Journal of the American College of Surgeons
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Multicenter Study
Impact of conversion on surgical outcomes after laparoscopic operation for rectal carcinoma: a retrospective study of 1,073 patients.
In laparoscopic operations for rectal carcinoma, only a few multicenter studies of a large number of patients have examined the impact of conversion on outcomes and determined risk factors for conversion. This study was designed to evaluate short-term outcomes and risk factors for conversion to open operation in laparoscopic operations for rectal carcinoma. ⋯ Conversion to open operation is associated with greater morbidity than completed laparoscopic resection. Body mass index and the particular laparoscopic procedure are risk factors for conversion, indicating that appropriate patient selection is essential in laparoscopic operations for rectal carcinoma.
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We investigated differences in breast cancer mortality between younger (younger than 40 years of age) and older (40 years of age and older) women by stage at diagnosis to identify patient and tumor characteristics accounting for disparities. ⋯ Higher breast cancer mortality in younger women was attributed to poorer outcomes with early-stage disease. Additional studies should focus on specific tumor biology contributing to the increased mortality of younger women with early-stage breast cancer.
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Approximately 5% of combat-related injuries include burns. Previous studies have shown similar mortality rates between military and civilian burn casualties; but causes of death were not detailed. ⋯ Casualties of military operations are clinically different and die from different causes than patients not burned during military operations. The differences are likely reflective of a younger population, with greater severity of illness and longer times from injury to admission. Therapeutic interventions should focus on prevention of infection and gastrointestinal catastrophes in military burn casualties, which are similar to younger burn patients in the US, and minimizing cardiac complications in civilian burn casualties, who are typically older patients and possibly reflective of patients with more comorbidities.
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Preoperative imaging has been demonstrated to improve diagnostic accuracy in appendicitis. This prospective study assessed the accuracy of a diagnostic pathway in acute appendicitis using ultrasonography (US) and complementary contrast-enhanced multidetector CT in a general community teaching hospital. ⋯ A diagnostic pathway using primary graded compression US and complementary multidetector CT in a general community teaching hospital yields a high diagnostic accuracy for acute appendicitis without adverse events from delay in treatment. Although US is less accurate than CT, it can be used as a primary imaging modality, avoiding the disadvantages of CT. For those patients with negative US and CT findings, observation is safe.
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Biography Historical Article
John Miller Turpin Finney: the first president of the American College of Surgeons.