Percutaneous embolization of thoracic duct injury post-esophagectomy should be considered initial treatment for chylothorax before proceeding with open re-exploration.

Background: Post-esophagectomy patients who develop high-output chylous fistula and chylothorax can be successfully treated with percutaneous ablation thereby avoiding reoperation.

Methods: Five patients with refractory chylous fistula post-esophagectomy were treated with percutaneous embolization. Fistula outputs, evaluation of lymphatic access sites, agents used and additional procedures were analyzed.

Surgical repair of pulmonary artery sling in an adult.

Pulmonary artery sling is a rare congenital vascular anomaly that typically presents in the first month of life with severe respiratory symptoms. In this condition, the left pulmonary artery originates off the right pulmonary artery and courses between the trachea and esophagus, causing compression of both structures. Of those patients with pulmonary artery sling, a small subset survives to adulthood with few or no symptoms.

The effect of abdominal binders on postoperative pulmonary function.

Abdominal binders are ordered by some surgeons postoperatively for patient comfort and to prevent wound complications. There has been some question as to the compressive effect that an abdominal binder has on pulmonary function. We prospectively randomized 54 patients undergoing a midline laparotomy incision to two groups: a "binder" group and a "no binder" group.

Laparoscopic management of the wandering spleen.

Wandering spleen is a rare clinical condition associated with a high incidence of splenic torsion and infarction. The preferred treatment for this condition is splenopexy to reposition the spleen in the left upper quadrant of the abdomen and to preserve splenic function. We present two cases of wandering spleen managed by laparoscopic splenopexy.

Atypical ductal hyperplasia of the breast diagnosed by 11-gauge directional vacuum-assisted biopsy.

Background: Small nonpalpable mammographic abnormalities are frequently diagnosed by percutaneous stereotactically guided core needle biopsy. The reliability of the histologic diagnosis of atypical ductal hyperplasia (ADH) made from tissue obtained by 11-gauge directional, vacuum-assisted biopsy of these nonpalpable breast lesions is unknown.

Methods: The records of 31 patients who were found to have ADH by 11-gauge directional vacuum-assisted biopsy were reviewed.

Risk of needle-track seeding after diagnostic image-guided core needle biopsy in breast cancer.

Objective: Image-guided core needle biopsy (IGCNB) is an accepted technique for sampling nonpalpable mammographically detected suspicious breast lesions. However, the concern for needle-track seeding in malignant lesions remains. An alternative to IGCNB is needle-localization breast biopsy (NLBB).

Prophylactic antibiotics are not indicated in clean general surgery cases.

Background: In assigning risk of infection, the traditional wound classification system has been replaced by the National Nosocomial Infection Surveillance (NNIS) system. NNIS classification is determined by procedure length, wound cleanliness, and ASA status. To date, no prophylactic antibiotic guidelines have been proposed for the NNIS system.

Does peer-reviewed publication change the habits of surgeons?

Background: From April 1994 to December 1995 a prospective randomized trial was conducted at our institution comparing outcomes of laparoscopic and open appendectomy. It demonstrated no significant advantage to laparoscopic appendectomy. Our current study evaluates whether surgeon's habits at our hospital have been influenced by our previously published study.

Recurrent common bile duct stones containing metallic clips following laparoscopic common bile duct exploration.

A case of recurrent common bile duct stones 2 years following laparoscopic cholecystectomy and laparoscopic common bile duct exploration in a 52-year-old man is reported. Surgical material as a nidus for recurrent stone formation has been reported and occurred in the present case. Factors influencing metallic clip migration after biliary surgery are discussed, with recommendations for decreasing recurrent stones caused by foreign material.

Prophylactic antibiotics for elective laparoscopic cholecystectomy: are they necessary?

Hypothesis: Prophylactic antibiotic treatment in elective laparoscopic cholecystectomy does not lower the already low infection rate associated with this procedure.

Design And Setting: Prospective double-blind randomized trial at a community-based training hospital.

Patients: Four hundred fifty patients undergoing elective laparoscopic cholecystectomy were randomized into 1 of 3 treatment arms: (1) preoperative cefotetan disodium, 1g intravenously; (2) preoperative cefazolin, 1g intravenously; and (3) intravenous placebo.

Laparoscopic colon surgery for benign disease: a comparison to open surgery.

Backgrounds And Objectives: There remains a debate in the literature about the advisability of laparoscopic surgery for malignant disease of the colon. Current prospective studies will hopefully answer this question. However, for benign diseases of the colon, we believe laparoscopic surgery offers many advantages including decreased postoperative pain, early discharge from the hospital, and early return to normal activities.

Laparoscopic paraesophageal hernia repair.

Background And Objective: Paraesophageal hernias are uncommon yet potentially lethal conditions. Their repair has now been facilitated by laparoscopic technology. We present a series of 20 patients with paraesophageal hernias repaired laparoscopically.

Supplemental dietary arginine accelerates intestinal mucosal regeneration and enhances bacterial clearance following radiation enteritis in rats.

Background: Arginine is a dibasic amino acid with significant metabolic and immunologic, effects especially in trauma and stress situations. Arginine supplementation has been shown to promote wound healing and improve immune system. We designed a study to evaluate the effects of supplemental dietary arginine on intestinal mucosal recovery and bacterial translocation and bacterial clearance after induction of radiation injury in rats.

Use of fine needle aspiration for solid breast lesions is accurate and cost-effective.

Background: Palpable breast tumors have traditionally been diagnosed with open biopsy or core biopsy. We propose fine needle aspiration biopsy (FNA) as a reliable, cost-saving initial procedure in these patients.

Methods: Eighty-five palpable solid breast masses of the breast in 85 patients were classified by a combination of physical examination, mammography, and/or ultrasound as probably benign, indeterminate, or highly suspicious for cancer.

Thoracoscopic excision of mediastinal parathyroid adenomas: a report of two cases and review of the literature.

Background: Most abnormal parathyroid glands can be removed through a standard cervical incision; even those in the superior mediastinum. Those located in certain areas of the mediastinum, for example posteriorly or in the aortopulmonic window, historically have required excision through a median sternotomy or thoracotomy. Angioablation is a nonsurgical alternative to management of these lesions.

Laparoscopic vs open appendectomy. Prospective randomized study of outcomes.

Objective: To compare open appendectomy (OA) with laparoscopic appendectomy (LA) for length of the operation, complications, postoperative pain control, length of hospitalization, postdischarge recovery time, and hospital charges.

Design: Prospective randomized clinical trial of patients with acute appendicitis.

Setting: Tertiary care, urban teaching hospital.

Axillary lymph node dissection: is it required in T1a breast cancer?

Background: Several authors have questioned the need for axillary lymph node dissection in T1a breast cancer (primary tumors 5 mm or less in diameter), although current practice typically includes routine axillary lymph node dissection.

Study Design: We retrospectively reviewed the records of 2,242 breast cancers in our tumor registries from 1987 to 1994. The incidence of axillary lymph node metastases was determined according to primary breast cancer size.