The “parathyroid blush” in the identification of parathyroid glands

When part of a parathyroid gland is excised for biopsy, the cut surface remaining becomes diffusely red from microscopic bleeding in one to three seconds, the “parathyroid blush.” By this simple observation the surgeon can distinguish grossly similar structures such as lobular fat from parathyroid tissue.Advantages include consistency, shortened operating time, fewer frozen section confirmations needed, reliability as a teaching aid, and safety, especially in avoiding postoperative tetany.     

Local recurrence after microwave thermosphere ablation of malignant liver tumors: results of a surgical series

Background

Microwave thermosphere ablation is a new treatment modality that creates spherical ablation zones using a single antenna. This study aims to analyze local recurrence associated with this new treatment modality in patients with malignant liver tumors.

Effect of transversus abdominis release on core stability: Short-term results from a single institution

Introduction

Transversus abdominis release is an increasingly used procedure in complex abdominal wall reconstruction. The transversus abdominis muscle is a primary stabilizer of the spine, yet little is known regarding the effect of transversus abdominis release on core stability, back pain, or hernia-specific quality of life. The purpose of our study was to investigate the effect of complex abdominal wall reconstruction using transversus abdominis release on patient quality of life and core stability function.

Tailored surgical treatment of duodenal polyposis in familial adenomatous polyposis syndrome

Background

To review our experience in patients undergoing operative treatment for duodenal polypoisis associated with familial adenomatous polyposis with an emphasis on operative approach and long-term outcomes.

Do psoas muscle area and volume correlate with postoperative complications in patients undergoing rectal cancer resection?

Background

Increasingly, patients with multiple co-morbidities undergo surgery for rectal cancer. We aimed to evaluate if decreased psoas muscle area and volume, as measures for sarcopenia, were associated with postoperative morbidity.

A surgical residency preparatory course for senior medical students leads to earlier independence in ACGME competencies

Background

It is unknown whether surgery residency preparatory courses lead to earlier independent practice.

Heterogeneous and low-intensity parathyroid autofluorescence: Patterns suggesting hyperfunction at parathyroid exploration

Background

Although parathyroid glands have been found to exhibit autofluorescence with near-infrared fluorescence imaging, it is unknown if autofluorescence characteristics vary between hyperfunctioning and normofunctioning glands. The hypothesis was that pattern of autofluorescence exhibited by hyperfunctioning versus normofunctioning parathyroid glands would be different.

Vagotomy and drainage for obstructing duodenal ulcers: importance of adequate drainage

Sixty patients with gastric outlet obstruction from chronic duodenal ulcer were treated by vagotomy and a variety of drainage procedures including Finney pyloroplasty, Heineke-Mikulicz pyloroplasty, gastrojejunostomy, and gastroduodenostomy (Jaboulay). Postoperative gastric atony or delayed gastric emptying was not a problem when a sufficient period of preoperatiye gastric decompression was employed and an adequate drainage procedure was accomplished. The best long-term results were achieved with vagotomy and Finney pyloroplasty. We believe that surgeons should continue to use vagotomy and drainage in the surgical management of patients with obstructing duodenal ulcers.     

Incidence,Management, and Risk Factors for Lower Gastrointestinal Bleeding in Renal Transplant Recipients

Background

There are limited convincing data regarding management and outcomes of lower gastrointestinal bleeding (LGB) in renal transplant recipients (RTR). The aim of this study was to evaluate incidence, management strategies, and risk factors associated with LGB in RTR.

T tube catheter drainage of the duodenal stump

This brief report presents my experience with technics of catheter drainage of the duodenal stump after gastric resection. The technic of lateral drainage of the duodenum, using a T tube introduced through a stab incision in the descending duodenum, away from the duodenal stump closure, is described and its value emphasized. Drainage through the end of the duodenal stump, with stump closure around the catheter, will occasionally result in leakage of duodenal contents and may be hazardous.     

Intrascrotal Wilms' tumor developing in a heterotopic renal anlage of probable mesonephric origin

A case of intrascrotal primary Wilms' tumor is reported. The histopathologic appearance of the primary tumor and subsequent pulmonary metastasis are identical with that of a typical intrarenal Wilms' tumor. The origin of this tumor in a heterotopic renal anlage consistent with mesonephric origin suggests that tissue from the intermediate and caudal segments of the nephrogenic cord may produce Wilms' tumor. Wilms' tumor arising in an embryologic rest of renal tissue is a rare occurrence. We are reporting the seventh well-documented case and the first case with confirmed distant metastasis.     

