T S Helling

University of Mississippi Medical Center, Jackson, MS, United States

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Publications (105)277.84 Total impact

  • Thomas S Helling, Magdeline Martin
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    ABSTRACT: Surgically directed therapy for liver metastases from colorectal cancer (CRC) has received substantial attention in the literature as a major focus of treatment for metastatic CRC. It is presumed, but not proven, that liver metastases are a major threat to life. This study examined the course of a cohort of consecutive patients who died with CRC to determine the role played by the presence of liver metastases. This is single-institution retrospective observational study involved all patients who died of CRC. Records were examined and imaging studies reviewed to determine the extent of liver and extrahepatic metastases in these patients. Overall survival in patients with and without liver metastases and those in whom liver metastases were thought to contribute to death was determined. After patient exclusions, the study population totaled 121 patients. There were 75 patients (62 %) with liver metastases at death. In 40 of 75 (53 %) patients, the liver metastases contributed to the patients' death. In 46 of 121 patients (38 %), metastatic disease did not include liver metastases. Overall survival in patients with and without liver metastases (median survival 12 vs. 8.5 months, p = 0.089) and in those whose liver metastases did or did not contribute to death (median survival 11.5 vs. 14 months, p = 0.361) was not significant. The presence of liver metastases seemed to contribute to death in approximately half of the study patients, although there did not appear to be a survival disadvantage in these patients.
    Annals of Surgical Oncology 10/2013; · 4.12 Impact Factor
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    ABSTRACT: Objective. This study evaluates treatment of gastroparesis patients refractory to gastric electrical stimulation (GES) therapy with surgical replacement of the entire GES system. Summary Background Data. Some patients who have symptomatic improvement with GES later develop recurrent symptoms. Some patients improve by simply altering pulse parameter settings. Others continue to have symptoms with maximized pulse parameters. For these patients, we have shown that surgical implantation of a new device and leads at a different gastric location will improve symptoms of gastroparesis. Methods. This study evaluates 15 patients with recurrent symptoms after initial GES therapy who subsequently received a second GES system. Positive response to GES replacement therapy is evaluated by symptoms scores for vomiting, nausea, epigastric pain, early satiety, and bloating using a modified Likert score system, 0 to 4. Results. Total symptom scores improved for 12 of 15 patients with GES replacement surgery. Total score for the replacement group decreased from 17.3 ± 1.6 to 13.6 ± 3.7 with a difference of 3.6 (P value = .017). This score is compared with that of the control group with a preoperative symptom score of 15.8 ± 3.6 and postoperative score of 12.3 ± 3.5 with a difference of 3.5 (P value = .011). The control group showed a 20.3% decrease in mean total symptoms score, whereas the study group showed a 22.5% decrease in mean with an absolute reduction of 2.2. Conclusion. Reimplantation of a GES at a new gastric location should be considered a viable option for patients who have initially failed GES therapy for gastroparesis.
    Surgical Innovation 09/2013; · 1.54 Impact Factor
  • Thomas S Helling
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    ABSTRACT: Carbohydrate antigen (CA) 19.9 is a Lewis blood group oligosaccharide antigen which exists in fixed and soluble forms. The CA 19.9 antigen is synthesized by epithelial cells of the gastrointestinal tract, pancreatic duct, and biliary tree. The CA 19.9 antigen is commonly used as a tumor marker for malignancies of the pancreas and biliary tract. High levels (> 300 U/ml) of antigen have strongly suggested malignant processes. Four patients are described with markedly elevated levels of CA 19.9 due to benign calculous disease. Three of four patients underwent endoscopic stone removal followed by cholecystectomy; the fourth patient spontaneously passed stones and had a subsequent cholecystectomy with benign inflammatory pathology. Removal or passage of the obstructing stones produced normalization of the CA 19.9 in each case even with long-term follow-up up to one year. All pathology specimens were interpreted as benign. Marked elevations of CA 19.9 may be found in benign obstructive disease and should be interpreted with caution until biliary obstruction is relieved.
