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Biomedical subjects

E J Reddick

Publications and source records attributed to E J Reddick.

14 recordsLinked to original sources
PubMed1992

Credentialing in laparoscopic surgery: a survey of physicians.

Laparoscopic surgery is now established as a major advance in modern surgery. Assurance of adequate training and credentialing is still a significant problem. Using laparoscopic cholecystectomy as an example, a survey was conducted to assess what criteria surgeons deem necessary for training and credentialing in a laparoscopic procedure. One hundred and forty-nine questionnaires were completed by surgeons from academic and private practice. A total of 110 (74%) surgeons consider that a course involving a hands-on animal lab should be required. Ninety-two (84%) of them answered that a preceptorship also should be required (average of 6.42 as surgeon and 5.86 as assistant). Ninety-nine (66%) responders believe that a surgeon should serve a probationary period (average of 11.6 cases) with review of morbidity, prior to being given full privileges. No statistical difference was found when comparing the answers of academic surgeons with private practitioners or between surgeons who had performed laparoscopic cholecystectomy and those who had not.

Cholecystectomy↗
PubMed1992

Laparoscopic cholecystectomy in freestanding outpatient centers.

Laparoscopic cholecystectomy has been shown to effectively reduce the hospitalization and postoperative recovery of patients undergoing cholecystectomy and has now become the most common method of cholecystectomy across the United States. Although previous reports document that this procedure can be performed safely on an outpatient basis, there is still some concern about discharging patients immediately after surgery. This study was undertaken by a cross section of general surgeons to determine whether laparoscopic cholecystectomy could be performed safely in an outpatient center.

Adult↗
PubMed1991

Safe performance of difficult laparoscopic cholecystectomies.

Laparoscopic cholecystectomy has been advocated for the treatment of uncomplicated symptomatic gallstone disease, but has not been widely advocated for the management of more complicated gallbladder disease such as acute cholecystitis, previous surgery, or common duct stones. During the last 9 months, 360 patients underwent laparoscopic removal of their gallbladder. A total of 138 had a complicated presentation, making surgery more difficult. This article discusses the management of these patients with acute cholecystitis, previous surgery, or common duct disease. Using the described techniques, there were no complications or mortality. Laparoscopic management of difficult gallbladder problems is safe and effective.

Acute Disease↗
PubMed1991

Laparoscopic laser cholecystectomy: analysis of 500 procedures.

Laparoscopic laser cholecystectomy (LLC) is a less morbid alternative to open cholecystectomy. The advantages of laparoscopic techniques associated with advances in laser technology have heralded a dramatic advancement in the surgical treatment of biliary disease. Earlier return to work, lower morbidity, and lower medical expense are known advantages of laparoscopic surgery. We present the findings of our initial 500 procedures. The outcome of the first 200 procedures is compared to the following 300 procedures. Operating time averaged 88 min, and cholangiograms were achieved in 79%. Thirty-two percent were performed as outpatients and average hospital stay was 0.98 days. Conversion to open cholecystectomy occurred in 1.8% of cases and there were 5 major complications related to the procedure. No wound infections and no respiratory complications were encountered. There were no mortalities. Management of common bile duct stones with combined surgical and endoscopic modalities are discussed.

Adolescent↗
PubMed1991

Laparoscopic cholecystectomy: cost analysis.

Recently laparoscopic cholecystectomy (LC) has become an accepted alternative to the traditional open cholecystectomy (OP). The purpose of this study was to compare laparoscopic cholecystectomy to open cholecystectomy with respect to four variables: (a) operative time, (b) length of hospital stay, (c) total hospital cost, and (d) morbidity and mortality rates. The most recent 200 LCs performed at HCA West Side Hospital were selected for comparison in the study. Demographic data, including age and sex were collected for all patients. The medical record for each patient was then reviewed to obtain the study variables. A control group of 200 patients undergoing elective open cholecystectomy over the same period was selected. Complications occurred in 12 patients (6.0%) in the LC group with one postoperative mortality. Nineteen patients (9.5%) suffered complications in the OC group with no operative mortality. The difference between the two groups was not statistically significant. The average length of operation (recorded in minutes) in the OC group was 87.79 (SD +/- 20.69) as compared to 103.78 (SD +/- 29.01) in the LC group. This difference proved to be slight, but significantly greater (p < 0.0001). The average length of stay (recorded in days) in the OC group was 4.43 (SD +/- 1.29) versus 1.13 (SD +/- .93) in the LC group. Again, the difference proved to be statistically significant (p < 0.0001). The corrected average total hospital charge from OC was $3,006 (SD +/- 755) versus $2,312 (SD +/- 484) for LC, a difference that was statistically significant (p < 0.0001). Laparoscopic cholecystectomy is a safe, effective, and cost-efficient alternative to open cholecystectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Laparoscopic laser cholecystectomy and choledocholithiasis.

