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Biomedical subjects

M C Airan

Publications and source records attributed to M C Airan.

14 recordsLinked to original sources
PubMed1998

Two unusual cases of postcholecystectomy pain.

I report on two patients who were initially diagnosed with sphincter of Oddi dysfunction (S.O.D.) because of postcholecystectomy pain in the right upper quadrant; both had other causes of pain. One patient had an aberrant hepatic duct that drained into a remnant of the cystic duct resulting in formation of stones. The second patient had adhesions of the stomach to the liver with the ligamentum teres bowing across the antrum. Gastroenterologists and endoscopic surgeons should be aware of causes of postcholecystectomy pain that are unrelated to sphincter of Oddi dysfunction.

Adult↗
PubMed1996

Forum on economic credentialing (E.C.).

What is economic credentialing? The California Medical Association defines economic credentialing as follows: "The use of economic criteria that do not apply to quality for granting or renewing medical staff pr ivileges?" The American Medical Association defines economic credentialing as " ... the use of economic criteria unrelated to quality of care or professional competency in determining an individual's qualification for initial or continuing hospital medical staff membership or pr-ivileges?" The Florida Medical Association defines economic credentialing as " ... any practice that denies access to hospitals based on eco- nomic criteria unrelated to the clinical qualifications or professional responsibilities of the physician." It also defines economic credentialing as " ... fiscal responsibility in practicing quality healthcare," and specifically notes that the governing body of a hospital has the right to discipline physicians (and presumably, exclude them) on the basis of resource utilization.

Journal Article↗
PubMed1994

Effectiveness of strict credentialing and proctoring guidelines on outcomes of laparoscopic cholecystectomy in a community hospital.

UNLABELLED: Strict credentialing and proctoring guidelines were set up prior to initiating a program of laparoscopic cholecystectomy at the Good Samaritan Hospital in Downers Grove, Illinois. This is a private 386-bed community hospital. At the inception of the program, there were 15 general surgeons who were going to participate in this program. In 1992, there were 20 general surgeons performing the laparoscopic cholecystectomy (LC). The following guidelines were approved by the Credentials Committee and authorized by the Executive Committee: A. Training: A SAGES-approved or equivalent course in LC, meeting or exceeding SAGES guidelines. B. Proctoring: Proctoring of 10 LC cases, prior to operating independently. C. Prevention of injuries: Two surgeons credentialed in LC to operate as a surgeon-cosurgeon team. D. EVALUATION: 100% concurrent review of all LC cases.

Cholecystectomy, Laparoscopic↗
PubMed1993

Complications of laparoscopic cholecystectomy: a national survey of 4,292 hospitals and an analysis of 77,604 cases.

Complications of laparoscopic cholecystectomy were evaluated by a survey of surgical department chairpersons at 4,292 US hospitals. The 77,604 cases were reported by 1,750 respondents. Laparotomy was required for treatment of a complication in 1.2% of patients. The mean rate of bile duct injury (exclusive of cystic duct) was 0.6% and was significantly lower at institutions that had performed more than 100 cases. Bile duct injuries were recognized postoperatively in half of the cases and most frequently required anastomotic repair. Intraoperative cholangiography was practiced selectively by 52% of the respondents and routinely by 31%. Bowel and vascular injuries, which occurred in 0.14% and 0.25% of cases, respectively, were the most lethal complications. Postoperative bile leak was recognized in 0.3% of patients, most commonly originating from the cystic duct. Eighteen of 33 postoperative deaths resulted from operative injury. These data demonstrate that laparoscopic cholecystectomy is associated with low rates of morbidity and mortality but a significant rate of bile duct injury.

Bile Ducts↗
PubMed1992

Assessment of quality of care in laparoscopic cholecystectomy.

With the advent of laparoscopic cholecystectomy, assessment of data and its relationship to quality of care became important. The Mount Sinai Hospital Medical Center conducted a prospective survey in conjunction with the Society of American Gastrointestinal Endoscopic Surgeons (SAGES) National Survey. In this survey, only two surgeons operated as surgeon and co-surgeon with an extremely small rate of complication. A national survey of chairpersons in surgery was designed at Rush Presbyterian St. Luke's Hospital, and 4300 chairpersons were mailed questionnaires to record complications of laparoscopic cholecystectomy. There were 36,232 patients and 3111 surgeons in the survey. The Southern Surgeons Club experience, as reported in New England Journal of Medicine, was reviewed. Because of the complexity of understanding the implications of the survey results, the authors have arrived at a simplified system of evaluating quality of care in laparoscopic cholecystectomy. In this system only three considerations are taken into account: (a) elective conversions to standard operation, (b) forced conversions (due to iatrogenic injuries), and (c) reoperation rate (delayed complication). It is hoped that data collection will be simplified and more meaningful.

Cholecystectomy↗
PubMed1991

Review of 300 consecutive laparoscopic cholecystectomies: development, evolution, and results.

The present paper reviews 300 laparoscopic cholecystectomies with intraoperative cholangiograms that were performed by the authors. The development and evolution of this procedure are described along with the results. The guidewire technique used for operative cholangiography and the maneuver applied to control bleeding of the cystic artery are detailed. Five cases were converted to open operations. No serious complications were encountered. One common bile duct injury occurred during endoscopic retrograde cholangiopancreaticography performed on postoperative day 8 for diagnostic purposes.

Adolescent↗
PubMed1986

Infarction of the greater omentum. Elusive cause of acute abdominal pain.

Omental infarction may be much more common than the number of cases reported in the literature would imply. The condition should be considered in the differential diagnosis of acute abdominal pain. A thorough search for it should be made in patients whose findings at laparotomy are not consistent with the preoperative diagnosis (usually acute appendicitis), especially when serosanguineous fluid is found in the peritoneal cavity. Treatment is excision of infarcted omentum to prevent formation of adhesions with obstructive and septic complications.

Abdomen, Acute↗
PubMed1975

Parathyroid identification by methylene blue infusion.

The intravenous infusion of methylene blue was investigated as a procedure that would identify parathyroid glands during operation in 17 patients with primary hyperparathyroidism. The dye was found to stain all adenomas, most hyperplastic glands and occasionally normal parathyrodi glands. In addition, the frequency of glandular staining was directly related to the size of the gland, although size and histology may have been independent variables. Methylene blue infusion is a safe effective method of localizing abnormal parathyroid glands.

Adenoma↗
PubMedDate not supplied

Therapeutic laparoscopic suturing techniques.

With the introduction of the technique of Interventional laparoscopy, a new era of minimally invasive general surgery has begun. The well-established principles of general surgical technique have not been altered by this new technology. As the new laparoscopic technology has become available, intraabdominal laparoscopic suturing and ligating techniques have been developed. The authors have attempted to elucidate the techniques of endoligation, "Endoloop" application, endosuture placement, sling suture placement, and continuous suture placement in laparoscopic surgery.

Humans↗