American journal of surgery

Publisher: Elsevier

Description

  • Impact factor
    2.36
  • 5-year impact
    0.00
  • Cited half-life
    0.00
  • Immediacy index
    0.46
  • Eigenfactor
    0.03
  • Article influence
    0.83
  • ISSN
    1879-1883

Publisher details

Elsevier

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    • Publisher last contacted on 18/10/2013
  • Classification
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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Background Hypothermia may decrease postoperative intra-abdominal adhesion. We sought to determine the most suitable temperature for hypothermia for decreasing postoperative adhesion formation. Methods One hundred and twenty male BALB/c mice weighing 25-30 g were randomized into five groups: adhesion model with infusion of cold saline at (I) 15°C; (II) 10°C; or (III) 4°C; (IV) adhesion model without infusion of saline; and (V) sham operation without infusion of saline. Adhesion scores, incidence of adhesion, and serum cytokine levels were measured at postoperative days 1, 3, 7, and 14. Results Adhesion scores among groups I, II, and III did not differ significantly. IL-6 was significantly decreased in groups I, II, and III, compared to the levels in groups IV and V (p <0.05). TNF-α levels in groups I and II were significantly decreased compared to those in groups III, IV, and V (p <0.05). Conclusions We suggest that 15°C is the appropriate temperature for induction of hypothermia to decrease postoperative intra-abdominal adhesion formation.
    American journal of surgery 09/2014;
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    ABSTRACT: Background Self expandable metallic stents can be used to treat patients with symptomatic anastomotic complications after colorectal resection. Material and Methods Twenty patients with symptomatic anastomotic stricture after colorectal resection were treated with endoscopic placement of a self expandable metal stent. Ten patients had “simple” anastomotic stricture. In the remaining 10 patients a leak was associated to the stricture. Results The anastomotic leakage healed without evidence of residual stricture or major fecal incontinence in 8 out of 10 patients. Overall the anastomotic stricture was resolved in 14 out of the 20 patients. Conclusions Self expandable metal stents represent a valid adjunctive to treat patients with symptomatic anastomotic complications after colorectal resection for cancer. They have a complementary role to balloon dilatation in case of simple anastomotic stricture, and they improve the rate of healing when the stricture is associated with a leak.
    American journal of surgery 09/2014;
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    ABSTRACT: Backgound To examine predictive factors for subclinical central neck lymph node metastases (LNM) of papillary thyroid microcarcinoma (PTMC). Methods The clinical and pathological findings of 287 patients with clinically non-invasive, node-negative, solitary papillary thyroid carcinoma (PTC), who had undergone thyroidectomy plus central compartment neck dissection and showed pathologically confirmed nodal metastases, were analyzed. Predictive risk factors for central LNM were quantified. Results Pathologic LNM was identified in 63 (32.6%) PTMC patients and 48 (51.0%) PTC patients (tumor size > 1 cm; P = 0.003). Tumor size (> 0.7 cm; P = 0.011), multifocality (P = 0.010), and microscopic extracapsular extension (P = 0.050) were significant variables predictive of central LNM from PTMC in univariate analysis. Tumor size (odds ratio [OR] 2.28, 95% confidence interval [CI] 1.19–4.38; P = 0.014) and multifocality (OR: 2.38, 95% CI 1.14–4.93; P = 0.020) were independent variables predictive of central LNM in multivariate analysis. Conclusion Cervical LNM is highly prevalent in clinically non-invasive, node-negative PTC. Central neck LNM is associated with larger tumor size and multifocality of PTMC.
