The therapeutic role of octreotide in the management of surgical disorders

The long-acting somatostatin analogue, octreotide, has recently been made available for clinical use in the United States. This novel synthetic peptide possesses a broad spectrum of physiologic actions primarily involving the inhibition of a variety of gastrointestinal and endocrine functions. Such actions have been utilized in the management of a variety of surgical disorders. Current understanding of the indications and efficacy of this agent in the treatment of surgical disease is reviewed.     

The human bulbo-urethral glands. A transmission electron microscopy and scanning electron microscopy study

This paper investigates the ultrastructure of human bulbo-urethral glands using specimens obtained at surgery. The tubulo-alveolar endpieces of these glands are lined by typical mucous cells in different stages of the secretory cycle. The most interesting features of their cytoplasm are membrane-bounded bodies with a filamentous texture that usually fuse with the mucous droplets before they discharge into the lumen. Cells with apical dark granules are sometimes encountered in the ductal portions of the gland, which are probably ductal cells endowed with a scanty synthetic and secretory activity. Myoepithelial cells are not very numerous and are observed around mucous cells only.     

The role of lymphadenectomy in the surgical management of renal cell carcinoma

After decades of evaluation, the role of lymphadenectomy in the management of renal cell carcinoma remains a controversy. Contemporary series suggest that the true incidence of isolated lymph node metastases in clinically localized disease is small, and the location of such metastases is unpredictable. While several institutional series have suggested a therapeutic benefit for extended lymphadenectomy, there remains a lack of randomized data to support its routine use. Despite this, there remains a role for lymphadenectomy in individuals with high risk of lymph node metastasis or known lymphadenopathy in whom few other options exist for aggressive, potentially curative therapy.     

The role of the intensive care unit in the management of the critically ill surgical patient.

Surgical patients make up 60-70% of the work load of intensive care units in the UK. There is a recognised short fall in the resource allocation for high dependency units (HDUs) and intensive care units (ICUs) in this country, despite repeated national audits urging that this resource be increased. British ICUs admit patients later and with higher severity of illness scores than elsewhere and this leads to higher ICU mortality. How can this situation be improved? Scoring systems that allow selection of appropriate patients for admission to ICU and avoid inappropriate admission are still in development. Pre-operative admission and optimisation in ICU is rare in this country despite increasing evidence to support this practice in high risk surgical patients. Early admission to ICU, with potential improvement in outcomes, could also be achieved using multi-disciplinary medical emergency teams. These teams would be alerted by ward staff in response to set specific conditions and physiological criteria. These proposals are still under trial but may offer benefit by reducing mortality in critically ill surgical patients.     

The role of ultrasound in the surgical management of patients diagnosed with ductal carcinoma in situ of the breast

The purpose of this study was to determine the usefulness of ultrasound (US) as an adjunct to mammography (MMG) in the surgical treatment planning for patients with ductal carcinoma in situ (DCIS) of the breast. A total of 119 patients diagnosed with DCIS, who were treated between 1999 and 2002, were identified from the institutional database. US and MMG size of suspicious abnormalities, pathologic tumor size, and findings of axillary US and surgical axillary evaluation were analyzed. The median size difference of US versus pathologic tumor size and MMG versus pathologic tumor size was 1.0 and 2.0 cm, respectively. Correlation coefficients for US versus pathologic tumor size and MMG versus pathologic tumor size were 0.53 and -0.09, respectively. The negative and positive predictive values of axillary US to predict nodal disease were 93% and 27%, respectively. US evaluation appears to be a useful tool in conjunction with MMG in determining the extent of disease in patients diagnosed with DCIS. However, the low positive predictive value of US for evaluating metastases to axillary lymph nodes does not justify the routine use of this modality for axillary evaluation in patients with DCIS. Therefore the use of US for patients diagnosed with DCIS needs further investigation.     

Akin截骨术在拇外翻手术应用的探讨

背景：Akin截骨术能够纠正拇外翻手术中残留拇趾畸形但也存在并发症,总结探讨在拇外翻手术时联合应用Akin截骨治疗拇外翻的临床疗效并探讨使用指征。 方法：总结分析2006年10月至2010年10月,在拇外翻手术时联合应用Akin截骨术48足,软组织手术加Akin截骨术6足,chevon截骨术加Akin截骨术29足,跖骨基底截骨加Akin截骨术8足,第一跖楔关节融合加Akin截骨术5足。 结果：所有病例均获得随访,随访时间6个月至5年,平均30．3个月,未见拇外翻复发病例。术前拇外翻角为37．2°±8．9°,IMA为16．5°±6．7°;术后拇外翻角为13±6．8°,IMA为8．9°．±4．5°。术前AOFAS评分为（43±10．5）分,术后为（84±7．8）分,具有统计学意义。 结论：在拇外翻手术时,根据趾骨畸形情况联合应用Akin截骨术可以降低拇外翻手术复发率,临床效果确切,但需要严格掌握手术适应证。     

