<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_459"
                     title="Murtha Dead at 77"
                     score="0.015"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18388?impressionId=1265747584484"
                     
      &lt;p&gt;Representative John P. Murtha (D-Pa.), 77, long-time chairman of the House Appropriations Subcommittee on Defense, died yesterday afternoon from complications following a planned laparoscopic cholecystectomy, according to a statement from the congressman&apos;s office.&lt;/p&gt;
&lt;p&gt;He had been admitted to the intensive care unit at Virginia Hospital Center in Arlington on Jan. 31, days after surgeons at the National Naval Medical Center in Bethesda, Md., accidentally nicked his intestine during the operation, according to a report in &lt;em&gt;The Washington Post&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;In that same report, Rep. Bob Brady (D-Pa.), a close friend of Murtha&apos;s, said the congressman developed an infection and fever.&lt;/p&gt;
&lt;p&gt;Citing a request for privacy from the Murtha family and patient privacy laws, a spokesperson for the National Naval Medical Center declined to provide information on the operation.&lt;/p&gt;
&lt;p&gt;In a statement, Virginia Hospital Center said Murtha died &quot;despite aggressive critical care interventions.&quot;&lt;/p&gt;
&lt;p&gt;According to the American College of Surgeons, risks of laparoscopic cholecystectomy include bleeding, infection, injury to the bile duct, liver injury, numbness, hernia at the incision site, anesthesia complications, and puncture of the intestine.&lt;/p&gt;
&lt;p&gt;Death is extremely rare in healthy individuals, occurring in no more than one per 1,000 patients, according to the college.&lt;/p&gt;
&lt;p&gt;A 2009 Cochrane Review comparing laparoscopic versus open cholecystectomy for patients with symptomatic cholecystolithiasis found no difference in mortality in 38 trials. No patients died in the laparoscopic group and only 0.09% died in the open group.&lt;/p&gt;
&lt;p&gt;Severe complications were reported in 2.2% of the laparoscopic patients and 6.8% of the open patients.&lt;/p&gt;
&lt;p&gt;Murtha had recently become the longest serving member of Congress in Pennsylvania state history.&lt;/p&gt;
&lt;p&gt;First elected in 1974, Murtha, a former Marine, was the first Vietnam War combat veteran to serve in Congress, and he served as an advocate for the military throughout his career. He was also a prominent critic of the Iraq War.&lt;/p&gt;
&lt;p&gt;Murtha is survived by his wife, Joyce, and three children.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_402"
                     title="Minimally Invasive Surgery Takes Toll on MDs, Poll Shows (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18306?impressionId=1265747584484"
                     
      &lt;p&gt;Four out of five surgeons agree: Laparoscopic procedures cause substantial discomfort and pain for the surgeons who perform them.&lt;/p&gt;
&lt;p&gt;More than 80% of surgeons completing an online questionnaire reported pain or stiffness in the hands, neck, back, or legs after performing minimally invasive surgeries, according to Adrian Park, MD, of the University of Maryland Medical Center in Baltimore, and colleagues.&lt;/p&gt;
&lt;p&gt;For most symptoms, the strongest predictor was high case volume, the researchers reported online in the &lt;em&gt;Journal of the American College of Surgeons&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Park and colleagues warned of &quot;an impending epidemic&quot; of occupational injuries among clinicians specializing in minimally invasive surgeries, as such procedures become more common.&lt;/p&gt;
&lt;p&gt;&quot;Now, especially in the face of an impending shortage of general surgeons in the U.S., the last thing that we as a society can afford is surgical careers shortened by occupationally related symptoms and conditions,&quot; they asserted.&lt;/p&gt;
&lt;p&gt;The researchers recommended more research into the ergonomics of laparoscopic surgery, as well as better implementation of existing guidelines meant to reduce injuries associated with the awkward postures and long surgical times often required with these procedures.&lt;/p&gt;
&lt;p&gt;&quot;That research must more clearly and emphatically define the ergonomic impact of minimally invasive surgery on the practicing surgeon (then set about improving it) is now all too painfully clear,&quot; Park and colleagues concluded.&lt;/p&gt;
&lt;p&gt;The researchers invited some 2,000 board-certified members of the Society of American Gastrointestinal and Endoscopic Surgeons (of which Park is currently secretary) to complete the online survey.&lt;/p&gt;