    Journal of the Mississippi State Medical Association 04/2013; 54(4):96-9.
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    ABSTRACT: Background Unexpected clinical deterioration (failure events) in surgical patients on standard nursing units (WARDs) could have a significant impact on eventual survival. We sought to investigate failure events requiring intensive care (SICU) transfer of surgical patients on standard nursing units (WARDs) in a single center academic setting Study Design Surgical patients admitted to WARDs over a 12 month period who developed failure events were retrospectively reviewed. Time to deterioration since WARD arrival, clinical factors, notification chain, and outcome were identified. A physician review panel determined the preventability of failure events. Results Ninety-eight patients experienced 111 failure events requiring SICU transfer. Most patients (85%) were emergency admissions. Of 111 events, 90% had been previously discharged from SICU or Post Anesthesia Care Unit (PACU). Recognition of failure was by nursing (54%) and on routine physician rounds (34%). Rapid response or code blue alone was less common (12%). A second physician notification was needed in 29% with delays due to failure to identify severity of illness. Most commonly respiratory events prompted notification (77/111, 69%). The overall mortality was 26/98 (27%). The median time to failure was 2 days and was associated with early transfer from SICU or PACU. Rapid response or code blue activation was associated with higher mortality than physician notification. Conclusions Patients most at risk for WARD failures were those with acute surgical emergencies or recently discharged from SICU/PACU. Respiratory complications were the most common cause of WARD failure events. Many early failures may have been due to premature transfer from SICU/PACU. Failure events on WARDs can have lethal consequences. Awareness, monitoring, and communication are important components of preventative measures
    Journal of the American College of Surgeons 01/2013; · 4.50 Impact Factor
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    ABSTRACT: INTRODUCTION: This study evaluates the modeling of gastric electrophysiology tracings during long-term gastric electrical stimulation for gastroparesis. We hypothesized that serosal electrogastrogram may change over time representing gastric remodeling from gastric stimulation. PATIENTS: Sixty-five patients with gastroparesis underwent placement of gastric stimulator for refractory symptoms. Mean age at initial stimulator placement was 44 years (range, 8-76), current mean age was 49, and the majority of the subjects were female (n = 51, 78 %). Only a minority had diabetes-induced gastroparesis (n = 16, 25 %); the remainder were either idiopathic or postsurgical. METHODS: At the time of stimulator placement, electrogastrogram was performed after the gastric leads were placed but before stimulation was begun. Patients underwent continuous stimulation until pacer batteries depleted. At the time of replacement, before the new pacemaker was attached, electrogastrogram was again performed. RESULTS: After a mean of 3.9 years of stimulation therapy, the mean of baseline frequency before stimulation therapy was 5.06 cycles/min and declined to 3.66 after replacement (p = 0.0000002). The mean amplitude was 0.33 mV before stimulation therapy and decreased to 0.31 mV (p = 0.73). The frequency/amplitude ratio was 38.4 before stimulation therapy and decreased to 21.9 (p = 0.001). CONCLUSION: Long-term gastric electrical stimulation causes improvement in basal unstimulated gastric frequency to near normal.
    Journal of Gastrointestinal Surgery 09/2012; · 2.36 Impact Factor
  • T S Helling
    British Journal of Surgery 03/2012; 99(3):345. · 4.84 Impact Factor
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    ABSTRACT: Ectopic liver is defined as liver parenchyma situated outside the liver proper with no connection to native hepatic tissue. This rare developmental anomaly is most commonly described as an attachment to the gallbladder with an incidence <0.3%, but it has been reported in other locations within the abdomen and thorax.(2-4) Most cases are found incidentally in asymptomatic patients, but ectopic liver has been known to cause visceral or vascular obstruction.(4,5) Herein we present a unique case of ectopic liver attached by a thin stalk seemingly floating in the suprahepatic inferior vena cava.
