JSurg » Review Articles

The management of the open abdomen in trauma and emergency general surgery: part 1-damage control.

Sat, 17 Jul 2010 06:49:33 +0000

The management of the open abdomen in trauma and emergency general surgery: part 1-damage control.

J Trauma. 2010 Jun;68(6):1425-38

Authors: Diaz JJ, Cullinane DC, Dutton WD, Jerome R, Bagdonas R, Bilaniuk JO, Collier BR, Como JJ, Cumming J, Griffen M, Gunter OL, Kirby J, Lottenburg L, Mowery N, Riordan WP, Martin N, Platz J, Stassen N, Winston ES

BACKGROUND: The open abdomen technique, after both military and civilian trauma, emergency general or vascular surgery, has been used in some form for the past 30 years. There have been several hundred citations on the indications and the management of the open abdomen. Eastern Association for the Surgery of Trauma practice management committee convened a study group to organize the world’s literature for the management of the open abdomen. This effort was divided into two parts: damage control and the management of the open abdomen. Only damage control is presented in this study. Part 1 is divided into indications for the open abdomen, temporary abdominal closure, staged abdominal repair, and nutrition support of the open abdomen. METHODS: A literature review was performed for more than 30 years. Prospective and retrospective studies were included. The reviews and case reports were excluded. Of 1,200 articles, 95 were selected. Seventeen surgeons reviewed the articles with four defined criteria. The Eastern Association for the Surgery of Trauma primer was used to grade the evidence. RESULTS: There was only one level I recommendation. A patient with documented abdominal compartment syndrome should undergo decompressive laparotomy. CONCLUSION: The open abdomen technique remains a heroic maneuver in the care of the critically ill trauma or surgical patient. For the best outcomes, a protocol for the indications, temporary abdominal closure, staged abdominal reconstruction, and nutrition support should be in place.

PMID: 20539186 [PubMed - indexed for MEDLINE]

The diagnosis of intraabdominal visceral injury.

Rozycki GS, Root HD — Sun, 30 May 2010 01:32:37 +0000

The diagnosis of intraabdominal visceral injury.

J Trauma. 2010 May;68(5):1019-23

Authors: Rozycki GS, Root HD

This article outlines the different modalities that have been used for the diagnosis of intraabdominal visceral injury. The methods span decades, and their development was driven by the need to provide an accurate and rapid diagnosis of intraabdominal injury for the patient. Some of these modalities parallel the explosion in technology. Each has been validated and criticized but eventually had developed its own “niche” in the assessment of the injured patient. Finally, they have all withstood the test of time.

PMID: 20453755 [PubMed - indexed for MEDLINE]

Neurological effects of blast injury.

Hicks RR, Fertig SJ, Desrocher RE, Koroshetz WJ, Pancrazio JJ — Sat, 29 May 2010 01:26:25 +0000

Neurological effects of blast injury.

J Trauma. 2010 May;68(5):1257-63

Authors: Hicks RR, Fertig SJ, Desrocher RE, Koroshetz WJ, Pancrazio JJ

Over the last few years, thousands of soldiers and an even greater number of civilians have suffered traumatic injuries due to blast exposure, largely attributed to improvised explosive devices in terrorist and insurgent activities. The use of body armor is allowing soldiers to survive blasts that would otherwise be fatal due to systemic damage. Emerging evidence suggests that exposure to a blast can produce neurologic consequences in the brain but much remains unknown. To elucidate the current scientific basis for understanding blast-induced traumatic brain injury (bTBI), the NIH convened a workshop in April 2008. A multidisciplinary group of neuroscientists, engineers, and clinicians were invited to share insights on bTBI, specifically pertaining to: physics of blast explosions, acute clinical observations and treatments, preclinical and computational models, and lessons from the international community on civilian exposures. This report provides an overview of the state of scientific knowledge of bTBI, drawing from the published literature, as well as presentations, discussions, and recommendations from the workshop. One of the major recommendations from the workshop was the need to characterize the effects of blast exposure on clinical neuropathology. Clearer understanding of the human neuropathology would enable validation of preclinical and computational models, which are attempting to simulate blast wave interactions with the central nervous system. Furthermore, the civilian experience with bTBI suggests that polytrauma models incorporating both brain and lung injuries may be more relevant to the study of civilian countermeasures than considering models with a neurologic focus alone.

PMID: 20453776 [PubMed - indexed for MEDLINE]

Clinical review of nonalcoholic steatohepatitis in liver surgery and transplantation.

Tevar AD, Clarke C, Wang J, Rudich SM, Woodle ES, Lentsch AB, Edwards ML — Wed, 07 Apr 2010 10:34:34 +0000

Clinical review of nonalcoholic steatohepatitis in liver surgery and transplantation.

J Am Coll Surg. 2010 Apr;210(4):515-26

Authors: Tevar AD, Clarke C, Wang J, Rudich SM, Woodle ES, Lentsch AB, Edwards ML

PMID: 20347746 [PubMed - indexed for MEDLINE]

Research and the independent academic medical center.

Helling TS — Wed, 24 Mar 2010 08:27:21 +0000

Research and the independent academic medical center.

Surgery. 2010 Mar;147(3):313-7

Authors: Helling TS

PMID: 20176242 [PubMed - indexed for MEDLINE]

Withdrawal of care in a potentially curable patient.

Murphy J, Fayanju O, Brown D, Kodner IJ — Wed, 24 Mar 2010 08:27:00 +0000

Withdrawal of care in a potentially curable patient.

Surgery. 2010 Mar;147(3):441-5

Authors: Murphy J, Fayanju O, Brown D, Kodner IJ

PMID: 20176245 [PubMed - indexed for MEDLINE]

Conversion of emergent cricothyrotomy to tracheotomy in trauma patients.

Talving P, DuBose J, Inaba K, Demetriades D — Sat, 30 Jan 2010 00:30:27 +0000

Conversion of emergent cricothyrotomy to tracheotomy in trauma patients.

Arch Surg. 2010 Jan;145(1):87-91

Authors: Talving P, DuBose J, Inaba K, Demetriades D

OBJECTIVES: To review the literature to determine the rates of airway stenosis after cricothyrotomy, particularly as they compare with previously documented rates of this complication after tracheotomy, and to examine the complications associated with conversion. DATA SOURCES: We conducted a review of the medical literature by the use of PubMed and OVID MEDLINE databases. STUDY SELECTION: We identified all published series that describe the use of cricothyrotomy, with the inclusion of the subset of patients who require an emergency airway after trauma, from January 1, 1978, to January 1, 2008. DATA EXTRACTION: Only 20 published series of cricothyrotomy were identified: 17 retrospective reports and 3 prospective, observational series. DATA SYNTHESIS: Considerable variance in methods and follow-up periods were noted between examinations. Published experiences documented the results of 1134 total patients for whom cricothyrotomy was performed, including 368 trauma patients who underwent emergent cricothyrotomy. The rate of chronic subglottic stenosis among survivors after cricothyrotomy was 2.2% (11/511) overall and 1.1% (4/368) among trauma patients for follow-up periods with a range from 2 to 60 months. Only 1 (0.27%) of the 368 trauma patients in whom an emergent cricothyrotomy was performed required surgical treatment for chronic subglottic stenosis. Although the literature that documents complications of surgical airway conversion is scarce, rates of severe complications of up to 43% were reported. CONCLUSIONS: Cricothyrotomy after trauma is safe for initial airway access among patients who require the establishment of an emergent airway. The prolonged use of a cricothyrotomy tube, however, remains controversial. Although no study to date has demonstrated any benefit of routine conversion to tracheostomy, considerable deficiencies in existing studies highlight the need for further investigations of this practice.

