Abstract：
BACKGROUND:In 1991, a National Institutes of Health Consensus Panel stated that preoperative localization for primary hyperparathyroidism is not cost effective. Since then, the sestamibi scan has been applied to parathyroid disease with excellent results, even allowing unilateral exploration under local anesthesia. STUDY DESIGN:A metaanalysis of the English literature over the past 10 years was performed to determine the collective sensitivity and specificity of sestamibi scanning to establish its utility in directing a unilateral procedure. The cost effectiveness of scanning all patients with sporadic primary hyperparathyroidism was examined by determining the costs of seven operative technique-dependent variables that could be reduced with a limited procedure. RESULTS:The average sensitivity and specificity of sestamibi were 90.7% and 98.8%, respectively, indicating its ability to guide an accurate unilateral exploration. The analysis of 6,331 patients showed that 87% had solitary adenomas. An average cost savings of $650 was demonstrated for a unilateral operation, which could be realized in as many as 90% (sestamibi sensitivity) of those with solitary adenomas. CONCLUSIONS:A preoperative sestamibi scan is specific enough in identifying solitary adenomas to allow unilateral exploration with a < 1% failure rate. The sensitivity of this scan suggests that 78% of all patients with sporadic primary hyperparathyroidism (90% of the 87% with solitary adenomas) are candidates for unilateral exploration. This rate is significantly higher than the 51% rate at which scanning all patients becomes cost effective.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Denham DW,Norman Jdoi
10.1016/s1072-7515(98)00016-7subject
Has Abstractpub_date
1998-03-01 00:00:00pages
293-305issue
3eissn
1072-7515issn
1879-1190pii
S1072-7515(98)00016-7journal_volume
186pub_type
杂志文章,meta分析abstract：BACKGROUND:Thyroid surgery is performed using general anesthesia by the majority of surgeons in current practice. This study was conducted to analyze the utility and safety of local anesthesia for thyroid surgery. STUDY DESIGN:Prospective data were collected for 1,025 consecutive patients undergoing thyroidectomy usin...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2005.04.034
更新日期：2005-09-01 00:00:00
abstract：BACKGROUND:Injury is the leading cause of childhood morbidity and mortality in the US. The associated costs exceed $20 billion annually. This study examined disparities in disadvantaged populations of critically injured pediatric patients admitted to a level 1 pediatric trauma center. STUDY DESIGN:A retrospective stud...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2013.02.032
更新日期：2013-08-01 00:00:00
abstract：BACKGROUND:Clinicians must choose a treatment strategy for patients with symptomatic cholelithiasis without knowing whether common bile duct (CBD) stones are present. The purpose of this study was to determine the most cost-effective treatment strategy for patients with symptomatic cholelithiasis and possible CBD stone...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.02.017
更新日期：2011-06-01 00:00:00
abstract：BACKGROUND:The destructive human consequences of terrorist bombing always challenge the medical system in diagnosis, decision making, and patient management. This injury is produced by multiple injury mechanisms, and departs from the conventional description of trauma complexity. Our objective was to characterize and c...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2004.09.003
更新日期：2004-12-01 00:00:00
abstract：BACKGROUND:An association between frailty and mortality exists; we hypothesized this is secondary to failure to rescue (F2R). STUDY DESIGN:Data were obtained from the NSQIP (2005 to 2012) for patients undergoing thoracoabdominal operations. Using the Modified Frailty Index, patients were classified as not (0 points), ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2017.12.055
更新日期：2018-06-01 00:00:00
abstract：BACKGROUND:Mirizzi syndrome (MS) is characterized by extrinsic compression of the common hepatic duct by stones impacted in the cystic duct or gallbladder neck. Open cholecystectomy (OC) has been the standard treatment; however, laparoscopy has challenged this approach. STUDY DESIGN:The objective of this study was to ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2011.03.008
更新日期：2011-07-01 00:00:00
abstract：BACKGROUND:Recurrent hepatocellular carcinoma (RHCC) after curative resection is a major challenge for hepatic surgeons. A better understanding of the clonal origin of RHCC will help clinicians design personalized therapy and assess postoperative outcomes. The current study was performed to determine the clonal origin ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2013.07.402
更新日期：2013-12-01 00:00:00
