Jay K. Harness

Office-based cryoablation of breast fibroadenomas with long-term follow-up.

Abstract:  Approximately 10% of women will experience a breast fibroadenoma in their lifetime. Cryoablation is a new treatment that combines the better attributes of the current standards: surveillance and surgery. It is a minimally invasive office‐based procedure that is administered without the use of general anesthesia, involving minimal patient discomfort and little to no scarring. This work aimed to establish the long‐term (2–3 years) efficacy, safety, and satisfaction of the procedure, as well as the impact of cryoablation on mammogram and ultrasound images. Thirty‐seven treated fibroadenomas were available for assessment with an average follow‐up period of 2.6 years. Of the original 84% that were palpable prior to treatment, only 16% remained palpable to the patient as of this writing. Of those fibroadenomas that were initially ≤2.0 cm in size, only 6% remained palpable. A median volume reduction of 99% was observed with ultrasound. Ninety‐seven percent of patients and 100% of physicians were satisfied with the long‐term treatment results. Mammograms and ultrasounds showed cryoablation produced no artifact that would adversely affect interpretation. Cryoablation for breast fibroadenomas has previously been reported as safe and effective both acutely and at the 1‐year follow‐up mark, and thus has been implemented as a treatment option. At long‐term follow‐up, cryoablation as a primary therapy for breast fibroadenomas demonstrates progressive resolution of the treated area, durable safety, and excellent patient and physician satisfaction. The treatment is performed in an office setting rather than an operating room, resulting in a cost‐effective and patient‐friendly procedure. Cryoablation should be considered a preferred option for those patients desiring definitive therapy for their fibroadenomas without surgical intervention. 

Operative experience of U.S. general surgery residents in thyroid and parathyroid disease

BACKGROUND We wanted to determine whether the experience of general surgery residents is adequate and effective. METHODS The Resident Statistic Summaries (Report C) of the Residency Review Committee (Surgery) for 8 academic years from 1986 through 1994 were analyzed. The main outcome measurements were total number of residents and programs, average number of operations performed, maximum number of operations performed, standard deviation, and the most common number of operations performed. RESULTS For thyroidectomy the average per resident ranged from 10.3 to 12.6. The maximum ranged from 52 to 102. The standard deviations ranged from 6.96 to 8. The most common number of thyroidectomies performed ranged from 7 to 10 per graduating resident. For parathyroidectomy the average ranged from 4.1 to 5.1, the standard deviations were 3.44 to 4, the maximum ranged from 25 to 60, and the most common number performed was 2. CONCLUSIONS U.S. graduates have highly variable experience in thyroid and parathyroid surgery. Most residents have inadequate experience in parathyroid surgery and marginal experience in thyroid surgery.

Radionuclide evaluation of bile leakage and the use of subhepatic drains after cholecystectomy

Our study addresses the question of efficacy of drainage after cholecystectomy by evaluation of the leakage of radiolabeled bile. Based on our data, drains placed at the time of surgery do not appear to reliably remove bile or to decrease morbidity. Our study reveals that bile leakage after cholecystectomy is frequent, cannot be accurately predicted at operation, is not related to the experience of the operating surgeons, and does not necessarily correlate with morbidity. The shorter postoperative hospital stay in the group of patients with subhepatic bile leakage compared with the group without evidence of leakage after cholecystectomy is not statistically significant. However, this trend does suggest that there is no increase in morbidity associated with bile leakage per se. A large, clinically significant bile leak can easily be treated by modern interventional radiologic techniques if drainage is indicated. A larger, double-blind study is necessary to further evaluate the issues surrounding bile leakage and drainage after cholecystectomy.

The Role of Assisted Circulation in the Management of Endotoxic Shock

Abstract Despite recent advances in treatment, the mortality from endotoxic shock remains high. Death in these patients is frequently associated with progressive myocardial failure. A lethal dose (LD 100 ) of Escherichia coli endotoxin (1 mg. per kilogram of body weight) was administered intravenously to 12 dogs. The dogs were then divided into two experimental groups of 6 each. The treatment of the dogs in Group I consisted of positive-pressure ventilation and maintenance of circulating blood volume and acid-base balance. The dogs in Group II were treated identically, except that one and one-half hours after the induction of endotoxic shock the dogs underwent a period of assisted circulation. Survival was significantly prolonged in Group II dogs (Group I, 10.6 hours; Group II, 24.5 hours [ p p p p p This study demonstrates the value of prolonged assisted circulation in the treatment of endotoxic shock.

Immunolymphoscintigraphy in Breast Cancer: Evaluation Using 131I-Labeled Monoclonal Antibody B72.3

Noninvasive axillary lymph node staging was investigated using [131I]murine monoclonal antibody B72.3 in 16 patients with breast cancer scheduled for axillary dissection. [131I]B72.3 was injected into ipsilateral finger webs or around the breast biopsy. Scintigraphy to 72 h and gamma-counting/immunohistochemistry of nodes were performed. Specific antibody uptake (%ID/g) and the ratio of specific:nonspecific antibody uptake were not significantly different in tumor-positive versus tumor-negative nodes, suggesting that [131I]B72.3 is unsuitable to discriminate axillary node tumor involvement.