PMID: 20083759 [PubMed - indexed for MEDLINE]

Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia.

Karthikesalingam A, Markar SR, Holt PJ, Praseedom RK — Fri, 01 Jan 2010 19:31:28 +0000

Meta-analysis of randomized controlled trials comparing laparoscopic with open mesh repair of recurrent inguinal hernia.

Br J Surg. 2010 Jan;97(1):4-11

Authors: Karthikesalingam A, Markar SR, Holt PJ, Praseedom RK

BACKGROUND: Although there is plentiful evidence regarding the use of laparoscopic surgery for primary inguinal hernia, there is a paucity of literature concerning its role after recurrence. There has been no quantitative review of the evidence, despite suggestions that pooled analysis of existing data is required. METHODS: Medline, Embase, trial registries, conference proceedings and reference lists were searched for controlled trials of laparoscopic versus conventional open surgery for mesh repair of recurrent hernia. The primary outcomes were recurrence and chronic pain. Secondary outcomes were operating time, visual analogue pain score, superficial wound infection, haematoma or seroma formation, time to return to normal activities and serious complications requiring operation. Pooled odds ratios were calculated for categorical outcomes and weighted mean differences for continuous outcomes. RESULTS: Four trials were included in the analysis. There was no effect on recurrence or chronic pain. Laparoscopic surgery was associated with significantly less postoperative pain, a quicker return to normal activities and fewer wound infections, at the cost of a longer operating time. There was no difference in haematoma formation or the need for additional operations. CONCLUSION: Careful patient selection and surgeons’ experience are important in the selection of technique for recurrent inguinal hernia repair.

PMID: 20013926 [PubMed - indexed for MEDLINE]

Phaeochromocytomas and sympathetic paragangliomas.

Petri BJ, van Eijck CH, de Herder WW, Wagner A, de Krijger RR — Thu, 17 Dec 2009 16:45:58 +0000

Phaeochromocytomas and sympathetic paragangliomas.

Br J Surg. 2009 Dec;96(12):1381-92

Authors: Petri BJ, van Eijck CH, de Herder WW, Wagner A, de Krijger RR

BACKGROUND: About 24 per cent of phaeochromocytomas (PCCs) and sympathetic paragangliomas (sPGLs) appear in familial cancer syndromes, including multiple endocrine neoplasia type 2, von Hippel-Lindau disease, neurofibromatosis type 1 and PCC-paraganglioma syndrome. Identification of these syndromes is of prime importance for patients and their relatives. Surgical resection is the treatment of choice for both PCC and sPGL, but controversy exists about the management of patients with bilateral or multiple tumours. METHODS: Relevant medical literature from PubMed, Ovid and Embase websites until 2009 was reviewed for articles on PCC, sPGL, hereditary syndromes and their treatment. DISCUSSION: Genetic testing for these syndromes should become routine clinical practice for those with PCC or sPGL. Patients should be referred to a clinical geneticist. Patients and family members with proven mutations should be entered into a standardized screening protocol. The preferred treatment of PCC and PGL is surgical resection; to avoid the lifelong consequences of bilateral adrenalectomy, cortex-sparing adrenalectomy is the treatment of choice.

PMID: 19918850 [PubMed - indexed for MEDLINE]

The “off-label” role of recombinant factor VIIa in surgery: is the problem deficient evidence or defective concept?

Al-Ruzzeh S, Navia JL — Sat, 05 Dec 2009 14:45:40 +0000

The “off-label” role of recombinant factor VIIa in surgery: is the problem deficient evidence or defective concept?

J Am Coll Surg. 2009 Nov;209(5):659-67

Authors: Al-Ruzzeh S, Navia JL

PMID: 19854409 [PubMed - indexed for MEDLINE]

Management of recurrent inguinal hernias.

Itani KM, Fitzgibbons R, Awad SS, Duh QY, Ferzli GS — Thu, 12 Nov 2009 05:52:09 +0000

Management of recurrent inguinal hernias.

J Am Coll Surg. 2009 Nov;209(5):653-8

Authors: Itani KM, Fitzgibbons R, Awad SS, Duh QY, Ferzli GS

PMID: 19854408 [PubMed - indexed for MEDLINE]

Enteric fistulas: principles of management.

Tue, 27 Oct 2009 00:43:18 +0000

Enteric fistulas: principles of management.

J Am Coll Surg. 2009 Oct;209(4):484-91

Authors: Schecter WP, Hirshberg A, Chang DS, Harris HW, Napolitano LM, Wexner SD, Dudrick SJ

PMID: 19801322 [PubMed - indexed for MEDLINE]

Evidence-based guidelines for prevention of perioperative hypothermia.

Tue, 27 Oct 2009 00:43:16 +0000

Evidence-based guidelines for prevention of perioperative hypothermia.

J Am Coll Surg. 2009 Oct;209(4):492-503.e1

Authors: Forbes SS, Eskicioglu C, Nathens AB, Fenech DS, Laflamme C, McLean RF, McLeod RS,

PMID: 19801323 [PubMed - indexed for MEDLINE]

Special report: Consensus conference III. Image-detected breast cancer: state-of-the-art diagnosis and treatment.

Tue, 27 Oct 2009 00:43:09 +0000

Special report: Consensus conference III. Image-detected breast cancer: state-of-the-art diagnosis and treatment.

J Am Coll Surg. 2009 Oct;209(4):504-20

Authors: Silverstein MJ, Recht A, Lagios MD, Bleiweiss IJ, Blumencranz PW, Gizienski T, Harms SE, Harness J, Jackman RJ, Klimberg VS, Kuske R, Levine GM, Linver MN, Rafferty EA, Rugo H, Schilling K, Tripathy D, Whitworth PW, Willey SC

PMID: 19801324 [PubMed - indexed for MEDLINE]

Metastatic activity and chemotherapy resistance in human pancreatic cancer–influence of cancer stem cells.

Ischenko I, Seeliger H, Jauch KW, Bruns CJ — Fri, 18 Sep 2009 14:46:59 +0000

Metastatic activity and chemotherapy resistance in human pancreatic cancer–influence of cancer stem cells.

Surgery. 2009 Sep;146(3):430-4

Authors: Ischenko I, Seeliger H, Jauch KW, Bruns CJ

PMID: 19715799 [PubMed - indexed for MEDLINE]

Patient-reported outcome measures: the importance of patient satisfaction in surgery.

Chow A, Mayer EK, Darzi AW, Athanasiou T — Fri, 18 Sep 2009 14:46:58 +0000

Patient-reported outcome measures: the importance of patient satisfaction in surgery.

