Management of Gallstone Cholangitis in the Era of Laparoscopic Cholecystectomy
In 184 consecutive patients with gallstone cholangitis and comorbid illnesses, with a mean age of 70.5 years, the authors used endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) followed by interval laparoscopic cholecystectomy. Open or laparoscopic common-duct exploration was used only when ERCP or ES failed. The success rate with ERCP and ES exceeded 90%, with a morbidity of 4% and a mortality of 1.6%. Only 21 patients required surgical common-duct exploration. Unless an interval laparoscopic cholecystectomy is performed, there is a 25% risk of recurrent biliary symptoms.
Abbreviated Thoracotomy and Temporary Chest Closure: An Application of Damage Control After Thoracic Trauma
As an extension of damage control laparotomy, this trauma center introduces abbreviated thoracotomy and temporary chest closure after repair of life-threatening injuries, thus delaying treatment of nonthreatening trauma in patients with acidemia, hypothermia, and coagulopathy. In a series of 11 patients, surgeons were able to salvage 7 following reoperation after correction of metabolic exhaustion in the intensive care unit. Although each patient sustained at least 1 complication attributable to thoracic surgery, this strategy had a significant effect on survival.
Penetrating Trauma to the Diaphragm: Natural History and Ultrasonographic Characteristics of Untreated Injury in a Pig Model
Having developed a penetrating diaphragm injury model capable of duplicating the natural history of this trauma, the authors suggest that ultrasound may prove to be an important diagnostic adjunct in evaluating these injuries.
Comparative Analysis of Tumor Cell Dissemination in Mesenteric, Central, and Peripheral Venous Blood in Patients With Colorectal Cancer
Attempting to detect the predominant pattern of hematogenic tumor cell dissemination in colorectal cancer, this group examined mesenteric, superior vena cava, and antecubital venous blood before and after manipulation of colorectal tumors in 40 consecutive patients. Their findings emphasize the limited filter function of the liver for circulating tumor cells and the early systemic tumor cell spread in colorectal cancer.
Reliability of the Advanced Dundee Endoscopic Psychomotor Tester for Bimanual Tasks
Developed and tested for reliability at the Ninewells Medical Center in Dundee, Scotland, this system is capable of evaluating psychomotor skills and training progress in endoscopic instrumentation.
Resident Experience and Opinions About Physician-Assisted Death for Cancer Patients
This survey at a university medical center reveals differing views on physician-assisted death among a group of surgical residents and staff oncologists.
Soft Tissue Tumors of the Abdominal Wall: Analysis of Disease Patterns and Treatment
After a study of 85 patients with soft tissue tumors of the abdominal wall, it is apparent that these tumors encompass a broad spectrum of biological behavior. Complete surgical resection is recommended to achieve local control, with stratification of prognostic factors—histologic grade, depth, and size—facilitating the selection of patients with soft tissue sarcomas for adjuvant therapies.