Journal of the American College of Surgeons
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The application of video-endoscopy to general thoracic surgery is radically changing the approach to many benign and malignant diseases of the chest. Since July 1991, we have performed 794 purely thoracoscopic and 101 video-assisted thoracic surgical (VATS) procedures on 860 patients. ⋯ These data underscore the flexibility, safety, efficacy, and potential for cost savings of videoscopic surgery in patients with thoracic diseases. The ability to perform excisional biopsy improves diagnostic specificity and sensitivity to nearly 100 percent. Video-assisted thoracic surgical techniques also offer a minimally invasive procedure with acceptable risk to patients heretofore inoperable by standard thoracotomy.
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Although the use of alcohol and drugs by surgery residents is of concern, no large-scale studies of this specific population exist. ⋯ Despite the optimistic findings of the survey, the authors advocate the following: Implementation of educational programs to prevent potential abuse of alcohol and drugs, and establishment of tighter controls on cocaine or use of a cocaine substitute for patient care.
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In the United States of America, the five-year survival rate among patients surviving curative resection for gastric carcinoma will range between 20 and 25 percent. In Japan, early diagnosis and an aggressive surgical approach including planned lymph node dissection has resulted in the five-year survival rate exceeding 50 percent for all patients with newly diagnosed gastric carcinoma. This report is a retrospective review evaluating the effect of extended lymph node dissection (D2) on overall survival in 101 patients with gastric adenocarcinoma who underwent a potentially curative gastric resection from 1975 to 1990 at Roswell Park Cancer Institute. ⋯ Patients treated by extended resection (D2, D2.5) were more likely to survive five years and had prolonged median survival times when compared with patients treated with limited resection (D1, D1.5). For patients with T2-4, N0-1, M0 gastric carcinomas treated with extended resection, their differences reached levels at or approaching statistical significance.
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There is very little published data concerning the knot handling properties of suture materials. The few studies that are available on this subject contain discrepancies in nomenclature, testing methods, and in the type of data reported. To date, there has been no effort to present what is currently known concerning knot security in a unified format. ⋯ Existing studies have demonstrated a strong variation in the efficiency of different surgical knots. Standards for testing and nomenclature have been presented. Effort now needs to be directed in three areas: simulating in vivo conditions, testing knots under these conditions, and determining the factors that make some suture materials more efficient in knot holding than others.
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The Roux-en-Y gastrojejunostomy is a popular method in the operative treatment of alkaline reflux gastritis and other postgastrectomy sequelae, but is associated with a high incidence of the so-called "Roux stasis syndrome." The Henley jejunal interposition has been used occasionally, albeit not widely, as an alternative to the Roux-en-Y reconstruction. ⋯ This experience suggests that the Henley jejunal interposition is our effective method of treating reflux gastritis and is not associated with the poor emptying frequently associated with the Roux-en-Y reconstruction.