Arch Surg Chicago
-
Bariatric surgery for Medicare patients must be performed in an accredited hospital that performs at least 125 cases per year. We assessed the validity of this volume threshold and its policy implications. ⋯ When the results of statistical analysis are used for policy determination, the consequences for patient care may be substantial. Most studies of volume-outcome relationships rely on statistical methods that tend to amplify the effects and few fully characterize their statistical models. Despite the weak evidence for a volume-outcome relationship for bariatric surgery, a 125-case per year threshold has been set for center-of-excellence status, which eliminates most hospitals currently providing these services and disproportionately restricts access for the poor and underinsured.
-
To summarize our experience with small-bowel obstructions after laparoscopic Roux-en-Y gastric bypass. ⋯ Altered gastrointestinal tract anatomy results in vague symptoms and a poor yield with imaging studies. A sound knowledge of altered anatomy is the key to correct interpretation of imaging studies and prompt diagnosis.
-
Comparative Study
Mortality in adolescent girls vs boys following traumatic shock: an analysis of the National Pediatric Trauma Registry.
Female sex imparts a survival benefit after traumatic injury in children. ⋯ Adolescent girls exhibit lower mortality than boys following traumatic shock. This effect is not seen in prepubescent children. These findings suggest that hormonal differences may play a role in the sex-based outcome disparities following traumatic shock in children.
-
Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections have also affected the microbial profile of breast abscesses. ⋯ Staphylococcus aureus is the most common pathogenic organism in modern breast abscesses. Many breast abscesses have community-acquired MRSA, with more than 50% of all S aureus and 19% of all cultures being MRSA. This finding parallels the local and national increases in MRSA reported in other soft-tissue infections. With increasing bacterial resistance and more minimally invasive management of breast abscesses, understanding the current bacteriologic profile of these abscesses is essential to determining the correct empirical antibiotic drug therapy.
-
Dynamic contrast-enhanced (DCE) magnetic resonance imaging (MRI) is a reliable and accurate method for monitoring primary tumor response in the breast and can be used as a surrogate to predict final axillary nodal status. ⋯ The results of DCE-MRI of the primary tumor can be predictive of axillary nodal status, especially in patients receiving trastuzumab who are HER2/neu positive. The HER2/neu-positive patients with a complete clinical response on DCE-MRI are highly unlikely to benefit from an axillary lymph node dissection. For HER2/neu-negative patients, sentinel lymph node sampling is warranted.