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This Month in
March 2001

This Month in Archives of Surgery

Arch Surg. 2001;136(3):259. doi:10.1001/archsurg.136.3.259

Editor's Comment

Several innovative approaches to the lessening of adhesion formation are suggested in the articles, "Sodium Hyaluronate Increases the Fibrinolytic Response of Human Peritoneal Mesothelial Cells Exposed to TNF-α"Article and "A Novel Approach to Reducing Postoperative Intraperitoneal Adhesions Through the Inhibition of IGF-1 Activity."Article Although numerous papers and countless animal and clinical trials have not yet found a successful answer to the adhesion problem, these inroads may prove helpful.

The Case for β-Adrenergic Blockade as Prophylaxis Against Perioperative Cardiovascular Morbidity and Mortality

High-risk patients are found to benefit from β-adrenergic antagonists during the perioperative period of noncardiac operations. This is thought to be related to the drug action of decreasing myocardial oxygen consumption and to the generally excellent tolerance of patients to the medication.

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Some Thoughts on Breast Cancer

The article by John MortonArticle (medical school graduate of 1946) and the invited critique by Dahlia SataloffArticle (medical school graduate of 1978) truly reflect the changing pattern of our knowledge and treatment of this disease. We still have a lot to learn about the biological nature of breast cancer.

Pedicled Bone Flap Formation Using Transplanted Bone Marrow Stromal Cells

This exceptionally planned and executed group of experiments demonstrate that a functional pedicled bone flap graft can be fashioned for reconstructive surgery using bone marrow stromal cells—a concept worthy of continued experimentation.

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Thoracolumbar Immobilization for Trauma Patients With Torso Gunshot Wounds: Is It Necessary?

The need for body immobilization following a gunshot wound to the torso is challenged in light of the infrequency of association of these injuries and the resulting neurologic consequences. The authorsArticle point out that time is of the essence.Article

Small Tissue Bites and Wound Strength: An Experimental Study

A study was conducted to determine the most appropriate technique for suture placement in the closure of a midline abdominal wound in an experimental animal. Based on the premise that the suture length to wound length ratio must be at least 4, it was concluded that at the crucial period for dehiscence of the wound, bursting strength is greater when bites are placed 3 to 6 mm from the wound edges rather than 1 cm or more as other authors have suggested. Wound bursting strength increases with the number of stitches placed in the closure.

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Improved Survival and Local Control After ORT and Postoperative Radiotherapy (for Pancreatic Head Cancer)

In reviewing 46 patients with adenocarcinoma of the head of the pancreas who underwent pancreatic resection, the authors attempt to compare the results of those having resection alone with those who, following resection, received intraoperative radiotherapy and adjuvant external beam therapy. Morbidity was not increased by the additional treatments. The results favored radiotherapy supplementation with modest improvement in overall survival and local control.

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