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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 30, 2012
Annals of Surgery Journal Club Final Comment from Herb Chen
The surgical approach to patients with primary hyperparathyroidism continues to be controversial. While Dr. Udelsman and colleagues believe that target or minimally invasive parathyroidectomy is optimal, a poll of the participants in this journal club suggest otherwise. In fact, by a ratio of 3:1, our readers do not agree with Dr. Udelsman’s conclusions and prefer bilateral exploration. Interestingly, there are data from multiple institutions, including our own, that with longer term follow-up minimally invasive parathyroidectomy may be associated with a slightly higher recurrence rate. In any case, in the hands of experienced surgeons, both techniques have been proven to be effective and safe. I think all surgeons can agree that the most effective therapy for patients with primary hyperparathyroidism is parathyroidectomy, and collectively we should advocate for referral of all patients with this disease for surgery. -Herb Chen, MD
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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