Transverse colon volvulus associated with scleroderma.

An unusual case of volvulus of the transverse colon associated with scleroderma is presented. The morphologic changes in the large bowel due to progressive systemic sclerosis, resulting in pseudo-obstruction, are considered in the etiology and pathogenesis of colonic torsion.

Surgical morbidity after mastectomy operations.

The records of 146 consecutive patients with mastectomy operations over a three year period were reviewed. Of these, ninety-three (63.6 per cent) had one or more complications secondary to surgery. There were 175 complications, of which complications, of which 107 (73.2 per cent) were wound-related. Seroma formation occurred most frequently but was of minor consequence. The incidence of flap necrosis was 19.1 per cent, with cellulitis or suppurative infection appearing in thirteen patients. Immediate postoperative edema of the arm was fairly rare (2.7 per cent) and appeared related to delayed wound healing. Postoperative complications after total, modified radical, and radical mastectomy present problems unique from those seen after other major surgery, in that local complications predominate. The very nature of the procedure, with the creation of large thin skin flaps, extensive axillary dissection, and an open wound for a prolonged period of time, predisposes to wound morbidity.

Commitment.

Many trends in military medicine and civilian medical practice portend change that is unsettling to physicians. Historically, the medical profession has responded to patients' needs with both the art and the science of medicine. Many of the lessons learned regarding humanism in medicine are worth repeating. It is the job of physicians as teachers to keep bringing us back to certain basic principles. Commitment to God, country, honor, courage, leadership, and teaching should be stressed among those principles. Military physicians must also develop an attitude regarding their dual officer/doctor role because military and medical objectives may present difficult ethical decisions. In addition, observance of time-honored customs and traditions can bring a sense of justifiable pride to the physician caring for our nation's military members, their families, and retirees.

USS Franklin and the USS Stark--recurrent problems in the prevention and treatment of naval battle casualties.

Events such as the Falklands War and naval actions in the Persian Gulf have emphasized the unique nature of battle casualty care on warships. The purpose of this paper is to describe two actions which illustrate the problems that a medical officer may confront when a warship sustains battle damage: that of the USS Franklin in March 1945 and that of the USS Stark in May 1987. Although neither ship was sunk, damage was severe and about one-quarter of each ship's crew became casualties. More than three-quarters of the casualties were killed, death being due to blast, fire and smoke inhalation.

Unique aspects of anticipated shipboard vascular trauma.

This article mentions notable historical examples of vascular injuries that occur at sea. It traces the development of modern ships and the concomitant capability to provide medical care to the personnel who go in harm's way on these ships. The importance of vascular surgery training for the general surgeon assigned to sea duty is stressed.

Liver scan and carcinoma of the breast.

The results of 100 liver scans obtained as part of the preoperative evaluation of patients known to be harboring a potentially resectable carcinoma of the breast were evaluated. Of the five positive results of these studies, four were found to be falsely positive. During the period included in the study, 317 other liver scans were performed on patients known to have recurrent, residual, or metastatic disease or on patients returning for routine postoperative evaluation. The information derived from these studies was of practical significance only in the group receiving therapy for the secondary tumor. On the basis of this small series, the routine use of the liver scan in evaluating the patient with carcinoma of the breast cannot be supported.