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Michal Mekel MD Hayim Gilshtein MD Katya Chapchay MD Bishara Bishara MD Michael M. Krausz MD Herbert R. Freund MD Yoram Kluger MD Ahmed Eid MD Haggi Mazeh MD 《Annals of surgical oncology》2014,21(4):1369-1373
Background
Single adenoma is the cause of 80 % of primary hyperparathyroidism (PHPT) resulting in wide acceptance of minimally invasive parathyroidectomy (MIP). The incidence of PHPT increases with age. Little information is available regarding the prevalence of multiglandular disease (MGD) in older patients.Methods
The records of 537 patients that underwent parathyroid surgery between January 2005 and October 2012 at two endocrine surgery referral centers were retrospectively reviewed. Comparison was performed between patients younger than 65 and older than 65 years of age. Clinical variables included preoperative laboratories and imaging, extent of neck exploration, number of glands excised, and intraoperative parathyroid hormone levels during surgery.Results
There were 374 (70 %) patients in the younger age group (YG) and 163 (30 %) patients in the older age group (OG). The mean age was 50 ± 0.5 and 71 ± 0.4 years, respectively. There was no difference between the groups in terms of gender or laboratory results. MGD was significantly more common in the OG (24 % vs. 12 %; p = 0.001) and similarly MIP was less commonly completed in the OG (49 % vs. 68 %; p < 0.001). Cure rates were comparable between the OG and YG (93 % vs. 95 %; p = 0.27). In the OG, patients with MGD had significantly smaller glands as compared to patients with single adenomas in this group (331 ± 67 vs. 920 ± 97 mg; p = 0.006, respectively).Conclusions
MGD in PHPT was found to be more prevalent in older patients. Planning a bilateral neck exploration should be considered in older patients, especially when a relatively small gland is suggested by imaging or encountered during surgery. 相似文献2.
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Rosemarie Tremblay‐LeMay MD MSc Jean‐Charles Hogue PhD Louise Provencher MD MA Brigitte Poirier MD Éric Poirier MD Sophie Laberge MD PhD Caroline Diorio PhD Christine Desbiens MD 《The breast journal》2017,23(3):315-322
The surgical management of phyllodes tumors (PTs) is still controversial. Some studies have suggested surgical margins ≥1 cm, but recent studies suggested that negative margins could be appropriate regardless of their width. To evaluate recurrence rates of PTs following surgery according to margins. Retrospective study of women who attended a tertiary breast cancer reference center between 1998 and 2010: 142 patients with a PT diagnosis, either at minimally invasive breast biopsy or at surgery, were identified. Clinical, pathologic and follow‐up characteristics were assessed. Among 140 patients who underwent surgery, 64.3% of biopsies accurately predicted the final PT diagnosis at surgery. Forty‐two (42/87, 48.3%) PTs had positive margins. Twenty‐one (21/42, 50.0%) patients had a surgical revision of margins. Only one (1/42, 2.4%) had margins greater or equal to 1 cm. After a median follow‐up of 1.29 years in benign PTs, 4.99 years in borderline PTs, and 5.42 years in malignant PTs, there were five local recurrences, three in originally benign PTs and two in borderline PTs. All were managed with surgery. Four had initial margins ≤1 mm. One patient with borderline PT had a local recurrence and later progressed to regional recurrence and metastasis. Free surgical margins are necessary to treat PT, and margins of at least 1 mm might be sufficient to prevent recurrence. Core needle biopsy might not be the best diagnostic tool for PTs. 相似文献
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Papillary Microcarcinoma of the Thyroid: How Should It Be Treated? 总被引:10,自引:5,他引:5
Ito Y Tomoda C Uruno T Takamura Y Miya A Kobayashi K Matsuzuka F Kuma K Miyauchi A 《World journal of surgery》2004,28(11):1115-1121
