<?xml version="1.0" encoding="utf-8"?>
<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_338"
                     title="Surgical Database Collects Haiti Cases"
                     score="0.007"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18216?impressionId=1265767698239"
                     
      &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_201"
                     title="Viral Cause of Appendicitis Called Unlikely (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18048?impressionId=1265767698239"
                     
      &lt;p&gt;The cause of appendicitis remains a mystery, according to a study that discounts flu and intestinal infection as candidates.&lt;/p&gt;
&lt;p&gt;Influenza&apos;s distinctive seasonal variations don&apos;t match appendicitis hospitalization rates, according to researchers led by Edward H. Livingston, MD, of the University of Texas Southwestern Medical Center in Dallas.&lt;/p&gt;
&lt;p&gt;Enteric infections and rotavirus showed trends that were likewise dissimilar to those of perforating and nonperforating appendicitis, the researchers reported in the January issue of the &lt;em&gt;Archives of Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;&quot;Most theories regarding the underlying causes of appendicitis rely on the notion that the appendix becomes obstructed,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;However, a more complex explanation appears necessary, they said, citing studies suggesting that blockage by hard pieces of stool called fecaliths is rare and that intraluminal pressures become elevated only in late-stage disease as inflammation progresses.&lt;/p&gt;
&lt;p&gt;Viral infection has been proposed as one explanation.&lt;/p&gt;
&lt;p&gt;And apparent &quot;outbreaks&quot; of appendicitis have been described in epidemiologic studies, suggesting an infectious etiology, Livingston&apos;s group noted.&lt;/p&gt;
&lt;p&gt;&quot;Viral infection of the appendix could cause mucosal ulceration followed by secondary bacterial infection of the appendix,&quot; they wrote. &quot;Alternatively, viral disease could result in lymphoid hyperplasia of the appendix with resultant obstruction and mucosal injury followed by bacterial infection.&quot;&lt;/p&gt;
&lt;p&gt;To explore the viral etiology scenario, the researchers used the National Hospital Discharge Survey to measure disease incidence trends from 1970 to 2006 based on admissions for appendicitis, flu, rotavirus, and enteric infections.&lt;/p&gt;
&lt;p&gt;They found a decline in overall annual incidence of both nonperforating appendicitis and influenza until 1995, after which the incidence for both rose in parallel.&lt;/p&gt;
&lt;p&gt;Perforating appendicitis, on the other hand, slowly rose in incidence over the years without a U-shaped curve.&lt;/p&gt;
&lt;p&gt;The incidence of perforating appendicitis, in fact, did not correlate with that of nonperforating appendicitis or any infectious disease studied.&lt;/p&gt;
&lt;p&gt;This suggested that &quot;perforated appendicitis has causative factors that are more complex than the simple delay in treating acute appendicitis,&quot; the researchers said.&lt;/p&gt;
&lt;p&gt;Rebecca C. Britt, MD, of Eastern Virginia Medical School in Norfolk, Va., commented that this was perhaps the most important implication of the study  --  that perforating and nonperforating appendicitis may be separate entities.&lt;/p&gt;
&lt;p&gt;Her critique accompanying the &lt;em&gt;Archives&lt;/em&gt; paper cautioned that further investigation is &quot;definitely warranted.&quot;&lt;/p&gt;
&lt;p&gt;But if confirmed, management patterns could shift, the researchers said.&lt;/p&gt;
&lt;p&gt;&quot;This has important clinical ramifications since appendectomy is generally performed as an emergency operation for fear of causing a perforation if treatment is delayed,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;For nonperforating appendicitis, the year-to-year association with influenza was discounted by the lack of within-year correlation.&lt;/p&gt;
&lt;p&gt;Appendicitis occurred throughout the year, with a &quot;slight tendency&quot; to occur more often in summer months whereas the flu was largely limited to winter.&lt;/p&gt;
&lt;p&gt;Furthermore, appendicitis is predominantly a disease of the young, while influenza disproportionately affects the older population, &quot;which goes against influenza as a proximate agent,&quot; Britt added.&lt;/p&gt;
&lt;p&gt;&quot;While perhaps influenza plays a role in the development of appendicitis by sensitizing the immune system to another viral agent, there remains no clear evidence that it is a causative agent for appendicitis,&quot; she wrote.&lt;/p&gt;
&lt;p&gt;Rotavirus infection also peaked in the winter months, without an apparent association with appendicitis incidence.&lt;/p&gt;
&lt;p&gt;Intestinal infection incidence matched the fairly even distribution of appendicitis throughout the year, but had a propensity to be higher in winter months rather than during the summer as was the case with appendicitis.&lt;/p&gt;
&lt;p&gt;Overall and peak hospital admission rates for intestinal infection began a yearly rise in 1989 and have been steadily increasing, which also did not match trends in appendicitis.&lt;/p&gt;
