Early removal of catheters in an Enhanced Recovery Pathway (ERP) with intrathecal opioid injection does not affect postoperative urinary outcomes.

BACKGROUND: Postoperative urinary retention (POUR) and catheter-associated urinary tract infections (CAUTI) are associated with significantly longer hospital length-of-stay and increased costs.1 This study investigates the effect of early removal of urinary catheters on POUR and CAUTI in patients undergoing an ERP with a preoperative intrathecal injection. METHODS: Retrospective cohort study of a prospectively maintained database of patients who underwent elective colorectal surgery in an Enhanced Recovery pathway was compared to historical National Surgical Quality Improvement Program cohort of patients. Primary outcomes measured are 30-day POUR and postoperative CAUTI rates. RESULTS: The overall POUR rate of ERP patients compared to non-ERP patients was significantly less (8% vs. 13%, p < 0.05). CAUTI rates were not significantly different between pre-ERP and ERP patients (1.2 vs 2.3%, p = 0.19). CONCLUSIONS: For patients undergoing ERP with a preoperative intrathecal opioid injection, early removal of urinary catheter significantly decreased POUR and did not significantly affect CAUTI rates. SUMMARY: The effect of early removal of urinary catheters on postoperative urinary retention and catheter-associated UTI rates in patients undergoing an ERP with a single preoperative intrathecal opioid injection was studied. Early urinary catheter removal after intrathecal injection was associated with decreased rates of POUR and equivalent CAUTI rates.

Effect of vascular occlusion on radiofrequency ablation of the liver: results in a porcine model.

OBJECTIVE: This study determined the effect of vascular occlusion on radiofrequency lesion shape, volume, and temperature in a porcine liver model. SUBJECTS AND METHODS: Radiofrequency lesions (n = 33) were created in the livers of six domestic pigs in vivo using a multiprong radiofrequency electrode. Lesions were randomly assigned to one of four vascular occlusion groups: portal vein, hepatic artery, Pringle maneuver (both hepatic artery and portal vein), or no occlusion. Radiofrequency parameters were time, 7 min; power, 50 W; and target temperature, 100 degrees C. Temperatures were measured 5, 10, and 15 mm from the electrode. After the animals were sacrificed, the lesions were excised. Lesion volume, diameter, and shape; maximum temperature; and time exposed to lethal temperatures (42-60 degrees C) were determined. RESULTS: Lesion volume was greatest with the Pringle maneuver lesions (12.6 +/- 4.8 cm(3)), followed by occlusion of the portal vein (8.6 +/- 3.8 cm(3)), occlusion of the hepatic artery (7.6 +/- 2.9 cm(3)), and no occlusion (4.3 +/- 1.0 cm(3)) (p < 0.05). Maximum lesion diameter was similar with the Pringle maneuver (3.3 +/- 0.3 cm), the portal vein (3.3 +/- 0.2 cm), and the hepatic artery (3.2 +/- 0.2 cm) groups compared with no occlusion (2.6 +/- 1.0 cm) (p < 0.05). Minimum lesion diameter ranged from 2.9 cm for Pringle maneuver lesions to 1.0 cm for lesions with no occlusion (p < 0.05). Vascular occlusion increased the time tissue was exposed to lethal temperatures (> 42-60 degrees C) and created more spherical lesions than no occlusion. CONCLUSION: Vascular occlusion combined with radiofrequency ablation increases the volume of necrosis, creates a more spherical lesion, and increases the time tissue is exposed to lethal temperatures when compared with radiofrequency alone. Most of this vascular occlusion effect could be accomplished with hepatic artery occlusion alone.

Metastatic breast cancer.

The unfortunate reality of metastatic breast cancer is that all treatment is palliative in nature. This is a disease that currently has no cure and for which therapy is directed towards accentuating survival and relieving symptoms. Current technology allows the prediction and detection of metastases earlier and with greater accuracy. These achievements need to be consolidated by the discovery of innovative therapies that can alter the inevitable outcome of this disease.

Changing leaders: the board's role in CEO succession ... roundtable discussion.

The selection of a CEO is one of the most important- and risky-events in the life of any company. Yet the way CEOs are chosen remains little discussed and little understood. The succession process has traditionally unfolded behind closed doors--some observers have even likened it to the election of a pope. To shed light on what works and what doesn't in CEO succession, the authors lead a roundtable discussion with five distinguished corporate directors: Philip Caldwell, George D. Kennedy, G. G. Michelson, Henry Wendt, and Alfred M. Zeien. Collectively, the five directors have participated in dozens of successions, either as board members or as CEOs. In a lively and frank exchange of views and experiences, the roundtable participants explore a broad range of questions: What can a company do to ensure a successful succession? How should management-development and succession processes be managed? How should the board work with the sitting chief executive during the process? What makes for a strong CEO candidate? When should outside candidates be considered? How much competition should be encouraged among potential CEO candidates? What role should executive search firms play? What role should former CEOs play after they are succeeded? Their conversation illuminates a corporate challenge that is as difficult as it is important.