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Liver resection as the definitive treatment for unilateral non-oriental primary intrahepatic lithiasis. | bidity rate was 7.4% (2 patients with biliary fistula). After a median follow-up of 41.2 months; the overall rate of good results was 92.6%. All patients submitted to liver resection alone presented good late results; while 80% of those with associated hepaticojejunostomy did not have complications (P = .12). Late complications were observed in 2 patients (7.4%): 1 with a liver abscess and 1 with cholangitis and recurrent stones. There was no mortality during long-term follow-up.Liver resection showed low i | 16531136 | [
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Liver resection as the definitive treatment for unilateral non-oriental primary intrahepatic lithiasis. | ncidence of complications and good long-term results. None of the patients with unilateral disease without associated extrahepatic bile duct dilation presented complications and they were considered cured. We believe that resection indications should be expanded and the procedure should be indicated as routine in patients with unilateral PHIL even in the absence of parenchymal fibrosis/atrophy or biliary stenosis. | 16531136 | [
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Sentinel lymph node mapping with technetium-99m colloidal rhenium sulfide in patients with gastric carcinoma. | The objective of this study was to determine; with the use of technetium-99m colloidal rhenium sulfide; whether the concept of sentinel lymph nodes (SLNs) is applicable to gastric cancers.Fifty-nine gastric cancer patients underwent radical gastrectomy and SLN mapping with an intraoperative hand-held gamma probe. After surgery; each transected lymph node was measured for radioisotope (RI) activities by a well-type scintillation counter.SLNs were detectable in 57 (96%) of 59 patients. The sensitivity; specif | 16531137 | [
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Sentinel lymph node mapping with technetium-99m colloidal rhenium sulfide in patients with gastric carcinoma. | icity; and diagnostic accuracy were calculated to be 83.3%; 100%; and 92.9%; respectively. Sensitivity was 100% in the T1 group; 91.6% in the T2 group; and 62.5% in the T3 group. When RI activities were measured with a well-type scintillation counter; every metastatic non-SLN was found to be situated in the same lymphatic basin as the SLNs.The SLN concept is applicable to patients with early gastric cancer (T1). SLN mapping is suitable for identifying the lymphatic basin in cases of gastric cancer. | 16531137 | [
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Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux. | Long-term outcome of antireflux operations as well as pre- and postoperative parameters able to predict their clinical results are still controversial. The aim of the present study was to evaluate long-term quality of life of patients undergoing open fundoplication for chronic GERD and to investigate pre- and early postoperative functional parameters possibly related to persistence or recurrence of symptoms.A cohort of 25 patients who underwent open Nissen fundoplications was reviewed for an evaluation of l | 16531138 | [
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Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux. | ong-term residual symptoms and quality of life at an average follow-up of more than 10 years. Clinical evaluation was performed by using a symptom-specific score (DeMeester's score); 3 health-related quality of life scores; a GERD-specific (GERD-HRQL score) score; and 2 generic scores (SF-36) evaluating physical and psychological well-being. Subjective satisfaction grade of the patients was also investigated. In addition; a univariate analysis is provided; according to the long-term presence or absence of r | 16531138 | [
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Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux. | esidual symptoms (120.6-month follow-up); taking into account pre- and postoperative (6-month follow-up) data of endoscopy; 24-hour pH monitoring; stationary manometry; and gastric-emptying test.Persistence or recurrence of GERD-specific symptoms (heartburn and regurgitation) were reported by 8 patients (32%); 2 patients (8%) were reoperated on for persistent dysphagia; whereas 17 patients (68%) were asymptomatic. GERD-HRQL and SF-36 scores displayed significant postoperative improvement; which continued in | 16531138 | [
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Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux. | long-term follow-up. Twenty patients (80%) had repeat fundoplication. Among tested parameters; only postoperative mean supine esophageal clearance and gastric emptying half-time; although on average improved significantly after the antireflux procedure; differed significantly in long-term asymptomatic and symptomatic subgroups. In long-term asymptomatic patients; postoperative (6 month) mean supine esophageal clearance was 0.8 +/- 0.3 minutes (P = .011) and 2.4 +/- 0.2 minutes in symptomatic patients. Post | 16531138 | [
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Quality of life and predictors of long-term outcome in patients undergoing open Nissen fundoplication for chronic gastroesophageal reflux. | operative (6 month) mean gastric emptying half-time of long-term asymptomatic patients was 93.3 +/- 8.9 minutes; whereas in symptomatic patients it was 127.5 +/- 14.3 minutes (P = .047).Patients undergoing Nissen fundoplication had a satisfactory long-term quality of life. Clinical results did not deteriorate over time and showed to be related to postoperative esophageal clearance and gastric emptying; which could be regarded as early postoperative predictors of long-term clinical outcome. | 16531138 | [
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Minimal postoperative pain using properitoneal nontension sutured repair of direct inguinal hernias. | Numerous repairs exist for direct inguinal hernias. These repairs are limited by the shortcomings of their respective technique. Reported recurrence rates for all currently employed hernia repairs for direct inguinal hernias range from 1% to 10%. With recurrence rates for nontension mesh repairs <2%; the evaluation of postoperative outcomes has shifted instead to that of pain and return to normal activities.We describe a novel inexpensive technique that employs the placement of conventional properitoneal te | 16531139 | [
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Minimal postoperative pain using properitoneal nontension sutured repair of direct inguinal hernias. | nsion-free mesh for repair of direct inguinal hernia. This technique; performed as day surgery with the patient under local anaesthetic; offers the beneficial aspects of contemporary mesh repair while avoiding its limitations.Three-year independent follow-up of 52 patients undergoing this repair demonstrated 1 (1.9%) early failure. Postoperative pain was measured using a visual analog pain scale (0 to 10) at 2 months (mean +/- SD; 1.39 +/- .58); 1 year (.37 +/- .27); 3 years (.58 +/- .40); at work (.59 +/- | 16531139 | [