Surgery. 2009 Sep;146(3):435-43

Authors: Chow A, Mayer EK, Darzi AW, Athanasiou T

In recent years, much attention has been paid to the assessment of the quality of health care. This focus has been driven mainly by a desire to improve health care and decrease inequalities within health care systems. As well as addressing key areas such as structure, process, and outcome, which are normally taken from the provider’s viewpoint, it is also necessary to address the patient’s perspective. Patient-reported outcomes are an increasingly popular method of assessing the patient’s experience within the health care system. Along with well-known patient reported outcomes such as health-related quality of life and current health state, patient satisfaction can provide an ultimate end point to health care quality. It is thus an essential part of quality assessment. The concept of patient satisfaction and its measurement, however, has often been overlooked by researchers. Therefore, current measures of satisfaction may not be adequate to assess quality of health care. This article aims to provide an overview of the concept of patient satisfaction. It also discusses current methods of patient-reported outcome assessment and suggests methodology to create new instruments to measure patient satisfaction.

PMID: 19715800 [PubMed - indexed for MEDLINE]

Can decision making in general surgery be based on evidence? An empirical study of Cochrane Reviews.

Fri, 18 Sep 2009 14:46:51 +0000

Can decision making in general surgery be based on evidence? An empirical study of Cochrane Reviews.

Surgery. 2009 Sep;146(3):444-61

Authors: Diener MK, Wolff RF, von Elm E, Rahbari NN, Mavergames C, Knaebel HP, Seiler CM, Antes G

BACKGROUND: This empirical study analyzes the current status of Cochrane Reviews (CRs) and their strength of recommendation for evidence-based decision making in the field of general surgery. METHODS: Systematic literature search of the Cochrane Database of Systematic Reviews and the Cochrane Collaboration’s homepage to identify available CRs on surgical topics. Quantitative and qualitative characteristics, utilization, and formulated treatment recommendations were evaluated by 2 independent reviewers. Association of review characteristics with treatment recommendation was analyzed using univariate and multivariate logistic regression models. RESULTS: Ninety-three CRs, including 1,403 primary studies and 246,473 patients, were identified. Mean number of included primary studies per CR was 15.1 (standard deviation [SD] 14.5) including 2,650 (SD 3,340) study patients. Two and a half (SD 8.3) nonrandomized trials were included per analyzed CR. Seventy-two (77%) CRs were published or updated in 2005 or later. Explicit treatment recommendations were given in 45 (48%). Presence of a treatment recommendation was associated with the number of included primary studies and the proportion of randomized studies. Utilization of surgical CRs remained low and showed large inter-country differences. The most surgical CRs were accessed in UK, USA, and Australia, followed by several Western and Eastern European countries. CONCLUSION: Only a minority of available CRs address surgical questions and their current usage is low. Instead of unsystematically increasing the number of surgical CRs it would be far more efficient to focus the review process on relevant surgical questions. Prioritization of CRs needs valid methods which should be developed by the scientific surgical community.

PMID: 19715801 [PubMed - indexed for MEDLINE]

Codeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of post-abdominal surgery pain: a systematic review of randomized trials.

Nauta M, Landsmeer ML, Koren G — Sat, 22 Aug 2009 05:10:50 +0000

Codeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of post-abdominal surgery pain: a systematic review of randomized trials.

Am J Surg. 2009 Aug;198(2):256-61

Authors: Nauta M, Landsmeer ML, Koren G

BACKGROUND: Cesarean section, episiotomy, and third and perineal tears are associated with significant tissue damage, causing pain in the immediate postpartum period. The current standard in North America is to prescribe oral acetaminophen/codeine (A + C) for postpartum pain. Codeine has opioid-related adverse effects and may not be safe during breastfeeding in the postpartum period for all neonates. Nonsteroidal anti-inflammatory drugs (NSAIDs) are devoid of opioid-related adverse effects and could be a possible alternative for analgesia in postpartum pain. The objective of this systematic review was to compare the analgesic effect and safety profile of acetaminophen/codeine (A + C) with NSAIDs in the management of pain after laparotomy. METHODS: A systematic search was performed by using MEDLINE, EMBASE, CINAHL, and Cochrane Library databases to identify randomized controlled trials comparing A + C to NSAIDs for postlaparotomy pain. Selected articles were critically appraised by using the CONSORT method and Jadad score. RESULTS: Nine relevant articles were identified. All 9 studies used a visual analog scale for pain intensity and reported the incidence of adverse effects as an outcome. None of the studies showed lower pain intensity scores after treatment with A + C compared with different NSAIDs. In 3 studies, the number of patients with adverse effects was significantly lower in the NSAID group compared with the A + C-group. In 1 other study, the rate of constipation was significantly lower in the NSAID group when compared with the A + C-group. The other 5 studies did not report any significant differences in the rates of adverse effects between the 2 groups. CONCLUSIONS: None of the studies found A + C to be superior to NSAIDs in controlling postlaparotomy pain. NSAIDs appear to be an equipotent alternative in the treatment of postlaparotomy pain. Four of the 9 studies reported less adverse effects in the NSAID group. There appears to be an overall better risk/benefit ratio for the use of NSAIDs for postpartum pain.

PMID: 19628064 [PubMed - indexed for MEDLINE]

18F-fluorodeoxiglucose positron emission tomography for the evaluation of neoadjuvant therapy response in esophageal cancer: systematic review of the literature.

Sat, 22 Aug 2009 05:10:48 +0000

18F-fluorodeoxiglucose positron emission tomography for the evaluation of neoadjuvant therapy response in esophageal cancer: systematic review of the literature.

Ann Surg. 2009 Aug;250(2):247-54

Authors: Rebollo Aguirre AC, Ramos-Font C, Villegas Portero R, Cook GJ, Llamas Elvira JM, Tabares AR

Neoadjuvant treatment is a relatively new therapeutic approach for locally advanced esophageal cancer. Response assessment is crucial for the treatment of these patients. Cross sectional imaging has traditionally being used as the elective method of response assessment. Recently, 18F fluorodeoxyglucose- positron emission tomography (FDG-PET) has emerged as a new valuable tool defining therapy response assessment in other tumors. AIM: We systematically reviewed the increasing number of publications appearing in the literature analyzing the utility of FDG-PET in the evaluation of neoadjuvant therapy response assessment. METHODS: We performed a bibliographic search according to the COSI protocol and selected only prospective studies to achieve the highest levels of evidence. Quality assessment was defined with the QUADAS questionnaire. RESULTS: Eight of 237 potentially relevant publications were selected for the analysis. Ranged sensitivity, specificity, positive predictive value, and negative predictive value for primary tumor response assessment were 27.3% to 93.3%, 41.7% to 95.2%, 70.8% to 93.3% and 71.4% to 93.5%, respectively, and for N restaging, 16.0% to 67.5%, 85.7% to 100%, 33% to 100% and 91.7% to 93.3%, respectively. The heterogeneity of the publications ruled out the possibility of meta-analysis. FDG-PET is more precise compared with computed tomography in the evaluation of induction therapy response assessment. CONCLUSION: FDG-PET seems to be the best available imaging modality for neoadjuvant therapy response assessment in esophageal cancer. But more prospective studies with larger populations are needed to confirm the power of this imaging tool in this aim and to determine the best analytical interpretation method and threshold to differentiate responders from nonresponding patients.

