Fast-track office-based anesthesia: a comparison of propofol versus desflurane with antiemetic prophylaxis in spontaneously breathing patients.

Compared to propofol, maintenance of anesthesia with desflurane provided significantly better intraoperative conditions during office-based surgery. In addition, desflurane with routine antiemetic prophylaxis was associated with a faster early recovery and similar incidence of postoperative side effects.

Report of the Council on Scientific Affairs. Use of restraints for patients in nursing homes. Council on Scientific Affairs, American Medical Association.

Objective: To examine issues related to the use of restraints on nursing home patients, including regulations and guidelines, risks and benefits of restraint use, system problems, and measures to reduce restraint use, to determine when the use of restraints results in clinically desirable outcomes.

Methods: Sources of information included a review of published articles and reports, a survey of federal and state regulations and guidelines relating to restraint use in nursing homes, review of current legislative initiatives, and consultation with experts in the field.

Results: The data reveal that restraint use imposes more risk of falls and other undesirable outcomes than it prevents.

Manganese in gasoline. Council on Scientific Affairs, American Medical Association.

This report responds to a resolution that asked the American Medical Association (AMA) to take action to reduce potential health risks from the use of methylcyclopentadienyl manganese tricarbonyl (MMT) in gasoline. Information for this report was derived from a search of the MEDLINE database and references listed in pertinent articles, as well as through communications with medical and public health experts. Based on this information, the AMA Council on Scientific Affairs determined that there is insufficient scientific evidence to assess the public health impact of MMT use.

Silicone elastomer cerebrospinal fluid shunt systems. Council on Scientific Affairs, American Medical Association.

A 1995 resolution of the American Medical Association House of Delegates, introduced by the American Academy of Neurology, the American Association of Neurological Surgeons, and the Congress of Neurological Surgeons, asked the American Medical Association Council on Scientific Affairs to add the use of hardened silicone shunts to its study of the effects of silicone gel used in breast implants. On consideration of the important differences between the two materials, silicone elastomer ("hardened silicone") and silicone gel, the Council on Scientific Affairs elected to address the subject of silicone elastomer shunt systems separately. This report describes the different types of medical-grade silicone used in medical devices, the incidence of hydrocephalus and its causes and treatment, and the use of cerebrospinal fluid shunt systems made of silicone elastomer.

Calcifications in breast biopsy specimens: discrepancies in radiologic-pathologic identification.

To analyze the effectiveness and accuracy of the diagnostic process from screening mammography to final diagnosis at pathologic examination, the authors conducted a prospective study of 277 consecutive patients who underwent 291 mammographically directed biopsies of nonpalpable lesions. Of the 170 lesions that demonstrated findings consistent with calcification on preoperative mammograms and radiographs of specimens, 12 (7.1%) were not described by the pathologist as being calcified.