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Minimal postoperative pain using properitoneal nontension sutured repair of direct inguinal hernias. | .33); and with recreational activity (.73 +/- .40). More than one third of patients had returned to work 1 week after surgery (37.8%) with 62.2% returning by 2 weeks and 100% by 6 weeks. Most significantly; 90.9% of patients had resumed full recreational activities by 8 weeks.In addition to providing minimal recurrence; these results of our technique demonstrate that this it provides less postoperative pain than has been reported in other nontension types of repair. Furthermore; use of this procedure result | 16531139 | [
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A 10-year single-institutional study of the biofragmentable anastomosis ring. | The biofragmentable anastomosis ring (BAR) was introduced by Hardy in 1985 as a simple alternative to sutured or stapled intestinal anastomosis.The aim of this study was to analyze complications related to the use of the BAR in elective intraperitoneal intestinal anastomosis to identify technical aspects important in the safe use of the device. The BAR was used by a single surgeon over a 10-year period. Three hundred fifty sequential intraperitoneal anastomoses were performed in 346 patients. There were 12 | 16531140 | [
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A 10-year single-institutional study of the biofragmentable anastomosis ring. | enteroenteric; 2 gastrojejunal; 199 enterocolic; and 137 colocolic anastomoses.There was 1 suture line recurrent carcinoma but no strictures. There were 11 complications that appeared related to construction of the anastomosis; 2 of them resulting in death. The 2 patients who died both had cirrhosis with ascites. Eight patients required re-exploration for suspected anastomotic complications. Six of them recovered and were discharged.The BAR appears to be a safe alternative to sutured or stapled bowel anasto | 16531140 | [
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A 10-year single-institutional study of the biofragmentable anastomosis ring. | mosis provided certain precautions are taken in its use. | 16531140 | [
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An evaluation of the American College of Surgeons' ultrasound education program. | Ultrasound has a wide variety of applications in surgery; but until recently few surgeons received any formal training in its use. To facilitate incorporation of ultrasound into surgical practice; the American College of Surgeons (ACoS) developed an ultrasound educational program. The purpose of this study was to evaluate the impact and effectiveness of the ACoS ultrasound education program.A survey was mailed to all surgeons who had completed at least one of several ultrasound courses offered by the ACoS f | 16531142 | [
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An evaluation of the American College of Surgeons' ultrasound education program. | rom 1998 to 2002.A total of 1;791 surveys were mailed out and 873 completed surveys were returned. Sixty-five percent (576) of respondents reported using ultrasound in their practices after these educational courses. Of those performing ultrasound examinations; 267 did so in one clinical area and 309 in more than one. The most common examination was breast (369 surgeons); vascular; acute/trauma; abdominal; intraoperative/laparoscopic; and head/neck were utilized fairly equally (100-200 surgeons). The number | 16531142 | [
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An evaluation of the American College of Surgeons' ultrasound education program. | of examinations performed by surgeons before they felt competent was between 11 and 20 and did not vary by the type of ultrasound examination. Of the 267 surgeons performing ultrasound in one clinical area; 176 performed ultrasound-guided procedures. Most surgeons had access to 2 ultrasound machines; but 386 (67%) were restricted from performing ultrasound in certain locations.The ACoS ultrasound courses are extremely popular and have contributed to the increasing use of ultrasound in surgical practice. Su | 16531142 | [
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An evaluation of the American College of Surgeons' ultrasound education program. | rgeons successfully use ultrasound in their practices including performance of ultrasound-guided procedures but are restricted from using ultrasound in certain patient care areas. Since many surgeons received prior and/or additional training outside of the ACoS; there is a need to facilitate export of ACoS courses to other venues and to focus on incorporating ultrasound training into surgical residency programs. | 16531142 | [
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Classifying patients suspected of appendicitis with regard to likelihood. | We sought to develop a clinical predictive model for acute appendicitis and contrast it with current clinical practice.A prospective observational study of patients presenting with signs or symptoms consistent with acute appendicitis. Random-partition modeling was used to develop an appendicitis likelihood model (ALM).Four hundred thirty-nine patients were enrolled; 101 with appendicitis; and 338 with other diagnoses. The ALM classified patients as "low likelihood" if they had a white blood cell count <9;50 | 16531143 | [
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Classifying patients suspected of appendicitis with regard to likelihood. | 0 and either no right lower-quadrant tenderness or a neutrophil count <54%. Patients were classified as "high likelihood" if they had a white blood cell count >13;000 with rebound tenderness or both voluntary guarding and neutrophil count >82%. The ALM outperformed actual clinical practice with regard to "missed" appendicitis; negative laparotomies; and total number of imaging studies.The ALM may permit more judicious use of advanced radiographic imaging with lower nontherapeutic laparotomy rates. | 16531143 | [
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The effect of heme oxygenase-1 induction by glutamine on radiation-induced intestinal damage: the effect of heme oxygenase-1 on radiation enteritis. | Radiation enteritis is a significant clinical problem in patients receiving ionizing radiation directed at the abdomen or pelvis. The small intestine is the most radiosensitive gastrointestinal organ. Myeloperoxidase (MPO) activity and malondialdehyde (MDA) levels of the small intestine were measured to determine the oxidative damage caused by radiation. In addition; caspase-3 activity of the small intestine was measured to define the degree of apoptosis. The present study was undertaken to investigate the | 16531144 | [
