Abstract:
BACKGROUND:Axillary lymph node dissection (ALND) is performed less commonly for the axillary staging of elderly patients because it is felt to uncommonly alter therapy. Sentinel lymph node (SLN) dissection can accomplish axillary staging with less morbidity, but it is unclear if it alters subsequent therapy. METHODS:Review of a prospectively collected breast cancer SLN mapping database. Medical records were reviewed to supplement the database. RESULTS:Among 730 breast cancer SLN mapping patients, 261 (35.8%) were >or=70 years of age (range 70 to 95). The overall SLN identification rate was 98.8% among those <70 and 97.1% for those >or=70 (P=.11) and 100% and 99.4%, respectively (P=.25), among the most recent 500 patients. SLN metastases were detected by hematoxalin and eosin staining (H&E) in 24.2% of those <70 and 13.4% of those >/=70 (P<.01) and by immunohistochemistry staining (IHC) only in 4.6% and 5.0% of patients, respectively. No elderly patients with histologically negative SLNs underwent ALND, but 88.9% of patients with H&E metastases and 84.6% with IHC metastases underwent ALND. Of the H&E-positive women, 88% underwent adjuvant systemic therapy versus 55% of H&E-negative women (P<.01). Hormonal therapy was administered to 86.9% of SLN-positive women and 54.3% of SLN-negative women (P<.01) and cytotoxic chemotherapy was administered to 24% of SLN-positive patients versus 2.8% of SLN-negative patients (P<.01). SLN status was associated with significantly different rates of systemic therapy for patients with tumors <1 cm and 1 to 2 cm, but not with tumors >2 cm. Mean follow-up was 15.4 months. No patient experienced local or regional recurrence. Distant metastases occurred in 8.2% of patients with SLN metastases and in no patients with negative SLNs (P<.01). CONCLUSIONS:The results of SLN mapping and biopsy in elderly patients significantly influences subsequent therapy decisions, including ALND, hormonal therapy, and cytotoxic chemotherapy. SLN biopsy should be recommended to elderly breast cancer patients.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
McMahon LE,Gray RJ,Pockaj BAdoi
10.1016/j.amjsurg.2005.03.028subject
Has Abstractpub_date
2005-09-01 00:00:00pages
366-70issue
3eissn
0002-9610issn
1879-1883pii
S0002-9610(05)00485-Xjournal_volume
190pub_type
杂志文章abstract:BACKGROUND:Changes in surgical training have raised concerns about residents' operative exposure and preparedness for independent practice. One way of addressing this concern is by optimizing teaching and feedback in the operating room (OR). The objective of this study was to perform a systematic review on perioperativ...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/j.amjsurg.2016.12.014
更新日期:2017-07-01 00:00:00
abstract:OBJECTIVE:Arterial base deficit (BD) is a commonly used marker of injury severity and endpoint of resuscitation but requires an arterial puncture and blood gas analysis. Serum bicarbonate (HCO3) is routinely obtained as part of the chemistry panel on most admissions. We hypothesized that serum HCO3 strongly correlates ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.08.024
更新日期:2005-12-01 00:00:00
abstract:BACKGROUND:Clostridium difficile infection (CDI) is a common cause of healthcare associated infections contributing to morbidity and mortality. Our objective was to evaluate the impact of the implementation of a CDI bundle along with probiotic utilization. METHODS:A retrospective review of trauma admissions from 2008 ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.01.005
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Medical schools are undergoing major curricular reform, partly in attempts to increase the number of graduates pursuing careers in the generalist disciplines. These reforms have often resulted in a shortening of the surgery clerkship, decreasing students' experiences in several domains important to the gener...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(97)89595-5
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:Ductal carcinoma in situ (DCIS) accounts for nearly 20% of new breast cancer diagnoses and ductal carcinoma in situ with microinvasion (DCIS-MI) is found in 5% to 10% of DCIS. Controversy exists regarding the appropriate local treatment as well as whether or not examination of the axilla should be performed ...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/s0002-9610(03)00166-1
更新日期:2003-08-01 00:00:00
abstract:BACKGROUND:Cholangiocarcinoma develops in 5% to 15% of patients with choledochal cysts, sclerosing cholangitis, and intrahepatic stones. The detection of cholangiocarcinoma in patients with premalignant biliary conditions has been difficult. Serum levels of carcinoembryonic antigen (CEA) have been neither sensitive nor...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/S0002-9610(99)80090-7
更新日期:1996-01-01 00:00:00
abstract:OBJECTIVE:This study investigated the use of ultrasound (US) as a first-line diagnostic tool. METHODS:All women attending our breast center underwent bilateral whole-breast US in addition to all other investigations, and results were documented prospectively and preoperatively. RESULTS:Of 796 patients with breast can...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2004.06.032
更新日期:2004-10-01 00:00:00
abstract:BACKGROUND:Laparoscopic adjustable gastric banding (LAGB) is an option for the treatment of severe obesity. Few US studies have reported long-term outcomes. We aimed to present long-term outcomes with LAGB. METHODS:Retrospective study of patients who underwent LAGB at an academic medical center in the US from 1/2005 t...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2017.06.027
更新日期:2018-01-01 00:00:00
abstract:BACKGROUND:Despite efforts at standardization, evaluation and reporting of clerkships remains highly variable. This study reviews the current spectrum of surgical clerkship grading. METHODS:Data were reviewed for every medical school from which an application was received to a single surgery residency program in 2017 ...
