Journal of the American College of Surgeons
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Molecular events impact systemic dissemination. Overexpression of eukaryotic initiation factor 4E (eIF4E) has been shown to predict worse clinical outcomes in breast cancer. Node-positive breast cancer patients were specifically studied to determine if eIF4E elevation increases risk for systemic dissemination. ⋯ High eIF4E is correlated with an increased risk for systemic metastasis in node-positive breast cancer patients. High eIF4E overexpression was associated with a higher incidence of metastasis to multiple sites. Therefore, high eIF4E overexpression appears to be a marker for molecular events that increases risk for systemic dissemination.
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The surgical management of esophageal perforation (EP) often results in mortality and significant morbidity. Recent less invasive approaches to EP management include endoscopic luminal stenting and minimally invasive surgical therapies. We wished to establish therapeutic efficacy of minimally invasive therapies in a consecutive series of patients. ⋯ Endoscopically placed removable esophageal stents with minimally invasive repair of the perforation and feeding access is an effective treatment method for patients with EP. This multidisciplinary method enabled us to care for severely ill patients while minimizing morbidity and mortality and avoiding open esophageal surgery.
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Even after negative sentinel lymph node biopsy (SLNB) for primary melanoma, patients who develop in-transit (IT) melanoma or local recurrences (LR) can have subclinical regional lymph node involvement. ⋯ In this study, we demonstrate the technical feasibility and clinical use of repeat SLNB for recurrent melanoma. Performing SLNB cannot only optimize local, regional, and systemic treatment strategies for patients with LR or IT melanoma, but also appears to provide important prognostic information.
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Comparative Study
Subscription to the Surgical Council on Resident Education web portal and qualifying examination performance.
The Surgical Council on Resident Education (SCORE) curriculum for general surgery was developed to guide surgery residents in the acquisition of knowledge for patient care. We hypothesized that residents in programs that subscribed to the SCORE web portal would perform better on the American Board of Surgery (ABS) Surgery Qualifying Examination (QE). ⋯ There was a considerable improvement in mean QE scaled scores for residents in programs that initially subscribed to the SCORE web portal. The percent passing the QE showed a trend toward improvement for subscribing programs and their residents. This association is promising and deserves additional investigation.