JSurg » Surgical Clinics of North America

Management of an Incidental Liver Mass.

Boutros C, Katz SC, Espat NJ — Thu, 22 Jul 2010 03:54:14 +0000

Management of an Incidental Liver Mass.

Surg Clin North Am. 2010 Aug;90(4):699-718

Authors: Boutros C, Katz SC, Espat NJ

The increased use of sensitive imaging modalities has led to increased identification of the incidental liver mass (ILM). A combination of careful consideration of patient factors and imaging characteristics of the ILM enables clinicians to recommend a safe and efficient course of action. Using an algorithmic approach, this article includes pertinent clinical factors and the specific radiologic criteria of ILMs and discusses the indications for potential procedures. It is the aim of this article to assist with the development of an individualized strategy for each patient with an ILM.

PMID: 20637942 [PubMed - as supplied by publisher]

Management of Benign Hepatic Tumors.

Buell JF, Tranchart H, Cannon R, Dagher I — Thu, 22 Jul 2010 03:54:13 +0000

Management of Benign Hepatic Tumors.

Surg Clin North Am. 2010 Aug;90(4):719-735

Authors: Buell JF, Tranchart H, Cannon R, Dagher I

Advances in imaging techniques will dramatically decrease the number of undiagnosed tumors. New molecular techniques should allow the identification of pathologic factors that are predictive of complicated forms. Surgery should be limited to symptomatic benign tumors or those who have a risk for complication (hemorrhage, rupture, or degeneration). When surgery is indicated, patients with benign disease are the best candidates for laparoscopy.

PMID: 20637943 [PubMed - as supplied by publisher]

Current Management of Hepatic Trauma.

Piper GL, Peitzman AB — Thu, 22 Jul 2010 03:54:10 +0000

Current Management of Hepatic Trauma.

Surg Clin North Am. 2010 Aug;90(4):775-785

Authors: Piper GL, Peitzman AB

With the shift toward nonoperative management, most hepatic injuries are managed nonoperatively. On the other hand, up to two-thirds of high-grade hepatic injuries require laparotomy; these cases are technically difficult and challenging. Damage-control approaches, understanding of liver anatomy, and advances in technology have dramatically changed the approach to hepatic trauma, with improved outcomes. Anatomic or nonanatomic liver resection is required in 2% to 5% of liver injuries. Mortality with liver injury following resection is 9% with current advances.

PMID: 20637947 [PubMed - as supplied by publisher]

Current Approach to Hepatocellular Carcinoma.

Abrams P, Marsh JW — Thu, 22 Jul 2010 03:54:01 +0000

Current Approach to Hepatocellular Carcinoma.

Surg Clin North Am. 2010 Aug;90(4):803-816

Authors: Abrams P, Marsh JW

Hepatocellular carcinoma (HCC) accounts for 80% of all primary liver cancers and ranks globally as the fourth leading cause of cancer-related death. Partial hepatectomy remains the best treatment option for select patients with HCC without cirrhosis. Liver transplantation is well established as the gold standard for patients with HCC and cirrhosis in the absence of extrahepatic spread and macrovascular invasion. Local regional therapy is indicated in select patients who are not surgical candidates, and its role as adjuvant therapy remains to be clarified by prospective studies.

PMID: 20637949 [PubMed - as supplied by publisher]

Neuroendocrine Liver Metastases.

Reddy SK, Clary BM — Wed, 21 Jul 2010 03:44:05 +0000

Neuroendocrine Liver Metastases.

Surg Clin North Am. 2010 Aug;90(4):853-861

Authors: Reddy SK, Clary BM

This review summarizes regional strategies for management of neuroendocrine liver metastases (NLM), including hepatic resection, ablation, liver transplantation, and hepatic arterial embolization/chemoembolization. Despite early disease recurrence and/or progression, resection of NLM with or without combined ablation provides long-term survival and symptom improvement. When complete resection of gross liver disease is not feasible, resection as a tumor debulking strategy should be considered in patients with extreme hormonal symptoms refractory to other treatments or with tumors in locations that would affect short-term quality of life. Hepatic arterial embolization with or without local instillation of chemotherapy may induce disease response, symptomatic improvement, and prolonged survival in patients with unresectable NLM. Early disease recurrence, high postoperative mortality, the absence of extensive experience, and lack of universal indications for organ allocation preclude orthotopic liver transplantation as an option for most patients with unresectable NLM.

PMID: 20637952 [PubMed - as supplied by publisher]

Hepatic Tumor Ablation.

Sindram D, Lau KN, Martinie JB, Iannitti DA — Wed, 21 Jul 2010 03:44:04 +0000

Hepatic Tumor Ablation.

Surg Clin North Am. 2010 Aug;90(4):863-876

Authors: Sindram D, Lau KN, Martinie JB, Iannitti DA

Ablation of liver tumors is part of a multimodality liver-directed strategy in the treatment of various tumors. The goal of ablation is complete tumor destruction, and ultimately improvement of quality and quantity of life for the patient. Technology is evolving rapidly, with important improvements in efficacy. The current state of ablation technology and indications for ablation are described in this review.

PMID: 20637953 [PubMed - as supplied by publisher]

Fulminant Hepatic Failure: When to Transplant.

Khanna A, Hemming AW — Wed, 21 Jul 2010 03:43:57 +0000

Fulminant Hepatic Failure: When to Transplant.

Surg Clin North Am. 2010 Aug;90(4):877-889

Authors: Khanna A, Hemming AW

Fulminant hepatic failure is a life-threatening condition that can lead to rapid deterioration and death if timely treatment is not instituted. Many patients recover with supportive care. Patients with deteriorating signs and laboratory parameters require prompt assessment and listing for liver transplantation. Outcome following transplantation is a function of severity of illness before transplantation, timeliness of liver transplantation and graft quality and function. With appropriate immunosuppression and close follow-up most patients can lead near normal lives following liver transplantation.

PMID: 20637954 [PubMed - as supplied by publisher]

Simulation and Surgical Competency. Foreword.

Martin RF — Sat, 17 Jul 2010 03:24:11 +0000

Simulation and Surgical Competency. Foreword.

Surg Clin North Am. 2010 Jun;90(3):xiii-xv

Authors: Martin RF

PMID: 20497818 [PubMed - indexed for MEDLINE]

Emerging trends that herald the future of surgical simulation.

Satava RM — Sat, 17 Jul 2010 03:24:10 +0000

Emerging trends that herald the future of surgical simulation.

Surg Clin North Am. 2010 Jun;90(3):623-33

Authors: Satava RM

For the first time in over 100 years, there is a revolution in surgical education. One of the most important core technologies generating this revolution is simulation science, which includes not only the technology of simulators but new curricula, objective assessment methods, and criterion-based requirements. By reviewing the current status of simulation and making comparisons with the emerging technologies, an analysis of the gaps can demonstrate the necessary direction for the future.

PMID: 20497831 [PubMed - indexed for MEDLINE]

Simulation in surgery: perfecting the practice.

Choy I, Okrainec A — Wed, 30 Jun 2010 01:02:52 +0000

Simulation in surgery: perfecting the practice.

Surg Clin North Am. 2010 Jun;90(3):457-73

Authors: Choy I, Okrainec A

The apprenticeship model that surgical training has traditionally relied on has proven to be an expensive, time-consuming, and inconsistent model for producing skilled surgeons. Combined with increased public scrutiny on patient safety, financial concerns, restricted work hours, and expanding skill requirements, it has become clear that a new pedagogic paradigm is required. This article reviews the evidence supporting the need and justification of simulation in surgical education and explores the existing and potential roles of simulation in the training and evaluation of future surgeons.

PMID: 20497820 [PubMed - in process]

Optimal acquisition and assessment of proficiency on simulators in surgery.

Stefanidis D — Wed, 30 Jun 2010 01:02:50 +0000

Optimal acquisition and assessment of proficiency on simulators in surgery.

Surg Clin North Am. 2010 Jun;90(3):475-89

Authors: Stefanidis D

Increasingly, trainees are being exposed to simulators for the purpose of acquiring surgical skills. This article addresses the theoretical framework behind surgical skill acquisition and explores the factors that optimize learning on simulators. Furthermore, this article evaluates the role of currently used performance metrics for documentation of skills proficiency and provides suggestions for the incorporation of additional, more sensitive performance metrics that may lead to improved transfer of simulator-acquired skill.

PMID: 20497821 [PubMed - in process]

Running a surgical education center: from small to large.

Meier AH — Wed, 30 Jun 2010 01:02:49 +0000

Running a surgical education center: from small to large.

Surg Clin North Am. 2010 Jun;90(3):491-504

Authors: Meier AH

In the last 2 decades, surgical education has experienced a transformative paradigm shift from the purely service-based Halstedian system to a curriculum-driven model based on educational theory. With the advent of minimally invasive surgery and its educational challenges, fostered by the simultaneously occurring rapid advances of computer technology and graphics and further promoted by rising concerns about patient safety, simulation and skills training has become a well-established tool in the arsenal of the surgical educator. Although most training institutions now have access to skills laboratories and simulation centers, running and integrating these facilities into the surgical curriculum remains a challenge. This article outlines general principles that are relevant for training facilities of all sizes and covers aspects from the initial phase of planning and establishing the center until its ultimately successful integration into the surgical education program.

PMID: 20497822 [PubMed - in process]

Focused surgical skills training for senior medical students and interns.

Klingensmith ME, Brunt LM — Wed, 30 Jun 2010 01:02:47 +0000

Focused surgical skills training for senior medical students and interns.

Surg Clin North Am. 2010 Jun;90(3):505-18

Authors: Klingensmith ME, Brunt LM

Surgical skills laboratories have become an increasingly important component of technical skills training for learners entering surgical fields. This article describes the experiences with intensive skill preparation courses for senior medical students and interns. The advantages, limitations, and challenges of learning in the skills laboratory are described, and practical information is provided regarding the resources needed to carry out training for junior learners.

