Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002
Is there an answer to the question of the value of sentinel node biopsy in patients with cutaneous melanoma? Lens et al have analyzed several series and endeavored to treat fairly both those treated by local excision and node dissection and those with local treatment alone. In the series they present, there is no obvious advantage for those receiving node dissection as an additional procedure. Although the authors assert that the trials they reviewed are of questionable validity and call for a large-scale additional trial to resolve the issue, the technique of sentinel node biopsy has been widely accepted as a staging modality, which probably precludes additional studies of this nature. Thus, until we can examine the melanoma primary and thereby make valid decisions regarding the need for node dissection, sentinel node biopsy rules the day.
Several articles deal with the value of a lavage cytologic technique in predicting the value of operative intervention for malignant disease, whether primary or metastatic. This is far from an exact science, but there does appear to be a correlation between the extent of disease and the positivity of the lavage cytologic technique. As is stated by Konishi et al, chemoradiation may make up for the variations in disease presence.
To establish a diagnosis in every situation, we have resorted to interventional radiologic examination for angiographic help. The problems associated with vascular puncture, primarily pseudoaneurysm, have been successfully handled with the use of small amounts of locally injected thrombin under ultrasound guidance. Although not a new technique, it deserves repeated emphasis for its simplicity and high success rate.
Much has been written about the wonderful immediate results with laparoscopic fundoplication for gastroesophageal reflux disease. This article and discussion review the significant difficulties noted in longer-term follow-up of these patients, including heartburn treated with medication, hoarseness and coughing, dysphagia and bloating, and changes in diet or lifestyle. All in all, 19% of interviewees were bothered by the results of their operation.
Preoperative selection is the key to appropriate therapy for rectal cancer. The authors point out the advantages of magnetic resonance imaging with external phase-arrayed coils as an alternative after ultrasound failure for bulky lesions, strictures, low tumors, and locally advanced disease. Using this technique, it was possible to achieve excellent sensitivity, specificity, and overall accuracy in a series of consecutive patients. Even for malignant lymphadenopathy, 70% accuracy was obtained. With the advent of newer contrast media specifically for the lymphatic system, or in combination with positron emission tomographic scanning, we may possess the ideal staging tools.
Innumerable articles have dealt with the causes of inflammatory bowel disease. This article provides elegant data in an attempt to support the role of interleukin 1β as a mediator of motor dysfunction of the colonic circular muscle in patients with ulcerative colitis. Other cytokines are to be part of the investigation.
This Month in Archives of Surgery. Arch Surg. 2002;137(4):389. doi:10.1001/archsurg.137.4.389