Education for rural surgical practice: the Oregon Health & Science University model.

Physicians of all types are in short supply, with the shortage particularly acute in primary care and general surgery. As the site of the only surgery residency program in the state, Oregon Health & Science University's Department of Surgery has long been aware of the critical need for general surgeons to provide emergency and elective surgical care for those who live in remote areas and to support small rural hospitals whose survival depends on the presence of a surgeon. Based on our experience over the past 7 years, we believe that residents will benefit from a training program that provides extensive exposure to procedures unique to a rural practice.

The national mortality burden and significant factors associated with open and laparoscopic cholecystectomy: 1997-2006.

Introduction: This study aims to determine the mortality rate and significant factors associated with laparoscopic (LC) and open cholecystectomies (OC) over a 10-year period.

Methods: Using the Nationwide Inpatient Sample, we analyzed data for both LC and OC between 1997 and 2006. Cholecystectomies performed as part of another primary procedure were excluded.

A randomized, crossover design study of sevelamer carbonate powder and sevelamer hydrochloride tablets in chronic kidney disease patients on haemodialysis.

Background: Sevelamer carbonate is an improved, buffered form of sevelamer hydrochloride developed for the treatment of hyperphosphataemia in CKD patients. Sevelamer carbonate formulated as a powder for oral suspension presents a novel, patient-friendly alternative to tablet phosphate binders. This study compared the safety and efficacy of sevelamer carbonate powder with sevelamer hydrochloride tablets in CKD patients on haemodialysis.

Comparison of laparoscopic inversion esophagectomy and open transhiatal esophagectomy for high-grade dysplasia and stage I esophageal adenocarcinoma.

Hypothesis: The perioperative outcomes of laparoscopic inversion esophagectomy (LIE) are comparable to those of open transhiatal esophagectomy (THE), with potential benefits related to the use of minimally invasive techniques.

Design: Case-control study.

Setting: Tertiary care university hospital.

Cyclooxygenase-1 or -2--which one mediates lipopolysaccharide-induced hypothermia?

Systemic inflammation is associated with either fever or hypothermia. Fever, a response to mild systemic inflammation, is mediated by cyclooxygenase (COX)-2 and not by COX-1. However, it is still disputed whether COX-2, COX-1, neither, or both mediate(s) responses to severe systemic inflammation, and, in particular, the hypothermic response.

Symptom classification in irritable bowel syndrome as a guide to treatment.

Objective: The treatment of irritable bowel syndrome (IBS) remains unsatisfactory. There are no objective markers for diagnosis, and classification (currently based on symptoms) provides little insight into potential causes or optimal therapy. The aim of this study was to determine whether a Swedish classification of IBS based on cluster analysis of patients' symptoms might provide a guide to successful treatment.

Depression and anxiety symptoms after lower limb amputation: the rise and fall.

Objective: To examine the time course of anxiety and depressive symptoms over a three year period after amputation.

Design And Settings: A prospective study in inpatients admitted to a rehabilitation ward after lower limb amputation.

Subjects: Successive admissions over a one-year period of whom 68 were alive at follow-up, 2-3 years later.

Perioperative outcomes of laparoscopic transhiatal inversion esophagectomy compare favorably with those of combined thoracoscopic-laparoscopic esophagectomy.

Aims: Wide acceptance of laparoscopic esophagectomy has been hampered by the technical difficulty of the procedure and inconsistent improvements in morbidity and mortality. Most case series have utilized a combined thoracoscopic-laparoscopic approach (TLE), but laparoscopic inversion esophagectomy (LIE), a method of transhiatal esophagectomy, has been proposed as an alternative. Inversion esophagectomy simplifies retraction and improves exposure during the mediastinal dissection; however, no previous studies have directly compared LIE outcomes with those of the combined approach.

Reducing U.S. health care spending: is it realistic or even desirable?

Background: Many people believe that U.S. health care spending (16.

Bicycle injury documentation before and after charting intervention.

Background: Previous studies have shown that routinely completed free-text emergency department medical records contain limited information necessary for injury surveillance. We instituted an injury documentation sheet into our emergency department records to evaluate the impact on completeness of bicycle injury documentation rates.

Methods: The pretest/posttest study design used E-codes to identify bicycle-related injuries.

Case volume as a predictor of inpatient mortality after esophagectomy.

