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Patients rely on the Internet for medical information. It is difficult to discern which resources are accurate or appropriate for patients. The purpose of this study was to develop a quality-assessment tool for health Internet Web sites and to apply this tool to assess the quality of burn scar management information on the Internet. Between September and December 2001, we prospectively evaluated all Web sites on the Internet search engine Yahoo! containing the headings 'burn scar management,' 'burn scar healing,' 'burn scar treatment,' and 'burn scar therapy.' The quality of each Web site's medical information was evaluated using our scoring system consisting of the following two components: quality and technical characteristics. The total score for each Web site was converted to a percent grade (eg, > or =80% = excellent, 70 to 79% = very good, 60 to 69% = good, 50 to 59% = fair, and <50% = poor). The Web sites were grouped into three categories: commercial (for profit), academic (university, hospital), and organizational (nonprofit). Of 88 Web sites evaluated, the majority 68 (77%) were commercial, 7 (8%) academic, and 13 (15%) organizational. Burn scar management information on the Internet was poor in the majority (79%) of commercial Web sites and was excellent, very good, or good in the majority of academic (86%) and organizational (77%) Web sites. Using our health information evaluation, we found that the majority of burn scar management information on the internet (77%) was of fair or poor quality. Academic and organizational Web sites had the best quality of burn scar management information. Additional testing of the developed tool will be needed to analyze the reproducibility of the results and their applicability in other medical domains. [ABSTRACT FROM AUTHOR]

Background: There is scant data concerning surgeon-performed thyroid fine-needle aspiration (FNA), and controversy regarding its accuracy in larger nodules. This study aimed to specifically assess accuracy of surgeon-performed ultrasound (US)-guided FNA on a per-nodule basis, with a subanalysis of nodule size., Methods: Data of 1,000 surgeon-performed US-guided thyroid FNAs at a single institution from 2000 to 2010 were prospectively collected. Standard clinical information, FNA results using the Bethesda criteria, and final histology were recorded., Results: Fine-needle aspiration results were reported as: cancer (7%), suspicious for cancer (2%), suspicious for follicular neoplasm (17%), atypia of unknown significance (AUS) (1%), benign (67%), and insufficient (6%). Of nodules with FNA results of cancer, suspicious for cancer, suspicious for follicular neoplasm, and atypia of unknown significance, 94% were operated on, with malignancy rates of 97%, 58%, 21%, and 12%, respectively. Of nodules with benign FNA, 26% underwent surgery for associated symptoms, concerning features, or other remote pathology. A total of 56% were followed, and 18% were lost to follow-up. Of nodules with insufficient FNA, 46% had repeat FNA (yielding a diagnosis in 81%), 23% underwent surgery, 21% with hypocellular features were followed, and 9% were lost to follow-up. In size subanalysis, there was no statistically significant difference in risk of malignancy or increased rate of falsely negative FNA with increasing nodule size., Conclusions: The Bethesda system appropriately stratified lesions for risk of malignancy, and repeat FNA had high diagnostic yield in lesions with inadequate FNA. The results suggest no trend toward larger lesions harboring thyroid malignancy nor an increased likelihood of false-negative benign FNA.

Recurrent and persistent primary hyperparathyroidism remains a significant surgical challenge. Abnormal, hypersecreting parathyroid glands are found in ectopic locations in up to 15% to 20% of patients. A small portion of these ectopic glands will be found in the mediastinum at a location that precludes removal through the traditional cervical incision. Minimally invasive approaches to these glands are desirable because of the significant morbidity, pain, and hospital stay associated with sternotomy or thoracotomy. Recently, robotic approaches have been described for mediastinal parathyroids. We report a case of young woman with persistent primary hyperparathyroidism who was cured after undergoing robotic thoracoscopic mediastinal parathyroidectomy using radiooperative and intraoperative parathyroid hormone guidance.

BACKGROUND: Advanced laparoscopic training is becoming a valuable asset for surgeons as more procedures are carried out in a minimally invasive fashion. The purpose of our study was to determine whether laparoscopic fellowship training affects outcomes in patients undergoing laparoscopic cholecystectomy for acute cholecystitis. METHODS: We obtained data from a retrospective review of 110 patients with acute cholecystitis who underwent laparoscopic cholecystectomy on an urgent basis from March 2002 to June 2005. We compared the outcomes of 31 patients whose surgeries were performed by a surgeon with advanced laparoscopic training with those of 79 patients whose surgeries were performed by surgeons without such training. RESULTS: The 2 groups were similar in terms of demographics and time to surgery. Outcome measures included conversion rates, postoperative length of stay (LOS) and complications. There was a significant difference in conversion rates (3.2 % v. 16.5 %, p = 0.050) and postoperative LOS (1.77 v. 2.82 d, p < 0.006) between the 2 groups, but there was no difference in the rate of postoperative complications. There was no significant difference in conversion rates among the surgeons without advanced training (p = 0.64). CONCLUSION: Based on our results, laparoscopic cholecystectomy in acute cholecystitis is associated with improved outcomes when performed by a surgeon with fellowship training in laparoscopic surgery.

Objective: To determine prevalence of, and risk factors for, odontoclastic resorptive lesions in cats seen in a private veterinary practice population., Design: Population-based cross-sectional study., Animals: 145 cats more than 1 year of age that underwent anesthesia for various procedures., Procedure: Cats were evaluated under anesthesia for odontoclastic resorptive lesions. Lesions were graded, using a published classification system. Clients completed a standardized survey on signalment, indoor-outdoor status, medications, diet during the past year, number of daily feedings, treat feeding, source of water, and oral hygiene practices., Results: 48% of cats had resorptive lesions. Lesions were most commonly mandibular, and premolars were more often affected. Compared with cats without oral lesions, cats with oral lesions were more likely to be older, female, taking medications, drinking city (vs well) water, and playing less often with toys. In addition, cats without oral lesions were more likely to have owners who cleaned their teeth daily or twice a week and to be fed diets with higher magnesium, calcium, phosphorus, and potassium contents. Frequency of teeth cleaning was inversely related to the development of odontoclastic resorptive lesions. Variables significantly associated with oral lesions were age and magnesium content of diet., Clinical Implications: Older cats should be examined closely for odontoclastic resorptive lesions. Clients should be advised on methods and frequency of teeth cleaning in cats to prevent lesions. Dietary nutrients may play a role in the development of odontoclastic resorptive lesions in cats.