    Journal of vascular surgery: official publication, the Society for Vascular Surgery [and] International Society for Cardiovascular Surgery, North American Chapter 02/2012; 55(6):1759-61. · 3.52 Impact Factor
  • Thomas S Helling, Flavia Davit, Kim Edwards
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    ABSTRACT: Rural trauma has been associated with higher mortality because of a number of geographic and demographic factors. Many victims, of necessity, are first cared for in nearby hospitals, many of which are not designated trauma centers (TCs), and then transferred to identified TCs. This first echelon care might adversely affect eventual outcome. We have sought to examine the fate of trauma patients transferred after first echelon hospital evaluation and treatment. All trauma patients transferred (referred group) to a Pennsylvania Level I TC located in a geographically isolated and rural setting during a 68-month period were retrospectively compared with patients transported directly to the TC (direct group). Outcome measures included mortality, complications, physiologic parameters on arrival at the TC, operations within 6 hours of arrival at the TC, discharge disposition from the TC, and functional outcome. Patients with an injury severity score <9 and those discharged from the TC within 24 hours were excluded. During the study period, 2,388 patients were transported directly and 529 were transferred. Mortality between groups was not different: 6% (referred) versus 9% (direct), p = 0.074. Occurrence of complications was not different between the two groups. Physiologic parameters (systolic blood pressure, heart rate, and Glasgow Coma Scale score) at admission to the Level I TC differed statistically between the two groups but seemed near equivalent clinically. Sixteen percent of patients required an operative procedure within 6 hours in the direct group compared with 10% in the referral group (p = 0.001). Hospital and intensive care unit length of stay were less in the referred group, although this was not statistically significant. Performance scores on discharge were equivalent in all categories except transfer ability. Time from injury to definitive care (TC) was 1.6 hours ± 3.0 hours in the direct group and 5.3 hours ± 3.8 hours in the referred group (p < 0.0001). The most common procedure performed at first echelon hospitals was airway control (55% of referred patients). In this rural setting, care at first echelon hospitals, most (95%) of which were not designated TCs, seemed to augment, rather than detract from, favorable outcomes realized after definitive care at the TC.
    The Journal of trauma 12/2010; 69(6):1362-6. · 2.35 Impact Factor
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    ABSTRACT: Resident duty hour restriction was instituted to improve patient safety, but actual impact on patient care is unclear. We sought to determine the effect of duty hour restriction on trauma outcomes in Level I trauma centers (TCs; surgery residency programs) versus Level II TCs (those with no surgery residency programs) within the state of Pennsylvania, using noninferiority as our hypothesis testing. Outcomes (mortality and length of stay [LOS]) were compared in Level II TCs without surgery residencies (n = 7) with Level I TCs (with surgery residencies; n = 14) PRE80 (2001-2003) and POST80 (2004-2007). The subcategories of critically injured patients, Injury Severity Score (ISS) >15, ISS >25, Trauma and Injury Severity Score (TRISS) ≤ 50, Abbreviated Injury Scale (AIS) head/chest/abdomen score >3, age >65 years, mechanism, and shock, functioned as outcome predictors. There was a decrease in mortality overall PRE80 to POST80 for Level I and II TCs. There was a decrease in mortality in Level I TCs POST80 in ISS >15 (16.5% vs. 14.8%, p = 0.0001), AIS (head) score >3 (20.8% vs. 17.8%, p < 0.0001), age >65 years (12.2% vs. 10.7%, p = 0.0013), and blunt mechanism (5.2% vs. 4.6%, p = 0.0004). LOS was reduced in ISS >15, AIS (head) score >3, age >65 years, and penetrating mechanism in Level I TCs POST80. A similar but more profound decrease was also seen in Level II TCs PRE80 and POST80 (ISS >15, 25; AIS (head) score; shock; blunt mechanism; and TRISS ≤ 50). Testing for inhomogeneity identified less-severely injured patients at Level II TCs POST80 compared with Level I TCs in certain subcategories (ISS >15, 25; AIS (head) score; shock; blunt mechanism; and TRISS ≤ 50) regarding mortality and LOS (TRISS >50%). Decreases in mortality and LOS during the study periods were likely not related to resident work hour restriction but rather to overall improvement in outcomes seen at Level II (no residents) and Level I (residents) TCs. Resident work hour restrictions had no discernible effect on patient care (noninferiority).
