PubMed · 13867843
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A BERINGER, K BURIAN, H ELLEGAST, H FRISCHAUF. 1962-03-24. [Problems in pituitary destruction].. https://pubmed.ncbi.nlm.nih.gov/13867843/
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Non-inflammatory cystic lesions of the pancreas are increasingly recognized. Two distinct entities have been defined, i.e., intraductal papillary mucinous neoplasm (IPMN) and mucinous cystic neoplasm (MCN). Ovarian-type stroma has been proposed as a requisite to distinguish MCN from IPMN. Some other distinct features to characterize IPMN and MCN have been identified, but there remain ambiguities between the two diseases. In view of the increasing frequency with which these neoplasms are being diagnosed worldwide, it would be helpful for physicians managing patients with cystic neoplasms of the pancreas to have guidelines for the diagnosis and treatment of IPMN and MCN. The proposed guidelines represent a consensus of the working group of the International Association of Pancreatology.
BACKGROUND AND AIMS: The purpose of this study was to present the current topographic and anatomical knowledge in neurolaryngology, with special regard to laryngeal paralyses as a major complication in thyroid surgery. PATIENTS AND METHODS: Microscopic anatomical preparation of 22 human hemilarynges was accomplished. RESULTS: Due to their neuroanatomical courses, the following extralaryngeal nerves may be at risk in thyroid surgery: the external branch of the superior laryngeal nerve, the paralaryngeal part of the vagal nerve, the Ansa Galeni, the trunk of the recurrent laryngeal nerve (RLN) and the delicate branches of the RLN to the posterior cricoarytaenoid muscle. The anterior and posterior branches of the RLN (antRLN and postRLN) are less endangered by thyroid surgery because they are covered by the thyroid cartilage and posterior cricoarytaenoid muscle (PCA), respectively. In contrast, the antRLN is vulnerable if a ventilation tube is dislocated, with cuff-induced pressure to the glottic level. CONCLUSION: The increased knowledge in neurolaryngology provides the basis for a selective neuromonitoring to lower the risk of laryngeal paralyses after thyroid surgery.
The growth of knowledge and complexity now seen in General Surgery, has led to the sub-specialization of the discipline. Although it is considered by some to have led to the fragmentation of General Surgery and the erosion of the specialty as we know it today, others would argue that it has and will continue to lead to a stronger division and a higher standard of care. Most would argue that a higher standard of care in focus areas stimulates research and research, in turn, improves the quality of education and training. Ultimately, improved education and training leads to better patient care. Organ-specific specialization such as orthopedics and urology evolved from General Surgery and demonstrates this principle. Further sub-specialization is likely inevitable, if the discipline of General Surgery is to remain a desired specialty. Endocrine surgery has evolved into a sub-specialty of General Surgery, and over the last few decades has matured as a discipline. With this maturation comes the responsibility of defining the standard of care to be provided by surgeons involved in endocrine surgery. To achieve this goal, endocrine surgical associations and societies must set the standard of training both at the residency and postgraduate level. Where we are as a sub-specialty, where we came from, and what it will take to meet this goal are discussed.