American Surgeon最新文献

{"title":"The Combined Use of Fine-Needle Aspiration (FNA) and BRAF V600E Gene Testing: Can it Increase the Definitive Diagnosis Rate of Nodules Categorized as Bethesda III for Papillary Thyroid Carcinoma?","authors":"Lu Lei, Shang Hong Qing, Li Wei, Fu Ma Mo Yang, Yao Xiao Xiang","doi":"10.1177/00031348241265143","DOIUrl":"10.1177/00031348241265143","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to analyze the malignant probability of thyroid nodules diagnosed as indeterminate cytology, including atypia of undetermined significance or follicular lesion of undetermined significance (AUS/FLUS), and investigate the diagnostic value of combining BRAF V600E gene testing within this classification.</p><p><strong>Methods: </strong>We conducted a retrospective analysis of 126 patients who underwent fine-needle aspiration (FNA) examination of thyroid nodules and subsequent surgical treatment at Beijing Haidian Hospital between October 2021 and November 2022. Among them, there were 22 male and 104 female patients, aged between 18 and 75 years old. Surgical pathology results were considered the gold standard for diagnosing the nature of thyroid nodules, evaluating the malignant incidence of cytological results categorized as AUS/FLUS. Fisher's exact test and diagnostic test evaluation methods were used to analyze the discriminatory diagnostic efficacy of preoperative FNA combined with BRAF V600E gene testing for papillary thyroid carcinoma (PTC). Statistical analysis was performed using SPSS 22.0 software<b>.</b></p><p><strong>Results: </strong>In PTC patients, the BRAF V600E gene mutation rate was 87.93% (102/116). Within the category of FNA results as AUS/FLUS, the proportion of PTC was 60.00% (15/25). The specificity, sensitivity, positive predictive value, and negative predictive value of the BRAF V600E gene mutation in diagnosing PTC within the AUS/FLUS category were 10/10, 6/15, 6/6, and 10/19, respectively. The BRAF V600E gene mutation significantly increased the detection rate of PTC in patients classified under this cytology (<i>P</i> = 0.028, <0.05).</p><p><strong>Conclusion: </strong>Preoperative FNA combined with BRAF V600E gene mutation testing significantly enhances the malignant detection rate of thyroid nodules diagnosed cytologically as AUS/FLUS. This combined approach provides a potent tool to improve diagnostic accuracy in this indeterminate classification.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3209-3215"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756679","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of General Surgery Resident Participation in Thoracic Surgery on Oncologic Outcomes: An Observational Cohort Study.","authors":"Riley S Grogan, Alex P Wieser, Barbara A Bennie, Cathy L Fischer, Venki Paramesh, Benjamin T Jarman","doi":"10.1177/00031348241269407","DOIUrl":"10.1177/00031348241269407","url":null,"abstract":"<p><p><b>Background:</b> Despite increasing sub-specialization, general surgeons continue to perform oncologic thoracic surgeries. Our objective was to determine whether general surgery resident participation in thoracic surgery affects surgical quality or oncologic outcomes. We hypothesized that patient outcomes with and without resident participation would be similar. <b>Methods:</b> We retrospectively reviewed the electronic health records of patients with stage 0-IV lung cancer undergoing oncologic pulmonary resection at BLINDED FOR REVIEW during an 11-year period (2012-2022). Patients younger than 18 years or older than 85 years were excluded, as were those who had incomplete follow-up data or were unregistered in our institutional cancer registry. Patients were divided into groups based on whether residents or staff surgeons completed >50% of the critical portions of the operation. We compared 30-day morbidity outcomes, overall survival (OS), and disease-free survival (DFS). <b>Results:</b> Three hundred thirteen patients met inclusion criteria. Demographic and clinical characteristics were similar between groups, as were types of surgical resection and median operative times. A statistical difference was found in the distribution of surgical approach. The odds of morbidity were 65% higher in the Staff group (OR=1.65; 95% CI, 1.007-2.71). Resident participation was not significantly associated with OS or DFS (<i>P</i> =.32 and <i>P</i> =.54, respectively). <b>Discussion:</b> General surgery resident involvement in lung cancer operations is not associated with longer operative times but is associated with a higher likelihood of a thoracotomy. General surgery resident involvement was associated with decreased postoperative morbidity and did not significantly affect OS or DFS.