    American journal of surgery 09/2014;
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    ABSTRACT: Background Transanal minimally invasive surgery (TAMIS), an alternative technique to transanal endoscopic microsurgery, was developed in 2009. Herein, we describe our initial experience using TAMIS for benign and malignant rectal neoplasia. Methods This is an IRB approved, retrospective case series report. Results TAMIS was performed in 32 patients for rectal adenoma (13), adenocarcinoma (16), and carcinoid (3). There were 14 females, mean age 62 +/- 15 years, and BMI 28 +/- 5 kg/m2. Lesion size ranged from 0.5 – 8.5 cm, distance from the dentate line 1 - 11 cm, and circumference of the lesion 10 - 100%. The mean operative time was 123 +/- 62 minutes. Mean hospital length of stay was 2.5 +/- 2 days. Complications included urinary tract infection (1), clostridium difficile diarrhea (1), atrial fibrillation (1), rectal stenosis (1), and rectal bleeding (1). Conclusions TAMIS using a disposable transanal access platform is a safe and effective method to remove rectal lesions in this case series.
    American journal of surgery 09/2014;
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    ABSTRACT: Background Reports of secondary modifications into aortouniiliac configuration to salvage failed endovascular aneurysm repair (EVAR) are limited. We evaluated long-term results after these procedures and compared them with those after primary aortouniiliac endografting (AUE). Methods A retrospective review of all EVAR performed from March 1995 until July 2011 was conducted. Patients were included when primary AUE (group I) or modification into aortouniiliac configuration (group II) was done. Results Data analysis obtained 27 group I and 23 group II patients. Salvage of failed EVAR could be achieved in 96% of group II patients and mortality was zero. Frequency of adverse events and amount of interventions to maintain aneurysm exclusion were not increased after secondary AUE. Kaplan-Meier estimates for long-term survival between groups were comparable (p=0.36). Conclusions Secondary AUE allows correction of graft-related endoleaks potentially leading to late aneurysm rupture. Complications and adverse events throughout long-term follow-up were not necessarily increased when compared with primary AUE.
    American journal of surgery 09/2014;
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    ABSTRACT: Background Neoadjuvant chemoradiotherapy (CRT) in esophageal cancer (EC) patients may increase the formation of thromboembolic events (TEE’s). We analyzed the incidence and impact of TEE’s in EC patients treated with platinum-based CRT. Patient and methods A total of 336 patients with EC underwent an esophagectomy of which 110 patients received neoadjuvant CRT (41.4Gy with concurrent Carboplatin/Paclitaxel). Patients were matched based on pre- and perioperative characteristics. Results Preoperatively, 9 (8.2%) patients with neoadjuvant CRT (p=0.004) were diagnosed with TEE’s. Despite delay until surgery (p=0.021), the postoperative course did not differ. In multivariate analysis, a history of DVT (p=0.005) and neoadjuvant CRT (p=0.004) were identified as risk factors. Postoperatively, there was no differences in TEE’s (p=0.560) observed. In multivariate analysis, a history of pulmonary embolism (p=0.012) was identified as risk factor for postoperative TEE’s. Conclusion Preoperatively, EC patients treated with neoadjuvant CRT have an increased risk to develop a TEE, especially those with a previous history of TEE. After surgery no increased incidence was observed. We recommend secondary prophylaxis during neoadjuvant treatment in this high-risk group.
    American journal of surgery 08/2014;
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    ABSTRACT: Background Carcinoembryonic antigen (CEA) is the most widely used tumor marker for colorectal cancer. This study aimed to investigate the role of CEA reduction ratio after pre-operative chemoradiotherapy (CRT). Patients and Methods We enrolled 284 patients who underwent preoperative CRT followed by radical surgical resection. Patients were divided into 3 groups: pre-CRT CEA < 5 ng/ml (group 1); pre-CRT CEA ≥ 5 ng/ml with CEA reduction ratio ≥ 50% (group 2); pre-CRT CEA ≥ 5 ng/ml with CEA reduction ratio < 50% (group 3). Results The 5 year disease-free survival (DFS) rate was not different between group 1 (71.8%) and 2 (69.4%), but was significantly lower in group 3 (49.5%). CEA group, ypN stage and histologic type were independent prognostic factors for DFS upon multivariate analysis. Conclusions CEA reduction ratio might be an independent prognostic factor for disease-free survival in rectal cancer patients treated with pre-operative CRT and radical surgery.
