of preoperative characteristics that could predict outcome after surgery is necessary to optimize clinical management and guide surgical timing. Data were retrospectively collected on patients operated on for C.

Innovative technique to reduce incidence of Frey's syndrome after parotid surgery.

Frey's syndrome was first described by Lucia Frey, a Polish neurologist in 1923. It is well accepted that it involves injury to the branches of the auriculotemporal nerve with subsequent aberrant regeneration. Due to this abnormal communication, the skin glands and vessels are always stimulated at the same time as eating and mastication, which results in symptoms such as flushing and sweating.

Biliary dyskinesia as a rare presentation of metastatic breast carcinoma of the gallbladder: a case report.

Background. Breast carcinoma is the most common malignancy in women worldwide. It is most commonly associated with metastases to the liver, lung, bone, and the brain.

Transumbilical laparoscopic cholecystectomy: a novel technique.

Objective: To describe a novel technique for performing laparoscopic cholecystectomies using no proprietary or specially designed equipment, while still minimizing the incision and leaving a nearly invisible scar.

Design: Retrospective review.

Setting: Community teaching hospital.

Axial-spin technique of endoscopic intracorporeal knot tying: comparison with the conventional technique and objective assessment of knot security, learning curves, and performance efficiency across training levels.

Introduction: A major limitation of conventional laparoscopic surgery is the placement of an intracorporeal (IC) knot, which requires a significant amount of training and practice. An easier technique of IC knot tying using 90-degree grasper is compared with the conventional technique (CLT). The new axial-spin technique (AST) uses the spin of the instrument shaft to tie IC knots.

Outpatient surgery centers draw cases away from hospitals, impact resident training volume.

Purpose: Across the United States, ambulatory surgery centers (ASCs) are increasing in both number and surgical volume. This trend has been the focus of debate regarding reimbursement and patient safety, as well as surgical productivity and efficiency. However, the impact on surgical resident training caused by this shift toward outpatient surgery in nonhospital settings has not been studied.

Towards automatic augmentation of electronic medical records with MEDLINE citations.

The adoption of Electronic Medical Records (EMR)is increasing every year even though the rate of adoption is slow. MEDLINE is adding thousands of new citations every day. It may be possible to enrich an EMR system with relevant information from NLM resources.

"Broken heart syndrome": catecholamine surge or aborted myocardial infarction?

Takotsubo cardiomyopathy, also called transient left ventricular apical ballooning or "broken heart syndrome", is a cardiac condition that mimics the clinical presentation of acute coronary syndrome but without any evidence of obstructive atherosclerotic coronary artery disease. An episode of intense emotional or physiologic stress, serving as the nidus for a catecholamine surge, has been reported prior to presentation and is presumed to be the triggering factor playing the pathogenic role. We report a unique case of Takotsubo cardiomyopathy without any known precipitating factors.

Burkitt lymphoma presenting as colonic ischemia and overwhelming sepsis.

Lymphomas may occasionally present as acute surgical emergencies in children, most commonly because of obstruction, intussusception, or direct bowel invasion. We present the case of a 14-year-old adolescent boy who presented with septic shock and was found to have necrosis of the cecum because of a Burkitt lymphoma. The cause of the ischemia appeared to be mesenteric infiltration and subsequent vascular compromise of the bowel.

eHand-offs: An IBM Lotus Domino application for ensuring patient safety and enhancing resident supervision in hand-off communications.

Reliable communication of patient information among physicians during shift changes is an important patient safety parameter. The Joint Commission on Accreditation of Healthcare Organizations [JCAHO] recognized the pitfalls in hand off communications by including standardized hand-offs as a National Patient Safety Goals. We are presenting an electronic application called eHand-offs to address this problem in our residency program.

Use of Transcyte and dermabrasion to treat burns reduces length of stay in burns of all size and etiology.

Background: With the cost of healthcare increasing, greater emphasis is placed on finding better ways to manage burn patients by increasing the quality of care while reducing length of hospital stay (LOS), thereby reducing overall cost. To date, this is the largest study to determine if Transcyte reduces LOS for partial thickness burns of any size or etiology.

Methods: All consecutive patients with deep partial thickness burns from April 2002 to December 2002 were reviewed (n=110) with IRB approval.

Laparoscopic Roux-en-Y gastric bypass in patients with congenital malrotation.

Bariatric surgery is the only solution for morbidly obese individuals who desire to lose weight and maintain it and have failed to do so by non-surgical means. As the incidence of morbid obesity rises, laparoscopic Roux-en-Y gastric bypass (LRYGBP) is increasingly performed. With the increase in bariatrics, the chances of discovering aberrant anatomy at the operating-table also increase.

An unusual presentation of desmoid tumor in the ileum.

Desmoid tumors are nonencapsulated, locally invasive tumors of fibrous origin. Although lacking the ability to metastasize, they are notorious for recurrence. A wide variety of locations have been documented in the literature with respect to the origin of these tumors.

The axial-spin technique of intracorporeal knot tying: a novel and simplified approach for junior residents.

Since its introduction, laparoscopic surgery has been limited by various factors including 2-dimensional vision and limited spatial mobility of instruments. A major limitation of conventional laparoscopic surgery is the placement of an intracorporeal knot, which requires a significant amount of training and practice. We describe a novel, easier technique of intracorporeal knot tying using a right-angled 10 mm grasper/mixter.

Pancreatic mass of unusual etiology: case report of metastatic disease after a prolonged lag phase.

Although not a typical site, the pancreas does occasionally harbor metastatic disease. Management of these metastases differs from the management of conventional primary cancers. Our case is one of an 85-year-old female presenting with obstructive jaundice and whose workup revealed a pancreatic mass.

A case of pyonephrosis secondary to ureteral stent calculus.

Ureteric stents, a good solution to many urologic problems, can lead to significant morbidity if left in situ longer than required. Our case is that of an elderly male with a history of intractable hypertension presenting with urosepsis, anemia, diabetes and chronic renal failure. His work-up revealed a stent in the right kidney with secondary staghorn calcification in the renal pelvis and a large vesical calculus.

Zero-based print journal collection development in a community teaching hospital library: planning for the future.

Objectives: The paper describes and evaluates the success of a zero-based collection development approach to print serials in a community teaching hospital.

Methods: The authors first assessed the environmental factors that would determine future needs of the medical library and its customers. Liaisons to various departments and constituencies were substantially involved in the data-gathering phase.