Percutaneous discal cyst rupture in a professional football player using sublaminar epidural injection for thecal sac displacement.

A case of percutaneous discal cyst rupture in a 25-year-old professional American football player is reported. The patient presented with a 3-day history of severe left-sided back pain. Magnetic resonance imaging examination demonstrated a discal cyst effacing the left L4-L5 lateral recess, with interposed thecal sac.

Using Both Clinical Registry and Administrative Claims Data to Measure Risk-adjusted Surgical Outcomes.

Objective: To examine the validity of hybrid quality measures that use both clinical registry and administrative claims data, capitalizing on the strengths of each data source.

Background: Previous studies demonstrate substantial disagreement between clinical registry and administrative claims data on the occurrence of postoperative complications. Clinical data have greater validity than claims data for quality measurement but can be burdensome for hospitals to collect.

Aortic Root Replacement for Pseudoaneurysm Arising from Freestyle Aortic Bioprosthesis.

A 70-year-old female presented with a new systolic murmur and shortness of breath three years after undergoing aortic root replacement using a 27-mm Medtronic Freestyle® stentless full root bioprosthesis (Medtronic, Inc., Fridley, Minnesota, USA). A large complex aortic root pseudoaneurysm was identified on contrasted computed tomography of the chest and transesophageal echocardiogram.

Measuring risk-adjusted value using Medicare and ACS-NSQIP: is high-quality, low-cost surgical care achievable everywhere?

Objective: To evaluate the relationship between risk-adjusted cost and quality for colectomy procedures and to identify characteristics of "high value" hospitals (high quality, low cost).

Background: Policymakers are currently focused on rewarding high-value health care. Hospitals will increasingly be held accountable for both quality and cost.

Variations in definition and method of retrieval of complications influence outcomes statistics after pancreatoduodenectomy: comparison of NSQIP with non-NSQIP methods.

Background: NSQIP and the Accordion Severity Grading System have recently been used to develop quantitative methods for measuring the burden of postoperative complications. However, other audit methods such as chart reviews and prospective institutional databases are commonly used to gather postoperative complications. The purpose of this study was to evaluate discordance between different audit methods in pancreatoduodenectomy--a common major surgical procedure.

Identification of modifiable factors for reducing readmission after colectomy: a national analysis.

Background: Rates of hospital readmission are currently used for public reporting and pay for performance. Colectomy procedures account for a large number of readmissions among operative procedures. Our objective was to compare the importance of 3 groups of clinical variables (demographics, preoperative risk factors, and postoperative complications) in predicting readmission after colectomy procedures.

Priorities for the primary prevention of breast cancer.

Despite recent calls to intensify the search for new risk factors for breast cancer, acting on information that we already have could prevent thousands of cases each year. This article reviews breast cancer primary prevention strategies that are applicable to all women, discusses the underutilization of chemoprevention in high-risk women, highlights the additional advances that could be made by including young women in prevention efforts, and comments on how the molecular heterogeneity of breast cancer affects prevention research and strategies.

A simple effective method for generation of a permanent record of the Critical View of Safety during laparoscopic cholecystectomy by intraoperative "doublet" photography.

Background: The Critical View of Safety (CVS) is an established method for identifying the cystic duct during laparoscopic cholecystectomy. Its goal is to prevent misidentification of the bile ducts and avoid biliary injury. However, a visual record of CVS is not usually made.

Life-threatening diphenhydramine toxicity presenting with seizures and a wide complex tachycardia improved with intravenous fat emulsion.

Diphenhydramine toxicity manifests with signs of anticholinergic toxicity; therapy is generally supportive. In rare cases, patients can also present with a wide complex tachycardia due to sodium channel blockade. Treatment involves sodium bicarbonate.

Hypoglycemia-associated autonomic failure in diabetes.

