Nutrition in the critically-ill obese patient.

People are fatter than they used to be. Although the upward trend has slowed in recent years, more than one third of all adults in the US are obese, and one in six children are overweight or obese. Reflecting this reality, there are a large number of obese patients in the intensive care unit. Some 30-35% of adult ICU patients are obese, and 5% or more are morbidly obese. Patients who are both critically-ill and morbidly obese present unique challenges to care. These range from basic care, such as prevention of bedsores and ambulation, to sophisticated issues, such as medication dosing and ventilator management. It takes a team of caregivers, for example, to help a 400-pound patient in and out of bed. One of the most difficult aspects of the care of such patients is nutrition support, which is the subject of the present review.

Acute care surgery: redefining the general surgeon.

These are uncertain times for general surgery residents. Problems include professional burnout-diminished quality of life, declining reimbursement for services, and erosion of the breath of surgical procedures performed. As a consequence there is a shortage of general surgeons, especially in rural areas. Trauma surgeons are becoming even more scarce. The American Association for the Surgery of Trauma (AAST) is attempting to address these problems by creation of Acute Care Surgeons. This paper discusses this new type of surgical practice.

Human papillomavirus-58 and -73-associated digital squamous cell carcinoma in a patient with aggressive digital papillary adenocarcinoma.

Aggressive digital papillary adenocarcinoma (ADPA) is a rare tumor that is considered to arise from eccrine sweat glands of the skin. It occurs predominantly in men with a mean age in the sixth decade. It shows a strong tendency for local recurrence and has the potential to metastasize to distant sites. Prompt diagnosis and regular follow-up are important to ensure the best possible outcome. We discuss a case of recurrent ADPA associated with subsequent squamous cell carcinoma (SCC) in different contralateral digits in a 55-year-old man. One SCC lesion tested positive for human papillomavirus (HPV)-58. HPV-associated digital SCCs have been reported; most cases are HPV-16 positive. This report describes a rare case of an HPV-58-positive invasive digital SCC and an HPV-73-positive SCC in situ associated with ADPA.

The effects of race and age on axillary lymph node involvement in breast cancer patients at a Midwestern safety-net hospital.

BACKGROUND: Black and premenopausal patients have been shown to have poorer stage for stage survival than the overall population. The purpose of this study was to define the effects of age and race on axillary lymph node involvement at a Midwestern safety-net hospital. The hypothesis was that black patients under the age of 50 would be found to have increased rates of axillary involvement in breast cancer. METHODS: A retrospective case review was performed of 184 breast cancer patients from 2000 to 2005. Statistical analysis was performed by race and age. Patients under 50 years of age were defined as premenopausal. RESULTS: The overall rate of axillary involvement was 47.8%. Black patients had an overall rate of axillary involvement of 52.9%. However, premenopausal black patients had a 70.8% rate of axillary involvement (P < .05). Premenopausal white patients had a 46.3% rate of axillary involvement. Logistic regression analysis was performed, and premenopausal age and tumor size were found to be independent predictors of positive lymph node status in black patients. CONCLUSION: In our study, premenopausal black patients had a much higher rate of axillary lymph node involvement than any other group. This finding was consistent even when tumor size was taken into account. More research needs to be done to better define this difference and to detect this disease at an earlier stage.