The ARCHIVES OF SURGERY (ISSN 0004-0010) is published monthly by the American Medical Association, 515 N State St, Chicago, IL 60610-0946, and is an official publication of the Association. The ARCHIVES OF SURGERY reaches more than 21 500 readers in over 71 countries each month. Periodicals postage paid at Chicago, IL, and at additional mailing offices. GST registration number 12622 5556 RT. Canada Post International Publications Mail (Canadian Distribution) Sales Agreement No. 319309. POSTMASTER, send all address changes to Archives of Surgery, c/o the AMA Unified Service Center, American Medical Association, 515 N State St, Chicago, IL 60610. Printed in the USA. Official publication of the New England Surgical Society, Pacific Coast Surgical Association, and Western Surgical Association.