journal_title:American journal of surgery
pub_type: 杂志文章,多中心研究
doi:10.1016/j.amjsurg.2018.09.024
更新日期:2019-02-01 00:00:00
abstract:BACKGROUND:Base Deficit (BD) and lactate have been used as indicators of shock and resuscitation. This study was done to determine the association of BD and lactate and to determine if one is superior. METHODS:A retrospective review from 3/2014-12/2016 was performed. Data included demographics, systolic BP, ISS, BD, l...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.01.025
更新日期:2018-04-01 00:00:00
abstract:BACKGROUND:Lack of exposure to surgery in the preclinical years of medical school contributes to students' negative opinions of the field and to low application rates to categorical surgical programs. METHODS:Forty preclinical medical students attended a series of 16 seminars and practice sessions covering the gamut o...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2006.12.038
更新日期:2007-08-01 00:00:00
abstract:BACKGROUND:Few data exist regarding surveillance for multiple primary melanoma (MPM) in elderly patients or whether the incidence and risk factors are the same as for younger patients. Thus, we studied the frequency and characteristics of MPM in the elderly melanoma patients. METHODS:From our prospective melanoma regi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.05.023
更新日期:2016-01-01 00:00:00
abstract::Histiocytosis X describes a disease characterized by histiocytic infiltration of the reticuloendothelial system, skin, bones, and pituitary gland. The disseminated form frequently occurs in infants and children. Chemotherapy has significantly improved the prognosis in this disorder. Sixty-three per cent of survivors, ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90431-1
更新日期:1976-01-01 00:00:00
abstract:BACKGROUND:Portal vein embolization (PVE), proposed to induce contralateral hepatic hypertrophy before major hepatectomy, carries some negative side effects since growth rate of metastases in the future remnant liver (RL) can be more rapid than that of nontumoral liver parenchyma. Therefore, metastases in the RL should...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)01373-9
更新日期:2003-03-01 00:00:00
abstract:BACKGROUND:The radial forearm free flap has become a workhorse flap in head and neck reconstruction. Its lack of bulk, ease of dissection, vascularity, and malleability are among its many advantages. PATIENTS AND METHODS:A review of 157 radial forearm free flaps performed in 155 patients between March 1988 and June 19...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80096-0
更新日期:1994-11-01 00:00:00
abstract:INTRODUCTION:Intestinal-cutaneous fistulas (ICFs) constitute a major surgical challenge. Definitive surgical treatment of ICFs continues to be associated with significant morbidity. The purpose of this study was to utilize a nationwide database to define the morbidity associated with current treatment strategies in the...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.08.038
更新日期:2020-09-02 00:00:00
abstract::Cytologic examination of peritoneal washings was performed in 40 patients with pancreatic ductal adenocarcinoma (35 head, 5 body) whose tumors had been selected as potentially resectable by computed tomographic (CT) findings. Saline (100 mL) was instilled and aspirated at laparoscopy in 27 patients and at laparotomy i...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(91)90356-i
更新日期:1991-01-01 00:00:00
abstract:BACKGROUND:Rectal cancer treatment has become multimodal as a result of significant advances in imaging, staging, surgery, radiotherapy, and chemotherapy. Multidisciplinary teams can incorporate these developments into tailor-made treatment plans and offer state-of-the-art services for rectal cancer patients. METHODS:...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/j.amjsurg.2009.09.023
更新日期:2010-09-01 00:00:00
abstract::In a prospective, randomized trial, selective proximal vagotomy with complete ulcer excision was compared with partial gastrectomy with gastroduodenostomy for the treatment of primary corporeal gastric ulcer in 30 patients. The results were evaluated by clinical follow-up examinations at regular intervals, endoscopy, ...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-9610(83)90300-8
更新日期:1983-11-01 00:00:00
