Prognostic impact of lymphadenectomy in clinically early stage malignant germ cell tumour of the ovary.

BACKGROUND: The aim of this study was to determine the impact of lymphadenectomy and nodal metastasis on survival in clinical stage I malignant ovarian germ cell tumour (OGCT). METHODS: Data were obtained from the National Cancer Institute registry from 1988 to 2006. Analyses were performed using Student's t-test, Kaplan-Meier and Cox proportional hazard methods. RESULTS: In all, 1083 patients with OGCT who have undergone surgical treatment and deemed at time of the surgery to have disease clinically confined to the ovary were included 590 (54.48%) had no lymphadenectomy (LND-1) and 493 (45.52%) had lymphadenectomy. Of the 493 patients who had lymphadenectomy, 441 (89.5%) were FIGO surgical stage I (LND+1) and 52 (10.5%) were upstaged to FIGO stage IIIC due to nodal metastasis (LND+3C). The 5-year survival was 96.9% for LND-1, 97.7% for LND+1 and 93.4% for LND+3C (P=0.5). On multivariate analysis, lymphadenectomy was not an independent predictor of survival when controlling for age, histology and race (HR: 1.26, 95% CI: 0.62-2.58, P=0.5). Moreover, the presence of lymph node metastasis had no significant effect on survival (HR: 2.7, 95% CI: 0.67-10.96, P=0.16). CONCLUSION: Neither lymphadenectomy nor lymph node metastasis was an independent predictor of survival in patients with OGCT confined to the ovary. This probably reflects the highly chemosensitive nature of these tumours.

The use of conscious sedation for outpatient dermatologic surgical procedures.

BACKGROUND: Dermatologic surgery has undergone increasing levels of sophistication over the past few decades. Commensurate with this demand, an established anesthesia technique called conscious sedation has been employed. OBJECTIVES: Methods for performing office-based conscious sedation are described. Recommendations are made regarding prerequisites for conscious sedation in an office setting, patient selection, complications management, and postoperative discharge requirements. CONCLUSION: The goals of anesthesia are to provide for patient safety and comfort, to increase patient acceptance of the procedure, and to enhance the surgeon's efficiency and satisfaction.

The combined use of propofol and fentanyl for outpatient intravenous conscious sedation.

BACKGROUND: Intravenous conscious sedation is currently being widely utilized for outpatient surgery including dermatologic surgery. Even though this type of anesthesia is typically administered by a trained, licensed anesthetist, it is important for dermatologists who either intend to or are currently utilizing this type of anesthesia to be familiar with some of the methods and agents that are commonly employed. OBJECTIVE: Propofol and fentanyl are two anesthetic agents that are in prevalent use for skin and soft tissue surgery of brief or limited duration. With the goal of familiarizing dermatologic surgeons with this form of anesthesia, a study was conducted to evaluate the safety and effectiveness of the combination of propofol and fentanyl when used for conscious sedation in an outpatient dermatology center. METHODS: Twenty patients, ages 25-65 years, who required conscious sedation were enrolled. Each patient received a standard dosage of fentanyl and propofol, as determined on a kilogram basis. Sedation time, total procedure time, recovery time, and total propofol dose, along with side effects, were determined. RESULTS: The mean onset to sedation was 52.5 seconds, the mean procedure time was 40 minutes 37 seconds, and the mean interval to recovery was 3 minutes 43 seconds, with a mean total dose of propofol of 5.83 mg/kg. Minimal side effects occurred. CONCLUSION: Propofol when used in conjunction with fentanyl appears to be a safe, quick, and effective method of providing conscious sedation.

Depression in primary care. Why do we miss the diagnosis?

Depressed patients are often undiagnosed, misdiagnosed, or underdiagnosed. Is this because family physicians are trained mainly to treat somatic complaints? Are patients reluctant to accept psychological causes for their physical symptoms? High volume of patients and short visits make it difficult for doctors to recognize depression. We propose strategies for identifying depressed patients in primary care.

A technique for blepharoplasty without incising or "puncturing" orbital septum.

A blepharoplasty procedure is described in which the actual dissection and removal of adipose tissue has been replaced simply with unipolar electrodesiccation.

Obstetrics and gynecology: avoiding pregnancy in isotretinoin users.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in obstetrics and gynecology. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers, or scholars to stay abreast of these items of progress in obstetrics and gynecology that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Obstetrics and Gynecology of the California Medical Association, and the summaries were prepared under its direction.

Fat transfer--a "pinch" technique for accurate placement of donor tissue.

A useful and simple technique for fat transfer requiring bilateral pressure prior to injection for effective correction of cosmetic defects is described.

Anesthesia for outpatient dermatologic cosmetic surgery: midazolam--low-dosage ketamine anesthesia.

Cardiovascular, respiratory, CNS, and postoperative effects of using low-dose ketamine and midazolam combined with local anesthesia during 40 outpatient cosmetic procedures are reviewed. This method of anesthesia is safe, effective, and well-tolerated by patients.

Syringe-assisted liposuction: a cosmetic surgeon's office technique.

Liposuction surgery is the fastest growing cosmetic surgical procedure in the United States. Our goal is to present a clinical review of our last 50 patients. We will present a technique of liposuction void of suction machine that is easily managed as an office surgical technique. The technique is modified from that of Dr. Fournier. We will outline the technique, including patient preoperative evaluation, monitoring, fluid management, postprocedure complications, photographic results, and, most importantly, patient selection.

Quantitative evaluation of thin-layer chromatograms.

A commercially available scanning photometer, designed to scan paper electrophoresis strips, has been used to evaluate thinlayer chromatograms. The chromatogram may be lifted off the glass plate with cellophane tape which is then cut into strips and scanned, or the thin-layer chromatogram may be photographed and the photograph scanned. Newly developed cellulose-backed thin layers of silica or alumina may also be cut into strips and scanned. The instrument has also been modified to scan glass plates. A correction is applied for non-uniformity of the thin layer. Zones containing colourless components can be located by means of an auxiliary chromatogram, and the components present determined by carbon analysis.