This is the first Enhanced Recovery After Surgery (ERAS) guideline dedicated to standardizing and optimizing perioperative care for women undergoing minimally invasive gynecologic surgery. The guideline was rigorously formulated by an American Association of Gynecologic Laparoscopists Task Force of US and Canadian gynecologic surgeons with special interest and experience in adapting ERAS practices for patients requiring minimally invasive gynecologic surgery. It builds on the 2016 ERAS Society recommendations for perioperative care in gynecologic/oncologic surgery by serving as a more comprehensive reference for minimally invasive endoscopic and vaginal surgery for both benign and malignant gynecologic conditions. For example, the section on preoperative optimization provides more specific recommendations derived from the ambulatory surgery and anesthesia literature for the management of anemia, hyperglycemia, and obstructive sleep apnea. Recommendations pertaining to multimodal analgesia account for the recent Food and Drug Administration warnings about respiratory depression from gabapentinoids. The guideline focuses on workflows important to high-value care in minimally invasive surgery, such as same-day discharge, and tackles controversial issues in minimally invasive surgery, such as thromboprophylaxis. In these ways, the guideline supports the American Association of Gynecologic Laparoscopists and our collective mission to elevate the quality and safety of healthcare for women through excellence in clinical practice.
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Small-cell carcinoma of the esophagus is a rare tumor. In most reported cases, surgery has been the major mode of therapy. Most patients have relapsed rapidly with disseminated disease. We treated a patient with small-cell carcinoma of the esophagus with a multi-drug regimen being used in small cell-carcinoma of the lung. Within two months of beginning therapy, the primary lesion, as evaluated by barium esophogram, had completely resolved. Residual disease was seen on panendoscopy. The patient was considered to be in partial remission. She relapsed nine months after starting therapy and died with widespread metastases. Small-cell carcinoma of the esophagus should not be treated surgically but rather in the same fashion as is small-cell carcinoma of the lung, i.e., with multi-drug chemotherapy and radiation therapy.
Three freshwater mussel shell tools recovered from the Lake Mungo lunette, in semi-arid south-eastern Australia with bracketing age estimates of 40-30 ka, and a possible fourth tool with bracketing age estimates of 50-40 ka, are described. An experimental approach, combined with detailed structural and taphonomic analysis of the shell establishes the presence of both deliberate cultural modification and wear traces from use on the mussel fragments. The characterization of Australian Pleistocene stone artefacts as being simple and unchanging is steadily being challenged through recent studies of Pleistocene assemblages from Lake Mungo and elsewhere, and these early shell tools reinforce the multidimensionality of ancient Australian technologies. Disciplines Medicine and Health Sciences | Social and Behavioral Sciences Publication DetailsWeston, E., Szabo, K. & Stern, N. (2017). Pleistocene shell tools from Lake Mungo lunette, Australia: identification and interpretation drawing on experimental archaeology. Quaternary International, 427 229-242. AbstractThree freshwater mussel shell tools recovered from the Lake Mungo lunette, in semi-arid south-eastern Australia with bracketing age estimates of 40-30 ka, and a possible fourth tool with bracketing age estimates of 50-40 ka, are described. An experimental approach, combined with detailed structural and taphonomic analysis of the shell establishes the presence of both deliberate cultural modification and wear traces from use on the mussel fragments. The characterization of Australian Pleistocene stone artefacts as being simple and unchanging is steadily being challenged through recent studies of Pleistocene assemblages from Lake Mungo and elsewhere, and these early shell tools reinforce the multidimensionality of ancient Australian technologies. KeywordsShell tool, Experimental archaeology, Lake Mungo, Pleistocene archaeology, Australian prehistory 1: IntroductionExpedient shell tools are being identified more frequently in archaeological assemblages as awareness of these types of tools, and the techniques for identifying and analysing them, improves (e.g. Lucero, 2004, Szabó, 2005, Lammers, 2008, Harris, 2011, Romagnoli et al., 2014, Fujita and Melgar, 2014, Cuenca-Solana, 2015, Szabó and Koppel, 2015. Despite this recent work, there remain considerable gaps in our knowledge of the criteria that can be used to identify and interpret shells across a wide range of taxa that have been modified for and through use. Here, we present the identification of utilised freshwater mussel shells from the Pleistocene landscape at Lake Mungo, coupled with innovative techniques for their recognition and interpretation.An understanding of the structural composition and internal arrangement of the specific shell taxa being studied underpins all robust analytical methodologies when examining worked shell. Such considerations are presented here, followed by an experimental use-2 wear programme prefacing the analysis of archaeological freshwater mussels collected during recent...
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