Computed tomographic angiography as the primary diagnostic modality in penetrating lower extremity vascular injuries: a level I trauma experience.

Background: Computed tomographic angiography (CTA) has been established as a valid modality for the assessment of extremity vascular injury. Over the last several years at our institution, CTA has evolved as the primary diagnostic modality for penetrating extremity injuries, largely replacing diagnostic angiography. The purpose of this study was to evaluate the outcomes with this imaging modality at a high-volume Level I trauma center.

Axillary recurrence after sentinel lymph node biopsy for breast cancer.

Sentinel lymph node biopsy (SLNB) is routinely performed as an axillary staging procedure for breast cancer. Although the reported false-negative rate approaches 10 per cent, this does not always lead to axillary recurrence. We previously reported an axillary recurrence rate of 1 per cent at a median follow-up of 2 years.

The use of drotrecogin alpha for necrotizing soft tissue infections.

The use of Drotrecogin alfa (DAA) (Xigris) in select patients with sepsis has had demonstrable improvement in survival, though its benefit in necrotizing soft tissue infections (NSTI) is unclear. A retrospective review of NSTI patients receiving DAA at our institution from 2006 to 2009 was performed. Our previously derived mortality prediction model, based on classification and regression tree analysis, was applied to patients and the predicted mortality was compared with the actual mortality rate.

Acute care surgery performed by sleep deprived residents: are outcomes affected?

Background: The Institute of Medicine recently recommended further reductions in resident duty hours, including a 5-h rest time for on-call residents after 16 h of work. This recommendation was purportedly intended to better protect patients against fatigue-related errors made by physician trainees. Yet no data are available regarding outcomes of operations performed by surgical trainees working without rest beyond 16 h in the current 80-h workweek era.

Low sensitivity of physical examination findings in necrotizing soft tissue infection is improved with laboratory values: a prospective study.

Background: When clinical "hard signs" of necrotizing soft tissue infection (NSTI) are present, establishing the diagnosis of NSTI is not difficult. However, hard signs of NSTIs are often absent on presentation, thus potentially delaying diagnosis and surgical intervention. A prior retrospective study performed at our institution demonstrated that admission white blood cell (WBC) count >15,400/microL x 10(9)/L and/or serum sodium (Na) <135 mEq/L could help differentiate NSTI from non-NSTI.

Total bilirubin is a useful predictor of persisting common bile duct stone in gallstone pancreatitis.

Accepted guidelines for preoperative endoscopic retrograde cholangiopancreatography (ERCP) in gallstone pancreatitis are lacking. Our previous investigations suggested that serum total bilirubin on hospital Day 2 best predicts persisting common bile duct (CBD) stones. We aim to identify an optimal total bilirubin threshold on hospital Day 2 that would predict persisting CBD stones and guide obtaining preoperative ERCP.

Decreased bile duct injury rate during laparoscopic cholecystectomy in the era of the 80-hour resident workweek.

Background: Considerable concern has been raised about the effects of restricted duty hours on surgical training. However, to our knowledge, the effect of the 80-hour resident workweek on operative outcomes after laparoscopic cholecystectomy has not been well studied.

Objective: To compare the rates of bile duct injury and overall complications after laparoscopic cholecystectomy before and after the institution of the duty-hour restriction.

Early cholecystectomy for mild to moderate gallstone pancreatitis shortens hospital stay.

Background: The timing of cholecystectomy in gallstone pancreatitis remains controversial. We hypothesized that in patients with mild to moderate gallstone pancreatitis (three or fewer Ranson's criteria), performing early cholecystectomy before resolution of laboratory or physical examination abnormalities would result in shorter hospitalization, without adversely affecting outcomes.

Study Design: An observational study consisting of a retrospective and a prospective group was conducted.

En bloc resection of the duodenum for locally advanced right colon adenocarcinoma.

Direct invasion of colorectal adenocarcinoma into adjacent structures occurs frequently, but only rarely is the duodenum involved. This study was undertaken to assess the safety and efficacy of en bloc resection of locally advanced right colon carcinoma invading the duodenum. A retrospective review of 49 patients with locally advanced colon cancer, surgically managed between 2000 and 2005, was performed.

Cholangitis: analysis of admission prognostic indicators and outcomes.

Acute cholangitis is a life-threatening complication of biliary obstruction that is exacerbated by delays in diagnosis and treatment. Since the introduction of endoscopic retrograde cholangiography and endoscopic therapeutic modalities, few investigations have addressed admission prognostic indicators of adverse outcomes. A retrospective review of all patients with a diagnosis of acute cholangitis from 1995 to 2005 was performed.

Axillary regional recurrence after sentinel lymph node biopsy for breast cancer.

The accuracy of sentinel lymph node biopsy (SLNB) staging in breast cancer has been demonstrated in studies comparing it with axillary dissection. There is a 5 per cent false-negative rate, but this does not always correlate with axillary recurrence. Our purpose was to determine the rate of axillary lymphatic recurrence in breast cancer patients who had a negative SLNB.

Success of neoadjuvant chemotherapy in conversion of mastectomy to breast conservation surgery.

Neoadjuvant chemotherapy (NC) in patients with breast cancer results in high response rates and has been used with the purpose of reducing tumor size and achieving breast conservation (BC) in individuals who initially require mastectomy. Our objective is to determine the success of NC in achieving BC in women who initially were not candidates for BC. We conducted a cohort study of women with invasive breast cancer who required mastectomy but desired BC surgery.