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This Month in Archives of Surgery
Arch Surg. 2005;140:325.
Chan et al from Harvard Medical School are advocating the use of rapid parathyroid hormone assay on parathyroid gland aspirates as compared with normal thyroid tissue as a means of identifying parathyroid tissue, replacing frozen section during parathyroid surgery. Clinical judgment then prevails as to the adenomatous nature of the parathyroid gland.
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Pappu and associates at Yale University School of Medicine reviewed the sensitivity of sestamibi scanning techniques for 148 consecutive patients with primary hyperparathyroidism. By adjusting the scan sensitivity meticulously, they were able to achieve an improved result at operation, including positive result (96%), correct lateralization (92%), and precise localization (70%), with a 96% cure rate. This technique may permit a focused, minimally invasive operation.
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Many have tried to come up with the perfect solution for the surgical treatment of hyperparathyroidism in patients with multiple endocrine neoplasia type I. Lambert and colleagues at M. D. Anderson Cancer Center of the University of Texas, Houston, explain the situation well and propose a solution—3-gland parathyroidectomy with transcervical thyrectomy and cryopreservation of parathyroid tissue. In their small series, they found that if fewer than 3 glands are removed at initial parathyroidectomy, recurrent hyperparathyroidism is frequent. Optimal surgical intervention must balance the risk of recurrent hypercalcemia with the morbidity of permanent hyperparathyroidism.
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Twenty-Year Experience With Liver Transplantation for Hepatocellular Carcinoma
Island et al from the Lahey Clinic (Burlington, Mass) have reviewed their experience with liver transplantation for hepatocellular carcinoma and concluded that improved preoperative staging has resulted in improved 5-year survival. Further refinements in pretransplant staging may increase the effectiveness of liver transplantation for hepatocellular carcinoma (5-year survival rate is currently 69%).
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Is There a Role for Routine Preoperative Endoscopic Retrograde Cholangiopancreatography for Suspected Choledocholithiasis in Children?
Vrochides and colleagues from Hasbro Children’s Hospital and the Brown Medical School, Providence, RI, studied 100 patients retrospectively. They suggest that choledocholithiasis does occur in children and that spontaneous passage of common duct stones is common. Conservative management is successful in the vast majority of patients, and routine preoperative or postoperative endoscopic retrograde cholangiopancreatography is usually not indicated.
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Can External Signs of Trauma Guide Management? Lessons Learned From Suicide Bombing Attacks in Israel
Almogy and colleagues conducted a retrospective analysis of all 15 suicide bombing attacks that occurred in Israel from April 1994 to August 1997. They identify external signs of trauma that would assist medical crews in recognizing blast lung injury and effectively triaging salvageable and nonsalvageable victims.
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Proposed protocol for determining evacuation preferences from the scene.
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SECTION EDITOR: GERALD W. PESKIN, MD
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