Journal Of The Royal College Of Surgeons Of Edinburgh[JOURNAL]

We report here an interesting presentation of a primary colonic carcinoma in a urological setting. A previously unknown case of colonic carcinoma presented with a lesion in the glans penis which was later diagnosed as a... We report here an interesting presentation of a primary colonic carcinoma in a urological setting. A previously unknown case of colonic carcinoma presented with a lesion in the glans penis which was later diagnosed as a secondary deposit from colonic cancer. Penile involvement has been implicated as a metastatic site in several tumours. Although uncommon, this presentation is not unknown. A literature review of this unusual presentation has been performed and is summarised in the article

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Clinical and functional results of open operative repair for Achilles tendon rupture in a non-specialist surgical unit.

Coutts A, MacGregor A, Gibson J … +1 more , Maffulli N

J R Coll Surg Edinb · 2002 Dec · PMID 12510968

We followed up 25 patients (average age 47.9 years, range 22 to 77) after open repair of their Achilles tendon rupture. All had been operated on by a single general surgeon using an end-to-end reabsorbable suture, and im... We followed up 25 patients (average age 47.9 years, range 22 to 77) after open repair of their Achilles tendon rupture. All had been operated on by a single general surgeon using an end-to-end reabsorbable suture, and immobilised in a plaster of Paris cast for six weeks. All patients had been discharged from follow up by 18 weeks from the operation. At an average of 3.4 years (range six months to 9.25 years), 18 had "excellent", six (24%) "good" and one (4%) "satisfactory" results. All but one patient were able to walk on tiptoes, and 20 of the 22 patients examined directly walked without a limp. Ultrasonography showed the injured tendons to be on average 2.3 times thicker in the antero-posterior diameter and 1.7 times thicker in the transverse diameter. In the hands of a single non-specialist but fully trained general surgeon, this management regimen produced full return to pre-operative activities in the majority of patients, and a low rate of local complications. The macroscopic and ultrasonographic appearance of the operated tendon remained abnormal, but this was not associated with any overt clinical disturbance

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Cellular transplantation: new horizons in the surgical management of heart failure.

Al Attar N, Razak AB, Scorsin M

J R Coll Surg Edinb · 2002 Dec · PMID 12510967

End-stage heart failure results from the irreversible destruction of cardiomyocytes, which do not have the capacity to regenerate. Transplantation of myogenic cells into the damaged myocardium is an emerging therapeutic... End-stage heart failure results from the irreversible destruction of cardiomyocytes, which do not have the capacity to regenerate. Transplantation of myogenic cells into the damaged myocardium is an emerging therapeutic alternative in the management of this major public health problem. Experimental and clinical data suggest that cellular transplantation could improve ventricular function in ischaemic or dilated cardiomyopathies. Implantation of allogeneic and autologous cell types has been applied to induce cardiac myogenesis and, recently, other cell types have been tested for the induction of myocardial angiogenesis. The results of cellular transplantation are encouraging although the role of therapeutic angiogenesis remains to be clarified and the full potential of cellular transplantation to be determined

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Asymptomatic gallstones in the laparoscopic era.

Meshikhes AW

J R Coll Surg Edinb · 2002 Dec · PMID 12510966

Recent introduction of new treatment options has significantly altered the approach towards gallstone management. There is now general agreement that cholecystectomy is the treatment of choice for symptomatic gallstones.... Recent introduction of new treatment options has significantly altered the approach towards gallstone management. There is now general agreement that cholecystectomy is the treatment of choice for symptomatic gallstones. Controversy, however, exists as to the management of asymptomatic gallstones. The ready availability of abdominal ultrasonography for the investigation of a wide range of abdominal symptoms has resulted in the increased diagnosis of asymptomatic gallstones. Management of such accidentally discovered gallstones poses a dilemma as conclusive evidence of the benefits of cholecystectomy is lacking. This is further complicated by the fact that the majority of asymptomatic gallstones remain so and patients rarely experience symptoms or complications. Furthermore, cholecystectomy is associated with a low but recognised morbidity. Recent introduction of laparoscopic cholecystectomy as the treatment of choice of symptomatic gallstones has further complicated the issue of asymptomatic gallstone management. This article reviews the current management of asymptomatic gallstones in the era of laparoscopic cholecystectomy

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Iatrogenic splenic injury.