Diagnosis and management of bile duct strictures.

In the majority of patients, strictures of the common bile duct result from an injury to the duct. The earlier the injury is repaired or the more quickly the diagnosis of stricture is made and repaired, with antibiotics to prevent infection, the better are the results of the repair. Five types of repair have been utilized: (1) choledochoduodenostomy, (2) duct-to-duct repair, (3) choledochojejunostomy, (4) plastic revision of the stricture, or (5) dilatation of a previous stricture when multiple, previous operative procedures or the difficulty of operative exposure proves too great for adequate repair. Our overall results after repair of biliary stricture are good or excellent in 84 per cent of patients. We have had the best results in patients in whom choledochoduodenostomy was performed.     

Ureteral obstruction secondary to Crohn's disease: A need for ureterolysis?

A review of 2,368 patients with Crohn's disease identified 45 patients with hydroureteronephrosis treated with various medical and surgical regimens. Twenty-six of 30 patients undergoing both pre- and post-treatment intravenous pyelography showed resolution of the obstructed ureter, even though ureterolysis was rarely used.     

Bowen's disease of the anal and perianal area. A report and analysis of twelve cases.

Retrospective evaluation of twelve patients treated at the Cleveland Clinic for perianal Bowen's disease showed that these patients can be cured by wide local excision with skin grafting when necessary. No recurrence or metastasis was found during the follow-up period when the systematic technic was used. Only involved anal mucosa was removed, and normal mucosa was preserved; this aids in controlling anal continence. The margins of the resected skin must be subjected to frozen section study to be sure that total excision has been achieved. In this study a diagnosis of perianal Bowen's disease was made incidentally in six of the twelve patients during histologic examination of anorectal tissue removed for other reasons. Seven of the twelve either had had a systemic or cutaneous cancer previously or another systemic or cutaneous cancer subsequently developed, indicating the high association between Bowen's disease and other cancers. Therefore, it is important that all excised skin from anal or perianal operations be submitted for histologic examination, and if the diagnosis is Bowen's disease, the lesion must be completely removed using wide local excision. These patients should be evaluated and followed up because other malignancies may be present or evolve at a later time.     

Bile duct cysts: Experience with 15 patients

Fifteen patients, all of whom underwent surgery at this institution from 1955 to 1981, were included in this study. Bile duct cysts were classified into Types I to V to include cysts of the intra- and extrahepatic bile ducts. The association of this entity with other congenital abnormalities is discussed. Carcinoma of the biliary tree occurred in two cases. The treatment of this condition is surgical. Excision is preferred whenever technically possible; otherwise a bypass procedure is performed. The technique of excision described by Lilly [32,34] is preferred because it is safer, decreasing the risk of injury to the hepatic artery and portal vein. Controversy continues regarding the procedure of choice.     

Endoscopic pancreatography: its value in preoperative and postoperative assessment of pancreatic disease.

Examples of the use of endoscopic pancreatography in the preoperative evaluation and postoperative follow-up study of patients with pancreatic disease are presented and discussed. Six cases selected from a total experience of forty-eight patients have been summarized. The direct role of pancreatography in the management of these cases is cited. There is a small but definite risk to the procedure. With increased use of endoscopic pancreatography, it is hoped that earlier diagnoses of a variety of pancreatic diseases will be obtained which will permit more accurate medical and surgical therapy.     

Familial polyposis coli associated with bile duct cancer

The clinical features and surgical management of two patients with primary adenocarcinoma of the bile duct in association with familial polyposis coli are described. The first patient had had subtotal colectomy for familial polyposis coli, and several resections of duodenal tumors. Carcinoma developed in the common bile duct and was treated with intubation and radiation therapy; he isstill alive 2 years later. A second patient with cancer at the bifurcation of the bile ducts was treated with intubation and radiotherapy; 1 year later she had intestinal hemorrhage from a sigmoid colon cancer, and multiple colonic polyps were noted. We believe that this is the first report in the English literature of biliary cancer in association with familial polyposis coli or Gardner's syndrome.