American journal of surgery
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Review Comparative Study
The role of sentinel lymph node biopsy in the management of thin melanoma.
The lifetime risk for developing thin (< or =1 mm) melanoma continues to increase steadily. Although generally associated with an excellent prognosis, it also has a proven capacity to metastasize. ⋯ However, it is difficult to define clinicopathologic factors that reliably predict the presence of nodal metastasis. The prognostic significance of a positive sentinel lymph node in thin melanoma remains to be defined.
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Care of the injured patient has been a focal point of surgical training at the University of Louisville. Under the direction of Dr. Hiram C. ⋯ Summaries of contributions to the peer-reviewed literature or to hospital programs by former trainees who specialized in pediatric surgery are presented. Topics include the treatment of pediatric solid-organ injury, pelvic fracture, pellet-gun injury, and caustic cutaneous burns. The impact of the pediatric Trauma Service at Kosair Children's Hospital in Louisville, KY, with an emphasis on compassionate care and the development of a bereavement intervention program, also is presented.
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Several decades ago, a shift occurred in the management of adult splenic injuries. Influenced by the experience in pediatric trauma patients, adult trauma surgeons began turning from mandatory operative treatment of all splenic injuries toward nonoperative management. ⋯ However, controversy exists about how to appropriately select patients for nonoperative treatment since bleeding from splenic injuries can incur significant morbidity and mortality. Recent refinements in the management of adult blunt splenic injuries will be reviewed.
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Review Comparative Study
Education and training of the future trauma surgeon in acute care surgery: trauma, critical care, and emergency surgery.
Trauma surgery as a specialty in the United States is at a crossroads. Currently, less than 100 residents per year pursue additional specialty training in trauma and surgical critical care. Many forces have converged to place serious challenges and obstacles to the training of future trauma surgeons. In order for the field to flourish, the training of future trauma surgeons must be modified to compensate for these changes. ⋯ The new post-graduate trauma training fellowship of the future should be built on a foundation of general surgery. The goal of this program will be to train a surgeon with broad expertise in trauma, critical care, and emergency general surgery. This new emphasis on non-trauma emergency surgery required an image change and thus a new name; Acute Care Surgery: Trauma, Critical Care, and Emergency Surgery.
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Operative mortality after repair of even the most complex congenital heart lesions has become rare. As such, the gaze of the surgical team has been diverted beyond that of early survival to focus on decreasing early and late morbidity. Important and concerning information is accumulating delineating the vulnerability of the neonatal brain to injury as the result of congenital heart disease and/or the techniques employed to correct the lesions. ⋯ It is yet undetermined whether these strategies will translate into improved short- and long-term neurologic outcome. Common to all surgical disciplines is a trend that as mortality decreases for a particular disease process, focus is adjusted, and refinements in treatment protocols are designed to minimize morbidity of the disease and its treatment. This natural refining process of a discipline's maturation is increasingly present in the field of congenital heart surgery.