    American journal of surgery 07/2014;
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    ABSTRACT: Background Recently, there has been a growth in studies supporting the hypothesis that video games have positive effects on basic laparoscopic skills. This review discusses all studies directly related to these effects. Data sources A search in the PubMed and Embase databases was performed using synonymous terms for video games and laparoscopy. All available articles concerning video games and their effects on skills on any laparoscopic simulator (box trainer, virtual reality, and animal models) were selected. Conclusions Video game experience has been related to higher baseline laparoscopic skills in different studies. There is currently, however, no standardized method to assess video game experience, making it difficult to compare these studies. Several controlled experiments have, nevertheless, shown that video games cannot only be used to improve laparoscopic basic skills in surgical novices, but also as a temporary warming-up prior to laparoscopic surgery.
    American journal of surgery 07/2014;
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    ABSTRACT: Background Rib fractures are common, and can be disabling. Recently, there has been increased interest in surgical stabilization of rib fractures (SSRF). It is difficult to define long-term benefits of the procedure. This is a descriptive study of patient outcomes after SSRF. Methods SSRF patients between April 2010-August 2012 at a Level I trauma center were identified. Data were collected from the medical record. A telephone survey asking about pain, satisfaction, and employment was administered to patients after hospital discharge. Results 101 patients met inclusion criteria. 50 (50%) completed the survey. Indications for SSRF included flail chest, displaced fractures, pain, and inability to wean from mechanical ventilation. Pain was gone at 5.4±1.1 weeks post discharge. Satisfaction with SSRF on a scale of 1-10 was 9.2±0.2. 90% of employed patients returned to the same work at 8.5±1.2 weeks. Conclusion SSRF patients are satisfied and are able to return to normal activity with few limitations. A prospective study using modern rib fixation technology is needed to further define benefits.
    American journal of surgery 07/2014;
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    ABSTRACT: Inguinodynia is an undesirable postoperative complication reported following groin hernia repair done with and without mesh implantation. It can be minimized by good technique. Personal recognition of less than ideal results can be helpful in the decision to pursue improved performance.
    American journal of surgery 06/2014;
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    ABSTRACT: Cyclo-oxygenase-2 (COX-2), an inducible enzyme expressed in areas of inflammation, is a target of interest for colorectal cancer therapy. Currently, the predictive significance of COX-2 in colorectal cancer remains unclear. Tissue microarrays were constructed using 118 colon cancer and 85 rectal cancer specimens; 44 synchronous metastatic colon cancer and 22 rectal cancer lymph nodes were also evaluated. COX-2 expression was assessed by immunohistochemistry. Univariate analysis was used to determine the predictive significance of clinicopathologic variables. Overall survival, disease-specific survival, and disease-free survival were the main outcomes examined. COX-2 was found to be expressed in 93% of colon cancers and 87% of rectal cancers. Decreased COX-2 expression was related to decreased disease-specific survival (P = .016) and decreased disease-free survival (P = .019) in the rectal cancer cohort but not in the colon cancer cohort. COX-2 expression has predictive utility for management of rectal but not colon cancer.
    American journal of surgery 05/2014; 207(5):712-6.
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    ABSTRACT: The North Pacific Surgical Association Historian's centennial lecture, with review of the geographic challenges for members of this society at the time of its founding and selected insights into surgical practices and philosophies of a century ago.
    American journal of surgery 05/2014; 207(5):670-2.
