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Background: This is the first systematic review and meta-analysis of published mortality data after bariatric surgery. Methods: The review includes all papers published in English from January 1, 1990 to April 30, 2006, identified through electronic searches in MEDLINE, Current Contents, and the Cochrane Library, supplemented by manual reference checks. All accepted studies were assigned a level of evidence (Centre for Evidence-Based Medicine, Oxford, UK), and randomized controlled trials were rated for quality using the Jadad scoring method. Random effects meta-analyses were performed. Mortality was analyzed at either ≤30 days or 30 days to 2 years. Results: The data set includes 361 studies with 478 treatment arms and 85,048 patients. At baseline, the mean age was 40.0 years, body mass index was 47.4 kg/m2, 85% were female, and 11.5% had previous bariatric procedures. Meta-analysis of total mortality at ≤30 days was 0.28% (95% confidence interval [CI], 0.22-0.34) in 475 treatment arms (n = 84,931); total mortality at >30 days to 2 years was 0.35% (95% CI, 0.12-0.58) in 140 treatment arms (n = 19,928). Mortality at ≤30 day for all restrictive procedures was 0.30% (95% CI, 0.15-0.46) for open and 0.07% (95% CI, 0.02-0.12) for laparoscopic procedures; restrictive/malabsorptive (gastric bypass) was 0.41% (95% CI, 0.24-0.58] for open and 0.16% (95% CI, 0.09-0.23) for laparoscopic; and malabsorptive was 0.76% (95% CI, 0.29-1.23) for open and 1.11% (95% CI, 0.00-2.70) for laparoscopic. Subgroup analyses of ≤30-day mortality show a male:female ratio of 4.74:0.13, with 1.25% (95% CI, 0.56-1.94) incidence in the superobese and 0.34% (95% CI, 0.00-1.29) in the elderly (≥65 years). Conclusion: The early and late mortality rates after bariatric surgery are low and can be subjected to risk stratification for comparative analyses and prospective risk assessments. [Copyright &y& Elsevier]

Background: The development of an intrathymic parathyroid adenoma is common, and thymectomy is a significant component of the parathyroid surgeon’s technical armamentarium. Over the last decade, minimally invasive parathyroidectomy (MIP) has become the standard technique for removal of an abnormal parathyroid gland, and the requirement for thymectomy should remain unchanged during the era of minimally invasive techniques. The aim of this paper was to assess the feasibility and outcomes of cervical thymectomy for intrathymic parathyroid adenomas during MIP. Methods: This is a retrospective case series. The study group comprised all patients undergoing parathyroidectomy in the University of Sydney Endocrine Surgical Unit during a 5-year period (January 2001 to December 2005). Patients undergoing MIP and open parathyroidectomy with a concomitant cervical thymectomy were compared. Results: A total of 840 patients underwent parathyroid surgery for primary hyperparathyroidism (PHPT) during this period. A total of 30 MIP procedures with concurrent thymectomy were performed, and 99 open bilateral neck explorations with cervical thymectomy were performed. Of the MIP thymectomy group, there were 25 female and 5 male patients; the average age was 57 years (range, 22 to 82). A mean length of 34 mm of thymus was extracted via the minimally invasive approach (range, 8 to 85 mm). In 5 cases, only fatty tissue was identified histologically, and, in 5 cases, a small supernumerary parathyroid gland was identified in the histologic specimen. Only 1 patient suffered temporary, recurrent laryngeal nerve palsy; there were no cases of postoperative hemorrhage requiring return to the operating room. Conclusions: Cervical thymectomy for removal of intrathymic parathyroid adenomas can be performed during lateral focused mini-incision MIP with a safety and efficacy equivalent to open bilateral neck explorations. [Copyright &y& Elsevier]

Background: The purpose of this study was to determine if there was an increase in the average number of articles published per year for surgery department chairs and if there was an association of publication patterns during their academic careers to authorship position and types and quality of articles written. Methods: Computerized literature searches were performed for 299 chairs of departments of surgery between 1950 and 2004. We compiled data on time as chair, number of publications per year, article types, authorship positions, and impact factors of the journals. Nonparametric tests allowed identification of differences between groups, and regression analyses were used to analyze publication trends over time. Results: There was a significant increase in the number of articles published per year from the beginning to the end of the study (P < .01). Articles were more likely to be clinical than nonclinical (P < .01), and more review articles were written for nonclinical publications (P < .01). Individuals overall were most likely to be last authors than first or contributing authors (P < .01). More papers were published prior to becoming chairs compared to during tenure as chair or post-chair (P < .01). As post-chairs, individuals were most likely to be contributing authors (P < .01). There was no difference in the quality of the journals to which chairs’ submitted their manuscripts during their academic careers. Conclusions: These findings provide valuable insight into the publication patterns of chairs of surgery departments. Individuals publish fewer articles as chairs and post-chairs, most likely due to the greater emphasis on administration and leadership duties during these career stages. Nevertheless, surgical department chairs tend to publish prolifically throughout their careers. [Copyright &y& Elsevier]