abstract：BACKGROUND:Significant confusion exists about management of blunt carotid injuries (BCI). Currently, three common treatments are being used without significant longterm followup data to demonstrate efficacy. Although heparin has been shown to reduce in-hospital stroke rates, antiplatelet therapy (aspirin and clopidogre...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2006.12.041
更新日期：2007-05-01 00:00:00
abstract：BACKGROUND:Thyroid surgery is associated with low mortality and morbidity and often is performed in an ambulatory setting. The majority of patients undergoing thyroidectomy have an uncomplicated outcome, but common comorbidities may increase mortality and morbidity. Due to low complication rates, studies using single s...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2014.01.055
更新日期：2014-06-01 00:00:00
abstract：BACKGROUND:Head injury is an increasing contributor to death and disability, particularly among the elderly. Older patients are less likely to be treated at trauma centers, and head injury is the most common severe injury treated at non-trauma centers. We hypothesized that patients initially triaged to trauma centers w...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2018.01.055
更新日期：2018-05-01 00:00:00
abstract：UNLABELLED:Some of the concepts contained here have been discussed and incorporated in another publication, but the data are entirely unique to this manuscript. (See: Transforming the Surgical "Time-Out" Into a Comprehensive "Preparatory Pause." Backster A, Teo A, Swift M, MD, Polk HC Jr, MD, FACS, Harken AH, MD, FACS....
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2007.01.009
更新日期：2007-04-01 00:00:00
abstract：BACKGROUND:The goal of this study was to investigate the surgical management and outcomes of patients with primary colorectal cancer (CRC) and synchronous liver metastasis (sCRLM). STUDY DESIGN:Using a multi-institutional database, we identified 1,004 patients treated for sCRLM between 1982 and 2011. Clinicopathologic...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2012.12.029
更新日期：2013-04-01 00:00:00
abstract：BACKGROUND:Infectious morbidity after total abdominal hysterectomy includes fever (31%) and antibiotic administration (45%). Whether vaginal cuff closure reduces postoperative infectious morbidity remains unresolved. STUDY DESIGN:We reviewed the records of 172 consecutive abdominal hysterectomies for nonmalignant dise...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1997-10-01 00:00:00
abstract：BACKGROUND:This study describes, quantifies, and evaluates the University of Michigan Department of Surgery medical malpractice experience for the 1992 to 2002 period. The goal is to gain an understanding of what our claims experience has been, what services are highest risk, and where the financial exposure lies. STU...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2006.05.011
更新日期：2006-09-01 00:00:00
abstract：BACKGROUND:The Agency for Healthcare Research and Quality (AHRQ) developed patient safety indicator (PSI) 5, "Foreign body left during procedure," to flag accidental foreign bodies in surgical and medical procedures. This study examined how well this indicator identifies true foreign body events in the Veterans Health ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2011.02.003
更新日期：2011-06-01 00:00:00
abstract：BACKGROUND:Vulvar melanoma is a very rare form of cancer. The purpose of this study was to describe practice patterns for the management of vulvar melanoma. STUDY DESIGN:The National Cancer Data Base was reviewed from 1985 through 1994 for patient reports submitted with a diagnosis of vulvar melanoma. RESULTS:Five hu...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(99)00033-2
更新日期：1999-06-01 00:00:00
abstract：BACKGROUND:This study was undertaken to compare safety, outcome, and costs of laparoscopic (LS) and open splenectomy (OS) for a variety of hematologic diseases. STUDY DESIGN:The records of 137 patients who underwent splenectomy (63 LS and 74 OS) at a large private teaching hospital between March 1991 and April 1996 we...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1997-07-01 00:00:00
abstract：BACKGROUND:In laparoscopic operations for rectal carcinoma, only a few multicenter studies of a large number of patients have examined the impact of conversion on outcomes and determined risk factors for conversion. This study was designed to evaluate short-term outcomes and risk factors for conversion to open operatio...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2008.12.002
更新日期：2009-03-01 00:00:00
abstract：BACKGROUND:Voluntary resident attrition remains problematic despite recent changes in postgraduate general surgery training, including reduction of work hours. STUDY DESIGN:We conducted a prospective study of all postgraduate year (PGY)-1 and -2 trainees on the 2008 American Board of Surgery resident roster (ABS-RR) w...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2012.11.005
