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This Month in
October 2002

This Month In Archives Of Surgery

Arch Surg. 2002;137(10):1094. doi:10.1001/archsurg.137.10.1094

Because 9% of their breast cancer patients had a delay in their diagnosis, Goodson and Moore created a standardized description of clinical breast examinations, taking into account the hardness or "durity" and the "nodularity" of the breast. They developed an easy-to-apply scale and noted an increased risk of delayed diagnosis in breasts that had less "dur" but more nodularity. Their article alerts readers to their system and particularly to the less dur/more nodular breast, with its potential for improvement in clinical diagnosis.

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Two articles related to operative intervention for breast cancer center on the sentinel node procedure. Luini et al relate their positive experience with sentinel node biopsy in patients with early-stage breast cancer (maximum diameter, 2.5 cm). They used a gamma probe to locate the nodes after injection of a mixture of colloidal human albumin particles labeled with technetium Tc 99m a few hours earlier. Patients with metastatic nodes were then candidates for full axillary dissection.

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Finally, we present the provocative article by the John Wayne Cancer Institute Group, who popularized the use of sentinel node biopsy in breast cancer. The authors followed a group of 238 patients (85% T1 and 15% T2 tumors) for a median of 38.9 months. Because there were no recurrences in the axillae of patients with sentinel nodes negative for metastasis, the authors propose that sentinel node biopsy can be offered as the sole axillary staging procedure.

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When looking at the surgical literature, it is hard to ignore the fact that laparoscopic techniques have captured the imagination of surgeons and patients. Two articles are presented. One, by Greenway et al, explains the benefits of bariatric procedures on non–insulin-dependent diabetes mellitus, and the other, by Ertem et al, offers a new procedure for dealing with liver hydatid cysts.

Effects of Obesity Surgery on Non–Insulin-Dependent Diabetes Mellitus

Greenway et al reviewed all the procedures currently in vogue for weight reduction, with emphasis on the fact that many are performed laparoscopically. Further, they speculate regarding the relative role of these operations in ameliorating non–insulin-dependent diabetes mellitus in these obese patients. They favor 2 procedures, Roux-en-Y gastric bypass and biliary-pancreatic diversion, for their ability to offer the greatest weight loss and their dramatic effects on non–insulin-dependent diabetes. Their thought is that these techniques bypass the foregut and increase enteroglucagon levels. Obviously, clinical trials will be necessary to confirm these suppositions.

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Laparoscopically Treated Liver Hydatid Cysts

Ertem et al, who see and treat a number of patients with liver hydatid cysts, have devised a laparoscopic manipulation that is effective and reliable. Their system is used for selected patients (48 of 276 in their series), usually with solitary cysts, and is fully described and illustrated. All patients were discharged promptly and treated with a 3-week course of albendazole. No recurrences were noted after a mean follow-up of 34 months. Morbidity was 6%, and there was no mortality.

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Splenorenal Shunt: An Ideal Procedure in the Pacific

This article and its invited critique point out that shunting is an important treatment for noncompliant patients or those living in remote areas where specialized treatment is limited. It is much more permanent than transjugular intrahepatic portosystemic shunt and can be performed with low mortality.

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