Simple index to predict likelihood of skilled nursing facility admission after coronary artery bypass grafting among older patients.

Background: Acceptable short-term mortality rates for elderly patients undergoing coronary artery bypass grafting (CABG) are reported in the literature. However, rather than death, older patients considering CABG are generally most concerned about a postoperative loss of functional independence. To address this concern, we describe an index that predicts a patient's likelihood of admission to a skilled nursing facility (SNF) after CABG.

Multiple, simultaneous trauma patients: Are they worse off?

Background: The simultaneous management of multiple severely injured patients has the potential to overwhelm trauma center resources. We hypothesize that trauma patients presenting in clusters of two or more patients within a short time period have worse outcomes.

Methods: From the registry at our urban Level I trauma center, we reviewed 4,619 "major" trauma patients admitted during a span of 5.

Lymphoscintigraphy does not enhance sentinel node identification or alter management of patients with early breast cancer.

Unlabelled: Lymphoscintigraphy (LS) is often performed before sentinel lymph node dissection (SLND) for breast cancer. The purpose of this study was to determine whether routine LS enhances rate of identification of sentinel nodes (SN), and if findings on LS alter either the SLND procedure or the subsequent patient management.

Methods: LS using technetium-99m sulfur colloid (99mTc) was performed in 136 consecutive patients undergoing SLND for invasive breast cancer.

COX-2 induces IL-11 production in human breast cancer cells.

Background: Cyclooxygenase-2 (COX-2) is overexpressed in 40% of human invasive breast cancers. Interleukin-11 (IL-11), a potent mediator of osteoclastogenesis, is involved in breast cancer metastasis to bone. Since breast cancers that overexpress COX-2 are associated with a higher rate of metastasis to bone, we hypothesized that COX-2 expression in tumor cells would induce IL-11.

COX-2 overexpression increases motility and invasion of breast cancer cells.

Cyclooxygenase-2 (COX-2), an inducible enzyme involved in prostaglandin (including PGE(2)) biosynthesis, is overexpressed in several epithelial malignancies including breast cancer. We tested the hypothesis that COX-2 overexpression in breast cancer cells results in increased cell motility and invasion. COX-2 overproducing cells were generated by stable transfection of several human breast cancer cells with pSG5-COX2 vector.

Assessment of the current Medicare reimbursement system for breast cancer operations.

Background: Medicare determines procedural reimbursement by means of formulas considering physician work, practice, and liability expenses. Since no mechanism exists to consider outcomes in calculating reimbursements, we hypothesized that Medicare reimbursements do not correlate with outcomes for different breast cancer operations.

Methods: We prospectively studied 240 patients with T1, 2N0M0 breast cancer in three surgical treatment arms: segmental mastectomy with axillary node dissection (SM&ALND ; n = 42); SM with sentinel node dissection (SM&SLND ; n = 96); and mastectomy without reconstruction (MRM; n = 102).