更新日期：2013-03-01 00:00:00
abstract：BACKGROUND:Hereditary predisposition to colorectal cancer most often manifests itself as familial adenomatous polyposis from mutations of APC, or hereditary nonpolyposis colorectal cancer, resulting from mutations of MSH2, MLH1, MSH6, or other genes. Previously, we described a rare founder mutation MSH2*1906C > G in As...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/S1072-7515(02)01808-2
更新日期：2003-02-01 00:00:00
abstract：BACKGROUND:Pancreas transplants are still associated with the highest surgical complication rate of all routinely performed solid organ transplants. To date, the impact of serious surgical complications in the cyclosporine era on perioperative patient morbidity, graft and patient survival, and hospital costs has not be...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(01)00895-x
更新日期：1997-08-01 00:00:00
abstract：BACKGROUND:Splenectomy at the time of resection of esophageal, gastric, or colon cancer has been correlated with inferior longterm survival. No such effect has yet been demonstrated for pancreatic cancer. STUDY DESIGN:Patients undergoing resection of pancreatic adenocarcinoma with curative intent at Memorial Sloan-Ket...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(99)00041-1
更新日期：1999-05-01 00:00:00
abstract：BACKGROUND:We recently reported, in a prospective randomized trial, that ultra-staging of patients with colon cancer is associated with significantly improved disease-free survival (DFS) compared with conventional staging. That trial did not control for lymph node (LN) number or adjuvant chemotherapy use. STUDY DESIGN...
journal_title：Journal of the American College of Surgeons
pub_type： 临床试验,杂志文章
doi：10.1016/j.jamcollsurg.2015.05.007
更新日期：2015-09-01 00:00:00
abstract：BACKGROUND:While the costs of medical training continue to increase, surgeon income and personal financial decisions may be challenged to manage this expanding debt burden. We sought to characterize the financial liability, assets, income, and debt of surgical residents, and evaluate the necessity for additional financ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2018.05.002
更新日期：2018-08-01 00:00:00
abstract：BACKGROUND:Emergency general surgery (EGS) contributes to half of all surgical mortality nationwide, is associated with a 50% complication rate, and has a 15% readmission rate within 30 days. We assessed associations between surgeon and hospital EGS volume with these outcomes. STUDY DESIGN:Using Maryland's Health Serv...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究
doi：10.1016/j.jamcollsurg.2017.08.009
更新日期：2017-11-01 00:00:00
abstract：BACKGROUND:The management of 1- to 2-cm appendiceal carcinoid tumors remains controversial. Here we use the National Cancer Data Base (NCDB) to compare long-term outcomes for patients treated via resection of the primary tumor alone vs right hemicolectomy (RHC). STUDY DESIGN:The 1998 to 2011 NCDB User File was queried...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2015.01.005
更新日期：2015-05-01 00:00:00
abstract：BACKGROUND:Peripheral ports represent a new option for central venous access that have a low complication rate while providing long duration. This study provides five years of evaluation of this device. STUDY DESIGN:All patients had follow-up evaluation concurrently, with detailed information collected for the first 7...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：
更新日期：1995-04-01 00:00:00
abstract：BACKGROUND:Immediate reconstruction of perineal defects secondary to abdominoperineal resection (APR) or pelvic exenteration with pedicled flaps decreases postoperative wound complications when compared with direct closure in high-risk patients. Although some authors have been proponents of abdominal-based flaps, here ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/j.jamcollsurg.2016.06.383
更新日期：2016-10-01 00:00:00
abstract：:Portal vein thrombosis was considered to be a major contraindication to liver transplantation before the introduction of vessel grafts from the recipient's area of confluence of the splenic and superior mesenteric veins, behind the neck of the pancreas, to the graft's portal vein. Refinement in surgical technique has ...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(99)00299-9
更新日期：2000-04-01 00:00:00
abstract：BACKGROUND:Acute limb ischemia initiates a systemic inflammatory response, including pulmonary polymorphonuclear leukocyte (PMN) sequestration and acute lung injury. Lung injury is partly attributed to release by PMN's of extracellular matrix (ECM) modifying metalloproteinases (MMPs). We hypothesized that acute hindlim...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/S1072-7515(03)00134-0
更新日期：2003-05-01 00:00:00