The concept of hypoglycemia-associated autonomic failure (HAAF) in diabetes posits that recent antecedent hypoglycemia, as well as sleep or prior exercise, causes both defective glucose counterregulation (by attenuating the adrenomedullary epinephrine response, in the setting of absent insulin and glucagon responses) and hypoglycemia unawareness (by attenuating the sympathoadrenal, largely the sympathetic neural, response) and thus a vicious cycle of recurrent hypoglycemia. Albeit with different time courses, the pathophysiology of defense against hypoglycemia - no decrease in therapeutic insulin, no increase in glucagon and an attenuated increase in sympathoadrenal activity - is the same in type 1 diabetes and advanced type 2 diabetes. Hypoglycemia unawareness is reversible by 2-3 weeks of scrupulous avoidance of hypoglycemia in most affected patients.

Long-term effect of infection prevention practices and case mix on cesarean surgical site infections.

Objective: To estimate trends in patient characteristics and obstetric complications in an 8-year cohort of patients undergoing cesarean delivery and to use time series analysis to estimate the effect of infection prevention interventions and secular trends in patient characteristics on postcesarean delivery surgical site infections.

Methods: A multivariable autoregressive integrated moving average model was used to perform time series analysis on a 96-month retrospective cohort of patients who underwent cesarean delivery (January 2003-December 2010) in a U.S.

Impact of video-assisted thoracoscopic surgery on benign resections for solitary pulmonary nodules.

Background: Differentiating benign from malignant pulmonary lesions is an important part of surgical decision making. We reviewed our experience of resecting suspicious pulmonary nodules to test the hypothesis that the increased use of video-assisted thoracic surgery (VATS) has increased the resection rate of benign lesions.

Methods: A retrospective analysis was carried out on 3,217 patients who underwent resection for focal pulmonary lesions between 1995 and 2009.

Retrograde jejunogastric decompression after esophagectomy is superior to nasogastric drainage.

Background: Nasogastric tubes (NG) are commonly used for maintaining conduit decompression after esophagectomy. We investigated the use of retrograde tube gastrostomy (RG) after esophagectomy.

Methods: Patients underwent either NG or RG placement for postoperative conduit decompression.

Endoscopic ultrasound for early stage esophageal adenocarcinoma: implications for staging and survival.

Background: Patients often receive induction therapy based on endoscopic ultrasound (EUS)-identified nodal spread (N1) or deep tumor invasion (T3), although controversy exists regarding the role of induction therapy for early stage disease. We aim to evaluate the reliability of EUS in identifying early stage disease and the subsequent impact on treatment and outcomes.

Methods: We retrospectively studied 149 patients who underwent EUS and esophagectomy for adenocarcinoma between January 2000 and December 2008.

Providing care for the "whole patient" in the cancer setting: the psycho-oncology consultation model of patient care.

This paper describes a psycho-oncology consultation model of care (POCM) that provides a framework for psychosocial clinical work with cancer patients. Goals for care are addressed that follow the recommendations of the Institute of Medicine report advocating care for the "whole patient." Specific goals include reducing distress and symptoms, building on the patient's existing strengths, enhancing self-efficacy, expanding the patient's repertoire of healthy coping strategies, and addressing informational needs.

Titanium mesh reconstruction to maintain scalp contour after temporalis musculofascial flap reconstruction of the floor of the middle cranial fossa: a technical note and report of two cases.

Objective: Temporalis musculofascial rotational flaps can provide excellent tissue for reconstruction of defects in the floor of the middle cranial fossa. This technique can, however, result in cosmetic deformity of the temporal fossa with an asymmetric contour of the head. We report a technique that uses titanium mesh and autologous abdominal adipose to maintain a normal scalp contour.

Effect of reclassification on the incidence of benign and malignant renal tumors.

Purpose: The incidence of benign renal tumors has increased in recent years. This trend is commonly attributed to the increased use of cross-sectional imaging and minimally invasive surgical approaches. An alternative hypothesis is that recent changes in histological classification are responsible for the increasing incidence.

Revision total knee arthroplasty for major osteolysis.

Twenty-eight knees in 26 patients underwent revision TKA requiring surgical management of major osteolytic defects. Three groups of osteolytic defects were identified based upon the degree of implant stability and the magnitude of bone loss. Outcome measures included the Knee Society Clinical Rating Score (KSCRS), visual analog pain score, and radiographs.