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The effect of heme oxygenase-1 induction by glutamine on radiation-induced intestinal damage: the effect of heme oxygenase-1 on radiation enteritis. | effect of glutamine administration on heme oxygenase-1 (HO-1) expression of the radiation enteritis model.Rats received 1 g/kg/d glutamine (HO-1-inducer) for 7 days before irradiation and continued for 3 days after irradiation. Zn-prothoporphyin (Zn-PP) 40 micromol/kg was delivered subcutaneously for 1 day before irradiation. Intestinal MPO activities and MDA levels are indicators of oxidative damage; whereas caspase-3 activities show the degree of apoptosis of the small intestine. At histopathologic examin | 16531144 | [
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The effect of heme oxygenase-1 induction by glutamine on radiation-induced intestinal damage: the effect of heme oxygenase-1 on radiation enteritis. | ation; terminal ileum tissue was analyzed for morphologic changes. Also; the nuclear factor-kappa (NF-kappa) expression level of the terminal ileum was determined with immunohistochemistry methods to show the mucosal inflammatory process.Irradiation significantly increased the intestinal MPO and caspase-3 activities; MDA levels; and HO-1 expression in comparison with the sham group. Glutamine treatment was associated with increased HO-1 expression; decreased MPO activity; caspase-3 activity; and MDA levels. | 16531144 | [
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The effect of heme oxygenase-1 induction by glutamine on radiation-induced intestinal damage: the effect of heme oxygenase-1 on radiation enteritis. | Inhibition of HO-1 activity by Zn-PP completely eliminated the protective effects of glutamine. Histopathologic examination showed that the intestinal mucosal structure was preserved in the glutamine-treated group. In the irradiation group; NF-kappaB overexpression was detected. NF-kappaB positivity was strongest in the intestine of animals in the radiation alone group and the Zn-PP-treated irradiation group.Glutamine appears to have protective effects against radiation-induced intestinal damage. This prot | 16531144 | [
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The effect of heme oxygenase-1 induction by glutamine on radiation-induced intestinal damage: the effect of heme oxygenase-1 on radiation enteritis. | ective effect is mediated in part by the induction of HO-1 activity because inhibition of Zn-PP resulted in the complete abolishment of the protective effect of glutamine. | 16531144 | [
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Inosine reduces microcirculatory disturbance and inflammatory organ damage in experimental acute pancreatitis in rats. | Despite improvement in the management of severe necrotizing pancreatitis; mortality remains high. Today; no specific treatment exists. Inflammatory cascades and microcirculatory disturbances play a key role in the pathogenesis of acute pancreatitis. The aim of the present study was to evaluate the effects of inosine; an immunomodulatory substance; on the severity of experimental necrotizing pancreatitis.Severe necrotizing pancreatitis was induced in rats. Treatment groups received inosine either prophylacti | 16531145 | [
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Inosine reduces microcirculatory disturbance and inflammatory organ damage in experimental acute pancreatitis in rats. | cally or therapeutically. Pancreatic injury was evaluated by microcirculatory assessment and histology.Prophylactic inosine significantly attenuated pancreatic microcirculatory disturbances and morphologic injury in necrotizing pancreatitis. However; inosine treatment did not have any beneficial effects when applied therapeutically several hours after onset of the disease.Prophylactic inosine reduces microcirculatory and pancreatic injury in acute necrotizing pancreatitis. These effects should be assessed i | 16531145 | [
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Inosine reduces microcirculatory disturbance and inflammatory organ damage in experimental acute pancreatitis in rats. | n the clinical setting of ERCP and pancreas transplantation. | 16531145 | [
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Colon cancer and apoptosis. | The implementation of new therapeutic options for the management of metastatic colon cancer mandates a revisit to apoptosis and its role in colon cancer tumorigenesis with an emphasis on the mechanisms leading to chemotherapeutic resistance and immune system evasion of colon cancer cells.Literature regarding molecular apoptosis mechanisms and the role of apoptosis in colon cancer progression are reviewed by this article.Programmed cell death has rapidly emerged as a potential target for cancer treatment at | 16531147 | [
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Colon cancer and apoptosis. | various stages of tumor progression. Chemoprevention; immuno-regulation; and metastasis are prospective targets by which apoptotic mechanisms could be utilized in the prevention and management of tumorigenesis. Understanding how defects in the death receptor pathway of apoptosis permit colon cancer cells to escape the immune system would allow for treatment options whereby the body's immune system could again recognize and eliminate unwanted cells. | 16531147 | [
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Double pylorus. | Double pylorus is a rare abnormality and it occurs most commonly secondary to chronic peptic ulcer disease. It is usually treated conservatively with anti-ulcer therapy. However; refractory cases may require surgery. | 16531146 | [
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Work-hour restrictions as an ethical dilemma for residents. | We propose that the standardized work-hour limitations have created an ethical dilemma for residents.A survey tool was designed to assess factors that influence the number of hours residents work and report. The program directors of pediatrics; internal medicine; and general surgery at our institution supported their residents' participation. A voluntary; anonymous survey of these residents was performed.One hundred seventy of 265 eligible residents were surveyed. Eighty-one percent of residents surveyed re | 16531148 | [
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Work-hour restrictions as an ethical dilemma for residents. | sponded. Eighty percent of respondents reported exceeding work-hour restrictions at least once within the past 6 months. The factor of greatest influence measured was concern for patient care (80%). Forty-nine percent of respondents admitted underreporting their work hours.The Accreditation Council for Graduate Medical Education work-hour restrictions have created an ethical dilemma for residents. Our data show that a significant number of residents feel compelled to exceed work-hour regulations and report | 16531148 | [
