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Arch Surg. 2001;136:498.

The Health Care Crisis
Impact on Surgery in the Community Hospital Setting
In this addition to our recent symposium on the effects of the health care crisis on surgical practice and scholarship, we are led through multiple causes of the challenge to the community-based hospital, including decreasing operating margins, attracting and retaining the best medical staff and employees, the technology explosion, consumerism, and surgical leadership. Solutions are set forth.

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Predicting the Status of the Nonsentinel Axillary Nodes
A Multicenter Study
This interesting study points out that even in patients with small breast tumors (T1), there is a substantial risk (15%) of residual axillary node disease in the nonsentinel nodes, and that this risk increases (overall, 37%) with the size of the primary tumor. Should all breast cancer patients have a full axillary dissection? Is axillary dissection a therapeutic procedure? These are the legitimate questions posed in this article.

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Is Any Method of Vascular Control Superior in Hepatic Resection of Metastatic Cancers?
Longmire Clamping, Pringle Maneuver, and Total Vascular Isolation
The application of vascular control is beneficial to the surgeon during hepatic resection for any purpose. This article indicates that the method of control should be based on the location and complexity of the resection and the preference of the individual surgeon since all methods seem equivalent in nearly every respect.

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Pancreatic Infection in Severe Pancreatitis
The Role of Fungus and Multiresistant Organisms
The use of antibiotic therapy in patients with severe necrotizing pancreatitis seems to be gaining more and more popularity as each new favorable opinion appears in the literature. Still to be determined is the type or types of antibiotics and the duration of administration. This article points out several of the problem areas with regard to resistant organisms encountered following antibiotic use.

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Operative Management of Chronic Pancreatitis in Children
This interesting series of 18 children with chronic pancreatitis (familial, posttraumatic, postmedication, and idiopathic) who had undergone prolonged medical therapy and repeated hospitalizations benefited from aggressive resectional surgical therapy.

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Adrenocortical Carcinoma
Surgical Progress or Status Quo?
With the advent of improved imaging studies, surgeons are faced with 2 predicaments: the adrenal incidentaloma and the management of adrenocortical carcinoma in this age of local (surgery) and systemic (adjuvant chemotherapy) treatment. This article presents an update on the surgical treatment of this malignant neoplasm—improved 5-year survival—and an appeal for consideration of other therapies for advanced disease.

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Use of Intraoperative Parathyroid Hormone Measurement Does Not Improve Success of Bilateral Neck Exploration for Hyperparathyroidism
The intraoperative measurement of parathyroid hormone is finding its place in the surgical treatment of hyperparathyroidism; namely, as a useful adjunct in reoperative surgery and in localized or unilateral operative intervention.

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