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No abstract text is available yet for this article.

No abstract text is available yet for this article.

In 2012, it was estimated that 9180 people in the United States would die from melanoma and that more than 76,000 new cases would be diagnosed. Surgical resection is effective for early-stage melanoma, but outcomes are poor for patients with advanced disease. Expression of tumor-associated antigens by melanoma cells makes the disease a promising candidate for immunotherapy. The hematopoietic cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) has a variety of effects on the immune system including activation of T cells and maturation of dendritic cells, as well as an ability to promote humoral and cell-mediated responses...

High-dose interleukin-2 (HDIL2) treatment of patients with metastatic melanoma and renal cell carcinoma is associated with durable responses, but therapy is accompanied by significant toxicity related to vascular leak syndrome (VLS). Currently, the cause of VLS is not well defined; however, based on the role of endothelial cell (EC) permeability in VLS and the commonly observed hypoalbuminemia in patients receiving HDIL2 therapy, we established an in vitro approach utilizing primary human pulmonary microvascular ECs to monitor the effect of HDIL2 therapy on albumin uptake...

BACKGROUND: Hiatal hernia (HH) is closely associated with morbid obesity. There is controversy over the need for preoperative imaging before laparoscopic adjustable gastric band placement. The aim of this study is to determine the predictive value of preoperatively diagnosing HH with upper gastrointestinal (UGI) series imaging. METHODS: A retrospective review of a single surgeon's experience with laparoscopic adjustable gastric band placements was performed. All patients received a preoperative UGI series...

OBJECTIVE: Bicuspid aortic valve (BAV) disease is associated with aortic dilatation and aneurysm (AN) formation. The American College of Cardiology/American Heart Association (ACC/AHA) 2006 guidelines recommend replacement of the ascending aorta for an aortic diameter (AD)> 45 mm in patients undergoing aortic valve replacement (AVR). We evaluated the outcomes of AVR and AVR with aortic replacement (AVR/AN). METHODS: We retrospectively reviewed (2004-2011) the data from 456 patients with BAV and compared the morbidity and mortality between the AVR and AVR/AN groups and 3 subgroups: AVR with an AD<45 mm; AVR/AN with an AD of 45 to 49 mm; and AVR/AN with an AD of ≥50 mm...

BACKGROUND: We hypothesize that currently minimally invasive techniques are underutilized, leading to unnecessary morbidity and mortality. The objective of the study was to compare morbidity and mortality rates in patients receiving a minimally invasive (MIS) small bowel resection to patients receiving an open (OP) small bowel resection. METHODS: Patients in the National Surgical Quality Improvement Program (NSQIP) database who underwent a small bowel resection between 2007 and 2011 were enrolled in the study and grouped whether they received a MIS procedure (n = 1,780) or an OP procedure (n = 17,701)...

Extrinsic compression of the bile duct from gallstone disease is associated with bilio-biliary fistulization, requiring biliary-enteric reconstruction. Biliary-enteric fistulas are associated with intestinal obstruction at various levels. The primary goal of therapy is relief of intestinal obstruction; definitive repair is performed for selected patients. Hemobilia from gallstone-related pseudoaneurysms is preferentially controlled by selective arterial embolization. Rapidly increasing jaundice with relatively normal liver enzymes is a diagnostic hallmark of bilhemia...

OBJECTIVE: Most medical schools in the United States use the National Board of Medical Examiners Subject Examinations as a method of at least partial assessment of student performance, yet there is still uncertainty of how well these examination scores correlate with clinical proficiency. Thus, we investigated which factors in a surgery clerkship curriculum have a positive effect on academic achievement on the National Board of Medical Examiners Subject Examination in Surgery. DESIGN: A retrospective analysis of 83 third-year medical students at our institution with 4 unique clinical experiences on the general surgery clerkship for the 2007-2008 academic year was conducted...

BACKGROUND: Laparoscopic cholecystectomy is the treatment of choice for biliary dyskinesia; however, long-term outcomes remain unclear. METHODS: A retrospective review of patients diagnosed with biliary dyskinesia and treated with laparoscopic cholecystectomy at a single institution between 2001 and 2012 was conducted. Long-term outcome data were obtained by telephonic interview using a modified Likert scale. RESULTS: Sixty-seven patients met inclusion criteria, of which 34 patients (51%) had long-term follow-up data...

