Minimally invasive evaluation and treatment of colorectal liver metastases.

Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR).

Outcome based on management for duodenal adenomas: sporadic versus familial disease.

Introduction: Management and outcomes for duodenal adenomas may vary based on etiology, familial versus sporadic. We reviewed the records of patients managed at our institution for duodenal adenomatous polyps for the 20-year period ending July 2006.

Discussion: Methods of polyp resection (endoscopic, local surgical resection, or definitive surgical resection) within both sporadic and familial patient groups were compared.

Pancreas-sparing duodenectomy is effective management for familial adenomatous polyposis.

Duodenal adenocarcinoma remains the leading cause of cancer death in familial adenomatous polyposis patients following colectomy. Stratification based on Spigelman's criteria provides a means for determining therapy. Spigelman stage IV patients have been selected for pancreas-sparing duodenectomy.

Percutaneous transesophageal gastrostomy tube for decompression of malignant obstruction: report of the first case and our series in the US.

Background: Historically, surgical gastrostomies, gastrojejunostomy, and percutaneous endoscopic gastrostomy have been used palliatively. Recently, enteral stenting has also provided a means of reestablishing gastrointestinal flow in proximal and colonic obstructions.

Study Design: Seven patients with known intraabdominal malignancy leading to gastrointestinal obstruction were evaluated for PTEG.

Subxiphoid incisional hernias after median sternotomy.

Background: Subxiphoid hernias are difficult to repair. This study attempts to identify risk factors associated with incisional hernia formation after median sternotomy.

Study Design: A retrospective review was conducted on patients undergoing subxiphoid incisional hernia repair between 1995 and 2002.

Prospective evaluation of sestamibi scan, ultrasonography, and rapid PTH to predict the success of limited exploration for sporadic primary hyperparathyroidism.

Background: The aim of this study was to determine the ability of localizing studies and rapid intraoperative parathyroid hormone (PTH) to predict the success of a limited approach in patients who then underwent bilateral exploration.

Methods: Preoperative sestamibi-iodine subtraction scan and neck ultrasonography (US) were used to direct a focal (1-gland) and unilateral (1-sided) parathyroid exploration by using rapid intraoperative PTH determinations in 350 patients with sporadic primary hyperparathyroidism. Regardless of the findings, the contralateral side was then explored.

Relational factors in understanding satisfaction in the lasting relationships of same sex and heterosexual couples.

Satisfying relationships are important to the well-being of individuals and families. Because of increased longevity, many couples are staying together for extended periods of time. Thus, it is valuable to understand the factors that contribute to a sense of satisfaction among partners in lasting relationships.