    The Journal of trauma 09/2010; 69(3):607-12; discussion 612-3. · 2.35 Impact Factor
  • The American surgeon 05/2010; 76(5):E15-6. · 0.92 Impact Factor
  • Thomas S Helling
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    ABSTRACT: Pancreatic cancer remains a deadly disease. Currently, the only hope for cure is surgical resection at an early stage of the disease. However, there is evidence that many individuals do not receive this treatment, perhaps because of health care disparities. Mississippi, because of its socioeconomic composition, has been the focus of concern for health care disparities. In order to determine whether such disparities exist in Mississippi for pancreatic cancer, a retrospective analysis was done from 2000 2006 of case diagnosis, treatment, and mortality from this disease. The Mississippi Cancer Registry, the American College of Surgeons (ACS) National Cancer Data Base (NCDB), and the National Cancer Institute (NCI) Surveillance Epidemiology and End Results (SEER) program were surveyed. Outcomes at all 12 ACS Commission on Cancer (CoC) accredited hospitals within the state were compared to the NCDB nationwide (n=1331 hospitals). In 2006 Mississippi had the highest death rate from pancreas cancer in the nation (12.7/100,000). Age-adjusted incidence by county ranged to a high of 26.91/100,000. Fifty-one percent of patients who died from pancreatic cancer in the state were treated at ACS CoC hospitals. The fate of the other 49% is not known. Of the patients tracked at CoC hospitals, there was essentially no significant difference with respect to age distribution, stage at diagnosis, or first treatment modalities when compared to NCDB nationwide CoC data. There were fewer patients surviving two years with locally advanced disease compared to national figures. Of concern was the large number of patients whose treatment for pancreatic cancer is unknown. It is incumbent on health care providers in the state to develop a system of care for pancreatic cancer that is accessible, inclusive, and comprehensive.
    Journal of the Mississippi State Medical Association 04/2010; 51(4):99-103.
  • Thomas S Helling
    Surgery 03/2010; 147(3):313-7. · 3.37 Impact Factor
  • Gastroenterology 01/2010; 138(5). · 12.82 Impact Factor
  • Roman Grinberg, Thomas S Helling
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    ABSTRACT: Postoperative hemorrhage (PH) that requires reoperation to control bleeding represents a potentially life-threatening and avoidable complication that could have serious implications for recovery. All surgical patients were reviewed who developed PH and required reoperation for control of hemorrhage over a 12-year period, to examine contributing factors possibly related to surgeon misadventure. Of 89,663 operations during this period, there were 1,031 patients (1.2%) who developed PH. Of these, 36 patients required reoperation for control of PH (0.04%), including, general surgery (17), otolaryngologic (9), cardiovascular (9), and gynecologic (1) patients. In 27 general, cardiovascular, and gynecologic patients (29 reoperations), the age ranged from 6 to 91 years. Almost one-half of patients (56%) developing PH were on preoperative anticoagulation. Estimated operative blood loss (EBL) was moderate (EBL = 100-500 mL, 48%). Most patients were normothermic (80%) and normotensive (93%) intraoperatively. The decision to reoperate was not made for at least 8 hours in 55 per cent of patients. At reoperation 10/29 patients were hypotensive. In 20/36 patients (56%) the reoperation note did not identify a single source of bleeding. PH is a distinctly uncommon complication of surgery and often not due to obvious surgeon misadventure. Reoperation for PH is even rarer and embarked upon with reluctance, frequently not yielding a discernible cause for hemorrhage.