&lt;p&gt;The response rate was 14.4%, with 317 surgeons identified as actively and regularly involved in laparoscopic practices participating.&lt;/p&gt;
&lt;p&gt;Of these, 272 reported experiencing physical symptoms or discomfort that they believed were the result of performing minimally invasive procedures.&lt;/p&gt;
&lt;p&gt;This rate of reported symptoms is markedly higher than that found in earlier studies and surveys, in which the prevalences were in the range of 15% to 60%, Park and colleagues noted.&lt;/p&gt;
&lt;p&gt;They speculated that the current survey, as the most recent, may better reflect the accumulation of injuries over time as surgeons&apos; careers doing minimally invasive surgery have grown longer.&lt;/p&gt;
&lt;p&gt;Fortunately, they found, symptoms were generally not persistent. Only 10.8% of respondents indicated that pain or discomfort continued beyond the immediate aftermath of surgery.&lt;/p&gt;
&lt;p&gt;The largest class of symptoms were those occurring during surgery, with 20.8% of surgeons saying they had symptoms only during procedures and 27.8% reporting symptoms both during and immediately after surgery.&lt;/p&gt;
&lt;p&gt;Another 22.4% indicated that symptoms occurred only immediately after surgery and not persistently.&lt;/p&gt;
&lt;p&gt;About 15% chose &quot;nothing bothers me&quot; in the questionnaire.&lt;/p&gt;
&lt;p&gt;Age appeared to be a factor in the incidence of some complaints, although the pattern was not what might be expected. In particular, hand pain was most common among surgeons younger than 40 and in those older than 60, whereas it was least frequent among surgeons in their 50s.&lt;/p&gt;
&lt;p&gt;Park and colleagues did not report specific hazard ratios or correlation coefficients for case volume as a predictor of symptoms, but they indicated that it was associated with complaints more strongly than other factors such as age, career duration, gender, and height.&lt;/p&gt;
&lt;p&gt;About three-quarters of respondents attributed symptoms to instrument design. Some 40% indicated that operating room table setup and the display monitor location were also contributing factors.&lt;/p&gt;
&lt;p&gt;On the other hand, more than 180 respondents said they had slight or no awareness of published recommendations on surgical ergonomics, such as guidelines published last year in the journal &lt;em&gt;Surgical Endoscopy&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Among those reporting any level of knowledge about the guidelines, only 60% indicated that they had applied it in their practices, Park and colleagues indicated. But more than 90% of surgeons who said they had high awareness of ergonomic guidelines reported putting it to use.&lt;/p&gt;
&lt;p&gt;The researchers said future studies should address other issues not covered adequately in the survey, such as the effects of different monitor positions and instrument designs, as well as whether surgeon discomfort during laparoscopic surgery leads to adverse patient outcomes.&lt;/p&gt;
&lt;p&gt;Park and colleagues also suggested that similar research be conducted on open surgery.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_338"
                     title="Surgical Database Collects Haiti Cases"
                     score="0.009"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18216?impressionId=1265747584484"
                     
      &lt;p&gt;An electronic data collection system, now available to track cases in Haiti, should provide valuable information for future disasters, according to the American College of Surgeons.&lt;/p&gt;
&lt;p&gt;&quot;We need to have a good understanding of how to react and respond to these sorts of things,&quot; said Kathleen Casey, MD, director of the college&apos;s humanitarian program, Operation Giving Back.&lt;/p&gt;
&lt;p&gt;But the reaction and response is often complicated by the &quot;predictable loss&quot; of coordination in the first few days, Casey told &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;In the midst of chaos,&quot; she said, it&apos;s often difficult to get an overview of what is happening on the ground, let alone figure out whether aspects of the response are working well or poorly.&lt;/p&gt;
&lt;p&gt;The college decided one way to help was to repurpose an electronic tool already used by many of its members to track their cases.&lt;/p&gt;
&lt;p&gt;The system allows surgeons to enter all the details of a case using a computer or Palm and PocketPC phones. Blackberry and iPhone versions will be released soon, the college said.&lt;/p&gt;
&lt;p&gt;Surgeons usually use the system to record the basic clinical details of cases and help them keep on top of reporting requirements. But it also gives them access to statistical information on a large pool of patients (whose identities are concealed), which they can use for self-evaluation.&lt;/p&gt;
