The pancreas remains a difficult organ to treat when diseased. Two of our articles suggest resectional therapy for select patients with problems of postobstructive chronic pancreatitis and adult-onset nesidioblastosis.
With the increasing number of female medical school graduates and their greater presence in surgical residency programs, it is only appropriate that attention be directed to the problems associated with childbearing and child care, the need for better facilities and time sharing, and the effect of these issues on career choice by women. This limited survey and the authors' comments give emphasis to many problems that need resolution.
Our new feature, "Image of the Month," continues under the guidance of Dr Grace Rozycki. This month's presentation is a beautifully documented patient problem satisfactorily resolved and illustrated for your diagnostic acumen.
This article helps to bring reason and fiscal responsibility to the diagnosis of appendicitis. At all institutions the trend has been for emergency department physicians to obtain a computed tomographic scan and/or an ultrasound of the pelvic area for all patients experiencing lower abdominal pain, and then to elicit a surgical opinion. This very informative series illustrates the value of the abdominal physical examination, especially in the male patient, the cost savings of a coordinated approach to the patient, and the problems associated with the ultrasound examination.
Reviewing 52 trauma patients requiring damage control laparotomy who survived longer than 48 hours, it is apparent that this type of intervention is fraught with frequent complications. Of these problems, abdominal compartment syndrome (ACS) can potentially occur in a high percentage of patients, with associated adult respiratory distress syndrome and multiple organ failure. By avoiding primary fascial closure at the initial laparotomy, the risk of ACS can be minimized.
It is interesting to review the trials and tribulations of developing an endovascular program for selected patients. This article analyzes the difficulties encountered in the first 41 patients treated for aneurysm with endovascular repair, noting the cardiac comorbidity of the population as well as the approach to the groin incision, the virtues of the various devices, and the need for follow-up.
This Month in Archives of Surgery. Arch Surg. 2001;136(6):618. doi:10.1001/archsurg.136.6.618