PMID: 20497823 [PubMed - in process]

Assessment and feedback in the skills laboratory and operating room.

Sugden C, Aggarwal R — Wed, 30 Jun 2010 01:02:46 +0000

Assessment and feedback in the skills laboratory and operating room.

Surg Clin North Am. 2010 Jun;90(3):519-33

Authors: Sugden C, Aggarwal R

Significant advances have been made in recent years in the accurate and reliable assessment of surgical skill. The many applications for such a facility range from selection and training to certification, revalidation, and the implementation of new technologies. In the process of developing an assessment procedure it is necessary to select elements that safely, feasibly, and reliably capture variations in technical and nontechnical performance. The laboratory lends itself well to the assessment of deconstructed skills in a safe environment, whereas the operating room demands integration of technical and nontechnical skill in a high-risk setting. Therefore, both have an important role to play and should coexist within a continuous assessment pathway.

PMID: 20497824 [PubMed - in process]

FLS and FES: comprehensive models of training and assessment.

Vassiliou MC, Dunkin BJ, Marks JM, Fried GM — Wed, 30 Jun 2010 01:02:43 +0000

FLS and FES: comprehensive models of training and assessment.

Surg Clin North Am. 2010 Jun;90(3):535-58

Authors: Vassiliou MC, Dunkin BJ, Marks JM, Fried GM

The Fundamentals of Laparoscopic surgery (FLS) is a validated program for the teaching and evaluation of the basic knowledge and skills required to perform laparoscopic surgery. The educational component includes didactic, Web-based material and a simple, affordable physical simulator with specific tasks and a recommended curriculum. FLS certification requires passing a written multiple-choice examination and a proctored manual skills examination in the FLS simulator. The metrics for the FLS program have been rigorously validated to meet the highest educational standards, and certification is now a requirement for the American Board of Surgery. This article summarizes the validation process and the FLS-related research that has been done to date. The Fundamentals of Endoscopic Surgery is a program modeled after FLS with a similar mission for flexible endoscopy. It is currently in the final stages of development and will be launched in April 2010. The program also includes learning and assessment components, and is undergoing the same meticulous validation process as FLS. These programs serve as models for the creation of simulation-based tools to teach skills and assess competence with the intention of optimizing patient safety and the quality of surgical education.

PMID: 20497825 [PubMed - in process]

Verification of proficiency: a prerequisite for clinical experience.

Sanfey H, Dunnington G — Wed, 30 Jun 2010 01:02:40 +0000

Verification of proficiency: a prerequisite for clinical experience.

Surg Clin North Am. 2010 Jun;90(3):559-67

Authors: Sanfey H, Dunnington G

Several factors, including reduced resident work hours and concerns for patient safety, have led to the introduction of dedicated skills laboratories and a more widespread belief in the value of time spent in skills training. The American College of Surgeons and the Association of Program Directors in Surgery established a three-phase skills curriculum for all surgery residents. Phase 1 involves basic surgical skills instructional modules and a Verification of Proficiency assessment. After undergoing teaching and practice sessions in the authors’ skills lab, all first-year surgical residents (post graduate year 1 residents) from general surgery and four surgical specialty programs are tested on 11 non-specialty specific basic surgical skills before performing these in clinical situations.

PMID: 20497826 [PubMed - in process]

Surgical team training: promoting high reliability with nontechnical skills.

Paige JT — Wed, 30 Jun 2010 01:02:36 +0000

Surgical team training: promoting high reliability with nontechnical skills.

Surg Clin North Am. 2010 Jun;90(3):569-81

Authors: Paige JT

This article focuses on key aspects of the “nontraditional” surgical subjects of organizational structure and team interaction. First, the deficiencies in team dynamics found within the modern operating room (OR) and their resultant consequences are highlighted. Next, essential human factors concepts related to error generation, organizational culture, high reliability, and team science as applied to the OR environment are reviewed. Finally, various strategies for improving OR team function, including the use of high-fidelity simulation (HFS) in team training are discussed.

PMID: 20497827 [PubMed - in process]

Optimizing learning in surgical simulations: guidelines from the science of learning and human performance.

Cannon-Bowers JA, Bowers C, Procci K — Wed, 30 Jun 2010 01:02:27 +0000

Optimizing learning in surgical simulations: guidelines from the science of learning and human performance.

Surg Clin North Am. 2010 Jun;90(3):583-603

Authors: Cannon-Bowers JA, Bowers C, Procci K

Simulation-based training is rapidly becoming an integral part of surgical training. However, the effectiveness of this type of training is as dependent on the manner in which it is implemented and delivered as it is on the simulator itself. In this article, the authors identify specific elements from the science of learning and human performance that may assist educators in optimizing the effects of simulation-based training. These elements include scenario design, feedback, conditions of practice, and others. Specific guidelines for simulation-based surgical training are provided.

PMID: 20497828 [PubMed - in process]

Virtual reality in surgical skills training.

Palter VN, Grantcharov TP — Sun, 27 Jun 2010 00:30:55 +0000

Virtual reality in surgical skills training.

Surg Clin North Am. 2010 Jun;90(3):605-17

Authors: Palter VN, Grantcharov TP

With recent concerns regarding patient safety, and legislation regarding resident work hours, it is accepted that a certain amount of surgical skills training will transition to the surgical skills laboratory. Virtual reality offers enormous potential to enhance technical and non-technical skills training outside the operating room. Virtual-reality systems range from basic low-fidelity devices to highly complex virtual environments. These systems can act as training and assessment tools, with the learned skills effectively transferring to an analogous clinical situation. Recent developments include expanding the role of virtual reality to allow for holistic, multidisciplinary team training in simulated operating rooms, and focusing on the role of virtual reality in evidence-based surgical curriculum design.

PMID: 20497829 [PubMed - in process]

The role of simulation in certification.

Buyske J — Wed, 23 Jun 2010 00:04:48 +0000

The role of simulation in certification.

Surg Clin North Am. 2010 Jun;90(3):619-21

Authors: Buyske J

The role of simulation in certification by the American Board of Surgery is in flux. Until 2010, there was no formal requirement for simulation of any kind in the certification process. Starting in 2010, successful completion of Fundamentals of Laparoscopic Surgery as well as Advanced Trauma Life Support and Advanced Cardiovascular Life Support is required for certification. Development of additional simulation measures is desirable, but standardization, validation, accessibility, and affordability all need to be addressed.

PMID: 20497830 [PubMed - in process]

Preface.

Orr RK — Thu, 08 Apr 2010 01:40:10 +0000

Preface.

Surg Clin North Am. 2010 Apr;90(2):xv-xvi

Authors: Orr RK

PMID: 20362782 [PubMed - in process]

Outcomes in pancreatic cancer surgery.

Orr RK — Thu, 08 Apr 2010 01:40:05 +0000

Outcomes in pancreatic cancer surgery.

Surg Clin North Am. 2010 Apr;90(2):219-34

Authors: Orr RK

The increase in surgery for pancreatic cancer during the last 3 decades can be correlated with a gradual decline in operative mortality and postoperative complications. Although not all surgeons (nor all hospitals) can have equal outcomes, the definition and tabulation of these outcomes have been difficult. This article asks several pertinent questions: (1) what is the scientific rationale for pancreatic resection? (2) what are the best available results at this time? (3) who should be performing pancreatic resections? The article analyzes results of resection for adenocarcinoma of the exocrine pancreas, and excludes duodenal and ampullary cancers, pancreatic endocrine tumors, and tumors of less malignant potential.

PMID: 20362783 [PubMed - in process]

Evidence-based imaging of pancreatic malignancies.

Kinney T — Thu, 08 Apr 2010 01:40:03 +0000

Evidence-based imaging of pancreatic malignancies.

Surg Clin North Am. 2010 Apr;90(2):235-49

Authors: Kinney T

A high-quality pancreatic protocol computed tomography (CT) is the primary imaging modality for diagnosing and staging pancreatic malignancy. The main limitation of CT is the lack of sensitivity for early pancreatic lesions. Endoscopic ultrasound (EUS) provides an excellent complement to CT for both diagnosis and staging of pancreatic cancer, and allows easy access for needle aspiration and tissue diagnosis. Magnetic resonance (MR) can be helpful for evaluating small hepatic nodules or cystic lesions of the pancreas, but in general, the role of MR and positron emission tomography remains limited to special situations when the results of CT and EUS are equivocal.

PMID: 20362784 [PubMed - in process]

The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer.

Varadarajulu S, Eloubeidi MA — Thu, 08 Apr 2010 01:40:00 +0000

The role of endoscopic ultrasonography in the evaluation of pancreatico-biliary cancer.

Surg Clin North Am. 2010 Apr;90(2):251-63

Authors: Varadarajulu S, Eloubeidi MA

Accurate staging of pancreatico-biliary cancer is essential for surgical planning and for identification of locally advanced and metastatic disease that is incurable by surgery. The complex regional anatomy of the pancreatico-biliary system makes histologic diagnosis of malignancy at this region difficult. The ability to position the endoscopic ultrasound transducer at endoscopy in direct proximity to the pancreas and the bile duct, combined with the use of fine-needle aspiration, enables accurate preoperative staging of cancer, especially cancer too small to be characterized by CT or MRI. Endoscopic ultrasonography (EUS) identifies patients unlikely to be cured by surgery due to vascular invasion or regional nodal metastasis, thereby limiting procedure-related morbidity and mortality. This article focuses on the utility and recent advances of EUS in the evaluation of pancreatico-biliary cancer.

PMID: 20362785 [PubMed - in process]

The evidence for technical considerations in pancreatic resections for malignancy.

Martin RF, Zuberi KA — Thu, 08 Apr 2010 01:39:56 +0000

The evidence for technical considerations in pancreatic resections for malignancy.

