Leptin receptor expression in neoplastic and normal ovarian and endometrial tissue

PURPOSE

The objective of this study was to investigate the expression of leptin receptors in benign and malignant tumors of the ovaries and endometrium and its association with body mass index (BMI).

METHODS

Histological uterine and ovarian samples of normal and neoplastic tissue from 35 patients aged 37-72 years were examined for the expression of leptin receptors with the method of RT-PCR. T.

RESULTS

A BMI > 30 was correlated with increased expression of leptin receptors. Both Ra and Rb receptors were expressed in normal and neoplastic tissues. A statistically significant difference in leptin receptor expression was detected between normal and neoplastic tissue, with expression being around 5-fold higher in neoplatic tissue.

CONCLUSION

Endometrial neoplasms and long leptin isoform receptor expression were associated with an increased BMI. A role of long isoform in endometrial carcinogenesis is proposed.

Re-operation due to severe late-onset persisting groin pain following anterior inguinal hernia repair with mesh

OBJECTIVES

Mild pain lasting for a few days is common following mesh inguinal hernia repair. In some patients however, severe groin pain may appear months or even years postoperatively. The aim of this study was to report our experience of late-onset persisting severe postoperative groin pain occurring years after mesh hernioplasty.

METHODS

In a 9-year period, 1,633 patients (1,073 men), median age 63 years (range 19-88), underwent mesh groin hernia repair. Between 1.5 and 4 years postoperatively, six patients (0.35%) presented with severe chronic groin pain unrelieved by conservative measures and surgical exploration was essential. The patients' records were retrospectively reviewed for the purpose of this study.

RESULTS

Ilioinguinal nerve entrapment was detected in four patients. The meshes appeared to be indistinguishable from the nerve and were removed along with the stuck nerve. New meshes were properly inserted. Mesh fixation on the periostium of the pubic tubercle by a staple was found in the other two patients. The staples were removed from the periostium in both patients. Neither hernia recurrence nor chronic groin pain was persisting in all six patients during a follow-up of 6-44 months postoperatively.

CONCLUSION

From the results of this study, it appears that ilioinguinal nerve entrapment and/or mesh fixation on the periostium of the pubic tubercle are the causes of late-onset severe chronic pain after inguinal mesh hernioplasty. Mesh removal, along with the stuck ilioinguinal nerve and staple detachment from the periostium, are the gold-standard techniques if conservative measures fail to reduce pain.

The role of antibiotic prophylaxis in elective tension-free mesh inguinal hernia repair: results of a single-centre prospective randomised trial

Hernia repair is one of the so-called clean operations. Many surgeons, however, use antibiotics, especially in the mesh repair era, without strong evidence to support this policy. We conducted a single-centre prospective randomised trial with a view to clarify this issue on a scientific basis. From January 2000 all patients undergoing elective inguinal hernia repair using a tension-free polypropylene mesh technique, provided they fulfilled predetermined criteria, were randomised to have a single dose of amoxicillin and clavoulanic acid or placebo in a double-blind manner. The main end point was to detect any difference in infectious complication rates - with specific interest to wound infection rates - between the two groups. Between January 2000 and June 2004, 386 patients entered the study (364 men and 22 women, median age 63 years, range 15-90 years) and were randomised to have antibiotic prophylaxis (group A, n = 193) or placebo (group B, n = 193). The two groups were comparable regarding demographic data. In total, 19 (5%) cases with infectious complications were detected. Fourteen of these were wound infections (3.7%). There were five cases of wound infection in group A and nine in group B (p = 0.4, Fisher's exact test). All wound infections were treated with antibiotics. The wound was opened in some cases. Mesh removal was not required in any of the cases. From the results of this study it does not appear that antibiotic prophylaxis offers any benefits in the elective mesh inguinal hernia repair.

Late-onset deep mesh infection after inguinal hernia repair

BACKGROUND

Groin sepsis requiring mesh removal is said to be a rare complication of tension-free inguinal hernioplasty. Furthermore, late-onset deep-seated prosthetic infection seems to be an unexpected complication. The aim of this study was to report our experience on late mesh infection occurring years after open hernia repair.

METHODS

Between 1998 and 2005, 1,452 patients (954 men), median age 64 years (range 19-89) underwent groin hernioplasty using a tension-free polypropylene mesh technique. Five patients (0.35%) appeared with late mesh infection (between 2 and 4.5 years postoperatively). The patients' records were retrospectively reviewed for the purpose of this study. Antibiotic prophylaxis had been given in the five patients, while none of them had a prior history of wound infection.

RESULTS

The patients were re-operated and the meshes were removed. Pus was found in three patients and Staphylococcus aureus was isolated in one. There was no hernia recurrence and none of the patients had chronic groin pain for a period of 6-44 months postoperatively.

CONCLUSION

From the results of this study, it appears that late-onset deep-seated prosthetic mesh infection is an important complication which has been rarely reported upon. Its true incidence is yet to be established. Late graft infection does not seem to correlate to neither the administration or not of antibiotic prophylaxis, nor to the presence or not of previous superficial wound infection. Furthermore, graft infection does not seem to correlate to neither the type of mesh inserted, nor to the fixation material. With the increasing use of synthetic materials for primary and recurrent hernia repair, the number of patients presenting with late mesh infections is likely to increase.

