Scholarly Output by Army General Surgery Residents.

INTRODUCTION: To characterize and compare the scholarly activity of applicants to Army First Year Graduate Medical Education (FYGME) general surgery positions over the course of a residency. METHODS: All applicants for the 2011-2012 Army FYGME positions in general surgery were included. Applications were used to obtain demographics and peer-reviewed publications. Publications were verified using PubMed and Google Scholar. Applicants were tracked for acceptance to a FYGME position, graduation from a general surgery program, and future publications. Comparisons were made between selectees and non-selectees. RESULTS: There were 46 applicants for 22 positions. Seven of the selectees (32%) had prior publications versus three non-selectees (12%; p < 0.109). Eighteen of the selectees went on to complete a general surgery residency by 2017. Of those who completed a general surgery residency, 16 (89%) have at least one publication with the mean number of publications of 4.0 versus 10 (43%), and of those not selected had at least one publication and the mean number of publications was 0.7 (p < 0.05). CONCLUSIONS: The majority of applications for general surgery residencies have no prior research publications. However, after 6 years, graduates of a general surgery residency have significantly published out those not selected for training.

Syndrome of inappropriate antidiuretic hormone associated with rectal small cell neuroendocrine carcinoma: a case report.

Neuroendocrine tumors can arise from any portion of the gastrointestinal tract including the colon and rectum. In the scope of all colon and rectal malignancies, they are a rare cause of colorectal carcinoma. Relating to their pluripotent neuroendocrine cellular origins these carcinomas can produce a variety of biologically active peptides with several resultant paraneoplastic syndromes. One of these paraneoplastic syndromes is the syndrome of inappropriate antidiuretic hormone (SIADH). In the SIADH, supraphysiologic levels of vasopressin (antidiuretic hormone, AVP) precipitates exorbitant free water retention and resultant electrolyte abnormalities, most notably hyponatremia. Herein we report a rare case of paraneoplastic SIADH from rectal small cell neuroendocrine carcinoma. To our knowledge, SIADH from rectal small cell neuroendocrine carcinoma has been reported only three times.

A Highly Predictive Model for Diagnosis of Colorectal Neoplasms Using Plasma MicroRNA: Improving Specificity and Sensitivity.

OBJECTIVE: To develop a plasma-based microRNA (miRNA) diagnostic assay specific for colorectal neoplasms, building upon our prior work. BACKGROUND: Colorectal neoplasms [colorectal cancer (CRC) and colorectal advanced adenoma (CAA)] frequently develop in individuals at ages when other common cancers also occur. Current screening methods lack sensitivity, specificity, and have poor patient compliance. METHODS: Plasma was screened for 380 miRNAs using microfluidic array technology from a "Training" cohort of 60 patients, (10 each) control, CRC, CAA, breast cancer, pancreatic cancer, and lung cancer. We identified uniquely dysregulated miRNAs specific for colorectal neoplasia (P < 0.05, false discovery rate: 5%, adjusted α = 0.0038). These miRNAs were evaluated using single assays in a "Test" cohort of 120 patients. A mathematical model was developed to predict blinded sample identity in a 150 patient "Validation" cohort using repeat-sub-sampling validation of the testing dataset with 1000 iterations each to assess model detection accuracy. RESULTS: Seven miRNAs (miR-21, miR-29c, miR-122, miR-192, miR-346, miR-372, and miR-374a) were selected based upon P value, area under the curve (AUC), fold change, and biological plausibility. Area under the curve (±95% confidence interval) for "Test" cohort comparisons were 0.91 (0.85-0.96) between all neoplasia and controls, 0.79 (0.70-0.88) between colorectal neoplasia and other cancers, and 0.98 (0.96-1.0) between CRC and colorectal adenomas. In our "Validation" cohort, our mathematical model predicted blinded sample identity with 69% to 77% accuracy, 67% to 76% accuracy, and 86% to 90% accuracy for each comparison, respectively. CONCLUSIONS: Our plasma miRNA assay and prediction model differentiate colorectal neoplasia from patients with other neoplasms and from controls with higher sensitivity and specificity compared with current clinical standards.

Isolated perivesicular hematoma after military parachuting.