abstract::We found clinical phlebitis in 57 of 88 patients with peripheral hyperalimentation (65%). To determine if this was a problem common to all intravenous fluid therapy at our hospital, we performed a point-prevalence study. The prevalence of phlebitis in nonhyperalimentation intravenous patients was 18% (84 of 456 patien...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/s0002-9610(05)80266-1
更新日期:1990-02-01 00:00:00
abstract::Fifty-one cervical nodes from 19 patients with advanced head and neck cancer were stimulated with phorbol dibutyrate and ionomycin (PDBu + Io) to determine the effect of such stimulation on the generation of cytotoxic T cells and whether this stimulation could bypass the need for autologous tumor stimulation. Lymphocy...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80718-4
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:Laparoscopic splenectomy (LS) has been used to treat a variety of splenic disorders. However, there have been few direct comparisons of this approach with open splenectomy (OS). METHODS:Results and outcomes were compared retrospectively in 46 consecutive patients treated by laparoscopic (n = 26) or open spl...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(96)00241-3
更新日期:1996-11-01 00:00:00
abstract:BACKGROUND:Work-related injuries (WRIs) represent a significant economic and logistical burden to healthcare systems. METHODS:All patients with severe WRIs (Injury Severity Score [ISS] ≥ 12) (1995 to 2013) were compared with patients with non-WRIs using standard methodology (P < .05). RESULTS:A total of 1,270 (8.5%) ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.01.023
更新日期:2015-09-01 00:00:00
abstract::The wire introducer method is a satisfactory technique for management of central venous catheters if bacteriologic monitoring of the removed catheter is used to determine whether the introduced catheter should be allowed to remain. The data indicate that when central venous catheters become infected, they do so throug...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(81)90327-5
更新日期:1981-12-01 00:00:00
abstract:BACKGROUND:The aim of this study was to identify patient-related and/or disease-related factors that influence outcomes in patients with vascular prosthetic graft infections. METHODS:Through the hospital patient administration system, between January 1997 and December 2007, a total of 44 patients were diagnosed with c...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.05.018
更新日期:2010-07-01 00:00:00
abstract::Dissatisfaction with time-consuming double layer anastomoses in intestinal surgery and with occasionally questionable stapled anastomoses prompted a review of available techniques for hand sewn suture lines. Single layer anastomoses have been used extensively and their integrity and safety have often been questioned. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(85)80189-6
更新日期:1985-06-01 00:00:00
abstract:BACKGROUND:While percutaneous tracheostomy (PT) is becoming the procedure of choice for elective tracheostomy, there is little late complication data. This study compared incidence of, and factors contributing to, tracheal stenosis following PT or open tracheostomy (OT). METHODS:A 10-year review was conducted of traum...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2013.12.036
更新日期:2014-11-01 00:00:00
abstract:BACKGROUND:The purpose of this study was to investigate the relationship between perforated appendicitis and patient with diabetes using a population-based data set. METHODS:This study used data from the Longitudinal Health Insurance Database 2005 in Taiwan. We identified 4,806 patients hospitalized with acute appendi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.08.041
更新日期:2016-10-01 00:00:00
abstract::This study of 89 women who underwent 100 consecutive needle localization procedures for nonpalpable breast lesions revealed a 19 percent malignancy rate. These lesions tended to be small and had a 6.2 percent incidence of nodal metastasis. Needle localization also identified 19 additional patients who were at increase...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(87)90223-6
更新日期:1987-12-01 00:00:00
abstract:BACKGROUND:Peritoneal macrophages play an important role in the immune response after abdominal operations. The stress response after these operations has been associated with impaired phagocytosis by peritoneal macrophages. This study examined the influence of minimally invasive techniques and preoperative corticoster...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.07.023
更新日期:2008-12-01 00:00:00