Archives of surgery (Chicago, Ill. : 1960)
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Comparative Study
Local and paravertebral block anesthesia for outpatient elective breast cancer surgery.
Most breast cancer operations in the United States are performed with the patient given general anesthesia. We retrospectively reviewed our prospective breast cancer database to determine the percentage of patients who underwent breast cancer operations with either local or paravertebral block regional anesthesia from January 1 through June 30, 2008. Fifty-two of 70 patients (74%) were able to undergo breast cancer surgery with local or paravertebral block regional anesthesia. ⋯ There were no conversions to general anesthesia and no unplanned overnight admissions. Only 5 of 52 patients (10%) undergoing surgery with local or paravertebral block regional anesthesia developed postoperative nausea or vomiting. We conclude that most elective outpatient breast cancer surgery operations can be performed with the patients given local or regional anesthesia.
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Recent investigations of nutrition support in the intensive care unit (ICU) have revived discussion of optimal strategies for tight glucose control and the administration of total parenteral nutrition. Mode, timing, and adequacy of nutritional support affect glycemic control and outcomes in critically ill patients. The delivery of correctly formulated and safely administered nutritional and metabolic support is a matter of life or death in surgical and critical care units. ⋯ Obese patients heighten surgical risk and require extra caution by ICU nutrition support specialists. This commentary will address the direction of nutrition support services by covering the history, progress, and potential of the field. It will review parenteral nutrition from its inception to its current standing in ICU patient care and discuss the future role of parenteral nutrition in a rapidly changing and increasingly diverse population.
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To explore attitudes of physicians from all specialties toward gifts from and interactions with the pharmaceutical and medical device industries. ⋯ Physicians continue to hold positive attitudes toward marketing-oriented activities of the pharmaceutical and device industries. Changes in medical culture and physician education focused on surgeons and trainees may align physician attitudes with current policy trends.
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Comment Letter Randomized Controlled Trial
Effect of stitch length on complications.
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Comment Letter Comparative Study
Bariatric surgery centers of excellence do not improve outcomes.