    The American surgeon 12/2009; 75(12):1242-6. · 0.92 Impact Factor
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    ABSTRACT: The use of permanent inferior vena cava filters (IVCFs) offers protection against pulmonary embolism (PE) but increases the long-term risk of deep vein thrombosis (DVT) and does not affect long-term mortality. The use of retrievable IVCFs in trauma patients offers the dual advantage of protection against PE during the risk period and the option of filter removal thus avoiding complications of DVT. Despite the safety of removal, it is likely that many of these retrievable filters are not removed. This was a retrospective, single-center, observational cohort study at a rural level I trauma center. We sought to investigate the number of patients and the circumstances under which retrievable IVCFs were placed and removed. During a 4-year period, 3,455 trauma patients were admitted and 125 patients had retrievable IVCFs placed (71 therapeutic and 54 prophylactic). The most common indications were traumatic brain and spinal cord injuries (66%). During in-hospital filter use, there were 36 new incidences (29%) of PE (1) and DVT (35). Nine patients died before removal. In 40 patients (32%), removal was attempted, and 32 (26%) retrievable IVCFs were successfully removed and in most patients (76%) within 180 days of insertion. Seventeen patients were transferred out of the area for extended care and lost to follow-up. In 55 patients, the filters were not removed. In 20 patients, the surgeon decided against removal. Thirty patients were transferred to extended care or rehabilitation within the community, but they did not return for removal. Thus, of 108/125 patients with follow-up, 76 patients (70%) did not have their IVCFs removed, and 50 patients did not have their IVCFs removed because of the choice of the surgeon, extended care, or rehabilitation. The use of retrievable IVCFs, when necessary, produced predictable protection against PE and DVT complications. Despite the opportunity for removal, most patients, in fact, did not have their filters removed, even when posthospital care could be tracked. The practices of the surgeon, the transfer to extended-care facilities, near or far, and the reluctance to remove long-standing IVCFs contributed to the high-retention rate.
    The Journal of trauma 12/2009; 67(6):1293-6. · 2.35 Impact Factor
  • Thomas S Helling, Russell D Dumire, Kim Augustosky
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    ABSTRACT: Teaching physicians and academic medical centers may find it more difficult to meet clinical productivity expectations and still contribute to scholarly activity in the present economic climate of health care. A multiquestion survey was developed and distributed via the Association of Program Directors in Surgery list-serve. There were 80 respondents (31% response rate), 29 university program (UP), 43 independent program (IP), and 8 "other." Although most programs had designated teaching faculty (72% UP, 93% IP), the trend was not to compensate for scholarly activity whether voluntary (100% UP, 91% IP), employed (82% UP, 74% IP), or contracted (57% UP, 85% IP; P = not specified). Most (69% UP, 75% IP) programs had no incentives for scholarly activities, despite dissatisfaction with involvement of volunteer faculty (19% UP, 55% IP; P = .04). Most compensation plans (79% UP, 66% IP) were discretionary or atypical. Most programs, UP and IP, did not compensate for scholarly activity for teaching faculty. There was a significant proportion that believed compensation would improve teaching efforts.
    American journal of surgery 04/2009; 197(3):360-4. · 2.36 Impact Factor
  • Thomas S. Helling, Michael R. Ward, Jennifer Balon
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    ABSTRACT: Background: Computed tomography (CT) has become the preferred method for evaluation of the abdomen for victims of blunt trauma. Grading of liver injuries, primarily by CT, has been advocated as a measure of severity and, by implication, the likelihood for intervention or complications. We have sought to determine if grading of liver injuries, as a clinical tool, affects immediate or extended management of patients. Methods: We have retrospectively reviewed all patients sustaining blunt liver injuries as diagnosed by CT over a five-year period at a Level I trauma center to determine if grading of injury influenced management. The AAST organ scaling system was utilized (major grade 4–5, minor grade 1–3), as well as the ISS, AIS, mortality, morbidity, and treatment. There were 133 patients available for review. The patients were grouped into major (n = 20) and minor (n = 113) liver injuries and operative (n = 12) and nonoperative (n = 121) management. Results: Major liver injuries had a higher ISS (39 + 13 vs. 27 + 15, p = 0.001) and were more likely to require operative intervention (5/20 vs. 7/113, p = 0.02). Mortality in this group was not different (major vs. minor), and there were no differences in the incidence of complications. Twelve patients (9%) required operation, all for hemodynamic instability, all within 24 h, and 11/12 within 6 h. At operation 8/12 patients had other sources of bleeding beside the liver injury, and 7/12 had minor hepatic injuries. The operative patients had higher ISS and AIS scores (head/neck, chest, abdomen, extremities) than those managed nonoperatively. More patients died in the operative group (6/12 vs. 8/121, p = 0.0003). There were more pulmonary (6/12 vs. 16/121, p = 0.005), cardiovascular (6/12 vs. 19/121, p = 0.01), and infectious (5/12 vs. 20/121, p = 0.049) complications in the operative group. There were 14 deaths overall; 13/14 were due to traumatic brain injury, and 8/14 required urgent operation for hemorrhage. Conclusions: In conclusion, grading of liver injuries does not seem to influence immediate management. Physiologic behavior dictated management and need for operative intervention, as well as prognosis. However, both major hepatic injuries and need for early operation reflected overall severity and the possibility of associated injuries.
