Dividing a patient's intake of bowel prep solution results in a more effective cleansing for colonoscopy than if the solution were consumed all at once, and is also better tolerated, according to Italian researchers.

For a study published in the August issue of Gastrointestinal Endoscopy, the journal of the American Society for Gastrointestinal Endoscopy, the researchers observed the cases of 868 colonoscopy patients. While 433 were directed to consume the bowel prep solution as a standard single dose the day before the procedure, another 435 were prescribed a split-dosage schedule.

The endoscopists performing the procedures, who were not aware which prepping method their patients had undertaken, were asked to score each patient's level of bowel cleansing. The study reports that split-dose patients showed better cleansing results than single-dose patients, with 75.2% of split-dose patients scoring "good/excellent" as compared to 43% of the single-dose group.

The researchers also noted that cleaning scores dropped when colonoscopies were performed more than 8 hours after the patient completed the preparation process, leading them to suggest that late morning or afternoon might be an optimal time for split-dose colonoscopies.

The patients of both groups, split- and single-dose, prepped randomly with 1 of 2 different products, either the standard, high-volume, polyethylene glycol and electrolyte solution or a newer, low-volume polyethylene glycol and ascorbic acid solution. While the product that was consumed did not significantly affect the effectiveness of the cleansing, split-dose consumption was seen to provide the best prep for both products and patients reported that the low-volume product tasted better.

David Bernard

Surgeons in San Diego have removed excess stomach through the mouth following a sleeve gastrectomy, which they say is the first time such a natural orifice weight-loss procedure has been performed in the United States.

Performed at the University of California San Diego School of Medicine, the 1-hour procedure combined conventional laparoscopic techniques with natural orifice translumenal endoscopic surgery. Physicians at the university's Center for the Treatment of Obesity made 5 incisions in the patient's abdomen wall to insert laparoscopic cameras as well as tools to remove a small portion of the stomach and to staple it closed afterwards. Most of the excised stomach was pulled up through the esophagus and out of the patient's mouth.

Santiago Horgan, MD, chief of minimally invasive surgery and the center's director, says removing 80% of the stomach through the mouth avoids the need for a large incision in the abdomen, reduces abdominal trauma, lowers hernia risks and results in less post-op pain for the patient.

This isn't the first natural orifice procedure pioneered at UCSD. Surgeons there performed the first transoral removals of the gallbladder and appendix as well as a hernia repair that entered the vagina and employed a small incision behind the uterus.

"The number of options for minimally invasive weight-loss surgery is rapidly evolving," says Dr. Horgan. "Our goal is to offer patients a customized long-term solution for losing weight with as few scars as possible, and if desired, no medical devices."

Daniel Cook

Injecting the protein lubricin into a knee joint that has suffered trauma to the anterior cruciate ligament can reduce cartilage deterioration and encourage production of the natural lubricant found in synovial fluid, according to researchers at Brown University's Warren Alpert School of Medicine in Providence, R.I.

By heading off the degradation process, these injections might prevent the osteoarthritis it leads to, write the researchers, whose study appears in the August issue of the journal Arthritis & Rheumatism.

They tested 3 types of fluid - purified human synoviocyte lubricin, recombinant protein lubricin and purified synovial fluid - in the knee joints of rats who had damaged ACLs, and found the lubricin worked best.

"Basically, by placing the lubricin there, it encouraged the joint's normal activity to produce this [synovial fluid] molecule," says lead author Gregory Jay, MD, PhD, a professor of emergency medicine and engineering at the university.

Lubricin injections may someday replace viscosupplementation of hyaluronic acid, he says. "Viscosupplementation is a $500 million-per-year device market that just doesn't work particularly well. Past studies by us and others indicate this. We now need a paradigm shift in how we are thinking about preventing and treating arthritic diseases."

Kent Steinriede

Many surgical facility managers are finding themselves between a rock and a hard place when it comes to complying with CMS's new infection control guidelines. While the guidelines prohibit reusing single-dose medication vials, administrators are loath to waste the medication remaining in an opened vial when the drug isn't packed in small quantities. How have you dealt with this dilemma? Be honest: Have you used single-dose medication vials multiple times in violation of CMS guidelines? Let us know in our instant and completely anonymous online poll, and check back next week for the results.

Last week's InstaPoll asked in which types of cases your surgeons used surgical glue as opposed to sutures. Our 74 respondents reported a variety of uses for surgical adhesives: