Fertility-sparing surgery for advanced juvenile granulosa cell tumor of the ovary.

Background: Juvenile granulosa cell tumors (JGCT) of the ovary are rare. They usually present in children and adolescents. About 90% are diagnosed in early stage (FIGO I) with a favorable prognosis.

Proper catheter selection for needle thoracostomy: a height and weight-based criteria.

Background: Obesity increases the incidence of mortality in trauma patients. Current Advanced Trauma Life Support guidelines recommend using a 5-cm catheter at the second intercostal (ICS) space in the mid-clavicular line to treat tension pneumothoraces. Our study purpose was to determine whether body mass index (BMI) predicted the catheter length needed for needle thoracostomy.

An evaluation of hernia education in surgical residency programs.

Purpose: The purpose of this study was to evaluate surgical residents' educational experience related to ventral hernias.

Methods: A 16-question survey was sent to all program coordinators to distribute to their residents. Consent was obtained following a short introduction of the purpose of the survey.

Teaching cholangiography in a surgical residency program.

Objective: To evaluate the time associated with routine cholangiography in a residency teaching program.

Design: We retrospectively reviewed all patients undergoing laparoscopic cholecystectomy with intraoperative cholangiography by a single surgeon from April 2010 to September 2011. Cholangiogram time, demographic, and operative information was recorded, and factors associated with increased cholangiogram times were compared using Fisher's exact test, Kruskal-Wallis test, and linear regression; a p value <0.

Assessing resident performance and training of colonoscopy in a general surgery training program.

Background: Recently, the adequacy of endoscopy training in general surgery residency programs has been questioned. Efforts to improve resident endoscopic training and to judge competency are ongoing but not well studied. We assessed resident performance using two assessment tools in colonoscopy in a general surgery residency program.

Solid organ injury grading in trauma: accuracy of grading by surgical residents.

The American Association for the Surgery of Trauma developed an Organ Injury Scale for management of patients with splenic, kidney, or liver injuries. Despite widespread use of the guidelines, the person who determines the injury grade varies among institutions. Our purpose was to determine the accuracy and interobserver agreement between surgical residents and a radiologist in grading solid organ injuries.

Non-operative management in penetrating abdominal trauma: is it feasible at a Level II trauma center?

Background: The recent mandate for surgical exploration for all penetrating abdominal trauma has been questioned. High-volume centers report good outcomes for non-operative treatment in penetrating trauma for hemodynamically stable patients without peritonitis and with tangential wounds. The applicability of this strategy in smaller hospitals is unknown.

After-hours urgent and emergent surgery in the elderly: outcomes and prognostic factors.

Surgeons are becoming increasingly involved in the care of elderly patients. The purpose of this project was to evaluate contemporary outcomes of emergent surgeries performed after hours in elderly patients and to determine any risk factors for poor outcome. We retrospectively reviewed patients 80 years or older undergoing an urgent or emergent surgery at our medical center from 6 pm to 6 am from October 2006 through July 2009.

Use of laparoscopy in trauma at a level II trauma center.

Background And Objectives: Enthusiasm for the use of laparoscopy in trauma has not rivaled that for general surgery. The purpose of this study was to evaluate our experience with laparoscopy at a level II trauma center.

Methods: A retrospective review of all trauma patients undergoing diagnostic or therapeutic laparoscopy was performed from January 2004 to July 2010.

Micropapillary thyroid carcinoma and concomitant ectopic thyroid tissue in the adrenal gland: metastasis or metaplasia?

Background: Ectopic thyroid tissue is a rare finding but has been reported in many thoracic and abdominal locations. It is usually an incidental pathologic finding after an unrelated surgical intervention. When thyroid tissue is found outside the thyroid bed, it is important to rule out thyroid cancer metastasis.

Resident case coverage in the era of the 80-hour workweek.

Objectives: The purpose of our study was to evaluate resident case coverage before and after the implementation of duty-hour restrictions and discuss its potential impact on surgical attendings.

Design: We reviewed cases before (6/2002 to 6/2003) and after (6/2008 to 6/2009) the implementation of duty-hour restrictions, retrospectively.

Setting: Academic-affiliated community surgical residency program.

An evaluation of snake bites and antivenin use at a regional medical center.

