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Kenneth S Azarow

Publications and source records attributed to Kenneth S Azarow.

11 recordsLinked to original sources
PubMed2006

From the combat medic to the forward surgical team: the Madigan model for improving trauma readiness of brigade combat teams fighting the Global War on Terror.

BACKGROUND: Medics assigned to combat units have a notable paucity of trauma experience. Our goal was to provide intense trauma refresher training for the conventional combat medic to better prepare them for combat casualty care in the War on Terror. MATERIALS AND METHODS: Our Tactical Combat Casualty Care Course (TC3) consisted of the following five phases: (1) One and one-half-day didactic session; (2) Half-day simulation portion with interactive human surgical simulators for anatomical correlation of procedures and team building; (3) Half-day of case presentations and triage scenarios from Iraq/Afghanistan and associated skills stations; (4) Half-day live tissue lab where procedures were performed on live anesthetized animals in a controlled environment; and (5) One-day field phase where live anesthetized animals and surgical simulators were combined in a real-time, field-training event to simulate realistic combat injuries, evacuation problems, and mass casualty scenarios. Data collection consisted of surveys, pre- and posttests, and after-action comments. RESULTS: A total of 1317 personnel participated in TC3 from October 2003 through May 2005. Over the overlapping study period from December 2004 to April 2005, 327 soldiers participated in the formal five-phase course. Three hundred four (94%) students were combat medics who were preparing for combat operations in Iraq or Afghanistan. Of those completing the training, 97% indicated their confidence and ability to treat combat casualties were markedly improved. Moreover, of those 140 medics who took the course and deployed to Iraq for 1 year, 99% indicated that the principles taught in the TC3 course helped with battlefield management of injured casualties during their deployment. CONCLUSION: The hybrid training model is an effective method for training medical personnel to deal with modern battle injuries. This course increases the knowledge and confidence of combat medics deploying and fighting the Global War on Terrorism.

Anesthesia↗
PubMed2006

Splanchnic perfusion pressure: a better predictor of safe primary closure than intraabdominal pressure in neonatal gastroschisis.

BACKGROUND/PURPOSE: Both measured intraabdominal pressure (IAP) and calculated splanchnic perfusion pressure (SPP) have been advocated for use in operative management of gastroschisis. We directly compared these 2 clinical indices. METHODS: Institutional review board-approved multi-institutional retrospective review from 3 centers with 112 subjects. Splanchnic perfusion pressure was recorded as mean arterial pressure-IAP. We compared the clinical utility of IAP and SPP using univariate and multivariate regression analyses. RESULTS: Calculated mean SPP was higher among neonates requiring silo placement compared to those without (39.0 +/- 1.9 vs 33.7 mm Hg, P < .01). Measured IAP levels were similar between groups (11.5 +/- 1.1 vs 10.0 +/- 0.5, mm Hg, P < .4). On a receiver operating characteristic curve, the inflection point for more than 90% specificity for silo placement was at an SPP of 44. In multivariate regression analysis adjusting for all factors below, SPP was independently associated with silo placement (odds ratio 1.2, 95% confidence interval 1.1-1.3, P < .01), and IAP was not (odds ratio 1.2, 95% confidence interval <1.0-1.5, P < .1). CONCLUSIONS: These data suggest that SPP is a stronger predictor than IAP for the ability to achieve primary closure in the management of neonatal gastroschisis. We infer from these data that intraoperative SPP of more than 43 mm Hg may obviate the need for silo placement.

Female↗
PubMed2005

The significance of incidental thyroid abnormalities identified during carotid duplex ultrasonography.

