Journal of surgical oncology
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Thyroid diseases and surgery for thyroid neoplasms are both very common. Several complications of thyroidectomy are well known. Some of these are quite disturbing, such as recurrent laryngeal nerve injury and permanent hypoparathyroidism. ⋯ A conservative approach may be considered in selected patients with minimal hematoma and no progression. However, it generally takes a long time for the hematoma to resorb. A better understanding of the complications of thyroidectomy will minimize morbidity and make thyroidectomy a safer procedure and a surgical triumph.
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Comparative Study
Wound complications in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction for breast cancer.
A retrospective study was done to evaluate the frequency and severity of wound complications in 112 patients with breast cancer who received adjuvant chemotherapy following mastectomy with immediate breast reconstruction. Data on wound complications were available for 120 mastectomies. The rate of complications in 36 mastectomies treated with chemotherapy after mastectomy and immediate reconstruction was compared to that in 84 mastectomies not receiving adjuvant therapy. ⋯ Logistic regression analysis found no correlation between age, type of operation, tumor pathology, stage, number of lymph nodes harvested, type of prosthesis or chemotherapy, and wound complications in patients undergoing immediate breast reconstruction after mastectomy. The frequency of wound complications was not increased in patients receiving adjuvant chemotherapy after mastectomy and immediate breast reconstruction. The administration of adjuvant chemotherapy does not need to be delayed in patients who have had immediate breast reconstruction following mastectomy for breast cancer.
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Hypothermia is a significant clinical problem during hepatic cryosurgery, which at times causes the procedure to be halted until the patient's body temperature can be raised. This study examines the effects of the Bair Hugger (a warming device) on body temperature during hepatic cryosurgery. Twenty-eight cases of hepatic cryosurgery were performed without the Bair Hugger, while 44 cases included the Bair Hugger. ⋯ In addition, this group showed a significantly greater mean change in temperature during the procedure (1.81 degrees C vs. 0.73 degrees C; P < 0.0001). No patient in the Bair Hugger group reached the point of clinically significant hypothermia. In conclusion, the Bair Hugger is safe and very effective in regulating body temperature and it is an essential piece of equipment performing hepatic cryosurgery.
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The conventional surgical treatment of anal squamous cell carcinoma is abdominoperineal resection. A new approach of combined radiotherapy and chemotherapy has been proposed following the observation of excellent local control. In this retrospective study, 40 cases of primary anal squamous cell carcinoma without distant metastasis were collected between 1979 and 1986 and the individual prognosis of the above two methods of treatment was evaluated. ⋯ All the mortalities in both groups died of distant metastasis or abdominal carcinomatosis. From the above results, the overall survival rate of combined radiotherapy and chemotherapy was not significantly worse than that of conventional abdominoperineal resection. In conclusion, combined radiotherapy and chemotherapy may be chosen as an alternative management in treating anal squamous cell carcinoma.
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Comparative Study
Quality of life in bone tumor patients comparing limb salvage and amputation of the lower extremity.
In 33 long-term survivors of lower extremity bone cancer quality-of-life data were studied following limb salvage compared to amputation. Self-report questionnaires, semistructured interviews and visual analog scales were used to measure psychoneurotic and somatical distress, activities of daily living, self-esteem, and adjustment to illness. Fourteen patients with limb salvage (age 13-56 years, median 24) and 19 patients with an amputation (age 21-53 years, median 27) were evaluated 2-17 years (median 10 years) after surgery. ⋯ However, physical complaints were reported more often by limb salvage patients, whereas the amputees showed a trend toward lower self-esteem and isolation in social life, due to their disability. Both groups felt equal diminution of quality of life and disability as measured on the visual analog scale. These findings could support the cosmetic advantage of limb salvage compared to amputation.