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Background and Study Aim: Previous studies have shown that both scheduled second-look endoscopy and high-dose continuous omeprazole infusion are effective in preventing peptic ulcer rebleeding. The aim of this noninferiority trial was to compare the efficacy of these two strategies for the prevention of rebleeding following primary endoscopic hemostasis.Patients and Methods: Consecutive patients who received endoscopic treatment for bleeding peptic ulcers (actively bleeding, with nonbleeding visible vessels) were randomized to two treatment groups following hemostasis. One group (second-look endoscopy group) received the proton pump inhibitor (PPI) omeprazole as an intravenous bolus every 12 hours for 72 hours and a second endoscopy within 16 - 24 hours with retreatment for persistent stigmata of bleeding. The other group (PPI infusion group) received continuous high-dose omeprazole infusion for 72 hours. Patients who developed rebleeding underwent surgery if repeat endoscopic therapy failed. The primary outcome was the rebleeding rate within 30 days after initial hemostasis. The margin for noninferiority was set at 5 %.Results: A total of 153 patients were randomized to the PPI infusion group and 152 to the second-look endoscopy group. Rebleeding occurred within 30 days in 10 patients (6.5 %) in the PPI infusion group and in 12 patients (7.9 %) in the second-look endoscopy group (P = 0.646). Surgery was required for rebleeding in six patients from the PPI infusion group and three patients in the second-look endoscopy group (P = 0.32). Intensive care unit stay, transfusion requirements, and mortality were not different between the groups. Patients in the second-look endoscopy group were discharged 1 day earlier than those in the PPI infusion group (P < 0.001).Conclusions: After endoscopic hemostasis, high-dose PPI infusion was not inferior to second-look endoscopy with bolus PPI in preventing peptic ulcer rebleeding.Trial Registration: ClinicalTrials.gov (NCT: 00164931). [ABSTRACT FROM AUTHOR]

Background The benefits of central compartment dissection ( CCD) in papillary thyroid carcinoma ( PTC) are still debatable and should be weighed against its potential risks. We aim to compare the complication rates in total thyroidectomy with and without CCD for patients with PTC. Methods This is a retrospective study on prospectively collected data from our cancer registry over a 15-year period. Patients with pathologically proven PTC treated with total thyroidectomy alone or with CCD were included. CCD was performed at the operating surgeon's discretion. A total of 105 patients were included and divided into two groups for analysis: group A - total thyroidectomy alone (51 patients, 49%) and group B - total thyroidectomy with CCD (54 patients, 51%). The operative complications between the two groups were then evaluated. Results Overall, 6.9% and 0.98% patients had transient and permanent recurrent laryngeal nerve palsies, respectively. About 19.0% and 2.9% patients had transient and permanent hypoparathyroidism, respectively and 27.6% patients had parathyroid glands found to be included in the resected specimen. Complication rates in terms of transient or permanent recurrent laryngeal nerve palsy or hypoparathyroidism did not differ significantly between groups A and B. Within group B, 41 patients had unilateral CCD and 12 had bilateral CCD. Transient hypoparathyroidism was more frequent in bilateral CCD (50% versus 12.2%, P = 0.01). Conclusions Total thyroidectomy with prophylactic unilateral CCD is a safe procedure for PTC without added complication rates compared with total thyroidectomy alone. It is recommended for patients with PTC and clinically negative neck lymph nodes. [ABSTRACT FROM AUTHOR]

Aim: Classically, parotidectomy is performed by the antegrade facial nerve dissection technique. However, a significant amount of normal parotid parenchyma is mobilized and killed needlessly, without enhancing the oncological outcome, as most tumours do not reside in the proximity of the facial nerve trunk. We investigate whether retrograde facial nerve dissection (the facial nerve branches were identified and dissected proximally) is a safe or better alternative. Patients and Methods: Patients who underwent parotidectomy for clinically-benign parotid tumours from September 2000 to December 2009 were enrolled. From 2007, we adopted retrograde parotidectomy as the form of surgery for treating parotid masses. A comparison was made between the antegrade and retrograde facial nerve dissection groups regarding the operation time, hospital stay and surgical complications. Results: The patient and tumour characteristics were comparable between the two groups. The mean operation time was shorter in the retrograde group: 144 min versus 176.2 min ( P = 0.002). The postoperative stay was also shorter for the retrograde group: 3.3 days versus 4.1 days ( P = 0.037). There was no tumour relapse in either group. More great auricular nerves were divided in the antegrade group: 59 per cent versus 10.3 per cent ( P = 0.009). A consistent trend of a lower rate of transient facial palsy, pinna numbness, sialocele/salivary fistula and Frey's syndrome was seen in the retrograde group, although they were statistically insignificant. Conclusion: Retrograde parotidectomy can be performed safely without compromising the oncological outcome. [ABSTRACT FROM AUTHOR]

Objective: To assess the feasibility and advantages of submandibular sialoadenectomy under local anesthesia. Study Design: Retrospective clinical study. Subjects and Methods: Twenty patients with benign submandibular masses underwent submandibular sialoadenectomy. The procedure was carried out under local anesthesia (LA) in 12 patients and general anesthesia (GA) in 8 patients. The patient and tumor characteristics, as well as treatment outcome or complications, were compared between the two groups. Results: There was no conversion from LA to GA. Nine patients in the LA group could be discharged as day-case surgery versus none in the GA group, P = 0.001. The postoperative hospital stay was also much shorter in the LA group: 0.4 day vs 2.0 days, P < 0.001. Postoperative vomiting occurred in only two of the eight patients of the GA group. Complication rate was similar. Conclusion: Submandibular sialoadenectomy under local anesthesia is feasible. It can shorten the hospital stay and facilitate day-case surgery. [Copyright &y& Elsevier]

Objective: Because of the smaller breast size of Chinese women, postmastectomy reconstruction without prosthesis by extended latissimus dorsi (LD) flap is potentially more applicable in the Chinese population. Methods: Patients who had undergone immediate postmastectomy breast reconstruction by extended latissimus dorsi flap without prosthesis were retrospectively studied. Surgical complications, aesthetic result and patient satisfaction were evaluated. Results: Ten Asian patients (nine Chinese and one Filipino) underwent extended LD flap for breast reconstruction after mastectomy. There was no total or partial flap failure. Operative complications included seroma in one patient and minor wound edge slough at back wounds in two patients. Simultaneous seroma and minor donor wound slough occurred in another patient. Aesthetic outcome was excellent ( n = 5), good ( n = 4) and poor ( n = 1). Patient satisfaction with the procedure was very satisfied in four, satisfied in four and dissatisfied in two, respectively. All but two patients would recommend the same procedure to their friends or relatives. Conclusion: Extended LD flap can reliably achieve pleasing results with low morbidity. It has more potential to become a competitive alternative to transverse abdominis myocutaneous flap in most Chinese women for postmastectomy reconstruction. [ABSTRACT FROM AUTHOR]