Arch Surg Chicago
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Volume criteria are poor predictors of inpatient mortality after esophagectomy. Because many factors influence mortality for complex procedures, this study was designed to quantify such factors and analyze the volume-outcome relationship for esophagectomy. ⋯ Patient factors have a greater influence on inpatient mortality than case volume does. Although there is generally an inverse relationship between case volume and mortality, there is wide scatter between individual surgeons and hospitals, with a complex volume-outcome relationship. Using volume criteria alone to choose a provider may in some instances increase the risk of mortality.
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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.
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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.
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To determine the optimal number of lymph nodes to examine for accurate staging of node-negative pancreatic adenocarcinoma after pancreaticoduodenectomy. ⋯ Examination of 15 lymph nodes appears to be optimal to accurately stage node-negative adenocarcinoma of the pancreas after pancreaticoduodenectomy. Furthermore, evaluation of at least 15 lymph nodes of a pancreaticoduodenectomy specimen may serve as a quality measure in the treatment of pancreatic adenocarcinoma.
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The 80-hour workweek limitation for surgical residents is associated with an increase in mortality and complication rates among adult trauma surgical patients. ⋯ Although there was no difference in deaths between the 2 time periods, there was a significant increase in total, preventable, and nonpreventable complications. This increase in complication rate may be due, in part, to the new 80-hour workweek policy.