Surg Clin North Am. 2010 Apr;90(2):265-85

Authors: Martin RF, Zuberi KA

The surgeon who wishes to perform successful resections for malignant processes involving the pancreas has to be conversant with a broad range of topics. There are extensive collections of data that usually give excellent guidance, but sometimes also provide conflicting advice. No matter what the data suggest might work best, the surgeon and local collaborators must be able to deliver the quality care cited in some of these reports; usually it is the best results that are published. There is a difference between results that are statistically significant, clinically significant, and important to the patient, and these concepts should never be confused.

PMID: 20362786 [PubMed - in process]

Solid tumors of the body and tail of the pancreas.

Morgan KA, Adams DB — Thu, 08 Apr 2010 01:39:51 +0000

Solid tumors of the body and tail of the pancreas.

Surg Clin North Am. 2010 Apr;90(2):287-307

Authors: Morgan KA, Adams DB

Solid lesions of the body and tail of the pancreas challenge all the diagnostic and technical skills of the modern gastrointestinal surgeon. The information available from modern computed tomography (CT), magnetic resonance (MR), and endoscopic ultrasound (EUS) imaging provide diagnostic and anatomic data that give the surgeon precise information with which to plan an operation and to discuss with the patient during the preoperative visit. A preoperative evaluation includes a thorough history and a pancreas protocol CT scan, supplemented by MR imaging and EUS when needed, to differentiate between the various potential diagnoses. These same modalities can be essential in proper staging in the case of malignant lesions, thus aiding in management decisions. Most lesions ultimately require operative resection, barring metastatic disease, with the notable exception of autoimmune pancreatitis.

PMID: 20362787 [PubMed - in process]

Portal vein resection.

Christians KK, Lal A, Pappas S, Quebbeman E, Evans DB — Thu, 08 Apr 2010 01:39:48 +0000

Portal vein resection.

Surg Clin North Am. 2010 Apr;90(2):309-22

Authors: Christians KK, Lal A, Pappas S, Quebbeman E, Evans DB

The American Hepato-Pancreatico-Biliary Association and Society of Surgical Oncology published a consensus statement in 2009 on the subject of vein resection and reconstruction during pancreaticoduodenectomy (PD), and concluded that PD with vein resection and reconstruction is a viable option for treatment of some pancreatic adenocarcinomas. This article describes the current approaches and recent advances in the management, staging, and surgical techniques regarding portal vein resection. With proper patient selection, a detailed understanding of the anatomy of the root of mesentery, and adequate surgeon experience, vascular resection and reconstruction can be performed safely and does not impact survival duration. Isolated venous involvement is not a contraindication to PD when performed by experienced surgeons at high-volume centers as part of a multidisciplinary and multimodal approach to localized pancreatic cancer.

PMID: 20362788 [PubMed - in process]

Adjuvant and neoadjuvant therapy in curable pancreatic cancer.

Nugent FW, Stuart K — Thu, 08 Apr 2010 01:39:44 +0000

Adjuvant and neoadjuvant therapy in curable pancreatic cancer.

Surg Clin North Am. 2010 Apr;90(2):323-39

Authors: Nugent FW, Stuart K

Pancreatic cancer is the tenth most common cancer in the United States and the fourth leading cause of cancer death. Afflicting approximately 37,000 Americans yearly, more than 80% of patients are unresectable and, therefore, incurable at the time of their diagnosis. Although surgical resection offers the only opportunity for cure, it remains largely unsuccessful; most patients who are candidates for surgical resection relapse and die in fewer than 5 years. This mortality leaves a 5-year overall survival of about 4% for patients diagnosed with pancreatic cancer. Perhaps the most daunting realization for physicians involved in the management of this disease is the understanding that these numbers have not changed in more than 30 years. As surgery remains the foundation of curative therapy for pancreatic cancer, this article reviews the data on adjuvant chemotherapy and adjuvant chemotherapy with radiotherapy as efforts to boost cure rates.

PMID: 20362789 [PubMed - in process]

Curative radiation therapy for pancreatic malignancies.

Cooke EW, Hazard L — Thu, 08 Apr 2010 01:39:41 +0000

Curative radiation therapy for pancreatic malignancies.

Surg Clin North Am. 2010 Apr;90(2):341-54

Authors: Cooke EW, Hazard L

Surgery is generally considered as the only curative therapy for pancreatic cancer; however, even with optimal surgery, long-term cure is achieved in very few patients, thus highlighting the need for adjuvant therapies. Radiation therapy, usually in combination with chemotherapy, plays a role in the setting of unresectable, nonmetastatic pancreatic cancer. Its role in the adjuvant setting remains controversial and as yet undefined. This article reviews the role of radiation therapy in the adjuvant and definitive settings, and describes recent improvements in the delivery of radiotherapy that allow for improved dose delivery with decreased toxicity.

PMID: 20362790 [PubMed - in process]

Palliation in pancreatic cancer.

Kruse EJ — Thu, 08 Apr 2010 01:39:35 +0000

Palliation in pancreatic cancer.

Surg Clin North Am. 2010 Apr;90(2):355-64

Authors: Kruse EJ

Pancreatic cancer is rarely curable, and because of its location causes significant symptoms for patients in need of palliation. The common problems of incurable pancreatic cancer are biliary obstruction, duodenal obstruction, and pain. Approaches include surgical, endoscopic and radiologic interventions. This article discusses the palliative options and controversies related to these symptoms.

PMID: 20362791 [PubMed - in process]

Palliative chemotherapy for pancreatic malignancies.

Mehta SP — Thu, 08 Apr 2010 01:39:27 +0000

Palliative chemotherapy for pancreatic malignancies.

Surg Clin North Am. 2010 Apr;90(2):365-75

Authors: Mehta SP

Metastatic pancreatic cancer is often one of the most challenging malignancies a medical oncologist faces. Although the primary endpoint of many studies remains overall survival, palliation and quality of life are now more commonly being addressed. The author discusses the most common chemotherapeutic modalities for the treatment of metastatic pancreatic cancer, such as single agent chemotherapy, combination therapy, targeted therapy, and second line treatment.

PMID: 20362792 [PubMed - in process]

Intraductal papillary mucinous neoplasm: a clinicopathologic review.

Augustin T, Vandermeer TJ — Thu, 08 Apr 2010 01:39:19 +0000

Intraductal papillary mucinous neoplasm: a clinicopathologic review.

Surg Clin North Am. 2010 Apr;90(2):377-98

Authors: Augustin T, Vandermeer TJ

Intraductal papillary mucinous neoplasm (IPMN) is an intraductal mucin-producing epithelial neoplasm that arises from the main pancreatic duct (MD-IPMN), secondary branch ducts (BD-IPMN), or both (mixed type; Mix-IPMN). Neoplastic progression from benign adenoma to invasive adenocarcinoma has not been proven but is generally thought to occur. With increasing recognition of IPMN, our understanding of the diagnosis and management of the tumors is evolving. At present, treatment options for patients with IPMN range from observation to pancreatic resection depending on the natural history of the lesion. This review focuses on currently available data that guide management decisions for patients with IPMN.

PMID: 20362793 [PubMed - in process]

Diagnostic evaluation of pancreatic cystic malignancies.

Hutchins G, Draganov PV — Thu, 08 Apr 2010 01:39:13 +0000

Diagnostic evaluation of pancreatic cystic malignancies.

Surg Clin North Am. 2010 Apr;90(2):399-410

Authors: Hutchins G, Draganov PV

Cystic neoplasms of the pancreas are increasingly recognized because of expanding use and improved sensitivity of cross-sectional imaging studies. Major advances in the last decade have led to an improved understanding of the various types of cystic lesions and their biologic behavior. Despite significant improvement in imaging technology and the advent of endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) the diagnosis and management of pancreatic cystic lesions remains a significant clinical challenge. Previous “operate in all cases of pancreatic cyst” strategies have been refined and largely replaced using EUS and cyst fluid analysis as the crux for a more practical management approach. The first diagnostic step remains the differentiation between pancreatic pseudocyst and cystic neoplasm. If a pseudocyst has been effectively excluded, the cornerstone issue becomes to determine the malignant potential of the pancreatic cystic neoplasm. In most cases the correct diagnosis and successful management is based not on a single test but on incorporating data from various sources including patient history, radiologic studies, endoscopic evaluation, in particular EUS, and cyst fluid analysis obtained during fine-needle aspirate. This review focuses on describing the various types of cystic neoplasms of the pancreas and their malignant potential, and provide the clinician with a comprehensive diagnostic approach.

PMID: 20362794 [PubMed - in process]

Pancreatic cystic neoplasms.

Verbesey JE, Munson JL — Thu, 08 Apr 2010 01:39:08 +0000

Pancreatic cystic neoplasms.

Surg Clin North Am. 2010 Apr;90(2):411-25

Authors: Verbesey JE, Munson JL

Cystic neoplasms of the pancreas have been recognized for almost 2 centuries, but the principles of management continue to evolve. Clinicians have a better understanding now of the diverse pathologies and behaviors of cystic neoplasms, and can characterize them more precisely into benign, malignant, and of uncertain potential in their manifestations. Treatment is dependent on accurate diagnosis and tailored to the potential aggressiveness of the lesion, the surgical fitness of the patient, and the probability of effecting long-term palliation or survival of the patient. In this article the authors review the classification based on the World Health Organization classification and the latest evidence-based literature of cystic neoplasms, and present their considerations for surgical management of the various lesions. A better understanding of the biologic potential of cystic neoplasms such as intraductal papillary mucinous neoplasms allows for a more patient-specific evidence-based management plan.

PMID: 20362795 [PubMed - in process]

Laparoscopic management of pancreatic malignancies.

Kooby DA, Chu CK — Thu, 08 Apr 2010 01:38:50 +0000

Laparoscopic management of pancreatic malignancies.

Surg Clin North Am. 2010 Apr;90(2):427-46

Authors: Kooby DA, Chu CK

Laparoscopic pancreatic resection is performed with increasing frequency for malignant tumors. Data are emerging demonstrating the safety of the laparoscopic approach for distal (left) pancreatectomy, with potential benefits over the standard open approach; however, less information exists as to the effects of laparoscopic resection of cancers of the pancreas. This article reviews and analyzes the existing literature on laparoscopic pancreatectomy for pancreatic malignancies.

