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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_459"
                     title="Murtha Dead at 77"
                     score="0.01"
                     href="http://www.medpagetoday.com/Washington-Watch/Washington-Watch/tb/18388?impressionId=1265794369571"
                     
      &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;Mark Malangoni, MD, surgeon-in-chief at MetroHealth Medical Center in Cleveland, told &lt;em&gt;MedPage Today&lt;/em&gt; that serious complications, including bowel damage and death, are not common following cholecystectomy. More complicated patients, such as the obese and diabetics, have a greater risk of complications and of a switch to an open procedure.&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 American College of Surgeons (ACS).
    &lt;p&gt;More common, but still infrequent, are bleeding and leakage of bile, both of which can be treated fairly easily, said Malangoni, a regent of the ACS.&lt;/p&gt;


&lt;p&gt;When the bowel is damaged, as reportedly occurred in Murtha&apos;s case, it typically occurs in two ways -- either from a sharp injury when the trocars used for a laparoscopic procedure are inserted or from a cautery burn.
    &lt;p&gt;Both types of injury can go unnoticed by the surgeon and may not become apparent for days after the operation, Malangoni said.&lt;p&gt;
    &lt;p&gt;Although he did not know the details of Murtha&apos;s case, Malangoni said a patient would usually be admitted right away, at least overnight, if the surgeon realized that an injury had occurred. The procedure likely would have switched from a laparoscopic one to an open one as well.&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;Malangoni said most surgeons become experienced with performing laparoscopic cholecystectomies before completing their residency; most will perform 40 or 50 by the end of training.&lt;p&gt;
    &lt;p&gt;&quot;It is a very common operation, so once out into practice, most general surgeons are doing dozens of these each year,&quot; he said. &quot;So your experience comes about pretty quickly.&quot;
    &lt;p&gt;It is unclear how much experience Murtha&apos;s surgeon had.&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="0.009"
                     href="http://www.medpagetoday.com/Surgery/GeneralSurgery/tb/18306?impressionId=1265794369571"
                     
      &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="0.004"
                     href="http://www.medpagetoday.com/EmergencyMedicine/EmergencyMedicine/tb/18216?impressionId=1265794369571"
                     
      &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_245"
                     title="Accidents, Illness Cause Most War-Zone Casualties (CME/CE)"
                     score="-0.004"
                     href="http://www.medpagetoday.com/PublicHealthPolicy/MilitaryMedicine/tb/18100?impressionId=1265794369571"
                     
