Constipation in patients with thiamine deficiency after Roux-en-Y gastric bypass surgery.

Background/aims: Roux-en-Y gastric bypass surgery is the most common bariatric surgery worldwide. We have described thiamine deficiency in patients with small intestinal bacterial overgrowth after gastric bypass. We hypothesized that symptoms of thiamine deficiency are common after gastric bypass.

The epidemiology of acute respiratory distress syndrome in patients presenting to the emergency department with severe sepsis.

Background: Acute respiratory distress syndrome (ARDS) is a serious complication of sepsis, and sepsis-associated ARDS is associated with significant morbidity and mortality. To date, no study has directly examined the epidemiology of ARDS in severe sepsis from the earliest presentation to the health care system, the emergency department (ED).

Methods: This was a single-center retrospective, observational cohort study of 778 adults with severe sepsis presenting to the ED.

Incidence of corneal abrasions during pelvic reconstructive surgery.

Objectives: To compare the incidence of corneal abrasions after robotic/laparoscopic sacral colpopexies versus vaginal apical suspensions, and to determine risk factors associated with the development of corneal abrasions.

Study Design: This retrospective cohort study included all women undergoing robotic/laparoscopic sacral colpopexy or vaginal apical suspensions over a 5-year period. The incidence of corneal abrasions was compared between groups and statistical analysis was performed.

The use of biological materials in urogynecologic reconstruction: a systematic review.

There are numerous randomized controlled trials examining biological materials in urogynecologic surgery. For prolapse surgery, the addition of a biological graft adds no benefit compared with native tissue repairs for rectocele repair. Conflicting data exist regarding cystocele repair.

Management of massive mastectomy skin flap necrosis following autologous breast reconstruction.

Background: The optimal management of severe mastectomy skin flap necrosis continues to remain a challenge. Following autologous reconstruction, small or minor areas of ischemia/tissue necrosis can result in multiple office visits, increased expenses due to dressing supplies and nursing care, and revisional operations. The purpose of this study is to describe outcomes of a common management strategy for surgeons when confronted with a patient with extensive mastectomy skin flap necrosis.

A head-to-head comparison of quality of life and aesthetic outcomes following immediate, staged-immediate, and delayed oncoplastic reduction mammaplasty.

Background: Oncoplastic reduction mammaplasty offers patients breast conservation with the added benefit of functional improvement in symptoms related to macromastia. The reduction can be performed in the immediate setting with the lumpectomy, in a staged-immediate fashion after final pathology has been confirmed or in a delayed fashion after completion of both lumpectomy and radiation. This study compared quality of life and aesthetic outcomes for these different cohorts.

Managing medical and surgical disorders after divided Roux-en-Y gastric bypass surgery.

The National Longitudinal Study of Adolescent Health and the National Health and Nutrition Examination Survey reported that over 40% of the US population is overweight. The average weight loss attained by medical management programs is neither sufficient nor durable enough to treat medically complicated obesity. An estimated 220,000 bariatric procedures are performed yearly in the USA and Canada.

Physical activity and cardiovascular disease prevention: current recommendations.

Epidemiologic studies support an inverse and robust relationship between physical activity (PA) and mortality risk, even after adjusting for potential confounding factors. The authors have reported 13% lower mortality risk for every 1-MET (metabolic equivalent) increase in exercise capacity. For those with an exercise capacity >7 METs, the mortality risk was approximately 50% to 70% lower when compared with those achieving <5 METs.

The nonthyroidal illness syndrome.

This article briefly summarizes thyroid function alterations generally seen in the euthyroid sick syndrome, provides an overview of specific thyroidal adaptations during several clinical conditions and secondary to specific pharmacologic agents, and discusses the current controversy in thyroid hormone treatment of nonthyroidal illness.

Memory and the creation of art: the syndrome, as in de Kooning, of 'creating in the midst of dementia'.

The creation of abstract art demands high intellectual capacities. Willem de Kooning, nonetheless, accomplished his last paintings while crippled by impairments diagnosed as Alzheimer's disease. Until my research neither art nor science offered an explanation, or a thinking method, for identifying this phenomenon, for solving a mystery that pertains to human discovery and creation.

Chronic gastrointestinal symptoms of Thomas "Stonewall" Jackson following Mexican-American War exposure: a medical hypothesis.

In a recent study, a large proportion of veterans seen for chronic heartburn or dyspepsia after the Persian Gulf War had evidence for Helicobacter pylori. Thomas Jackson was born and raised in an area of West Virginia that has a high prevalence of H. pylori.

Prospective association between distress and mammography utilization among women with a family history of breast cancer.

In this study we sought to evaluate the prospective association between psychological distress and mammography utilization among women with a family history of breast cancer. We evaluated the association of cancer worry, cancer-specific distress, and general distress with mammography utilization after controlling for potential confounders. The results revealed that 74% of our sample had obtained a mammogram within 12 months of the baseline assessment.

Understudied populations with hepatitis C.

Managing patients with hepatitis C virus (HCV) infection consists primarily of antiviral treatment, currently with peginterferon and ribavirin. Unfortunately, treatment recommendations derive largely from trials that have focused on highly selected patient populations. As a consequence of the strict inclusion and exclusion criteria in these studies, more than half of all HCV-infected patients would be ineligible for enrollment.

Studies in hemodynamics and hypertension.

This review covers a representative sampling of investigations in hemodynamics and hypertension performed by the author during the period from approximately 1945 to 1980. The hemodynamic studies included a description of changes associated with congestive heart failure and with acute myocardial infarction. These studies emphasized for the first time the importance of left ventricular afterload and of the mobilizable venous reservoir.

I Stood: Observations of an Emergency Physician.

[Paganussi PJ: I stood: Observations of an emergency physician. Ann Emerg Med April 1998;31:521-523.].