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3235-3243"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141756677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Corrigendum to \"Geriatric Bariatric Surgery: Outcomes at a Single Institution\".","authors":"","doi":"10.1177/00031348241250000","DOIUrl":"10.1177/00031348241250000","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3309"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141160284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Application and Prognostic Analysis of Vacuum Sealing Drainage in the Incision Infection in Patients With Stage II-III Colorectal Cancer.","authors":"Bao Lin, Hongjian Zhang, Shijie Sun, Changqing Lin, Yuanlong Chi","doi":"10.1177/00031348241265133","DOIUrl":"10.1177/00031348241265133","url":null,"abstract":"<p><strong>Introduction: </strong>This study aims to explore the application value of vacuum sealing drainage (VSD) technology in the treatment of incision infection dehiscence after surgery in patients with stage II-III colorectal cancer and analyze its impact on prognosis.</p><p><strong>Methods: </strong>This retrospective study included patients who experienced incision infection dehiscence after surgery for colorectal cancer between February 2014 and August 2019. Clinical and pathological data, short-term outcomes, and long-term outcomes were compared between the traditional group and the VSD group.</p><p><strong>Results: </strong>A total of 97 patients were included in this study. There was no significant difference in clinical and pathological data between the traditional group and the VSD group (<i>P</i> > 0.05). The VSD group had fewer dressing changes, lower pain scores during dressing changes, and better granulation tissue growth grading than the traditional group, with statistical significance (<i>P</i> < 0.05). The VSD group started adjuvant chemotherapy earlier and had a higher proportion of ≥4 cycles of chemotherapy. The three-year overall survival rate in the VSD group was better than the traditional group, but the difference was not statistically significant (<i>P</i> > 0.05).</p><p><strong>Conclusion: </strong>The application of VSD technology can promote granulation tissue growth, accelerate incision healing, and facilitate patients to complete subsequent adjuvant chemotherapy. However, further verification of its long-term impact on prognosis requires longer-term follow-up results.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3253-3261"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141726792","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Telemedicine in Acute Trauma Care: A Review of Quantitative Evaluations on the Impact of Remote Consultation.","authors":"Prem Patel, John Aucar","doi":"10.1177/00031348241265146","DOIUrl":"10.1177/00031348241265146","url":null,"abstract":"<p><strong>Background: </strong>There is extensive literature describing the application of telemedicine techniques to trauma care. However, there is a paucity of articles showing quantitative assessment of its safety and efficacy. This structured review examines articles with quantitative assessment of telemedicine's impact in acute trauma care.</p><p><strong>Methods: </strong>Medline and CINAHL databases were searched for peer-reviewed articles that quantitatively assess the impact of telemedicine on diagnostic accuracy, clinical decision-making, emergency department length of stay, transfer rates, and mortality in initial trauma management.</p><p><strong>Results: </strong>Only 9 of the 408 screened articles met the criteria for quantitative assessment. Telemedicine appears to be preferentially used for more severely injured patients. Limited quality evidence supports procedural interventions at remote sites. Telemedicine may help abbreviate pre-transfer length of stay. However, its impact on diagnosis and mortality remains unclear.</p><p><strong>Conclusions: </strong>Telemedicine's potential to enhance the quality and efficiency of trauma care, especially for resource-scarce areas, warrants continued quantitative research.