British Journal of Surgery

Warren, Kenneth W; Mountain, John C; Lloyd-Jones, William

doi: 10.1002/bjs.1800590702pmid: 4114995

The 77 cases of malignant neoplasm of the extrahepatic bile-ducts treated at the Lahey Clinic between 1965 and 1969 are reviewed. Exploratory laparotomy was performed in 68 cases, although in 9 cases operation was not indicated because of the patients' poor condition. Of the 68 surgical patients, 24 (35 per cent) had a radical procedure, of which 17 survived for more than 1 year and 5 are still alive more than 3 years later, 3 having no evidence of recurrent disease. Forty-one patients had palliative treatment usually with some form of decompression procedure of the obstructed common bile-duct, and in 15 patients this was combined with hepatic artery infusion chemotherapy. Of these patients, 16 survived for more than 1 year, including 9 from the group treated by hepatic artery infusion chemotherapy. Only 1 patient is still alive after more than 3 years.Of all the patients, 44 per cent survived for more than 1 year, 23 per cent for more than 2 years, and 8 per cent for more than 3 years. The mean survival time was 13 months. These results compare favourably with those of the previous survey from the Lahey Clinic, and it is concluded that the improvement is the result of the increase in the radical resection rate from 18 to 31 per cent and in the institution of hepatic artery infusion chemotherapy in palliative cases.

Mitchell, Roger J

doi: 10.1002/bjs.1800590703pmid: 5041100

An attempt has been made to correlate the Varidase test with possible immunological phenomena as assessed histologically. It would appear statistically that the test is more likely to be negative in the presence of poor differentiation, suggesting that there may be some form of immunological suppression in these cases. In the majority of these poorly differentiated cases there was an absence of lymphocytic involvement of the tumour. However, no obvious connexion between Varidase and lymphocytic infiltration of the tumour or sinus histiocytosis has been found.The Varidase test cannot therefore be assumed to be a reliable guide of the accepted histological criteria of host-defence reactions. Any information as to why this test should be so consistently depressed in the presence of malignant disease has not been forthcoming. This work is a preliminary report and is an attempt to assess the total immune competence of a group of adult patients in the presence of mammary carcinoma. It is freely acknowledged that further work into the long-term survival of these patients is necessary before further conclusions can be drawn.

Elmslie, R G; Slavotinek, A H

doi: 10.1002/bjs.1800590704pmid: 4114375

Twenty-seven patients with obstructive jaundice due to unresected cancer of the pancreas have been reviewed. The surgical objectives in treating this sort of patient were taken as the need to make a positive diagnosis and to palliate until death. There was failure to establish the diagnosis of cancer at operation (17 patients), failure to attain permanent biliary decompression (1 patient), failure to anticipate duodenal obstruction (3 patients), and failure to relieve pancreatic pain (8 patients). As a result of this review we have evolved a set of guide-lines which should be considered when treating patients with irresectable cancer of the pancreas.

Frawley, John E; Dickson, G H; Jamieson, C W; Eastcott, H H G

doi: 10.1002/bjs.1800590705pmid: 5041101

Successful abdominal aortic replacement for aneurysm in 3 patients with horse-shoe kidney is reported. The anatomy of the horse-shoe kidney, particularly in relation to its blood-supply, is described. Because of the lack of correlation between the radiological and operative findings it is suggested that the final decision for replacement of the aorta must be taken at opertion. Techniques for grafting which obviate the need to divide the isthmus of the horse-shoe kidney and decrease the operating time are described.

Gordon-Smith, I C; Hickman, J A; Masri, S H El

doi: 10.1002/bjs.1800590706pmid: 5041103

Sixty-two patients undergoing retropubic prostatectomy were examined for evidence of deep-vein thrombosis using the 125I-fibrinogen technique. Patients were allocated randomly into two groups. The first grops was given the fibrinolytic inhibitor epsilonminocaproic acid (EACA) during the perioperative period, while the second group of patients acted as a control. The administration of EACA did not increase the incidence of deep-vein thrombosis after prostatectomy. This finding is discussed together with the possible role of the fibrinolytic system i postoperative venous thrombo-embolic disease.

Shaw, H J

doi: 10.1002/bjs.1800590707pmid: 4557357

The present situation regarding the nature and treatment of cancer in this area is given. Types of defect and methods of repair, their complications, and the choice of methods are described. Emphasis is laid on the increased hazards of surgery for the patient after full dosage of irradiation. Treatment should be based on surgical resection, usually preceded by a modified plan of irradiation often completed after surgery.In conclusion the most valuable recent advances in the techniques of surgical repair of the laryngopharynx and cervical oesophagus afer irradiation and resection for cancer are the use of large regional skin-flaps from outside irradiated areas, and total pharyngooesophageal replacement by means of vascular pedicled gut segments.

Penn, C R H; Hope-Stone, H F

doi: 10.1002/bjs.1800590708pmid: 4114376

A series of 18 cases of malignant thymoma referred for radiotherapy during a 21-year period is reviewed. The presentation, treatment policy, and results are examined. Of the 7 cases treated with a full radical dose all were alive at 3 years, all 4 cases followed for 5 years survived that period, and 3 of the 4 cases followed for 10 years were alive at that time. Of these, only 3 cases had had macroscopically complete excision of the tumour at thoracotomy. These findings suggest that postoperative radiotherapy should be of benefit in all cases of invasive thymoma whether operable or otherwise.

Leech, Peter; Cuthbert, Hugh

doi: 10.1002/bjs.1800590709pmid: 5041104

Among 19 patients admitted to hospital following a major disaster it was noted that 15 showed evidence of traumatic asphyxia and 7 had sustained brachial plexus injury. Three such cases are presented, the possible pathogenesis of the brachial plexus lesions is discussed, and the diagnostic difficulty presented by unconscious traumatically asphyxiated patients with monoparesis is highlighted.

Mazzoni, G; Di Martino, C; Demofonti, A; Valli, A; Pellegrini, S; Gentili, B; Melis, M

doi: 10.1002/bjs.1800590710pmid: 4557358

The results obtained when both kidneys were allografted in the pig are described. The experiments were performed in two groups of animals. In one group both kidneys were transplanted with portal venous drainage and in the other group caval drainage was used. Animals with portal venous drainage of the renal grafts survived for more than 4 months whereas those with caval drainage died within 15 days.

Psarras, A; Papadopoulos, S N; Livadas, D; Pharmakiotis, A D; Koutras, D A

doi: 10.1002/bjs.1800590711pmid: 5041105

Between November, 1966, and March, 1970, 2736 patients with single thyroid nodules were investigated at the Alexandra Hospital. Females were more frequently affected than males, with a ratio of females to males of about 7:1. The right lobe was one and a half times more frequently involved than the left. In both lobes the lower pole was six to eight times more commonly involved than the upper pole. Pathological data after surgical excision were available in 692 of these patients. Malignancy was proved in 81 cases. The overall incidence of carcinoma was 11.7 per cent. Malignant nodules were two to three times more frequent in persons aged below 20 and over 60 and in males than in females. The incidence of carcinoma in cold and warm nodules was 12.8 and 6.6 per cent respectively. No malignancy was foun in a hot nodule or in a toxic adenoma. The location of the nodule was not helpful in predicting malignancy. It is concluded that the incidence of malignancy in cold and warm single thyroid nodules in high, and for this reason surgical removal supplemented with replacement therapy is recommended.