Surgery
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Lymph node metastases from papillary thyroid cancer is believed to disseminate sequentially, first to the central neck and later to the lateral neck. Skip metastases of papillary thyroid cancer, however, are defined as lateral lymph node metastasis without central lymph node metastasis. The aim of this study was to investigate the risk factors for skip metastases and lateral lymph node metastasis of papillary thyroid cancer. ⋯ Greater tumor size, central lymph node metastasis, and an increased number of both central lymph nodes and lateral lymph nodes dissected were predictors for lateral lymph node metastasis of papillary thyroid cancer. In addition, papillary thyroid microcarcinoma was an independent risk factor for skip metastases. A complete and comprehensive central compartment dissection may decrease the false-positive detection of skip metastases of papillary thyroid cancer.
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We present the largest single-center study to date of surgical and quality-of-life outcomes among patients treated with laparoscopic antireflux surgery for reflux-associated chronic cough. Extraesophageal manifestations of chronic gastroesophageal reflux are increasingly recognized, among which chronic cough may substantially compromise patient quality of life. Although the benefits of antireflux surgery are well documented in patients with typical symptoms of gastroesophageal reflux disease, less is known about the short-term impact of antireflux surgery on associated chronic cough. ⋯ Chronic cough associated with gastroesophageal reflux disease after a thorough, objective medical workup can be expected to have an excellent rate of resolution and quality-of-life outcomes after laparoscopic antireflux surgery. A high-volume practice, objective documentation of gastroesophageal reflux disease, and a multidisciplinary approach are key in achieving optimal outcomes.
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High-fidelity simulation-based training is used increasingly for prelicensure student teams. Such sessions rely on faculty who are able to provide quality prebriefing and debriefing to foster learning among participants. We investigated how well faculty conducted prebriefing and debriefing as part of high-fidelity simulation-based training for interprofessional education. ⋯ Interprofessional faculty combinations in this study tended to have good quality prebriefings and debriefings. The quality of the prebriefings and debriefings can, however, be influenced by the composition of the facilitator teams, most prominently for prebriefings, and team performance does appear to change through time, especially during the debriefing. Future work will focus on whether the quality of prebriefings and debriefings influences learning by trainees.
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Burn-induced compartment syndrome is a severe sequela after circumferential burns of the extremities and is avoidable by immediate release of the underlying pressure under the eschar. Although the current gold standard is operative escharotomy, this procedure carries considerable morbidity. Our study evaluates the safety and effectiveness of immediate enzymatic debridement to prevent the need for operative escharotomy because of burn-induced compartment syndrome in selected patients. ⋯ If the specific contraindications are respected, enzymatic debridement is safe and effective for the prevention of burn-induced compartment syndrome after deep circumferential burns at the upper extremity, and thus making operative escharotomy unnecessary.
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Randomized Controlled Trial Comparative Study
Long-term oncologic outcomes of a randomized controlled trial comparing laparoscopic versus open gastrectomy with D2 lymph node dissection for advanced gastric cancer.
Laparoscopy-assisted gastrectomy is a feasible and safe procedure for treating advanced gastric cancer in terms of short-term outcomes. However, concern about long-term oncologic outcomes has limited the adoption of laparoscopy-assisted gastrectomy for advanced gastric cancer. ⋯ Laparoscopy-assisted gastrectomy can provide comparable long-term survival without an increase in recurrence and metastasis in treating advanced gastric cancer.