American journal of surgery
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We previously described a feasible, reliable, valid, and acceptable clinical assessment form for basic surgical trainees (BSTs). We now recently assessed tissue-handling skills using real-time assessment (RTA) and video assessment (VA) and addressed feasibility, reliability, validity, and trainer-trainee agreement using the same assessment form. ⋯ VA of BST tissue-handling skills is feasible, reliable, valid, and highly sensitive. It may also improve trainee self-assessment skills by promoting reflective practice.
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The current study compared the outcome of morbidly obese patients undergoing laparoscopic versus open appendectomy. ⋯ In the morbidly obese, laparoscopic appendectomy performed for acute and perforated appendicitis is associated with a shorter length of stay and lower morbidity and costs. Laparoscopic appendectomy should be the procedure of choice for the treatment of acute appendicitis in the morbidly obese population.
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Clinical studies have shown that enteral immune-enhancing diets (IEDs) containing l-glutamine decrease septic complications and length of stay in some patient populations. Animal studies suggest IED benefits might include augmented gut blood flow. We hypothesized that enteral glutamine supplementation modulates gastrointestinal blood flow. ⋯ Enteral glutamine supplementation (as in IEDs) appears to impair gastrointestinal blood flow. Because glutamine provides energy directly to active enterocytes, enteral glutamine availability might diminish metabolic stimuli of absorptive hyperemia. This finding might partially explain the benefits observed with parenteral versus enteral glutamine supplementation in clinical studies (such as bone-marrow-transplant patients).
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Randomized Controlled Trial
Sublingual hyoscyamine spray as premedication for colonoscopy: a randomized double-blinded placebo-controlled trial.
Colonic motility and spasm during colonoscopy may affect duration and quality of the examination as well as patient comfort during and after the procedure. Previous studies assessing the utility of antispasmodic agents in colonoscopy demonstrated conflicting results. The aim of this study was to determine the effect of sublingual hyoscyamine spray (IB-Stat, Inkine Pharmaceutical) on the performance of colonoscopy. ⋯ Procedural difficulty and colonic motility scores were significantly lower in subjects who received sublingual hyoscyamine before colonoscopy.
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Clinical studies suggest that leukocytes in banked blood may increase infectious complications after transfusion. However, these investigations included few injured patients. Therefore, the effect of the use of leukoreduced red blood cell (RBC) products in this patient population is unknown. In addition, large numbers of RBC transfusions are frequently required in the treatment of patients with hemorrhagic shock, which may have a more profound effect on infectious risk. The purpose of this study was to determine the effect of prestorage leukoreduction on infectious complications in injured patients. ⋯ Prestorage leukoreduction is associated with a reduction of infectious complications in injured patients. Furthermore, this protective effect appears more pronounced in patients receiving massive transfusion (>6 U packed RBCs).