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Educational scholarship as a route to academic promotion: a depiction of surgical education scholars. | Education is the central component of academic medicine. Historically; academic promotion has favored clinician-investigators over clinician-educators. However; there are increasing numbers of individuals pursuing education scholarship as their academic focus. This study sought to describe these individuals and their experiences with academic promotion.A cross-sectional survey of surgical educators was undertaken; eliciting demographic data and attitudes toward educational efforts and promotion.Advanced aca | 16531149 | [
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Educational scholarship as a route to academic promotion: a depiction of surgical education scholars. | demic rank was associated with male gender; age; publication on education topics; funding for research in education; recipient of teaching awards; and status as officer in an education association.Educational scholarship is a viable pathway for academic promotion when sentinel components are included. | 16531149 | [
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Telepathy: maximizing resident exposure to surgical pathology decision making. | General surgery residents are often not present for the critical intraoperative discussion between surgeon and pathologist regarding surgical pathology findings.A prospective pilot study analyzed general surgery resident exposure to surgical pathology. Thereafter; an operating room was equipped to view frozen section images in real time and verbally communicate with the pathologist (TelePATHy). Total operative cases; cases using frozen sections; and use of TelePATHy were recorded.Most residents (78%) report | 16531150 | [
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Telepathy: maximizing resident exposure to surgical pathology decision making. | ed they were exposed to frozen-section surgical pathology < or =10% of the time. Overall; 202 operations were performed over the 123-day period. Forty-four cases had frozen-section specimens. General surgery residents were present for 40 cases. TelePATHy was successfully used in 32 cases (80%).General surgery resident exposure to intraoperative pathology findings increased from a reported < or =10% to an observed 80%. TelePATHy is a novel intraoperative tool capable of maximizing the intraoperative experien | 16531150 | [
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Laparoscopy as an educational and recruiting tool. | General surgeons can supplement traditional gross anatomy instruction by using laparoscopy to provide clinical correlations. Early; positive interaction with surgeons may stimulate student interest in this field.Basic laparoscopy was performed on fresh cadavers for first year medical students in gross anatomy over 2 consecutive years. Surgical residents reviewed anatomy of the abdomen; and students manipulated intra-abdominal organs using laparoscopic instruments. Students completed pre- and post-demonstrat | 16531151 | [
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Laparoscopy as an educational and recruiting tool. | ion questionnaires that were compared independently.More than 95% of responding students agreed the demonstration enhanced their understanding of abdominal anatomy. Regardless of planned area of specialization; students felt the demonstration reinforced the clinical relevance of gross anatomy. Among students already anticipating surgical careers; 88.2% said the demonstration increased their interest in general surgery; this was significantly higher than among those intending careers in internal medicine (27 | 16531151 | [
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Laparoscopy as an educational and recruiting tool. | .3%) or other fields (23.5%; P < .0001).Cadaver-based laparoscopy demonstrations by general surgeons supplement didactic sessions and enhance learning in gross anatomy. Furthermore; such demonstrations may stimulate student interest in general surgery at an early point in their medical education; particularly in those already interested in a surgical career. | 16531151 | [
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A novel technique to facilitate laparoscopic repair of large paraesophageal hernias. | Laparoscopic repair of large paraesophageal hernias (LPEH) is technically challenging; and requires advanced laparoscopic skills. We have developed a novel technique for facilitating laparoscopic repair of LPEHs safely and easily; using a Nelaton catheter.Seven patients with LPEHs were operated on through a laparoscopic approach. During surgery; the left lobe of the liver and right diaphragmatic crus were elevated using a suspended thread covered by a Nelaton catheter.All patients were operated on laparosco | 16531152 | [
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A novel technique to facilitate laparoscopic repair of large paraesophageal hernias. | pically using this technique. No patient required conversion to open method. The median operating time was 205 minutes and the range was from 155 to 295 minutes. No intraoperative or early complications occurred in any patient. Late complications occurred in 2 patients due to a small sliding hernia: a slipped fundoplication in 1 patient; and a gastric ulcer in the other.In conclusion; laparoscopic repair of LPEH is a challenging procedure that requires wide experience in laparoscopic gastroesophageal surger | 16531152 | [
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A novel technique to facilitate laparoscopic repair of large paraesophageal hernias. | y. Further refinement for this operation may be necessary. | 16531152 | [
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Laparoscopic central pancreatectomy. | The role of mini-invasive surgery in pancreatic surgery is still being debated. Indications and results are still controversial. Only a few centers in the world report on laparoscopic pancreatic resections. With the aim of improving the use of minimally invasive surgery; we have devised a novel laparoscopic procedure for surgical treatment of neuroendocrine tumor of the neck of the pancreas.A central laparoscopic pancreatic resection was successfully performed. The pancreatic resection was performed using t | 16531153 | [
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Laparoscopic central pancreatectomy. | he harmonic scalpel. The duct was isolated and transected. The proximal duct stump was closed by an endoscopic stitch. The pancreaticojejunostomy was intracorporeally performed using a Roux-en-Y loop.Histologic findings showed a well differentiated neuroendocrine tumor. Operating time was 330 minutes and blood loss 300 mL. The postoperative course was uneventful.Laparoscopic central pancreatectomy is a feasible and safe procedure. The minimally invasive approach ensures an adequate treatment despite requiri | 16531153 | [
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Laparoscopic central pancreatectomy. | ng the expertise of highly skilled laparoscopic surgeons. | 16531153 | [
