Feasibility of Prospectively Comparing Opioid Analgesia With Opioid-Free Analgesia After Outpatient General Surgery: A Pilot Randomized Clinical Trial.

Importance: The overprescription of opioids to surgical patients is recognized as an important factor contributing to the opioid crisis. However, the value of prescribing opioid analgesia (OA) vs opioid-free analgesia (OFA) after postoperative discharge remains uncertain.

Objective: To investigate the feasibility of conducting a full-scale randomized clinical trial (RCT) to assess the comparative effectiveness of OA vs OFA after outpatient general surgery.

Serotonergic antidepressants and increased bleeding risk in patients undergoing breast biopsy.

Objectives: Recent investigations have shown that serotonergic antidepressant (SAd) use may increase the risk of peri-operative bleeding events. Our objective was to evaluate the possibility of a similar association in patients undergoing radiologic breast biopsies.

Methods: We used data from 3890 patients undergoing 6300 biopsy procedures between January 2011 and October 2014 in the Breast Clinic of McGill University Health Centre, Montreal, Canada.

Assessing clinical judgment using the Script Concordance test: the importance of using specialty-specific experts to develop the scoring key.

Background: The Script Concordance test (SCT) assesses clinical judgment. The purpose of this study was to determine whether a specialty-specific scoring key improves the validity of the SCT.

Methods: Thirty experts from 6 general surgery disciplines answered questions pertaining to their area of expertise.

The script concordance test as a measure of clinical reasoning: a national validation study.

Introduction: The script concordance test (SCT) is an innovative tool for clinical reasoning assessment. It has previously been shown to be a reliable and valid measure of clinical reasoning among general surgical residents.

Purpose: To determine if the SCT maintained its validity and reliability when administered on a national level.

A case of unresectable rectal necrosis.

Introduction. Necrosis of the rectum is an uncommon finding due to abundant collateral vasculature. Its management remains challenging, without clear consensus in the literature.

Anorectal melanoma: diagnosis and treatment.

An increase in the incidence of anorectal melanoma has recently been noted in the United States. Anorectal melanoma is an uncommon and lethal condition, with a median survival of <20 months. Unfortunately, nonspecific symptoms also attributable to common and benign conditions (eg, hemorrhoids) cause significant delay in its diagnosis.

Analysis of clinical applicability of the breast cancer nomogram for positive sentinel lymph node: the canadian experience.

Background: A Breast Cancer Nomogram (BCN) for predicting nonsentinel lymph node (NSLN) involvement has been developed and prospectively tested in several series. However, its clinical applicability has never been tested among surgeons.

Methods: The BCN was applied to 209 SLN-positive patients.

Nail-Patella syndrome: a case report and anesthetic implications.

Purpose: To report a case of asystole during combined epidural and general anesthesia occurring in a patient with Nail-Patella syndrome (NPS), and to review the management and anesthetic implications of this rare genetic syndrome.

Clinical Features: A 64-yr-old male with NPS, renal impairment and coronary artery disease presented for right hemicolectomy for colon cancer. Following initiation of surgery and during insertion of a nasogastric tube there was sudden loss of the patient's pulse oxymetry, and arterial pressure waveforms with an asystolic electrocardiogram signal.

A novel method of assessing clinical reasoning in surgical residents.

At present, surgical educators can readily assess knowledge with multiple-choice examinations, and inanimate models can be used to assess technical skills. Clinical judgment and reasoning are indispensable skills used by expert surgeons to solve ill-defined problems encountered in the emergency department, clinic, and operating room. The Script Concordance Test, a new tool of clinical reasoning assessment, can test the elaborated networks of knowledge that experienced surgeons develop over the years.

Successful use of letrozole in male breast cancer: a case report and review of hormonal therapy for male breast cancer.

Male breast cancer is an uncommon occurrence. Treatment of male breast cancer is typically extrapolated from data on the treatment of female breast cancer. Recently, aromatase inhibition has been proven as an effective therapy for female breast cancer, particularly in the setting of advanced cancers.

A case of penile melanoma illustrating the low sensitivity of frozen sections in the assessment of sentinel lymph nodes.

A 75 year-old uncircumcised man presented with a 1.1mm thick malignant melanoma on the ventral aspect of the glans penis. He underwent isosulfan blue and technetium 99m guided sentinel lymph node (SLN) biopsy and distal penectomy with 2 cm margins.