PMID: 20362796 [PubMed - in process]

Foreword.

Martin RF — Wed, 03 Feb 2010 15:54:07 +0000

Foreword.

Surg Clin North Am. 2010 Feb;90(1):xiii-xiv

Authors: Martin RF

PMID: 20109627 [PubMed - in process]

Preface: anorectal disease.

Steele SR — Wed, 03 Feb 2010 15:54:03 +0000

Preface: anorectal disease.

Surg Clin North Am. 2010 Feb;90(1):xv-xvi

Authors: Steele SR

PMID: 20109628 [PubMed - in process]

Anorectal anatomy and physiology.

Barleben A, Mills S — Wed, 03 Feb 2010 15:53:58 +0000

Anorectal anatomy and physiology.

Surg Clin North Am. 2010 Feb;90(1):1-15

Authors: Barleben A, Mills S

The rectum and anal canal form the last portion of the gastrointestinal tract. The rectum serves as a reservoir for fecal contents, and the anal canal regulates continence and defecation via synchronization of events regulated by complex interactions between sympathetic and parasympathetic nerves, striated and smooth muscle, and environmental factors. Normal function can be compromised by various pathologies. Investigation into these pathologies includes a detailed history and thorough physical exam and can be augmented by a number of different studies, including manometry, electromyelography, defecography, nerve stimulation, and compliance. Some of these techniques have incorporated the use of ultrasound and magnetic resonance imaging.

PMID: 20109629 [PubMed - in process]

Diagnosis and Management of Symptomatic Hemorrhoids.

Sneider EB, Maykel JA — Wed, 03 Feb 2010 15:53:51 +0000

Diagnosis and Management of Symptomatic Hemorrhoids.

Surg Clin North Am. 2010 Feb;90(1):17-32

Authors: Sneider EB, Maykel JA

Hemorrhoidal disease is a common problem that is managed by various physicians, ranging from primary care providers to surgeons. This article reviews the pathophysiology, clinical presentation, and updated treatment of hemorrhoids, including nonoperative options, office-based procedures, and surgical interventions from standard excision to stapled hemorrhoidopexy and Doppler-guided ligation. The article also covers complications and provides guidance for special circumstances, such as pregnancy, hemorrhoidal crisis, and inflammatory bowel disease.

PMID: 20109630 [PubMed - as supplied by publisher]

Anal Fissure.

Herzig DO, Lu KC — Wed, 03 Feb 2010 15:53:44 +0000

Anal Fissure.

Surg Clin North Am. 2010 Feb;90(1):33-44

Authors: Herzig DO, Lu KC

Anal fissure is a common disorder that is effectively treated and prevented with conservative measures in its acute form, whereas chronic fissures may require medical or surgical therapy. This article discusses the nonoperative and operative management strategies, reviews the current literature on expected outcomes, and provides guidance on dealing with fissures in special situations, such as patients with inflammatory bowel disease or hypotonic sphincters.

PMID: 20109631 [PubMed - as supplied by publisher]

Anorectal Abscess and Fistula-in-Ano: Evidence-Based Management.

Rizzo JA, Naig AL, Johnson EK — Wed, 03 Feb 2010 15:53:38 +0000

Anorectal Abscess and Fistula-in-Ano: Evidence-Based Management.

Surg Clin North Am. 2010 Feb;90(1):45-68

Authors: Rizzo JA, Naig AL, Johnson EK

The management of anorectal abscess and anal fistula has changed markedly with time. Invasive methods with high resulting rates of incontinence have given way to sphincter-sparing methods that have a much lower associated morbidity. There has been an increase in reports in the medical literature describing the success rates of the varying methods of dealing with this condition. This article reviews the various methods of treatment and evidence supporting their use and explores advances that may lead to new therapies.

PMID: 20109632 [PubMed - in process]

Rectovaginal Fistula.

Champagne BJ, McGee MF — Wed, 03 Feb 2010 15:53:23 +0000

Rectovaginal Fistula.

Surg Clin North Am. 2010 Feb;90(1):69-82

Authors: Champagne BJ, McGee MF

Despite the prevalence and severe implications of rectovaginal fistula, there is no universally accepted evidence-based approach to surgical management. This article offers a disease-based review of traditional management strategies and highlights the variety of technical approaches that are currently effective for the eradication of this socially disabling condition.

PMID: 20109633 [PubMed - as supplied by publisher]

Condyloma and Other Infections Including Human Immunodeficiency Virus.

Lee PK, Wilkins KB — Tue, 02 Feb 2010 15:53:18 +0000

Condyloma and Other Infections Including Human Immunodeficiency Virus.

Surg Clin North Am. 2010 Feb;90(1):99-112

Authors: Lee PK, Wilkins KB

Sexually transmitted diseases (STDs) are a common public health problem and as such may be more common in a surgical practice than is believed. The recognition that a virus can be responsible for a cancer has profound significant public health implications. This article reviews the presentation and management of the more common perianal STDs including human immunodeficiency virus, as well as the pathogenesis and management of anal intraepithelial neoplasia.

PMID: 20109635 [PubMed - as supplied by publisher]

Evaluation and management of pilonidal disease.

Humphries AE, Duncan JE — Tue, 02 Feb 2010 15:53:13 +0000

Evaluation and management of pilonidal disease.

Surg Clin North Am. 2010 Feb;90(1):113-24

Authors: Humphries AE, Duncan JE

Pilonidal disease is a common condition, ranging from the routine cyst with abscess to extensive chronic infection and sinus formation. It can be associated with significant morbidity and prolonged wound healing after definitive surgery. This article reviews the history and pathogenesis of this often challenging surgical problem and the numerous nonoperative and operative treatment options currently available for it.

PMID: 20109636 [PubMed - in process]

Pruritus Ani: Etiology and Management.

Markell KW, Billingham RP — Tue, 02 Feb 2010 15:53:01 +0000

Pruritus Ani: Etiology and Management.

Surg Clin North Am. 2010 Feb;90(1):125-135

Authors: Markell KW, Billingham RP

Pruritus ani is a dermatologic condition characterized by an unpleasant itching or burning sensation in the perianal region. This article briefly discusses the incidence and classification of pruritus ani followed by a more lengthy discussion of primary and secondary pruritus ani. The important points are summarized and a simple algorithm is provided for the clinical management of pruritus ani.

PMID: 20109637 [PubMed - as supplied by publisher]

Anal Stenosis.

Katdare MV, Ricciardi R — Tue, 02 Feb 2010 15:52:56 +0000

Anal Stenosis.

Surg Clin North Am. 2010 Feb;90(1):137-145

Authors: Katdare MV, Ricciardi R

Anal stenosis occurs most commonly following a surgical procedure, such as hemorrhoidectomy, excision and fulguration of anorectal warts, endorectal flaps, or following proctectomy, particularly in the setting of mucosectomy. Patients who experience anal stenosis describe constipation, bleeding, pain, and incomplete evacuation. Although often described as a debilitating and difficult problem, several good treatment options are available. In addition to simple dietary and medication changes, surgical procedures, such as lateral internal sphincterotomy or transfers of healthy tissue are other potentially good options. Flap procedures are excellent choices, depending on the location of the stenosis and the amount of viable tissue needed. This article presents the definition, pathophysiology, diagnosis, and treatment of anal stenosis, and methods to prevent it.

PMID: 20109638 [PubMed - as supplied by publisher]

Anal Neoplasms.

Garrett K, Kalady MF — Tue, 02 Feb 2010 15:52:42 +0000

Anal Neoplasms.

Surg Clin North Am. 2010 Feb;90(1):147-161

Authors: Garrett K, Kalady MF

A variety of lesions comprise tumors of the anal canal, with carcinoma in situ and epidermoid cancers being the most common. Less common anal neoplasms include adenocarcinoma, melanoma, gastrointestinal stromal cell tumors, neuroendocrine tumors, and Buschke-Lowenstein tumors. Treatment strategies are based on anatomic location and histopathology. In this article different tumors and management of each, including a brief review of local excision for rectal cancer, are discussed in turn.

PMID: 20109639 [PubMed - as supplied by publisher]

Retrorectal Tumors.

Bullard Dunn K — Mon, 01 Feb 2010 15:24:53 +0000

Retrorectal Tumors.

Surg Clin North Am. 2010 Feb;90(1):163-171

Authors: Bullard Dunn K

Retrorectal or presacral tumors are rare and can be challenging to diagnose and treat. Because the retrorectal space contains multiple embryologic remnants derived from various tissues, the tumors that develop in this space are heterogeneous. Most lesions are benign, but malignant neoplasms are not uncommon. Lesions are classified as congenital, neurogenic, osseous, inflammatory, or miscellaneous. Although treatment depends on diagnosis and anatomic location, most retrorectal lesions will require surgical resection.

PMID: 20109640 [PubMed - as supplied by publisher]

Rectal Foreign Bodies.

Goldberg JE, Steele SR — Mon, 01 Feb 2010 15:24:42 +0000

Rectal Foreign Bodies.

Surg Clin North Am. 2010 Feb;90(1):173-184

Authors: Goldberg JE, Steele SR

Rectal foreign bodies present a difficult diagnostic and management dilemma because of delayed presentation, a variety of objects, and a wide spectrum of injuries. An orderly approach to the diagnosis, management, and post-extraction evaluation of the patient with a rectal foreign body is essential. This article outlines and describes the stepwise evaluation and management of the patient with a rectal foreign body. The authors also describe the varied techniques needed to successfully remove the different foreign bodies that may be encountered.

PMID: 20109641 [PubMed - as supplied by publisher]

Fecal Incontinence.

Mellgren A — Mon, 01 Feb 2010 15:24:34 +0000

Fecal Incontinence.

