Journal of the American College of Surgeons
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Comparative Study
A trend analysis of the relative value of blue dye and isotope localization in 2,000 consecutive cases of sentinel node biopsy for breast cancer.
Among the advocates of blue dye, isotope, or combined dye-isotope mapping of the sentinel lymph node (SLN) for breast cancer, there is no universal consensus as to which technique is optimal and whether the relative value of each method changes with increasing experience. The objective of this study was to examine the relative contributions of blue dye and radioisotope to successful identification of the SLN as the SLN-mapping technique evolved over our first 2,000 consecutive cases. ⋯ Using a combined technique of blue dye and radioisotope mapping, and with refinement of the radioisotope technique, we report 97% success identifying the SLN. Although we continue to recommend the use of both methods in SLN mapping for breast cancer, we observe with experience a declining marginal benefit for blue dye.
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Clinically, the severity of uremia is known to be inversely proportional to sexual desire and activity in patients with chronic renal failure. We studied sexual function and sex hormones in male patients with symptomatic hyperparathyroidism before and 3 months after parathyroidectomy. ⋯ Sexual function of male patients with symptomatic hyperparathyroidism can possibly be improved by parathyroidectomy and autotransplantation. Decreases in the levels of prolactin, calcium, phosphorus, and iPTH are also noticed after parathyroidectomy.
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The onset of atrial fibrillation (AFIB) in the postoperative setting has been associated with increased morbidity and mortality in patients undergoing major noncardiothoracic operations. The purpose of this study was to determine the incidence, associated complications, and outcomes of AFIB after open aortic operations. ⋯ These data suggest that AFIB is not uncommon after aortic operations but is not associated with increased morbidity, mortality, or length of hospital stay. Although a minority of affected patients can have other cardiac complications such as MI, these complications are usually recognized before the onset of AFIB. AFIB does not affect the outcomes of aortic operations. Most patients will revert spontaneously to normal sinus rhythm and do not require longterm anticoagulation to prevent thromboembolic complications.
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Chagas' disease has a wide distribution in Central and South America. It is endemic in 21 countries, with 16 to 18 million persons infected and 100 million at risk. Surgical treatment of achalasia from Chagas' disease is the first choice in advanced stages. The aim of this study was to analyze the late clinical followup of 50 patients operated on for Chagas megaesophagus with the Thal-Harafuku procedure. ⋯ We conclude that the Thal-Hatafuku operation is a therapeutic option that should be considered in the treatment of achalasia of the esophagus secondary to Chagas' disease, in advanced cases.