&lt;p&gt;While fellows of the college have been able to use the case-log system for some time, now it&apos;s open to anyone doing surgery in Haiti at a special Web address, Casey said.&lt;/p&gt;
&lt;p&gt;&quot;We thought, &apos;what do we have around that might be able to help people manage the stream of information that&apos;s coming in,&apos;&quot; Casey said. She and her colleagues decided the &quot;simple and streamlined tool&quot; already available was the best option.&lt;/p&gt;
&lt;p&gt;&quot;We just had to unlock the door&quot; to surgeons who weren&apos;t members of the college, she said.&lt;/p&gt;
&lt;p&gt;Data collected will be useful for tracking patients and outcomes as well as types of procedures, but will also help to identify areas where the response fell short or can be improved in future disasters, Casey said.&lt;/p&gt;
&lt;p&gt;The system is only a &quot;first iteration,&quot; she said. &quot;It will clearly have to be refined, because it wasn&apos;t designed for humanitarian purposes.&quot;&lt;/p&gt;
&lt;p&gt;Nonmembers of the college can register to use the tool at &lt;a href=&quot;https://acspbls.resiliencesoftware.com/Haiti-registration&quot; mce_href=&quot;https://acspbls.resiliencesoftware.com/Haiti-registration&quot; target=&quot;_blank&quot;&gt;https://acspbls.resiliencesoftware.com/Haiti-registration&lt;/a&gt;. Members can continue to use the tool as usual, but simply use &quot;Haiti&quot; as a locator, the college said.&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_318"
                     title="Preop CT May Reduce Unnecessary Appendectomy (CME/CE)"
                     score="0.008"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18185?impressionId=1265747584484"
                     
      Using computed tomography (CT) to diagnose appendicitis may reduce the likelihood of removing healthy organs in women under 45, but not among other groups, a retrospective study showed.&lt;br&gt;
&lt;br&gt;Over a 10-year period, the use of preoperative CT increased from 18.5% of patients who ultimately had their appendices removed to 94.2% (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.00001), according to Courtney Coursey, MD, of Duke University Medical Centeri, and colleagues.&lt;br&gt;
&lt;br&gt;During the same time period, the rate of negative appendectomy (removal of a healthy organ) declined, although the trend was significant only among women 45 and younger (&lt;em&gt;P&lt;/em&gt;=0.0001), the researchers reported in the February issue of &lt;em&gt;Radiology&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;We believe our study . . . supports the use of preoperative CT, particularly in the evaluation of women of reproductive age suspected of having acute appendicitis,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;They acknowledged the radiation risk and potential overuse of CT scans, but concluded, &quot;We believe that the risk of unnecessary surgery justifies the use of CT in patients in whom the clinical diagnosis of appendicitis is uncertain.&quot;&lt;/p&gt;
&lt;p&gt;Previous studies looking at the link between the use of preoperative CT and the negative appendectomy rate have yielded mixed results.&lt;/p&gt;
&lt;p&gt;So Coursey and her colleagues looked at the relationship using data from 1998 to 2007 for 925 adult patients who underwent an appendectomy at Duke. Two-thirds had a preoperative CT no more than 48 hours before surgery.&lt;/p&gt;
&lt;p&gt;Although the overall negative appendectomy fell by nearly half during the study (16.7% to 8.7%, &lt;em&gt;P&lt;/em&gt;&amp;lt;0.0001), it was driven almost entirely by a reduction among women 45 and younger (42.9% to 7.1%, &lt;em&gt;P&lt;/em&gt;=0.0001).&lt;/p&gt;
&lt;p&gt;&quot;However, the timing of the decline in negative appendectomy rates for women 45 years and younger could not be proved to be associated with the increase in CT use,&quot; the researchers noted.&lt;/p&gt;
&lt;p&gt;There were no significant trends in older women or in men of any age.&lt;/p&gt;
&lt;p&gt;&quot;The lack of a decline in the negative appendectomy rates for men and women older than 45 years may be a consequence of the initially low rates resulting in low power,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;During the study, false-negative CT scans ranged from 0% to 20%, with lower rates in the later years of the study.&lt;/p&gt;
&lt;p&gt;False-positive scans fluctuated between 1.7% to 10%. A drop in rates of false-positive scans was associated with advances in CT technology.&lt;/p&gt;
