The impact of chronic obstructive pulmonary disease and obesity on length of stay and cost of spine surgery.

Background: Chronic obstructive pulmonary disease (COPD) and obesity may be more common among spine surgery patients than in the general population and may affect hospital cost.

Materials And Methods: We retrospectively studied the prevalence of COPD and obesity among 605 randomly selected spine surgery inpatients operated between 2005 and 2008, including lumbar microdiskectomy, anterior cervical decompression and fusion and lumbar decompression and fusion patients. The length of hospital stay and hospital charges for patients with and without COPD and obesity (body mass index [BMI]≥30 kg/m(2)) were compared.

How does chronic endocrine disease affect cost in spine surgery?

Background: Previous research has suggested that increases in length of stay and hospital cost in patients undergoing spine surgery can be due to comorbidities, especially diabetes mellitus. To study how endocrine comorbidities impact spine surgery cost, we conducted the further analysis.

Methods: We reviewed the charts of 787 patients operated between 2005 and 2008 and their treatment cost.

Comparison of outpatient and inpatient spine surgery patients with regards to obesity, comorbidities and readmission for infection.

Outpatient spine surgery is becoming popular because of its substantial economic advantages. We retrospectively studied 97 spine surgery outpatients and 578 inpatients who had proceeded through a common process of surgical venue selection. No differences (p > 0.

Successful treatment with intravenous immunoglobulin of acute flaccid paralysis caused by west nile virus.

West Nile virus (WNV) is one of the leading causes of insect-borne encephalitis and acute flaccid paralysis in the US. Acute flaccid paralysis is a potentially serious illness, which manifests itself as a Guillain-Barré-like syndrome with generalized weakness and shortness of breath. We report a case involving a patient who presented with acute flaccid paralysis due to WNV infection and was successfully treated with intravenous immunoglobulin from Israeli donors.

Diagnosis and laparoscopic treatment of cornual ectopic pregnancy.

Cornual (interstitial) ectopic pregnancy is an uncommon variant of ectopic pregnancy which often poses a diagnostic and therapeutic challenge with a significant risk of rupturing and bleeding. We present a ruptured right cornual pregnancy and explain how to deal with such a case laparoscopically.

After-hours complications: evaluation of the predictive accuracy of resident sign-out.

Resident duty-hour restrictions demand effective communication and teamwork in patient care. The process of resident sign-out is a potential source of miscommunication and medical error. Resident sign-out was followed over a 3-month period.

Management of the surgical newborn: physiological foundations and practical considerations.

The unique physiological changes that occur at birth and the adaptations that come in the first weeks of life profoundly affect the clinical management of the surgical newborn patient. The newborn has adaptive challenges that have to be met at birth: (a) establish a functional residual capacity and breathe; (b) change from a fetal to a newborn circulatory circuit; (c) change from fetal hemoglobin to hemoglobin A; (d) sustain a heart rate dependent cardiac output; (e) maintain normal body temperature; establish renal function and regulate postnatal body fluid composition; (f) establish hepatic function; and (g) maintain normal vital signs. Classical physiological studies of the last century describe the physiological basis of these adaptive tasks, and support practical considerations that we follow in clinical practice.

Providing competency-based family medicine residency training in substance abuse in the new millennium: a model curriculum.

Background: This article, developed for the Betty Ford Institute Consensus Conference on Graduate Medical Education (December, 2008), presents a model curriculum for Family Medicine residency training in substance abuse.

Methods: The authors reviewed reports of past Family Medicine curriculum development efforts, previously-identified barriers to education in high risk substance use, approaches to overcoming these barriers, and current training guidelines of the Accreditation Council for Graduate Medical Education (ACGME) and their Family Medicine Residency Review Committee. A proposed eight-module curriculum was developed, based on substance abuse competencies defined by Project MAINSTREAM and linked to core competencies defined by the ACGME.

Laparoscopy-to-laparotomy quotient in obstetrics and gynecology residency programs.

Introduction: Laparoscopic skills are indispensable to the practice of present-day gynecologists. Hence, we investigated the share of minimal invasive surgery in the training of obstetricians and gynecologists.

Materials And Methods: Information on resident experience from 197 obstetrics and gynecology (OBGYN) residency programs was obtained from the Association of Professors of Gynecology and Obstetrics.

Interleukin-lβ induces migration of rat arterial smooth muscle cells through a mechanism involving increased matrix metalloproteinase-2 activity.

Background: Interleukin-lβ (IL-lβ) is associated with vascular smooth muscle cell (VSMC) migration during neointimal formation following arterial injury, of which matrix metalloproteinase-2 (MMP-2) may have an important role. We investigated whether IL-lβ stimulated migration and MMP-2 production in VSMC, and, if so, whether migration correlated with MMP-2 activity.

