Sentinel lymph node dissection in papillary thyroid carcinoma.

BACKGROUND: Occult lymph node (LN) metastasis is common in papillary thyroid carcinoma. Sentinel lymph node (SLN) biopsy has been proven to be successful and accurate to predict the nodal status in melanoma and breast cancer. We investigate the use of SLN in papillary thyroid carcinoma. METHODS: Patients of previously untreated papillary thyroid carcinoma, diagnosed preoperatively by fine-needle cytology without any palpable cervical LN are prospectively studied. Blue dye injection was utilized for the SLN biopsy followed by central compartment lymphadenectomy. The histopathological results of the SLN and lymphadenectomy specimens were compared. RESULTS: Fifteen consecutive patients underwent surgery including SLN biopsy for papillary thyroid carcinoma. Occult nodal metastases were identified in 10 patients (67%). The other five cases had no nodal metastasis. SLN were found in 10 cases. One, two and three SLN were present in three, three and four patients, respectively. SLN were located in the central compartment in eight cases. The SLN were found in the lateral compartment in one case. In the remaining one case, the SLN were found in both the central and lateral compartments. Of the group with found SLN, false negative occurred in one case. The overall accuracy of the SLN in predicting the nodal status was 90%. The sensitivity, specificity, positive predictive value and negative predictive value were 88%, 100%, 100% and 67%, respectively. No complications were directly related to SLN biopsy. CONCLUSION: Occult nodal spread is frequently encountered in papillary thyroid carcinoma. SLN biopsy is safe and feasible in papillary thyroid cancer, however further studies are necessary to improve the diagnostic accuracy prior to routine clinical use.

Introduction of night shift call system for surgical trainees: a prospective self-controlled trial.

OBJECTIVE: The number of hours worked by specialty trainees has come under scrutiny recently. One approach aimed at decreasing the number of consecutive hours worked is the night shift call system (NSCS). This study aimed to determine the advantages and disadvantages of an NSCS compared with those of the conventional overnight call system (ONCS). SUBJECTS AND METHODS: Sixteen basic surgical trainees (BSTs) from our unit participated in this prospective, self-controlled trial. During April 2000, the conventional 1-in-4 ONCS with a post-call half-day off was instituted. From May to June 2000, each BST rotated to work 1 week of night duty (20.00-08.00) and 7 weeks of daytime duty. A battery of neuropsychological tests were administered to the group after call during the study period. RESULTS: On average the numbers of consecutive hours worked during the NSCS and ONCS periods were 12 and 28 hours, respectively. There was no difference in numbers of errors committed and no difference in discrepancy between diagnoses made on admission and discharge. Two of the simple neuropsychological tests (memory scanning and addition tests) showed a significant fall-off in performance during the ONCS period (P < 0.05). Most specialists preferred the ONCS, while the majority of the BSTs preferred the NSCS (P < 0.05). This was because without extra manpower, the overall workloads of senior staff were increased. CONCLUSIONS: The NSCS is 1 way of reducing work hours, and was associated with significantly less impaired cognition on the part of our BSTs. It is only feasible if extra relieving staff are available to cover daytime duties.

Acupuncture anaesthesia in inguinal hernia repair.

BACKGROUND: The present study was undertaken to evaluate the efficacy of acupuncture anaesthesia in inguinal hernia repair. METHODS: Twelve patients with non-recurrent inguinal hernia had Lichtenstein mesh repair under acupuncture anaesthesia. Selected acupuncture loci were stimulated with fine needles connected to low frequency current. Supplementary local anaesthetic was given when required. RESULTS: Four (33%) patients reported satisfactory analgesic effect throughout the operation without need for additional medication, eight (67%) patients experienced mild discomfort during the operation requiring 1-4 mL of 1% lignocaine injection. Blood pressure and heart rate were stable during the procedure. All patients were able to sit up and resume their diet immediately post-operatively. All but one patient were discharged on day one after the procedure, with no early or late complications reported. Most patients were satisfied with the analgesic effect of acupuncture anaesthesia. CONCLUSIONS: Acupuncture anaesthesia is a feasible anaesthetic option. It reduces the amount of local anaesthetic required, and thus the associated potential complications. It is effective in pain relief and inhibiting gastrointestinal upset. Postoperative recovery was rapid and complication free.