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Procalcitonin is used as a marker for sepsis but there is little known about the correlation of the procalcitonin elevation with the causative organism in sepsis. All patients aged 18 to 80 years who were admitted to the surgery service from June 2010 to May 2012 and who had a procalcitonin drawn were evaluated. Culture data were reviewed to determine the causative organism. Infections analyzed included pneumonia, urinary tract infection (UTI), bloodstream infection, and Clostridium difficile. Other parameters assessed included reason for admission, body mass index, pressor use, antibiotic duration, and disposition. Two hundred thirty-two patient records were reviewed. Patients without a known infection/source of sepsis had a mean procalcitonin of 3.95. Those with pneumonia had a procalcitonin of 20.59 ( P = 0.03). Those with a UTI had a mean procalcitonin of 66.84 ( P = 0.0005). Patients with a bloodstream infection had a mean procalcitonin of 33.30 ( P = 0.003). Those with C. difficile had a procalcitonin of 47.20 ( P = 0.004). When broken down by causative organisms, those with Gram-positive sepsis had a procalcitonin of 23.10 ( P = 0.02) compared with those with Gram-negative sepsis at 32.75 ( P = 0.02). Those with fungal infections had a procalcitonin of 42.90 ( P = 0.001). These data suggest that procalcitonin elevation can help guide treatment by indicating likely causative organism and infection type. These data may provide a good marker for initiation of antifungal therapy.

An institutional review board-approved retrospective database of 99 patients under the age of 40 with breast cancer treated between January 2001 and March 2011 was generated from patients seen in breast practice. Choi et al.3 reviewed demographic data with regards to early onset breast cancer revealing a 47.5 per cent HER2 positive level in their Korean patients compared with a 15.8 per cent positivity in white patients.

Extracorporeal membrane oxygenation has increased survival from 20 to 55 per cent, although the morbidity associated with pulmonary hypertension, pulmonary hypoplasia, and ventilator dependence has not been altered.3 Several theories exist regarding the embryologic origins of these hernias. Several centers suggest that proximity to the pericardium or involvement of the pericardium requires open repair, but several case reports have demonstrated the efficacy of laparoscopic repair in the trauma population.3 Laparoscopic repair of traumatic diaphragmatic hernias has been documented as well.1 Laparoscopic repair of Morgagni hernias is well tolerated, although there is still debate regarding the need to excise the hernia sac.

Male breast cancer is a rare disease entity, representing less than 1 per cent of malignancies in men.1 Male breast cancers tend to occur later in life and exhibit a single peak incidence in the early sixties, whereas female breast cancer (FBC) has a bimodal distribution. 1 Several risk factors have been identified in conjunction with male patients presenting with breast cancer. An excess of estrogen or deficiency in testosterone as seen in obesity, Klinefelter's syndrome, gynecomastia, and liver disease is thought to contribute to the development of breast cancer in males.1 Additionally, having diabetes, orchitis/epididymitis, cholelithiasis, having a first-degree relative with male breast cancer, and African-American race predispose men to breast cancer.2 Studies suggest that approximately 20 per cent of men with breast cancer have a first-degree female relative with breast cancer, which adds to their personal risk of breast cancer two to three times.1 Lastly, BRCA1 and BRCA2 mutations have long been associated with the development of breast cancer in males.1, 3 Studies have found that rates of BRCA1/2 mutations in families with male breast cancer range from 4 to 34 per cent.3 Male breast cancers are largely encompassed by invasive ductal type, up to 90 per cent.1 It is generally thought that MBC most closely resembles postmenopausal FBC.

Small bowel follow-through (SBFT) is a diagnostic tool commonly used in the management of patients with small bowel obstruction (SBO). This study assessed whether early implementation of Gastrografin SBFT would reduce the time to resolution of the SBO and decrease the time to operative intervention. In this retrospective chart review, 103 patients with the clinical diagnosis of adhesive SBO were evaluated. End points of the study were resolution of SBO with non-operative management or operative intervention. The patient group that had received a SBFT was then compared with those that did not receive a SBFT. There were 103 patients with adhesive SBO who met inclusion criteria for this study. Seventy-two of 103 patients had undergone Gastrografin SBFT and 31 did not. In the SBFT group, mean time to the operating room was 1.0 days after SBFTs, whereas in the group that did not receive SBFT, it was 3.7 days ( P < 0.0001). Mean time to nonoperative resolution of SBO in the SBFT group was 1.8 days and 4.7 days in the no SBFT group ( P < 0.0001). There were no Gastrografin-related complications. Obtaining Gastrografin SBFT in patients with adhesive SBO leads to both a shorter time in identifying the need for operative intervention and to resolution of SBO with nonoperative management. SBFT seems to be a more definitive assessment of whether an SBO will resolve on its own or if operative intervention is necessary.

There is a significant body of data that suggests that achieving negative margins is essential for local control.1 Numerous studies have also suggested a negative financial and social impact associated with the need for re-excision.2 Most surgeons agree that achieving negative margins at the initial surgery can significantly improve cosmetic outcome as well. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole breast irradiation in stages I and II invasive breast cancer. Cost analysis of a surgical consensus guideline in breast-conserving surgery.

Multiple studies have shown the detrimental effect of miscommunication during transitions of care. The aim of this study is to determine whether a certain method of “sign-out” can improve information transmission and thereby reduce medical errors. Surgical interns underwent a 90-minute training session before starting residency in five previously verified methods of sign-out. They were randomly assigned to six groups (five methods and a control group). They were then given seven simulated patient charts with varying levels of medical complexity. They were then instructed to “sign-out” the patients to randomly selected colleagues. The control group did not use any of the previously taught methods and passed on information in a manner of their choosing. None of the methods consistently results in excellent transitions of care. Patient information values ranged from 26 to 40 (depending on complexity). Major points were consistently missed by all methods, but this may have been a component of the time constraint placed on this study. The “SIGNOUT?” method resulted in superior data transmission when compared with the control group (P = 0.0401). The only method that seemed to be significantly inferior was the “9Ds” method (P = 0.0610). The “SIGNOUT?” method leads to the largest amount of relevant information transmitted to the incoming team. There was no statistically significant difference among the other methods. Improvement in “sign-out” modalities and training may improve transmission of relevant patient information, but larger studies are needed to verify the data seen in this small, single-site study.