American journal of surgery
-
The appropriate management for patients with multifocal branch-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas involving the entire pancreatic gland remains unclear. We present a 66-year-old woman who underwent pylorus-preserving pancreaticoduodenectomy for a branch-duct intraductal papillary mucinous carcinoma demonstrating a grape-like multilocular cyst, 35 mm in diameter, in the head of the pancreas along with numerous number of small branch-duct IPMNs in the whole pancreas. ⋯ The patient has been doing well without any recurrence during 9-year follow-up after surgery. Surgical removal of the prominent lesions suspicious of malignancy and a close observation of the remaining lesions in the remnant pancreas may be a reasonable treatment plan for patients with multifocal branch-duct IPMNs involving the entire pancreatic gland.
-
The purpose of this study was to determine the rate of surgical site infection for open elective umbilical hernia repairs and to identify the factors related to an increased risk of infection and/or recurrence. ⋯ Umbilical hernia repair is associated with a high rate of infection, and most superficial mesh infections can be treated with antibiotics alone. In addition, mesh repair of umbilical hernias decreased the rate of recurrence but increased the risk of infection compared with suture repairs.
-
The field of simulation-based procedural education in medicine is undergoing rapid development, with significant improvements in both graphic and tactile fidelity. As a consequence, the use of simulation for competency assessment and credentialing is evolving rapidly. Establishing the conceptual framework for developing such assessments using simulation is becoming critical to the expansion of simulation-based education and assessment in medicine. ⋯ An alternative methodology of standards setting involving the use of benchmarking may be more appropriate to assessing critical procedural skills. Although much of the existing simulation literature (and practice) implicitly uses benchmarking methods, the conceptual framework that justifies its use has not been discussed explicitly. Finally, the development of clinical benchmarks as the standards-setting mechanism for procedural simulation-based learning, feedback, and assessment will be critical to establishing the clinical relevance of simulation.
-
The study aim was to determine the accuracy of axillary ultrasound (AUS) and fine-needle aspiration biopsy (FNAB)/needle core biopsy in axillary breast cancer staging. ⋯ AUS-guided FNAB/needle core biopsy is accurate in predicting the status of the axilla in 70% of clinically node-negative breast cancer patients. This technique is minimally invasive with a low complication rate and can obviate the need for staged lymph node procedures.
-
A 39-year old man was admitted to our hospital with a chest stab wound. The stab wound was approximately 3 cm long by 4 cm deep and located in the subxiphoid process area. ⋯ The patient was treated by conservative therapy, and the pneumopericardium spontaneously disappeared after 5 days. The patient was discharged on hospital day 7.