Surg Clin North Am. 2010 Feb;90(1):185-194

Authors: Mellgren A

Fecal incontinence is a debilitating and socially embarrassing condition. Significant advances in the evaluation and treatment of this condition have been made in recent years, and several new treatment modalities are in the pipeline to be made available to affected patients. This article reviews the workup and operative and nonoperative management of fecal incontinence, and it discusses the emerging role of methods, such as bioinjectable agents and sacral nerve stimulation.

PMID: 20109642 [PubMed - as supplied by publisher]

Overview of Pelvic Floor Disorders.

McNevin MS — Mon, 01 Feb 2010 15:24:07 +0000

Overview of Pelvic Floor Disorders.

Surg Clin North Am. 2010 Feb;90(1):195-205

Authors: McNevin MS

Disorders of the pelvic floor are common sources of morbidity, decreased quality of life, and are unfortunately increasing in incidence. Owing to their complex and often coexistent nature, a comprehensive, multidisciplinary strategy of testing and care is required. Many nonoperative and operative approaches for management of the symptoms of pelvic floor disorders are available. This article reviews the evaluation and management for these difficult disorders.

PMID: 20109643 [PubMed - as supplied by publisher]

Foreword.

Martin RF — Wed, 02 Dec 2009 08:36:11 +0000

Foreword.

Surg Clin North Am. 2009 Dec;89(6):xiii-xiv

Authors: Martin RF

PMID: 19944805 [PubMed - in process]

Preface.

Zuckerman R, Borgstrom D — Wed, 02 Dec 2009 08:36:08 +0000

Preface.

Surg Clin North Am. 2009 Dec;89(6):xv-xvi

Authors: Zuckerman R, Borgstrom D

PMID: 19944806 [PubMed - in process]

Rural surgery: framing the issues.

Doty B, Zuckerman R — Wed, 02 Dec 2009 08:36:04 +0000

Rural surgery: framing the issues.

Surg Clin North Am. 2009 Dec;89(6):1279-84

Authors: Doty B, Zuckerman R

Many rural residents have limited access to surgical care. Although this problem has been ongoing for the past few decades, several factors threaten to exacerbate the situation. The narrowing of general surgery practice, workforce shortages and inappropriate distribution of surgeons, changes in how surgeons are trained, and increasing health care costs contribute to the problem. Creative approaches to address these issues are needed to provide high-quality surgical services to the approximately 50 million Americans living in rural communities.

PMID: 19944808 [PubMed - in process]

Introduction.

Sheldon GF — Wed, 02 Dec 2009 08:36:04 +0000

Introduction.

Surg Clin North Am. 2009 Dec;89(6):xvii-xix

Authors: Sheldon GF

PMID: 19944807 [PubMed - in process]

Workforce issues in rural surgery.

Lynge DC, Larson EH — Wed, 02 Dec 2009 08:36:03 +0000

Workforce issues in rural surgery.

Surg Clin North Am. 2009 Dec;89(6):1285-91

Authors: Lynge DC, Larson EH

Almost one quarter of America’s population and one third of its landmass are defined as rural and served by approximately 20% of the nation’s general surgeons. General surgeons are the backbone of the rural health workforce. There is significant maldistribution of general surgeons across regions and different types of rural areas. Rural areas have markedly fewer surgeons per population than the national average. The demography of the rural general surgery workforce differs substantially from the urban general surgery workforce, raising concerns about the extent to which general surgical services can be maintained in rural areas of the United States.

PMID: 19944809 [PubMed - in process]

Interdependence of general surgeons and primary care physicians in rural communities.

Pathman DE, Ricketts TC — Wed, 02 Dec 2009 08:36:02 +0000

Interdependence of general surgeons and primary care physicians in rural communities.

Surg Clin North Am. 2009 Dec;89(6):1293-302

Authors: Pathman DE, Ricketts TC

This article describes the unique roles and interrelations of general surgeons and primary care physicians in rural communities. It describes the various ways in which the work and success of the rural surgeon and the rural primary care physician rely on coordinating their efforts with the other. It draws on available data, summary reports, and the authors’ personal experiences in rural practice and fifty years of combined experience in research and policy analysis of rural health professions issues. Various issues are discussed, including the specific and unique roles that rural surgeon need to play in rural health systems, the ways in which rural surgeons relate to other physicians, and the likely consequences of not having proximal surgical services.

PMID: 19944810 [PubMed - in process]

Rural general surgery training: the gundersen lutheran approach.

Cogbill TH, Jarman BT — Wed, 02 Dec 2009 08:36:01 +0000

Rural general surgery training: the gundersen lutheran approach.

Surg Clin North Am. 2009 Dec;89(6):1309-12

Authors: Cogbill TH, Jarman BT

This article outlines the approach taken at Gundersen Lutheran Medical Foundation to prepare general surgery residents for rural general surgery practice. The methods focus on strong core training in general and minimally invasive surgery, additional technical skill sets, rural surgery electives, outcomes-based research experience, practice management education, and maintenance of relationships with graduates after residency.

PMID: 19944812 [PubMed - in process]

Education for rural surgical practice: the Oregon health & science university model.

Deveney K, Hunter J — Wed, 02 Dec 2009 08:36:01 +0000

Education for rural surgical practice: the Oregon health & science university model.

Surg Clin North Am. 2009 Dec;89(6):1303-8

Authors: Deveney K, Hunter J

Physicians of all types are in short supply, with the shortage particularly acute in primary care and general surgery. As the site of the only surgery residency program in the state, Oregon Health & Science University’s Department of Surgery has long been aware of the critical need for general surgeons to provide emergency and elective surgical care for those who live in remote areas and to support small rural hospitals whose survival depends on the presence of a surgeon. Based on our experience over the past 7 years, we believe that residents will benefit from a training program that provides extensive exposure to procedures unique to a rural practice. The objective of the training program is discussed in the article.

PMID: 19944811 [PubMed - in process]

Education of the rural surgeon: experience from tennessee.

Giles WH, Arnold JD, Layman TS, Sumida MP, Brown PW, Burns RP, Cofer JB — Wed, 02 Dec 2009 08:36:00 +0000

Education of the rural surgeon: experience from tennessee.

Surg Clin North Am. 2009 Dec;89(6):1313-9

Authors: Giles WH, Arnold JD, Layman TS, Sumida MP, Brown PW, Burns RP, Cofer JB

The rural surgery rotation that is contained within the general surgery residency program at The University of Tennessee College of Medicine-Chattanooga is described in this article. The advantages of this experience, including the extensive endoscopy experience and the close exposure to practicing general surgeons, are also outlined. The rotation receives uniformly positive evaluations from residents at completion, and it has become the primary gastrointestinal endoscopy educational experience in this program. The description serves as a model that can be used by other programs to construct a rural surgery rotation.

PMID: 19944813 [PubMed - in process]

Bassett healthcare rural surgery experience.

Borgstrom DC, Heneghan SJ — Wed, 02 Dec 2009 08:35:59 +0000

Bassett healthcare rural surgery experience.

Surg Clin North Am. 2009 Dec;89(6):1321-3

Authors: Borgstrom DC, Heneghan SJ

The surgical training at Bassett is naturally broader than in many university settings, with a survey showing that nearly 70% of graduates who practice general surgery remain in a rurally designated area. Rural surgery experience falls into 3 categories: undergraduate, graduate, and postgraduate. The general surgery training program has no competing fellowships or subspecialty residencies; residents get significant experience with endoscopy; ear, nose, and throat; plastic and hand surgery; and obstetrics and gynecology. The rural setting lifestyle is valued by the students, residents, and fellows alike. It provides an ideal setting for recognizing the specific nuances of small-town American life, with a high-quality education and surgical experience.

PMID: 19944814 [PubMed - in process]

Rural surgery: the Australian experience.

Bruening MH, Maddern GJ — Wed, 02 Dec 2009 08:35:58 +0000

Rural surgery: the Australian experience.

Surg Clin North Am. 2009 Dec;89(6):1325-33

Authors: Bruening MH, Maddern GJ

A significant proportion of the Australian population resides nonmetropolitan regions. For the majority of these smaller regional centers, the surgical service delivery has been traditionally provided by either solo or two-person surgical practices. As medical students’ interest in rural practice declined, new models were created to ensure medical care in these areas. This article outlines the past and current state of medical care in rural areas, highlighting models used in Port Augusta, Mount Gambier, and Port Lincoln. It concludes that these models are successful and should be further developed.

PMID: 19944815 [PubMed - in process]

Surgery in remote and rural Scotland.

Sim AJ, Grant F, Ingram AK — Wed, 02 Dec 2009 08:35:56 +0000

Surgery in remote and rural Scotland.

Surg Clin North Am. 2009 Dec;89(6):1335-47

Authors: Sim AJ, Grant F, Ingram AK

Over the past 15 years, rural surgery in Scotland has emerged from the backwaters of the Scottish Health service to a recognized and important part of overall health care provision in Scotland. No longer is the rural surgeon regarded by his city colleague as the eccentric poor relation of the urban specialist. The rural surgeon is now more likely to have the skills and experience necessary for the work that must be done. Training pathways are defined to ensure succession planning. The support of the Scottish Government, Health Boards, and the Royal Colleges has been essential; their continued involvement will ensure safe surgery for those who dwell in the more isolated areas of Scotland.

PMID: 19944816 [PubMed - in process]

Building and maintaining a successful surgery program in rural Minnesota.

McCollister HM, Severson PA, Lemieur TP, Roberts SA, Gujer MW — Wed, 02 Dec 2009 08:35:55 +0000

Building and maintaining a successful surgery program in rural Minnesota.

