Twenty-year follow-up of the breast cancers diagnosed during the Breast Cancer Detection Demonstration Project.

This study reports on the 20-year follow-up of the women diagnosed with breast cancer in the Breast Cancer Detection Demonstration Project (BCDDP) between 1973 and 1980. This project provided 5 years of screening with physical examination and two-view mammography for 280,000 volunteer women across the United States. Based on a 96% follow-up from 1993 to 1995 of the 4,051 women with breast cancer available for analysis, 2,658 (66%) were alive and 1,393 (34%) were dead.

Surgical techniques of the modified radical mastectomy for the treatment of breast cancer.

Although the clinical status of each patient must be dealt with in an individual fashion, we continue to favor the modified radical mastectomy as described in the overwhelming majority of patients we see with proven carcinoma of the breast.

Quality of life after Brooke ileostomy and ileal pouch-anal anastomosis. Comparison of performance status.

Although the clinical results of Brooke ileostomy are good, patients are permanently incontinent of stool and gas. Alternative operations designed to restore enteric continence, such as ileal pouch-anal anastomosis, must not only be as safe and effective as Brooke ileostomy, but should provide an improved quality of life in order to establish long-term acceptability. Ileal pouch-anal anastomosis has been performed safely and good functional results have been reported.

Modified and complete neck dissection in the treatment of squamous cell carcinoma of the head and neck.

The relative merits and indications for complete or modified dissection of the neck are straightforward. Which operation is selected centers on the perception of the value of the preservation or the risk with the loss of one or more of three structures: the spinal accessory nerve, the internal jugular vein and the sternocleidomastoid muscle. If these were the only issues, the choice of operation would be easy.

Continent ileostomy and ileoanal procedures.

It is fortunate today that several alternatives are available for reconstruction of the intestinal tract when proctocolectomy is required in the management of inflammatory diseases of the colon or multiple neoplastic diseases. The Brooke ileostomy proves to be very satisfactory and is acceptable to the majority of patients but does require the continual wearing of an appliance. For patients with chronic ulcerative colitis and a poorly functioning anal sphincter or one that is diseased, a continent ileostomy is the preferred procedure.

Gross anatomy in medical education.

The present state of human gross anatomy in medical education can generally be characterized as the presentation of a large bolus of information that is swallowed and only partly digested during the first year of medical school. The subject is often taught in a depth beyond that which would be relevant to all physicians irrespective of their future professional careers. This condition has resulted from adaptive adjustments to the escalating discrepancy between a rapidly expanding knowledge base in science and technology and the relatively fixed time period for education of a physician.