Stop cancer colon. Colorectal cancer screening--updated guidelines.

Colorectal cancer (CRC) remains one of the most commonly diagnosed cancers in the U.S. Its incidence and mortality have shown a decreasing trend over the last several decades. The greatest contribution to this trend has been colorectal cancer screening. Colonoscopy continues to be the preferred screening modality. However, recommendations for the use of screening tests other than colonoscopy have generated much interest. Guidelines regarding current screening and surveillance recommendations have recently been updated by expert panels, such as the U.S. Multi-Society Task Force, National Comprehensive Cancer Network and National Institute of Health. A review of the updated guidelines as well as a PubMed search for articles dating 2006 to present relating to colorectal cancer screening and surveillance was performed. We discuss the importance of colorectal screening and highlight updates to current colorectal cancer screening and surveillance guidelines.

Thoracoscopic excision of a paraesophageal bronchogenic cyst in a child.

BACKGROUND: Bronchogenic cysts are not uncommon in either children or adults. In children, they comprise approximately 6% of all mediastinal masses. Their presentation can range from an asymptomatic incidental finding to sudden respiratory distress. CASE REPORT: Video-assisted thoracoscopy was utilized to remove a bronchogenic cyst that was densely adherent to the adjacent esophagus in a child. This was accomplished with a Harmonic scalpel. The chest tube was removed on postoperative day 1, and the patient was discharged on postoperative day 2. An esophagogram obtained 2 weeks after surgery was normal, and the patient's preoperative symptoms had not returned. CONCLUSIONS: Bronchogenic cysts should be considered in the differential diagnoses for mediastinal masses at any age. Given their benign nature, thoracoscopy offers an excellent alternative to open thoracotomy for their removal.

Surgeon-performed ultrasound for pneumothorax in the trauma suite.

BACKGROUND: Surgeon-performed ultrasound has become ubiquitous in the trauma suite. Initial reports suggest that sonography may be used for the detection of pneumothorax. The purpose of this study was to evaluate the efficacy of sonography to rule out the presence of a pneumothorax in the trauma population. METHODS: A prospective analysis of 328 consecutive trauma patients at an American College of Surgeons-verified Level I trauma center was undertaken. Thoracic ultrasound was performed before chest radiography. The presence or absence of a "sliding-lung" sign or "comet-tail" artifact was recorded. RESULTS: Of 328 evaluations, there were 312 true-negatives, 12 true-positives, 1 false-negative, 1 false-positive, and 2 exclusions. Specificity, negative predictive value, and accuracy were 99.7%, 99.7%, and 99.4%, respectively. CONCLUSION: Ultrasound is a reliable modality for the diagnosis of pneumothorax in the injured patient. This modality may serve as an adjunct or precursor to routine chest radiography in the evaluation of injured patients.

Pediatric empyema--an algorithm for early thoracoscopic intervention.

INTRODUCTION: The management of pediatric empyema remains controversial. We contend that early thoracoscopic intervention results in shorter hospital stays, decreased morbidity, and superior outcomes. We propose an algorithm using early image-guided thoracoscopy as an effective treatment for pediatric empyema. METHODS: Consecutive pediatric empyemas treated from November 1997 to April 2001 using a prospective management algorithm were reviewed. Demographic data, days to diagnosis, days to surgery, length of stay, chest tube days, complications, and follow-up were recorded. RESULTS: Twenty-two children with 24 empyemas were treated using this algorithm. Their mean age was 49 months. Mean days to diagnosis was 11 and from diagnosis to surgery was 3. Imaging included chest radiography (CXR) in all, ultrasound in 17 (77%), and computed tomography (CT) scan in 13 (59%). One thoracoscopy was converted to a mini-thoracotomy because of difficulty with ventilation. Chest tube removal averaged 3 days with an average length of stay of 13 days. One patient required a second thoracoscopy for recurrent empyema, and 1 patient developed a contralateral empyema. No other complications or deaths occurred. Follow-up in 19 of 22 (86%) children at 5 months revealed no recurrences or mortality. CONCLUSION: This treatment algorithm, using early image-guided thoracoscopy, is a safe and effective means of managing pediatric empyema, while shortening hospital stay and avoiding the morbidity of thoracotomy.

A survey of residents and faculty regarding work hour limitations in surgical training programs.

HYPOTHESIS: Surgical faculty and residents have significantly different attitudes regarding work hour restrictions. SETTING: All general surgery residencies approved by the Accreditation Council for Graduate Medical Education (ACGME). PARTICIPANTS: All voluntarily participating surgical faculty and residents. MAIN OUTCOME MEASURES: Current hours worked, days off per month, and attitudes and opinions regarding the current surgical-training environment. METHODS: A 17-question survey instrument was mailed to the program directors of all ACGME-approved surgical-training programs in the United States. They were requested to distribute the survey to all faculty and residents for completion and to return the forms for analysis. RESULTS: Responses (N = 1653) were received from 46% of surgical-training programs. A significant difference was noted between faculty and resident responses in most categories. Most residents (87%) reported more than 80 duty hours per week, whereas 45% reported working more than 100 hours per week. Only 30% of residents reported an average of 1 day per week free of clinical activities. Although a minority of residents (43%) felt that their workload was excessive, 57% felt that their cognitive abilities had been impaired by fatigue. A significant number of residents (64%) and faculty (39%) believe that duty hour restrictions should be adopted. A minority of residents (20%) and faculty (47%) believe that the duration of residency training should be increased to compensate for duty hour restrictions. One quarter of residents regret choosing a career in surgery. CONCLUSIONS: Current duty hours for most surgical residents exceed the proposed ACGME limits. Although most residents support duty hour limits; surgical faculty are less supportive. Significant alterations in the current design and structure of surgical-training programs will be required to meet the ACGME guidelines.