American journal of surgery
-
Trauma surgery has changed significantly over the past decade. Nonoperative evidence-based algorithms have become common and surgical trauma volume has become increasingly difficult to maintain. The acute care surgery (ACS) model, which integrates trauma, critical care, and emergency surgery, has been proposed as a future model of trauma practice. ⋯ Surgical practice in a county-run trauma hospital can be similar to the ACS model, with positive results in terms of clinical volume and physician satisfaction. As clinical practices shift to the ACS model, there are lessons to be learned from currently existing, thriving, long-standing similar prototypes.
-
We hypothesized that early use of external mechanical compression (EMC) reduces hemorrhage and mortality associated with pelvic fractures. ⋯ Early EMC with pelvic binders does not reduce hemorrhage or mortality associated with pelvic fractures.
-
Multicenter Study Clinical Trial
Five-year results: the initial clinical trial of MammoSite balloon brachytherapy for partial breast irradiation in early-stage breast cancer.
Patients with early-stage invasive ductal breast cancer were prospectively evaluated using MammoSite RTS balloon brachytherapy (RTS Cytyc Corp, Marlborough, MA) as the sole modality for delivering accelerated partial breast irradiation to the lumpectomy bed with breast-conserving surgery. This report presents the 5-year results of the treated patients. ⋯ MammoSite balloon brachytherapy as a sole modality for delivering radiation to the tumor bed has been successful in achieving excellent local control in this initial clinical study of patients with early-stage invasive ductal breast cancer. This has been achieved with minimal toxicities and good-excellent cosmetic outcomes in 83.3%. Accelerated partial breast irradiation using the MammoSite balloon in a carefully selected group of patients has demonstrated 5-year local recurrence results comparable to those achieved with conventional whole breast radiation therapy and interstitial catheter brachytherapy as reported at 5-year data points in studies of these treatment modalities. Poor cavity conformance and inadequate skin distance were the main factors limiting use of the MammoSite device. Extended follow-up will be required to determine the long-term efficacy of this treatment modality.
-
Secular trends in mortality associated with new therapeutic strategies in surgical critical illness.
Since 1999 randomized controlled trials have shown that new therapeutic strategies, such as strict glycemic control, increased use of noninvasive ventilation and of lung-protective ventilation, and early goal-oriented shock therapy, may reduce mortality in selected groups of critically ill patients. Whether these benefits can be translated to a surgical clinical setting is unclear. We wanted to evaluate longitudinally the successive routine implementation of new therapeutic measures and its effect on postsurgical patients admitted to the intensive care unit. ⋯ Implementing of a variety of new therapeutic measures into routine care of critically ill surgical patients was associated with improved survival after 2001.
-
Randomized Controlled Trial
The TARGIT trial: targeted intraoperative radiation therapy versus conventional postoperative whole-breast radiotherapy after breast-conserving surgery for the management of early-stage invasive breast cancer (a trial update).
The principal objective of the targeted intraoperative radiation therapy trial was to determine whether single-fraction intraoperative radiotherapy (IORT) targeted to the tumor bed provides equivalent local control compared with whole-breast irradiation in patients with early-stage invasive breast cancer. ⋯ Targeted IORT allowed the entire dose of radiotherapy to be administered in a single fraction at the time of breast-conserving surgery, thus avoiding the need for repeated radiotherapy treatments or placement of indwelling radiotherapy devices.