    European Journal of Trauma and Emergency Surgery 01/2009; 35(2):95-101. · 0.26 Impact Factor
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    ABSTRACT: Medication errors during hospitalization can lead to adverse drug events. Because of preoccupation by health care providers with life-threatening injuries, trauma patients may be particularly prone to medication errors. Medication reconciliation on admission can result in decreased medication errors and adverse drug events in this patient population. The purpose of this study is to determine the accuracy of medication histories obtained on trauma patients by initial health care providers compared to a medication reconciliation process by a designated clinical pharmacist after the patient's admission and secondarily to determine whether trauma-associated factors affected medication accuracy. This was a prospective enrollment study during 13 months in which trauma patients admitted to a Level I trauma center were enrolled in a stepwise medication reconciliation process by the clinical pharmacist. The setting was a rural Level I trauma center. Patients admitted to the trauma service were studied. The intervention was medication reconciliation by a clinical pharmacist. The main outcome measure was accuracy of medication history by initial trauma health care providers compared to a medication reconciliation process by a clinical pharmacist who compared all sources, including telephone calls to pharmacies. Patients taking no medications (whether correctly identified as such or not) were not analyzed in these results. Variables examined included admission medication list accuracy, age, trauma team activation mode, Injury Severity Score, and Glasgow Coma Scale (GCS) score. Two hundred thirty-four patients were enrolled. Eighty-four of 234 patients (36%) had an Injury Severity Score greater than 15. Medications were reconciled within an average of 3 days of admission (range 1 to 8) by the clinical pharmacist. Overall, medications as reconciled by the clinical pharmacist were recorded correctly for 15% of patients. Admission trauma team medication lists were inaccurate in 224 of 234 cases (96%). Admitting nurses' lists were more accurate than the trauma team's (11% versus 4%; 95% confidence interval 2.5% to 11.2%). Errors were found by the clinical pharmacist in medication name, strength, route, and frequency. No patients (0/20) with admission GCS less than 13 had accurate medication lists. Seventy of 84 patients (83%) with an Injury Severity Score greater than 15 had inaccurate medication lists. Ten of 234 patients (4%) were ordered wrong medications, and 1 adverse drug event (hypoglycemia) occurred. The median duration of the reconciliation process was 2 days. Only 12% of cases were completed in 1 day, and almost 25% required 3 or more (maximum 8) days. This study showed that medication history recorded on admission was inaccurate. This patient population overall was susceptible to medication inaccuracies from multiple sources, even with duplication of medication histories by initial health care providers. Medication reconciliation for trauma patients by a clinical pharmacist may improve safety and prevent adverse drug events but did not occur quickly in this setting.
