Annals of surgery
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Many patients undergoing thyroidectomy for papillary thyroid carcinoma (PTC) have subclinical nodal disease at the time of surgery. Prophylactic bilateral central neck dissection (CND) is gaining acceptance in the treatment of PTC as studies have shown nodal disease increases the rate of local recurrence and may alter postsurgical radioactive iodine dosing. Given the potential complications of bilateral CND, we undertook a prospective study to determine the adequacy of prophylactic ipsilateral CND for PTC. ⋯ Ipsilateral CND appears to be sufficient in patients with tumors <=1 cm. In tumors >1 cm, bilateral CND should be considered as these patients are more likely to have bilateral positive nodes. If tumor size is used as criteria for prophylactic CND, approximately one-third of patients can be spared a bilateral CND.
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We evaluated a large single center experience of endograft repair of blunt traumatic injury of the thoracic aorta. ⋯ Endovascular repair of blunt traumatic aortic injury can be performed with a low morbidity and mortality. Anatomic patterns in the aortic arch appear to be predictive of early device failure. Midterm durability is excellent, but reliable follow-up remains challenging in this group of patients.
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To analyze a large national database, the National Trauma Data Bank, regarding the contribution of motorcycle helmet use to outcome and the efficacy of state helmet laws. ⋯ Unhelmeted motorcycle crash patients suffer more severe brain injuries, consume more resources, and have the worst payor mix. Society bears a large financial burden for these uninsured unhelmeted patients. There is a survival advantage for helmeted patients. All states should have universal motorcycle helmet laws that are aggressively enforced.
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Comment Letter
Not all minorities are underrepresented in academic surgery.