The Role of Regional Anesthesia in ICU Pain Management.

Purpose Of Review: The purpose of this review is to provide the most recent update and summary on the consideration, benefits and application of regional anesthesia in the ICU setting, as it pertains to the management of perioperative pain.

Recent Findings: Regional anesthesia and analgesia have become ubiquitous in the perioperative setting, with numerous indications and benefits. As integral part of the multimodal analgesia approach, various regional blocks have been increasingly utilized in critically ill patients.

The Impact of a Comprehensive Simulation-Based Training and Certification Program on Resident Central Venous Catheter Complication Rates.

Introduction: Millions of central venous catheters (CVCs) are placed annually in the United States, many by resident physicians. Simulation training has been proposed as a means to increase resident physician competence with CVC placement and decrease the incidence of line-associated mechanical complications. We aimed to evaluate the impact of a novel simulation-based CVC training program for resident physicians on CVC-associated mechanical complication rates.

Are self-explanations always beneficial?

We present evidence suggesting that the effect of self-explanations on learning is not always beneficial and, in fact, in some contexts has a detrimental effect. Over eight sessions, fourth-graders engaged in investigation of a database with the goal of identifying causal effects. In a separate task, children in one condition also generated self-explanations regarding the mechanisms underlying the causal effects they believed to be present.

The role of human glandular kallikrein 2 for prediction of pathologically organ confined prostate cancer.

Background: In recent studies serum levels of human glandular kallikrein 2 (hK2) demonstrated significant differences in pathologically organ-confined versus non-organ-confined prostate cancer (PCa). In this study we investigated whether hK2 adds independent information when considered together with traditionally used parameters to predict organ confined (pT2a/b) PCa.

Methods: Serum levels of hK2, total and free prostate-specific antigens (PSA) were obtained one day before radical prostatectomy in 245 consecutive men.

Mode of presentation of renal cell carcinoma provides prognostic information.

Purpose: Broadened applications of imaging modalities have increased the incidental detection of renal cell carcinoma (RCC) over the past decade. Previous small series have suggested a prognostic benefit for incidental presentation. This study utilizes a large contemporary patient cohort to examine patterns of RCC presentation and their clinical implications.

Partial nephrectomy: the rationale for expanding the indications.

Background: We report preliminary results of partial nephrectomy for renal tumors of > or =4 cm in 39 patients with the intent of extending the indications for kidney-sparing surgery.

Methods: From July 1989 to October 2001, 39 patients underwent a partial nephrectomy for renal cortical tumors >4 cm in maximum diameter. Fourteen (36%) had the procedure performed for essential reasons, and 25 (64%) had an elective kidney-sparing operation.

Natural history of chronic renal insufficiency after partial and radical nephrectomy.

Objectives: To compare the incidence of newly developed chronic renal insufficiency after partial nephrectomy (PN) and radical nephrectomy (RN). Elective PN for renal tumors is intended to preserve renal function; however, studies of transplant donors suggest normal renal function is also maintained after unilateral nephrectomy.

Methods: We retrospectively compared all patients undergoing PN or RN for renal tumors 4 cm or less in the presence of a normal contralateral kidney from 1989 to 2000.

Clinical stage T1c prostate cancer: pathologic outcomes following radical prostatectomy in black and white men.

Background: The incidence of prostate cancer in black men is 50% to 70% higher than among age-matched white men. Black men have a twofold higher mortality rate and overall tend to have higher serum prostate-specific antigen (PSA) levels than white men. To determine whether racial differences exist in men whose prostate cancer was diagnosed based solely on an elevated serum PSA level, we compared clinical and pathologic features in black and white men undergoing radical prostatectomy (RP) for clinical stage T1c prostate cancer.