BACKGROUND: Isolated perivesicular hematomas are uncommonly described and not an injury typically reported in the literature after parachuting or skydiving. CASE REPORT: Herein, we described a series of three patients with isolated perivesicular hematomas sustained after military parachuting. All three patients were managed nonoperatively after a somewhat prolonged hospital course. Despite the lack of orthopedic injuries, all required physical therapy consultation and required an assisting device to aide with ambulation at the time of discharge. For all three individuals, follow-up imaging months after the injury demonstrated a continued presence of the hematoma. Clinically, the patients continued to have ambulatory and urological difficulties for several months after their injury. DISCUSSION: This injury pattern is uncommonly reported in the literature. An appropriate index of suspicion must be maintained or there may be a delay in diagnosis. Management of these injuries requires coordinated care between the trauma service, urology, and physical therapy.

Impact of implementation of the Surgical Care Improvement Project and future strategies for improving quality in surgery.

BACKGROUND: We present a comprehensive systematic review of the effect of Surgical Care Improvement Project (SCIP) measures on surgical site infections (SSIs) as related to SCIP compliance. DATA SOURCES: A systematic review of the peer-reviewed literature was performed on PubMed, Medline, and Cochrane database group using their own search engines. Keywords used were Surgical Care Improvement Project (SCIP), adherence, compliance, surgical site infection (SSI), infection bundle, antibiotics, perioperative antibiotics, and combinations thereof. Furthermore, reference lists of selected articles were cross-searched for additional literature. Papers published from January 1, 1998 to January 1, 2014 were included. RESULTS: A comprehensive analysis of these data demonstrated an 18% decrease in the odds of developing SSI and a cumulative 4% decrease in SSI. The largest increases in compliance for individual SCIP measures were reported between 2004 and 2006. However, compliance with multiple measures simultaneously had the sharpest increase between 2006 and 2009 without a definitive asymptote ascertained from the current data. CONCLUSIONS: These results represent some positive progress toward the SCIP task force's 2006 goal of a 25% decrease in SSI by 2010. Suggestions for improved future papers in this area were also added.

Planned delayed operation for barium extravasation into the peritoneal cavity.

BACKGROUND: Extravasation of barium into the peritoneal cavity occurs rarely but has lethal results. CASE: We describe a case of extravasation from the small bowel that was initially managed medically before a planned, delayed operation. We discuss the benefit/risk of delayed operation and reoperation.

Crohn's disease: presentation and severity compared between black patients and white patients.

PURPOSE: Common belief based on clinical experience suggests that Crohn's disease is more severe among black patients, although little data exists on the effect of race on Crohn's disease. We compared multiple variables among black patients with Crohn's disease requiring surgery to those of white patients presenting to a university colorectal surgery unit during a five-year period. METHODS: A total of 345 patients required surgery for Crohn's disease between June 1998 and September 2003. The following data were abstracted from patient charts and a prospectively maintained database: age at diagnosis; age at first Crohn's disease surgery; presenting symptoms; incidence, number and location of fistulas at presentation; number of Crohn's disease operations; and family history of inflammatory bowel disease. Data regarding medical insurance coverage also were obtained. Complete data were evaluable on 178 patients. Patient variables were analyzed using the chi-squared, Fisher exact, and Student t-tests. RESULTS: Mean age at diagnosis was 28 years for white males, 20 years for black males, 30 years for white females, and 28 years for black females (all p > 0.05). Thirty-seven percent of white females presented with obstructive symptoms vs. 12 percent of black females. (P = 0.011). Sixty-five percent of black females presented with inflammatory symptoms compared with 28 percent of white females (P = 0.001). Of females presenting with fistulas, 15 percent of black patients had a rectovaginal fistula compared with 5 percent of white patients. Seventeen percent of black males and 21 percent of white males had intra-abdominal fistulas. None of these differences were statistically significant. The incidence of fistulas at presentation, mean number of fistulas, total number of operations, and family history of inflammatory bowel disease did not differ. CONCLUSIONS: Contrary to expectations, Crohn's disease does not seem to be more severe among black patients, who had an earlier age of diagnosis, although this was not statistically significant. Overall, there was no difference in disease presentation. White females were more likely to present with obstructive symptoms compared with black females, who more often presented with inflammatory symptoms. Among patients with fistulas, the incidence of rectovaginal fistulas was higher in black females compared with white females, and white males were somewhat more likely to have intra-abdominal fistulas than black males. Although there was no demonstrated difference in incidence and mean number of fistulas at presentation, the number of operations for Crohn's disease, or family history of inflammatory bowel disease among blacks and whites, there are differences in presenting symptoms among these populations.