Journal of the American College of Surgeons
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Subungual melanoma is an unpredictable and aggressive tumor with a propensity to metastasize widely. Because it is an uncommon condition, statistical analysis of its behavior patterns is difficult, factors that determine its prognosis are unclear, and optimal management is ill defined. ⋯ The treatment of subungual melanoma of the toenail apparatus is primarily surgical, by amputation at or proximal to the metatarsophalangeal joint. Even if there is no clinical evidence of metastatic disease in regional lymph nodes, radical node dissection is desirable. The condition is most appropriately managed at a specialist center.
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This study was done to examine the outcome of cardiopulmonary resuscitation (CPR) in the surgical intensive care unit (SICU) and to identify factors preceding cardiopulmonary arrest that could predict survival. ⋯ Patients in the SICU who survived CPR had a stable or improving clinical course as determined by APS and GCS score, and had not had acute organ failure. Patients who were critically ill with a declining clinical course did not survive after CPR.
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Developments in the specialty of general surgery have never been more important, nor have the opportunities for general surgeons been more exciting, than at the present. Technologic advances and the expansion of basic knowledge of surgical diseases have contributed to this renaissance of the field. ⋯ Education of the student preparing for a nonsurgical career in the fundamental concepts underlying surgical therapy must be kept at the forefront of an undergraduate surgical curriculum. Integration and coordination of graduate surgical education in all of the general surgery-based specialties is an important obligation for the future, as knowledge expands in each specialty and the need for more specialty-specific education becomes apparent.
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Editorial Comment
Cardiopulmonary resuscitation in the intensive care unit.
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Continuous arteriovenous hemofiltration does not improve survival in a canine model of septic shock.
We examined whether or not continuous arteriovenous hemofiltration (CAVH), in the absence of renal failure, would improve either hemodynamic abnormalities or survival in a canine model of septic shock. ⋯ The results of this study suggest that CAVH would be unlikely to provide benefit to patients with gram-negative septic shock, in the absence of renal failure.