Whereas in the past the requirements of the Residency Review Committee for Surgery centered on the technical aspects of each program, such as an adequate number of defined category cases per graduating resident, work hours, and the publications and activities of the staff, starting in July 2003, a change will occur. This will involve assessing the competency of residents-in-training, including their professionalism, a behavior that describes relationships with patients, families, other health care personnel, and the community. Physicians are expected to understand and commit to the ethical care of patients. This includes the primacy of patient welfare, patient autonomy, and social justice. Welling and Boberg not only spell out these principles but also provide the means to instill in our house staff the true significance of professionalism and its integral relationship with the other competencies of communication, medical knowledge, patient care, and systems-based practice. They are committed to this because it is in our patients' best interest. In his invited critique, Thomas R. Russell, MD, FACS, executive director of the American College of Surgeons, wholeheartedly endorses the concept that all surgeons must maintain a high level of professionalism and inculcate this trait in surgical trainees from their acceptance into a program through the completion of training.
Much has been written concerning axillary sentinel node biopsy, its importance, and its predictive value in many instances. Perhaps less has been documented regarding the contraindications for this procedure. The vast experience of Intra et al indicates that in the treatment of ductal carcinoma of the breast in situ, sentinel lymph node biopsy is unnecessary owing to the low incidence of metastases in these nodes, except in patients at high risk of harboring an invasive component using definitive pathological features.
In a retrospective review of 130 consecutive patients with retroperitoneal soft tissue sarcomas of varying types (60% primary and 39% locally recurrent) but without metastases, it is noted that (1) a high resectability rate (95%) is possible; (2) with complete resection, survival estimates (65% at 5 years) are similar to those observed after resection of extremity lesions; (3) wide resection, when feasible, lowers the local recurrence rate and improves survival; and (4) survival estimates vary significantly according to the grade of the tumor.
In a continuing study of soft tissue tumors from the Memorial Sloan-Kettering Cancer Center in New York, NY, Martin and Brennan review 59 cases of soft tissue Ewing sarcoma or primitive neuroectodermal tumors and find that the initial presentation of the disease was the only predictor of survival in this small group.
After carefully studying 32 fibroadenomas and all of their complexities, including chromosomal analysis, Franco et al conclude that fibroadenomas are not associated with breast carcinogenesis, based primarily on their genetic alterations.
In addition, we draw your attention to 2 excellent reviews, "Hyperbaric Oxygen for Treating Wounds"Article and "Management Dilemmas With Choledochal Cysts."Article
This Month in Archives of Surgery. Arch Surg. 2003;138(3):237. doi:10.1001/archsurg.138.3.237