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3284-3293"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-Layer Interrupted Spoke Wheel Suture Pancreaticojejunostomy: A Safe and Reliable Anastomosis Technique After Pancreaticoduodenectomy.","authors":"Somak Das, Jayanta Biswas, Somdatta Lahiri, Sreecheta Mukherjee","doi":"10.1177/00031348241265141","DOIUrl":"10.1177/00031348241265141","url":null,"abstract":"","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3305-3308"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141730978","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Appendicitis in the Neutropenic Patient: A Systematic Review.","authors":"Tomasz Kasprzycki, Melissa Devito, Nancy Pina, David Winston, Marium Gul-Muhammad, Robert Joyner, Gopal Kowdley","doi":"10.1177/00031348241265136","DOIUrl":"10.1177/00031348241265136","url":null,"abstract":"<p><p>Neutropenia increases the complexity of surgical decision-making in cases of acute appendicitis. In this systematic review, we discuss medical vs surgical management and timing of appendectomy in the neutropenic adult patient. We queried databases utilizing the key words \"neutropenia\" and \"appendicitis.\" The search identified 999 articles of which 481 articles were reviewed after duplicates were removed. Studies with pediatric patients, single case studies, and abdominal pain in neutropenic patients not caused by appendicitis were excluded. Seven studies remained in this review accounting for 130 patients, of which 28 were diagnosed with neutropenic appendicitis, and were included for final analysis. Four of the 7 articles were case reports, demonstrating the relative paucity of literature on this subject. Studies referred to the high risk of morbidity and mortality after surgical intervention in the neutropenic population, and attempting medical management first was common but not universal, reserving appendectomy for failure of medical management. Three studies suggested medical therapy as first-line management while 2 studies suggested surgical management and 2 studies did not distinguish a precedence. Both medical and surgical management have been successfully used in treating appendicitis in neutropenic patients. In most patients, medical management was attempted first (n = 16/28) vs immediate appendectomy (n = 7/28). Appendectomy was performed when medical management failed (n = 2/28) or after correction of neutropenia (n = 1/28). Timing or performance of appendectomy was unclear in 2 patients. With the increasing use of immunosuppressive medications, broad-spectrum antibiotics, and recent data from the CODA (Comparison of Outcomes of Antibiotic Drugs and Appendectomy) trial, medical management as a first-line treatment for most patients with neutropenia and appendicitis is warranted, and identifying a protocol for such patients would be of value.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3267-3271"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-Injury Statin Exposure is Associated With Improved Outcomes in Injured Patients That Receive Whole Blood.","authors":"Gregory R Stettler, Bethany Bouldin, Kristin A Rebo, Mohamed-Omar S Arafeh, Samuel P Carmichael, Nathan T Mowery, Andrew M Nunn","doi":"10.1177/00031348241265142","DOIUrl":"10.1177/00031348241265142","url":null,"abstract":"<p><p><b>Introduction:</b> Whole blood (WB) is associated with improved mortality while lowering blood product utilization. Furthermore, statin medications are associated with favorable outcomes in traumatic brain injury and risk reduction of venous thromboembolism. However, the use of statin medications has not been evaluated in those receiving WB. The objective of this study is to determine the effects of pre-injury statin exposure on patients receiving WB.<b>Methods:</b> Patients that underwent WB first resuscitation and received pre-injury statins were compared to those that did not receive pre-injury statins. Demographics as well as complication rates, blood product transfusion volumes, and mortality were evaluated. Univariate and multivariable analyses were used to determine independent predictors of mortality.<b>Results:</b> In the study period, 785 patients received WB as part of their resuscitation. One hundred and thirty five patients (17.3%) took statin medications prior to injury. Patients that were exposed to a pre-injury statin had a lower mortality rate than those that were not exposed (21.5% vs 32.5%, <i>P</i> = .01). After adjusting for imbalances, age, ISS, Glasgow Coma Scale, admission systolic blood pressures, and pre-injury statin use were independent predictors of mortality following multiple logistic regression. When evaluating outcomes based on statin intensity, the use of high-intensity statins was associated with lower mortality (OR: .37, 95% CI: .13-.93), whereas moderate and low-intensity statins were not.<b>Conclusion:</b> In patients resuscitated with WB, pre-injury statins use was associated with improved outcomes. Specifically, patients that received high-intensity pre-injury statins appeared to be the population that benefited.