The American surgeon
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Although ductal carcinoma in situ (DCIS) does not require axillary evaluation, controversy exists regarding the use of sentinel lymph node biopsy (SLNB) in patients with DCIS diagnosed by core needle biopsy (CNB). Advocates of concomitant SLNB and lumpectomy cite the low morbidity of SLNB, the high rate of invasive ductal carcinoma in resected specimens, and the positive nodes found in 1 to 2 per cent of patients with resected DCIS despite finding no invasive component. Opponents of this practice cite the complication risk and the improbability of clinically significant axillary recurrence. ⋯ Five patients (4.5%) were spared additional operative intervention by initially performing SLNB. We suggest using concomitant SLNB when a high clinical suspicion of invasive cancer exists, in the presence of a palpable mass, or when mastectomy precludes future SLNB. Intraoperative margin assessment is needed to avoid return to the operating room.
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An increasing number of super geriatric (age older than 80 years) patients are being hospitalized with traumatic brain injury (TBI). Although geriatric (age older than 65 years) patients have been reported to have a worse functional outcome compared with younger patients who present with the same or less severe degree of TBI; the mortality for the super geriatric (age older than 80 years) remains to be determined. Knowledge of their hospital mortality may help improve clinical decision-making protocols and resource use. ⋯ There was a trend toward decrease in mortality from age Group III to IV (21 vs. 6%, P = 0.09), which is of unclear etiology and warrants further study. In patients with blunt TBI, there is no significant difference in mortality between the super geriatric age group (age older than 80 years) and the younger pediatric, adult, and geriatric age groups. Resource use therefore should not be limited to patients older than 80 years with TBI.
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The American surgeon · Sep 2010
Day-case Limberg flap for recurrent pilonidal sinus: does obesity complicate the issue?
The purpose of this study was to analyze the long-term outcome of rhomboid excision with Limberg flap reconstruction (LF) as one-day surgery in treatment of recurrent pilonidal sinus (RPS). The effect of obesity on outcome will be addressed. Forty-nine patients with RPS were treated by rhomboid excision and LF as one-day surgery. ⋯ Obesity significantly increased the operative time, however, it affected neither the postoperative outcome nor the long-term recurrence. Rhomboid excision and LF as one-day surgery is a safe and reliable method for treatment of RPS. It guarantees low morbidity, short hospital stay, short time off work, and carries low risk of recurrence, even in obese patients.
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The American surgeon · Sep 2010
Outcomes with the use of recombinant human erythropoietin in critically ill burn patients.
Recent data demonstrate a possible mortality benefit in traumatically injured patients when given subcutaneous recombinant human erythropoietin (rhEPO). The purpose of this report is to examine the effect of rhEPO on mortality and transfusion in burn patients. We conducted a review of burn patients (greater than 30% total body surface area, intensive care unit [ICU] days greater than 15) treated with 40,000 u rhEPO over an 18-month period (January 2007 to July 2008). ⋯ No difference in mortality for the rhEPO and NrhEPO (32.0 vs. 22.2%; P = 0.43) was found. Thromboembolic complications were similar in all three groups. No effect was seen for rhEPO treatment on mortality or blood transfusion requirements in the severely burned.