What is a stent and where can you get one.

The development of the word stent as we use it today refers to a material to hold tissues in position or to make tissues patent. Dr. Charles Thomas Stent, a 19th century London dentist, created a compound for dental impressions that was used to hold skin grafts in place by later plastic surgeons, presaging its present usage.

Official organs and entangling alliances. The brief association of The American Journal of Surgery and the Southern Surgical Association (1932-1935).

In this article, the short-lived editorial relationship between the Southern Surgical Association and The American Journal of Surgery is described. Some of the factors that may have been responsible for the abrupt termination of this relationship are discussed, including in particular the rejection by the Journal editors of certain papers presented before the Association, and the steadfast refusal of the Journal to categorize itself as the official publication of any organization. Despite the brevity of the relationship, it was of great value to the Association, since it served for the first time to bring the scientific proceedings of the organization to the attention of the surgical population of America and of the English-speaking world.

Efficacy of peroperative liver function tests and ultrasound in detecting hepatic metastasis in carcinoma of the breast.

Two hundred and twenty patients with clinical stage I, II, or III carcinoma of the breast who presented for mastectomy were prospectively evaluated for hepatic metastases with abdominal sonography and routinely available liver enzymes (LE). Both abdominal ultrasound (US) and LE were assessed. There were two false-positive sonogram, both with normal enzymes, in patients with Stage I and II. There was one positive sonogram at presentation in a patient with Stage III, confirmed by needle biopsy, with a lactate dehydrogenase (LDH) elevation. The metastatic yield was low with ultrasound, but other findings were revealed. LE were not useful in the preoperative diagnosis of hepatic metastases, demonstrating a low specificity. Thirty-three patients demonstrated abnormalities of Le. Twenty-seven of 33 had elevation of a single enzyme, LDH being the most common. Three patients had an elevation of four enzymes preoperatively. Hepatic metastases were not diagnosed in these three patients preoperatively on ultrasound or biopsy. The patients were observed with physical examination (PE) and LE for a mean of 26 months. During the follow-up study, 0.9 per cent of the patients with Stage I, 3.4 per cent with Stage II and 12.5 per cent with Stage III had hepatic metastases develop. In patients with these metastases, involvement of the liver was suggested by elevated LE In 66 per cent, on PE in 42 per cent and by history in 28 per cent. LE were the first indication of liver involvement in two patients. We are in agreement with previous authors for abandonment of hepatic imaging in the preoperative assessment because of the low yield for metastases. Forty-eight thousand dollars would have have been spent on this cohort ot diagnose one instance of hepatic metastasis preoperatively. US may be efficacious in the subgroup of patients with grossly elevated LE or a PE suggestive of hepatic involvement. Those patients who demonstrate metastases by us should have histologic confirmation if treatment would thereby be altered.

John Allan Wyeth, MD. Surgeon, soldier, author and founder of postgraduate medical education in America.

John Allan Wyeth, surgeon, soldier and author, received his medical training during the era immediately after the Civil War. After realizing the inadequacy of American medical education. Wyeth sought to establish a system of postgraduate medical instruction in the United States. The New York Polyclinic, founded in 1882, was the first facility to provide such training in America and was an important factor in the movement to revolutionize the teaching and practice of medicine and surgery in this country. Wyeth's other contributions include a classic textbook of surgery, the development of numerous surgical procedures, narratives of battles and leaders of the Civil War, and progressive leadership in prominent medical organizations of the period.

Presidential address: the woman in the case. Jane Todd Crawford, 1763--1842.

The 1978 Presidential Address of the Southern Surgical Association is dedicated to the wives of the members, past and present, in acknowledgment and appreciation of the enduring contribution that they have made to the quality and character of this association.

Gastric fistula following splenectomy: its cause and prevention.

Gastro-cutaneous fistula following splenectomy, a rare but serious occurrence, may result in death or prolonged disability. Six previous cases have been reported in detail, while 8 others have been mentioned briefly. The current report reviews the literature and describes 4 additional instances of this complication. Two of the 4 patients died. Sever factors, acting singly or incombination, may predispose to the development of post-splenectomy gastrocutaneous fistulas. These include direct surgical trauma to the gastric wall, generalized arteriosclerotic disease, hematoma in the gastrosplenic omentum, and reflection of gastric muscle fibers into the gastrosplenic ligament. The usual site of rupture of stomach is along the greater curvature in the fundic portion. In circumstances in which splenectomy is associated with known or suspected compromise of the blood supply to this portion of the stomach, a method of enfolding the greater curvature is proposed to prevent the development of a gastro-cutaneous fistula. Awareness of the possibility of this uncommon but serious complication will aid in its early recognition and treatment.