Surg Clin North Am. 2009 Dec;89(6):1349-57

Authors: McCollister HM, Severson PA, Lemieur TP, Roberts SA, Gujer MW

For decades, it has been axiomatic that rural health care systems are crucial factors not only in the health of the populations that they serve but also in the viability of America’s rural communities. Medical care, as it is delivered in rural America, is becoming increasingly problematic as national health care delivery models evolve. Increasing reimbursement pressures and changing practitioner lifestyle expectations have had negative effects on rural communities and resulted in rural hospital closings and a declining level of surgical care available. These two factors are interrelated, given the importance of surgical services to the revenue stream of any hospital.

PMID: 19944817 [PubMed - in process]

Rural surgical practice: an iowa group model.

Breon TA — Wed, 02 Dec 2009 08:35:52 +0000

Rural surgical practice: an iowa group model.

Surg Clin North Am. 2009 Dec;89(6):1359-66

Authors: Breon TA

The general surgery workforce has been well characterized recently but few recommendations have been offered to help make the practice of general surgery in rural areas more attractive. This article describes how Iowa Rural Surgical Associates, a group practice, was developed to meet the surgical needs of three rural communities in southeast Iowa. Developing the group resulted in a system of surgical delivery improving patient care in the area and quality of life for the group’s surgeons.

PMID: 19944818 [PubMed - in process]

Rural surgery: the north dakota experience.

Antonenko DR — Wed, 02 Dec 2009 08:35:50 +0000

Rural surgery: the north dakota experience.

Surg Clin North Am. 2009 Dec;89(6):1367-72

Authors: Antonenko DR

Surgeon availability is a problem for small and isolated rural areas. Unless the supply of surgeons trained for rural areas increases, patient care will be jeopardized. Nationally, a diminishing number of graduating residents opt for careers in general surgery. This crisis is unrecognized or ignored by major teaching programs. This article describes a program at the University of North Dakota that allows exposure to surgical specialties by incorporating them into the general surgical services. It concludes that distinct training for urban and rural general surgeons must be recognized; and general surgery programs should be allowed to be innovative and not penalized for adjusting their programs to allow residents to train for rural and community sites.

PMID: 19944819 [PubMed - in process]

Assessing and improving the quality of surgical care in rural america.

Finlayson SR — Wed, 02 Dec 2009 08:35:45 +0000

Assessing and improving the quality of surgical care in rural america.

Surg Clin North Am. 2009 Dec;89(6):1373-81

Authors: Finlayson SR

The quality of surgical care in rural hospitals is important, as surgery remains a critical component of rural health care systems. Current models for surgical quality assessment and improvement largely reflect the characteristics of larger urban hospital settings, which include proximity to other providers for peer review, higher procedure volumes to accurately assess outcomes, and greater financial resources to acquire data collection systems and finance participation in regional or national quality improvement programs, such as the American College of Surgeons National Surgical Quality Improvement Program. Although rural surgeons and hospitals face numerous challenges in their efforts to demonstrate or improve the quality of their surgical practices, developments in surgical quality favor their increased participation in quality improvement initiatives.

PMID: 19944820 [PubMed - in process]

General surgery contributes to the financial health of rural hospitals and communities.

Doty B, Heneghan SJ, Zuckerman R — Wed, 02 Dec 2009 08:35:32 +0000

General surgery contributes to the financial health of rural hospitals and communities.

Surg Clin North Am. 2009 Dec;89(6):1383-7

Authors: Doty B, Heneghan SJ, Zuckerman R

Rural hospitals and communities often profit from the ability to provide surgical services. There can also be substantial financial costs for individuals, hospitals, and communities associated with not having access to surgical care in rural areas. Despite these advantages, limitations that include a shortage of rural general surgeons and other surgical staff and financial constraints prevent some rural institutions from offering surgical services. Few concrete data are available on this subject, and more research is needed to confirm anecdotal reports regarding the positive economic impact derived from general surgical services. It is especially important to examine and quantify the direct and indirect financial contribution that a general surgeon makes to a rural hospital and community.

PMID: 19944821 [PubMed - in process]

Foreword.

Martin RF — Wed, 21 Oct 2009 22:49:54 +0000

Foreword.

Surg Clin North Am. 2009 Oct;89(5):xiii-xiv

Authors: Martin RF

PMID: 19836482 [PubMed - in process]

Preface.

Zeiger MA — Wed, 21 Oct 2009 22:49:53 +0000

Preface.

Surg Clin North Am. 2009 Oct;89(5):xv-xvi

Authors: Zeiger MA

PMID: 19836483 [PubMed - in process]

Preface.

Zeiger MA — Wed, 21 Oct 2009 22:49:52 +0000

Preface.

Surg Clin North Am. 2009 Oct;89(5):xv-xvi

Authors: Zeiger MA

PMID: 19836483 [PubMed - in process]

Surgical Management of MEN-1 and -2: State of the Art.

Akerström G, Stålberg P — Wed, 21 Oct 2009 22:49:47 +0000

Surgical Management of MEN-1 and -2: State of the Art.

Surg Clin North Am. 2009 Oct;89(5):1047-68

Authors: Akerström G, Stålberg P

Multiple endocrine neoplasia syndrome type 1 (MEN-1) consists of endocrine tumors of the parathyroid, the endocrine pancreas-duodenum, and the pituitary. Surveillance and screening for the endocrinopathies is recommended in gene carriers. Surgery for MEN-1-related hyperparathyroidism is generally performed as radical subtotal parathyroidectomy, because less surgery is likely to result in persistent or recurrent disease. Multiple endocrine neoplasia syndrome type 2 (MEN-2) consists of medullary thyroid carcinoma, pheochromocytoma, and hyperparathyroidism. Prophylactic thyroidectomy based on DNA testing in the MEN-2 syndrome is considered one of the greater achievements in cancer treatment, because it may be performed before thyroid carcinoma development and provides cure for the patient.

PMID: 19836484 [PubMed - in process]

Surgical Management of Nonmultiple Endocrine Neoplasia Endocrinopathies: State-of-the-Art Review.

Landry CS, Waguespack SG, Perrier ND — Wed, 21 Oct 2009 22:49:43 +0000

Surgical Management of Nonmultiple Endocrine Neoplasia Endocrinopathies: State-of-the-Art Review.

Surg Clin North Am. 2009 Oct;89(5):1069-89

Authors: Landry CS, Waguespack SG, Perrier ND

The development of genetic testing has given patients with familial endocrine diseases the opportunity to be identified earlier in life. The importance of this technological advancement cannot be underestimated, as some of these heritable diseases have significant potential for malignancy. This article focuses on the identification and surgical management of familial endocrinopathies of the thyroid, parathyroid, adrenal glands, and pancreas. Familial endocrinopathies discussed include hereditary nonmedullary carcinoma of the thyroid, Cowden disease, familial adenomatous polyposis, Carney complex, Werner syndrome, familial medullary thyroid carcinoma, Pendred syndrome, hereditary hyperparathyroidism jaw-tumor syndrome, familial isolated hyperparathyroidism, Beckwith- Wiedemann syndrome, Li-Fraumeni syndrome, neurofibromatosis I, von Hippel-Lindau disease, and tuberous sclerosis.

PMID: 19836485 [PubMed - in process]

Surgical Management of Nonmultiple Endocrine Neoplasia Endocrinopathies: State-of-the-Art Review.

Landry CS, Waguespack SG, Perrier ND — Wed, 21 Oct 2009 22:49:43 +0000

Surgical Management of Nonmultiple Endocrine Neoplasia Endocrinopathies: State-of-the-Art Review.

Surg Clin North Am. 2009 Oct;89(5):1069-89

Authors: Landry CS, Waguespack SG, Perrier ND

PMID: 19836485 [PubMed - in process]

Surgical management of zollinger-ellison syndrome; state of the art.

Morrow EH, Norton JA — Tue, 20 Oct 2009 22:43:37 +0000

Surgical management of zollinger-ellison syndrome; state of the art.

Surg Clin North Am. 2009 Oct;89(5):1091-103

Authors: Morrow EH, Norton JA

Much has been learned about the diagnosis and treatment of Zollinger-Ellison Syndrome (ZES), and certain questions require further investigation. Delay in diagnosis of ZES is still a significant problem, and clinical suspicion should be elevated. The single best imaging modality for localization and staging of ZES is somatostatin receptor scintigraphy. Goals of surgical treatment for ZES differ between sporadic and MEN-1-related cases. All sporadic cases of ZES should be surgically explored (including duodenotomy) even with negative imaging results, because of the high likelihood of finding and removing a tumor for potential cure. Surgery for MEN-1-related cases should be focused on prevention of metastatic disease, with surgery being recommended when pancreatic tumors are greater than 2 cm. The role of Whipple procedure, especially for MEN-1 cases, should be explored further. Laparoscopic and endoscopic treatments are more experimental, but may have a role.

PMID: 19836486 [PubMed - in process]

Insulinoma.

Mathur A, Gorden P, Libutti SK — Tue, 20 Oct 2009 22:43:33 +0000

Insulinoma.

Surg Clin North Am. 2009 Oct;89(5):1105-21

Authors: Mathur A, Gorden P, Libutti SK

Insulinoma is a rare neuroendocrine tumor with an incidence of 4 per 1 million persons per year, which may occur as a unifocal sporadic event in patients without an inherited syndrome or as a part of multiple endocrine neoplasia type 1. Key neuroglycopenic and hypoglycemic symptoms in conjunction with biochemical proof establish the diagnosis. Once the diagnosis is established, the insulinoma is preoperatively localized within the pancreas with the goal of surgical excision for cure. This review discusses the historical background, diagnosis, and management of sporadic insulinoma.

PMID: 19836487 [PubMed - in process]

Carcinoid tumors.

Pasieka JL — Tue, 20 Oct 2009 22:43:30 +0000

Carcinoid tumors.