Cassar K, Munro A

J R Coll Surg Edinb · 2002 Dec · PMID 12510965

BACKGROUND: Iatrogenic injury to the spleen is a recognised complication of abdominal surgery but the extent of the problem is often under-estimated. This may be due to failure to report splenic injury on the operation n... BACKGROUND: Iatrogenic injury to the spleen is a recognised complication of abdominal surgery but the extent of the problem is often under-estimated. This may be due to failure to report splenic injury on the operation note or inaccurate recording of the indication for splenectomy. In this review article we have tried to estimate the incidence of iatrogenic splenic injury during abdominal surgery, the morbidity and mortality associated with splenic injury and the risk factors for injury to the spleen. We have also identified the common types and mechanisms of injury to the spleen and have made suggestions as to how splenic injury can be avoided and, when it occurs, how it should be managed. METHODS: A Medline literature search was performed to identify articles relating to "incidental splenectomy", "iatrogenic splenic injury", "iatrogenic splenectomy" and "splenectomy as a complication of common abdominal procedures". The relevant articles from the reference lists were also obtained. RESULTS: Up to 40% of all splenectomies are performed for iatrogenic injury. The risk of splenic injury is highest during left hemicolectomy (1-8%), open anti-reflux procedures (3-20%), left nephrectomy (4-13%) and during exposure and reconstruction of the proximal abdominal aorta and its branches (21-60%). Splenic injury results in prolonged operating time, increased blood loss and longer hospital stay. It is also associated with a two to ten-fold increase in infection rate and up to a doubling of morbidity rates. Mortality is also reported to be higher in patients undergoing splenectomy for iatrogenic injury. The risk of injury to the spleen is higher in patients who have previously undergone abdominal surgery, in the elderly and in obese patients. A transperitoneal approach significantly increases the risk of splenic injury during left nephrectomy compared with an extraperitoneal approach and the risk is even higher if the indication for surgery is malignancy. Excessive traction, injudicious use of retractors and direct trauma are the commonest mechanisms of injury. CONCLUSIONS: The incidence of iatrogenic splenic injury is underestimated because of poor documentation. Splenic injury during abdominal surgery can be reduced by achieving good exposure and adequate visualisation, avoiding undue traction and by early careful division of splenic ligaments and adhesions. When the spleen is injured splenic preservation is desirable and often feasible, but this should not be at the expense of excessive blood loss

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Gastro-oesophageal cancer: facts, myths and surgical folk lore.

Park KG

J R Coll Surg Edinb · 2002 Dec · PMID 12510964

The prognosis of patients with gastric and oesophageal cancers remains poor but increased knowledge of the factors involved in carcinogenesis and a better understanding of the disease process has led to strategies to imp... The prognosis of patients with gastric and oesophageal cancers remains poor but increased knowledge of the factors involved in carcinogenesis and a better understanding of the disease process has led to strategies to improve outcomes. These are discussed under the following headings: (1) Prevention of the disease, (2) early detection of tumours, (3) treatment selection and (4) treatment. The likely impact of developments in each of these areas is considered in relation to population-based data from the Scottish Audit of Gastro-Oesophageal Cancer (SAGOC). Although there are a number of novel developments in the management of gastric and oesophageal cancer it is only by the conduct of controlled trials that the value of these will be determined. More immediate improvements in patient care may be derived from rationalisation of existing resources to ensure that all patients benefit from early diagnosis, the appropriate selection and delivery of treatment. One model of care, which may ensure this is the development of managed clinical networks, would maintain the involvement of all units in the management and treatment of upper GI cancers to a level that is possible with the facilities available. At the same time the patients requiring more specialised treatment would benefit from established referral networks

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Focused rigidity casting: a prospective randomised study.

Martin WN, Sandhu H

J R Coll Surg Edinb · 2002 Oct · PMID 12463715

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Synchronous perforation of a Meckel's diverticulum and duodenal ulcer.