PMID: 19638908 [PubMed - indexed for MEDLINE]

The role of lymphadenectomy in esophageal cancer.

Jamieson GG, Lamb PJ, Thompson SK — Sat, 22 Aug 2009 05:10:47 +0000

The role of lymphadenectomy in esophageal cancer.

Ann Surg. 2009 Aug;250(2):206-9

Authors: Jamieson GG, Lamb PJ, Thompson SK

OBJECTIVE: To address the role of lymphadenectomy in the treatment of esophageal cancer. BACKGROUND: The role of lymphadenectomy in esophageal cancer surgery is controversial, and there is a lack of uniformity as to what the term means. METHODS: The published data was reviewed to evaluate the evidence base for, and the terminology associated with, lymphadenectomy for esophageal cancer. RESULTS: Recommendations are given for a standardization of terminology for radical and nonradical lymphadenectomy procedures. Although there is no doubt that the presence of lymph node metastases worsens prognosis for a patient, there is a lack of high-level evidence to support lymphadenectomy. Logically, the best procedure, from a staging and perhaps theoretical oncologic point of view, is a 3-field lymphadenectomy but it is not clear which patients, if any, are most likely to benefit. CONCLUSIONS: Well-designed randomized controlled trials are required to test, in a scientific manner, which of these procedures we should be offering our patients.

PMID: 19638911 [PubMed - indexed for MEDLINE]

The accordion severity grading system of surgical complications.

Strasberg SM, Linehan DC, Hawkins WG — Sat, 22 Aug 2009 05:10:45 +0000

The accordion severity grading system of surgical complications.

Ann Surg. 2009 Aug;250(2):177-86

Authors: Strasberg SM, Linehan DC, Hawkins WG

BACKGROUND: A severity grading system is essential to reporting surgical complications. In 1992, we presented such a system (T92). Its use and that of systems derived from it have increased exponentially. Our purpose was to determine how well T92 and its modifications have functioned as a severity grading system and to develop an improved system for reporting complications. METHODS: 129 articles were studied in detail. Twenty variables were searched for in each article with particular emphasis on type of study, substitution of qualitative terms for grades, grade compression, and cut-points if grade compression was used. We also determined relative distribution of complications and manner of presentation of complications. RESULTS: T92 and derivative classifications have received wide use in surgical studies ranging from small studies with few complications to large studies of complex operations that describe many complications. There is a strong tendency to contract classifications and to substitute terms with self evident meaning for the numerical grades. Complications are presented in a large variety of tabular forms some of which are much easier to follow than others. CONCLUSIONS: Current methods for reporting the severity of complications incompletely fulfill the needs of authors of surgical studies. A new system-the Accordion Severity Grading System-is presented. The Accordion system can be used more readily for small as well as large studies. It introduces standard definition of simple quantitative terms and presents a standard tabular reporting system. This system should bring the field closer to a common severity grading method for surgical complications.

PMID: 19638919 [PubMed - indexed for MEDLINE]

Hilar cholangiocarcinoma: current management.

Ito F, Cho CS, Rikkers LF, Weber SM — Sat, 22 Aug 2009 05:10:40 +0000

Hilar cholangiocarcinoma: current management.

Ann Surg. 2009 Aug;250(2):210-8

Authors: Ito F, Cho CS, Rikkers LF, Weber SM

OBJECTIVE: To review the literature with regard to outcome of surgical management for hilar cholangiocarcinoma (Klatskin tumor). BACKGROUND: Hilar cholangiocarcinoma is a rare tumor with a poor prognosis. Surgical resection provides the only possibility for cure. Advances in hepatobiliary imaging and surgical strategies to treat this disease have resulted in improved postoperative outcomes. METHODS: We performed a review of the English literature on hilar cholangiocarcinoma from 1990 to 2007. This review included preoperative evaluation, surgical techniques, issues and controversies in management, prognostic variables, and considerations for future directions. RESULTS: Complete resection remains the most effective and only potentially curative therapy for hilar cholangiocarcinoma. Negative resection margins are associated with improved outcomes, and major hepatic resections have enhanced the likelihood of R0 resection. Portal vein embolization may be indicated in selected patients before extensive hepatic resection. Staging laparoscopy should be considered to detect occult metastatic disease. Orthotopic liver transplantation might be applicable for a highly selected subgroup. CONCLUSIONS: Surgical resection including major hepatic resection remains the mainstay of treatment of hilar cholangiocarcinoma. Additional evidence is needed to fully define the role of orthotopic liver transplantation. Improvements in adjuvant therapy are essential for improving long-term outcome.

PMID: 19638920 [PubMed - indexed for MEDLINE]

Blunt rupture of the subclavian-innominate venous junction: case report and review of literature.

Kang TL, Dudick C, Ashiku S, Baker C — Wed, 01 Jul 2009 10:53:21 +0000

Blunt rupture of the subclavian-innominate venous junction: case report and review of literature.

J Trauma. 2009 Jun;66(6):1728-30

Authors: Kang TL, Dudick C, Ashiku S, Baker C

PMID: 19509637 [PubMed - indexed for MEDLINE]

Subcutaneous splenosis in gunshot outlet: case report.

Chang NJ, Yeh JT, Lin YT, Lin CH — Mon, 11 May 2009 23:25:24 +0000

Subcutaneous splenosis in gunshot outlet: case report.

J Trauma. 2009 Apr;66(4):E55-6

Authors: Chang NJ, Yeh JT, Lin YT, Lin CH

PMID: 19359899 [PubMed - indexed for MEDLINE]

Acute compartment syndrome of the anterior thigh in the absence of fracture secondary to sporting trauma.

McCaffrey DD, Clarke J, Bunn J, McCormack MJ — Mon, 11 May 2009 23:25:23 +0000

Acute compartment syndrome of the anterior thigh in the absence of fracture secondary to sporting trauma.

J Trauma. 2009 Apr;66(4):1238-42

Authors: McCaffrey DD, Clarke J, Bunn J, McCormack MJ

PMID: 19359943 [PubMed - indexed for MEDLINE]

Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials.

Qadan M, Akça O, Mahid SS, Hornung CA, Polk HC — Mon, 11 May 2009 23:25:21 +0000

Perioperative supplemental oxygen therapy and surgical site infection: a meta-analysis of randomized controlled trials.

