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  1. Article: Choledocholithiasis: evolving standards for diagnosis and management.

    Freitas, Marilee-L / Bell, Robert-L / Duffy, Andrew-J

    World journal of gastroenterology

    2005  Volume 12, Issue 20, Page(s) 3162–3167

    Abstract: Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the ...

    Abstract Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct (CBD) stones. CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans (CT), and magnetic resonance cholangiopancreatography (MRCP). Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones. The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised. The availability of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is often dictated by the clinical situation.
    MeSH term(s) Cholangiopancreatography, Endoscopic Retrograde ; Cholangiopancreatography, Magnetic Resonance ; Cholecystectomy ; Choledocholithiasis/diagnosis ; Choledocholithiasis/pathology ; Choledocholithiasis/surgery ; Humans ; Tomography, X-Ray Computed ; Ultrasonography
    Language English
    Publishing date 2005-07-20
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 2185929-2
    ISSN 2219-2840 ; 1007-9327
    ISSN (online) 2219-2840
    ISSN 1007-9327
    DOI 10.3748/wjg.v12.i20.3162
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article: The status of ultrasonography training and use in general surgery residency programs.

    Freitas, Marilee L / Frangos, Spiros G / Frankel, Heidi L

    Journal of the American College of Surgeons

    2006  Volume 202, Issue 3, Page(s) 453–458

    Abstract: Background: Effective use of ultrasonography (US) by surgeons was demonstrated a decade ago. Major surgical organizations now require its incorporation into surgical training and practice. But little information about the teaching of US to surgical ... ...

    Abstract Background: Effective use of ultrasonography (US) by surgeons was demonstrated a decade ago. Major surgical organizations now require its incorporation into surgical training and practice. But little information about the teaching of US to surgical residents exists. This study assesses the current status of US training in general surgery residency programs.
    Study design: A survey was mailed to the directors of 255 Accreditation Council for Graduate Medical Education-accredited general surgery residency programs. It questioned whether and how US was taught, who performed the examinations, and the types of US performed. Data were analyzed using chi-square tests comparing university versus community programs and training and practice in trauma US versus training in other US modalities.
    Results: The response rate was 51% (130 of 255). Ninety-six percent of the programs responding taught US, with no differences between university- and community-based training programs in presence of training. Focused Assessment for the Sonography of Trauma (FAST) instruction was done by 79% (hands-on) and 68% (didactic) of programs that responded. Abdominal, laparoscopic, breast, endocrine, and vascular US were each taught less frequently (22% to 55%). Program directors at university programs reported that their attending surgeons performed FAST and abdominal US more often than their community counterparts (71% and 31% versus 47% and 14%). Program directors reported that university trainees performed laparoscopic, endocrine, and vascular US more often than community surgery residents (47%, 17%, 35% versus 29%, 3%, 19%). Program directors reported that surgery attendings or residents performed trauma and laparoscopic US more often than their radiology counterparts, and radiology attendings or residents performed more abdominal, breast, endocrine, and vascular US.
    Conclusions: The majority of general surgery residency programs whose directors responded to this survey are teaching US, but most of the training is in FAST. There is no difference in the reported presence of overall US training between university and community programs. But university programs report that their surgeons or residents performed more US in all areas (other than breast) than their community counterparts reported.
    MeSH term(s) General Surgery/education ; Humans ; Internship and Residency ; Program Evaluation/standards ; Program Evaluation/trends ; Ultrasonography ; United States ; Wounds and Injuries/diagnostic imaging
    Language English
    Publishing date 2006-03
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 1181115-8
    ISSN 1879-1190 ; 1072-7515
    ISSN (online) 1879-1190
    ISSN 1072-7515
    DOI 10.1016/j.jamcollsurg.2005.10.023
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Management options in blunt aortic injury: a case series and literature review.

    Simeone, Alan / Freitas, Marilee / Frankel, Heidi L

    The American surgeon

    2006  Volume 72, Issue 1, Page(s) 25–30

    Abstract: Blunt aortic injury (BAI) is a devastating consequence of high-energy trauma. The majority of its victims do not survive; those who do generally have significant associated injury. The standard treatment of BAI has been emergent replacement or repair of ... ...

