Splenic artery aneurysm: an important cause of hemoperitoneum and shock.

BACKGROUND: Splenic artery aneurysm ruptures are rare and highly morbid events that are frequently associated with pregnancy. However, approximately 15% may occur in men, and it is important to have this possibility in the differential diagnosis in cases of hemoperitoneum and hemorrhagic shock. Rapid diagnosis and treatment is essential to survival. OBJECTIVES: The aim of this report is to educate emergency physicians on the early recognition and treatment of this life-threatening event and to increase the awareness of this condition in male patients. CASE REPORT: We describe the evaluation and management of two cases of splenic artery rupture in male patients with unique presentations. CONCLUSION: Splenic artery aneurysm ruptures should be considered in the differential diagnosis in any patient with undifferentiated shock. Early diagnosis and treatment can save lives.

A multi-institutional study of the Family Conference Objective Structured Clinical Exam: a reliable assessment of professional communication.

BACKGROUND: To test the value of a simulated Family Conference Objective Structured Clinical Exam (OSCE) for resident assessment purposes, we examined the generalizability and construct validity of its scores in a multi-institutional study. METHODS: Thirty-four first-year (PG1) and 27 third-year (PG3) surgery residents (n = 61) from 6 training programs were tested. The OSCE consisted of 2 cases (End-of-Life [EOL] and Disclosure of Complications [DOC]). At each program, 2 clinicians and 2 standardized family members rated residents using case-specific tools. Performance was measured as the percentage of possible score obtained. We examined the generalizability of scores for each case separately. To assess construct validity, we compared PG1 with PG3 performance using repeated measures multivariate analysis of variance (MANOVA). RESULTS: The relative G-coefficient for EOL was .890. For DOC, the relative G-coefficient was .716. There were no significant performance differences between PG1 and PG3 residents. CONCLUSIONS: This OSCE provides reliable assessments suitable for formative evaluation of residents' interpersonal communication skills and professionalism.

Laparoscopic ventral hernia repair: are there comparative advantages over traditional methods of repair?

Recent studies have noted advantages of laparoscopic over open repair of ventral hernias. Because few reports have involved comparison with traditional repair we report a comparison between laparoscopic and open approaches. We retrospectively reviewed the records of patients undergoing ventral hernia repair over a 28-month period. Patients were grouped into three categories: laparoscopic repair with mesh, open repair with mesh, and open repair without mesh. There were 295 ventral hernia repairs and there was no difference in age, gender, operative complications, or hospital stay between the groups. Mesh and defect size was greater in the laparoscopic group. The overall postoperative complication rate was greater in the open group with mesh. Yet when specific wound complications were analyzed there was no difference between the groups. Furthermore a death occurred in the laparoscopic group from an unrecognized bowel injury. The recurrence rate was greatest in the open repair without mesh group. Finally hospital cost was greatest in the laparoscopic group and third-party reimbursement was better for the open techniques. We were unable to demonstrate a significant advantage to laparoscopic ventral hernia repair. Although many patients with large fascial defects were well served with this approach it may not be a better option for these patients.