&lt;p&gt;Britt cautioned that the study relied on hospital discharge data, which is not likely to be a complete picture of incidence for viral illness because the vast majority of cases do not require hospitalization and many are not treated at all.&lt;/p&gt;
&lt;p&gt;&quot;Certainly this makes comparison onerous,&quot; she 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;The researchers reported no conflicts of interest. Britt reported no conflicts of interest.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_191"
                     title="Dissolving Implant Aids Nasal Surgery (CME/CE)"
                     score="-0.003"
                     href="http://www.medpagetoday.com/Surgery/PlasticSurgery/tb/18027?impressionId=1265767698239"
                     
      &lt;p&gt;A polymer-based, resorbable plate implanted in the nose as part of extracorporeal surgery to repair deviated septums appeared to improve outcomes, researchers said.&lt;/p&gt;
&lt;p&gt;Rhinomanometry confirmed that almost 82% of 396 patients receiving the polydioxanone implants at two centers achieved &quot;remarkably improved nasal flow&quot; according to Miriam Boenisch, MD, PhD, now of Medicent Linz in Linz, Austria, and Gilbert J. Nolst Trenit&amp;#233;, MD, PhD, of the University of Amsterdam in the Netherlands.&lt;/p&gt;
&lt;p&gt;No cases of perioperative complications such as bleeding, septal hematomas, inflammatory reactions, or necrosis were reported. &quot;Postoperative crusts disappeared after two weeks in almost all patients,&quot; Boenisch and Nolst Trenit&amp;#233; wrote in the January issue of the &lt;em&gt;Archives of Facial and Plastic Surgery&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Slight septal thickening, lasting some three weeks and disappearing over two months, occurred in 19 patients, they added.&lt;/p&gt;
&lt;p&gt;&quot;To date, we have encountered no short- or long-term complications as a consequence of the use of polydioxanone plate,&quot; the researchers wrote, adding that cosmetic results have been good as well, with up to 10 years of follow-up.&lt;/p&gt;
&lt;p&gt;&quot;The fundamental surgical goal, straightening of the nasal septum, was achieved in about 87% of patients. From the patients&apos; viewpoint, the success rate for improvement of nasal breathing was even higher and was supported by rhinomanometry results,&quot; according to the report.&lt;/p&gt;
&lt;p&gt;However, the study had no control group and reflected the experience of two centers in Austria, in Linz and Steyr.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; reported that the first patients were treated treated with the polydioxanone plates in 1996.&lt;/p&gt;
&lt;p&gt;The material is water soluble and is completely resorbed by the body over a period of weeks. Polydioxanone plates have a long history in restoration of bone discontinuities, the researchers noted.&lt;/p&gt;
&lt;p&gt;Physicians at the centers believed such plates could help make extracorporeal septum repair  --  in which the septum is removed from the nose, reshaped, and perhaps augmented for reimplantation  --  more feasible for patients with extensive defects not reparable with conventional methods.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; described a general procedure in which septal cartilage was removed and sutured to a custom-cut piece of polydioxanone for reimplantation.&lt;/p&gt;
&lt;p&gt;In patients with insufficient septal cartilage to create a full new septum, additional cartilage was harvested from their ears. In addition to the polydioxanone plate, foil made of the same material was used to stabilize the construction.&lt;/p&gt;
&lt;p&gt;A total of 47 patients required such compound grafts, including five in which the new septum was made entirely of ear cartilage.&lt;/p&gt;
&lt;p&gt;All but about 5% of the procedures, including those with compound grafts, could be completed in a single outpatient session, the researchers reported.&lt;/p&gt;
&lt;p&gt;The journal report included serial photographs of three patients before and after the procedures.&lt;/p&gt;
&lt;p&gt;One set showed a patient, six days after surgery, whose appearance was essentially normal, except for a scab at the base of the septum. Six months later, he appeared to be completely healed.&lt;/p&gt;
&lt;p&gt;Boenisch and Nolst Trenit&amp;#233; reported that one patient in the series needed revision surgery due to a nasal trauma suffered a month after the reconstruction. The patient originally had a so-called saddle deformity because of trauma, and the new injury caused it to recur after the polydioxanone resorbed.&lt;/p&gt;
&lt;p&gt;The researchers said the revision, performed seven months after the first attempt, involved a compound graft including ear cartilage, and healed well.&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. The polydioxanone plates and foil were supplied by Johnson &amp;amp; Johnson.&lt;/p&gt;&lt;p&gt;The researchers reported no potential conflicts of interest.&lt;/p&gt;&lt;p&gt;Boenisch analyzed the data as part of a PhD dissertation at the University of Pecs, Hungary. Medicent Linz, where she currently works, is part of a chain of private clinics in Austria.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_182"
