Adrenocortical carcinoma: which surgical approach?

Introduction  

There are no randomised studies comparing open and laparoscopic approaches foradrenalectomy in patients with adrenal cortical carcinoma.     

The surgical choice for unilateral thyroid carcinoma in pediatrics: Lobectomy or total thyroidectomy?

Background

Total thyroidectomy is no doubt the standard procedure for patients with bilateral thyroid carcinoma in pediatrics. However, for lesions confined in unilateral thyroid gland, lobectomy or radical total thyroidectomy is still controversial in pediatrics.

Current management of urolithiasis: progress or regress?

PURPOSE: To assess the impact of the development of less powerful second- and third-generation shockwave lithotripters on surgical stone therapy in light of recent advances in ureteroscopy and laser lithotripsy. As such, we sought to identify current trends in the treatment of stone disease, both at our university medical center and nationally, and to contrast them with the corresponding data from 1990. PATIENTS AND METHODS: All urolithiasis procedures (ureteroscopy, SWL, open surgery, and percutaneous stone removal) performed in 1998 were compared with all urolithiasis procedures performed 8 years earlier (1990) at a single institution (Washington University, St. Louis). In addition, Medicare data for each year from 1988 through 2000 were collected from the Health Care Financing Administration to assess the national trends for open stone surgery, ureteroscopic stone removal, SWL, and percutaneous nephrolithotomy. RESULTS: At Washington University, the number of percutaneous stone removals remained stable; however, the overall number of ureteroscopies increased by 53%, while the number of SWLs, decreased by 15%. The Medicare data likewise reflect a marked decrease in open stone surgery and a marked increase in ureteroscopic stone surgery with a slight increase in SWL. Utilization of percutaneous nephrolithotomy remained unchanged. CONCLUSIONS: We believe this trend toward ureteroscopy is attributable to several factors: improved, smaller rigid and flexible ureteroscopes; the availability of more effective intracorporeal lithotripters (e.g., pneumatic and holmium laser), and the lack of development of lower cost, more effective SWL. This is an unfortunate trend, as we are moving away from the noninvasive treatment that was the hallmark of urolithiasis therapy at the beginning of the last decade toward more invasive endoscopic therapy. Increased research efforts in SWL technology are sorely needed.     

Low back pain intervention: conservative or surgical?

Low back pain (LBP) is a very common disorder with a U.S. population incidence of 80%. The risk for developing chronic LBP is relatively low but the majority of the costs associated with LBP are generated specifically by this group. Unfortunately, there is no gold standard intervention and few comparative, randomized, prospective treatment studies have been done. Therefore, the optimal treatment approach continues to be controversial. Surgery is usually reserved for those patients with severe and debilitating symptoms and, with careful selection, can result in good outcomes with rapid return to function. For patients who are not surgical candidates, conservative treatment must emphasize restoration and maintenance of functional movement.     

Calcific parasite or surgical miscellany?

This article highlights the difficulties posed by initial radiological investigations that misleadingly interpreted a linear opacity in the ascending colon of a 2-year-old to be a complicating calcified Ascaris. Final surgical management revealed an unusual cause for the tram tracking effect so pathognomonic of Ascaris infestation. Of interest are the images of the abdominal x-ray, ultrasound scan, and barium study.