HYPOTHESIS: Incidental thyroid masses identified during carotid duplex ultrasonography may represent clinically significant lesions. DESIGN AND SETTING: Retrospective review of a prospective database in a tertiary care referral center. PATIENTS: A total of 2004 consecutive patients from January, 2000, through January, 2002, undergoing carotid duplex ultrasonography. INTERVENTIONS: After bilateral carotid duplex ultrasonography, selected patients additionally underwent 1 or more of the following: dedicated thyroid ultrasound, fine-needle aspiration biopsy, and/or partial or total thyroidectomy. MAIN OUTCOME MEASURES: The prevalence and type of thyroid abnormalities, correlation with a dedicated thyroid ultrasound, and results of histopathologic diagnosis. RESULTS: One or more thyroid abnormalities were identified in 188 duplexes (9.4%) involving 168 patients. Abnormalities were unilateral in 84 patients (50.6%) and bilateral in 81 patients (49.4%). Seventy-seven abnormalities (47%) were cystic, 72 (43%) were solid, and 16 (10%) were of mixed consistency. Sixty-six of the patients (40%) went on to have formal thyroid ultrasounds. Forty-five patients (70.3%) had masses greater than 1 cm on ultrasound. Based on ultrasound findings, 29 of 66 (44%) underwent fine-needle aspiration biopsy, with 13 of 66 (19.7%) eventually undergoing surgery. Surgical pathology included 5 patients with cancer (3 with papillary cancer, 2 with follicular cancer), 4 patients with a follicular adenoma, and 2 with lymphocytic thyroiditis). Two additional patients were discovered to have parathyroid adenomas following further workup and surgery. Thyroid abnormalities identified during carotid duplex ultrasonography correlated with formal ultrasound in 64 of 66 (97%) patients. Measurement of the thyroid mass by carotid duplex strongly correlated with measurement by formal thyroid ultrasound (r = 0.95, P<.001). Two patients with unilateral masses noted on carotid duplex had a normal thyroid formal ultrasound. CONCLUSIONS: Incidental thyroid abnormalities identified during carotid duplex ultrasound are common and contain clinically significant pathology. A multidisciplinary clinical pathway may facilitate the appropriate evaluation of these abnormalities.

Aged↗
PubMed2004

Is splanchnic perfusion pressure more predictive of outcome than intragastric pressure in neonates with gastroschisis?

BACKGROUND: The purpose of this study is to determine whether calculated splanchnic perfusion pressure (SPP) is more predictive of outcome than measured intragastric pressure (IGP) in patients with gastroschisis. METHODS: Retrospective chart review from 1997 through 2003 of 12 patients with gastroschisis. RESULTS: Eight total patients with gastroschisis underwent reduction and had adequate data for analysis. One patient underwent reduction on day of life (DOL) 6; the remainder underwent reduction on DOL 1. All patients had postreduction IGP <20 mm Hg. The correlation coefficient of IGP and date of extubation was 0.20 and of SPP and date of extubation was -0.51. The correlation coefficient of IGP and return of bowel function was -0.06 and of SPP and return of bowel function was -0.50. CONCLUSION: SPP may be more predictive of outcome than IGP after gastroschisis repair.

Abdomen↗
PubMed2004

A pilot study using total colonic manometry in the surgical evaluation of pediatric functional colonic obstruction.

BACKGROUND/PURPOSE: Total colonic manometry (TCM) can directly measure intraluminal pressures and contractile function of the entire colon. The utility of TCM to guide the surgical management of functional colonic obstruction has not been reported. METHODS: Total colonic manometry was performed on all patients referred for surgical evaluation of refractory functional colonic obstruction. Manometric tracings were obtained while fasting, after feeding, and after pharmacologic stimulation. RESULTS: Nine patients were referred for refractory colonic obstruction. The mean age was 4.8 years, and the mean duration of follow-up was 29 months. Two patients had functional obstruction after repair of Hirschsprung's disease, and 7 patients had idiopathic functional obstruction. In the idiopathic group, 4 distinct motility patterns were identified: (1) normal colonic motility, (2) dysmotility with massive distension, (3) persistent segmental dysmotility, and (4) global neuropathy/myopathy. Both Hirschsprung's patients showed globally abnormal motility. Surgical management was guided by TCM results. There was significant improvement in bowel function and weight gain after manometry-guided intervention. An unnecessary laparotomy was avoided in 2 patients. CONCLUSIONS: TCM can be valuable in deciding the need for and timing of diversion, the extent of resection required, and the suitability of the patient for restoring bowel continuity in refractory functional obstruction.

Adolescent↗
PubMed2003

Ethical use of tissue samples in genetic research.