Materials And Methods: Modified Boyden chamber assay quantified cultured rat aorta VSMC migration.

Syringomyelia: a complication of an underlying pathology.

Unlabelled: Patients with syringomyelia may have diverse etiology and experience a variety of symptoms. This report describes two cases of syringomyelia in patients with different profiles, presentations and pathomechanisms.

Keywords: Syrigomyelia; Syrinx; Arachnoid cyst; Arnold-Chiari.

The diagnosis of Marburg disease is course-dependent.

Marburg Disease, the fulminant form of multiple sclerosis, is a rare disease that typically kills within a year. We had a 38-year-old African American male who presented with right footdrop and was pathologically diagnosed with Marburg Disease. The patient recovered clinically after surgery and stayed stable for more than a year.

Prevalence of mood-altering and opioid medication use among spine surgery candidates and relationship with hospital cost.

Depression is the most common psychiatric illness in the USA and is commonly diagnosed in patients with chronic back pain. We investigated the use of mood-altering medications among spine surgery candidates and the relationship with opioid use and cost of care. We retrospectively reviewed the charts of 578 spine surgery patients who underwent surgery during 2005 to 2007 and their hospital charges.

Total laparoscopic hysterectomy with obliterated anterior cul-de-sac.

Endometriosis may in severe cases lead to obliteration of the anterior and/or posterior cul-de-sacs in the female pelvis. The anterior cul-de-sac is generally less commonly affected. This type of cases usually presents a challenge for the operating surgeon, whether via open route or through laparoscopy.

Quadruple H therapy for vasospasm.

Triple H therapy has been enthusiastically used to increase cerebral blood flow in cases of vasospasm. Nevertheless, the oxygen-carrying capacity of the blood is lowered with this treatment. This side effect can theoretically be partially corrected using hyperbaric oxygen therapy (HBO) which appears to be the missing ring in the above therapeutic regimen.

Professionalism in Kurosawa's medical dramas.

Film director Akira Kurosawa (1918-1998) portrayed doctors and patients in 4 films that spanned the most productive phase in his career: Drunken Angel, The Quiet Duel, Ikiru, and Red Beard. Observing death and destruction during the Second World War and the social disintegration that followed it in Japan, Kurosawa viewed the world as a dispiriting, dangerous, and chaotic place. His response was an optimistic and humanist view that life's meaning lies in the service to others.

A disparity between physician attitudes and practice regarding hyperglycemia in pediatric intensive care units in the United States: a survey on actual practice habits.

Introduction: Hyperglycemia is common in critically ill patients and is associated with increased morbidity and mortality. Strict glycemic control improves outcomes in some adult populations and may have similar effects in children. While glycemic control has become standard care in adults, little is known regarding hyperglycemia management strategies used by pediatric critical care practitioners.

The effect of ACGME duty hour restrictions on operative continuity of care.

Resident work restrictions limit participation in operations that address problems created by a prior operation, because complications occur at any time. We compared resident and attending surgeon staffing of operative complications. We reviewed all complications that required a second operation reported at our Morbidity and Mortality Conference over 1 year, noting surgeons present, their postgraduate year level, and call shift.

Successful treatment of a brain-metastasized renal cell carcinoma.

Renal cell carcinoma is an uncommon type of cancer that rarely metastasizes to the brain. The prognosis after discovering brain metastasis has traditionally been dismal. We are presenting a case of renal cell carcinoma with multiple brain metastases that was successfully treated with multimodal therapy including a new type of medication.

Laparoscopic ureterolysis and dissection of the paravesical space for deeply scarred adnexal masses.

Introduction: Laparoscopic ureterolysis is a delicate procedure that requires advanced laparoscopic skills.

Materials And Methods: We are reporting two cases of laparoscopic hysterectomy and salpingo-oophorectomy with severe adhesions to the pelvic sidewall that required ureterolysis and describing a modified technique suitable for the laparoscopic performance of this procedure.

Results: In more than 15 years of doing laparoscopic ureterolysis to deal with various gynecological cases, we have never had a ureteral injury related to the ureterolysis procedure.

Pain in nursing home residents and correlation with neuropsychiatric disorders.

Background: Pain is a common problem in older age and strongly interacts with neuropsychiatric disorders. In this paper we studied the prevalence of pain and the connection between pain and neuropsychiatric comorbidities among older nursing home residents.

Objective: To determine if data provided in 2004 National Nursing Home Survey supports connection between pain and neuropsychiatric comorbidities among older nursing home residents.