Arch Surg. 2009 Apr;144(4):359-66; discussion 366-7

Authors: Qadan M, Akça O, Mahid SS, Hornung CA, Polk HC

OBJECTIVE: To conduct a meta-analysis of randomized controlled trials in which high inspired oxygen concentrations were compared with standard concentrations to assess the effect on the development of surgical site infections (SSIs). DATA SOURCES: A systematic literature search was conducted using the MEDLINE, EMBASE, and Cochrane databases and included a manual search of references of original articles, poster presentations, and abstracts from major meetings (“gray” literature). STUDY SELECTION: Twenty-one of 2167 articles met the inclusion criteria. Of these, 5 randomized controlled trials (3001 patients) assessed the effect of perioperative supplemental oxygen use on the SSI rate. Studies used a treatment-inspired oxygen concentration of 80%. Maximum follow-up was 30 days. DATA EXTRACTION: Data were abstracted by 3 independent reviewers using a standardized data collection form. Relative risks were reported using a fixed-effects model. Results were subjected to publication bias testing and sensitivity analyses. DATA SYNTHESIS: Infection rates were 12.0% in the control group and 9.0% in the hyperoxic group, with relative risk reduction of 25.3% (95% confidence interval [CI], 8.1%-40.1%) and absolute risk reduction of 3.0% (1.1%-5.3%). The overall risk ratio was 0.742 (95% CI, 0.599-0.919; P = .006). The benefit from increasing oxygen concentration was greater in colorectal-specific procedures, with a risk ratio of 0.556 (95% CI, 0.383-0.808; P = .002). CONCLUSIONS: Perioperative supplemental oxygen therapy exerts a significant beneficial effect in the prevention of SSIs. We recommend its use along with maintenance of normothermia, meticulous glycemic control, and preservation of intravascular volume perioperatively in the prevention of SSIs.

PMID: 19380650 [PubMed - indexed for MEDLINE]

Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences.

Balch CM, Freischlag JA, Shanafelt TD — Mon, 11 May 2009 23:25:20 +0000

Stress and burnout among surgeons: understanding and managing the syndrome and avoiding the adverse consequences.

Arch Surg. 2009 Apr;144(4):371-6

Authors: Balch CM, Freischlag JA, Shanafelt TD

PMID: 19380652 [PubMed - indexed for MEDLINE]

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery.

Budde RP, Bakker PF, Gründeman PF, Borst C — Wed, 06 May 2009 22:27:32 +0000

High-frequency epicardial ultrasound: review of a multipurpose intraoperative tool for coronary surgery.

Surg Endosc. 2009 Mar;23(3):467-76

Authors: Budde RP, Bakker PF, Gründeman PF, Borst C

BACKGROUND: In open-chest coronary artery bypass grafting (CABG), the surgeon faces several intraoperative challenges: (1) to locate the target coronary artery, (2) to select the optimal anastomotic site, and (3) to assess the quality of the graft and distal anastomosis. Endoscopically, these three diagnostic aims are particularly challenging. METHODS: We reviewed the literature on the intraoperative application of high-frequency (6.5-15 MHz) epicardial ultrasound (ECUS) in CABG to aid in these challenges. RESULTS: Overall, ECUS was used in 628 patients to visualize and assess 912 (segments of) coronary arteries, as well as 418 grafts and distal anastomoses. In 96 cases, ECUS successfully located a coronary artery that was buried in the epicardial and/or myocardial tissue. In 37/155 (24%) imaged anastomotic sites, an alternative site free of pathology was selected. For quality assessment of the coronary anastomosis, experimental validation of ECUS included 218 anastomoses in ex vivo and animal models. ECUS showed high sensitivity (0.98) and specificity (1.00) for detection of anastomotic construction errors in 120 ex vivo anastomoses. In 418 grafts and distal anastomoses evaluated in patients, irregularities leading to revision were detected in 8 (1.9%) anastomoses and minor irregularities in an additional 23 (5.5%) anastomoses. However, little is known about the effect on long-term patency of specific anastomotic abnormalities revealed by ECUS. Scanning of arteries and anastomoses required several minutes. Current size ultrasound probes allowed successful experimental robot-assisted endoscopic application of ECUS. CONCLUSIONS: CABG may be facilitated and improved in several ways by intraoperative high-frequency epicardial ultrasound scanning. Totally endoscopic CABG may benefit from ultrasound diagnostics in particular.

PMID: 18806944 [PubMed - indexed for MEDLINE]

Regional collaborations as a tool for quality improvements in surgery: a systematic review of the literature.

Tue, 05 May 2009 22:24:37 +0000

Regional collaborations as a tool for quality improvements in surgery: a systematic review of the literature.

Ann Surg. 2009 Apr;249(4):565-72

Authors: Fung-Kee-Fung M, Watters J, Crossley C, Goubanova E, Abdulla A, Stern H, Oliver TK

BACKGROUND: A systematic review of the literature identifying regional collaborations in surgical practice examining practices related to quality improvement. METHODS: The MEDLINE, EMBASE, and Cochrane Library databases, were searched for published reports of regional collaborations in the surgical community relating to initiatives to enhance quality improvement, quality of care, patient safety, knowledge transfer, or communities of practice. RESULTS: Seven collaborative initiatives met the inclusion criteria and were included in the systematic review of the evidence. Motivations for initiating collaborations were often in response to external demands for performance data. Changes in the processes of clinical care and improvements in clinical outcomes were reported on the basis of the collaborative efforts. Significant improvements in clinical outcomes such as decreases in mortality rates, lower duration of postoperative intubations, and fewer surgical-site infections were reported. Quality improvement process measures were also reported to be improved across all of the collaborative initiatives. Success factors included (a) the establishment of trust among health professionals and health institutions; (b) the availability of accurate, complete, relevant data; (c) clinical leadership; (d) institutional commitment; and (e) the infrastructure and methodological support for quality management. CONCLUSIONS: A community of practice framework incorporating the success elements described in the systematic review of the literature can be used as a valuable model for collaboration amongst surgeons and healthcare organizations to improve quality of care and foster continuing professional development.

PMID: 19300234 [PubMed - indexed for MEDLINE]

Suppressing the suppressor: Role of immunosuppressive regulatory T cells in cancer surgery.

Baumgartner JM, McCarter MD — Mon, 04 May 2009 22:14:59 +0000

Suppressing the suppressor: Role of immunosuppressive regulatory T cells in cancer surgery.

Surgery. 2009 Apr;145(4):345-50

Authors: Baumgartner JM, McCarter MD

PMID: 19303982 [PubMed - indexed for MEDLINE]

Posttraumatic pulmonary arteriovenous fistula: is resection the procedure of choice? A case report and review of literature.

Ploch PJ, Datta S, Thompson JH, Raghavendran K — Thu, 30 Apr 2009 17:25:56 +0000

Posttraumatic pulmonary arteriovenous fistula: is resection the procedure of choice? A case report and review of literature.

J Trauma. 2009 Feb;66(2):554-7

Authors: Ploch PJ, Datta S, Thompson JH, Raghavendran K

PMID: 18349712 [PubMed - indexed for MEDLINE]

A comprehensive review of trauma and disruption to the sternoclavicular joint with the proposal of a new classification system.

Jaggard MK, Gupte CM, Gulati V, Reilly P — Wed, 29 Apr 2009 17:17:36 +0000

A comprehensive review of trauma and disruption to the sternoclavicular joint with the proposal of a new classification system.

