Activiteit

One patient was initially treated with sclerotherapy before undergoing intraoral excision of the sublingual gland. Two patients treated with transcervical excision of the cyst experienced recurrence compared to no recurrence with intraoral excision of the sublingual gland. CONCLUSION Intraoral removal of the sublingual gland is the most effective treatment for both simple and plunging ranulas. Plunging ranulas must be considered in patients presenting with a submandibular and submental cystic mass given intraoral extension may not be apparent. BACKGROUND The pedicled nasoseptal mucoperiosteal flap is currently widely used for the reconstruction of a skull base defect following transsphenoidal surgery. The flap is generally secured in position by a Foley catheter balloon. We describe an alternative technique using cylinders of Gelfoam™ (Pfizer Incorporated) to buttress the flap in place, obviating the need for a balloon catheter. MATERIAL AND METHODS A review of our database identified patients who underwent endoscopic transsphenoidal surgery for a pituitary macroadenoma with nasoseptal flap, secured with small rolls of Gelfoam™ (Pfizer Incorporated) rather than a nasal Foley catheter. Minimum follow-up clinical and MRI assessments 3 months. RESULTS 73 patients (mean follow-up 22 months) met the inclusion criteria 56 non-functioning and 17 functioning pituitary adenomas. 36 patients had an intraoperative CSF leak 30 high flow and 6 low flow leaks. The surgical repair in 35 patients included fat +/- fascia graft. One patient had a post-operative CSF leak repaired by subsequent surgery without the use of a Foley catheter. CONCLUSION Securing the nasoseptal flap using rolls of Gelfoam™ (Pfizer Incorporated) as described can be achieved without the use of a nasal Foley catheter. OBJECTIVE Health literacy (HL) is a person’s ability to practically apply a wide range of cognitive and non-cognitive skills, to make health-related decisions. Currently, no tool applies all HL core domains to capture necessary data to measures HL in adult asthma and COPD patients. We endeavored to develop a comprehensive, function-based tool that adequately and accurately measures HL skills of this patient population. We explored the perspectives of patients related to each core HL domain, with an emphasis on self-management practices. METHODS Sixteen focus groups were conducted (n = 93; 40 asthma and 53 COPD) across Canada. Data was analyzed using NVivo12. RESULTS Thirteen subthemes were identified within five HL domains (a) access active access; passive access; lack of access; (b) understanding how to improve understanding; (c) trustworthiness; relevancy and validity of information pre- and post- application of information; (d) communication barriers to proper communication; (e) application of information making health decisions. CONCLUSIONS Participants provided valuable insight in terms of disease management topics and corresponding items to include in our HL tool. PRACTICE IMPLICATIONS Involvement of patients from initial stage allowed us to develop a tool that will serve as a first ever developed HL tool for asthma and COPD patient group. BACKGROUND Sentinel lymph node biopsy (SLNB) is widely used for Merkel cell carcinoma (MCC), however in SLNB positive MCC the role of completion lymph node dissection (CLND) with or without adjuvant radiation therapy is unclear. OBJECTIVE Our goal was to determine the impact of CLND and adjuvant radiation therapy on survival in SLNB positive MCC. MATERIALS AND METHODS We examined 447 patients with MCC with a positive SLNB in the National Cancer Data Base from 2012 to 2015. We compared patients who underwent CLND versus observation with or without adjuvant radiation. RESULTS Compared with CLND and adjuvant radiation (reference) treatment with observation (HR 3.54, CI 1.36-9.18) or CLND alone (HR 2.54, CI 1.03-6.27) were associated with worse overall survival after adjusting for clinicopathologic differences. In contrast treatment with adjuvant radiation alone without CLND was not associated with worse overall survival (HR 1.70, CI 0.74-3.92) compared with CLND and adjuvant radiation (reference). CONCLUSIONS In SLNB positive MCC, CLND alone is associated with worse survival compared with treatment with adjuvant radiation or both CLND and adjuvant radiation. BACKGROUND Use of minimally invasive techniques for management of common bile duct (CBD) stones has led to declining number of CBD explorations (CBDE) performed at teaching and non-teaching institutions. We evaluate the impact of this decline on surgery training in bile duct procedures. STUDY DESIGN National operative data for general surgery residents (GSR) were examined from 2000 to 2018. Biliary operations including, cholecystectomy open and laparoscopic, and CBDE open and laparoscopic were evaluated for mean number of cases per graduating GSR. RESULTS Despite increases in number of GSR, case numbers for laparoscopic cholecystectomy increased 39% from 84 to 117, p  less then  .00001, per GSR. Mean number of cases for open CBDE, however, decreased 74% from 2.7 to 0.7, p  less then  .00001, per GSR and laparoscopic CBDE declined 22% from 0.9 to 0.7 per resident. CONCLUSION GSR operative case volume in CBDE has declined significantly creating a training deficiency for this complex skill. ZM 447439 nmr Novel simulation, including fresh cadavers, may offer the best option with high-fidelity, dynamic training to mitigate the loss of low volume, high acuity procedures. BACKGROUND This study evaluated closure techniques and incisional surgical site complications (SSCs) and incisional surgical site infections (SSIs) after pancreaticoduodenectomy (PD). METHODS Retrospective review of open PDs from 2015 to 2018 was performed. Outcomes were compared among closure techniques (subcuticular + topical skin adhesive (TSA); staples; subcuticular only). SSCs were defined as abscess, cellulitis, seroma, or fat necrosis. SSIs were defined according to the National Surgical Quality Improvement Program (NSQIP). RESULTS Patients with subcuticular + TSA (n = 205) were less likely to develop an incisional SSC (9.8%) compared to staples (n = 139) (20.1%) and subcuticular (n = 74) (16.2%) on univariable analysis (P = 0.024). Multivariable analysis revealed no statistically significant difference in incisional SSC between subcuticular + TSA and subcuticular (P = 0.528); a significant difference remained between subcuticular + TSA and staples (P = 0.014). Unadjusted median length of stay (LOS) (days) was significantly longer for staples (9) vs.