Sentinel lymph node biopsy for papillary thyroid cancer: 12 years of experience at a single institution.

BACKGROUND: The purpose of this study was to report our experience with sentinel lymph node dissection (SLND) for papillary thyroid carcinoma, to evaluate the feasibility and safety of the procedure, and to examine its potential utility as a guide for central neck dissection. MATERIALS AND METHODS: A retrospective chart review of patients undergoing total thyroidectomy from January 1998 thru January 2010 was conducted. Intratumoral injection of blue dye was used to identify the SLN. Central neck dissection (CND) was performed if the SLN was positive on frozen section. Locally advanced disease, previous thyroid surgery, or lymphadenopathy on preoperative imaging or intraoperative palpation were exclusion criteria. RESULTS: A total of 211 patients underwent SLN mapping. Of these, 165 patients (78%) were female and 46 (22%) were male. Also, 75 (36%) were ≤45 years of age, and 136 (64%) were older than 45. Tumors were ≤2.0 cm (T1) in 142 patients (67%), 2-4 cm (T2) in 35 patients (17%), >4 cm with minimal invasion (T3) in 32 patients (15%), and locally invasive (T4) in 2 patients (1%). At least 1 blue node was found in 192 patients (91%). Also, 47 patients had a positive SLN on frozen section, with an additional 24 node-positive patients on permanent section, for a total of 71 (37%). There were 43 patients (91%) who underwent central neck dissection; 26 (60%) had additional metastases. CONCLUSIONS: Sentinel lymphadenectomy for papillary thyroid carcinoma is feasible, safe, and can identify patients who may benefit from central neck dissection.

Mothers' reports of postpartum pain associated with vaginal and cesarean deliveries: results of a national survey.

BACKGROUND: As cesarean rates increase worldwide, a debate has arisen over the relationship of method of delivery to maternal postpartum physical health. This study examines mothers' reports of their postpartum experiences with pain stratified by method of delivery. METHODS: Listening to Mothers II was a survey of a total of 1,573 (200 telephone and 1,373 online) mothers aged 18 to 45 years, who had a singleton, hospital birth in 2005. They were interviewed by the survey research firm, Harris Interactive, in early 2006. Online respondents were drawn from an existing Harris panel. Telephone respondents were identified through a national telephone listing of new mothers. Results were weighted to reflect a United States national birthing population. Mothers were asked if they experienced any of eight postpartum conditions and the extent and the duration of the problem. Responses were compared by method of delivery. RESULTS: The most frequently cited postpartum difficulty was among mothers with a cesarean section, 79 percent of whom reported experiencing pain at the incision in the first 2 months after birth, with 33 percent describing it as a major problem and 18 percent reporting persistence of the pain into the sixth month postpartum. Mothers with planned cesareans without labor were as likely as those with cesareans with labor to report problems with postpartum pain. Almost half (48%) of mothers with vaginal births (68% among those with instrumental delivery, 63% with episiotomy, 43% spontaneous vaginal birth with no episiotomy) reported experiencing a painful perineum, with 2 percent reporting the pain persisting for at least 6 months. CONCLUSIONS: Substantial proportions of mothers reported problems with postpartum pain. Women experiencing a cesarean section or an assisted vaginal delivery were most likely to report that the pain persisted for an extended period.

Sternocleidomastoid myocutaneous esophagoplasty for benign cervical stricture.

Benign strictures of the cervical esophagus that are resistant to dilation present a formidable challenge to the surgeon. Numerous varied techniques have been developed to restore swallowing. Reports of the sternocleidomastoid myocutaneous pedicled flap for repair of benign cervical strictures are scarce. We are reporting a case of residual lye stricture that was treated with sternocleidomastoid myocutaneous esophagoplasty in order to promote awareness of this procedure. This one-stage operation took 1 hour to complete. The patient began eating on postoperative day 4 and has not had any further symptoms.