Band 111, Heft 8

Context: Postoperative ileus is a major complication of abdominal surgical procedures Objective: To evaluate the incidence of ileus and gastrointestinal morbidity in patients who received immediate postoperative feeding and bowel stimulation after undergoing major gynecologic surgical procedures. Methods: During a 5-year period, the authors tracked demographic, surgical outcome, and follow-up information for 707 patients who underwent major gynecologic operations. All patients received the same postoperative orders, including immediate feeding of a diet of choice and bowel stimulation with 30 mL of magnesium hydroxide (milk of magnesia) twice daily until bowel movements occurred. Results: Of 707 patients, 6 (<1%) had postoperative ileus. No patients experienced postoperative bowel obstruction and 2 patients (0.3%) had postoperative intestinal leak. No serious adverse effects associated with bowel stimulation were reported. Conclusion: Immediate postoperative feeding and bowel stimulation is a safe and effective approach to preventing ileus in patients who undergo major gynecologic surgical procedures.

Context: Using the Internet has transformed communication and improved access to health-related information for patients and physicians. Objective: To determine why patients use the Internet for health-related information, where patients find answers to their questions, and whether patient use of the Internet impacts the patient-physician relationship. This study focused on patients of osteopathic physicians to confirm previously published data in a more specific population. Methods: An anonymous 25-item survey was distributed to patients in a primary care setting. The survey elicited information regarding demographics, health-related Internet use, and discussion of Web-based health information during the clinical visit. Results: Two hundred eighty-five patient surveys were collected. Data based on sex, age, education level, and ethnicity were evaluated. Two hundred fifty of 280 patients (89%) reported that they use the Internet to find health-related information, and 134 of 250 patients (54%) indicated that they changed their health-related behaviors based on information they found. Seventy-three of 133 patients (55%) who changed their behaviors reported these findings to their physicians. This finding differed by age and ethnicity. Patients aged 50 to 64 years (22 responses, 73%) were the most likely group to report behavioral changes to their physicians ( P =.048). No patients who identified themselves as of Asian/Pacific Islander descent indicated that they reported behavioral changes to their physician ( P =.043). Two hundred forty-two of 261 patients (93%) reported that their personal physician is the most reliable source for health information. Conclusion: Most patients use the Internet to find health-related information, but many of them are not reporting potentially important health-related behavioral changes to their physicians. However, most patients still consider their physician as the most reliable source for health-related information. Physicians should ask patients about Internet use and counsel them about where to find reliable, accurate, high-quality health information.

The development of multiple primary malignancies in an individual is rare and unfortunate, and the care of such a patient presents specific challenges. We report the diagnosis and progression of 3 histologically different primary cancers in 1 patient over the course of 15 years. At age 50 years, the patient received a diagnosis of transitional cell carcinoma of the bladder; treatment was successful. When the patient was 64 years old, mesothelioma of the tunica vaginalis was diagnosed, and computed tomography performed for staging purposes revealed a lung lesion, which was later diagnosed as adenocarcinoma. Treatment for the adenocarcinoma was also successful, but the patient continues to have recurrence of mesothelioma. To our knowledge, the present report is the first description of a case of 3 primary cancers that includes a mesothelioma of the tunica vaginalis. Because mesothelioma of the tunica vaginalis is rare, we reviewed the literature on its prevalence, presentation, management, and prognosis.