Impact of hospital and surgeon volumes in the management of complicated portal hypertension: review of a statewide database in Florida.

Mortality after complex surgical procedures has been shown to be inversely related to hospital volume. The purpose of this study was to determine whether these findings are applicable to radiologic and surgical procedures for complicated portal hypertension. The Agency for Healthcare Administration for the State of Florida database was queried to determine outcomes after transjugular intrahepatic stent shunts (TIPS) or surgical shunts from 2000 to 2003.

Inflammatory myofibroblastic tumor of the midesophagus.

An inflammatory myofibroblastic tumor (IMFT) is a rare entity that can arise in a multiplicity of organs including the lung, liver, and at any location within the gastrointestinal tract. Typically, an IMFT presents as a localized mass with clinical symptoms dependent upon its site of origin. IMFTs pathologically resemble a neoplastic process but are theorized to arise from an unknown inflammatory event.

Laparoscopic cholecystectomy: past, present, and future.

Laparoscopic cholecystectomy is one of the most commonly undertaken procedures in General Surgery with more than 500,000 performed annually. Overall, the complication rate is less than 1.5%, and the mortality rate is less than 0.

Differential gene expression in patients genetically predisposed to pancreatic cancer.

Background: Nearly 10% of all pancreatic cancer (PCA) results from genetic predisposition. Although abnormalities in sporadic PCA have been described, little is known about the genetics of heritable PCA. The purpose of this study was to identify novel genes expressed in patients with a presumed genetic predisposition or "familial" PCA.

A complication-free course ensures a survival advantage in patients after regional therapy for metastatic colorectal cancer.

Hepatic artery infusional (HAI) chemotherapy has been shown to favorably impact outcome in patients with metastatic colorectal cancer, but complications often preclude complete treatment. The purpose of this study was to determine whether HAI complications impact survival in these patients. Patients undergoing HAI pump placement at our institution from September 2001 to July 2004 were separated into terciles based on the number of treatments completed: < or = 1 (none), 2 to 4 (partial), and > or = 5 (complete).

EGF receptor antagonism improves survival in a murine model of pancreatic adenocarcinoma.

Introduction: The purpose of this study was to determine whether inhibition of the epidermal growth factor receptor (EGFR) is a plausible therapeutic strategy in pancreatic cancer.

Methods: A human pancreatic cancer cell line (HPAC) was evaluated for the presence of EGFR with rtPCR and immunohistochemistry. Cells were grown in the presence of either 50 or 100 microM of erlotinib (EGFRI) for 72 hours and evaluated using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay.

Prognostic significance of new onset ascites in patients with pancreatic cancer.

Background: The purpose of this study was to determine risk factors for development of malignant ascites and its prognostic significance in patients with pancreatic cancer.

Methods: A prospective database was queried to identify patients with pancreatic cancer who develop ascites. Stage at presentation, size, and location of primary tumor, treatment received and length of survival after onset of ascites were determined.

Improved outcome with cytoreduction versus embolization for symptomatic hepatic metastases of carcinoid and neuroendocrine tumors.

Background: Few data exist regarding outcomes after resection versus embolic treatment of symptomatic metastatic carcinoid and neuroendocrine tumors. The purpose of this study was to determine whether cytoreduction provides any benefit over embolic management of diffuse neuroendocrine tumors.

Methods: A prospective database of 734 patients treated at our institution was retrospectively queried for symptomatic metastatic tumors treated with embolization or cytoreduction.

Stage does not predict survival after resection of hilar cholangiocarcinomas promoting an aggressive operative approach.

Introduction: Staging systems have been developed to predict survival after resection of hilar cholangiocarcinoma. Notably, they have not been validated nor compared for relative predictive ability.

Methods: Forty-two patients underwent resection of hilar cholangiocarcinoma and have been followed through a prospectively collected database.

Twenty-millimeter laparoscopic cholecystectomy: fewer ports results in less pain, shorter hospitalization, and faster recovery.

Improvements in technology offer the ability to refine operations without compromising safety. In this study, we determine whether a modified method of laparoscopic cholecystectomy using three ports and an aggregate incision length of 20 mm offers any advantage or poses increased risk. Using a 5-mm, 30 degree laparoscope, clip applier, and dissector, the gall bladder is removed through an extended umbilical incision.