Proye C

J R Coll Surg Edinb · 2002 Oct · PMID 12463714

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Infective lumbar discitis following laparascopic sacrocolpopexy.

Kapoor B, Toms A, Hooper P … +2 more , Fraser AM, Cox CW

J R Coll Surg Edinb · 2002 Oct · PMID 12463713

STUDY DESIGN: A case report of infective lumbar discitis following laparoscopic sacrocolpopexy. OBJECTIVES: To improve awareness of the possibility of surgical procedures for genital prolapse causing discitis by presenti... STUDY DESIGN: A case report of infective lumbar discitis following laparoscopic sacrocolpopexy. OBJECTIVES: To improve awareness of the possibility of surgical procedures for genital prolapse causing discitis by presenting a case history. BACKGROUND: Infective lumbar discitis following laparoscopic sacrocolpopexy is very rare. METHODS: Case history of a 63 year old lady who developed infective L5-S1 discitis three weeks following a laparoscopic sacrocolpopexy. CONCLUSION: Discitis following a laparoscopic sacrocolpopexy procedure is a very rare but significant complication.

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Percutaneous extra-articular excision of femoral neck osteoid osteoma: report of a new method.

Chaarani MW

J R Coll Surg Edinb · 2002 Oct · PMID 12463712

A simple new way for excision of intramedullary osteoid osteoma from the femoral neck without going through the hip joint is described. A trephine hole starting distal to the great trochanter with fluoroscopy guidance is... A simple new way for excision of intramedullary osteoid osteoma from the femoral neck without going through the hip joint is described. A trephine hole starting distal to the great trochanter with fluoroscopy guidance is used. This procedure (for such a lesion) has not been reported in the literature.

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The effects of desferrioxamin and vitamin E as supplements to antibiotics in the treatment of peritonitis in rats.

Soybir N, Soybir G, Lice H … +3 more , Dolay K, Ozşeker A, Köksoy F

J R Coll Surg Edinb · 2002 Oct · PMID 12463711

AIM: The aim of the study was to determine the effects of vitamin E and the iron chelating agent desferrioxamin (Dfx), supplemented by clindamycin and gentamycin therapy, on peritonitis caused by caecal ligation of a pun... AIM: The aim of the study was to determine the effects of vitamin E and the iron chelating agent desferrioxamin (Dfx), supplemented by clindamycin and gentamycin therapy, on peritonitis caused by caecal ligation of a puncture wound in an experimental model. MATERIALS AND METHODS: One hundred and twenty Spraque Dawley rats were divided into eight groups. Three groups were used as controls; intraperitoneal (i.p.), subcutaneous (s.c.) and i.p. and s.c., respectively. Group 4 was treated with Dfx, Group 5 with vitamin E and Group 6 with antibiotics. Group 7 was treated with vitamin E in combination with antibiotics, and Group 8 with a combination of antibiotics and Dfx. The rats were studied for 14 days following treatment, and survivors then humanely dispatched. Post-mortem examination was undertaken on all the rats studied. RESULTS: In the control groups, mortality at 14 days was 66%. Rats treated with antibiotics alone (Group 5) had a mortality rate of 40%. Those treated with a combination of antibiotics and vitamin E (Group 7), however, had a mortality rate of only 14%, and those treated with antibiotics and Dfx had a mortality rate of only 7%. CONCLUSION: This study suggests that treatment of peritonitis in rats with a combination of Dfx and antibiotics has a significant beneficial effect on survival, in comparison with treatment with antibiotics alone.

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Breast cancer in women aged 35 and under: prognosis and survival.

