ABSTRACT
Misconceptions and illusions prevail in the management of breast cancer. Historical review reminds us that medical practice is commonly rooted in tradition rather than proof. The Halsted mastectomy inadvertently served the burgeoning profession of surgery in the early 20th century more than it has benefited women with breast cancer, yet 100 years later the operation continues to thrive. Despite evidence that mastectomy, radiation following lumpectomy, axillary node dissection, or intensive follow-up surveillance have little impact on survival, these practices are adhered to tenaciously. The extent to which current treatment for breast cancer succeeds in prolonging life remains open to question. Many accepted ideas and interventions are perilously disconnected from their true merit. The imperative for doctors to do something sometimes contradicts their pledge to do no harm. Reflection on what is known should guide future action.
Subject(s)
Breast Neoplasms/history , Breast Neoplasms/therapy , Female , History, 19th Century , History, 20th Century , Humans , Lymph Node Excision , Mastectomy/history , Mastectomy, Segmental/history , PainABSTRACT
A community hospital's search for qualified surgical house staff in 1975 led to the development of a postgraduate residency program in surgery for physician assistants. Eleven years after its inception, the program's purpose and structure were reviewed, and its alumni, goals, and contributions were evaluated. A 1987 alumni survey provided data to assess the value of residency training to current employment and job satisfaction.
Subject(s)
General Surgery/education , Physician Assistants/education , Connecticut , Hospitals, Community , Internship and Residency , Job Satisfaction , Medical Staff, Hospital , Personnel Staffing and Scheduling , Program Evaluation , Retrospective Studies , Salaries and Fringe Benefits , School Admission CriteriaABSTRACT
Resistant lateral epicondylitis remains a difficult therapeutic problem. Lengthening of the extensor carpi radialis brevis has proved to be a simple, yet effective, method for treating this problem. Sixteen of the 18 patients in our series are asymptomatic and rated as having excellent results. The result in one patient is rated as good. The one failure in retrospect represented poor patient selection. The results we obtained support the original conclusions of another investigator that this simple surgical approach to the problem can give lasting relief. The procedure can be done on an ambulatory outpatient basis. Minimal postoperative restrictions are involved, and this procedure is appealing in terms of time of disability and cost.