J Trauma. 2009 Feb;66(2):576-84

Authors: Jaggard MK, Gupte CM, Gulati V, Reilly P

BACKGROUND: The sternoclavicular joint (SCJ) is rarely injured but should not be overlooked in cases of high-energy trauma. Stability is reliant on the ligamentous attachments. The methods of injury and the clinical presentations are examined. Obtaining informative plain radiology of the SCJ is challenging and the best methods to achieve this are discussed. METHODS: The Pubmed and Medline databases were searched for all literature relating to the keywords of “sternoclavicular” or “SCJ.” CONCLUSIONS: Early closed reduction in acute injury is advisable. Complications of posterior dislocation to the SCJ are potentially severe and occasionally life threatening. Long-term stability is often difficult to achieve and can be significantly debilitating. Operative methods to restore joint stability are examined and the evidence to support them is presented. We propose a simple classification system to aid in making management decisions.

PMID: 19204537 [PubMed - indexed for MEDLINE]

The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference.

Wexner SD, Bergamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH, John H — Sun, 26 Apr 2009 16:57:09 +0000

The current status of robotic pelvic surgery: results of a multinational interdisciplinary consensus conference.

Surg Endosc. 2009 Feb;23(2):438-43

Authors: Wexner SD, Bergamaschi R, Lacy A, Udo J, Brölmann H, Kennedy RH, John H

BACKGROUND: Despite the significant benefits of laparoscopic surgery, limitations still exist. One of these limitations is the loss of several degrees of freedom. Robotic surgery has allowed surgeons to regain the two lost degrees of freedom by introducing wristed laparoscopic instruments. METHODS: At the first Pelvic Surgery Meeting held in Brescia in June 2007, the participants focused on the role of robotic surgery in pelvic operations surgery for malignancy including prostate, rectal, uterine, and cervical carcinoma. All members of the interdisciplinary panel were asked to define the role of robotic surgery in prostate, rectal, and uterine carcinoma. All key statements were reformulated until a consensus within the group was achieved (Murphy et al., Health Technol Assess 2(i-v):1-88, 1998). For the systematic review, a comprehensive literature search was performed in Medline and the Cochrane Library from January 1997 to June 2007. The keywords used were Da Vinci, telemonitoring, laparoscopy, neoplasms for urology, colorectal, gynecology, visceral surgery, and minimally invasive surgery. The pelvic surgery meeting was supported by Olympus Medical Systems Europa. RESULTS: As of December 31, 2007, there were 795 unit shipments worldwide of the Da Vinci((R)): 595 in North America, 136 in Europe, and 64 in the rest of the world (http://investor.intuitivesurgical.com/phoenix.zhtml?c=122359&p=irol-faq#22324 ). It was estimated that, during 2007, approximately 50,000 radical prostatectomies were performed with the Da Vinci robot system in the USA, reflecting market penetration of 60% of radical prostatectomies in the USA. This utilization represents 50% growth as in 2006 only 42% of all radical prostatectomies performed in the USA employed robotics. CONCLUSION: While robotic prostatectomy has become the most widely accepted method of prostatectomy, robotic hysterectomy and proctectomy remain far less widely accepted. The theoretical benefits of the increased degrees of freedom and three-dimensional visualization may be outweighed in these areas by the loss of haptic feedback, increased operative times, and increased cost.

PMID: 19037694 [PubMed - indexed for MEDLINE]

Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization.

Hellan M, Stein H, Pigazzi A — Sun, 26 Apr 2009 16:31:20 +0000

Totally robotic low anterior resection with total mesorectal excision and splenic flexure mobilization.

Surg Endosc. 2009 Feb;23(2):447-51

Authors: Hellan M, Stein H, Pigazzi A

Some limitations of conventional laparoscopy have been overcome by the enhanced dexterity of the robotic da Vinci system, and its use in gastrointestinal procedures is evolving. However, difficulties accessing multiple quadrants of the abdomen with the first robotic system led to a rather slow introduction of the da Vinci into the field of abdominal surgery compared with its success with urologic and cardiac procedures. The new da Vinci S HD system offers improved range of motion that allows for easier access to a wider surgical field. The authors developed a new “one-step” setup to perform a low anterior resection with total mesorectal excision and splenic flexure mobilization for rectal cancer using a completely robotic approach. This technical report describes all the major aspects for successful performance of this complex minimally invasive procedure.

PMID: 19057962 [PubMed - indexed for MEDLINE]

Assessment of rotator cuff tendons after proximal humerus fractures: is preoperative imaging necessary?

admin — Mon, 23 Mar 2009 22:12:30 +0000

Assessment of rotator cuff tendons after proximal humerus fractures: is preoperative imaging necessary?

J Trauma. 2009 Mar;66(3):951-3

Authors: Gallo RA, Altman DT, Altman GT

PMID: 19276777 [PubMed - indexed for MEDLINE]

Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review.

admin — Mon, 23 Mar 2009 22:12:30 +0000

Management of prehospital antiplatelet and anticoagulant therapy in traumatic head injury: a review.

J Trauma. 2009 Mar;66(3):942-50

Authors: McMillian WD, Rogers FB

Trauma and emergency department clinicians encounter a growing number of patients admitted with traumatic head injury on prehospital antithrombotic therapies. These patients appear to be at increased risk of developing life-threatening intracranial hemorrhage. It is imperative that trauma clinicians understand the mechanism and duration of commonly prescribed outpatient antithrombotics in order to appropriately assess and treat patients who develop intracranial hemorrhage. This review summarizes current literature on the morbidity and mortality associated with premorbid non-steroidal anti-inflammatory drugs, aspirin, clopidogrel, warfarin, and heparinoids in the setting of traumatic head injury, and also examines the current strategies for reversal of these therapies.

PMID: 19276776 [PubMed - indexed for MEDLINE]

Neuroleptic malignant syndrome in traumatic brain injury patients treated with haloperidol.

admin — Mon, 23 Mar 2009 22:12:29 +0000

Neuroleptic malignant syndrome in traumatic brain injury patients treated with haloperidol.

J Trauma. 2009 Mar;66(3):954-8

Authors: Bellamy CJ, Kane-Gill SL, Falcione BA, Seybert AL

BACKGROUND: Haloperidol, which is commonly used to treat agitation in critically ill patients, has been associated with the development of neuroleptic malignant syndrome (NMS). The purpose of this manuscript was to review the literature describing NMS and haloperidol use in patients sustaining a traumatic brain injury (TBI) since these patients may be at greater risk for NMS. METHODS: A computerized search of MEDLINE was conducted (1966-May 2008) to identify all publications in which haloperidol was related to NMS in patients with a TBI. The references of these manuscripts were reviewed for additional literature. RESULTS: Nine case reports describe the development of NMS in patients with TBI treated with haloperidol for agitation. Cumulative haloperidol doses before the onset of NMS ranged from 10 mg to at least 210 mg. Most of these patients received high dose (> or =30 mg) haloperidol. Four patients received haloperidol parenterally. On diagnosis, of NMS, haloperidol was discontinued in five cases, and all were given supportive care and pharmacologic treatment. Patients were discharged with improved, but diminished functional capacity. CONCLUSION: Development of NMS in TBI patients treated with haloperidol should be a concern for clinicians since these patients may be at greater risk for this adverse event; especially if the patient is receiving haloperidol at high doses parenterally. Future studies are needed to evaluate the incidence and increased risk of adverse events in patients sustaining a TBI and receiving haloperidol especially since haloperidol is being used more frequently in the critically ill patients.