Snake bites are a rare but challenging problem for surgeons. The purpose of our study was to evaluate our experience with snake bites at a regional medical center. We reviewed patients treated for snake bites from 2004 to July 2008.

Abdominal wall closure: resident education and human error.

Purpose: Secure abdominal wall closure for laparotomy incisions is paramount in prevention of hernia formation. Despite the importance, abdominal closure is often delegated to the resident surgeon. The purpose of this study was to assess residents' formal training, knowledge, and technique in abdominal wall closure.

The eighty-hour workweek: surgical attendings' perspectives.

Objective: The year 2008 was a sentinel year in resident education; this was the first graduating general surgery class trained entirely under the 80-hour workweek. The purpose of this study was to evaluate attending surgeon perceptions of surgical resident attitudes and performance before and after duty-hour restrictions.

Design: An electronic survey was sent to all surgical teaching institutions in North Carolina.

Employment and satisfaction trends among general surgery residents from a community hospital.

Background: Physician satisfaction is an important and timely issue in health care. A paucity of literature addresses this question among general surgeons.

Purpose: To review employment patterns and job satisfaction among general surgery residents from a single university-affiliated institution.

Relationship between initial margin status for invasive breast cancer and residual carcinoma after re-excision.

Little data exists addressing the relationship between initial margin status in a specimen from an excisional biopsy and the presence of residual carcinoma in a subsequent specimen from lumpectomy or mastectomy. We sought to determine the relationship between initial margin status and the presence of residual invasive cancer, and to identify any relationship to other variables. This study was a retrospective review of pathology reports of 582 early-stage invasive duct carcinomas with open excisional biopsies.

A preliminary study of imiquimod treatment in variants of basal cell carcinoma.

Imiquimod is a topical immune response modifier that has proved efficacious in the treatment of the superficial variant of basal cell carcinoma. The nodular variant of basal cell carcinoma has shown moderate response to imiquimod; other variants have not been tested. The mechanism of action is largely unknown; however, studies indicate the mechanism involves alteration of local cytokine production.

Toxic cure: Hyperfractionated radiotherapy with concurrent cisplatin and fluorouracil for Stage III and IVA head-and-neck cancer in the community.

Purpose: To evaluate efficacy and toxicity of the Duke University chemoirradiation regimen for locally advanced head-and-neck cancer in a regional community cancer center.

Methods And Materials: Between June 1998 and June 2002, 50 patients with Stage III or IVA squamous cell carcinoma of the head and neck were treated definitively with concurrent combined modality therapy (CMT). Patients received accelerated, hyperfractionated radiotherapy (AFRT), 1.

Carotid body tumor excisions: adverse outcomes of adding carotid endarterectomy.

Background: Carotid body tumors (CBT) are rare, infrequently malignant vascular neoplasms that are near the carotid bifurcation. Surgical excision is the treatment of choice, but individual surgeons or an institution cannot accumulate sufficient expertise to evaluate their outcomes with confidence. Our purpose was to report outcomes of surgical procedures for CBT from a nationwide dataset.

Local and national trends over a decade in the surgical treatment of ductal carcinoma in situ.

Background: Ductal cancer in situ (DCIS) is an increasingly frequent diagnosis in breast cancer, and management continues to challenge surgeons and oncologists. The purpose of our study was to examine local and national rates of breast conservation surgery and breast reconstruction surgery and to explore patient and surgeon factors associated with the procedures.

Methods: Review of the 1,342 patients in our institutional breast cancer database yielded 211 patients with DCIS.

Prognostic indices in breast cancer are related to race.

African-American (AA) women have a higher mortality from breast cancer than Caucasians (C). This may be attributed to stage of disease at presentation, but specific prognostic factors are not well identified. We sought to identify prognostic factors in our database of early-stage (stage I and II) breast cancer from 1990 to 1999.

National estimates of mortality rates for radical pancreaticoduodenectomy in 25,000 patients.

Background: Recent publications suggest an inverse relationship between mortality rates in the Whipple procedure for periampullary cancer and hospital volume/teaching status.

Methods: The Nationwide Inpatient Sample database from 1988 to 1995, containing 24926 patients undergoing pancreatectomy for periampullary cancer, was used.

Results: The mean number of procedures per hospital per year was 1.