Social media, surgeons, and the Internet: an era or an error?

According to the National Research Corporation, 1 in 5 Americans use social media sites to obtain healthcare information. Patients can easily access information on medical conditions and medical professionals; however physicians may not be aware of the nature and impact of this information. All physicians must learn to use the Internet to their advantage and be acutely aware of the disadvantages. Surgeons are in a unique position because, unlike in the primary care setting, less time is spent developing a long-term relationship with the patient. In this literature review, we discuss the impact of the Internet, social networking websites, and physician rating websites and make recommendations for surgeons about managing digital identity and maintaining professionalism.

Validation of a novel staging system for disease-specific survival in patients with breast cancer treated with neoadjuvant chemotherapy.

PURPOSE: We previously described a novel breast cancer staging system for assessing prognosis after neoadjuvant chemotherapy on the basis of pretreatment clinical stage (CS), estrogen receptor status (E), grade (G), and post-treatment pathologic stage (PS). This clinical-pathologic stage (CPS) + EG staging system assigned and summed points for each factor, allowing for better determination of breast cancer-specific survival than CS or PS alone. The current study was undertaken to validate this staging system using internal and external cohorts. METHODS: We identified an internal cohort of 804 patients treated with neoadjuvant chemotherapy at our institution from 2003 to 2005 and an external cohort of 165 patients treated at another institution. Clinicopathologic characteristics, treatment regimens, and patient outcomes were assessed. Outcomes were stratified by CPS + EG score. RESULTS: Five-year disease-specific survival (DSS) for the internal cohort was 77% (95% CI, 72 to 82) at a median follow-up of 3.4 years (range, 0.3 to 5.9 years). Five-year DSS for the external cohort was 86% (95% CI, 79 to 91) at a median follow-up of 4.7 years (range, 0.5 to 10.5 years). The ability of the CPS + EG score to stratify outcomes was confirmed in both the internal and external cohorts. Application of the CPS + EG staging system facilitated more refined categorization of patients into prognostic subgroups by outcome than presenting CS or final PS as defined by the American Joint Committee on Cancer (AJCC) staging system. CONCLUSION: The current study validates the CPS + EG staging system in two independent cohorts. We recommend that biologic markers and response to treatment be incorporated into revised versions of the AJCC staging system for patients receiving neoadjuvant chemotherapy.

Compartment syndrome after endoscopic harvest of the great saphenous vein during coronary artery bypass grafting.

Compartment syndrome is a limb-threatening condition often associated with traumatic, crush, burn, and reperfusion injuries. It is characterized by the development of disproportionately severe pain, paresthesias, decreased range of motion, loss of pulse, and a tense, edematous limb. In addition, measured compartment pressures and creatine phosphokinase values are often elevated. The definitive treatment is a decompressive fasciotomy. Compartment syndrome after coronary artery bypass grafting, however, is rare. The few reported cases all occurred in the vein donor leg after open harvest. We present a patient with compartment syndrome after endoscopic harvest of the saphenous vein for coronary artery bypass grafting.