In this month's issue of the ARCHIVES, 2 articles originate from the productive burn unit at Shriners' Hospital, Galveston, Tex. In the first of these, Gore et alArticle demonstrate the relationship of severe fevers to increases in energy expenditure and muscle protein catabolism in otherwise hypermetabolic children with burns, suggesting a possible metabolic benefit in fever attenuation. Furthermore, Barret and HerndonArticle found that immediate burn excision was a therapeutically safe approach that modulated the hypermetabolic response after burn injury and proved superior to more conservative treatment with silver sulfadiazine and delayed excision. Both studies were conducted in a pediatric population.
We still have not been able to eradicate the horror of significant neurologic deficits after upper aorta surgery. Svensson et alArticle from the Cleveland Clinic, Cleveland, Ohio, and the Lahey Clinic, Burlington, Mass, undertook complex repairs in 132 consecutive patients using mild passive hypothermia, active cooling to 29°C to 32°C, or profound hypothermia with full cardiopulmonary bypass. They noted that moderate cooling or profound hypothermia resulted in fewer transient neurologic deficits. Thus, they recommend active cooling and cerebrospinal fluid drainage for most patients and profound hypothermia for complex repairs and reoperations.
We include 3 interesting review articles for your information: "Differential Diagnosis, Investigation, and Current Treatment of Lower Limb Lymphedema" by Tiwari et alArticle, "Diagnostic Implications of C-Reactive Protein" by Zimmerman et alArticle, and "Mechanisms and Treatment of Postoperative Ileus" by Luckey et alArticle. All are good, provocative reading.
This article demonstrates that the blood flow of the superior thyroid artery is positively related to thyroid microvascular density, glandular weight, and histopathologic pattern. Preoperative color flow Doppler ultrasonography can help identify patients with Graves disease who are more likely to bleed significantly during thyroidectomy. Perhaps some medication, such as Lugol solution, could be used.
Articles about resections of the pancreatic head with none or a portion of the duodenum are becoming increasingly common. In this study, 15 patients underwent one of these procedures for lesions such as intraductal mucinous papillary tumors, insulinomas, and parapapillary duodenal lesions. There appeared to be less delayed gastric emptying with these operations. In light of the short follow-up period, the authors conclude that both techniques can be alternatives to conventional pancreaticoduodenectomy with regard to organ preservation, postoperative morbidity, and nutrition.
Comparing stapled (both circular and linear) anastomosis with hand-sewn anastomosis in more than 100 patients, the investigators found hand-sewn to be superior.
This Month in Archives of Surgery. Arch Surg. 2003;138(2):125. doi:10.1001/archsurg.138.2.125