We previously demonstrated that (1) most papillary microcarcinomas can be followed without surgical treatment and (2) when surgery is performed, patients with lateral lymph node metastasis detected on preoperative ultrasonography (US) are more likely to develop recurrence. In this study, we further investigated the application of these strategies. To date, we have observed 211 patients (average follow-up 47.9 months). In more than 70% of these patients the tumor size did not increase during the follow-up period. There were no clinicopathologic features linked to tumor enlargement except in tumors 7 mm, which tended to enlarge in patients followed for 4 years. To evaluate not only whether observation can continue but also how to dissect the lymph nodes optimally at surgery, US diagnosis for lateral node metastasis is essential because the presence of US-diagnosed lateral metastasis is an even stronger predictive marker for recurrence than the presence of pathologically confirmed node metastasis. The positive predictive value (PPV) was 80.6% for US but reached 100% if fine-needle aspiration biopsy (FNAB) of nodes or FNAB-thyroglobulin measurement is added. Furthermore, carcinomas occupying the upper region of the thyroid more frequently showed US-diagnosed and pathologically confirmed lateral metastasis, and those measuring 7 mm were more likely to show pathologically confirmed lateral metastasis. These findings suggest that, for papillary microcarcinoma: (1) US-diagnosed lateral metastasis is a strong marker predicting a worse relapse-free survival; (2) FNAB of nodes and FNAB-thyroglobulin measurement are useful tools for evaluating lymph node metastasis; and (3) careful US evaluation for lateral metastasis is necessary in patients with a tumor measuring 7 mm or that is located in the upper region of the thyroid both during observation and preoperatively.This article was presented at the International Association of Endocrine Surgeons meeting, Uppsala, Sweden, June 14–17, 2004. 相似文献
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Background: The training and credentialing of surgeons for laparoscopic bariatric surgery is controversial. We sought to determine
if there is an association between surgeons' practice and choice of open or laparoscopic bariatric surgery. Methods: Members
of the ASBS were surveyed via email. Associations were tested with Cochran-Mantel-Haenszel or Pearson's chi-square. Results:
104/472 members responded; 65% were in private practice; 47% did 1-5 operations/week, 48% offered open procedures only, and
76% undertook gastric bypass. Respondents believe that laparoscopic procedures: should mimic open ones (77%), are safe (63%),
should be evaluated by clinical trials (48%), and that expertise in bariatric surgery is more important than laparoscopic
experience. 75% believe that courses and preceptorships are important. Regarding laparoscopic operations, surgeons doing only
open procedures believe that: 1) the ASBS should be the main credentialing body; 2) surgeons should do >25 open before laparoscopic
ones; and 3) clinical trials are needed (P<0.02, all). Surgeons with laparoscopic training or practices believe that laparoscopic surgery is safe and effective (P<0.002). Both laparoscopic and open surgeons believe bariatric surgeons should be the only surgeons doing laparoscopic bariatric
procedures (P<0.008). Conclusions:There is consensus that laparoscopic bariatric surgery should be undertaken only by surgeons with strong
interest in bariatric surgery. Laparoscopic bariatric surgeons should incorporate lessons learned from open surgery. Both
laparoscopic and open bariatric surgeons should seek added expertise via courses and preceptorships.The skepticism of surgeons
with 'open' practices could be addressed by clinical trials. The ASBS should maintain its leadership position and foster emerging
technologies. 相似文献
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Background
Emergency treatment of perforated colon cancer has traditionally been linked with dismal outcomes due to the double jeopardy of a septic insult combined with a malignant disease, leaving unclear how aggressive emergency surgical procedures should be. We aimed to define short- and long-term outcomes in the current era of critical care support and oncologic advances, to provide updated data for decision making. 相似文献15.
