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This Month in
March 2002

This Month in Archives of Surgery

Author Affiliations
 

GERALD WPESKINMD

Arch Surg. 2002;137(3):249. doi:10.1001/archsurg.137.3.249
Little Gems

To assist with your constant desire to improve clinical services, we offer a number of suggestions to mull over and perhaps apply to your current techniques in the way of modification.

First, a Mayo Clinic studyArticleexamines intramural small-bowel hematoma, presenting in many instances as bowel obstruction. The series of cases emphasizes the benign nature of this entity and the conservative treatment following computed tomographic scan.

Second, a randomized controlled studyArticleof the use of polymeric sealant as a means of rapidly stopping bleeding from suture holes at anastomotic sites of graft material in vascular surgery presents another interesting and time-saving idea.

Third, a comparison of matrix excision and segmental phenolization is made for treatment of ingrown toenailsArticle. The authors point out their preference in treatment because the results indicate no real difference between arms of the protocol.

Finally, an interesting study of 40 patients has been performed to evaluate stapled vs excision hemorrhoidectomy. The benefits for the stapled group include shorter operating time, less postoperative pain, and earlier return to work with no overall difference in recurrence. The authors point out that if this is confirmed in a larger, longer study, stapling (Longo technique) may become the standard for treatment of third-degree hemorrhoid disease.

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Melanoma Revisited

Hetzer et al point out that thick melanomas (Breslow >4 mm) with no positive nodes have a reasonably favorable prognosis (median overall survival of 70 months and disease-free survival of 51 months) before the era of adjuvant chemotherapy. Thus, the authors conclude that thickness of the melanoma itself should not be used as a criterion for adjuvant therapy but that other factors of prognosis should be considered (150 patients, node negative).

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Effective Prevention of Adhesions With Hyaluronic Sodium

The surgical world is looking for relief from the consequences of adhesion formation after mesh is placed to bridge a peritoneal defect. Kramer et al have suggested a bioresorbant membrane of hyaluronic acid as a mesh covering to prevent intra-abdominal adhesions. In an animal series, a very significant difference was noted in both the number and severity of adhesions when the bioresorbant membrane was used to conceal the mesh in the course of laparoscopic hernia repair. Studies in humans initially support the animal conclusions.

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