The British journal of surgery
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Randomized Controlled Trial Multicenter Study
Predictors of complications after direct-to-implant breast reconstruction with an acellular dermal matrix from a multicentre randomized clinical trial.
In the multicentre randomized trial BRIOS (Breast Reconstruction In One Stage), direct-to-implant (DTI) breast reconstruction with an acellular dermal matrix (ADM) was associated with a markedly higher postoperative complication rate compared with two-stage tissue expander/implant breast reconstruction. This study aimed to identify factors that contribute to the occurrence of complications after DTI ADM-assisted breast reconstruction. ⋯ Breast size appeared to be the most significant predictor of complications in DTI ADM-assisted breast reconstruction. The technique should preferably be performed in patients with small to moderate sized breasts. Registration number: NTR5446 ( http://www.trialregister.nl).
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Permanent hypoparathyroidism remains the most common adverse outcome after total thyroidectomy, but long-term effects of hypoparathyroidism are unknown. The aim was to investigate mortality in patients with permanent hypoparathyroidism after total thyroidectomy. ⋯ Permanent hypoparathyroidism after total thyroidectomy for benign disease is common and associated with an increased risk of death.
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In patients with multiple endocrine neoplasia type 2 (MEN2) syndrome, genetic testing offers early diagnosis, stratifies the risk of developing medullary thyroid cancer (MTC) and informs the timing of thyroidectomy. The efficacy of treatment, which depends on timely and safe surgery, is not well established. ⋯ Late genetic testing may preclude age-appropriate surgery, increasing the risk of operating when MTC has already developed. Early genetic testing and age-appropriate surgery may help avoid unnecessary lymphadenectomy and improve outcomes.
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The Anatomy Lesson of Willem Röell, painted by Cornelis Troost in 1728, should be considered a group portrait of the Amsterdam Guild of Surgeons. Professor Röell, praelector anatomiae (lecturer in anatomy) of the Surgeons' Guild, was portrayed while performing an anatomical dissection of the knee joint in the corpse of an elderly man. The three surgeons in the painting, dressed in fashionable suits, held important positions as governors of the Guild. ⋯ These works of art were painted to commemorate the praelector anatomiae, governors and surgeons of the Guild. Today, this painting is on display in the Amsterdam Museum in Amsterdam, The Netherlands. Read more about the stories behind this masterpiece in an essay online.
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Increasing evidence has indicated an association between immune infiltration in gastric cancer and clinical outcome. However, reliable prognostic signatures, based on systematic assessments of the immune landscape inferred from bulk tumour transcriptomes, have not been established. The aim was to develop an immune signature, based on the cellular composition of the immune infiltrate inferred from bulk tumour transcriptomes, to improve the prognostic predictions of gastric cancer. ⋯ The proposed immunoscore represents a promising signature for estimating overall survival in patients with gastric cancer.