Surgical Rounds is pleased to introduce two developments that the Editorial Board believes will enhance our publication. In this issue, we present a new feature entitled Casualty Surgery Series. This series deals with trauma surgery, prehospital care, management of major calamities, and military medicine. The feature's editor, Norman Rich, MD, Colonel, US Army Medical Corps (Ret.), has long been a leader in the care of injured patients and an outstanding surgical educator. He will be assisted most ably by the Editorial Board and especially by David Burris, MD, a colonel in the US Army Medical Corps and Chair of the Department of Surgery at the F. Edward Hébert School of Medicine, Uniformed Services University of the Health Sciences.

In October 2006, Surgical Rounds began including self-assessment questions and answers for the lead article of each issue. The feedback so far has been very positive. With this preliminary for­ay into continuing surgical education, Surgical Rounds has decided to commit to a broader-based, more extensive self-assessment program.

Beginning with the January 2007 issue, you will find a series of questions related to general surgery topics. The questions will also be available on the Web site, surgicalroundsonline.com, along with the answers and brief explanations of the correct responses. These questions will be very similar, although not identical, to those asked on the American Board of Surgery Recertification Examination and can be used in preparation. They will also serve to help you document learning to meet the requirements of the multiple Maintenance of Competence programs continually being developed by medical societies, etc. Finally, they offer you an exciting way to keep current with surgical developments and present you with an opportunity to pursue knowledge long after the formal requirement for study has passed.

Surgical Rounds hopes you will enjoy and utilize these new developments, and we would very much appreciate your feedback. Visit surgicalroundsonline.com and click on "Contact Us" in the upper right corner to send an e-mail to the editor about this or any other question or comment you may have concerning the journal.

Letters to the Editor

Rib fracture causing delayed aortic laceration

I suggest that an endovascular approach in the event of descending thoracic injury would be better than a "rapid thoracotomy." Femoral arterial access could be obtained and a wire placed in the thoracic aorta prior to mobilization of the fractured rib. If major hemorrhage occurred, an occlusion balloon could be temporarily placed while an endograft was being prepared.
Joseph S. Giglia, MD
Cincinnati, OH

Dr. Velmahos responds: An endovascular stent may have a role in this condition, if a perforation of the aorta is recognized but catastrophic bleeding has not yet occurred. In our case the aortic injury was suspected but not confirmed. It would be hard to advocate inserting a stent for what may end up being a normal aorta.

Needless to say, a stent would not be the procedure of choice in the presence of acute intrathoracic bleeding. Immediate control through a rapid thoracotomy would be necessary. A stent could be used prior to reducing the fractured rib if diagnostic imaging revealed a sealed perforation.
George C. Velmahos, MD
Boston, MA

A case of death
This was eloquently written and needs to be read by the public. Political opportunism ruthlessly damaging the careers of good people!
David H. Shapiro, MD
Tampa, FL