The American surgeon
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The American surgeon · Sep 2006
Detection of cervical spine injuries in alert, asymptomatic geriatric blunt trauma patients: who benefits from radiologic imaging?
There are differing recommendations in the literature regarding cervical spine imaging in alert, asymptomatic geriatric patients. Previous studies also have not used computed tomography routinely. Given that cervical radiographs may miss up to 60 per cent of fractures, the incidence of cervical spine injuries in this population and its implications for clinical management are unclear. ⋯ The overall incidence of cervical spine injury in the alert, asymptomatic geriatric population is low. The risk is increased with a potentially distracting injury above the clavicles. Patients with distracting injuries in other anatomic locations or no distracting injuries may not need routine cervical imaging.
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The American surgeon · Sep 2006
Effects of sentinel lymph node biopsy on surgical residency training.
Axillary node dissection (AND) is an integral part of surgical training. Sentinel lymph node biopsy (SLN) was introduced into our residency in 1997. Our purpose in this study was to evaluate the impact of SLN on AND experience. ⋯ Attendings cited 15 and 24 AND before feeling comfortable performing and teaching the procedure to a resident. Since the introduction of SLN into our residency, the number of AND has decreased, with senior residents feeling that SLN has decreased their ability to perform AND. As fewer AND are performed than our attendings cite to feel comfortable, future residents may not be competent to perform or teach AND.
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Since 1996, the technique for minimally invasive repair of pectus excavatum (MIRPE) has gained increasing acceptance among pediatric patients. However, the feasibility of the operation and outcomes have not yet been evaluated in adult patients. This study was a retrospective analysis of the author's experience combined with a survey of members of the American Pediatric Surgical Association in treating adult patients with MIRPE. ⋯ MIRPE can be used safely for repair of pectus excavatum in adult patients. The complication rate appears to be similar to previously reported series of pediatric patients. Although adult patients may have residual asymmetry of the chest postrepair, overall satisfaction with the repair was very good or excellent in 86 per cent of patients.