&lt;p&gt;The researchers noted some limitations of the study, including the retrospective design and the failure to evaluate the effect of CT detector configuration on diagnostic performance.&lt;/p&gt;
&lt;p&gt;In addition, they wrote, the measure of CT use to diagnose appendicitis was biased because the analysis excluded cases in which CT had ruled out appendicitis.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;One of Coursey&apos;s co-authors is a consultant to GE Healthcare.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_316"
                     title="STS: Delay in Treating Blunt Aortic Trauma Works Best (CME/CE)"
                     score="0.007"
                     href="http://www.medpagetoday.com/MeetingCoverage/STS/tb/18180?impressionId=1265747584484"
                     
      &lt;p&gt;FORT LAUDERDALE  --  Researchers here suggest that delaying treatment of selected blunt thoracic aortic injuries appears to improve overall survival of these critically ill patients.&lt;/p&gt;
&lt;p&gt;&quot;Although thoracic aortic injury still accounts for significant mortality during blunt trauma, patients reaching specialized trauma centers can achieve good results with thoracic aortic repair,&quot; said Anthony L. Estrera, MD, of the University of Texas Houston Medical School.&lt;/p&gt;
&lt;p&gt;In fact, since 1997, improved treatments have produced a 5.9% annual reduction in operative mortality and a 3% annual reduction among patients with blunt thoracic aorta injuries, he told colleagues at the annual meeting of the Society of Thoracic Surgeons here.&lt;/p&gt;
&lt;p&gt;Estrera reviewed the evolution of treatment, noting that between 1988 and 1996, his institution&apos;s doctors brought 75 patients to the operating room, 71 of whom had open surgery.&lt;/p&gt;
&lt;p&gt;Since then, treatment has changed with methods that include distal perfusion, the concept of treatment delay, and the development of thoracic endovascular aortic repair (TEVAR) using stent devices.&lt;/p&gt;
&lt;p&gt;At the Houston Level I trauma center, doctors treated 60,091 patients between January 1997 and March 2009, including 250 who were admitted with blunt thoracic aortic injury.&lt;/p&gt;
&lt;p&gt;Estrera said the average age of the patients was 32, and 70% were men. About three-fourths of the patients were riding in vehicles involved in accidents. Other victims included pedestrians and bicyclists, people who suffered falls, and one who was injured in a parachuting accident.&lt;/p&gt;
&lt;p&gt;About 35% died at or near time of admission; the others were ultimately repaired, Estrera reported.&lt;/p&gt;
&lt;p&gt;&quot;The overall mortality for the diagnosis of acute thoracic aorta injury was 44%,&quot; he said, including those who did not receive repair. &quot;Of those who underwent operative repair, mortality was 17%.&quot;&lt;/p&gt;
&lt;p&gt;Some 41% of the patients had delayed repair, which was associated with only one death, Estrata added. There was 28% mortality among those patients who underwent early surgery.&lt;/p&gt;
&lt;p&gt;He said 90 percent of the TEVAR cases involved delayed surgery  --  a median of four days from admission to the operating room.&lt;/p&gt;
&lt;p&gt;When researchers attempted to tease out what might be significant factors in reducing mortality, delayed repair &quot;was the only factor that was protective against mortality in this series,&quot; he said.&lt;/p&gt;
&lt;p&gt;Other surgeons agreed that delayed surgery is far more common now.&lt;/p&gt;
&lt;p&gt;&quot;It used to be that any time there was an indication of thoracic aorta disturbance, the patients was rushed to surgery and they underwent this massive surgery where you had to heparinize them,&quot; said Matthew Williams, MD, assistant professor of surgery at the University of Louisville.&lt;/p&gt;
&lt;p&gt;&quot;Since then, this idea of surgical delay has come forth. We let the patient&apos;s injuries calm down and take care of the other injuries and then do the thoracic aorta repair on sort of an elective basis.&lt;/p&gt;
&lt;p&gt;&quot;The combination of this idea and TEVAR has created the major chance in the management of blunt aortic thoracic injury. There is good data now to support this strategy, but if you have a patient that dies while you are waiting, there might be a problem with litigation. That may make some people a little bit reticent.&quot;&lt;/p&gt;
&lt;p&gt;Estrera said surgeons still have some concerns about TEVAR itself. &quot;The problem with TEVAR is the unknown factor of what is the durability of the TEVAR device especially in the younger patients,&quot; he said.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Estrera and Williams did not have any relevant disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>