PMID: 19276778 [PubMed - indexed for MEDLINE]

Totally endoscopic subxiphoid pericardioscopy: early steps with a new surgical tool.

admin — Fri, 27 Feb 2009 16:58:55 +0000

Totally endoscopic subxiphoid pericardioscopy: early steps with a new surgical tool.

Surg Endosc. 2009 Feb;23(2):444-6

Authors: Manca G, Codecasa R, Valeri A, Braconi L, Giunti G, Tedone A, Perna AM, Stefàno P, Gensini G

BACKGROUND: Pericardial pathology still has challenging diagnostic and treating issues. To reduce surgical trauma and pain for the patient, the authors developed a totally endoscopic echo-guided approach for both diagnostic and operative pericardioscopy. METHODS: Three steps moved from animal model (8 pigs) through concomitant open-chest interventions (7 patients) to closed-chest interventions for 10 patients with a diagnosis of severe pericardial effusion. RESULTS: A lesion of the right ventricle in one patient (10%) due to imperfect preoperative pericardial visualization needed sternotomy for repair. All the patients, except the aforementioned one, underwent surgery with local anesthesia or mild sedation. No method-related mortality was reported. CONCLUSION: The closed-chest nonintrapleural approach to the pericardium may represent an evolution, with a positive impact on the treatment of this pathology. Therapeutic maneuvers with rigid instruments in nonintubated patients are possible. Accurate patient selection and technical refinement should increase the safety and effectiveness of the method.

PMID: 18437483 [PubMed - indexed for MEDLINE]

Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer.

admin — Fri, 27 Feb 2009 16:58:49 +0000

Video. A novel laparoscopic approach for safe and simplified suprapancreatic lymph node dissection of gastric cancer.

Surg Endosc. 2009 Feb;23(2):436-7

Authors: Satoh S, Okabe H, Kondo K, Tanaka E, Itami A, Kawamura J, Nomura A, Nagayama S, Watanabe G, Sakai Y

BACKGROUND: Lymph node dissection is a crucial procedure for curative resection of gastric cancer [1]. To avoid portal vein injury during laparoscopic extended lymph node dissection for gastric cancer, taping of the common hepatic artery and subsequent confirmation of the portal vein have been recommended [2, 3]. This taping method, however, makes laparoscopic nodal dissection technically complicated. This study introduces a novel procedure for safe and simple laparoscopic suprapancreatic nodal dissection without taping of the common hepatic artery. METHODS: The authors’ novel, simplified method consists of four steps: (1) dissection along the cranial edge of the pancreas from right to left, (2) dissection along the splenic artery with exposure of the left renal fascia, (3) dissection along the left gastric and the common hepatic arteries, and (4) retraction of the lymph nodes surrounding the common and proper hepatic arteries and their complete dissection from the portal vein. This procedure is reversely directed compared with conventional open gastrectomy (i.e., the nodal dissection is from left to right). For this study, the lymph node stations and groups were defined according to the 13th edition of the Japanese Classification for Gastric Carcinoma. The described procedures were performed for 58 consecutive patients with gastric cancer. The indication for this operation is primary T1/T2 gastric cancer without clinical nodal metastasis. RESULTS: In all cases, safely extended suprapancreatic lymph node dissection was successfully accomplished using the described technique. A total of 43.5 +/- 18 lymph nodes were retrieved, including 14.4 +/- 6.3 second-tier lymph nodes. The overall number of retrieved lymph nodes in this study was similar to that reported previously [4]. Postoperative morbidity occurred at a rate of 22.3%, and the mortality rate was 0%. There was no conversion to open surgery. The mean blood loss was 127 ml (range, 0-490 ml), and the mean operative time was 289 min (range, 104-416 min) in the last 20 consecutive cases. To date, no tumor recurrence has been observed. The median postoperative observation period was 1.4 years (range, 0.4-2.4 years). CONCLUSION: The described novel procedure would be sufficient and convenient for dissection of the suprapancreatic lymph nodes.

PMID: 18528615 [PubMed - indexed for MEDLINE]

The role of staging laparoscopy for intraabdominal cancers: an evidence-based review.

admin — Fri, 27 Feb 2009 16:58:42 +0000

The role of staging laparoscopy for intraabdominal cancers: an evidence-based review.

Surg Endosc. 2009 Feb;23(2):231-41

Authors: Chang L, Stefanidis D, Richardson WS, Earle DB, Fanelli RD

Diagnostic laparoscopy is minimally invasive surgery for the diagnosis of intraabdominal diseases. The aim of this review is a critical examination of the available literature on the role of laparoscopy for the staging of intraabdominal cancers. A systematic literature search of English-language articles on MEDLINE, the Cochrane database of evidence-based reviews, and the Database of Abstracts of Reviews of Effects was performed for the period 1995-2006. The level of evidence in the identified articles was graded. The search identified and reviewed seven main categories that have received attention in the literature: esophageal cancer, gastric cancer, pancreatic cancer, hepatocellular carcinoma, biliary tract cancer, colorectal cancer, and lymphoma. The indications, contraindications, risks, benefits, diagnostic accuracy of the procedure, and its associated morbidity are discussed. The limitations of the available literature are highlighted, and evidence-based recommendations for the use of laparoscopy to stage intraabdominal cancers are provided.

PMID: 18813972 [PubMed - indexed for MEDLINE]

Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen.

admin — Mon, 23 Feb 2009 22:12:33 +0000

Temporary closure of the open abdomen: a systematic review on delayed primary fascial closure in patients with an open abdomen.

World J Surg. 2009 Feb;33(2):199-207

Authors: Boele van Hensbroek P, Wind J, Dijkgraaf MG, Busch OR, Carel Goslings J

BACKGROUND: This study was designed to systematically review the literature to assess which temporary abdominal closure (TAC) technique is associated with the highest delayed primary fascial closure (FC) rate. In some cases of abdominal trauma or infection, edema or packing precludes fascial closure after laparotomy. This “open abdomen” must then be temporarily closed. However, the FC rate varies between techniques. METHODS: The Cochrane Register of Controlled Trials, MEDLINE, and EMBASE databases were searched until December 2007. References were checked for additional studies. Search criteria included (synonyms of) “open abdomen,” “fascial closure,” “vacuum,” “reapproximation,” and “ventral hernia.” Open abdomen was defined as “the inability to close the abdominal fascia after laparotomy.” Two reviewers independently extracted data from original articles by using a predefined checklist. RESULTS: The search identified 154 abstracts of which 96 were considered relevant. No comparative studies were identified. After reading them, 51 articles, including 57 case series were included. The techniques described were vacuum-assisted closure (VAC; 8 series), vacuum pack (15 series), artificial burr (4 series), Mesh/sheet (16 series), zipper (7 series), silo (3 series), skin closure (2 series), dynamic retention sutures (DRS), and loose packing (1 series each). The highest FC rates were seen in the artificial burr (90%), DRS (85%), and VAC (60%). The lowest mortality rates were seen in the artificial burr (17%), VAC (18%), and DRS (23%). CONCLUSIONS: These results suggest that the artificial burr and the VAC are associated with the highest FC rates and the lowest mortality rates.