Hypothesis: Volume criteria are poor predictors of inpatient mortality after esophagectomy. Because many factors influence mortality for complex procedures, this study was designed to quantify such factors and analyze the volume-outcome relationship for esophagectomy.

Design: Retrospective review of the Nationwide Inpatient Sample database for esophagectomies.

Gender differences in amputation outcome.

Purpose: To assess the influence of gender on the success of limb-fitting after amputation.

Methods: One-hundred and five successive in-patients admitted to an amputee rehabilitation ward were followed to assess the success of limb-fitting at discharge. The influence of demographic, clinical and social factors on the success of lower limb-fitting was assessed using linear regression analysis and group comparisons.

The rapid resolution of depression and anxiety symptoms after lower limb amputation.

Objective: To ascertain the course of depressive and anxiety symptoms shortly after amputation and again after a period of inpatient rehabilitation.

Design And Settings: A cohort study in inpatients admitted to a rehabilitation ward after lower limb amputation.

Subjects: One hundred and five successive admissions over a one-year period.

Fluid collections in amputee stumps: a common phenomenon.

Objectives: To assess the incidence of fluid collections in postoperative amputee stumps and the impact on limb-fitting outcomes in patients with such collections.

Design: Cohort study.

Setting: Inpatient rehabilitation ward.

Percutaneous gelfoam embolization of chronic enterocutaneous fistulas: report of three cases.

Purpose: A relatively simple radiologically guided method for the treatment of enterocutaneous fistula by gelfoam embolization is described.

Methods: Three cases of chronic enterocutaneous fistula are presented. In each case, a sheath was positioned with its tip at the enteric opening of the fistula.

Parkinson's disease and driving ability.

Objectives: To explore the driving problems associated with Parkinson's disease (PD) and to ascertain whether any clinical features or tests predict driver safety.

Methods: The driving ability of 154 individuals with PD referred to a driving assessment centre was determined by a combination of clinical tests, reaction times on a test rig and an in-car driving test.

Results: The majority of cases (104, 66%) were able to continue driving although 46 individuals required an automatic transmission and 10 others needed car modifications.

Simplifying minimally invasive transhiatal esophagectomy with the inversion approach: Lessons learned from the first 20 cases.

Hypothesis: The laparoscopic transhiatal esophagectomy can be simplified and performed safely and effectively by using a novel esophageal inversion technique.

Design: Case series describing technique, initial experience, and learning curve with laparoscopic inversion esophagectomy.

Setting: Tertiary care university hospital and veteran's hospital.

Extracranial meningioma presenting as a neck mass in a patient with underlying ankylosing spondylitis.

Extracranial meningiomas are rare. They account for only 2% of meningiomas compared to the much more common intracranial site. We describe a rare case of extracranial meningioma presenting as a neck lump in a patient with preexisting neck disease due to ankylosing spondylitis.

Tubular acetabular intraosseous contrast tracking in MR arthrography of the hip: prevalence, clinical significance, and mechanisms of development.

Objective: The purpose of this study was to describe tubular intraosseous tracking of contrast medium in the acetabular fossa, to our knowledge a previously undocumented imaging finding in MR arthrography of the hip, and to discuss its prevalence, clinical significance, and possible mechanisms of development.

Conclusion: Tubular acetabular intraosseous contrast tracking is a common MR arthrographic finding that seems to have little clinical significance. Although the exact pathophysiologic mechanism is unknown, we presume repeated pumping of joint fluid through the nutrient foramina of the acetabular fossa may be one mechanism.

Predicting those who will walk after rehabilitation in a specialist stroke unit.

Objective: To establish whether the ability to use a wheelchair shortly after a stroke or continence are related to the likelihood of walking by time of discharge.

Design And Subjects: An observational study in patients admitted to a stroke rehabilitation unit for under-65s over a three-year period.

Methods: Functional Independence Measure (FIM) subscores for walking were examined on all patients at time of admission and discharge.

EUS characteristics of Nissen fundoplication: normal appearance and mechanisms of failure.

Background: In patients who develop symptoms after Nissen fundoplication, the precise mechanism of failure can be difficult to determine. Current testing modalities do not demonstrate sufficient anatomic detail to definitively determine the mechanism. This observational study establishes that EUS can determine fundoplication integrity and hiatal anatomic relationships after Nissen fundoplication.