Labs JD 《Hand (New York, N.Y.)》2008,3(3):197-202
Emergency Medical Treatment and Active Labor Act, an unfunded mandate for emergency hospital physician coverage, combined with falling reimbursement and escalating medico-legal risk, has resulted in declining enthusiasm for specialty coverage to emergency rooms. In a South West Florida community of 150,000, limited hand surgeons necessitated modification of acute on-call duties for hand trauma, whereby the hospital emergency room personnel performed evaluation and wound management with telephonic consultation followed by referral and definitive care in the outpatient setting by the hand surgeon. The policy for hand care, triage, management, and transfer is reviewed, as well as the first year experience with this highly efficient management methodology for urgent and emergent hand problems. In establishing a county-wide standard of care, emergency rooms and hand surgeons are coordinated to deliver excellent care by treatment protocol. 相似文献
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OBJECTIVE: To determine the impact of radical node dissection on the recurrence patterns and survival rates of patients with carcinoma of the esophagus. SUMMARY BACKGROUND DATA: The role of esophagectomy with radical lymphadenectomy in the treatment of esophageal cancer is controversial. Most centers favor a limited operation with no attempt at nodal clearance. However, disease recurrence and patient survival rates remain dismal with or without preoperative therapy. The authors postulate that a more radical node dissection would reduce local failure rates and enhance survival. METHODS: One hundred eleven patients with esophageal cancer underwent en bloc esophagectomy with radical lymph node dissection between 1988 and 1998. In 90% of patients the procedure was applied nonselectively and without any preoperative therapy. Patients were prospectively followed up for recurrence patterns and survival. RESULTS: The 5-year survival rate including noncancer deaths was 40%. The 5-year survival rates for patients with stage 1, 2A, 2B, 3, and 4 disease were 78%, 72%, 0%, 39%, and 27%, respectively. Forty percent of patients had node-negative disease (5-year survival rate, 75%), and 60% had nodal metastases (5-year survival rate, 26%). Recurrence occurred in 39% of patients and was local in only 8%. CONCLUSIONS: Radical esophagectomy results in superior overall and stage-specific 5-year survival rates. Extensive node dissection has a positive impact on survival rates, particularly in patients with nodal metastases. 相似文献
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Thomas K. Fehring Susan M. Odum Brian M. Curtin John B. Mason Keith A. Fehring Bryan D. Springer 《The Journal of arthroplasty》2018,33(10):3143-3146
Background
Patient optimization is becoming increasingly important before arthroplasty to ensure outcomes. It has been suggested that depression is a modifiable risk factor that should be corrected preoperatively. It remains to be determined whether psychological intervention before surgery will improve outcomes. We theorized that the use of preoperative depression scales to predict postoperative outcomes may be influenced by the pain and functional disability of arthritis. To determine whether depression is a modifiable risk factor that should be corrected preoperatively we asked the following questions: (1) What is the prevalence of depression in arthroplasty patients preoperatively? (2) Do depressive symptoms improve after surgery? (3) Is preoperative depression associated with outcome?Methods
Patients scheduled for surgery completed a patient health questionnaire (PHQ-9) to assess the presence and severity of depression pre-operatively and one year post-operatively.Results
Sixty-five of the 282 patients had a PHQ-9 score >10 indicating moderate depression and 57 (88%) improved to <10 postoperatively (P = .0012). Ten patients had a PHQ-9 score >20 indicating severe depression and 9 (90%) improved to <10 postoperatively (P = .10). Of the 65 patients who had a PHQ-9 score >10 preoperatively, the median postoperative Hip Disability and Osteoarthritis Outcome Score (N = 40) was 92.3, while the median postoperative Knee Injury and Osteoarthritis Outcome Score (N = 25) was 84.6. The median postoperative Hip Disability and Osteoarthritis Outcome Score and Knee Injury and Osteoarthritis Outcome Score in nondepressed patients were 96.2 and 84.6, respectively (P = .9041).Conclusion
By diminishing pain and improving function through arthroplasty, depression symptoms improve significantly. Patients with depressive symptoms preoperatively had similar postoperative outcome scores compared to non-depressed patients. Patients should not be denied surgical intervention through optimization programs that include a depression scale threshold.Level of Evidence
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