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Thomas F Tracy

Publications and source records attributed to Thomas F Tracy.

5 recordsLinked to original sources
PubMed2003

In-line image projection accelerates task performance in laparoscopic appendectomy.

BACKGROUND: In laparoscopy, the monitor usually is placed at or above eye level across from the operating surgeon. Position of the endoscopic image at hand level has been shown in a laboratory model to facilitate task performance. The authors tested the hypothesis that in-line image projection reduced operating time for a standardized procedure. METHODS: Children undergoing laparoscopic appendectomy were assigned randomly according to video image position: (1) at the top of the laparoscopy tower in front of the surgeon ("overhead") or (2) on a screen placed on the patient's abdomen ("in-line"). Operating time was recorded for each operation, and patients were stratified according to severity of appendicitis and training level of the operating surgeon. Statistical analysis was performed using Student's t, chi2 tests, and analysis of variance with post-hoc Fisher test (P <.05. significant). RESULTS: One hundred eight children, aged 2 to 17 years, underwent a laparoscopic appendectomy during a 26-month period. Fifty-four were assigned to the in-line projection screen and 54 to the overhead monitor. Operating time was significantly shorter (P =.013) when in-line projection was used (46.8 +/- 10.2 v. 52.2 +/- 15.1 minutes with overhead monitor). By analysis of variance (ANOVA) the only factors that significantly affected operating time were use of in-line projection (P =.030), severity of appendicitis (P =.002), and training level of the operating surgeon (P =.047). CONCLUSIONS: Placing the endoscopic image in the same field as the surgeon's hands decreases operating time by 10%, even for procedures that, like appendectomy, do not require complex suturing skills. This decrease in operating time occurs independently of the surgeon's level of proficiency or the degree of difficulty of the operation.

Adolescent↗
PubMed2003

Small bowel obstruction in an adolescent with pelvic inflammatory disease due to Chlamydia trachomatis.

A 19-yr-old adolescent, who was hospitalized because of pelvic inflammatory disease (PID) due to Chlamydia trachomatis, developed bile-stained emesis. A mild amount of free fluid in the pelvis was found on abdominal ultrasound but there was no sonographic evidence of a pelvic mass or of a tubo-ovarian abscess. Plain radiography and computer tomography (with contrast) of the abdomen revealed a high-grade partial small bowel obstruction. Conservative treatment, which included intravenous fluids and antibiotics together with continuous bowel decompression via nasogastric tube, led to resolution of the small bowel obstruction within 2 days and to resumption of oral feeding within 4 days of treatment. Follow-up for 6 months after this episode was uneventful. The present case calls for inclusion of plain radiography of the abdomen in the evaluation of PID associated with emesis. It also suggests that, in a clinically stable patient diagnosed with small bowel obstruction associated with PID, conservative treatment could be attempted before any operative intervention is considered.

Adult↗
PubMed2002

Benefits of term delivery in infants with antenatally diagnosed gastroschisis.

OBJECTIVE: To test the hypothesis that term gestation offers the best outcome. The relationship between gestational age and the extent of bowel injury in fetuses with gastroschisis is a matter of debate. Early delivery and cesarean delivery have been recommended to limit intestinal damage, but their benefits are unclear. METHODS: Data on all patients with gastroschisis seen at our institution from 1991 through 2001 were included. Patients were compared based on gestational age: less than 35 weeks, 35-37 weeks, and term (more than 37 weeks) with regard to age at definitive closure, age at first and full feedings, and hospital stay. Statistical significance (P <.05) was determined by analysis of variance and chi(2) analysis. RESULTS: Of the 57 patients, 19.3%, 43.8%, and 36.9% were born at less than 35 weeks, 35-37 weeks, and more than 37 weeks, respectively. Age at definitive closure was significantly higher at 35-37 weeks (5.9 +/- 4.6 days) than at more than 37 weeks (1.5 +/- 2.3 days) and less than 35 weeks (2.6 +/- 2.5 days) (P <.05). A prosthetic pouch (silo) was used more often at 35-37 weeks than at more than 37 weeks or less than 35 weeks (P =.03, chi(2)). Age at first (P =.04) and full feedings (P <.01) and length of hospitalization (P <.01) were all significantly higher at 35-37 weeks than at more than 37 weeks. CONCLUSION: Based on a homogeneous cohort of patients in whom gastroschisis was diagnosed antenatally, term delivery results in earlier closure of the defect and shorter time to full feedings. The benefit of early delivery postulated by others cannot be substantiated.

Delivery, Obstetric↗