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3229-3234"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141733360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bibliometric Insight Into Thyroid Cancer Research: A Comprehensive Review and Future Directions.","authors":"Christopher Wu, Sellers Swann, Michelle Holland, Julia A Kasmirski, Quince-Xhosa D Gibson, Jessica Fazendin, Herbert Chen, Andrea Gillis","doi":"10.1177/00031348241268124","DOIUrl":"10.1177/00031348241268124","url":null,"abstract":"<p><strong>Introduction: </strong>In the past 3 decades, thyroid cancer research has surged, becoming the leading topic in clinical thyroidology. Despite this, there's a lack of data identifying key articles, authors, and journals. This study aims to provide insights for authors, physicians, and research labs by highlighting the most influential journals, authors, and research topics in thyroid cancer.</p><p><strong>Methods: </strong>A comprehensive search was conducted using the Scopus database, employing the medical subject heading (MeSH) terms \"Thyroid\" and \"Cancer\" in the titles, abstracts, or keywords of articles. The search was limited to English articles in academic medicine journals published between January 1993 and December 2021.</p><p><strong>Results: </strong>The search yielded 21 472 articles across 3076 journals, authored by 13 974 senior authors. The number of journals publishing on thyroid cancer expanded from 29 in 1993 to 733 in 2021, marking an average annual growth of 14%. Article output on the topic increased from 54 in the initial year to 1580 by 2021, with an annual growth rate of 16%. A thematic analysis revealed 369 articles mentioning \"BRAF\" since 2004, 479 articles on \"ultrasound\" techniques, 325 on \"ablation\" methods, and 453 articles focusing on \"genetics\" in thyroid cancer. <i>The Journal of Clinical Endocrinology and Metabolism</i> emerged as the most prolific, publishing 1017 articles over the 29-year period.</p><p><strong>Conclusion: </strong>This study guides resource allocation towards impactful journals for thyroid cancer researchers, helps identify key contributors for collaboration or mentorship, and provides a framework for similar analyses in other fields.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3244-3252"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141764885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical Care Through a Community Free Clinic-Ambulatory Surgical Center Partnership.","authors":"Flora S Park, Jonathan C Pang, Christopher D Yang, Dalia Breziner, Karlos O Manzanarez-Felix, Juan Pablo Hoyos, Andres M Ruiz, Claudia A Alvarez, Lourdes Y Swentek, Theresa L Chin","doi":"10.1177/00031348241262433","DOIUrl":"10.1177/00031348241262433","url":null,"abstract":"<p><strong>Background: </strong>Disparities secondary to underinsurance present throughout the surgical care continuum. Community free clinics are uniquely capable to provide health care services to the medically underserved, but surgery often falls outside their scope of care.</p><p><strong>Methods: </strong>Retrospective chart review was conducted on consecutive community free clinic patients receiving free surgical services via referral to a partnering ambulatory surgery center between March 2016 and September 2021. Those with documented contact information were recruited 1-3 years post-procedure for long-term quality-of-life (LTQOL) outcomes assessment via modified Veterans RAND 12-item health survey.</p><p><strong>Results: </strong>Of 142 included patients, 95.7% identified as Hispanic/Latino and 75.6% were uninsured. Twelve patients had cancerous or precancerous lesions detected and/or removed through diagnostic or definitive procedures. 3.5% experienced postoperative complication including bacterial (n = 2) or fungal (n = 1) surgical site infection and wound dehiscence (n = 2). With a 48.9% response rate, no significant differences in sociodemographic or clinical characteristics were found between surveyed vs non-surveyed patients. Of surveyed patients, 59.7% and 52.2% reported pre-/post-operative improvement in physical health and emotional health, respectively.</p><p><strong>Discussion: </strong>Free diagnostic screening procedures provided timely diagnoses while free definitive surgeries safely and positively impacted long-term patient-reported physical health. Longitudinal, multidisciplinary follow-up and social support may be warranted to concurrently improve emotional and mental health in similarly underinsured populations.</p>","PeriodicalId":7782,"journal":{"name":"American Surgeon","volume":" ","pages":"3193-3200"},"PeriodicalIF":1.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141722828","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}