An investigation into a pair of hepatitis outbreaks in New York City has revealed that the same anesthesiologist was responsible for spreading 6 cases each of hepatitis B and C at a GI center in 2006 and 1 case of hepatitis C at another center the year before through the reuse of single-use vials of propofol.

The report, published in the July issue of the journal Gastroenterology, does not name the anesthesiologist, who practiced in 12 outpatient facilities in the city between December 2003 and May 2007, or the facilities involved. Investigators from the CDC as well as the city and state departments of health have contacted all 4,490 patients treated by the anesthesiologist.

None of the staff at the 2 facilities from which the outbreaks emerged were infected with hepatitis B or C, investigators say, and their endoscopes had been properly reprocessed. "The only common exposure among all infected patients in both offices was receiving propofol from one contract anesthesiologist," writes lead author Bruce Gutelius, MD, MPH, in the article, and that provider habitually reused single-dose vials of propofol. At 1 facility, the provider even saved a vial for reuse the following day.

The authors urge all GI physicians to keep an eye on and maintain high standards for the injection, medication handling and other infection control practices of all team members in the procedure rooms.

Kent Steinriede

The availability of virtual colonoscopy could increase colorectal cancer screening rates among non-high-risk patients, according to a recent survey, but only if the procedure is widely covered by healthcare insurers.

Researchers at Massachusetts General Hospital in Boston questioned 68 patients who'd declined to undergo routine colonoscopies about their reasons for avoiding the screenings and their likelihood of scheduling a computed tomography colonography, also known as virtual colonoscopy.

Their survey, described in a article appearing in the August issue of the American Journal of Roentgenology, reports that after education, 83% said they'd be willing to undergo a non-invasive, sedation-free virtual colonoscopy. However, 70% said they wouldn't schedule the procedure if their insurance didn't cover it and they had to pay for it out of pocket.

The other 30% said they'd only be willing to pay an average $244 for the exam, notes 1 of the study's authors. The procedure, which employs fluoroscopic imaging to render 2-dimensional and 3-dimensional images of the colon, is presently charged at $500 to $1,500.

David Bernard

Athletes who undergo hip arthroscopy to repair femoral acetabular impingement are likely to return to their pre-surgery levels of competition, according to research presented at the American Orthopaedic Society for Sports Medicine's annual meeting this month.

Femoral acetabular impingement, a condition caused by a bony bump on the upper thigh that limits normal movement in the hip's ball-and-socket joint, appears to manifests in competitive athletes earlier than it does in patients who are genetically predisposed to develop the condition. Patients who suffer from it present with hip pain, decreased range of motion at the joint and inability to compete athletically at a high level.

Researchers at the Hospital for Special Surgery in New York City reviewed the records of 47 impingement patients with an average age of 22.8 years who played competitive sports at the high school, college and professional levels. Following surgery, the patients' average Modified Harris Hip Scores and Hip Outcome Scores, which measure hip range of motion and pain level, jumped from 68.6 to 88.5 and 78.8 to 91.4, respectively. In addition, 78% of the patients studied were able to return to competitive action at an average of 9.4 months post-op, and 91.7% returned to the level of competition they played at prior to surgery.

Employing arthroscopic techniques to repair the hip joint is a viable and preferred alternative to open procedures in properly selected patients, notes Bryan Kelly, MD, a sports medicine orthopedic surgeon and co-director of the Hospital for Special Surgery's Center for Hip Pain and Preservation. "Although technically challenging, appropriately performed arthroscopic surgery results in less soft tissue trauma, less blood loss, shorter hospitalizations, and likely provides a faster return to a full recovery," he says.

Daniel Cook

Be honest: When you're on vacation, do you feel compelled to check your work e-mail 2 or 3 or 4 times a day? Or do you manage to leave it all behind? Tell us in this week's online poll, and check back next week for the results.

Last week's InstaPoll asked how you control fluid on your OR floors. Our 66 respondents' choices covered the spectrum: