Operable breast cancer may be managed equally well by a number of different regimens of mastectomy and/or radiotherapy. This paper examines the financial and morbidity costs, together with the node sampling efficacy, of three commonly employed techniques: simple mastectomy; total mastectomy with node biopsy or limited node excision; and modified radical mastectomy. Adjuvant radiotherapy (and/or chemotherapy) can only be applied rationally if node sampling is effective. Simple mastectomy cannot achieve this. Total mastectomy, providing that a node sample is obtained, is effective, and is probably the cheapest option. Total axillary clearance runs the risk of increased morbidity (and financial cost), while not necessarily guaranteeing more effective node sampling. Much of the cost and morbidity of mastectomy may be reduced by a limited but rational radiation policy.
Bile reflux has been studied by serial estimations of bile acid concentrations in the stomach before and after a liquid meal. Thirteen normal subjects and 38 patients with gastric ulcer were examined. Thirty-one in the ulcer group had the test repeated once or twice within two months of the initial test to observe any change in reflux associated with healing. Patients with gastric ulcer had significantly higher concentrations of bile acids than normal subjects, both before and after the meal, although there was an overlap between the groups. In patients with an ulcer which healed or showed some healing over two months, no consistent change in reflux was found.
Photoradiation therapy (phototherapy) is a recently introduced treatment for malignant tumours, which depends on the activation of a photoreactive drug selectively localized to tumours. An experience in 27 patients with haematoporphyrin derivative is described. The haematoporphyrin derivative was activated by light of 630-nm wavelength, which was delivered to cutaneous tumours from a specially designed incandescent lamp and to deep tumours through a quartz fibre from a laser system. Tumours were eradicated in five patients and incomplete tumour destruction was observed in 14 others. The only significant side effect was temporary cutaneous photosensitivity. This form of treatment has considerable potential, particularly when other treatments have either failed or cannot be applied. However, it is premature to formulate indications for its use. Rapid technological developments can be anticipated which will greatly enhance the efficacy of photodynamic destruction of tumours.
The aim of this study was to assess the value of colonoscopy as a pen‐operative investigation in patients treated for colorectal cancer by surgical excision. Patients (134 male, 83 female) undergoing curative resection for colorectal carcinoma between August 1984 and January 1989 had colonoscopy within 3 months of surgery. Eleven patients (5%) had a synchronous cancer, which was diagnosed by colonoscopy in eight. In six of these eight, the diagnosis was made after surgery and 3 patients needed a second colectomy. However, in 3 patients the synchronous cancer was removed endoscopically without the need for further surgical resection. Most synchronous cancers had an earlier pathological stage than the index tumour. The rate of synchronous cancers was higher in patients with synchronous benign polyps (16%) than in those without polyps (3%). Colonoscopy is clearly justified as a peri‐operative investigation in all patients undergoing potentially curative resection of colorectal cancer. If possible, the examination should be carried out prior to surgery, to guide the extent of resection.
Massive inguinoscrotal bladder herniation is a surgical rarity. A 2-stage voiding pattern is typically noted. Excretory urography and retrogradecystography are extremely helpful in verifying the diagnosis of bladder herniation. A case of scrotal cystocele is reported.
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