    Annals of emergency medicine 07/2008; 52(5):483-91. · 4.23 Impact Factor
  • Thomas S Helling, Anjay Khandelwal
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    ABSTRACT: Operations on the liver and pancreas have fallen within the domain of the general surgeon and have been part of general surgery training. The more complex procedures involving these organs are limited in number in most general surgery residencies and do not afford an opportunity for vast experience. Moreover, fellowship programs in hepato-bilio-pancreatic (HPB) surgery and the development of laparoscopic techniques may have further limited the familiarity of general surgery residents with these operations. To determine the experience accrued by finishing general surgery residents, we accessed, through the Residency Review Committee of the Accreditation Council for Graduate Medical Education, the Resident Case Log System used by general surgery residents throughout their training to document operative cases. The number of operations on the gallbladder, bile ducts, pancreas, and liver was examined over the past 16 years (there were missing data for 3 years). Reference years 1995 and 2005 were compared to detect trends. Experience with laparoscopic cholecystectomy has steadily increased and averaged more than 100 cases in 2006. Experience in liver resection, distal pancreatectomy, and partial (Whipple) pancreatectomy has statistically improved from 1995 to 2005, but the numbers of cases are low, generally less than five per finishing resident. Experience in open common bile duct and choledocho-enteric anastomoses has statistically declined from 1995 to 2005, averaging less than four cases per finishing resident. The mode (most frequently performed number) for liver and pancreas resections was either 0 or 1. It is doubtful this experience in HPB surgery engenders confidence in many finishing residents. Attention should be focused on augmenting training in HPB surgery for general surgery residents perhaps through a combination of programmatic initiatives, ex vivo experiences, and minifellowships. Institutional initiatives might consist of defined HPB services with appropriate expertise, infrastructure, process, and outcome measures in which a resident-oriented, competency-based curriculum could be developed.
    Journal of Gastrointestinal Surgery 02/2008; 12(1):153-8. · 2.36 Impact Factor
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    ABSTRACT: Nonalcoholic fatty liver disease is a frequent accompaniment of morbid obesity. A component of nonalcoholic fatty liver disease, steatosis, can, on occasion, lead to nonalcoholic steatohepatitis (NASH). Bariatric surgery has been shown to alter the course of this disease. Intraoperative liver biopsies might identify patients with NASH for more careful follow-up. We sought to determine noninvasive preoperative indicators of NASH. The patients scheduled for bariatric surgery underwent a preoperative assessment. The study variables included age, gender, race, body mass index, diabetes mellitus, hypertension, and the results of serum liver function tests and triglyceride, cholesterol, iron, and prealbumin measurements. Univariate and multivariate analyses were performed to identify significant variables associated with NASH as determined by subsequent core liver biopsies taken during open Roux-en-Y gastric bypass. A total of 139 patients were entered into the study. NASH or NASH-associated fibrosis was found in 57 patients (41%). On univariate analyses, male gender (odds ratio [OR] 2.46, P = .06), diabetes mellitus (OR 2.60, P = .009), elevated serum triglyceride levels (OR 1.003, P = .02), elevated gamma glutamyl transferase (OR 1.015, P = .01), and decreased prealbumin (OR 0.94, P = .04) correlated with the presence of NASH. On multivariate analysis, only increased triglycerides (OR 1.004, P = .04) and decreased prealbumin (OR 0.88, P = .005) correlated with the presence of NASH. NASH is a frequent accompaniment of morbid obesity in patients undergoing bariatric surgery. Univariate and multivariate analyses of the clinical parameters studied could not identify strong predictors of biopsy-verified NASH. Therefore, intraoperative biopsy remains instrumental in diagnosing NASH and providing information for additional follow-up.
    Surgery for Obesity and Related Diseases 02/2008; 4(5):612-7. · 4.12 Impact Factor

Publication Stats

1k Citations
277.84 Total Impact Points


  • 2010–2013
    • University of Mississippi Medical Center
      • Department of Surgery
      Jackson, MS, United States
  • 2007–2009
    • Conemaugh Health System
      United States
  • 1989–2008
    • University of Missouri - Kansas City
      • Department of Surgery
      Kansas City, MO, United States
  • 1994–2004
    • University of Missouri
      • Department of Surgery
      Columbia, MO, United States
  • 2003
    • North Kansas City Hospital
      Kansas City, Missouri, United States
  • 1988–1997
    • St. Luke's Hospital
      Cedar Rapids, Iowa, United States