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    <recommendedItem id="20100101_19_459"
                     title="Murtha Dead at 77"
                     score="0.013"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18388?impressionId=1265747279514"
                     
      &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_424"
                     title="AAPM: Facet Graft Quells Refractory Back Pain (CME/CE)"
                     score="0.013"
                     href="http://www.medpagetoday.com/MeetingCoverage/AAPM/tb/18343?impressionId=1265747279514"
                     
      &lt;p&gt;SAN ANTONIO  --  Minimally invasive facet arthrodesis significantly reduced pain and improved physical function for one&lt;strong&gt; &lt;/strong&gt;year in patients with medically refractory facet arthropathy, according to data from a prospective clinical series.&lt;/p&gt;
&lt;p&gt;Most patients discontinued narcotic pain relievers, researchers reported here, and only one of 28 patients in the series had no appreciable change in pain after the noninstrumented spinal surgery.&lt;/p&gt;
&lt;p&gt;&quot;The procedure does not disrupt stabilizing ligaments or muscular structures of the posterior spine, allowing unimpeded physiotherapy for low back muscular strengthening after 16 weeks,&quot; Daniel Bennett, MD, of Integrative Treatment Centers in Denver, told attendees at the American Academy of Pain Medicine meeting.&lt;/p&gt;
&lt;p&gt;&quot;If fusion occurs, symptoms should not return, as with traditional treatment modalities, such as thermal radiofrequency neurolysis.&quot;&lt;/p&gt;
&lt;p&gt;The results have provided the foundation for a prospective, multicenter, randomized clinical trial to compare radiofrequency neurolysis and minimally invasive spine facet arthrodesis, he added.&lt;/p&gt;
&lt;p&gt;Medical management of low back pain related to facet degeneration often provides minimal pain relief and can interfere with functioning. Direct injection of anesthesia into an affected joint also leads to negligible long-term benefits, said Bennett. Radiofrequency neurolysis provides only temporary pain relief and must be repeated because of nerve regeneration.&lt;/p&gt;
&lt;p&gt;All the patients had a return of pain after previous radiofrequency neurolysis and were eligible for repeat neurolytic procedures. Affected areas were confirmed by anesthetic injection, followed by a provocatory examination.&lt;/p&gt;
&lt;p&gt;The patients underwent a standardized procedure that included a small incision at the affected area, insertion of surgical pins to stabilize the joint, use of a surgical drill to achieve joint separation, and insertion of 5-mm or 7-mm Morse tapered cortical allografts.&lt;/p&gt;
&lt;p&gt;After surgery, patients wore a rigid brace for 16 weeks, at which point they began physical therapy to strengthen back muscles.&lt;/p&gt;
&lt;p&gt;The patients received a total of 102 grafts at 51 levels, and four dislodgements (3.9%) occurred. None of the patients had a return of pain after dislodgement.&lt;/p&gt;
&lt;p&gt;&quot;Among patients who retained grafts, all showed callus formation of the posterior joint and incorporation of the cortical allograft,&quot; said Bennett.&lt;/p&gt;
&lt;p&gt;At the 52-week follow-up, the average score on a 100-point visual analog pain scale was 23, down from an average of 79 prior to the intervention. Patients&apos; scores on the Oswestry Disability Index averaged 8.32, compared with 33.46 at baseline.&lt;/p&gt;
&lt;p&gt;All but four patients discontinued narcotic medication, and the morphine dose required by those four decreased from a baseline range of 150 to 360 mg to a range of 10 to 30 mg at one year.&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;The study was supported by Prism Healthcare Foundation.&lt;/p&gt;&lt;p&gt;Bennett disclosed relationships with Alphatec Spine, miniSURG, Boston Scientific, Cephalon, Nevro, and Paylon.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_402"
                     title="Minimally Invasive Surgery Takes Toll on MDs, Poll Shows (CME/CE)"
                     score="0.012"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18306?impressionId=1265747279514"
                     
      &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="0.007"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18216?impressionId=1265747279514"
                     
      &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="0.006"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18185?impressionId=1265747279514"
                     
      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>
</recommendedContent>
