Surgical treatment of melanoma patients with early sentinel node involvement.

Sentinel lymph node biopsy (SLNB) is a standard staging procedure for many patients with clinically node negative, invasive melanoma, providing excellent prognostic information in appropriately selected patients. The broad acceptance of SLNB into clinical practice has resulted in substantial numbers of patients found to have microscopic nodal metastases. For patients with a positive sentinel node, a completion lymph node dissection (CLND) is the current standard of care.

Experience with dedicated geriatric surgical consult services: meeting the need for surgery in the frail elderly.

Background: Surgeons are increasingly faced with consultation for intervention in residents of geriatric centers or in patients who suffer from end stage medical disease. We review our experience with consult services dedicated to the needs of these frail patients.

Study Design: Patients were prospectively followed after being evaluated by three different geriatric surgical consult services: Group 1 was based at a geriatric center associated with a tertiary medical center, Group 2 was based at a community geriatric center, and Group 3 was based with an hospital-based service for ambulatory patients with end stage congestive heart failure.

Invasive amebiasis and ameboma formation presenting as a rectal mass: An uncommon case of malignant masquerade at a western medical center.

A 54-year-old man presented with rectal pain and bleeding secondary to ulcerated, necrotic rectal and cecal masses that resembled colorectal carcinoma upon colonoscopy. These masses were later determined to be benign amebomas caused by invasive Entamoeba histolytica, which regressed completely with medical therapy. In Western countries, the occurrence of invasive protozoan infection with formation of amebomas is very rare and can mistakenly masquerade as a neoplasm.

Treatment of symptomatic vascular rings in the elderly.

A 76-year-old woman presented with respiratory failure that was later determined to be a result of a right aortic arch with an aberrant left brachiocephalic artery. This vascular ring compressed the trachea, requiring operative intervention. A median sternotomy gave access for an aorta-to-left brachiocephalic artery bypass and division of the vascular ring.

Surgery in the elderly: the evolving role of palliative care in general surgical practice.

Palliative care will continue to be an evolving part of general surgical practices, especially with an expanding elderly population. The challenge to a surgeon remains, namely, understanding when palliation is a better alternative to aggressive therapeutic measures. The transition from curative intervention to palliative care is aided by honest communication between physician and patient and respect for dying with dignity.