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1
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Overview of General Surgery Training in the USA: History and Present

100%
Dudrick S.
Polish Journal of Surgery
|
2010
|
vol. 82
|
issue 7
377-402
EN
A brief history of the development of surgery and early surgical training and practice is presented, starting in colonial America in the 18th century and extending to modern times in the USA. An abridged, but comprehensive overview of the metamorphosis and transformation of training programs in the United States is described and discussed, together with some of the most relevant rationale and justifications for the changes mandated, established and in progress. The current status of the accreditation requirements, oversight, and governance of general surgery training programs, together with the incorporation of the multiple technical and technological advances in general surgical practice; and, therefore, the addition of the required training modules and systems concurrently to the training programs; and their secondary implications, consequences, and impact upon the programs, are discussed. These include financial and other resource impediments, the 80 hour work week constraints, the technological explosion, the demands of the required expanded general surgical curriculum and operative case experience, the continued erosion of general surgery by surgical and medical specialists, the increasing workload coupled with decreasing reimbursement for general surgeons and their services, together with the difficulties of amalgamating all of these confounding or conflicting factors into an effective general surgery program which will be successful in attracting, recruiting, and retaining the best and brightest surgical candidates in the future in order to ensure the continuation of optimal general surgical care. Finally, the insights, opinions, experiences, and philosophy of the author regarding general surgery training and practice, accumulated during the more than half century served as a student, resident, clinician, scientist, administrator and educator, are incorporated into the presentation.
2
Content available remote

History and Evolution of the Management of Acute Pancreatitis

63%
Dudrick S., Paszkowiak J.
Polish Journal of Surgery
|
2007
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vol. 79
|
issue 3
239-255
3
Content available remote

Abdominal Wall Endometrioma

51%
Paszkowiak J., Dudrick S., Dardik A.
Polish Journal of Surgery
|
2007
|
vol. 79
|
issue 4
319-321
EN
Endometriosis is characterized by ectopic endometrial tissue, which responds to ovarian stimulation. Endometrioma is the term given to extra-pelvic endometriosis that forms a discrete mass surrounded by a connective tissue capsule. We present a retrospective review of five patients diagnosed with abdominal wall endometrioma in our institution within the last three years. We review symptoms, diagnostic methods, and surgical management, as well as current literature regarding this patient population.Endometrioma is an unusual disease process that must be included in the differential diagnosis of chronic abdominal pain associated with a mass in the incisional area of a patient with a previous Cesarean section. The development, cell biology, complex biochemical and endocrine features of its pathogenesis, and obvious intricate interaction with musculofascial elements relative to other abdominal wall layers are intriguing and merit further investigation.
4
Content available remote

Cervical Spine Injuries; An Outcome Analysis

45%
Fancher T., Król E., Rasmussen R., Panait L., Dudrick S.
Polish Journal of Surgery
|
2011
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vol. 83
|
issue 11
583-587
EN
Cervical spine injury (CSI) in octogenarians continues to carry a high morbidity and mortality rate. The incidence of CSI among individuals who are below the age of 80 is declining, whereas the incidence of CSI for those 80 years and above is rising.The aim of the study was to evaluate outcomes of cervical spine injuries in octogenarians caused by different mechanisms: motor vehicle accidents, compared to a fall.Material and methods. The National Trauma Data Bank (NTDB) was queried for patients ages 80 and above, who sustained a cervical spine injury via motor vehicle collision and falls. Patient demographics, mechanism of injury, Glasgow Coma Score (GCS), injury severity score (ISS), days in Intensive Care Unit, Temperature on arrival, blood pressure on arrival, CT Scan of head results, complications, sex, and mortality.Results. Three-thousand three hundred seventy-five patients, 80 years of age and older with CSI were included in the study; fifteen percent of these octogenarians with cervical spine injuries died. It was observed that patients in the motor vehicle accident (MVA) group have 1.737 (95% CI 1.407, 2.144 p-value < 0.0001) times the odds of dying, compared to those in the fall group. Patients over the age of 80 who were in a MVA have 1.209 (95% CI 0.941, 1.554 p-value = 0.1372) times the odds of having a positive head CT, compared with people over the age of 80 who experienced a fall. Patients involved in a motor vehicle accident with associated CSI were more likely to be a younger age, have a lower GCS on arrival, have a longer length of stay in the Intensive Care Unit, and a higher ISS (p<0.05).Conclusions. Cervical spine injury in octogenarians carries a high mortality regardless of mechanism. Elderly patients who suffer cervical spine injuries in motor vehicle accidents have a lower SBP, a higher ISS and are nearly twice as likely to die as those who were injured in a fall.
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