Purpose: Prothymosin-α and ERp57 were previously identified as markers for gastric metaplasia in a mouse model of Helicobacter-induced gastric metaplasia and neoplasia. In this paper we assess whether the expression of these putative biomarkers in humans is correlated with gastric metaplasia and adenocarcinoma and clinical outcomes. Methods: Eight tissue microarrays, containing 749 paraffin-embedded tissue cores from 164 gastric cancer patients, were stained for prothymosin-α and ERp57 by horseradish peroxidase immunohistochemical techniques. The proportion of stained cells per core was quantitated using the Ariol SL-50 automated image analysis system. Results: Prothymosin-α stained a significantly higher percentage of nuclei in cancer and metastases compared with normal gastric mucosa. ERp57 staining was significantly decreased in cancer and metastases compared with both normal gastric mucosa and metaplasias. ERp57 expression also correlated with greater depth of tumor invasion and advanced stage of disease. Kaplan-Meier survival analysis determined that tumors with the highest quartile of ERp57 expression were statistically associated with longer postoperative survival. A Cox proportional hazard analysis showed that maintenance of ERp57 expression was associated with longer postoperative survival. Conclusions: These results suggest that although prothymosin-α is overexpressed in gastric adenocarcinoma, it is not associated with alterations in survival. In contrast, loss of ERp57 expression correlated with more aggressive disease and could provide useful prognostic information for gastric cancer patients. [Copyright &y& Elsevier]

This article has been retracted at the request of the Editors. Please see http://www.elsevier.com/locate/withdrawalpolicy. Reason: It has been called to our attention by one of the indentified authors, Dr. Minoru Uematsu of Keio University School of Medicine, that he did not contribute to this paper and was unaware of its submission. In addition, Dr. Uematsu informs us that the data appear to be an updated version without attribution to his presentation at the 22nd Annual San Antonio Breast Cancer Symposium December 8–11, 1999 (previously published as an abstract (Breast Cancer Research and Treatment 1999; 57:108). Dr. Uematsu also states that the information contained in the SURGERY article is misleading and inaccurate in that the patients were treated with whole breast irradiation in addition to the accelerated partial breast irradiation, a fact that was not stated in the article. The Editors feel that this is a serious misrepresentation of the treatment method. The Editors have contacted Kazuhiko Sato, M.D., Ph.D., who submitted the manuscript for publication and is its first author. Dr. Sato concedes and apologizes for (1) the listing of Dr. Uematsu as an author without his permission, (2) failing to provide the attribution to the original presentation and (3) omitting the crucial fact that conventional whole breast irradiation of 50 Gy was used as a further treatment of patients receiving the APBI. With these facts in hand, it is regrettable but necessary that we retract this article in its entirety. [Copyright &y& Elsevier]

Background: This review examines the surgical and psychological literature on surgeons'' intraoperative non-technical skills. These are the critical cognitive and interpersonal skills that complement surgeons'' technical abilities. The objectives of this paper are (1) to identify the non-technical skills required by surgeons in the operating room and (2) assess the behavioral marker systems that have been developed for rating surgeons'' non-technical skills. Methods: A literature search was conducted against a set of inclusion criteria. Databases searched included BioMed Central, Medline, EDINA BIOSIS, Web-of-Knowledge, PsychLit, and ScienceDirect. Results: A number of “core” categories of non-technical skills were identified from 4 sources of data: questionnaire and interview studies, observational studies, adverse event analyses, and the surgical education/competence assessment literature. The main skill categories were communication, teamwork, leadership, and decision making. The existing frameworks used to measure surgeons'' non-technical skills were found to be deficient in terms of either their psychometric properties or suitability for rating the full range of skills in individual surgeons. Conclusions: Further work is required to develop a valid taxonomy of individual surgeons'' non-technical skills for training and feedback. [Copyright &y& Elsevier]

As part of efforts afoot to improve the overall quality of physician training, the Accreditation Council for Graduate Medical Education (ACGME) has endorsed a set of competencies that will be the blueprint for outcomes-based graduate medical education for years to come. While the spirit of this new law is taking shape, the letter remains largely unwritten. To bridge this gap, administrators of programs from all specialties must determine how the core competencies will be taught, evaluated, modeled, and enforced within their respective programs. This paper summarizes these challenges, in particular for surgical programs, and focuses constructively on the modeling/enforcement approach, describing key characteristics that programs should pursue and cultivate (virtues) as well as the signal prohibitions (vices) that both trainees and trainers must avoid. Regardless of specialty or programmatic particulars, virtues and vices may be used to define a context in which general competencies may be understood, and yield operational guidance upon which ultimate discussions of evaluation, remediation, and graduation may be predicated. [Copyright &y& Elsevier]

Background: Since Allen O. Whipple published his seminal paper in 1935, the procedure that bears his name has been performed widely throughout the world and is now a common operation in major medical centers. The goal of this study was to investigate the evolution of pancreatoduodenectomy at the Massachusetts General Hospital (MGH). Methods: We sought to identify all pancreatoduodenectomies performed at the MGH since 1935. Cases were obtained from a computerized database, hospital medical records, and the MGH historical archive. Demographics, diagnosis, intraoperative variables and short-term surgical outcomes were recorded. Results: The first pancreatoduodenectomy at the MGH was carried out in 1941; since then, 2,050 Whipple procedures have been performed. Pancreatic ductal adenocarcinoma was the most frequent indication (36%). Pylorus preservation has been the most important variation in technique, accounting for 45% of Whipple procedures in the 1980s; observation of frequent delayed gastric emptying after this procedure led to decline in its use. Pancreatic fistula was the most frequent complication (13%). Operative blood replacement and reoperation rates have decreased markedly over time; the most frequent indication for reoperation was intra-abdominal bleeding. Mortality has decreased from 45% to 0.8%, with sepsis and hypovolemic shock being the most frequent causes of death. Mean duration of hospital stay has decreased from >30 to 9.5 days, along with an increasing readmission rate (currently 19%). Conclusion: The Whipple procedure in the 21st century is a well-established operation. Improvements in operative technique and perioperative care have contributed in making it a safe operation that continues evolving. [ABSTRACT FROM AUTHOR]