Thomas B. Julian

Morbidity results from the NSABP B‐32 trial comparing sentinel lymph node dissection versus axillary dissection

Three year post‐surgical morbidity levels were compared between patients with negative sentinel lymph node dissection alone (SLND) and those with negative sentinel node dissection and negative axillary lymph node dissection (ALND) in the NSABP B‐32 trial.

Perioperative total parenteral nutrition in patients with gastrointestinal cancer

Forty-one male surgical patients with gastrointestinal cancer were randomized into three groups on the basis of preoperative weight loss: Group I (20 patients)—mean age 64.1 ± 11.0 years, less than 10-lb weight loss, no TPN; Group II (9 patients)—mean age 65.8 ± 12.0 greater than 10 pound weight loss, no TPN; Group III (12 patients)—mean age 63.7 ± 10.7 years, greater than 10-lb weight loss, TPN. Group III received greater than 2000 cc of D25/4.25% Travasol for at least 5 days preoperatively and 8 days postoperatively. Major postoperative complications included abscess, anastomotic leak, or wound infection. Results: Preoperative immunocompetence was no different between any group (P > 0.05). Postoperative weight loss was significantly greater in Group I than in Group III (P 0.05). Rate of major complications was not significantly different between any of the groups (P > 0.05). Mortality was 10% in Group I, 0% in Group II, and 0% in Group III. Conclusion: An 18-day duration of perioperative TPN in comparable randomized patients based on preoperative weight loss does not alter the rate of major postoperative complications or mortality, but allows patients to maintain weight.

Magnetic resonance imaging detection and wire localization of an ‘occult’ breast cancer

SummaryAn occult breast cancer was detected and wire localization performed using magnetic resonance imaging.

Evaluation of the Safety of End-to-End (EEA) Stapling Anastomoses Across Linear Stapled Closures

An experimental study involving circular stapled anastomoses across linear stapled closures is presented. Although the staples were deformed, cut in two, and sometimes uninjured, no complications were found. These data support the use of this technique, which is currently employed in clinic practice.

The triple-stapled colonic anastomosis

This study reports the preliminary results of a new totally stapled end-to-end colonic anastomosis in 11 dogs. This “triple-stapled” end-to-end anastomosis was performed with one circular staple line and two linear staple lines, eliminating the need for a colotomy or purse-string suture. The fact that the anvil and anvil stem of a new circular stapling device (Premium EEA™) can be detached from the frame of the instrument allows the anvil stem to be brought out through the proximal linear stapled colon. The trocar mounted on the main stem of the circular stapler allows the stem of the main device to be brought out through the distal staple line. Thus, a totally stapled colonic anastomosis is created after mating the anvil stem and main stem of the instrument. The new anastomosis was evaluated radiographically and at necropsy. The use of this technique resulted in no clinically detectable leaks, suggesting that it may facilitate the performance of anterior resections in humans.

Obstruction of the Pancreatic Duct by a Granular Cell Tumor

SummaryA 31-year-old woman presented with constant epigastric pain. Obstruction of the pancreatic duct was observed by ultrasonography and CT scan and was further defined by ERCP. Surgical exploration of the pancreas revealed a tumor in the pancreatic head. Histologic and immunocytochemical examination revealed a benign granular cell tumor, a neoplasm not previously described as causing obstruction in the pancreas.

Venous aneurysm after polytetrafluoroethylene arteriovenous dialysis fistula

True venous aneurysms are uncommon complications in patients undergoing hemodialysis through prosthetic grafts. We report the case of a large cephalic venous aneurysm that occurred proximal to a polytetrafluoroethylene hemodialysis fistula. The incidence, management, and possible cause of this unusual complication of prosthetic arteriovenous fistulas are reviewed.