The American surgeon
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The American surgeon · Nov 2011
ReviewRole of high-intensity focused ultrasound in treatment of hepatocellular carcinoma.
About 70 per cent of patients with hepatocellular carcinoma are diagnosed at intermediate or advanced stages, and most of them are technically unresectable. As a novel, emerging therapeutic modality, high intensity focused ultrasound (HIFU) has a great potential for tumor treatment. In this review, principle of HIFU technique is introduced, and an overview of clinical applications and limitations of HIFU for HCC treatment, as well as prospects for future development, is provided. Consequently, HIFU has been considered a safe and feasible procedure for HCC treatment.
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The American surgeon · Nov 2011
Comparative StudyEffect of glycemic state on hospital mortality in critically ill surgical patients.
Intensive insulin therapy can reduce mortality. Hypoglycemia related to intensive therapy may worsen outcomes. This study compared risk adjusted mortality for different glycemic states. ⋯ Hyper- and hypoglycemia increase mortality compared with APACHE III expected mortality, with highest mortality risk if both are present. Hypoglycemia is associated with worse risk. Glucose control may need to be loosened to prevent hypoglycemia and reduce glucose variability.
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The American surgeon · Nov 2011
Biography Historical ArticleRobert M. Zollinger, Sr., as a father, teacher, and mentor.
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The American surgeon · Oct 2011
Multicenter Study Comparative StudyUtilization and outcomes of laparoscopic versus open paraesophageal hernia repair.
The optimal operative approach for repair of diaphragmatic hernia remains debated. The aim of this study was to examine the utilization of laparoscopy and compare the outcomes of laparoscopic versus open paraesophageal hernia repair performed at academic centers. Data was obtained from the University HealthSystem Consortium database on 2726 patients who underwent a laparoscopic (n = 2069) or open (n = 657) paraesophageal hernia repair between 2007 and 2010. ⋯ The in-hospital mortality was 0.4 per cent for laparoscopic repair versus 0.0 per cent for open repair. In patients presenting with obstruction or gangrene, utilization of laparoscopic repair was 57 per cent and was similarly associated with improved outcomes compared with open repair. Within the context of academic centers, the current practice of paraesophageal hernia repair is mostly laparoscopy. Compared with open repair, laparoscopic repair was associated with superior perioperative outcomes even in cases presenting with obstruction or gangrene.
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The American surgeon · Oct 2011
Comparative StudyDoes preoperative magnetic resonance imaging beneficially alter surgical management of invasive lobular carcinoma?
The role of breast magnetic resonance imaging (MRI) in patients with newly diagnosed breast cancer remains controversial. The objective of this study is to determine the impact of preoperative breast MRI on patients with biopsy-proven invasive lobular carcinoma (ILC) initially deemed eligible for breast conserving therapy. We analyzed a prospective cohort study of patients with biopsy-proven ILC that consented to undergo preoperative diagnostic MRI at our institution. ⋯ MRI led to eight biopsies, for a pathologically confirmed true positive rate of 82 per cent [95% confidence interval (CI) 62-101%] and only two unnecessary biopsies. Preoperative MRI beneficially altered surgical management in 42 per cent of patients (95% CI 19-65%) without leading to unnecessary surgery, and only one patient required reexcision for positive margins (5.8%, CI -5.8-17.4%). In conclusion, preoperative MRI in patients with ILC can detect additional disease that was missed by conventional workup, allowing for better preoperative planning and more appropriate oncologic resection.