The role for surgical management of HPV-related oropharyngeal carcinoma

Human papillomavirus (HPV)-associated oropharyngeal carcinoma has become the predominate cause of oropharyngeal carcinoma in the United States and Europe. Management of this disease is controversial. Traditional open surgical techniques gave way to concurrent chemoradiotherapy following several American and European organ-preservation trials suggesting that both modalities were equally efficacious. More recently, minimally invasive surgical techniques have gained popularity. These techniques provide an opportunity to achieve a complete surgical resection without the treatment-related morbidity associated with open surgery. Proponents of this technique contend that transoral surgical techniques provide a means to analyze the tumor tissue, prognosticate, and personally direct therapy. Skeptics suggest that HPV-associated oropharyngeal carcinoma responds well to chemoradiotherapy and that surgery may not provide a treatment advantage. Both approaches provide a unique perspective and both are currently being studied under trial.     

Transmission electron microscopy as an aid in the management of infertile men

Light microscopic evaluation of the semen of infertile men with sperm motility and morphological problems and Kartagener's syndrome does not always provide sufficient evidence for the cause of infertility. Transmission electron microscopy (TEM) was performed on selected primary and secondary male infertility patients to determine the specific causes (ultrastructural) of infertility. A final diagnosis could be given to patients who had had over the years (average 8 years) several evaluations of their semen without any definite reason being given for their infertility. With TEM of the semen, ultrastructural abnormalities of the spermatozoa as causes of infertility could be demonstrated which were undetectable with standard routine light microscopy.     

The management of cardiac surgical patients in a general surgical recovery ward

A suitable combination of anaesthetic and surgical techniques has allowed the safe management of post-operative cardiac surgical patients to be conducted in a surgical recovery area rather than in the intensive care ward. The results of the first 103 patients so managed (aged 49 +/- 10.7 years) are presented. Coronary artery bypass grafts were performed on 98 patients, 4 patients underwent repair of atrial septal defect and on 1 patient a pulmonary valvotomy was performed. The complications and their management are described.     

The role of intraoperative parathyroid hormone assay in the surgical management of hyperparathyroidism

Surgical management of primary hyperparathyroidism has undergone several chances in recent years and historically has required bilateral neck exploration with identification of the parathyroid adenoma together with three normal glands. The intraoperative hormone assay allows a more limited procedure by confirming complete removal of hypersecreting tissue. The Authors report surgical treatment of 24 consecutive hyperparathyroidism and conclude that evaluation of intraoperative hormone assay accurately predicts the determination of adequacy of resection and the correct outcome of surgery in patients with parathyroid adenomas.     

The role of fine-needle aspiration cytology in the surgical management of thyroid cancer

Background: Diagnosis of thyroid malignancy relies on clinical assessment, imaging and fine‐needle aspiration cytology ‘FNAC’ of thyroid nodules. The purpose of this study was to evaluate how effective synoptically reported FNAC is in clinical practice in diagnosing thyroid cancer. We also examined the effectiveness of using preoperative FNAC results to plan the type of operation for treating thyroid cancer. Method: A retrospective case series of all patients undergoing thyroid surgery from 1993 to 2008 was analysed. All data were collected prospectively and recorded in a dedicated endocrine surgery database. Data analysed included age, sex, preoperative FNAC result, type of surgery, final histology and complications. Cytology was reported based on a five‐tiered classification system. Results: There were 1373 patients in total and 125 patients with a final diagnosis of thyroid cancer. Female to male ratio was 3:1. Cytology reported as ‘malignant’ was confirmed as thyroid cancer in 100% of the cases. Of the patients, 47% with ‘suspicious’ cytology report and 14% with ‘follicular/indeterminate’ cytology report had a final diagnosis of cancer. Thyroid cancer subtypes were 90 patients with papillary thyroid cancer ‘PTC’, 24 with follicular ‘FTC’, eight with medullary ‘MTC’ and two with anaplastic cancer. Cytology was suggestive of cancer in 89% of the patients with PTC >10 mm, 75% with FTC and 88% with MTC. Transient hypocalcaemia was the commonest complication occurring in 7.2%. There were no cases of permanent hypoparathyroidism. Recurrent laryngeal nerve neuropraxia occurred in 2.4% with a permanent palsy occurring in 0.8%. There were three cancer‐related deaths. Conclusions: Preoperative synoptically reported FNAC is effective when used in diagnosing and planning surgery for thyroid cancer.     

The surgical management of the arthritic hand.

The surgical management of the arthritic hand is very largely concerned with rheumatoid arthritis and Still's disease and less frequently with psoriatic and degenerative arthritis. In the rheumatoid hand the surgeon may be called upon to intervene at any point in the chain reaction leading to total deformity, performing synovectomies of joints or tendons to relieve pain or prevent further deformity, repairing ruptured tendons, restoring the mechanism of injured joints, and correcting deformities when they have been allowed to occur. The great variety of operations that may be necessary to achieve these ends, with varying degrees of success, are discussed with reference to a personal series of 970 cases and 2002 operations.