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Annals of Surgery Journal Club
Interactive resource for surgery residents and surgeons to discuss and critically evaluate articles published in Annals of Surgery selected by a monthly guest expert who will review an article each month, offer questions and respond to reader's comments.
Monday, January 02, 2012
Welcome to Annals of Surgery's Journal Club
Annals of Surgery is pleased to welcome you to the new Journal Club. To participate you first need to access this month's featured article "The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism" by Udelsman and his co-authors at Yale University. The article can be accessed for no cost by clicking on the resources link below.
 
This month's guest expert is Dr. Herbert Chen from the University of Wisconsin. His summary of this article and questions for you to ponder follow:
 
Summary: Surgery is the only curative therapy for primary hyperparathyroidism. When performed by experienced surgeons, parathyroidectomy is associated with high cure rates and low morbidity. Operative approaches include open bilateral exploration or unilateral "minimally invasive" parathyroidectomy. In this article, Dr. Rob Udelsman, one of the most experienced parathyroid surgeons in the world, reports his experience with both procedures. He concludes that the minimally invasive approach is a superior technique.
 
Questions:
      1. What complications can potentially be avoided with a targeted, minimally invasive parathyroidectomy?
      2. What are the theoretical advantages to a bilateral parathyroid exploration?
      3. What is the best imaging study for patients with primary hyperparathyroidism?
      4. Should I operate if the imaging is non-localizing?
 
We encourage you to read this paper (see the resources link below) and to carefully consider Dr. Chen's questions. We welcome and encourage any questions of your own or comments that can be posted to this blog. We will ask Dr. Chen to respond to posted questions and comments on a weekly basis. At the end of the month, Dr. Chen will provide an overall summary of the exchanges that have occurred throughout the month.
   
We hope you will find the Journal Club not only enlightening and engaging, but also entertaining and thoughtful. Of course, we look forward to hearing from you.
 
     Layton F. Rikkers, M.D., Emeritus Editor-in-Chief
1/24/2012
Pamela Nevar said:
Responses to our quick poll suggest readers do not necessarily agree with the conclusion of the article featured in this month's Journal Club. So, for those of you who don't agree, why don't you agree with the conclusion? Don't be shy! Please let us know what you think, and take a look at Dr. Chen's questions above, too. Thanks, Pamela Nevar, MS, RD, Managing Editor
About the Author

Dr. David T Efron
Dr. Efron is an Associate Professor of Surgery, Anesthesiology & Critical Care Medicine and Emergency Medicine at the Johns Hopkins School of Medicine. He is the Director of Trauma and Chief of the Division of Acute Care Surgery (encompassing Trauma, Emergency Surgery and Surgical Critical Care) in The Johns Hopkins Hospital Department of Surgery. He is currently the Vice-Chair of the Maryland State Committee on Trauma. Dr. Efron’s current research interests are within the realm of regulation of inflammatory mediators of septic and post-injury states, particularly focusing on the role that statins play in this milieu. Dr. Efron carries additional interest in traumatic injury from interpersonal violence, measures of violence intensity, and trauma recidivism with an eye to prevention strategies.

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