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Intraoperative intraductal injection of methylene blue dye to assist in major duct excision. | Nipple discharge is not uncommon in women during their reproductive years. The etiology is benign in the majority of cases. Patients presenting with nipple discharge often require major duct excision (MDE) for accurate diagnosis and treatment. MDE is enhanced by the use of intraoperative injection of methylene blue dye into the discharging duct in order to aid visualization. Methylene blue dye-enhanced MDE has several advantages over traditional techniques. Methylene blue dye staining identifies the major d | 16531154 | [
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Intraoperative intraductal injection of methylene blue dye to assist in major duct excision. | ischarging duct; as well as its side branches; which allows the surgeon to resect that specific ductal system only. This method allows neighboring major ducts to remain intact; preserving nipple function and permitting future cancer detection. Methylene blue-enhanced MDE allows the surgeon to more accurately determine the precise location and volume of tissue that needs to be excised. Lastly; methylene blue is both safe and inexpensive. | 16531154 | [
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Robot-assisted laparoscopic hysterectomy: technique and initial experience. | Our study objective was to develop a technique for robot-assisted laparoscopic hysterectomy and to evaluate feasibility of the technology to address the technical limitations of conventional laparoscopy.The study design was a case series analysis in a university hospital. Sixteen consecutive patients underwent robot-assisted laparoscopic hysterectomy and were assessed for outcomes. Robot-assisted hysterectomy technique was refined and is described.There were no conversions to laparotomy. The mean uterine we | 16531155 | [
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Robot-assisted laparoscopic hysterectomy: technique and initial experience. | ight was 131.5 g (range 30 to 327 g). Median operating time was 242 minutes (range 170 to 432). Average estimated blood loss was 96 mL (range 50 to 300 mL). One patient experienced a delayed thermal bowel injury; 2 developed postoperative infections; and 1 developed a vaginal cuff hematoma that was managed expectantly. The median length of hospital stay was 1.5 days.Robot-assisted laparoscopic hysterectomy is a feasible and promising new technique that may overcome surgical limitations seen with conventiona | 16531155 | [
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Robot-assisted laparoscopic hysterectomy: technique and initial experience. | l laparoscopy. | 16531155 | [
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Alphanumeric paging in an academic hospital setting. | To determine whether implementation of an alphanumeric-paging system would improve physician work environment.Surveys were distributed to all general surgery residents; faculty; and nurses before and after implementation of an alphanumeric-paging system. Housestaff also kept a detailed log of paging activity before and after the intervention.User satisfaction with the paging system was measured using a Likert format survey. Interruptions to patient care and pages requiring a call back were tracked using pag | 16531156 | [
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Alphanumeric paging in an academic hospital setting. | ing logs.Physician perceptions of the capability of text paging before the intervention were high and did not differ significantly postintervention. For nursing staff; postintervention perceptions of the text-paging system were significantly more positive than preintervention; especially with regard to perceived improvements in patient care (54.1% versus 81.6%; P < .05). Residents' paging logs reflected significantly decreased interruptions to patient care after the intervention (28.2% versus 46.9%; P < .05 | 16531156 | [
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Alphanumeric paging in an academic hospital setting. | ); with less pages requiring a call back (100% versus 73.6%; P < .05).Study participants rated the alphanumeric-paging system highly. Text-paging technology has the potential to reduce interruptions in patient care and improve physician work efficiency and satisfaction. | 16531156 | [
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With regards to optimal closure method of five-millimeter trocar sites. Am J Surg 2004;187:24-7. | nan | 16531157 | [
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Validation of aggressive surgical approach to intestinal typhoid perforation: a "new" and useful physical sign for peritonitis. | nan | 16531158 | [
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New recommendations for the periodic well-woman visit: impact on counseling. | Since 2000; the recommendations for women's health care have undergone considerable changes that have prompted a modification in terminology from the "annual examination" to the "periodic well-woman visit." A pelvic examination is not required before prescribing hormonal contraception; selected women 30 years or older may receive less frequent cytological testing and teaching breast self-examination is no longer recommended unless the patient requests it. Counseling will be needed to reassure women that the | 16531159 | [
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New recommendations for the periodic well-woman visit: impact on counseling. | se changes are based on sound scientific evidence. The periodic well-woman visit provides an opportunity for ongoing contraceptive counseling. The expanding array of contraceptive choices necessitates counseling that focuses on methods that are most appropriate for the individual. In addition to the changes in screening recommendations; increased utilization of ancillary staff; self-administered questionnaires and other time-saving strategies to gather information before the patient sees the health care pro | 16531159 | [
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New recommendations for the periodic well-woman visit: impact on counseling. | vider can increase the time available for counseling within the time constraints of an office visit. | 16531159 | [
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Management and localization strategies for the nonpalpable Implanon rod. | The goal of this paper is to review the imaging methods required for localizing nonpalpable Implanontrade mark.Different localization methods for nonpalpable Implanon rods are summarized; and clinical guidance is provided as to how best to localize such implants.In the great majority of cases; optimal visualization of the single-rod Implanon rod is obtained with ultrasound using a high-resolution linear array transducer (10-15 MHz). An implant located just under the skin; under the fascia muscularis or one | 16531160 | [
