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This Month in Archives of Surgery
Arch Surg. 2004;139:813.
The debate over treatment to prolong waiting time until liver transplantation persists for patients with hepatocellular carcinoma in end-stage liver disease. Radioablation therapy, embolus injection, and excision all have their role. Johnson et al point out the salvage rate achieved in their series with pretransplant treatment and the extended time frame of their waiting list.
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Miranda et al investigate the diagnostic yield of extensive testing of asymptomatic patients with positive sentinel nodes after melanoma excisions. Eliminating expensive routine testing procedures that fail to influence management may be one way of dealing with the rising cost of health care.
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On the topic of less is better, Ryan and Lee discuss 185 consecutive patients operated on for parathyroid disease and limiting one's approach to operation based on preoperative testing. They found an ultimate success rate of 99% with the combination of limited exploration and extended exploration, without monitoring intraoperative parathyroid hormone levels. Localization thus can limit exploration with success.
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Toll of Methamphetamine on the Trauma System
This article provides a compendium of information regarding methamphetamine and points out the universality and consequences of its use. The data from 1 tertiary trauma center in 2002 is presented. The information shows that the amphetamine-positive group had a significantly greater length of stay, had higher charges billed, and was more likely to be admitted to the hospital despite a low Injury Severity Score, thus using resources out of proportion to injury severity.
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The Effect of Inhibition of a Major Cell Signaling Pathway Following Trauma Hemorrhage on Hepatic Injury and Interleukin 6 Levels
Although this study was carried out in animals, this article illustrates that the inhibition of intracellular signaling pathways may represent a feasible approach to blunt the inflammatory response and improve outcome following traumatic injuries and hemorrhagic shock.
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Use of Preoperative Breast Ultrasonography for Mapping of Breast Cancer Extent Improves Resection Margins During Breast Conservation Surgery
How many times have you gone back to obtain adequate margins for your lumpectomies? Vargas et al show how to improve the margins of resection and decrease the incidence of positive margins by using ultrasound techniques in plotting a course of action.
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SECTION EDITOR: GERALD W. PESKIN, MD
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