Extended Pancreaticoduodenectomy with Vascular Resection for Pancreatic Cancer: A Systematic Review

Objectives  

This systematic review objectively evaluates the safety and outcomes of extended pancreaticoduodenectomy with vascular resection for pancreatic cancer involving critical adjacent vessels namely the superior mesenteric-portal veins, hepatic artery, superior mesenteric artery, and celiac axis.     

Predicting Four or More Metastatic Axillary Lymph Nodes in Patients with Sentinel Node-Positive Breast Cancer: Assessment of Existent Risk Scores

Background  

Patients with metastases in four or more axillary lymph nodes (≥4+ALN) represent a subset of patients with breast cancer who are at increased risk of local recurrence and who benefit from postmastectomy radiation. Risk prediction models designed to identify such patients have been published by Rivers et al., Chagpar et al., and Katz et al. We sought to evaluate and compare the performance of these models in an independent patient population.     

Left atrial hemangioma excision using minimally invasive endoscopic technique: a case report

Cardiac hemengioma’s are rare tumors and their management through minimally invasive endoscopic technique is not well documented. A 64-year-old lady presented with a history of worsening shortness of breath and arrhythmias. She was known to have hypertension, morbid obesity and chronic obstructive lung disease. Further investigations revealed a left atrial tumor, which was confirmed on coronary angiography by a “tumor blush”. Surgery was performed for this suspected vascular tumor through right mini thoracotomy using minimally invasive endoscopic techniques and histology confirmed it as a hemangioma. Although cardiac hemangiomas are rare, the same minimally invasive strategies that have been developed tackling the more common cardiac tumors can be applied successfully.     

Influence of the treatment of developmental dysplasia of the hip by the abduction brace on locomotor development in children

Purpose  

To assess the influence of treating developmental dysplasia of the hip (DDH) with the abduction brace on locomotor development in children.     

Management of Sleep Disorders in Stroke

Scientific studies have proven a very strong association between stroke and obstructive sleep apnea (OSA). The prevalence of OSA is very high in patients with acute stroke, and untreated OSA is a stroke risk factor. In the stroke patient population, symptoms of OSA may atypically appear as isolated insomnia, hypersomnia, a dysfunction of circadian rhythm, a parasomnia, or a sleep-related movement disorder. Thus, we believe that in patients with acute stroke, OSA should be addressed first, using full in-laboratory, attended polysomnography (PSG), before other specific sleep disorders are aggressively addressed with specific therapeutic interventions. When OSA is diagnosed, supportive techniques including the application of continuous positive airway pressure (CPAP) therapy, positional therapies, or both should be considered first-line treatments. If OSA is ruled out by PSG, the therapeutic emphasis for sleep-related complaints is routinely based on instituting good sleep hygiene practices and using cognitive behavioral techniques (cognitive therapies, sleep restriction, stimulus control, and progressive relaxation therapies) because patients with stroke may be prone to the adverse effects of many of the medications that are otherwise routinely prescribed for a variety of specific sleep disorders.     

The Emerging Role of Robotics in Adrenal Surgery

Robotic surgery is being performed more frequently for a variety of urologic procedures. Since the first robotic adrenalectomy less than a decade ago, this modality has gained increased acceptance in the urologic community and has been employed with increased frequency in minimally invasive centers. This review evaluates the current literature on robotic adrenalectomy, its indications, as well as its advantages and limitations compared with other forms of surgical management of adrenal pathology.     

Scimitar syndrome in an infant with right lung hypoplasia,ventricular septal defect,and severe pulmonary hypertension

A 5-month-old boy was presented for surgical repair of scimitar syndrome associated with right lung hyperplasia, severe pulmonary hypertension, ventricular septal defect (VSD), and atrial septal defect. The calculated shunt fraction (Qp/Qs) was 3.1:1.0, pulmonary vascular resistance was 4.6, and the perfusion lung scan showed a marked decrease (11%) in right pulmonary blood flow. Surgical repair was performed through the right fourth intercostal space with the patient supine. The anomalous vein was divided and interposed with a short azygos vein graft, followed by closure of the VSD. Finally, the interposed azygos vein was anastomosed to the left atrium. Although pulmonary artery pressure was normalized at the 2-year follow-up, cardiac catheterization 6 months after the operation demonstrated right pulmonary vein obstruction.     

Outcome of Patients with a Positive Sentinel Lymph Node who do not Undergo Completion Lymphadenectomy

Background  

Completion lymph node dissection (CLND), although considered a standard approach for patients with melanoma and a positive sentinel lymph node (SLN), is not performed in as many as 50% of indicated cases. This study evaluates the outcome of patients who had a positive SLN but did not undergo CLND at Memorial Sloan-Kettering Cancer Center.     

Primary hyperparathyroidism associated with hypocalcemia in a patient presenting with kidney disease

Elevated serum parathyroid hormone (PTH) level together with hypocalcemia in chronic kidney disease usually suggests secondary hyperparathyroidism. However, primary hyperparathyroidism should also be considered, especially if concomitant vitamin D deficiency is suspected. We report a case of parathyroid adenoma associated with hypocalcemia and metabolic bone disease in a patient presenting with kidney disorder. The patient was successfully treated by parathyroidectomy that was preceded and followed by intensive calcium and vitamin D supplementation.