Jmor S, Al-Sayer H, Heys SD … +5 more , Payne S, Miller I, Ah-See A, Hutcheon A, Eremin O

J R Coll Surg Edinb · 2002 Oct · PMID 12463710

BACKGROUND: Breast cancer comprises 22% of all cancers occurring in females but only 2% of cases occur in women aged 35 years and less. The presentation, behaviour and prognosis of breast cancer in such women, when compa... BACKGROUND: Breast cancer comprises 22% of all cancers occurring in females but only 2% of cases occur in women aged 35 years and less. The presentation, behaviour and prognosis of breast cancer in such women, when compared with older women, are unclear and conflicting results have been reported. This study has audited clinical and pathological features in patients aged 35 years and under with breast cancer. METHODS: One hundred and thirteen patients were identified. The details of clinical staging, local and distant disease recurrence and overall survival were obtained for all patients. Histological sections of tumours were examined for type, grade, size, presence of surrounding intraductal carcinoma, presence of vascular space invasion, lymph node involvement and oestrogen receptor (ER) status. RESULTS: Histological examination of the tumours revealed that 94% were invasive ductal carcinoma. In 73% of the cases the tumours were grade 3, 49% of patients who underwent axillary surgery had lymph node involvement and 20% of tumours expressed ERs. The overall 5-year survival was 64%. Predictors of a poorer survival (univariate analysis) were: increasing tumour size, absence of ERs, presence of lymphovascular space invasion, axillary lymph node involvement and detectable metastases at the initial presentation. Multivariate analysis revealed that only lymphovascular space invasion was an independent predictor of a poor survival. CONCLUSION: Breast cancer in young (< or = 35 years) women is biologically aggressive, compared with older women. Factors predicting survival and overall survival rates, however, were comparable with those previously reported for older women with breast cancer.

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Surgical treatment for pulmonary hydatidosis (a review of 422 cases).

Dakak M, Genç O, Gürkök S … +2 more , Gözübüyük A, Balkanli K

J R Coll Surg Edinb · 2002 Oct · PMID 12463709

OBJECTIVE: Hydatidosis in man is frequently encountered in sheep and cattle raising regions of the world. We reviewed 422 patients, treated surgically for pulmonary hydatid disease in our clinic between January 1980 and... OBJECTIVE: Hydatidosis in man is frequently encountered in sheep and cattle raising regions of the world. We reviewed 422 patients, treated surgically for pulmonary hydatid disease in our clinic between January 1980 and January 1998, assessing the clinical features and results of results of operative treatment management in our centre. PATIENTS AND METHODS: 52 of the patients were female and 370 were male. The median age of the patients was 33 years (range, 11 to 66 years). The cysts were located in the right lung in 214 (50.7%) patients, the left lung in 156 (37%) and bilaterally in 17 (4%) cases. We found an intrathoracic extrapulmonary cyst in 35 (8.3%) patients. We performed enucleation and capitonnage in 202 cases, wedge resection in 40, cystotomy and capitonnage in 171, and lobectomy in 9 patients. The high-risk patients were treated with Albendazol (10 mg/kg/day), for a period of 3 months postoperatively. RESULTS: Preoperative diagnosis was based primarily on chest roentgenograms and led to correct diagnosis in 347 cases (82.2%). An additional computerised tomography (CT) scan in 56 cases and magnetic resonavive imaging (MRI) were required in 15 cases. The diagnosis is established intraoperatively in 4 cases. Most (296) patients presented with a solitary lung cyst. The rest were found to have multiple cysts in one or more lobes. 87 of 422 also had cysts in the liver, 19 in the spleen, and 1 in the pancreas. The follow-up data was completed in 392 of 422 (92.8%) patients. The mean follow-up period was 4.3 years (2 to 19 years). We detected recurrence in 3 patients (0.71%). CONCLUSION: The effective treatment of hydatid cyst(s) in the lung is complete excision of the cyst(s) with maximum preservation of the lung parenchyma. Additional medical treatment with Albendazole should be carried out for high-risk group patients.

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A retrospective review of transcatheter hepatic arterial embolisation for ruptured hepatocellular carcinoma.