Many centrally based cancer protocols have begun to address the ethical issues concerning tissue banking for genetic research. A multidisciplinary subcommittee of the Madigan Army Medical Center Institutional Review Board was established to determine the scope of the problem and offer a concise, user-friendly policy with guidelines on how to control and monitor the use of stored tissue for future genetic and molecular research. Our institution participates in 69 Southern Oncology Group or National Surgical Adjuvant Breast and Bowel Project protocols and 47 Children's Oncology Group protocols. Of these protocols, 22 of 69 and 36 of 47, respectively, asked for tissue to be stored for future biologic study. Only 4 of 69 and 3 of 47, respectively, deal with specific consent for future genetic/biologic research. The multidisciplinary committee developed a policy that dealt with the following areas: exempt status, waived consent, informed consent, deceased status, family studies, and information flow. An algorithm was created to establish a system of checks and balances concerning privacy, protection and an appeals process.

Adult↗
PubMedDate not supplied

Are Army-trained surgeons satisfied with their residencies?

OBJECTIVE: To evaluate the perceptions of training adequacy among surgeons educated in Army general surgical residencies as a tool for surgical program directors and students considering a military surgical career. DESIGN: A questionnaire was sent to all general surgeons practicing in the Army during years 1999-2003 (n = 182). In addition to providing basic demographic information, subjects rated their perceptions of training experience in 13 areas on a 5-point Likert scale (1 = very dissatisfied, 2 = somewhat dissatisfied, 3 = neither satisfied nor dissatisfied, 4 = somewhat satisfied, 5 = very satisfied). Respondents were split into 3 groups based on graduation year (1968-1992, 1993-1998, 1999-2003) and thereby roughly on status of military obligation at the time of survey. Scores were compared with analysis of variance. RESULTS: A total of 96 (52.7%) questionnaires were returned, 84 of which were included in this study. The average score for all graduation groups and satisfaction areas was 4.37 +/- 0.91. No differences occurred among the 3 graduation groups in any of the 13 satisfaction areas evaluated, except for pediatric surgery experience, where the most recent graduates rated their satisfaction lower than the other 2 groups (1968-1992, 4.00 +/- 0.61; 1993-1998, 3.96 +/- 1.14; 1999-2003, 3.21 +/- 1.27, p < 0.05). With respect to comparison among the 13 satisfaction areas, several areas of note are present. Satisfaction with training in care for basic surgical problems and the ability to make correct decisions are both higher than 5 other areas (p < 0.01). By contrast, satisfaction with number of cases performed, research training, and pediatric surgery training are lower than at least 3 of the other 12 areas (p < 0.01). CONCLUSION: Army trained general surgeons, from the most distant to recent graduates, are satisfied with their residencies. Lower satisfaction scores in the areas of number of cases performed, research experience, and pediatric surgery training do, however, highlight aspects for continued research and improvement.

Adult↗
PubMedDate not supplied

Intestinal fatty acid binding protein (I-FABP) for the detection of strangulated mechanical small bowel obstruction.

OBJECTIVE: Intestinal fatty acid binding protein (I-FABP), a protein released by necrotic enterocytes, is a useful marker for the detection of ischemia from mechanical small bowel obstruction. DESIGN: Validation cohort. SETTING: Academic medical center. PARTICIPANTS: Cohort of 21 patients admitted with a clinical diagnosis of mechanical small bowel obstruction. Plasma and urine samples were collected from patients upon hospital admission and again immediately before laparotomy if surgical intervention was delayed. RESULTS: Plasma and urine I-FABP levels (pg/ml by enzyme-linked immunosorbent assay) in patients found to have small bowel necrosis at the time of laparotomy were compared with those without significant ischemia upon laparotomy and those that did not require laparotomy and, by default, did not have small bowel ischemia. A positive test was defined as 1000-pg/ml I-FABP in urine and 100-pg/ml I-FABP in plasma. Small bowel necrosis was confirmed in 3 of 21 enrolled patients. Urine I-FABP levels were positive in 3 of 3 patients with necrosis and 3 of 18 patients without necrosis (sensitivity 100%, specificity 83%, PPV 50%, NPV 100%). Plasma I-FABP levels were positive in 3 of 3 patients with necrosis and 4 of 18 patients without necrosis (sensitivity 100%, specificity 78%, PPV 43%, NPV 100%). CONCLUSIONS: I-FABP is a sensitive marker for ischemia in mechanical small bowel obstruction. Additional work should be done to validate I-FABP in a variety of clinical settings and to develop a rapid I-FABP laboratory assay.

Aged↗