New models and online calculator for predicting non-sentinel lymph node status in sentinel lymph node positive breast cancer patients.

Background: Current practice is to perform a completion axillary lymph node dissection (ALND) for breast cancer patients with tumor-involved sentinel lymph nodes (SLNs), although fewer than half will have non-sentinel node (NSLN) metastasis. Our goal was to develop new models to quantify the risk of NSLN metastasis in SLN-positive patients and to compare predictive capabilities to another widely used model.

Methods: We constructed three models to predict NSLN status: recursive partitioning with receiver operating characteristic curves (RP-ROC), boosted Classification and Regression Trees (CART), and multivariate logistic regression (MLR) informed by CART.

Are patients who have had a tracheoesophageal fistula repair during infancy at risk for esophageal adenocarcinoma during adulthood?

The authors present a case of a 46-year-old woman who had esophageal adenocarcinoma after having had a tracheoesophageal fistula (TEF) repair as an infant. A Medline search, which identified 2 other patients in the world literature who developed esophageal cancer (squamous cell carcinoma [J Pediatr Surg 36(4) (2001) 629-630] and adenocarcinoma [J Pediatr Surg 24(8) (1989) 741-744]) after TEF repair, was performed. As such patients reach middle age, it is possible that they are at increased risk for the development of esophageal cancer.

Laparoscopic suturing and knot tying: a comparison of standard techniques to a mechanical assist device.

Background: Suturing and knot tying are basic skills for surgeons. Performing these tasks laparoscopically can be a tedious, time-consuming endeavor associated with much frustration. We evaluated a mechanically assisted suture and pretied knot device (Quik-Stitch) for performing the basic tasks of suturing and knot tying.

Hand-assisted laparoscopic splenectomy: indications and technique.

Introduction: Laparoscopic splenectomy has become the procedure of choice for those patients who need to have a splenectomy. The skills required to perform a laparoscopic splenectomy are not easy to learn and therefore may limit the availability of this procedure to patients.

Methods: We present a hand-assisted technique that allows the performance of a laparoscopic splenectomy safely and rapidly by surgeons without a great deal of experience with this procedure.

Laparoscopic management of superior mesenteric artery syndrome.

Objectives: The differential diagnosis of intestinal obstruction includes mechanical obstruction, obstruction secondary to systemic disease, and idiopathic intestinal pseudo-obstruction. The causes of these are extensive; however, the majority of cases involve a mechanical cause. Superior mesenteric artery syndrome (SMAS) is a rare and controversial form of mechanical obstruction with just over 300 well-defined cases described in the literature.