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Diverticulitis continues to be a source of significant morbidity in the United States. However, our data show a trend toward increased use of laparoscopic techniques for elective operations and primary anastomosis for urgent operations.

Improved nutrition is associated with a reduced prevalence of PAD in the US population. Higher consumption of specific nutrients, including antioxidants (vitamin A, C, and E), vitamin B(6), fiber, folate, and omega-3 fatty acids have a significant protective effect, irrespective of traditional cardiovascular risk factors. These findings suggest specific dietary supplementation may afford additional protection, above traditional risk factor modification, for the prevention of PAD.

The objective of this study was to evaluate the distributions of U.S. Marine Corps and Army wounded in action (WIA) and disease and nonbattle injury (DNBI) casualties during Operation Iraqi Freedom Major Combat Phase (OIF-1) and Support and Stability Phase (OIF-2). A retrospective review of hospitalization data was conducted. chi2 tests were used to assess the Primary International Classification of Diseases, 9th Revision (ICD-9), diagnostic category distributions by phase of operation, casualty type, and gender. Of the 13,071 casualties identified for analysis, 3,263 were WIA and 9,808 were DNBI. Overall, the proportion of WIA was higher during OIF-1 (36.6%) than OIF-2 (23.6%). Marines had a higher proportion of WIA and nonbattle injuries than soldiers. Although overall DNBI distributions for men and women were statistically different, their distributions of types of nonbattle injuries were similar. Identifying differences in injury and illness distributions by characteristics of the casualty population is necessary for military medical readiness planning.

Sentinel lymph node biopsy (SLNB) provides accurate nodal staging in patients with melanoma. However, its prevalence across geographic regions is unknown. Our aim was to determine if SLNB for melanoma has been widely adopted throughout the United States. All patients in the Surveillance, Epidemiology and End Results (SEER) cancer registry for 2004 with melanoma were evaluated. Data were collected for demographics, depth of melanoma, and type of nodal evaluation (regional lymph node dissection vs SLNB). Registry sites were categorized into West, Midwest, Northeast, and Southeast. χ2 analysis was performed to identify regional differences in receipt of SLNB. Overall, the West region (n = 2352) had a higher use of SLNB compared with the Midwest (n = 497), Northeast (n = 630), and Southeast (n = 268) regions (82.1% vs 77.9%, 65.4%, and 60.1%, respectively; P < 0.001). Intermediate-thickness (1 to 4 mm) melanomas had differences in SLNB use between the West and Midwest (83.6% and 81.4%) versus the Northeast and Southeast (66.3% and 60.2%) (P < 0.05). This population-based analysis shows low use of SLNB for melanoma in some U.S. regions. Further studies need to address the reasons for these differences and target ways to improve rates. Results suggest that SLNB may be considered as a potential quality measure.

Objective:The SAPPHIRE trial established that carotid artery stenting (CAS) is not inferior to carotid endarterectomy (CEA) for patients at high surgical risk. The CREST trial has shown CEA has a lower stroke rate than CAS, at the expense of higher cardiac complications. The objective of this study was to evaluate the nationwide performance of CAS and CEA in both high-risk (HR) and low-physiologic-risk (LR) patients, outside of the clinical trial setting.Methods: Data from the National Inpatient Sample (NIS) were pooled for patients undergoing carotid intervention from 2004-2007. HR was defined as preexisting cardiac disease (CHF, valvular disease) or COPD. Stroke, death, myocardial infarction, and complication rates were determined in both HR and LR populations. Multivariate regression analysis was performed to determine adjusted odds of stroke and death.Results: From 2004-2007, CEA was performed in 490,665 patients (HR, 30.6%) and CAS in 50,283 patients (HR, 31.2%). Unadjusted stroke/ death rates were higher for CAS vs CEA in both HR and LR groups (Table ). Myocardial infarction rates were equivalent in the HR population and slightly higher for CAS in the LR population. Combined complication rates were higher after CEA vs CAS, mainly due to pulmonary and renal complications. Multivariate regression analysis revealed adjusted odds of stroke/ death were increased for CAS (OR, 1.36; CI, 1.28-1.45). HR patients had an equivalent odds of stroke/death after CAS (OR, 1.10; CI, 0.99-1.28), whereas LR patients had an increased odds (OR, 1.56; CI,.Conclusions: This nationwide, real-world study supports the use of CAS in the HR population undergoing carotid intervention. However, the LR population is at higher risk of stroke and death after CAS compared with CEA. Contrary to the CREST results, both carotid procedures can be performed with equivalent cardiac morbidity.

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