Although this is not the first study indicating that one can, under appropriate circumstances, perform directed parathyroidectomy, this article by Burkey et al reviewed 100 consecutive patients with untreated, sporadic primary hyperparathyroidism. Following preoperative imaging (sestamibi scintigraphy and ultrasonography), patients underwent parathyroidectomy with intraoperative parathyroid hormone monitoring through either a limited neck incision or bilaterally through a standard collar incision. In 70 of these individuals, a limited incision was possible, with excellent results and shorter operative time and length of hospital stay. All patients were eucalcemic postoperatively. The authors present an algorithm for your perusal.
Niederee et al from the University of Kansas, Wichita, obtained a large return of their questionnaires (1653, or 46% of all approved surgical training programs). They found that (1) current duty hours for most surgical residents exceed proposed ACGME limits; (2) most surgical residents support duty hours limits, whereas surgical faculty are less supportive; and (3) significant alterations in the current design and structure of surgical training programs will be required to meet ACGME guidelines. Further, approximately one quarter of residents regret choosing a career in surgery. The discussion raises the question of continuity of care and the increasing role of surgical faculty in providing this valuable aspect of care. Should the length of residency time be increased?
Offner et al treated 44 high-risk patients, mostly following severe injury (mean Injury Severity Score, 33), by the insertion of a temporary inferior vena cava filter. There were no complications associated with insertion or removal of these filters and no documented instances of venous thromboembolism, thus their conclusion that inferior vena cava filters are safe and effective in critically ill surgical patients. This concept has been disputed on a cost-benefit basis as well as the determination of who is sick enough to warrant such treatment.
This Month in Archives of Surgery. Arch Surg. 2003;138(6):581. doi:10.1001/archsurg.138.6.581