Surg Clin North Am. 2009 Oct;89(5):1123-37

Authors: Pasieka JL

Carcinoid tumors, which arise from the enterochromaffin cells of the gastrointestinal tract, encompass a diverse group of neoplasms. Once thought to be “carcinoma-like,” these neoplasms exhibit a biologic behavior that varies from an indolent, benign course to an aggressive, rapidly progressive, and deadly disease. Today the term carcinoid is reserved for neuroendocrine tumors arising from the small bowel or neuroendocrine tumors that can cause carcinoid syndrome. This newer terminology has yet to be universally adopted, adding to the confusion in the literature. For the general surgeon there are several “carcinoid” tumors that he or she must be familiar with because many of these lesions are encountered during emergency laparotomies or incidentally discovered during investigation for vague abdominal pain. This review focuses on the gastrointestinal neuroendocrine tumors that general surgeons are likely to encounter during their career.

PMID: 19836488 [PubMed - in process]

Molecular markers in thyroid cancer diagnostics.

Kato MA, Fahey TJ — Tue, 20 Oct 2009 22:43:27 +0000

Molecular markers in thyroid cancer diagnostics.

Surg Clin North Am. 2009 Oct;89(5):1139-55

Authors: Kato MA, Fahey TJ

Although fine-needle aspiration biopsy (FNA) remains the mainstay of the preoperative workup of thyroid nodules, it does not provide a diagnosis in up to 20% of nodules. This group of indeterminate lesions, including lesions with cellular atypia, suspicious cytology, and demonstrating a follicular pattern, provides one of the greatest challenges to researchers in thyroid cancer today. Over the last 2 decades, considerable work has been done to find molecular markers to resolve this diagnostic dilemma. This article explores some of the markers including galectin-3, HBME-1, BRAF, RET/PTC, PAX8-PPARgamma, hTERT, telomerase, miRNA, and microarray and multigene assays. Although no one marker has proven to be a panacea, several combinations of markers have shown great promise as an adjunct to FNA.

PMID: 19836489 [PubMed - in process]

Recurrent laryngeal nerve monitoring: state of the art, ethical and legal issues.

Angelos P — Tue, 20 Oct 2009 22:43:24 +0000

Recurrent laryngeal nerve monitoring: state of the art, ethical and legal issues.

Surg Clin North Am. 2009 Oct;89(5):1157-69

Authors: Angelos P

Despite many advances in surgical techniques during the last several decades, the risk for recurrent laryngeal nerve (RLN) injury during thyroid and parathyroid surgery has only declined, not disappeared. RLN monitoring is an attempt to reduce the risk of nerve injury during thyroid and parathyroid surgery. In this article, the author discusses how to use RLN monitoring, its effectiveness, and the options available. He also highlights potential legal and ethical issues that surround the use of this method.

PMID: 19836490 [PubMed - in process]

Surgical management of well-differentiated thyroid cancer: state of the art.

Suliburk J, Delbridge L — Tue, 20 Oct 2009 22:43:23 +0000

Surgical management of well-differentiated thyroid cancer: state of the art.

Surg Clin North Am. 2009 Oct;89(5):1171-91

Authors: Suliburk J, Delbridge L

Nonmedullary well-differentiated thyroid cancer (WDTC) comprises a group of tumors including papillary thyroid carcinoma (PTC) and follicular thyroid carcinoma (FTC), with Hürthle cell carcinoma being a subtype of follicular carcinoma. This article reviews the epidemiology, pathogenesis, preoperative and diagnostic evaluation, imaging, and staging of WDTC. Different approaches to therapy and follow-up care are discussed. The prognosis for WDTC remains good and most patients can expect to be cured of their disease.

PMID: 19836491 [PubMed - in process]

Sporadic and familial medullary thyroid carcinoma: state of the art.

Moo-Young TA, Traugott AL, Moley JF — Tue, 20 Oct 2009 22:43:20 +0000

Sporadic and familial medullary thyroid carcinoma: state of the art.

Surg Clin North Am. 2009 Oct;89(5):1193-204

Authors: Moo-Young TA, Traugott AL, Moley JF

Medullary thyroid cancer (MTC) accounts for 5% to 10% of all thyroid cancers. The high frequency of familial cases mandates screening and genetic testing. The aggressiveness and age of onset of familial MTC differs depending on the specific genetic mutation, and this should determine the timing and extent of surgery. Sporadic MTC can present at any age, and it is usually associated with a palpable mass and the presence of nodal metastases. Surgery is standard treatment for any patient presenting with resectable MTC. Further studies are needed to investigate the role of radiation therapy in the palliation and local control of postresection and advanced-stage MTC. New systemic therapies for metastatic disease are being investigated. Targeted molecular therapies, based on knowledge of the pathways affected by RET mutations, are being tested in multiple clinical trials.

PMID: 19836492 [PubMed - in process]

Surgical management of primary hyperparathyroidism: state of the art.

Lew JI, Solorzano CC — Tue, 20 Oct 2009 22:43:18 +0000

Surgical management of primary hyperparathyroidism: state of the art.

Surg Clin North Am. 2009 Oct;89(5):1205-25

Authors: Lew JI, Solorzano CC

This article reviews the current state of the art regarding therapy for primary hyperparathyroidism. Clinical evaluation and indications for parathyroidectomy are described, followed by a review of surgical techniques currently being practiced and possible outcomes involved. Focused parathyroidectomy has become a successful alternative to conventional bilateral cervical exploration.

PMID: 19836493 [PubMed - in process]

Secondary and tertiary hyperparathyroidism, state of the art surgical management.

Pitt SC, Sippel RS, Chen H — Tue, 20 Oct 2009 22:43:16 +0000

Secondary and tertiary hyperparathyroidism, state of the art surgical management.

Surg Clin North Am. 2009 Oct;89(5):1227-39

Authors: Pitt SC, Sippel RS, Chen H

This article reviews the current surgical management of patients with secondary and tertiary hyperparathyroidism. The focus is on innovative surgical strategies that have improved the care of these patients over the past 10 to 15 years. Modalities such as intraoperative parathyroid hormone monitoring and radioguided probe utilization are discussed.

PMID: 19836494 [PubMed - in process]

Aldosteronomas-state of the art.

McKenzie TJ, Lillegard JB, Young WF, Thompson GB — Tue, 20 Oct 2009 22:43:09 +0000

Aldosteronomas-state of the art.

Surg Clin North Am. 2009 Oct;89(5):1241-53

Authors: McKenzie TJ, Lillegard JB, Young WF, Thompson GB

Primary aldosteronism (PA) is the most common cause of secondary hypertension in nonsmokers. Widespread screening of unselected hypertensives has identified PA in as many as 15% of patients. With such screening efforts using the PAC/PRA ratio and PAC, the widespread prevalence of the disease has become apparent while the relative percentage of APA has decreased. PA is confirmed by demonstrating lack of aldosterone suppressibility with sodium loading. Subtype evaluation is best achieved with high resolution CT scanning and AVS in the appropriate setting. In patients with PA and a unilateral source of aldosterone excess, laparoscopic adrenalectomy is the treatment of choice with excellent outcomes and low morbidity as compared with older open approaches. Patients with IHA, or those not amenable or agreeable to surgery, are best managed with a MR antagonist.

PMID: 19836495 [PubMed - in process]

Adrenocortical cancer.

Wandoloski M, Bussey KJ, Demeure MJ — Tue, 20 Oct 2009 22:42:53 +0000

Adrenocortical cancer.

Surg Clin North Am. 2009 Oct;89(5):1255-67

Authors: Wandoloski M, Bussey KJ, Demeure MJ

Adrenocortical carcinoma (ACC) is a rare endocrine malignancy causing up to 0.2% of all cancer deaths This article reviews the incidence, presentation, and pathology of ACC. Particular attention is paid to the molecular oncogenesis of this disease, and the surgical and therapeutic options available for its cure.

PMID: 19836496 [PubMed - in process]

Advances in cardiac and aortic surgery. Foreword.

Martin RF — Sat, 03 Oct 2009 18:31:12 +0000

Advances in cardiac and aortic surgery. Foreword.

Surg Clin North Am. 2009 Aug;89(4):xiii-xiv

Authors: Martin RF

PMID: 19782833 [PubMed - in process]

Advances in cardiac and aortic surgery. Preface.

Kern JA, Kron IL — Sat, 03 Oct 2009 18:31:10 +0000

Advances in cardiac and aortic surgery. Preface.

Surg Clin North Am. 2009 Aug;89(4):xv

Authors: Kern JA, Kron IL

PMID: 19782834 [PubMed - in process]

Cardiac screening before noncardiac surgery.

Williams FM, Bergin JD — Sat, 03 Oct 2009 18:31:04 +0000

Cardiac screening before noncardiac surgery.

Surg Clin North Am. 2009 Aug;89(4):747-62, vii

Authors: Williams FM, Bergin JD

Cardiovascular complications are infrequent but can result in significant morbidity following noncardiac surgery, especially in patients with peripheral vascular disease or increased age. All patients require some level of preoperative screening to identify and minimize immediate and future risk, with a careful focus on known coronary artery disease or risks for coronary artery disease and functional capacity. The 2007 American College of Cardiology/American Heart Association Guidelines are clear that noninvasive and invasive testing should be limited to circumstances in which results will clearly affect patient management or in which testing would otherwise be indicated. beta-Blocker therapy has become controversial in light of recent publications but should be continued in patients already on therapy, and started in patients with high cardiac risk undergoing intermediate- or high-risk surgery.

PMID: 19782835 [PubMed - in process]

Noninvasive imaging of the heart and coronary arteries.

West AM, Kramer CM — Sat, 03 Oct 2009 18:31:00 +0000

Noninvasive imaging of the heart and coronary arteries.

Surg Clin North Am. 2009 Aug;89(4):763-80, vii

Authors: West AM, Kramer CM

There are multiple imaging modalities currently available to noninvasively evaluate the heart and coronary arteries. Choosing the most appropriate modality depends on the pertinent clinical question and the underlying patient characteristics. This article provides an overview of the fields of echocardiography, myocardial perfusion imaging, cardiac computed tomography, and cardiac magnetic resonance imaging, with particular attention to specific clinical applications for cardiac surgery patients.

