Surgery
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The treatment of bone metastasis in association with thyroid cancer represents a difficult challenge. Given the paucity of patients with bone metastasis and the difficulty of treating this disease, few studies have investigated the clinical features and prognostic factors of bone metastasis from differentiated thyroid cancer. ⋯ In the absence of definitive, effective treatments for this disease, radioactive iodine therapy combined with resection of bone metastasis, wherever possible, seems to represent the most potent therapy available. Although bone metastasis is a strong sign of poor prognosis, early detection and administration of appropriate therapy using radioactive iodine seems likely to improve the survival rate and quality of life in patients with bone metastasis from differentiated thyroid carcinoma.
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Multicenter Study Controlled Clinical Trial
Predictors of occult nodal metastasis in colon cancer: results from a prospective multicenter trial.
The relationship between primary colon cancer and occult nodal metastases (OMs) detected by cytokeratin immunohistochemistry (CK-IHC) is unknown. We sought to investigate the correlation of clinicopathologic features of colon cancer with OMs and to identify predictors of OM. ⋯ Adverse primary pathologic colon cancer characteristics correlate with OMs. In patients with negative nodes on H&E and stage T3/T4 colon cancer, lymphovascular invasion, or high tumor grade, consideration should be given to performing CK-IHC. The detection of OMs in this subset may influence decisions regarding adjuvant chemotherapy and risk stratification.
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Despite recent work hour restrictions, 24-hour calls remain an important part of patient care. The aim of this study was to assess the impact of 24-hour night calls on the psychomotor and cognitive skills of surgeons with a virtual surgery simulator (VSS) and psychometric tests. We hypothesized that sleep loss impairs surgical skills and concentration performance. ⋯ No performance impairment was found for surgeons with a VSS and standardized cognitive tests after a night of relative sleep loss. Although there is no doubt that sleep deprivation ultimately impairs human functioning, typical surgical skills do not necessarily deteriorate with a limited amount of sleep loss under clinical conditions.
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The aim of the "fast-track surgery" program is to decrease the peri-operative stress response to surgical trauma and thus to a decrease in complication rates after elective surgery. Critics of fast-track (FT) rehabilitation may argue that all reports of successful programs came from major specialized hospital units and that implementation in smaller or less specialized units may be difficult if not impossible. ⋯ Based on 6 comparative single-center studies, the FT program was found to reduce length of hospital stay, and was deemed safe for major abdominal surgeries. Present study shows that enhanced recovery or FT program can also be implemented safely in a general surgery unit.
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Groin hernia repair occasionally leads to severe chronic pain associated with entrapped or damaged nerves. Conservative treatment is often unsuccessful. Selective neurectomy may be effective, but long-term results are scarce. The authors assessed the long-term efficacy of surgical neurectomy for chronic, postherniorrhaphy groin neuralgia. ⋯ A selective operative neurectomy for postherniorrhaphy groin neuralgia provides good long-term pain relief in most patients. Hernia surgeons should feel responsible for this iatrogenic complication and should consider incorporating selective neurectomy in their surgical armamentarium.