Copyright 2002 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2002
Dr Arthur E. Baue, a former editor of the ARCHIVES and a former Chairman of Surgery at a prestigious medical school, reiterates the feelings of others that there are too many societies, too many meetings, and too many publications of insignificant merit or incompleteness.
As long as personalities, egos, the publish-or-perish mentality, affluence, and money from commercial sources and publishing houses tempt us, restraint is difficult, if not impossible. The only solution appears to be that offered by Hom, Organ, and Twomey (Am Coll Surgeons Bull. 1991;76:23-26), that of merging organizations and publications. Dr Baue concludes with the Harvard Law of Experimentation: "Under controlled conditions, animals and people (and organizations and publishers) behave as they damn well please."
Another report by an author who is very knowledgeable in his field relates to bacterial resistance to antibiotics. Dr Robert E. Condon, a longtime leader in this area and a thoughtful person, looks at the practical aspects of dealing with this problem and makes some important suggestions. He notes that "Bacterial resistance to antimicrobials will always be a problem" and that we now need to "choose novel strategies that have a potential for success."
Schwartz and Tumblin present a review of competitive health care organizations and point out the domination by leaders who practice an outmoded transactional style of leadership that breeds mediocrity and stagnation. They contrast this with entrepreneurship outside the health care sector, emphasizing the characteristics of successful leadership. Their report is well worth reading and pondering.
Because a large percentage of patients with hepatic malignancy have contraindications to major resection, this article by Adam et al, a highly experienced liver group from Villejuif, France, continues the search for the best ways to manage this difficult group of patients. Owing to the small number of patients involved, it is difficult to make a definitive statement, but it does appear that percutaneous radiofrequency ablation has an advantage in recurrence rate over percutaneous cryosurgery in patients with metastatic but not primary liver cancer.
In this era of laparoscopic, minimally invasive surgery, elective splenectomy is rarely performed by open technique. However, as Rosen, Ponsky, et al from the Cleveland Clinic, Cleveland, Ohio, report, splenomegaly may preclude safe mobilization and hilar control using a conventional laparoscopic procedure. In a modest series, hand-assisted laparoscopic splenectomy was employed with success for those patients with significantly larger spleens; there was no mortality.
As a logical extension of the sentinel node mapping technique, Bilchik et al have used molecular profiling in patients with early colorectal cancer. Of 31 patients with negative nodes on hematoxylin-eosin staining, 8 (26%) showed occult micrometastases by immunohistochemical staining, which correlated with the increased presence of tumor markers in the primary lesion.
This Month In Archives of Surgery. Arch Surg. 2002;137(12):1330. doi:10.1001/archsurg.137.12.1330