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Management and localization strategies for the nonpalpable Implanon rod. | located deep in the muscle can most often be localized with ultrasound. In rare cases where ultrasound does not definitively locate the implant; magnetic resonance imaging is usually the next best choice. Measurements of serum etonogestrel levels may be necessary to confirm the presence or absence of the implant when it cannot be visualized by either of the two imaging methods.Close clinical coordination between women's health care providers and radiologists is required to minimize or prevent removal compli | 16531160 | [
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Management and localization strategies for the nonpalpable Implanon rod. | cations and to facilitate subsequent contraceptive management of the patient. | 16531160 | [
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Use of exogenous hormones by women and lung cancer: evidence from the Royal College of General Practitioners' Oral Contraception Study. | The objective of this study was to assess the risk of lung cancer among women who have used oral contraception or hormone replacement therapy (HRT); especially those exposed to both classes of exogenous hormones.This study is a nested case-control one using prospectively collected data from the Royal College of General Practitioners' Oral Contraception Study (OCS). The 162 case patients were women with a diagnosis of lung cancer recorded on the OCS database by August 2004. Each case patient was matched with | 16531161 | [
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Use of exogenous hormones by women and lung cancer: evidence from the Royal College of General Practitioners' Oral Contraception Study. | 3 control subjects who were free of the disease at the time of the case patient's diagnosis; of similar age and with similar length of follow-up in the OCS.Compared with never use; current use of oral contraception was associated with a statistically nonsignificant reduced risk of lung cancer; with an adjusted odds ratio (OR) of 0.47 and a 95% confidence interval (CI) of 0.08-2.95 (OR=0.86 and 95% CI=0.50-1.48 for former use; OR=0.84 and 95% CI=0.49-1.43 for ever use). Similar comparisons for HRT were curr | 16531161 | [
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Use of exogenous hormones by women and lung cancer: evidence from the Royal College of General Practitioners' Oral Contraception Study. | ent use (OR=1.21; 95% CI=0.23-6.37); former use (OR=0.62; 95% CI=0.23-1.68) and ever use (OR=0.71; 95% CI=0.28-1.78). The OR among women who had used both classes of hormones was 0.53 (95% CI=0.16-1.72); as compared with those who had used neither.Our results are compatible with findings from other studies that suggest that oral contraceptives may reduce the risk of lung cancer. Evidence for a beneficial effect of HRT is less convincing. Further study is needed to determine how long any benefit lasts and wh | 16531161 | [
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Use of exogenous hormones by women and lung cancer: evidence from the Royal College of General Practitioners' Oral Contraception Study. | ether it is stronger in women exposed to both classes of exogenous hormones. The small number of events occurring in this very large cohort; however; shows that any public health benefit is likely to be marginal. | 16531161 | [
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A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 microg ethinyl estradiol and a reference containing desogestrel and 30 microg ethinyl estradiol. | In this open-label; randomized study; we assessed the effects on hemostasis of two combined oral contraceptives containing drospirenone (DRSP) as progestogen component.Three milligrams of DRSP; a progestogen with antimineralocorticoid activity; was combined with either 30 or 20 microg ethinyl estradiol (EE) (DRSP/30EE; DRSP/20EE) and compared with a preparation containing 150 microg desogestrel (DSG) and 30 microg ethinyl estradiol (DSG/30EE). A total of 75 healthy female volunteers aged 18-35 years were en | 16531162 | [
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A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 microg ethinyl estradiol and a reference containing desogestrel and 30 microg ethinyl estradiol. | rolled. The hemostasis variables were measured in the medication-free precycle (baseline); in the first; third and sixth treatment cycle; and in the follow-up phase. The target variables for comparison were the relative changes from baseline to Cycle 6.Data of 25 volunteers in each group were valid for the per-protocol evaluation. Most changes in hemostasis variables were similar in the three treatment groups. All procoagulatory variables and the anticoagulatory variable protein C antigen increased slightly | 16531162 | [
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A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 microg ethinyl estradiol and a reference containing desogestrel and 30 microg ethinyl estradiol. | ; while protein S antigen and activity decreased. For fibrinogen and protein S activity; the changes were statistically significant: less pronounced with DRSP/20EE compared to DSG/30EE at Cycle 6. There were no statistically significant differences in the changes of antifibrinolytic variables; the global clotting tests and D-dimer. All pairwise comparisons of DRSP/30EE vs. DSG/30EE yielded nonsignificant results; however; there was a trend of a lower impact of DRSP/20EE on nearly all hemostatic parameters c | 16531162 | [
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A prospective study on the effects on hemostasis of two oral contraceptives containing drospirenone in combination with either 30 or 20 microg ethinyl estradiol and a reference containing desogestrel and 30 microg ethinyl estradiol. | ompared to the 30EE products. All three study treatments were safe and well tolerated by the volunteers and provided adequate contraceptive reliability.The changes in the hemostatic variables for DRSP/20EE were less pronounced compared to DSG/30EE and DRSP/30EE. The results were in accordance with previous reports on effects of similar OCs. | 16531162 | [
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Effects of two different oral contraceptives on homocysteine metabolism in women with polycystic ovary syndrome. | This study was conducted to evaluate the effects of two different oral contraceptives (OCs) on homocysteine (Hcy) metabolism in 20 women with polycystic ovary syndrome (PCOS).Women were randomly allocated to receive either the biphasic OC containing 40/30 mug ethynylestradiol (EE)+25/125 mug desogestrel (DSG; n=10) or the monophasic OC containing 35 mug EE and 2 mg cyproterone acetate (CPA; n=10). Investigations were performed before and after 6 months of treatment. Fasting vitamin B(12); folate; Hcy and in | 16531164 | [
