Few advances in surgery are introduced without attendant problems. Each step forward produces new complications, often unrecognized initially. These new problems and complications then become the focus for research and problem solving. This makes us realize there are no absolutes in human biology. We cannot say "always" or "never," but rather "sometimes" or "usually," or even "practically never." In this sense we review recent progress, recognizing that such progress may become the problems of the future. New techniques, new operations, new measurements, new scientific thinking all may take their toll as they contribute, but, on balance, movement is forward. There is progression, not regression. The surgeon as a "doer" is critical in such developments, trying the difficult operation for the seemingly impossible problem, applying a different monitoring or diagnostic technique to identify the unknown, and to support better the injured, postsurgical, or otherwise jeopardized patient.
The past year has seen