The British journal of surgery
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Observational Study
Time-dependent trends in cardiovascular adverse events during follow-up after carotid or iliofemoral endarterectomy.
Recent observations have suggested a decline in vulnerable carotid artery and iliofemoral atherosclerotic plaque characteristics over the past decade. The aim of this study was to determine whether, in the presence of clinically manifest carotid or peripheral artery disease, secondary adverse cardiovascular events decreased over this period. ⋯ In patients who had undergone either CEA or IFE there was no evidence of a decrease in all secondary cardiovascular events. There were no differences in major cardiovascular events.
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Postoperative hypocalcaemia due to dysfunction of the parathyroid glands is the most common complication after total thyroidectomy plus central neck dissection (CND). There is a lack of surgical techniques described to help preserve the inferior parathyroid gland in situ during CND. The objective of this study was to introduce the 'TBP layer' (layer of thymus-blood vessel-inferior parathyroid gland) concept for preserving the inferior parathyroid gland in situ during CND, and to evaluate its effectiveness. ⋯ Applying the proposed surgical concept improved the rate of inferior parathyroid gland preservation in situ and decreased the incidence of transient postoperative hypoparathyroidism.
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Intraoperative nerve monitoring (IONM) provides dynamic neural information and is recommended for high-risk thyroid surgery. In this analysis, the cost-effectiveness of IONM in preventing bilateral recurrent laryngeal nerve (RLN) injury was investigated. ⋯ Use of IONM is cost-effective in patients undergoing bilateral thyroid surgery.
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Centralization of pancreatic surgery has resulted in improved short-term outcomes in a number of healthcare systems. The aim of this study was to see whether hospital volume influenced long-term prognosis, use of adjuvant therapy or histopathological evaluation of patients undergoing surgical resection for pancreatic ductal adenocarcinoma (PDAC). ⋯ Both short- and long-term survival was significantly better for patients operated on in HVCs. Histopathological analysis appears to be more comprehensive in HVCs.