The management of common bile duct stones during laparoscopic laser cholecystectomy (LLC) is uncertain. Open common bile duct exploration is the least desirable option since it defeats the purpose of LLC. Endoscopic retrograde cholangiopancreatography (ERCP) with papillotomy has become the procedure of choice since it has a high rate of success and results in minimal morbidity. Intraoperative techniques using balloon catheters and the flexible choledochoscope via the cystic duct may obviate the need for ERCP in selected cases.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1990

Outpatient laparoscopic laser cholecystectomy.

Laparoscopic laser cholecystectomy has been performed clinically in the United States since 1988. After refinement of the technique, the procedure was offered on an outpatient basis. Eighty-three patients underwent laparoscopic laser cholecystectomy during the study period. Thirty-seven (45%) had the procedure as an outpatient. Younger patients were more suited for the outpatient procedure and those without previous surgery were more likely to have the procedure done as an outpatient. Weight, operating time, and gallbladder pathology were similar, although patients with acute inflammation of the gallbladder were more likely to require hospitalization. The primary reason for patient admission was patient preference.

Ambulatory Surgical Procedures↗
PubMed1989

Laparoscopic laser cholecystectomy. A comparison with mini-lap cholecystectomy.

The standard treatment of cholelithiasis in the United States is surgical removal of the gallbladder, but this treatment often has a major economic impact on the patient: major surgery, lengthy hospitalization, and several weeks' absence from work. Because of this economic factor, there has been a movement toward non-invasive methods, but they, too, have their drawbacks: long-term medical therapy; a high risk of stone recurrence because the diseased gallbladder is still in place. We therefore developed a means of performing a cholecystectomy through a laparoscope using laser technology, the results of which are compared here with the results in a series of "mini-lap" cholecystectomies that we also performed during the same time period.

Adult↗
PubMed1985

Air gun injuries in children.

Air gun injuries occur frequently in children and are potentially lethal. Three cases of air gun injuries in children are described. Two children sustained air gun injuries to the neck that penetrated the platysma. Each had exploration of the wound. One had injury to the esophagus that was treated with external drainage; the other sustained no major injury to vital cervical structures. A third child received a penetrating injury to her right flank that did not appear to enter the peritoneal cavity. She was observed for 24 hours and released. After a six-month followup, all patients have remained free of complications. The emergency physician should be aware of the penetrating capabilities of these weapons, and they should be managed as would any other low-velocity gunshot wound.

Abdominal Injuries↗
PubMed1979

Evaluation of the helicopter in aeromedical transfers.

Since the end of the Vietnam conflict, the technology of moving patients by helicopter has been applied to peacetime uses. There is doubt, however, that the helicopter has much to offer the patient when used as a routine and semi-emergency ambulance. This study reviewed 52 consecutive aeromedical evacuation requests which included both civilian and military patients. By comparing the patient's condition at both pickup, delivery and his subsequent course, it was determined that most patients would not have been unduly harmed by the slower methods of ground transfer. Only 33% of the patients were benefitted by rapid aeromedical transfer. Those patients benefitted can roughly be grouped as true surgical and medical emergencies. The use of the helicopter for routine transfers is to be discouraged.

Aircraft↗
PubMed1978

Movement by helicopter of patients with decompression sickness.

Rapid movement of a patient with decompression sickness sometimes poses problems when the site of the hyperbaric treatment facility is located a considerable distance away. Six cases of aviator decompression sickness were diagnosed in altitude chamber participants during an 18-month period. Five cases were uncomplicated decompression sickness and the sixth case was of central nervous system decompression sickness. All cases were transferred by low-level helicopter flight. No complications were noted when the helicopter stayed within 200 ft (61 m) AGL of the take-off point. Symptoms of decompression sickness did worsen however, when this altitude was exceeded. This study shows that movement of patients with decompression sickness by low-level helicopter flight is both safe and effective, especially when pressurized aircraft is neither available nor practical.

Adult↗
PubMed1977

Aeromedical evacuation.

Physicians who use aircraft to transport patients should be familiar with the general principles of altitude physiology, the basic characteristics of aircraft and the specific medical problems which are encountered in an aviation environment. Hypoxia, gas expansion and acceleration forces are common effects of air travel which must be anticipated and avoided in acutely ill patients. Provision of supplemental oxygen, use of decompressive tubes and proper positioning of the patient may obviate or minimize these problems.

Aerospace Medicine↗