Surgical endoscopy training is integral to general surgery residency and should be integrated into residency and fellowships abandoned

It is a basic premise that laparoscopic procedures are an integral part of the practice of general surgery. Currently, general surgery training programs as a whole are failing to provide residents with significant surgical experience in advanced laparoscopic procedures. The teaching of advanced laparoscopic procedures can and should be incorporated into the 5-year surgical residency. The challenge for Program Directors is that it is time to restructure general surgery training so that additional fellowship training is not required to provide an adequate experience in this fundamental part of general surgery.     

Outcome of major cardiac injuries at a Canadian trauma center

Background  

Canadian trauma units have relatively little experience with major cardiac trauma (disruption of a cardiac chamber) so injury outcome may not be comparable to that reported from other countries. We compared our outcomes to those of other centers.     

Surveillance in Patients with Stage I Testicular Nonseminomatous Germ Cell Tumors

Fourteen patients with testicular nonseminomatous germ cell tumor, clinical stage I were entered into a surveillance study. Median age was 31 (range 18-58), Three patients had pure tumor, and 11, mixed tumor. In 2 patients, vascular invasion was noted, and in 1, involvement of the spermatic cord. Serum alpha fetoprotein and beta subunit choriogonadotropin were high in 9 and in 3 patients, respectively. In median follow-up of 21 months (range 2-63), 3 patients relapsed: I had inguinal lymphadenophathy and 2 had lung metastases at 12,4, and 16 months, respectively, Salvage chemotherapy PEB and PVB achieved complete response in the latter 2 patients for 6 and 49 months. Except for 1 patient lost to follow-up, all are alive.     

Does the amniotic fluid protein absorption contribute significantly to the fetal weight?

Objective : This study was carried out to evaluate the significance of amniotic fluid protein ingestion and absorption on fetal growth.
Methodology : Neonates with small bowel atresia during a 30 year period were studied retrospectively.
Results : There were 56 patients enlisted, 17 with duodenal atresia, 18 with jejunal atresia and 21 with ileal atresia. The percentage of mothers with polyhydramnios and the percentage of premature babies decreases as the intestinal atresia becomes more distal. The mean gestational age and the mean birthweight increase as the intestinal atresia becomes more distal. On the other hand, the percentage of the neonates with birthweight below the 50th and the 10th percentiles do not differ significantly as the intestinal atresia becomes more distal.
Conclusions : It appears that the variation of birthweights in babies with different levels of small bowel atresia may be due to the difference in gestation caused by polyhydramnios. The effect of amniotic fluid protein absorption on fetal bodyweight could not be demonstrated clinically in this study.     

Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis

Rademaker KJ, Groenendaal F, Jansen GH, Eken P, de Vries LS. Unilateral haemorrhagic parenchymal lesions in the preterm infant: shape, site and prognosis. Acta Pædiatr 1994;83:602–8. Stockholm. ISSN 0803–5253 In a prospective cranial ultrasound study of 544 infants with a gestational age of 32 weeks or less, 20 (3.6%) infants were diagnosed as having a unilateral parenchymal lesion (PL). Based on the shape of the PL and the evolution on ultrasound, the infants were divided into three groups: group I consisted of 11 infants, in whom the PL was triangular/fan-shaped and separate from the ventricle. The PL evolved into small cystic lesions; group II comprised 3 infants who had a PL with a similar shape, but partially communicating with the ventricle; group III consisted of 6 infants who had a globular-shaped lesion in communication with the ventricle. In groups II and III, the PL evolved into one porcncephalic cyst. The PL was considered to be due to venous infarction in all cases with intraventricular haemorrhage preceding the PL in 7 cases. Sixteen infants survived. A postmortem was performed in 2 of the 4 infants who died, confirming the diagnosis of venous infarction. Neurologicdl sequelae were present in only 2 cases in the first group, while all 6 survivors of the other two groups developed mild to severe hemiplegia. Long-term follow-up was not always available and 4 of the 18 survivors were still less than 18 months when last seen. In 9 of the 11 infants in group I, the PL was localized in the frontoparietal region, while in 8 of the 9 infants in group II or III, the PL was beyond the trigone in the occipital region. The outcome of the unilateral PL is not always unfavourable. It was evident that not only the shape of the lesion and whether or not there was communication with the lateral ventricle, but also the site of the lesion (whether or not it extended into the occipital periventricular white matter) appeared to be important with regard to neurodevelopmental outcome.     

The determination of oxalic acid, oxamic acid, and oxamide in a drug substance by ion-exclusion chromatography

Oxalic acid, oxamic acid and oxamide are potential impurities in some active pharmaceutical ingredients (API). The retention and separation of oxalic and oxamic acids are particularly challenging using conventional reversed-phase HPLC due to their high polarity. An ion-exclusion chromatography (IEC) method has been shown to provide good separation and sensitivity for the three oxalate-related impurities in a hydrophobic API matrix. The method uses a Dionex IonPac ICE-ASI column with 95/5 (v/v) 0.1% sulfuric acid/acetonitrile as the mobile phase and UV detection at 205 nm. Development and validation of this method are described.     

Transduodenal sphincteroplasty and transampullary septotomy for primary sphincter of Oddi dysfunction

We examined 29 patients without stone disease or pancreatic ductal ectasia who underwent transduodenal sphincteroplasty and transampullary septotomy for symptoms of biliary colic or pancreatitis. The combination of biliary symptoms and a fibrotic ampulla of Vater portends a favorable surgical outcome in virtually all such patients. Patients with pancreatitis did worse overall, perhaps due to the existence of unappreciated subclinical parenchymal disease not related to sphincter dysfunction. Although endoscopic retrograde cholangiography was sensitive in demonstrating abnormalities of the pancreaticobiliary system, its specificity as a predictor of good results was poor. It seems prudent to temper one's enthusiasm for sphincteroplasty in the patient with pancreatitis, whereas patients with biliary symptoms, the postcholecystectomy syndrome, or both will usually benefit significantly from this procedure.     

Radioimmunoassay for myeloma idiotype.

Rabbit anti-idiotype antisera were prepared against four human myeloma proteins. These antisera demonstrated a capacity to bind the 125I-labeled autologous purified monoclonal IgG, but failed to demonstrate any binding to 125I-labeled normal IgG or to labeled myeloma IgG obtained from other myeloma patients. The anti-idiotypic antisera were used with 125I-labeled autologous myeloma IgG preparations and goat antirabbit IgG for specific radioimmunoassay with a sensitivity limit of 20 ng/ml. Little or no cross-reaction occurred between these anti-idiotypic antisera and normal IgG preparations or other myeloma IgG proteins.