From the University of Hong Kong Medical Centre comes the quick parathyroid hormone assay of parathyroid and nonparathyroid tissue. They claim that this eliminates frozen sections and is cheaper in the long run. In a series of 138 glands excised, there was a definite cut-off between nonparathyroid and parathyroid tissue. Dr Monchik’s invited critique points out that a good endocrine surgeon and experienced pathologist can establish the diagnosis of primary hyperparathyroidism in almost all cases. This biochemical identification of parathyroid tissue intraoperatively does have a role.
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Foster et al investigate whether immediate reconstruction of the breast after surgery for advanced and inflammatory lesions is safe and effective. Although there is still a good deal of controversy over the concept of immediate reconstruction after lesions of an advanced nature are removed, this rather small series does offer solace for those who feel immediate reconstruction does not delay the timing of adjuvant therapy, with complications tending to be minor.
Schindl et al have developed a scoring system thought to be prognostic for operating on colorectal liver metastases. The independent prognosticators of survival were Dukes stage, number of metastases, and serum concentrations of carcinoembryonic antigen, alkaline phosphatase, and albumin. Significant differences were found in cumulative overall survival between patients assigned to good, moderate, and poor prognosis.
In this study, Bratzler et al describe the use of antimicrobial prophylaxis in Medicare patients within 1 hour before incision. The purpose of the exercise was to emphasize the substantial opportunities to improve the use of the correct antimicrobials for patients undergoing major surgery.
In this cohort study from the Department of Surgical Gastroenterology of the University of Copenhagen, Denmark, Sørensen et al evaluated 310 patients to determine the cause of their incisional hernia. Of the 34 variables examined, smoking appeared to be a significant risk factor along with relaparotomy, postoperative wound complications, advanced age, and male sex.
Dr Behrman reviews the known pathophysiological features of peptic ulcer disease with a focus on those complications encountered by the surgeon—perforation, bleeding, and obstruction. Despite the advent of secretory-inhibitory agents and the theory regarding Helicobacter pylori as the etiologic mechanism, there is still need for surgical management and intervention for the patient whose antacid therapy or antibiotic therapy fails or who has some other etiology of the ulcer syndrome.
Dalal et al examined the inflammatory markers between subjects with appendicitis and controls and found no significant differences by group. They determined that, presently, it is not practical to differentiate appendicitis in a pediatric population from other causes of abdominal pain based on the detection of systemic inflammatory response markers.
This Month in Archives of Surgery. Arch Surg. 2005;140(2):115. doi:10.1001/archsurg.140.2.115