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Effects of two different oral contraceptives on homocysteine metabolism in women with polycystic ovary syndrome. | sulin sensitivity (SI); and glucose utilization independent of insulin (Sg); by the minimal model method; were evaluated.Folate and vitamin B(12) were not significantly modified by either OC. EE/DSG decreased SI (2.53+/-0.35 vs. 1.68+/-0.45; p<.05); without modifying Hcy (9.54+/-0.7 micromol/L vs. 9.18+/-0.6 micromol/L). EE/CPA improved SI (1.47+/-0.38 vs. 3.27+/-0.48; p<.04) and decreased Hcy (9.8+/-1.9 micromol/L vs. 7.9+/-0.9 micromol/L; p<.05). This study indicates that in women with PCOS; EE/CPA; but n | 16531164 | [
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Effects of two different oral contraceptives on homocysteine metabolism in women with polycystic ovary syndrome. | ot EE/DSG; improves IS and decreases fasting Hcy. | 16531164 | [
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Effects of two different oral contraceptives on total body water: a randomized study. | This open-label; randomized study evaluated the effect of two different oral contraceptives on body weight and composition during one cycle of treatment.Eighty women (mean age; 24.6 years) were randomized into three groups and given one of the following contraceptive methods: ethinylestradiol 15 mug/gestodene 60 mug (EE/GST; n=25); ethinylestradiol 30 mug/drospirenone 3 mg (EE/DRS; n=29) or male condom (control group; n=26). Bioelectric impedance analysis (BIA) was carried out on the first; 10th and 21st da | 16531163 | [
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Effects of two different oral contraceptives on total body water: a randomized study. | ys during the use of oral contraceptives or in the menstrual cycle (control group); and total body water (TBW); fat mass (FM) and fat-free mass (FFM) were measured.No significant variations in TBW; FM or FFM were observed in the three groups during the cycle. Intergroup analysis showed no differences in TBW or FM; however; users of EE/GST showed a statistically significant increase in FFM compared to the control group.The different doses of ethinylestradiol associated with gestodene or drospirenone showed n | 16531163 | [
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Effects of two different oral contraceptives on total body water: a randomized study. | o statistically significant effects on TBW or FM during one cycle of observation. | 16531163 | [
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Actinomyces in cervical smears of women using the intrauterine device in Singapore. | Reproductive tract actinomyces have been associated with the use of intrauterine contraceptive device (IUCD). Thus; there is a need to evaluate the prevalence of colonization with Actinomyces israelii in a cohort of Singaporean women using an IUCD. Second; the occurrence of actinomycosis in colonized women and the clinical need to remove the IUCD and/or possibly the need to treat asymptomatic carriers with antibiotics were evaluated.The study population consisted of 1;108 IUCD users attending the Fertility | 16531165 | [
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Actinomyces in cervical smears of women using the intrauterine device in Singapore. | Control Clinic; National University Hospital; Singapore.In our study; the prevalence of actinomyces-positive cervical smears among IUCD users was 13.7%; the incidence of actinomyces-positive smears was similar with Copper T (34.2%); Multiload (32.9%) and Nova T (32.9%) IUCDs. We found no association with the duration of use of IUCD and actinomyces infection. In our study; 150 out of 152 (98.7%) IUCD users with actinomyces-positive smears were asymptomatic; and only 2 out of 152 (1.3%) who had actinomyces-po | 16531165 | [
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Actinomyces in cervical smears of women using the intrauterine device in Singapore. | sitive cervical smears developed pelvic inflammatory disease at 6 months.Our study suggests that removal of the IUCD in asymptomatic women with actinomyces-positive cervical smear is not necessary. Moreover; we suggest that asymptomatic carriers of actinomyces do not require preemptive antibiotic treatment. | 16531165 | [
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Ten years of experience with Norplant implantation in southern Thailand. | This study investigated clinical and contraceptive characteristics of a group of southern Thai women who had two consecutive Norplant implantations at Songklanagarind Hospital.Seventy reinsertions were performed from 251 original Norplant implantations during the years 1986-1996. Four women had an exposed capsule within 3 months after reinsertion; and two of them subsequently had to have the capsule removed due to infection.Following implantation; the recipients had gradually increased body mass index and s | 16531166 | [
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Ten years of experience with Norplant implantation in southern Thailand. | ystolic blood pressure; which returned to baseline 6 months after discontinuance after 10 years of implantation. Long-term continuation rates were 76.7% and 74.0% at the end of the first and second 5-year periods; respectively.The failure rate was 1.8% during the second period compared to 1.1% during the first period. | 16531166 | [
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Long-term evaluation of lipid profile and oral glucose tolerance test in Norplant users. | This study reports the results of the lipid profile and oral glucose tolerance test (OGTT) in 46 normal patients tested before and after 5 years of Norplant use.After 5 years; there was a substantial decrease of 28.9% in high-density lipoprotein cholesterol levels and a similar but less pronounced fall of 7.1% in the total cholesterol levels. The Castelli 1 index did not vary; and the triglycerides and low-density lipoprotein cholesterol levels remained normal and unchanged throughout the study period. All | 16531167 | [
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Long-term evaluation of lipid profile and oral glucose tolerance test in Norplant users. | the mean values of OGTT were significantly lower after 5 years; except for the 90-min glycemia.These findings indicate that long-term Norplant use does not increase cardiovascular risks. | 16531167 | [
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Transition from Norplant to Jadelle in a clinic with extensive experience providing contraceptive implants. | The purpose of this study was to understand the transition process from providing Norplant; the six-capsule first contraceptive implant system; to providing Jadelle; the two-rod second-generation system; in a clinical setting with extensive experience providing Norplant implants.Two hundred forty-nine women requesting contraceptive implants from the PROFAMILIA clinic (Santo Domingo; Dominican Republic) were provided with information regarding the differences and similarities between the two implant systems | 16531168 | [