PMID: 19782836 [PubMed - in process]

Cardiopulmonary bypass/extracorporeal membrane oxygenation/left heart bypass: indications, techniques, and complications.

Ailawadi G, Zacour RK — Sat, 03 Oct 2009 18:30:56 +0000

Cardiopulmonary bypass/extracorporeal membrane oxygenation/left heart bypass: indications, techniques, and complications.

Surg Clin North Am. 2009 Aug;89(4):781-96, vii-viii

Authors: Ailawadi G, Zacour RK

Cardiopulmonary bypass has revolutionized the ability to provide cardiorespiratory support and has advanced the field of cardiac surgery. This invention has given surgeons the ability to perform many procedures that were not possible previously. The concept and development of cardiopulmonary bypass has been pioneered by numerous legendary surgeons. Cardiopulmonary bypass, extracorporeal membrane oxygenation, and left heart bypass have revolutionized our ability to operate on the heart, great vessels, and aorta in addition to providing means of short-term support for reversible causes of cardiac and/or respiratory failure. The success of these approaches is dependent upon excellent communication between the surgeon, perfusionist, and anesthesiologist as well as constant vigilance and troubleshooting by the caregivers.

PMID: 19782837 [PubMed - in process]

Great vessel and cardiac trauma.

Cook CC, Gleason TG — Sat, 03 Oct 2009 18:30:51 +0000

Great vessel and cardiac trauma.

Surg Clin North Am. 2009 Aug;89(4):797-820, viii

Authors: Cook CC, Gleason TG

Thoracic great vessel and cardiac trauma are characterized by anatomic location and mechanism of injury: blunt or penetrating. Management strategies are also directed by the extent and mechanism of injury. Advances in imaging and catheter-based technologies have allowed easier and more accurate diagnosis and less-invasive treatments. Although the advantages of endovascular techniques are attractive, open surgical repair remains the definitive treatment for many of these thoracic injuries. Given the increasing sophistication of these technologies and the demonstrated usefulness of a disease-oriented approach toward patient management, trauma centers have adopted a multidisciplinary team model for management of multitrauma victims. In this review, the authors detail the diagnosis and management of blunt aortic, nonaortic great vessel, blunt cardiac, and penetrating cardiac injuries.

PMID: 19782838 [PubMed - in process]

Surgical treatment of great vessel occlusive disease.

Tracci MC, Cherry KJ — Sat, 03 Oct 2009 18:30:38 +0000

Surgical treatment of great vessel occlusive disease.

Surg Clin North Am. 2009 Aug;89(4):821-36, viii

Authors: Tracci MC, Cherry KJ

Occlusive disease of the supra-aortic trunks remains a diagnostic and therapeutic challenge to the surgeon. Although most cases in Western series are attributable to atherosclerotic disease, other entities such as Takayasu arteritis and radiation arteritis account for a substantial subset of patients in whom choice of therapy and clinical response may be significantly affected by the peculiarities of the disease process involved. This article reviews the anatomy, causes, and diagnosis of occlusive disease of the supra-aortic trunks. The indications, techniques, and outcomes of reconstruction are also discussed.

PMID: 19782839 [PubMed - in process]

Valve-sparing aortic root reconstruction.

Smith RL, Kron IL — Fri, 02 Oct 2009 18:09:38 +0000

Valve-sparing aortic root reconstruction.

Surg Clin North Am. 2009 Aug;89(4):837-44, viii

Authors: Smith RL, Kron IL

The aortic valve-sparing root reconstruction procedure remains an ideal concept, but it has not yet become an ideal operation. There is still great variation and evolution in techniques, which mirrors the increasing understanding of the aortic root’s functional anatomy and the disease processes that affect it. These operations remain complex, and the surgeons who perform them well are often times best armed with an experienced eye for what looks right more than a mathematical model that can predetermine who will do well, with what repair type and with what percentage chance of long-term success. Because of this, it will likely still be a while before these operations are more routinely used by a broader group of surgeons, as compared with the very reproducible Bentall and De Bono repair.

PMID: 19782840 [PubMed - in process]

Indications for the treatment of thoracic aortic aneurysms.

Elefteriades JA, Botta DM — Fri, 02 Oct 2009 18:09:34 +0000

Indications for the treatment of thoracic aortic aneurysms.

Surg Clin North Am. 2009 Aug;89(4):845-67, ix

Authors: Elefteriades JA, Botta DM

In an era of increasingly common and detailed imaging of the thorax, thoracic aortic aneurysms are being discovered in their precomplicated state with increasing frequency. At the same time, the list of potential treatments for thoracic aneurysms is beginning to expand. Deciding which treatment method to employ and which aneurysm to treat is often difficult. The risk of aneurysm complications must be balanced against the risks of the treatment. This work explores the behavior of thoracic aneurysms, the state-of-the-art in treatment, and a rational approach to the treatment decision is proposed.

PMID: 19782841 [PubMed - in process]

Approach to the treatment of aortic dissection.

Moon MR — Wed, 30 Sep 2009 18:03:43 +0000

Approach to the treatment of aortic dissection.

Surg Clin North Am. 2009 Aug;89(4):869-93, ix

Authors: Moon MR

Acute aortic dissection is a fatal disease if early diagnosis and institution of appropriate therapy are delayed. Unfortunately, the presentation of a dissection can be diabolical, leading to an initial misdiagnosis in more than 25% of patients. For type A dissections, surgical repair is essential because mortality rates approach 50% at 48 hours with expectant therapy alone. For type B dissections, medical management is successful in most patients, although a subset with complications or early dilation may benefit from newer endovascular techniques. The goal of this review is to summarize the diagnostic algorithm, initial therapeutic options, and long-term management regimen that offer patients with an acute aortic dissection the best chance for short-term and long-term survival. There is an emphasis on the specific practical approach that is applied at Washington University to patients who present with an aortic dissection.

PMID: 19782842 [PubMed - in process]

Endovascular repair of the thoracic aorta.

Adams JD, Garcia LM, Kern JA — Tue, 29 Sep 2009 17:46:09 +0000

Endovascular repair of the thoracic aorta.

Surg Clin North Am. 2009 Aug;89(4):895-912, ix

Authors: Adams JD, Garcia LM, Kern JA

The use of endovascular stent grafts for treatment of the descending thoracic aorta is reviewed. Currently, 3 devices have been approved by the US Food and Drug Administration for the treatment of descending thoracic aneurysms, and multiple studies are ongoing to investigate the efficacy of endovascular treatment in such pathologies as traumatic aortic injury and Stanford type B dissection. Outcomes are highly dependent on good case planning and patient selection and will likely continue to improve as newer-generation devices and delivery systems are designed and made available.

PMID: 19782843 [PubMed - in process]

Off-pump versus on-pump coronary artery bypass grafting.

Halkos ME, Puskas JD — Tue, 29 Sep 2009 17:46:04 +0000

Off-pump versus on-pump coronary artery bypass grafting.

Surg Clin North Am. 2009 Aug;89(4):913-22, ix

Authors: Halkos ME, Puskas JD

Off-pump coronary artery bypass is a safe and effective method of coronary revascularization that avoids the use of cardiopulmonary bypass. Randomized trials, typically enrolling low-risk patients, have shown comparable mortality and reduced morbidity between off-pump and on-pump coronary artery bypass. Larger retrospective analyses suggest improved mortality and a lower incidence of adverse events in patients undergoing off-pump coronary artery bypass. This article reviews the available literature comparing outcomes of patients undergoing on- and off-pump coronary artery bypass surgery.

PMID: 19782844 [PubMed - in process]

Minimally invasive valve surgery.

Woo YJ — Tue, 29 Sep 2009 17:46:00 +0000

Minimally invasive valve surgery.

Surg Clin North Am. 2009 Aug;89(4):923-49, x

Authors: Woo YJ

Traditional cardiac valve replacement surgery is being rapidly supplanted by innovative, minimally invasive approaches toward the repair of these valves. Patients are experiencing benefits ranging from less bleeding and pain to faster recovery and greater satisfaction. These operations are proving to be safe, highly effective, and durable, and their use will likely continue to increase and become even more widely applicable.

PMID: 19782845 [PubMed - in process]

Transcatheter cardiac valve interventions.

Brinkman WT, Mack MJ — Tue, 29 Sep 2009 17:45:56 +0000

Transcatheter cardiac valve interventions.

Surg Clin North Am. 2009 Aug;89(4):951-66, x

Authors: Brinkman WT, Mack MJ

Currently aortic valve replacement is performed for patients with severe aortic stenosis and symptoms or objective pathophysiologic consequences such as left ventricular dysfunction. For transcatheter mitral valve interventions, the complex pathophysiology of mitral regurgitation with varying causes along with challenging imaging and delivery issues has led to slower than anticipated clinical introduction. Transcatheter pulmonary valve intervention was primarily designed to treat the difficult problem of right ventricular to pulmonary artery conduit stenosis in the congenital population. These techniques are reviewed in this article.

PMID: 19782846 [PubMed - in process]

Surgical treatments for advanced heart failure.

Daneshmand MA, Milano CA — Tue, 29 Sep 2009 17:45:52 +0000

Surgical treatments for advanced heart failure.

Surg Clin North Am. 2009 Aug;89(4):967-99, x

Authors: Daneshmand MA, Milano CA

Patients with heart failure represent a significantly ill cohort, and the survival of the most advanced heart failure patients is dismal with medical management alone. This cohort of advanced heart-failure patients benefits from several surgical treatments. Although several techniques for surgical ventricular restoration in the setting of left ventricular aneurysms have been described, the broader application of these techniques to patients with ischemic cardiomyopathy has occurred during the last decade. This review focuses on left ventricular aneurysm (LVA) repair and surgical ventricular restoration, ventricular assist devices, and cardiac allograft transplantation for the treatment of advanced heart failure. Indications for these procedures are addressed, as well as intraoperative technical features and postoperative management strategies.

PMID: 19782847 [PubMed - in process]