    Abstract Blunt aortic injury (BAI) is a devastating consequence of high-energy trauma. The majority of its victims do not survive; those who do generally have significant associated injury. The standard treatment of BAI has been emergent replacement or repair of the damaged aorta via a posterolateral thoracotomy, with or without perfusion adjuncts. In addition to the substantial morbidity and mortality secondary to multisystem traumatic injuries, patients surviving to reach the operating room have been exposed to the risks related to their surgical treatment, namely death, paraplegia, hemorrhage, transfusion, organ dysfunction, prolonged intensive care unit stays, and extensive rehabilitation requirements. Contributions to the literature over the past several years have provided support for changing practice patterns in the management of BAI. Aggressive control of blood pressure has made it safe to delay high-risk interventions in patients with complex injuries. Advanced perfusion strategies using little or no anticoagulation appear to have positively affected bleeding complications and neurologic risk. Finally, endovascular stent grafting, though not yet rigorously evaluated in BAI, has been shown to be feasible and effective in the short term. This case presentation and literature review will examine treatment options and propose a management algorithm.
    MeSH term(s) Adult ; Aged ; Aneurysm, False/diagnostic imaging ; Aneurysm, False/etiology ; Aneurysm, False/surgery ; Aorta, Thoracic/diagnostic imaging ; Aorta, Thoracic/injuries ; Aorta, Thoracic/surgery ; Blood Vessel Prosthesis Implantation/methods ; Follow-Up Studies ; Humans ; Male ; Thoracic Injuries/complications ; Thoracic Injuries/diagnostic imaging ; Tomography, X-Ray Computed ; Wounds, Nonpenetrating/complications ; Wounds, Nonpenetrating/diagnostic imaging
    Language English
    Publishing date 2006-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article: Are resident work-hour limitations beneficial to the trauma profession?

    Abraham, Tara / Freitas, Marilee / Frangos, Spiros / Frankel, Heidi L / Rabinovici, Reuven

    The American surgeon

    2006  Volume 72, Issue 1, Page(s) 35–41

    Abstract: In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added ... ...

    Abstract In July 2003, work-hour restrictions were implemented by the Accreditation Council for Graduate Medical Education (ACGME) to limit resident duty hours. Attending surgeon work-hours have not been similarly reduced, and many trauma services have added emergency general surgery responsibilities. We hypothesized that trauma attending/resident work-hour disparity may disincentivize residents from selecting trauma careers and that trauma directors would view ACGME regulations negatively. We conducted a 6-month study of resident and in-house trauma attending self-reported hours at a level I trauma center and sent a questionnaire to 172 national level I trauma directors (TDs) regarding work-hours restrictions. TD survey response rate was 48 per cent; 100 per cent of 15 residents and 6 trauma faculty completed work-hour logs. Attending mean hours (87.1/ wk), monthly calls (5), and shifts > 30 hours exceeded that of all resident groups. Case volume was similar. Residents viewed their lifestyle more favorably than the lifestyle of the trauma attending (Likert score 3.6 +/- 0.5 vs Likert score 2.5 +/- 0.8, P = 0.0003). Seventy-one per cent cited attending work hours and lifestyle as a reason not to pursue a trauma career. Nationally, 80 per cent of trauma surgeons cover emergency general surgery; 40 per cent work greater than 80 hours weekly, compared with < 1 per cent of surgical trainees (P < 0.0001). Most TDs feel that residents do not spend more time reading (89%) or operating (96%); 68 per cent feel patient care has suffered as a result of duty-hours restrictions. Seventy-one per cent feel residents will not select trauma surgery as a career as a result of changes in duty hours. Perceived trauma attending/ resident work-hour disparity may disincentive trainees from trauma career selection. TDs view resident duty-hour restrictions negatively.
    MeSH term(s) Follow-Up Studies ; Humans ; Internship and Residency ; Retrospective Studies ; Surveys and Questionnaires ; Traumatology/education ; Work Schedule Tolerance ; Workload/standards
    Language English
    Publishing date 2006-01
    Publishing country United States
    Document type Comparative Study ; Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
    Database MEDical Literature Analysis and Retrieval System OnLINE

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    In stock of ZB MED Cologne/Königswinter

    Uk I Zs.106: Show issues Location:
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