Hamoui et al3013 alert us to the fact that elevated levels of parathyroid hormone are associated with malabsorption of calcium in the upper gastrointestinal tract and may be present when weight loss accompanies obesity but more so, perhaps, when a duodenal switch operation has been performed for morbid obesity with a short common channel (75 cm). although this does not produce hyperparathyroidism as we know it clinically, it does give us a lead to bone disease in later life.
Further, the fact that patients are very elderly does not preclude their undergoing surgical treatment for symptomatic hyperparathyroidism. kebebew et al3005 analyzed results from 54 consecutive patients 80 years and older (43 women and 11 men) with primary disease with excellent outcomes, short hospitalization time, no mortality, and a few minor complications. they conclude that parathyroidectomy in elderly patients is safe, curative, and beneficial.
No one has the answer to breast cancer treatment. two papers present information about various aspects of the problem. the first, by jimenez-lee et al,3023 promotes a breast-screening program for low-income women and found excellent compliance and the importance of a well-orchestrated clinical examination along with the mammographic study. this study also found a higher than usual incidence of advanced lesions. the second study3006 provides a rationale for excluding axillary dissection from the treatment of t1a lesions of the breast. this study found that higher tumor grade and lymphovascular and/or neural invasion were important factors in determining nodal metastases, which suggests the use of chemotherapy. axillary dissection did not improve the relapse rate or breast cancer–specific survival. more fodder for dr cady!
This excellent study demonstrates the value of a full-time trauma service in improving the timeliness of triage and therapeutic interventions and enhancing overall patient outcomes. however, it fails to definitively establish that this is due to in-house trauma attendings.
This large series demonstrates that aggressive surgical treatment can be accomplished in this group of patients with acceptable morbidity and low mortality and that survival following surgical intervention is excellent, even though most of these patients will develop recurrent tumor. thus, it is important to consider bypassing conventional contraindications to surgical resection in patients with advanced neuroendocrine tumors.
This interesting study brings out several points: (1) in a prospective study the rate of nonoperative management for solid organ injuries is higher than in other retrospective reports; (2) nonoperative treatment is less likely to fail in liver injuries than in splenic or kidney trauma; and (3) key items alerting personnel to operative management include the need for blood transfusion, fluid seen on focused abdominal sonography for trauma, and a significant quantity of blood discovered on a computed tomographic scan of the abdomen.
This interesting study points out the safety and effectiveness of using a prosthetic patch for hiatal closure in recurrent hiatal hernia repair.
This month in Archives of Surgery. Arch Surg. 2003;138(8):821. doi:10.1001/archsurg.138.8.821