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Arch Surg. 2004;139:357.

In the "Increasing Workload of General Surgery," Liu et al use the best projections available to foresee a workload increase of 31% by 2020, primarily as a result of the aging of the US population. When one combines this with the 80-hour workweek now promulgated for surgical residents, it presents a challenge for general surgeons.

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Another concept that deserves attention relates to the use of magnetic resonance imaging mammography in the surgical management of the index breast cancer. Using magnetic resonance imaging mammography immediately after a positive fine-needle aspiration or stereotactic biopsy or prior to the biopsy of a category 4/5 mammogram altered surgical management in half of the breast cancer cases in this small series at a Vermont hospital. This sort of study is an eye-opener.

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Andersen and Topazian have devised a technique for the treatment of benign lesions of the head of the pancreas, in which a central core of the proximal pancreas is excised by ultrasonic dissection. In this small series of 6 patients with either chronic pancreatitis or benign tumors of the pancreatic head, ultrasonic excavation and reconstruction were performed. It appears to be safe and effective and a worthwhile alternative to the more extensive procedures now used.

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Papers of the New England Surgical Society
Major Lower Extremity Amputation: Outcome of a Modern Series
This article by some of the leading vascular surgeons in the Boston, Mass, area presents the mortality and morbidity associated with major lower extremity amputation in 959 consecutive cases from January 1990 to December 2001. Their findings emphasize the significant morbidity and mortality that continues to result. Long-term survival is dismal for patients with diabetes (30% at 5 years), end-stage renal disease (14% at 5 years), and those undergoing above-knee amputation. Survivors with below-knee amputation infrequently required revision or conversion to above-knee amputation.

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Renal Transplant Survival From Older Donors: A Single Center Experience
From Morrissey et al, we learn that older donors (>55 years) were used successfully at the Rhode Island Hospital Division of Organ Transplantation, Providence. There was the same incidence of failure with the older-donor organs as with younger-donor organs in a consecutive series of 324 transplantations. Renal function was acceptable in all groups, and the same overall survival pertained. Thus, the authors concluded that the majority of patients receiving allografts from older donors do well and that allografts from older donors should be used.

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Predicting Outcome and Directing Therapy for Papillary Thyroid Carcinoma
In a series spanning almost 60 years at the Lahey Clinic, Kim et al divided patients into low- and high-risk groups based on age, metastases, extent, and size. High-risk patients were further stratified into a younger group and an older group (60 years of age). It was found in 727 patients that papillary thyroid carcinoma in low-risk patients had a favorable prognosis regardless of treatment, whereas older high-risk patients had a survival benefit with total thyroidectomy and lymph node dissection.

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SECTION EDITOR: GERALD W. PESKIN, MD

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