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Heterotopic mesenteric ossification (HMO) is a rare clinical entity with less than 40 reported cases in the literature. Frequently associated with prior abdominal surgery or trauma, the precise etiology and optimal approach to its management remain undefined.The index patient is a 58-year-old male who originally presented with perforated diverticulitis. Following resection, the patient developed an enterocutaneous fistula. After a trial of conservative management, the patient underwent exploration and was found to have widespread intra-abdominal calcification. Sheets of calcific tissue were resected, and a diagnosis of HMO was confirmed via pathology. The patient had a postoperative course complicated by bleeding and redevelopment of enteric fistula. Following a prolonged hospital course requiring multiple operations, the fistula persists, and the patient remains on parenteral nutrition.The etiology of HMO is unknown. Diagnosis requires a high degree of clinical suspicion, as radiologic findings are often misleading. A review of 18 cases demonstrates significant morbidity associated with operative intervention. Nonsteroidals, in particular indomethacin, have been shown to decrease heterotopic ossification, but their role in mesenteric disease is not clearly defined.HMO is a rare but complicated pathologic process. A trial of conservative management with NSAIDs, bowel rest, and total parenteral nutrition is prudent, given the high rate of morbidity and mortality associated with operative intervention.

Background As alcohol use is highly prevalent in trauma patients, we hypothesized that a significant proportion of hospitalized trauma patients would demonstrate alcohol withdrawal (AW). Methods The trauma registries at a joint trauma center system from 1999 to 2008 were evaluated for patients aged at least 16 years. Results Of 19,369 trauma admissions, 159 patients had AW. Blood alcohol concentration (BAC) testing was performed in 31.5% of the patients. BAC was significantly higher in AW patients versus other traumas (205.7 ± 130.1 vs 102.9 ± 121.7 mg/dL). BAC was 0 in 14.4% of AW patients. As compared with other trauma patients, patients with AW had a significantly greater age (50.2 vs 42.1 years), hospital length of stay (10 vs 3 days), intensive care unit length of stay (2 vs 0 days), need for mechanical ventilation (34% vs 12.7%), and pneumonia (12% vs 2.3%). AW patients were less frequently discharged to home (59.8% vs 69.9%). Mortality was not different. Conclusions AW was diagnosed in few patients. Of note, it occurred in patients with an initial BAC of 0. AW is associated with adverse outcomes.

Trauma continues to be a large source of poor outcomes for patients in the United States. While clinical guise is very important in the acute setting, objective physical data is becoming increasingly important in the diagnosis of many injuries sustained during trauma. Radiography has always been the primary diagnostic modality applied in trauma situations but it continues to be a time-consuming and unwieldy part of the acute resuscitation of the patient. The novel use of the Lodox Statscan (Lodox Systems (Pty), Ltd., Benmore, South Africa), a type of digital radiography, as a means to help combat these problems was evaluated at Creighton University Medical Center, Omaha, Nebraska. This new machine uses a linear beam technology to scan the entire body in 13 seconds. Here, we describe this digital radiography system, its introductory use in the trauma bay, and discuss cases where it has proven valuable. Based upon our preliminary experience, the use of the device in large centers shows promise for improving morbidity and mortality outcomes in trauma patients.

We prospectively examined brachial artery endothelial function using vascular ultrasound in 41 obese subjects treated with medical or surgical (gastric bypass) weight loss interventions. Surgical intervention produced greater weight loss and more pronounced improvement in endothelial function than medical treatment alone. Improved endothelial function with weight loss correlated strongly with fasting glucose but not with alteration in blood pressure, lipids, degree of weight loss, or plasma resistin concentrations. These data demonstrate that weight loss in markedly obese patients improves endothelial function and glycemic control that may represent important mechanisms of the cardiovascular benefit associated with weight reduction.

The pace of change and development of new technology in the new millennium necessitates fast and efficient data accumulation, processing, interpretation and dissemination to maintain a competitive advantage in any information orientated field. With regards to primary data accumulation, if academic institutions stick to rigid traditional tools and not embrace changes in the information/communications revolution they will face the criticism of further irrelevancy. Traditional academic surveys are also one of the most expensive components of any research project budget. Communication technology advancements, such as electronic mail (e-mail), the Internet and Cellular phone technology such as SMS (Short Messaging Service) and WAP (Wireless Application Protocol), create an opportunity to drastically reduce survey costs and time. The use of e-mail as a potential electronic medium for conducting a survey is discussed in this paper. E-mail was chosen because of the minimal costs involved and the specific market that can be targeted. It does, however, have its own problems and limitations. The key question asked in the e-survey was: "What do South African farmers need to do to survive, and better yet: prosper, in the new millennium?" The focus of this paper is not the answers to this question, but on the methodology, shortfalls, profile of respondents, reply statistics and some netiquette tips used in thee-survey.

e16554 Background: This study is the first comprehensive analysis of surgical outcomes in disseminated cancer patients. Methods: We analyzed the American College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) 30-day mortality data for major surgeries on 3,250 disseminated cancer patients and 144,199 patients who did not have disseminated cancer. Results: The most common procedures performed on disseminated cancer patients include a partial removal of the colon (354 patients), a partial removal of the liver (302 patients), a partial removal of the small intestine (169 patients), and an exploration of the abdomen (159 patients). The 30-day mortality for surgeries for cancer patients can be divided into low risk (