Local anesthesia and anxiolytic techniques for oculoplastic surgery.

This study discusses local anesthetic agents, administration techniques, ancillary considerations, and safety precautions for oculoplastic surgery including eyelid, lacrimal, orbital, and temporal artery biopsy procedures. Methods for reducing patient apprehension and discomfort including systemic premedication, topical pre-anesthetic, visual, auditory and tactile distraction techniques, regional blocks, small gauge needles, warmed lidocaine, and buffered lidocaine are discussed.

Long-Term Results of a Randomized Trial Comparing Iridium Implant Plus External Beam Radiation Therapy With External Beam Radiation Therapy Alone in Node-Negative Locally Advanced Cancer of the Prostate.

PURPOSE: To determine the impact on long-term survival from the addition of brachytherapy to external beam radiation therapy (EBRT) in patients with prostate cancer. METHODS AND MATERIALS: Between 1992 and 1997, 104 men with cT2-3, surgically staged node-negative prostate cancer were randomized to receive either EBRT (40 Gy/20 fractions) with iridium implant (35 Gy/48 hours) or EBRT alone (66 Gy/33 fractions) to the prostate. According to T stage, Gleason score, and prostate-specific antigen level, 60% of patients had high-risk disease. Substantial improvements in biochemical control at 8 years have previously been reported. Additional follow-up was collected on deaths and metastases. RESULTS: Median follow-up was 14 years. Five patients were lost to follow-up. All other patients have been followed a minimum of 13 years. There have been 75 deaths, including 21 from prostate cancer and 25 from second cancers. No patients developing a second cancer have died from prostate cancer. There was no difference in overall survival between the 2 treatment groups: 34 deaths (67%) in the implant arm and 41 (77%) in the EBRT arm (hazard ratio [HR] 1.00, 95% confidence interval [CI] 0.63-1.59). Similarly, there was no difference in prostate cancer-specific deaths: 9 (18%) patients in the implant arm compared with 12 (23%) in the EBRT arm (HR 0.79, 95% CI 0.34-1.87). There was no statistically significant difference in the number of patients developing metastatic disease: 10 (20%) in the implant arm and 15 (28%) in the EBRT arm (HR 0.70, 95% CI 0.32-1.57). Improvements in biochemical control were maintained (HR 0.53, 95% CI 0.31-0.88). CONCLUSIONS: Despite a dramatic reduction of biochemical recurrence rates, the addition of iridium implant to EBRT did not translate into improved overall survival or prostate cancer-specific survival.

Perspectives of anesthesia residents training in Canada on fellowship training, research, and future practice location.

PURPOSE: We conducted this study to determine the preferences of anesthesia residents training in Canada for fellowship training, research, and future practice location and to identify the factors that influence those preferences. METHODS: Using a cross-sectional study design, a survey was sent to all anesthesia residents enrolled at an accredited Canadian anesthesiology residency program (N = 629). Data were collected on demographics and preferences for fellowship training, research, and future practice location. A multivariable logistic regression model was used to determine significant associations. RESULTS: Two hundred forty-four residents (39%) responded to the survey. Seventy percent of residents intended to pursue fellowship training. The top three fellowships they favoured were regional anesthesia, intensive care, and cardiac anesthesia. Male sex was positively associated with the decision to pursue fellowship training, whereas having an additional graduate degree was negatively associated with this choice. Among those pursuing fellowship training, the most influential factors were personal interest, enhancing employability, and an interest in an academic career. Fifty-seven percent of residents preferred to work at an academic hospital. Thirty-four percent of residents intended to incorporate research into their future practice, and personal interest, employability, and colleagues were most influential in their decision. Research activity and publishing in residency were associated with the desire to pursue future research initiatives. CONCLUSION: The majority of anesthesia residents training in Canada choose to pursue fellowship training and work at an academic hospital. Approximately one-third of residents have an interest in incorporating research into their future careers.