Leung CS, Tang CN, Fung KH … +1 more , Li MK

J R Coll Surg Edinb · 2002 Oct · PMID 12463708

BACKGROUND: Hepatocellular carcinoma (HCC) is a disease with a high prevalence in South East Asia. It is not uncommon to encounter rupture of the tumour in an emergency situation. Operative measures in this situation are... BACKGROUND: Hepatocellular carcinoma (HCC) is a disease with a high prevalence in South East Asia. It is not uncommon to encounter rupture of the tumour in an emergency situation. Operative measures in this situation are often associated with high mortality rates. Transcatheter arterial embolisation (TAE) appears to be an effective alternative to surgery and is increasingly used by many centres. In this study, we have reviewed the outcome of our patients after receiving TAE and tried to identify prognostic indicator(s). PATIENTS AND METHODS: From 1996 to 2000, we had retrospectively reviewed the outcome of 31 patients who had undergone TAE for rupture of HCC and compared their survival with respect to different prognostic indicators. RESULTS: The were 31 patients with a mean age of 53 years. At the time of rupture, 19 patients had Child's A, 5 Child's B and 7 of Child's C disease. The most common presentation was abdominal pain (14 patients). Bleeding was successfully arrested in all 31 patients. The most common complication was fever (13 patients). The overall mean survival was 126 days. Eight patients died within 30 days of admission, the major cause of death was liver failure, which occurred in 6 patients. In addition, we had also postulated several prognostic indicators for patients' survival. The results showed that only those with a bilirubin level below 50 umol/L and who presented with shock had a poor outcome. CONCLUSION: TAE should be considered in the initial management of patients with ruptured HCC. It is effective in arresting tumour bleeding and allows the patient to have subsequent definitive management.

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Gastric adenocarcinoma missed at endoscopy.

Amin A, Gilmour H, Graham L … +3 more , Paterson-Brown S, Terrace J, Crofts TJ

J R Coll Surg Edinb · 2002 Oct · PMID 12463707

BACKGROUND AND PURPOSE: The diagnosis of gastric cancer is based on histological confirmation at endoscopy with the emphasis on early detection to improve prognosis. The aims of this study were to identify the proportion... BACKGROUND AND PURPOSE: The diagnosis of gastric cancer is based on histological confirmation at endoscopy with the emphasis on early detection to improve prognosis. The aims of this study were to identify the proportion of patients with gastric adenocarcinoma in whom the diagnosis was missed at first endoscopy and the subsequent delay which occurred before the histological diagnosis was established. METHODS: Retrospective review of 137 consecutive patients with biopsy-proven gastric adenocarcinoma presenting to one surgical unit over a five-year period. RESULTS: Two patients with a biopsy diagnosis at laparotomy and 6 patients in whom case notes could not be traced were excluded from the study. Of the remaining 129 patients, the diagnosis of gastric adenocarcinoma was missed at first endoscopy in 18 (14%). The median delay to histological diagnosis in this subgroup of patients was 13 weeks (range 3-102). CONCLUSION: Delays in establishing the diagnosis of gastric adenocarcinoma following initial endoscopy occur in a number of patients. Greater suspicion and a more rigorous protocol for repeat endoscopy and biopsy must be implemented in order to reduce the number of missed diagnoses after initial endoscopy.

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Minimal access mitral valve replacement.

Richens D, Jutley RS, Baker M … +1 more , Shajar M

J R Coll Surg Edinb · 2002 Oct · PMID 12463706

Minimally invasive mitral valve surgery has recently been advocated as an alternative to the conventional median sternotomy approach. It has several documented advantages and requires a close relationship betweeen the su... Minimally invasive mitral valve surgery has recently been advocated as an alternative to the conventional median sternotomy approach. It has several documented advantages and requires a close relationship betweeen the surgeons, anaesthetist and perfusionist for a successful outcome. This article demonstrates our surgical technique for replacement of the mitral valve. The various aspects of the specialised equipment used are also described.

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Contemporary management of renal calculus disease.

Downey P, Tolley D

J R Coll Surg Edinb · 2002 Oct · PMID 12463705

The management of renal calculus disease has changed. Non-invasive and minimally invasive techniques of stone disintegration and removal have replaced open stone surgery in managing this condition. In this article we dis... The management of renal calculus disease has changed. Non-invasive and minimally invasive techniques of stone disintegration and removal have replaced open stone surgery in managing this condition. In this article we discuss the investigation and management of patients with renal stone disease as currently performed in specialist stone centres.

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Journal Of The Royal College Of Surgeons Of Edinburgh[JOURNAL]

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