Journal of the American College of Surgeons
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Reoperation for hyperparathyroidism (HPT) carries an increased risk for morbidity and failure to cure. Accurate preoperative localization minimizes operative risk but is often difficult to achieve in the reoperative setting. Four-dimensional computed tomography (4D-CT) is an emerging technique that uses functional parathyroid anatomy for precise preoperative localization. We evaluated 4D-CT as a tool for localization of hyperfunctioning parathyroid tissue in the reoperative setting. ⋯ Four-dimensional-CT is an ideal tool for preoperative localization of hyperfunctioning parathyroid tissue in the reoperative setting. Localization and successful reoperation are most difficult in patients who have undergone an earlier operation that included resection of at least one hypercellular parathyroid suggesting multigland disease.
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Historical Article
The historic role and questionable future of public hospitals.
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Several recent reports have shown a lymphedema rate of about 7% with sentinel lymph node biopsy (SLNB) only. We hypothesized that this higher than expected rate of lymphedema may be secondary to disruption of arm lymphatics during an SLNB procedure. ⋯ Disruption of the blue ARM node because of proximity to the hot SLN may explain the surprisingly high rate of lymphedema seen after SLNB. Identifying and preserving the ARM blue nodes may translate into a lower incidence of lymphedema with SLNB and axillary lymph node dissection.
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Skills training plays an increasing role in residency training. Few medical schools have skills courses for senior students entering surgical residency. ⋯ Skills instruction for senior students entering surgical internship results in a higher perception of preparedness and improved skills performance. Medical schools should consider integrating skills courses into the 4(th)-year curriculum to better prepare students for surgical residency.
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The concept that premenopausal female patients are more resistant to shock than male patients has been shown in numerous preclinical models. The more relevant effect of gender on clinically important outcomes after trauma is less clear. Clinical studies have been conflicting, both supporting and refuting the protective effects of gender on outcomes, primarily because of limitations in sample size and patient stratification. In an attempt to resolve this ongoing dispute, we evaluated the effect of gender on various outcomes in the largest single institutional series of trauma patients reported in the literature after blunt injury. ⋯ Multivariable logistic regression analysis of a large trauma cohort definitively establishes that gender is not independently associated with mortality after blunt trauma in humans. In contrast, male gender was shown to be associated with increased morbidity. Unlike rodent studies, gender alone offers no survival advantage in humans after blunt trauma.