Surgery, gynecology & obstetrics
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Surg Gynecol Obstet · Mar 1975
Ultrasonically guided percutaneous fine needle biopsy of the pancreas.
By ultrasonic scanning, it is possible with reasonable accuracy to demonstrate space occupying lesions in the pancreas, and with a delicate ultrasonic technique, a puncture needle can be guided to a predetermined mass in the pancreas. In 25 patients with suspected pancreatic lesions, scanning demonstrated a solid mass lesion in the pancreas. Twenty-one patients had carcinoma; four had chronic pancreatitis. ⋯ In the four patients with chronic pancreatitis, normal pancreatic cells were aspirated. There were no immediate complications due to fine needle biopsy. The combination of ultrasonic scanning and ultrasonically guided percutaneous fine needle aspiration is an important adjunct to the management of pancreatic lesions.
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Surgeons will do well to remember that the two most important contributions to the growth and extension of surgery came from two disciplines, not then regarded as the most innovative. Anesthesia came from dentistry, the work primarily of W. T. ⋯ When will surgery experience another great catalytic forward thrust like that achieved through anesthesia, prophylactic antisepsis, and the antibiotics? No discipline in medicine can exist alone without privation. For its continuing advancement, surgery is dependent upon close and intimate relationships with many other medical disciplines. Apart from the enlightenment provided by a searching examination of the origins of our surgical discipline, the earnest and persistent pursuer will discover a lively pleasure and satisfaction that accrues as a special dividend.
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Respiratory failure in man most frequently follows sepsis. A sign of occult sepsis may be pulmonary failure. ⋯ Mechanical ventilation with intubation has adverse effects upon the lung as well as beneficial effects of the patient. The most important adverse effect is pneumonia.
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Surg Gynecol Obstet · Jan 1975
Comparative StudyTreatment of carcinoma of the breast by modified radical mastectomy.
To evaluate the results of treatment of Stage I and Stage II-T1 and T2, NO and N1-carcinoma of the breast by modified radical mastectomy with preservation of the pectoralis major muscle, the survival rates of all such patients treated by the senior author from 1965 through 1968 were compared with the survival rates of a simultaneous group of patients with similar stage disease treated by conventional radical mastectomy by the same surgeon. There were a total of 134 patients, of whom 51 had modified radical mastectomy and 83 conventional radical mastectomy. The five year survival rate for those treated by standard radical mastectomy was 81 per cent, and for those treated by modified radical mastectomy, it was 84 per cent. ⋯ There is a high incidence of recurrence-free survival after both of these operations. Since modified radical mastectomy is less traumatic, involving less damage to muscular tissues, and is followed by significantly decreased deformity, it is advised as the treatment of choice for patients with carcinoma of the breast having no or minimal evidence of axillary node involvement. More extensive tumors adherent to the pectoral fascia or associated with multiple or large palpable axillary nodes should still be treated by conventional radical mastectomy.