Surgery
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For patients with high spinal cord injury and chronic respiratory insufficiency, electrically induced diaphragm pacing is an alternative to long-term positive pressure ventilation. The goal of this study was to laparoscopically assess the phrenic nerve motor point of the diaphragm and then implant electrodes to produce chronic negative pressure ventilation. ⋯ Mapping and implantation of the electrodes can be done laparoscopically, providing for a low-risk, cost-effective, outpatient, diaphragm pacing system that will support the respiratory needs of patients.
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Comparative Study
Utility of total mechanical stapled cervical esophagogastric anastomosis after esophagectomy: a comparison to conventional anastomotic techniques.
Cervical esophagogastric anastomosis after esophagectomy is often troubled with anastomotic leak resulting in local sepsis, postoperative stricture, and prolonged hospitalization. We compared the anastomotic outcomes and clinical course of esophagectomy patients undergoing total mechanical stapled esophagogastric anastomosis versus a partial handsewn/mechanical stapled cervical anastomotic technique. ⋯ Total mechanical stapled technique after esophagectomy with cervical esophagogastric anastomosis appears to be effective in reducing hospitalization and anastomotic complications compared to partial or complete handsewn techniques. Liberal use of endoscopic staplers might shorten operative time. Esophageal surgeons should be aware of the advantages and become skilled with these techniques.
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Comparative Study
Fertility is reduced after restorative proctocolectomy with ileal pouch anal anastomosis: a study of 300 patients.
Restorative proctocolectomy and ileal pouch anal anastomosis (RP/IPAA) has become the gold standard surgical therapy for the majority of patients with mucosal ulcerative colitis and familial adenomatous polyposis. The aims of this study were to evaluate the fertility rates before and after RP/IPAA, to compare them with the reproductive data of the general United States population, and to determine surgical parameters that might influence subsequent fertility. ⋯ There was an increase in the infertility rate after RP/IPAA. Intraoperative blood transfusion had a negative impact on the fertility rate after operation in patients who tried to conceive both before and after RP/IPAA.
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Randomized Controlled Trial Comparative Study Clinical Trial
A prospective, randomized, controlled clinical trial of tissue adhesive (2-octylcyanoacrylate) versus standard wound closure in breast surgery.
Recent studies suggest that the use of tissue adhesive for closure of both traumatic lacerations and incisional surgical wounds leads to cosmetic outcome comparable to conventional sutures. To date, no studies have investigated tissue adhesive in breast surgery and costs. Our aim was to compare the tissue adhesive 2-octylcyanoacrylate (OCA) with standard suture in breast surgery. ⋯ OCA is effective and reliable in skin closure for breast surgery, yielding similar cosmetic results to standard suture. OCA is faster than standard wound closure and offers several practical advantages over suture repair for patients. Cost analysis has found that OCA adhesive can significantly decrease health care costs.
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Randomized Controlled Trial Clinical Trial
Teaching practicing surgeons critical appraisal skills with an Internet-based journal club: A randomized, controlled trial.
The effectiveness of interventions for developing critical appraisal skills in practicing physicians has not been studied, despite the documented importance of reading the literature in caring for patients and in continuing professional development. The objective of this study was to evaluate whether an Internet-based intervention would lead to enhanced critical appraisal skills in practicing surgeons. ⋯ A multifaceted, Internet-based intervention resulted in improved critical appraisal skills of practicing general surgeons.