Bedside Procedures for General Surgeons: Part 2

This review focuses on four procedures that are commonly performed by general surgeons in the emergency department and critical care unit and three procedures that are usually performed in the outpatient clinic. Although considered basic procedures, all have their own set of key steps that must be learned, practiced, and mastered. Included in the description for each procedure are technical points that are intended to facilitate successful performance of the procedures and pitfalls to avoid. The most frequent complications for each procedure are briefly discussed in an effort to raise awareness so that they can be recognized and managed expeditiously. Common to all of these procedures is a need to understand the indications based on a careful history, physical examination, and review of pertinent objective data. Whenever possible, informed consent should be obtained from the patient or family prior to the procedure and a complete surgical timeout performed. Sterile technique and personal protective gear/universal precautions should be employed whenever feasible. Finally, these patients should be followed postoperatively and appropriate follow-up studies and/or treatments arranged. This review contains 24 figures, 9 tables, and 33 references. Key words: extended focused assessment with sonography for trauma, focused assessment with sonography for trauma, pericardiocentesis for trauma, pigtail tube thoracostomy, skeletal muscle biopsy, superficial abscess drainage, temporal artery biopsy, tube thoracostomy

Bedside Procedures for General Surgeons: Part 2

This review focuses on four procedures that are commonly performed by general surgeons in the emergency department and critical care unit and three procedures that are usually performed in the outpatient clinic. Although considered basic procedures, all have their own set of key steps that must be learned, practiced, and mastered. Included in the description for each procedure are technical points that are intended to facilitate successful performance of the procedures and pitfalls to avoid. The most frequent complications for each procedure are briefly discussed in an effort to raise awareness so that they can be recognized and managed expeditiously. Common to all of these procedures is a need to understand the indications based on a careful history, physical examination, and review of pertinent objective data. Whenever possible, informed consent should be obtained from the patient or family prior to the procedure and a complete surgical timeout performed. Sterile technique and personal protective gear/universal precautions should be employed whenever feasible. Finally, these patients should be followed postoperatively and appropriate follow-up studies and/or treatments arranged. This review contains 24 figures, 9 tables, and 33 references. Key words: extended focused assessment with sonography for trauma, focused assessment with sonography for trauma, pericardiocentesis for trauma, pigtail tube thoracostomy, skeletal muscle biopsy, superficial abscess drainage, temporal artery biopsy, tube thoracostomy

Bedside Procedures for General Surgeons: Part 2

This review focuses on four procedures that are commonly performed by general surgeons in the emergency department and critical care unit and three procedures that are usually performed in the outpatient clinic. Although considered basic procedures, all have their own set of key steps that must be learned, practiced, and mastered. Included in the description for each procedure are technical points that are intended to facilitate successful performance of the procedures and pitfalls to avoid. The most frequent complications for each procedure are briefly discussed in an effort to raise awareness so that they can be recognized and managed expeditiously. Common to all of these procedures is a need to understand the indications based on a careful history, physical examination, and review of pertinent objective data. Whenever possible, informed consent should be obtained from the patient or family prior to the procedure and a complete surgical timeout performed. Sterile technique and personal protective gear/universal precautions should be employed whenever feasible. Finally, these patients should be followed postoperatively and appropriate follow-up studies and/or treatments arranged. This review contains 24 figures, 9 tables, and 33 references. Key words: extended focused assessment with sonography for trauma, focused assessment with sonography for trauma, pericardiocentesis for trauma, pigtail tube thoracostomy, skeletal muscle biopsy, superficial abscess drainage, temporal artery biopsy, tube thoracostomy

Linolenate transport by human jejunum: presumptive evidence for portal transport at low absorption rates

Are the small quantities of linolenic acid (LA) in a meal absorbed via a different pathway than the higher concentrations of the other long-chain fatty acids (LCFA) in a mixed meal? To answer this question, varying LA concentrations were infused into the human jejunum via a quadruple-lumen hydraulic biopsy tube. After 0.01-mM LA infusion, no LA was found in triglyceride (TG) extracted from jejunal biopsies, although 58% of the phospholipid plus monoglyceride fraction (PL + MG) and 42% of the LCFA fraction were LA. In marked contrast, after 5.0-mM LA infusion, 60% of the TG, 28% of the PL + MG, and only 3% of the LCFA fractions were LA. By electron microscopy, mostly very low-density lipoprotein-sized (less than 750 A) particles were seen within jejunal fasting biopsies and in biopsies after 0.01, 0.1, or 1.0-mM LA infusions; mostly chylomicrons (greater than 750 A) were seen within jejunal biopsies after 5.0-mM LA infusion. We conclude that LA at its usual very low dietary concentrations is absorbed mostly as invisible LCFA and PL molecules; whereas at higher concentrations it is absorbed like most dietary fat via lacteals as TG and PL within visible chylomicrons.