BACKGROUND: We evaluated the efficacy of pre-operative Staphylococcus aureus (SA) screening and chlorhexidine chest scrub in decreasing the incidence of empyema after major pulmonary resections. METHODS: For two years, a strategy aimed at decreasing post-resection empyema was instituted. This entailed pre-operative screening for nasal SA and chlorhexidine chest scrub the night before surgery (Group Swab-Scrub, n=192). Patients screened positive for SA, methicillin-resistant (MRSA) and methicillin-sensitive (MSSA), received 5 d of nasal mupirocin...

OBJECTIVES: Surgeon case volume has been utilized in the credentialing process as a surrogate for surgeon skill. The purpose of this study was to compare objective outcome measures of laparoscopic partial colectomies performed by laparoscopically skilled surgeons with varying annual case census. METHODS: We performed a retrospective cohort review of all patients (n = 255) undergoing elective laparoscopic partial colectomy. Patients were grouped according to surgeon's annual case volume as low annual case volume (LV; n = 48) and high annual case volume (HV; n = 207)...

BACKGROUND: The purpose of this study is to evaluate symptom relief, patient satisfaction, and safety of permanent mesh following Nissen fundoplication and hiatal hernia repair. METHODS: Patients who underwent Nissen fundoplication and hiatal hernia repair with permanent mesh (Crurasoft; Davol, Inc, Bard, Warwick, RI) between 2005 and 2011 were identified. A retrospective chart review was conducted. Long-term follow-up data were obtained via telephone interviews using a modified 5-point Likert scale...

BACKGROUND: There remains increasing societal pressure to limit the use of animals in medical education. The purpose of this study was to explore the subjective perceptions that medical students exposed to an animal model curriculum feel about the laboratory and its continued use. METHODS: A 6-month prospective study was performed during the medical college core surgical clerkship. Medical students participated in both a trainer-based simulation workshop (dry laboratory) and a live-tissue animal laboratory (wet laboratory) in addition to their operative experience...

Multiple studies have shown patients have a positive attitude toward medical students in outpatient facilities, but it is unknown whether these results can be extrapolated to inpatients. The purpose of this study is to describe the patients' attitude toward medical students in the inpatient facility and factors that may affect it. A 43-item questionnaire was provided to patients of the general surgery department; it gathered demographics, clinical condition, and patients' opinions regarding the medical students' involvement in their care...

BACKGROUND: The purpose of our study was to determine the predictive impact of individual academic measures for the matriculation of senior medical students into a general surgery residency. METHODS: Academic records were evaluated for third-year medical students (n = 781) at a single institution between 2004 and 2011. Cohorts were defined by student matriculation into either a general surgery residency program (n = 58) or a non-general surgery residency program (n = 723)...

BACKGROUND: Laparoscopic ultrasound (LUS) is a method of intraoperative bile duct imaging that can be used prior to any potentially hazardous dissection. The purpose of this study was to determine whether LUS could permit safe laparoscopic completion of difficult cholecystectomy (LC) cases and to assess whether its use had any impact on clinical outcome. METHODS: We identified prospectively 44 patients with severe cholecystitis in whom LUS was considered critical for intraoperative identification of the bile ducts...

BACKGROUND AND OBJECTIVES: Laparoscopic adjustable gastric banding is an effective and popular bariatric surgery for weight loss in obese patients that traditionally involves up to 5 incisions. Recently, a more minimally invasive single-incision technique has been developed. In this retrospective study, we compare conventional and single-incision laparoscopic adjustable gastric banding with regard to weight loss and complication rates in a cohort of demographically similar patients. METHODS: From February 2009 to February 2010, 59 patients underwent laparoscopic adjustable gastric banding by one surgeon at an outpatient surgery center...

INTRODUCTION: As attending surgeons' comfort with single-incision laparoscopic surgery (SILS) grows, and with continued improvement in surgical instruments, advanced laparoscopic techniques are increasingly being incorporated into surgical training. The aim of our study was to evaluate resident performance and patient outcomes in patients undergoing resident-performed SILS versus a resident-performed traditional laparoscopic cholecystectomy (LC). METHODS: A retrospective case-control study of 80 patients undergoing elective surgical intervention with a resident-performed SILS (n = 20) or a resident-performed traditional LC (n = 60) for gallbladder disease over a 15-month period was performed...

Although the treatment of malignant pleural mesothelioma has been refined during the past two decades, overall survival from this rather uncommon disease is still extremely poor. Here we review the current multimodal diagnostic and treatment options for patients with mesothelioma and discuss promising new experimental concepts in this disease.