We have reviewed a variety of surgical techniques for mastectomy, endocrine gland ablation and the management of pathologic fractures and pleural effusion. With their judicious use for the chronic disease of mammary cancer, many persons can be cured and many others can be given long periods of symptom-free survival. With (1) attention to proper indications and contraindications for surgery, (2) surgical detail and (3) good patient care, very few patients will be made worse.
Quality mammography with knowledgeable interpretation is now a widely utilized and reliable procedure. It permits clinically occult lesions to be detected and clinically obvious or indeterminate lesions to be managed more intelligently. Abnormal mammographic signs are well defined, as are their differential diagnoses. Thermography of the breast is a younger science than mammography and must mature before its full potential can be realized. It is clear that thermography today cannot be considered an adequate prescreening technique to obviate further examination, as was once anticipated. Used in conjunction with physical examination and mammography it can serve to reinforce suspicions, and the high acceptability of the examination is an impetus to further clarify its role in detection.
Although the diagnosis of peptic ulcer disease may be difficult in the pediatric age group, this problem is being faced increasingly by the physicians charged with the care of these children. Chronicity of symptoms has been documented in over 50 per cent of the patients demonstrating early peptic ulcers and therefore an aggressive approach to management has been advocated. Although the numbers are small, postgastrectomy syndromes of mechanical and nutritional nature appear less common in the young patient than in adults. Satisfactory growth and development are reported in nearly all series of patients followed after various gastric procedures. Both pyloroplasty and vagotomy and vagotomy and antrectomy appear to be extraordinarily well tolerated by the pediatric patient. Experimental evidence suggests that these patients should enjoy normal growth and development.
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