PMID: 19089494 [PubMed - indexed for MEDLINE]

Sulphate-reducing bacteria and hydrogen sulphide in the aetiology of ulcerative colitis.

admin — Mon, 23 Feb 2009 22:12:32 +0000

Sulphate-reducing bacteria and hydrogen sulphide in the aetiology of ulcerative colitis.

Br J Surg. 2009 Feb;96(2):151-8

Authors: Rowan FE, Docherty NG, Coffey JC, O’Connell PR

BACKGROUND: The aetiology of ulcerative colitis is uncertain but may relate to environmental factors in genetically predisposed individuals. Sulphate-reducing bacteria (SRB) have been implicated through the harmful effects of hydrogen sulphide, a by-product of their respiration. Hydrogen sulphide is freely permeable to cell membranes and inhibits butyrate. This review examines the available evidence relating to SRB as a possible cause of ulcerative colitis. METHODS: A literature search was conducted using the PubMed database and search terms ‘sulphate reducing bacteria’, ‘hydrogen sulphide’, ‘ulcerative colitis’, ‘mucous gel layer’ and ‘trans-sulphuration’. RESULTS: Search results were scrutinized and 113 pertinent full-text articles were selected for review. Collected data related to hydrogen sulphide metabolism, SRB respiration, mucous gel layer composition and their association with ulcerative colitis. CONCLUSION: There is evidence to implicate SRB as an environmental factor in ulcerative colitis. More sophisticated mucosal dissection and molecular techniques using bacteria-directed probes are required to determine an association definitively.

PMID: 19160346 [PubMed - indexed for MEDLINE]

Risk assessment in acute pancreatitis.

admin — Mon, 23 Feb 2009 22:12:32 +0000

Risk assessment in acute pancreatitis.

Br J Surg. 2009 Feb;96(2):137-50

Authors: Mofidi R, Patil PV, Suttie SA, Parks RW

BACKGROUND: Acute pancreatitis has a variable natural history and in a proportion of patients is associated with severe complications and a significant risk of death. The various tools available for risk assessment in acute pancreatitis are reviewed. METHODS: Relevant medical literature from PubMed, Ovid, Embase, Web of Science and The Cochrane Library websites to May 2008 was reviewed. RESULTS AND CONCLUSION: Over the past 30 years several scoring systems have been developed to predict the severity of acute pancreatitis in the first 48-72 h. Biochemical and immunological markers, imaging modalities and novel predictive models may help identify patients at high risk of complications or death. Recently, there has been a recognition of the importance of the systemic inflammatory response syndrome and organ dysfunction.

PMID: 19125435 [PubMed - indexed for MEDLINE]

Colonic anastomotic leak: risk factors, diagnosis, and treatment.

admin — Mon, 23 Feb 2009 22:12:31 +0000

Colonic anastomotic leak: risk factors, diagnosis, and treatment.

J Am Coll Surg. 2009 Feb;208(2):269-78

Authors: Kingham TP, Pachter HL

PMID: 19228539 [PubMed - indexed for MEDLINE]

Progress in tissue engineering of soft tissue and organs.

admin — Mon, 23 Feb 2009 22:12:31 +0000

Progress in tissue engineering of soft tissue and organs.

Surgery. 2009 Feb;145(2):127-30

Authors: Morrison WA

PMID: 19167966 [PubMed - indexed for MEDLINE]

Systematic review of endoscopic treatments for gastro-oesophageal reflux disease.

admin — Mon, 23 Feb 2009 22:12:31 +0000

Systematic review of endoscopic treatments for gastro-oesophageal reflux disease.

Br J Surg. 2009 Feb;96(2):128-36

Authors: Chen D, Barber C, McLoughlin P, Thavaneswaran P, Jamieson GG, Maddern GJ

BACKGROUND: The aim of this review was to assess the safety and efficacy of endoscopic procedures for gastro-oesophageal reflux disease. METHODS: Literature databases including Medline, Embase and PubMed were searched up to May 2006 without language restriction. Randomized controlled trials and non-randomized comparative studies with at least ten patients in each study arm, and case series studies of at least ten patients, were included. RESULTS: A total of 33 studies examining seven endoscopic procedures (Stretta procedure, Bard EndoCinch, Wilson-Cook Endoscopic Suturing Device, NDO Plicator, Enteryx, Gatekeeper Reflux Repair System and Plexiglas) were included in the review. Of the three procedures that were tested against sham controls (Stretta procedure, Bard EndoCinch and Enteryx), patient outcomes in the treatment group were either as good as, or significantly better than, those of control patients in terms of heartburn symptoms, quality of life and medication usage. However, for the two procedures that were tested against laparoscopic fundoplication (Stretta) procedure and Bard EndoCinch), outcomes for patients in the endoscopic group were either as good as, or inferior to, those for the laparoscopic group. CONCLUSION: At present there is insufficient evidence to determine the safety and efficacy of endoscopic procedures for gastro-oesophageal reflux disease, particularly in the long term.

PMID: 19160349 [PubMed - indexed for MEDLINE]

Necrotizing fasciitis: current concepts and review of the literature.

admin — Mon, 23 Feb 2009 22:12:30 +0000

Necrotizing fasciitis: current concepts and review of the literature.

J Am Coll Surg. 2009 Feb;208(2):279-88

Authors: Sarani B, Strong M, Pascual J, Schwab CW

PMID: 19228540 [PubMed - indexed for MEDLINE]

Intra-abdominal venous and arterial thromboembolism in inflammatory bowel disease.

admin — Mon, 23 Feb 2009 22:12:28 +0000

Intra-abdominal venous and arterial thromboembolism in inflammatory bowel disease.

Dis Colon Rectum. 2009 Feb;52(2):336-42

Authors: Di Fabio F, Obrand D, Satin R, Gordon PH

Venous and arterial thromboembolism constitutes a significant cause of morbidity and mortality in patients with inflammatory bowel disease. The most common thrombotic manifestations are lower extremity deep vein thromboses with or without pulmonary embolism. Occasionally, thromboembolic events occur in the main abdominal vessels, such as the portal and superior mesenteric veins, vena cava and hepatic vein, aorta, splanchnic and iliac arteries, or in the limb arteries. The decision-making process for the treatment of these uncommon thromboembolic complications in inflammatory bowel disease may be very challenging for several reasons: 1) no standardized therapies are available; 2) the decision of starting anticoagulant therapy implies the potential risk of intestinal bleeding; 3) thromboembolic events may recur and be life-threatening if inadequately treated. The literature was searched by using MEDLINE, Embase, and the Cochrane library database. Studies published between 1970 and 2007 were reviewed. We discuss the medical and surgical therapeutic options that should be considered to optimize the outcome and reduce the risk of complications in abdominal thromboembolisms associated with inflammatory bowel disease.

PMID: 19279432 [PubMed - indexed for MEDLINE]