Contributions of jewish surgeons in the United States.

The contributions of Jewish American surgeons in the nineteenth and early twentieth century at a time in which prejudice against ethnic and religious minorities was commonplace in the United States are detailed. The contributions of Jewish American surgeons and the positions they attained subsequent to a change in attitude toward religious minorities in the United States are presented as a comparison.

Franz John A. Torek.

Franz John A. Torek (1861 to 1938) is one of the pioneering surgeons in thoracic surgery. The son of German immigrants, he worked in the German (now Lenox Hill) Hospital in New York City. In 1913 he performed the first thoracic esophagectomy for cancer, and the patient survived for 12 years. We describe the surgical work and private life of Torek and recall the details of the groundbreaking operation.

Survival outcomes in liver transplantation for hepatocellular carcinoma, comparing impact of hepatitis C versus other etiology of cirrhosis.

The incidence of hepatocellular carcinoma (HCC) is on the rise worldwide as the most common primary hepatic malignancy. In the US approximately one half of all HCC is related to Hepatitis C virus (HCV) infection. The relationship between the primary disease and HCC recurrence after liver transplantation is unknown. We hypothesized that the primary hepatic disease underlying the development of cirrhosis and HCC would be associated with the risk of recurrent HCC after transplantation. A retrospective review was conducted of all primary liver transplants performed at the University of Rochester Medical Center from May 1995 through June 2004. The pathology reports from the native livers of 727 recipients were examined for the presence of HCC. There were 71 liver transplant recipients with histopathological evidence of HCC. These patients were divided in two groups on the basis of HCV status. Group 1 consisted of 37 patients that were both HCV and HCC positive, and Group 2 consisted of 34 patients that were HCC positive but HCV negative. Patient characteristics were analyzed, as well as number of tumors, tumor size, presence of vascular invasion, lobe involvement, recipient demographics, donor factors, pretransplantation HCC therapy, rejection episodes, and documented HCC recurrence and treatment. There were no statistically significant differences between the 2 groups, with the exception of recipient age and the presence of hepatitis B coinfection. The tumor characteristics of both groups were similar in numbers of tumors, Milan criteria status, vascular invasion, incidental HCC differentiation, and largest tumor size. The HCV positive population had a far lower patient survival rate with patient survival in Group 1 at 1, 3, and 5 years being 81.1%, 57.4%, and 49.3% respectively, compared with 94.1%, 82.8%, and 76.4% in Group 2 (p = 0.049). Tumor-free survival in Group 1 at 1, 3, and 5 years was 70.3%, 43%, and 36.8% respectively, vs. 88.1%, 73%, and 60.8% in Group 2. In a subgroup analysis, tumor-free survival was further examined by stratifying the patients on the basis of Milan criteria. Group 1 patients outside of Milan criteria had a statistically lower tumor-free survival. By contrast, there was no statistical difference in tumor-free survival in Group 2 patients stratified according to Milan criteria. Cox regression analysis identified HCV and vascular invasion as significant independent predictors of tumor-free survival. Our results suggest that Milan selection criteria may be too limiting and lose their predictive power when applied to patients without HCV infection.

Economic evaluation of minimally invasive colectomy.

BACKGROUND: We performed a cost-benefit analysis of minimally invasive colectomy (MIC) with the appreciation that this approach extends the duration of the operation and requires additional instruments and equipment when compared with the open procedure. These negatives may be offset by decreased pain, earlier initiation of oral feeding, and a shorter hospitalization. STUDY DESIGN: We reviewed operating room records of all open colectomies (OCs) and MICs performed at Strong Memorial Hospital between January 1, 2000, and March 31, 2004, as defined by CPT codes. Operating room times, total operating room costs, lengths of hospital stay, and total hospital costs were calculated for each procedure. RESULTS: Sixty-eight right hemicolectomies (54 OCs and 14 MICs) were performed. Operating room time was significantly longer for MIC compared with OC (214 +/- 41 minutes versus 170 +/- 56 minutes, p = 0.01). Length of hospital stay was shorter for MIC compared with OC (4.5 +/- 1.3 days versus 7.4 +/- 2.5 days, p = 0.004). There were 131 left hemicolectomies (104 OCs and 27 MICs) performed. Operating room time was significantly longer for left MIC compared with left OC (256 +/- 46 minutes versus 213 +/- 60 minutes, p = 0.005). Length of hospital stay was shorter for left MIC than for left OC (4.4 +/- 1.3 days versus 7.9 +/- 3.0 days, p = 0.001). Total hospital costs were significantly lower for MIC compared with OC (8,580 US dollars +/- 1,358 US dollars versus 10,303 US dollars +/- 3,299 US dollars, p = 0.046). CONCLUSIONS: MIC is associated with a significantly longer operating room time and a shorter hospital stay than OC. Operating room cost is significantly higher for MIC, but total hospital cost is lower. MIC is cost effective and results in significant savings to the health-care system.

The discovery of insulin: the Rochester, New York, connection.

The discovery of insulin in Toronto by Dr. Frederick G. Banting and colleagues has been well chronicled. The story of how insulin therapy was introduced into the United States has been less detailed. The first patient to be treated with insulin in the United States resided in Rochester, New York, a city with a then newly developed medical school that had also tried to recruit Dr. Banting. A series of letters from that period provides a description of the course of a juvenile patient with diabetes before and after the use of insulin as a therapeutic agent.