Feasibility of Day Surgery in Patients With Breast Conservation and Sentinel Node Biopsy: A Randomized Controlled Trial.

BACKGROUND AND AIMS: The aim of this study was to analyze feasibility of day surgery in breast cancer patients with breast conserving surgery and sentinel node biopsy. MATERIAL AND METHODS: The study was a randomized controlled trial comparing day surgery with one night hospital stay in breast cancer patients with breast conserving surgery and sentinel node biopsy. A total of 40 patients with ⩽3-cm tumor and clinically N0 were randomized to one night stay group and 38 patients to day surgery group. Within discharge, patients and their relatives were given questionnaires in order to evaluate their experience regarding the duration of hospital stay. RESULTS: Randomized groups were similar regarding patient age and tumor stage. A total of 18 (47%) day surgery group patients were discharged the same day. The most common reason for overnight hospital stay was axillary clearance, 9 (24%). None of the patients in the day surgery group, but 2 patients in the overnight hospital stay group had re-operation due to complications. Perception and preference results were analyzed both according to randomization and actual treatment groups. Patients in both groups had rather similar experiences on the first postoperative day. Also, spouse's or relative's perception after discharge was similar in both groups. CONCLUSION: Day surgery was well received by the patients and their relatives. Day surgery appears as feasible in patients with breast conservation and sentinel node biopsy.

Prophylaxis of sternal wound infections with gentamicin-collagen implant: randomized controlled study in cardiac surgery.

Postoperative infections may lead to prolonged hospital stay and increased morbidity, mortality and hospital costs, especially in heart surgery. Finding new means to prevent infections would benefit both the patient and society. The aim of this study was to assess if locally administered gentamicin prevents sternal wound infections in coronary artery bypass (CABG) surgery. We randomized 542 consecutive CABG patients to two groups: those who received gentamicin-collagen implant under their sternum before closure (N=272) and controls (N=270). The subjects received routine intravenous antimicrobial prophylaxis (85% cefuroxime, 14% cefuroxime and vancomycin), and were followed-up for three months. The sternal wound infection rate was 4.0% (11/272) in the gentamicin group and 5.9% (16/270) in the control group. The mediastinitis rates were 1.1 and 1.9%, respectively. This treatment was safe and easy to administer, and no side-effects occurred. No statistically significant difference was demonstrated between infection rates in the two groups. This is the first study on the use of gentamicin-collagen sponge as prophylaxis in cardiac surgery. Our data show that infection was reduced slightly in the gentamicin-collagen group compared with the control group, but the study population was too small to draw conclusions. Further evaluation is needed, and the results may warrant another larger, better-powered study.

Tobacco chemistry. 73. 4,6,8-trihydroxy-11-capnosene-2,10-dione, a new cembrane-derived bicyclic diterpenoid from tobacco.

A new diterpenoid containing a rare carbobicyclic cembrane-derived skeleton, the capnosane skeleton, has been isolated from flowers of Greek tobacco. It has been identified as (1S*,3R*,4S*,6R*,7R*,8R*,11Z)-4,6,8-trihydroxy-11-capnosene- 2,10-dione by spectral methods and X-ray analysis of the corresponding benzoate. A full account of the X-ray work is given.

Tobacco chemistry. 65. Two new 7,8-epoxycembranoids from tobacco.

Two new diterpenoids have been isolated from tobacco. They have been identified as the (1S,2E,4S,6R,7R,8R,11E)- and (1S,2E,4S,6R,7S,8S,11E)-7,8-epoxy-2,11-cembradiene-4,6-diols 1 and 2 by synthesis and X-ray analysis. The conformation about the 5,6 bond in some 7,8-epoxycembranoids is discussed, as is the biogenesis of the two new compounds.