Applications of Narrative Medicine to Surgical Education.

Narrative medicine describes the application of story to medical education and practice. Although it has been implemented successfully in many medical schools as a part of undergraduate medical education, applications to the residency environment have been relatively limited. There are virtually no data concerning the adoption of narrative medicine within surgical residencies.

Lymphedema following breast cancer: The importance of surgical methods and obesity.

Background: Breast cancer-related arm lymphedema is a serious complication that can adversely affect quality of life. Identifying risk factors that contribute to the development of lymphedema is vital for identifying avenues for prevention. The aim of this study was to examine the association between the development of arm lymphedema and both treatment and personal (e.

Intraoperative Radiotherapy for Breast Cancer Treatment in a Rural Community.

Background: Access to health care poses particular challenges for patients living in rural communities. Intraoperative radiotherapy (IORT) offers a treatment alternative to traditional whole-breast radiation therapy (WBRT) for select patients. This study aimed to analyze the use of IORT for patients undergoing breast-conserving surgery at an academic institution located in a rural state.

Review of risk factors for the development of contralateral breast cancer.

Background: Women treated for breast cancer have an increased risk for developing metachronous contralateral breast cancer (CBC). Patient perception of this risk is often overestimated and has been found to contribute to the decision to undergo contralateral prophylactic mastectomy. An individual's risk is dependent on both patient and tumor characteristics.

Management of contralateral axillary sentinel lymph nodes detected on lymphoscintigraphy for breast cancer.

Background: Detection of a contralateral axillary sentinel lymph node (SLN) during lymphoscintigraphy for breast cancer is rare, and its significance and management are unclear. The purpose of this study was to review our experience and analyze our results together with similar patients in the literature to identify common characteristics and propose a management strategy.

Methods: A PubMed search was performed for articles describing patients in whom contralateral axillary drainage was identified on lymphoscintigraphy.

The response to neoadjuvant chemotherapy predicts clinical outcome and increases breast conservation in advanced breast cancer.

Background: The aim of this study was to determine outcomes in patients with breast cancer treated with neoadjuvant chemotherapy.

Methods: Seventy-two consecutive patients receiving neoadjuvant chemotherapy for breast cancer were enrolled.

Results: Mastectomy was avoided in 46% of patients, and 42% converted to negative nodes after neoadjuvant chemotherapy.

Effect of introducing hematoma ultrasound-guided lumpectomy in a surgical practice.

Background: Preoperative needle localization (NL) is the gold standard for lumpectomy of nonpalpable breast cancer. Hematoma ultrasound-guided (HUG) lumpectomy can offer several advantages. The purpose of this study was to compare the use of HUG with NL lumpectomy in a single surgical practice.

Sampling of secondary margins decreases the need for re-excision after partial mastectomy.

Background: We analyzed factors that influenced the need for re-excision after partial mastectomy.

Methods: We conducted a retrospective study of 470 breast cancer patients treated with partial mastectomy with main outcome measures of re-excision, conversion to mastectomy, and recurrence.

Results: Of 470 patients, 146 (31%) underwent re-excision for inadequate margins and 42 (8.

Management of pregnant women with breast cancer.

Pregnancy complicates the diagnosis and treatment of breast cancer. Surgical treatment options of mastectomy or breast-conservation can be used as for non-pregnant patients. Sentinel lymph node biopsy can be safely used with lymphoscintigraphy.

Chair of surgery.

There are several essential qualities required for success as a chair of surgery. These include determination and resilience, thoughtful planning, superb organization skills, a balance of hard (accounting, management and finance) and soft skills (interpersonal including faculty development), and careful execution is absolutely essential as is a commitment to maintaining momentum.

Risk factors for development and recurrence of primary breast abscesses.

Background: We investigated risk factors that predispose to the development of primary breast abscesses and subsequent recurrence.

Study Design: This was a case control study of patients with a primary or recurrent breast abscess, with recurrence defined by the need for repeated drainage within 6 months.

Results: Sixty-eight patients with a primary breast abscess were identified.

The use of touch preparation for the evaluation of sentinel lymph nodes in breast cancer.

Background: This study was undertaken to evaluate the accuracy of touch preparation (touch prep) in the evaluation of sentinel lymph nodes (SLNs).

Methods: We performed a retrospective review of 402 breast cancer patients who underwent SLN biopsy.

Results: A SLN was identified in 381 patients.

A single institutional experience of factors affecting successful identification of sentinel lymph node in breast cancer patients.

Background: Sentinel lymph node biopsy (SLNB) has become the standard of care in axillary staging of clinically node-negative breast cancer patients. We hypothesized that certain clinical parameters are associated with failure to identify a SLN.

Methods: We performed an institutional review board-approved, retrospective analysis of 402 consecutive breast cancer patients who underwent SLNB from 2000 to 2007.

The risk of developing arm lymphedema among breast cancer survivors: a meta-analysis of treatment factors.

Background: As more women survive breast cancer, long-term complications that affect quality of life, such as lymphedema of the arm, gain greater importance. Numerous studies have attempted to identify treatment and prognostic factors for arm lymphedema, yet the magnitude of these associations remains inconsistent.

Methods: A PubMed search was conducted through January 2008 to locate articles on lymphedema and treatment factors after breast cancer diagnosis.

Measurement of uterine radiation exposure from lymphoscintigraphy indicates safety of sentinel lymph node biopsy during pregnancy.

Background: There is an increased incidence of breast cancer occurring during pregnancy. Controversy exists as to the safety of performing lymphoscintigraphy during pregnancy and no studies have reported the measured dose of uterine radiation.

Methods: We performed an institutional review board (IRB)-approved prospective study of uterine radiation resulting from lymphoscintigraphy.

Differences in the pattern of presentation and treatment of proximal and distal gastric cancer: results of the 2001 gastric patient care evaluation.

Background: While the overall incidence of gastric cancer has declined in the United States of America, the incidence of proximal gastric cancers has increased. The purpose of this analysis was to highlight key differences between proximal and distal gastric cancer as they relate to presentation and treatment.

Methods: Data on 6,099 patients diagnosed with gastric adenocarcinoma were collected as a patient care evaluation under the auspices of the American College of Surgeons Commission on Cancer.

Surgical therapy for colorectal adenocarcinoma.

Colorectal cancer (CRC) remains the second leading cause of cancer mortality among men, and the third leading cause among women. Worldwide, CRC is the fourth most common cancer with approximately 1 million new cases annually. Unfortunately, advanced disease at diagnosis is still all too common.

Laparoscopic surgery for the prevention, palliation, and cure of gastrointestinal malignancies.

The development of surgical laparoscopic techniques has revolutionized the way surgeons approach many diseases, including cancer. This article briefly discusses the historical development of surgical laparoscopy; describes laparoscopic surgical techniques, with a focus on techniques for common intra-abdominal malignancies; and reviews laparoscopic management of common gastrointestinal malignancies.

Spectrum of general surgery in rural Iowa.

Purpose: One-quarter of the United States of America's population lives in rural areas, but only 12.3% of physicians live and work in rural areas. Nearly one-quarter of the counties in Iowa boast a patient-to-physician ratio of 3000:1.