Although the articleArticle regarding palliation is in reference to a comprehensive cancer center, the principles apply everywhere. As Dr Brennan points out in his critiqueArticle, "Central to the theme of palliation is a clear understanding among patient, surgeon, and family of both expectations and ability to fulfill those expectations." This subject deserves wider dissemination. Palliative strategies are an important part of end-of-life care and must include control of pain and a reasonable assessment of quality of life for the individual. To make effective choices, surgeons must be educated as to the nature of palliative procedures and their effectiveness.
We have graduated from the handling of difficult wounds by individual practitioners to the concept of a wound care clinic with increased patient satisfaction. Now the article from Copenhagen, Denmark, suggests even greater efficiency (standardized protocols), more opportunity for research, better continuity of care, and enriched satisfaction by patients when a multidisciplinary wound care center incorporating outpatient and inpatient care, within an established department, is created. Perhaps this is the way to go.
In an attempt to be as thorough and all-inclusive as possible, trauma centers do tend to overtriage patients based on mechanism of injury. The article from the Ohio State University Medical Center does make one think about the potential for improvement in triage and subsequent resource allocation with modification of trauma response criteria to more physiologic/anatomic criteria.
To facilitate the management of pulmonary metastatic nodules, these authors have developed a new technique affording manual assistance in palpating and excising lesions with video-assisted thoracoscopy. The concept seems to be safe, relatively easy to apply, and has resulted in a high percentage of positive and unexpected resections.
This series of 44 patients with esophageal carcinoma demonstrates that long-term survival can be achieved following neoadjuvant chemoradiation and esophagectomy, that p53 mutational status may be significant in overall prognosis, and that recurrence is less likely in patients who survive 3 years or more after this treatment. A large multi-institutional phase III trial seems needed.
Utilizing a laparoscopic isolated hypobaric technique that they developed, the authors provide details of the safety and efficiency of the method in treating 52 symptomatic hydatid cysts in multiple areas of the abdomen.
This Month in Archives of Surgery. Arch Surg. 2001;136(7):731. doi:10.1001/archsurg.136.7.731