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    ABSTRACT: The role of sentinel lymph node status (SLNS) in thick melanoma is evolving. The purpose of this study was to determine the prognostic value of SLNS in thick melanoma. A retrospective analysis of 120 prospectively collected clinically node-negative thick melanomas over 5 years was performed. Patient (age/sex) and tumor (thickness, ulceration, SLNS, mitoses, metastases, and recurrence) features were collected. Multivariate analysis was performed using Cox proportional hazard model. Factors predictive of positive SLN included male sex, ulceration, and high mitoses. Factors associated with positive SLN had higher local-regional recurrence and metastases than negative SLN. SLNS and tumor thickness impacted 5-year disease-free survival (DFS) and overall survival (OS). Positive SLN, ulceration, age, and mitoses were independent predictors of DFS/OS. Nonulcerated/lower mitoses thick melanomas had lower positive SLN rates. Positive SLN develop recurrence and metastases and have worse OS/DFS. SLNS is an important prognosticator for OS/DFS. Sentinel lymph node biopsy delineates prognostic groups in thick melanomas and can impact management.
    American journal of surgery 05/2014; 207(5):702-7.
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    ABSTRACT: Both MRI and breast-specific gamma imaging are tools for surgical planning in newly diagnosed breast cancer. Breast-specific gamma imaging (BSGI) is used less frequently although it is of similar utility and lower cost. We compared the diagnostic and cost efficacy of BSGI with MRI. Retrospective review of 1,480 BSGIs was performed in a community breast health center, 539 had a new diagnosis of cancer, 75 patients having both MRI and BSGI performed within 2 months of each other. Institutional charges for BSGI ($850) and MRI ($3,381) were noted. BSGI had a sensitivity of 92%, specificity of 73%, positive predictive value of 78%, and negative predictive value of 90%. This compared favorably with MRI that had sensitivity of 89%, specificity 54%, positive predictive value 67%, and negative predictive value 83%. The accuracy of BSGI was higher at 82% vs MRI at 72%. Total cost of MRI imaging was $253,575 vs BSGI at $63,750. BSGI is a cost-effective and accurate imaging study for further evaluation of dense breast tissue and new diagnosis of cancer.
    American journal of surgery 05/2014; 207(5):698-701.
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    ABSTRACT: Many patients after lumpectomy have barriers to whole breast radiation. Accelerated partial breast irradiation (APBI) was introduced at our institution as an alternative. Retrospective review of patients who were treated with ABPI from March 2003 to December 2011 was conducted. Results of demographics, tumor pathology, infection, and recurrence were reviewed. Two hundred ninety-four patients received 298 treatments of APBI. The mean follow-up was 58.5 months. Using the American Society for Radiation Oncology criteria, 101 patients were suitable, 142 cautionary, and 52 patients were unsuitable. The average age was 65 with a range of 37 to 93. In our study, true local recurrence occurred in only 1.0% (n = 3). Patients recurring in the same breast elsewhere was 2% (n = 6). Outcomes after treatment with APBI were excellent, and breast recurrence was similar to whole breast irradiation. It may safely be offered to patients with less than suitable criteria or barriers to whole breast radiation.
    American journal of surgery 05/2014; 207(5):682-5.
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    ABSTRACT: Pediatric magnet ingestions are increasing. Commercial availability of rare-earth magnets poses a serious health risk. This study defines incidence, characteristics, and management of ingestions over time. Cases were identified by searching radiology reports from June 2002 to December 2012 at a children's hospital and verified by chart and imaging review. Relative risk (RR) regressions determined changes in incidence and interventions over time. In all, 98% of ingestions occurred since 2006; 57% involved multiple magnets. Median age was 8 years (range 0 to 18); 0% of single and 56% of multiple ingestions required intervention. Compared with 2007 to 2009, ingestions increased from 2010 to 2012 (RR = 1.9, 95% confidence interval 1.2 to 3.0). Intervention proportion was unchanged (RR = .94, 95% confidence interval .4 to 2.2). Small spherical magnets comprised 26.8% of ingestions since 2010; 86% involved multiple magnets and 47% required intervention. Pediatric magnet ingestions and interventions have increased. Multiple ingestions prompt more imaging and surgical interventions. Magnet safety standards are needed to decrease risk to children.
    American journal of surgery 05/2014; 207(5):754-9.