      &lt;p&gt;More than 85% of American military medical evacuations from the Middle East were not the direct result of enemy action, but the result of non-battle injuries and disease, researchers said.&lt;/p&gt;
&lt;p&gt;Of some 34,000 military personnel in Iraq and Afghanistan who shipped out for medical reasons from 2004 to 2007, only 14% had been wounded or injured in combat, according to Steven P. Cohen, MD, of Johns Hopkins, and colleagues.&lt;/p&gt;
&lt;p&gt;The most common reasons for medical evacuation were non-battle related musculoskeletal and connective tissue disorders, accounting for 24% of evacuations, the researchers wrote in the Jan. 23 issue of &lt;em&gt;The Lancet&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Combat injuries were the second most common, followed by neurological disorders (10%) and psychiatric illnesses (9%).&lt;/p&gt;
&lt;p&gt;&quot;Non-battle related injuries continue to be the leading cause of medical evacuation in modern warfare, and medical officers should be prepared for this burden in subsequent conflicts,&quot; Cohen and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;To reduce the number of evacuees, preventive medicine programmes and educational initiatives need to target health-care providers, non-commissioned officers, and combat soldiers.&quot;&lt;/p&gt;
&lt;p&gt;They also warned that &quot;the burden of psychiatric illness&quot; will increase with the duration of conflict and reliance on reserve units.&lt;/p&gt;
&lt;p&gt;Cohen and colleagues obtained data kept by the U.S. military on all medical evacuations from Iraq and Afghanistan spanning 2004 to 2007.&lt;/p&gt;
&lt;p&gt;In addition to describing the medical reasons for evacuation, the data included the individuals&apos; ranks, service affiliations, active-duty or reserve status, and whether personnel returned to duty.&lt;/p&gt;
&lt;p&gt;Any injury sustained during combat missions, including those not caused directly by enemy fire such as back strains, was counted as battle-related.&lt;/p&gt;
&lt;p&gt;The number of evacuations each year fell from 2004 to 2006  --  from 10,290 to 6,778  --  but abruptly rose in 2007 to 8,444 with the Iraq surge and the reinvigorated Afghan Taliban resistance.&lt;/p&gt;
&lt;p&gt;Not surprisingly, as these conflicts evolved over time, the balance of combat and non-combat injuries and illnesses changed and the characteristics of evacuated soldiers changed as well.&lt;/p&gt;
&lt;p&gt;The proportion of evacuations related to combat injuries climbed steadily in Afghanistan, from 10% in 2004 to 19% in 2007. Injuries from combat also increased over time in Iraq but not as much: from 24% of evacuations to 28% during the study period.&lt;/p&gt;
&lt;p&gt;But by 2007, combat wounds had become only the fourth most common reason for evacuation in both regions.&lt;/p&gt;
&lt;p&gt;Musculoskeletal and connective tissue disorders held steadily as the number one reason throughout the study period, ranging from 21% to 28%.&lt;/p&gt;
&lt;p&gt;But non-combat neurological and psychiatric disorders both increased substantially, especially the latter.&lt;/p&gt;
&lt;p&gt;Evacuations for psychiatric conditions soared from 5% to 6% of the total in 2004 to about 13% in 2007. Neurological disorders accounted for about 10% of evacuations early in the conflicts, rising to more than 12% in 2007. These figures did not differ substantially between Iraq and Afghanistan.&lt;/p&gt;
&lt;p&gt;Most of the evacuees did not return to duty: about 80% of those shipped from Iraq and 75% from Afghanistan.&lt;/p&gt;
&lt;p&gt;Although overall return-to-duty rates changed little with time, evacuations for some types of illness did increase or decrease.&lt;/p&gt;
&lt;p&gt;Personnel evacuated because of infectious disease became more likely to see service again  --  37% returned to active duty in 2007, compared with 8% in 2004. Cohen and colleagues identified better control of leishmaniasis as at least partly responsible for the increase.&lt;/p&gt;
&lt;p&gt;More significantly, the researchers indicated, return-to-duty rates declined progressively after 2004 for psychiatric evacuees, Cohen and colleagues reported.&lt;/p&gt;
&lt;p&gt;By 2007, only 7% of psychiatric evacuees from Iraq and 4% of those from Afghanistan were returning to duty.&lt;/p&gt;
&lt;p&gt;The researchers also found that, among particular types of psychiatric illness, personnel with stress reactions, depression, and bipolar disorder were least likely to return to duty.&lt;/p&gt;
&lt;p&gt;They also found that individuals with back pain were also more unlikely than most evacuees to return to duty.&lt;/p&gt;
&lt;p&gt;In their report, Cohen and colleagues said these latter trends were potentially related.&lt;/p&gt;
&lt;p&gt;&quot;The parallels between emotional distress and spinal pain are intriguing. Findings from several studies in patients presenting with back or neck pain have established that the major risk factors for disability and persistence are psychosocial (e.g., anxiety, depression, poor coping skills, and low job satisfaction),&quot; they wrote.&lt;/p&gt;
&lt;p&gt;&quot;As survival rates of combat injuries increase, and the burden of non-battle-related injuries and psychiatric disorders continues to soar, society must be prepared to deal with the aftermath of these injuries,&quot; Cohen and colleagues concluded.&lt;/p&gt;
&lt;p&gt;In an accompanying commentary, J. Don Richardson, MD, of St. Joseph&apos;s Health Care in London, Ontario, and colleagues also found the results on psychiatric evacuees most striking in the study.&lt;/p&gt;
&lt;p&gt;&quot;The low rate of return to duty in service personnel evacuated for psychiatric conditions warrants further study, and [the] article points out the importance of cumulative stress in repeated deployments and the physical and mental demands on the military member and their family,&quot; Richardson and colleagues wrote.&lt;/p&gt;
&lt;p&gt;&quot;The low rate of return to duty might be related to the nature of the combat operation for which military commanders might be reluctant to deploy an individual with a psychiatric diagnosis to a combat zone,&quot; they speculated.&lt;/p&gt;
&lt;p&gt;&quot;Early intervention becomes crucial to help promote recovery because military members often experience substantial stigma disclosing symptoms of PTSD and other psychiatric problems,&quot; Richardson and colleagues added.&lt;/p&gt;
&lt;p&gt;They also suggested that military doctors &quot;should have a high index of suspicion&quot; for PTSD when soldiers present with spinal pain or other somatic complaints, &quot;especially if there is a physical injury.&quot;&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 the federally funded John P. Murtha Neuroscience and Pain Institute and the U.S. Army.&lt;/p&gt;&lt;p&gt;No potential conflicts of interest were reported by study authors or the editorialists.&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="-0.005"
                     href="http://www.medpagetoday.com/Surgery/PlasticSurgery/tb/18027?impressionId=1265794369571"
                     
      &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>
</recommendedContent>