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Transition from Norplant to Jadelle in a clinic with extensive experience providing contraceptive implants. | being studied; including the easier insertion and removal procedures and the possible shorter use life associated with Jadelle. A questionnaire evaluating their preference and the reason why they chose either system was provided. The health care providers' opinions about the two systems were also studied.Fifty-three percent of the women preferred Jadelle over Norplant. The main reason behind their preference for Jadelle was its reduced number of implants with easier insertion and removal and less visibility | 16531168 | [
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Transition from Norplant to Jadelle in a clinic with extensive experience providing contraceptive implants. | in the arm; whereas that for Norplant was greater familiarity. Providers overwhelmingly preferred Jadelle. A 1-h presentation was sufficient training for providers experienced with Norplant. None had any problem with the management of Jadelle.The inclusion of Jadelle in a clinic with extensive experience with Norplant was easy and uneventful; but both methods should be available during a transition period of several months while confidence in the new method is being acquired by the community. | 16531168 | [
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Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. | The study objectives were to compare the effects of an etonogestrel-releasing implant (Implanon) and a nonmedicated intrauterine device (IUD) on parameters of lactation in breast-feeding women and on the growth of their breast-fed infants over a 3-year period. Healthy lactating women (28-56 days postpartum) chose either the implant (n=42) or the IUD (n=38). Infant growth during a 3-year follow-up period is reported here. Total duration of breast-feeding coinciding with the mothers' treatment was 421.0 and 4 | 16531169 | [
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Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. | 23.4 days in the Implanon and IUD groups; respectively. There were no differences between the infant groups in terms of body length; biparietal head circumference and body weight. No abnormalities were reported in psychomotor development or during physical examination. No treatment-related side effects were observed in either group. In conclusion; there were no differences in the growth of breast-fed infants of women treated with Implanon or a nonmedicated IUD. Implanon; therefore; appears to be a safe cont | 16531169 | [
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Effects of the etonogestrel-releasing implant Implanon and a nonmedicated intrauterine device on the growth of breast-fed infants. | raceptive option for breast-feeding women and their infants. | 16531169 | [
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Over-the-internet availability of hormonal contraceptives regardless of risk factors. | The purpose of this study is to measure the accessibility to purchase oral and transdermal contraceptives over the Internet for low- and high-risk individuals.The Internet was used to search for and order both oral and transdermal contraceptives. Using the "Google" search engine to locate online pharmacies by entering the term "purchase contraception;" we proceeded to purchase either oral contraceptives or contraceptive patches without a prescription. We first posed as a healthy 25-year-old woman; then as a | 16531170 | [
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Over-the-internet availability of hormonal contraceptives regardless of risk factors. | 35-year-old woman who was obese and a heavy tobacco user; and finally; as a 35-year-old smoker on an antihypertensive medication.Our attempts to order both combination oral contraceptives; as well as contraceptive patches; over the Internet without a prescription were successful for all three risk profiles. We ordered from three different Web sites; two within the United States and one international site. The two U.S. Web sites required us to complete a medical questionnaire to obtain a prescription from t | 16531170 | [
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Over-the-internet availability of hormonal contraceptives regardless of risk factors. | he site provider; but the foreign site had no questionnaire or risk information posted on the Web site. Despite entering known risk factors for estrogen use; we received all the medications. There was no medical follow-up to these sales except for offers to sell more products.Both oral and transdermal contraceptives are easy to obtain over the Internet without a physical appointment with a health care provider to obtain a prescription. | 16531170 | [
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Bleeding patterns after use of levonorgestrel emergency contraceptive pills. | The objective of this study was to describe bleeding after use of an emergency contraceptive pill (ECP) regimen consisting of 1.5 mg of levonorgestrel in a single dose.We asked 120 women who had been treated with the regimen to keep daily bleeding diaries for 9 weeks. We compared bleeding patterns observed after treatment with usual patterns reported by the participants and with patterns observed in a prior study on women who had not taken ECPs.Treatment in the first 3 weeks of the menstrual cycle significa | 16531171 | [
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Bleeding patterns after use of levonorgestrel emergency contraceptive pills. | ntly shortened that cycle as compared both with the usual cycle length and with the cycle duration in a comparison group. The magnitude of this effect was greater the earlier the pills were taken. In contrast; the duration of the first menstrual period after treatment increased significantly with cycle week of treatment and was longer in women who used the treatment than in those who did not. Intermenstrual bleeding occurred in only 5% of women in the first cycle after treatment.The effect of the single-dos | 16531171 | [
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Bleeding patterns after use of levonorgestrel emergency contraceptive pills. | e levonorgestrel ECP regimen on the timing and duration of the next menstrual period depends on when during the cycle the pills are taken. Intermenstrual bleeding following treatment is uncommon. | 16531171 | [
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Availability of emergency contraception at rural and urban pharmacies in Pennsylvania. | Pharmacy availability of emergency contraception (EC) is necessary for timely access to this important contraceptive method. This is especially important in rural areas where pharmacies are fewer and further apart.This study was conducted using a telephone survey of 186 pharmacies located in the northeast region of Pennsylvania.Only 32% of the pharmacies had EC in stock; which did not differ by rural or urban location. Pharmacies that stocked EC in rural counties were less likely to have evening store hours | 16531172 | [
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