                     title="Kids with Bionic Ears Have Trouble Controlling Their Voices (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/Surgery/Otolaryngology/tb/18018?impressionId=1265767698239"
                     
      Although children who are deaf may be able to hear when fitted with cochlear implants in both ears, they have a more difficult time controlling their voices than kids with normal hearing, a single-center study showed.&lt;br&gt;
&lt;br&gt;Children with bilateral implants had deficits in controlling both the pitch and loudness of their voices when making a sustained &quot;ahh&quot; sound (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both), according to Karen Gordon, PhD, of the Hospital for Sick Children in Toronto, and colleagues.&lt;br&gt;
&lt;br&gt;Pitch control, however, improved significantly the longer the implants were used (&lt;em&gt;P&lt;/em&gt;=0.03), the researchers reported in the January issue of &lt;em&gt;Archives of Otolaryngology  --  Head &amp;amp; Neck Surgery.&lt;/em&gt;&lt;br&gt;
&lt;br&gt;&quot;The more experience one has with hearing, the better able to produce voice they have,&quot; Gordon said in an interview.&lt;br&gt;
&lt;br&gt;The number of children who receive cochlear implants for deafness has been increasing steadily over the past two decades, and it is now common, she said.&lt;p&gt;&lt;/p&gt;
&lt;p&gt;The implants directly stimulate the auditory nerve to compensate for a nonfunctioning cochlea, regardless of the reason for the deafness.&lt;/p&gt;
&lt;p&gt;At the Hospital for Sick Children, a multidisciplinary team  --  including an audiologist, otolaryngologist, social worker, speech language pathologist, and auditory verbal therapist  --  assesses each child&apos;s suitability for the implants.&lt;/p&gt;
&lt;p&gt;&quot;We really look at the child, their candidacy from a hearing point of view, their expectations for what the implant can do for them, whether they&apos;re up for the surgery, and whether they&apos;re up for the therapy that&apos;s involved afterward,&quot; Gordon said.&lt;/p&gt;
&lt;p&gt;Although children with cochlear implants are able to hear, it&apos;s unclear exactly what their perception of sound is, she said. All must go through therapy lasting about two years to be able to interpret what they&apos;re hearing.&lt;/p&gt;
&lt;p&gt;However, the voicing of children with the implants compared with that of kids with normal hearing has not been extensively studied.&lt;/p&gt;
&lt;p&gt;So Gordon and her colleagues evaluated how 27 children with bilateral implants  --  ages 3 to 15  --  were able to control their voices, finding poorer control of long-term frequency perturbation (pitch) and long-term amplitude perturbation (loudness) compared with those with normal hearing.&lt;/p&gt;
&lt;p&gt;&quot;Despite the incredible opportunities that cochlear implants provide for auditory and linguistic development, abnormalities in acoustic voice outcomes persist,&quot; they wrote.&lt;/p&gt;
&lt;p&gt;However, through a four-month follow-up, pitch control  --  but not loudness control  --  improved significantly with increased implant use.&lt;/p&gt;
&lt;p&gt;&quot;This result underlines the importance of early recognition and treatment of children with hearing loss to provide auditory experience as soon as possible,&quot; the researchers wrote.&lt;/p&gt;
&lt;p&gt;However, the use of cochlear implants is not free of complications, according to another study in the same issue of the journal by Natalie Loundon, MD, of the H&amp;#244;pital d&apos;Enfants Armand-Trousseau in Paris, and colleagues.&lt;/p&gt;
&lt;p&gt;Among 434 children younger than 16 who received the devices, 9.9% had complications, nearly two-thirds of which occurred more than eight days after implantation (mean 2.2 years).&lt;/p&gt;
&lt;p&gt;Major complications included severe cutaneous infections or hematoma, magnet displacement, meningitis, cholesteatoma, cerebrospinal fluid leak, and electrode misplacement.&lt;/p&gt;
&lt;p&gt;Minor complications included vertigo, soft-tissue infection, persistent otitis media, and facial nerve palsy.&lt;/p&gt;
&lt;p&gt;A large minority of those with complications (30.2%) required reimplantation.&lt;/p&gt;
&lt;p&gt;Trauma to the mastoid area and inner ear malformations were risk factors for delayed major complications and early minor complications, respectively (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for both).&lt;/p&gt;
&lt;p&gt;Age at implantation was not associated with complication risk.&lt;/p&gt;
&lt;p&gt;&quot;The finding of complications several years after surgery highlights the need for long-term medical follow-up in this population and the importance of repeatedly providing information to the patients and their family,&quot; Loundon and colleagues wrote.&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;None of the authors of either of the studies made any financial disclosures.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20090101_2_596"
                     title="War Zone Medicine Takes on Definitive Facial Fracture Repair"
                     score="-0.005"
                     href="