Benign biliary strictures: repair and outcome with a contemporary approach.

BACKGROUND: The Hepp-Couinaud technique is an innovative approach for repair of proximal biliary strictures. We have used this method selectively for bile duct reconstruction since 1982. Our aim was to analyze our experience with the surgical repair of benign biliary strictures in the decade since the Hepp-Couinaud technique has become an integral component of our surgical management strategy. METHODS: Seventy-two patients undergoing surgical repair of benign biliary stricture between 1983 and 1992 were reviewed retrospectively. A grading system on clinical symptoms, results of liver function studies, and need for reintervention was used to assess outcome. RESULTS: For the 27 patients with noniatrogenic strictures, followed up a mean of 3.9 years, excellent or good results (grade A or B) were obtained in 88.9%. For the 45 patients with iatrogenic strictures, followed up a mean of 4.6 years, 86.7% were categorized as grade A or B. The cumulative probability of anastomotic failure was significantly less for the 21 patients in whom the Hepp-Couinaud method was used when compared with the 24 patients in whom it was not (p = 0.032). Outcome was not influenced by age, time delay from injury to reconstruction, preoperative stenting, the number of previous repairs, or the duration of postoperative stenting. CONCLUSIONS: Surgical reconstruction affords excellent or good results for the vast majority of patients with benign biliary strictures. For proximal iatrogenic strictures superior anastomotic durability is achieved with the Hepp-Couinaud technique.

Medical staff resources model and methodology: ambulatory/outpatient services.

This paper describes a methodology that has practical applicability in the planning, implementation, and evaluation of ambulatory/outpatient services at site specific health care organizations. Fiscal year 1990 cost and reimbursement data are used for baseline values, however the methodology remains constant, for use in future years, by updating fiscal year by fiscal year as increases occur. This conceptual model can be used by military, other public sector, and civilian community health center ambulatory/outpatient services organizations that require 24 hour medical staff coverage, and economically feasible cost reimbursement accountability.

The Doctors Mayo and military medicine.

This paper has described an historical range of seldom known accomplishments that are directly attributable to the Doctors Mayo in the field of military medicine. Military service, selfless dedication, and a sense of genuine patriotism can be recognized and identified as instilled in the Mayo brothers by their father's example of service during the Civil War era. World War I presented an opportunity for the medical profession to receive important recognition and representation at the highest levels of national defense with the organization and establishment of the General Medical Board of the Council of National Defense. From its inception both Mayo brothers became alternating members of the Board's executive committee. Also, during World War I, a Mayo Clinic pathologist, Dr. Louis B. Wilson, pioneered field laboratory services and conducted a special study, at the request of the Surgeon General of the Army, on the caliber of the bullet used at that time. Dr. Wilson's tireless work after the war and dedication helped foster the evolution of the American College of Clinical Pathologists. The Doctors Mayo always kept a feeling of strong personal remembrance of, and gratitude for, the contributions of the American soldier in the cause of world peace and American prosperity. The Doctors Mayo were strategic thinkers when it came to National Defense, and it is with a feeling of almost haunting prophetic significance to consider their timeless wisdom on preparedness as a means to ensure peace.

The Federal Prisons' Mental Health Program 1930-1985.

This administrative history study examines the evolution of the Federal Bureau of Prisons Mental Health Program from an initial functional reliance on the medical model to expanded parameters of quasi-scientific behavioral and custodial administrative management of inmates.