Copyright 2001 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.2001
In November 2000, we published a fine article by Eiseman and associates titled "Feasibility of Damage Control Surgery in the Management of Military Combat Casualties." We refer you to the "Correspondence and Brief Communications" section of this issue of the ARCHIVES with letters from Drs Holcomb and Champion and a reply by Dr Eiseman. Beyond the rhetoric regarding priority for the invention of technique, there is a great deal of information to be gleaned from the explanations of damage control surgery, the resources necessary to be successful in employing it in any setting, and the argument regarding its appropriate use.
In his usual thorough manner, Dr Ira Rutkow presents a succinct account of the accomplishments of Philip Syng Physick, the father of American surgery. Dr Syng Physick's skills and innovative thoughts stand out as a model for modern surgical practice. The treatise "Elements of Surgery" presented the first systematic work on surgery written by an American surgeon (his nephew) from Philip's lectures. This is fascinating reading for all history buffs.
We hope you have been following our series "Image of the Month." This month, under the guidance of Dr Grace Rozycki, another well-illustrated mystery case is presented and analyzed for your perusal.
A series of more than 100 patients undergoing Heller myotomy and Dor fundoplication for achalasia was analyzed in a standardized fashion, and it was ascertained by postoperative swallowing status that 89% had good or excellent results after a first operation. An additional 5 patients (5%) were helped by subsequent, primarily operative treatment. Although up to this time most patients have been treated initially by pneumatic dilatation, these results are so positive that surgery should now be considered the primary treatment for this disease.
Despite relatively small numbers and variations in treatment patterns and radiation dosage, it was apparent in this consecutive retrospective case review from a single institutional group that we have improved the treatment of invasive epidermal carcinoma of the anal canal in recurrence, survival, and colostomy-free survival without increasing major morbidity. The current program consists of concurrent chemoradiation (5400 rad [54 Gy] and 5-fluorouracil plus mitomycin C) with surgical intervention reserved for problems of initial treatment or advanced tumors.
This frank discussion of the increased use of live kidney donors with multiple renal arteries demonstrates the safety of laparoscopic nephrectomy under these circumstances and emphasizes the rationale for better instrumentation to improve and expand the technique.
Continuing their prospective analysis of laparoscopic and open gastric bypass for morbid obesity, the University of California–Davis group presents significant data that both techniques induce a hypercoagulable state of almost similar proportions and that deep venous thrombosis prophylaxis should be used for both operative approaches.
This Month in Archives of Surgery. Arch Surg. 2001;136(8):859. doi:10.1001/archsurg.136.8.859