We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
This Month in |

This Month In Archives Of Surgery FREE

Arch Surg. 2002;137(10):1094. doi:10.1001/archsurg.137.10.1094.
Text Size: A A A
Published online

Because 9% of their breast cancer patients had a delay in their diagnosis, Goodson and Moore created a standardized description of clinical breast examinations, taking into account the hardness or "durity" and the "nodularity" of the breast. They developed an easy-to-apply scale and noted an increased risk of delayed diagnosis in breasts that had less "dur" but more nodularity. Their article alerts readers to their system and particularly to the less dur/more nodular breast, with its potential for improvement in clinical diagnosis.

See Article

Two articles related to operative intervention for breast cancer center on the sentinel node procedure. Luini et al relate their positive experience with sentinel node biopsy in patients with early-stage breast cancer (maximum diameter, 2.5 cm). They used a gamma probe to locate the nodes after injection of a mixture of colloidal human albumin particles labeled with technetium Tc 99m a few hours earlier. Patients with metastatic nodes were then candidates for full axillary dissection.

See Article

Finally, we present the provocative article by the John Wayne Cancer Institute Group, who popularized the use of sentinel node biopsy in breast cancer. The authors followed a group of 238 patients (85% T1 and 15% T2 tumors) for a median of 38.9 months. Because there were no recurrences in the axillae of patients with sentinel nodes negative for metastasis, the authors propose that sentinel node biopsy can be offered as the sole axillary staging procedure.

See Article

When looking at the surgical literature, it is hard to ignore the fact that laparoscopic techniques have captured the imagination of surgeons and patients. Two articles are presented. One, by Greenway et al, explains the benefits of bariatric procedures on non–insulin-dependent diabetes mellitus, and the other, by Ertem et al, offers a new procedure for dealing with liver hydatid cysts.


Greenway et al reviewed all the procedures currently in vogue for weight reduction, with emphasis on the fact that many are performed laparoscopically. Further, they speculate regarding the relative role of these operations in ameliorating non–insulin-dependent diabetes mellitus in these obese patients. They favor 2 procedures, Roux-en-Y gastric bypass and biliary-pancreatic diversion, for their ability to offer the greatest weight loss and their dramatic effects on non–insulin-dependent diabetes. Their thought is that these techniques bypass the foregut and increase enteroglucagon levels. Obviously, clinical trials will be necessary to confirm these suppositions.

See Article


Ertem et al, who see and treat a number of patients with liver hydatid cysts, have devised a laparoscopic manipulation that is effective and reliable. Their system is used for selected patients (48 of 276 in their series), usually with solitary cysts, and is fully described and illustrated. All patients were discharged promptly and treated with a 3-week course of albendazole. No recurrences were noted after a mean follow-up of 34 months. Morbidity was 6%, and there was no mortality.

See Article


This article and its invited critique point out that shunting is an important treatment for noncompliant patients or those living in remote areas where specialized treatment is limited. It is much more permanent than transjugular intrahepatic portosystemic shunt and can be performed with low mortality.

See Article





Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Related Content

Customize your page view by dragging & repositioning the boxes below.