Among the new 5-mm laparoscopic electrosurgical and ultrasonic instruments available for testing, RX, LS, and FT produced the highest mean burst pressures. FT had the shortest mean seal times for medium and large vessels. Minimal or no seal failures occurred with HS, RX, LS, LM, and FT.

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Laparoscopic ventral hernia repair provides improved quality-of-life, compared with open repair, 6 months postoperatively. Nearly all physical variables measured by the CCS were significantly better when ventral hernias were repaired laparoscopically.

The purpose of our study was to provide guidelines for the use of a novel microwave ablation system. Microwave ablations using a 915-MHz system were evaluated in a porcine liver. The independent variables were power and time, with the outcome variable being diameter of ablation. After ablations, livers were procured for measurement and histologic evaluation. Our study consisted of 420 ablations. The outcome variable, ablation diameter, was affected significantly by time, power, and time/power interaction (p<0.0001). For each time point, a one-way analysis of variance (ANOVA) showed an overall significant difference in ablation size X wattage (p<0.0001). Tukey tests at each time point showed ablation sizes at 45, 50, and 60 W were not significantly different. After it was determined that 45 W was optimal, a one-way ANOVA showed an overall significant difference in ablation sizes for time points at 45 W (p<0.0001). Tukey tests revealed that at 45 W, ablation sizes at 10, 15, and 20 min were not statistically different. We propose guidelines for diameters based on different time and power variables and recommend 45 W for 10 min to achieve optimal diameters at the shortest time and lowest wattage.

The laparoscopic appendectomy procedure is a safe alternative to open appendectomy in pediatric patients and results in shorter hospital stays with less postoperative pain.

Current guidelines for the empiric treatment of ventilator-associated pneumonia (VAP) recommend that vancomycin is dosed 15 mg/kg and administered twice daily for a target trough level of 15 to 20 mg/mL. This study compared conventional intermittent vancomycin infusion (IVI) with continuous vancomycin infusion (CVI). Our prospective, randomized study compared CVI with IVI in trauma patients with suspected VAP. The primary outcome measure was a serum vancomycin level within the target level 48 hours after initiation of therapy. Treatment groups were compared using standard statistical methods. The study included 73 patients, 36 IVI and 37 CVI. Eighteen patients were withdrawn from the study as a result of discontinuation of the drug before 48 hours or failure to draw levels at the appropriate time, resulting in 27 IVI and 28 CVI study patients. There were no differences between treatment groups in gender ( P = 0.97), Injury Severity Score ( P = 0.70), total body weight ( P = 0.36), or age ( P = 0.81). The mean serum vancomycin level for the IVI group was 8.9 ± 3.9 mg/mL, and the CVI level was 19.8 ± 6.13 mg/mL ( P < 0.0001). Two patients in the IVI group (7.4%) were in the therapeutic range compared with 16 (57.1%) in the CVI group ( P < 0.0001). Six patients in the CVI group (21.4%) and none of the IVI patients had supratherapeutic levels. Four patients developed renal insufficiency, three IVI (11.1%) and one CVI (3.6%) ( P = 0.36). The current American Trauma Society dosing recommendations for vancomycin for presumptive VAP treatment are inadequate. Continuous vancomycin infusion should be adopted as the standard dosing strategy.

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