Biomedical subjects
Thomas E Baudendistel
Publications and source records attributed to Thomas E Baudendistel.
Postoperative rhabdomyolysis following laparoscopic gastric bypass in the morbidly obese.
HYPOTHESIS: Laparoscopic approaches for weight reduction in the morbidly obese have become common with more than 50,000 bariatric surgical procedures being performed in 2001. The objective of this article is to raise awareness among surgeons of a new complication of rhabdomyolysis from this frequent procedure. DESIGN: Case series extracted from surgical database from January 2, 2001, through December 31, 2002. PATIENTS AND METHODS: We identified 5 cases of postoperative rhabdomyolysis in morbidly obese patients who underwent laparoscopic duodenal switch procedures with parietal gastrectomy. The cause, pathogenesis, and clinical features are reviewed and discussed. RESULTS: Postoperative rhabdomyolysis developed in 5 of 353 morbidly obese patients who underwent consecutive laparoscopic duodenal switch procedures, an incidence of 1.4%. All 5 patients were male, had a mean peak serum creatine kinase level of 19 680 U/L, and reported muscle pain in either the buttock, hip, or shoulder regions during the early postoperative period. CONCLUSIONS: We hypothesized that morbidly obese patients develop critical surface and deep tissue pressures during bariatric surgery, increasing their risk for tissue injury and rhabdomyolysis. Unexplained elevations in the serum creatinine level or reports of buttock, hip, or shoulder pain in the postoperative period should raise the possibility of rhabdomyolysis and prompt clinical investigation. We recommend routine preoperative and postoperative measurements of the serum creatine kinase and serum creatinine levels to aid detection. Surgeons need to keep a low index of suspicion because early diagnosis and treatment are the cornerstones of successful management of rhabdomyolysis.
Hypertensive crisis associated with venlafaxine.
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The evolution of the hospitalist movement in the USA.
The hospitalist movement represents a novel paradigm of health care delivery in the USA, its evolution hastened by a variety of financial, clinical, and time pressures. Hospitalists are site-defined specialists who spend the majority of their professional time practising in the hospital, and in this respect are similar to emergency medicine or critical care specialists. Community hospitals were the sites of early growth in hospitalist systems, and academic medical centres quickly followed suit. The field has grown rapidly, and now has its own textbook, professional society, training programme, and research and educational agenda. Published research to date has upheld the promise of the hospitalist model: improving efficiency of care by reducing length of stay and hospital costs without compromising quality or patient satisfaction. Future hospitalist research will aim to elucidate the role of hospitalists in the care of critically ill and surgical patients, identify the competencies that will ultimately define this specialty, and expand our understanding of key inpatient issues, such as prevention of nosocomial infections, end-of-life care, and hospital quality measurement.