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Divi et al describe a group of 71 patients who developed subclavian vein compression and/or thrombosis. In this group, 73 operative procedures were performed following diagnosis, primarily catheter-directed thrombolysis followed in 3 or more weeks by surgical decompression. Patients with isolated subclavian vein obstruction have a more favorable outcome relative to those with combined neurogenic and venous pathologic features. Decompression should be delayed following thrombolysis to reduce the incidence of postoperative complications.
Hwang et al examined the reason for the high rate of breast cancer in Marin County, California, and the risk factors extant in this area that may produce estrogen receptor–positive breast cancer. Their conclusion was that patients with estrogen receptor–positive tumors were more likely to have undergone hormone therapy.
Granderath et al studied those patients with Nissen fundoplication and simple sutured crural closure and those with single sutured closure and onlay of a polypropylene mesh patch. Of the 100 patients (50 in each grouping), the preoperative studies were similar. At 3 months’ and 1-year follow-up, there was improvement in both groups; however, the intrathoracic wrap migration was 4 to 5 times as common in the unprotected crural closure.
A Single-Layer, Continuous, Hand-Sewn Method for Esophageal Anastomosis: Prospective Evaluation in 218 Patients
Law et al describe a 1-layer esophageal anastomosis used since 1996. They studied 218 consecutive patients prospectively, primarily for morbidity and mortality rates, anastomotic leaks, and stricture formation and recurrences. Anastomotic leaks occurred in 7 patients (3.2%) of whom 3 required reoperation. Hospital mortality was 0.9% attributed to myocardial infarction and malignancy. Anastomotic strictures developed in 24 patients (11%) primarily in cervical and distal stomach hook-ups. Recurrence occurred in 8 patients (3.7%), none of whom had a histologically involved resection margin. Thus, the 1-layer, continuous, hand-sewn technique seems safe and effective.
Identifying Risk Factors for Complications Following Sentinel Lymph Node Biopsy for Melanoma
Roaten et al studied the medical records of 339 consecutive patients undergoing sentinel lymph node biopsy for melanoma. Twenty complications were noted compared with more than 3 times as many in patients undergoing full regional lymph node dissection during the same period. The most common complications in the sentinel lymph node group were seroma formation, transient nerve injuries, and minor wound infections—complications far less significant than in the full regional lymph node group. Experience decreased complications, and patients with more than 1 sentinel lymph node excised or who underwent closed-suction drainage were at increased risk of complications.
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This Month in Archives of Surgery. Arch Surg. 2005;140(1):13. doi:10.1001/archsurg.140.1.13
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