Laparoscopic cholecystectomy under spinal anesthesia

BACKGROUND

Regional anesthesia has not been used as the sole anesthetic procedure other than in the scenario of a patient at high risk to undergo laparoscopic cholecystectomy with CO2 pneumoperitoneum under general anesthesia.

METHODS

Fifteen ASA grade I or II patients underwent laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under spinal anesthesia. Intraoperative parameters, postoperative pain and recovery in general, as well as patient satisfaction at follow-up were prospectively recorded in a pilot study to assess the feasibility and safety of the procedure.

RESULTS

All operations were completed laparoscopically and conversion from spinal to general anesthesia was not required in any of the cases. Median pain score 4 h postoperatively was 1.5 (range, 0-5), at 8 h it was 1 (range, 0-6), and at 24 h it was 1 (range, 0-4). All patients were discharged after 24 h. Follow-up 2 weeks postoperatively showed all but one patient to be satisfied and strongly recommending the anesthetic procedure.

CONCLUSION

Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum can be successfully and safely performed under spinal anesthesia. Furthermore, it seems that spinal anesthesia is associated with minimal postoperative pain and at least an equally good recovery as with general anesthesia.

Local treatment of a loop colostomy prolapse with a linear stapler

Stomal prolapse is considered to be a common complication especially following loop colostomies. A variety of methods has been reported for the management of this condition, with many of them requiring extensive reconstruction of the stoma under anesthesia. We report a simple and fast technique for the local correction of the prolapse under minor sedation. A linear stapler device was applied for the amputation and reconstruction of the prolapse stoma at the desired level.

Perianal abscesses due to ingested foreign bodies

Four cases of perianal abscesses due to foreign bodies (FBs) impacted in the anal canal are reported. The clinical presentation mimics common causes of acute anal pain. Digital rectal examination under local or general anaesthesia and/or proctoscopy can establish the diagnosis, but may miss the presence of an FB. Incision and drainage of the abscess along with removal of the FB results in immediate pain relief and long-term cure. Impacted FBs must not be overlooked as an unusual cause of perianal abscess.

Electrocoagulation: an alternative palliative treatment for rectal cancer

BACKGROUND

We present our experience with palliative transanal electrocoagulation therapy (TEC) for rectal cancer.

METHODS

Eight patients with biopsy-proven localised low rectal adenocarcinoma were treated with palliative TEC. Inclusion criteria were: high risk patients with anal adenocarcinoma less than 3 cm in diameter, localised less than 7 cm from the anal verge, limited to the rectal wall. Under local anaesthesia all patients underwent TEC using the traditional cautery.

RESULTS

No mortality and morbidity was found. Four patients required a second procedure and one patient had a third session . Two patients died within 2 years from distal metastasis. The remaining six patients are alive and free of local recurrence (follow-up 9 months to 4 years).

CONCLUSIONS

In poor surgical candidates, palliative TEC of rectal adenocarcinoma may have a role as an alternative to radical surgical treatment.

Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study

BACKGROUND

Although the use of stapling devices in elective colon surgery has been shown to be as safe as handsewn techniques, there have been concerns about their safety in emergency trauma surgery. The purpose of this study was to compare stapled with handsewn colonic anastomosis following penetrating trauma.

METHODS

This was a prospective multicenter study and included patients who underwent colon resection and anastomosis following penetrating trauma. Multivariate logistic regression analysis was used to identify independent risk factors for abdominal complications and compare outcomes between stapled and handsewn repairs.

RESULTS

Two hundred seven patients underwent colon resection and primary anastomosis. In 128 patients (61.8%) the anastomosis was performed with handsewing and in the remaining 79 (38.2%) with stapling devices. There were no colon-related deaths and the overall incidence of colon-related abdominal complications was 22.7% (26.6% in the stapled group and 20.3% in the handsewn group, p = 0.30). The incidence of anastomotic leak was 6.3% in the stapled group and 7.8% in the handsewn group (p = 0.69). Multivariate analysis adjusting for blood transfusions, fecal contamination, and type of antibiotic prophylaxis showed that the adjusted odds ratio (OR) of complications in the stapled group was 0.83 (95% CI, 0.38-1.74, p = 0.63). In a second multivariate analysis adjusting for blood transfusions, hypotension, fecal contamination, Penetrating Abdominal Trauma Index, and preoperative delays the adjusted OR in the stapled group was 0.99 (95% CI, 0.46-2.11, p = 0.99).

CONCLUSION

The results of this study suggest that the method of anastomosis following colon resection for penetrating trauma does not affect the incidence of abdominal complications and the choice should be surgeon's preference.

Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study

BACKGROUND

The management of colon injuries that require resection is an unresolved issue because the existing practices are derived mainly from class III evidence. Because of the inability of any single trauma center to accumulate enough cases for meaningful statistical analysis, a multicenter prospective study was performed to compare primary anastomosis with diversion and identify the risk factors for colon-related abdominal complications.

METHODS

This was a prospective study from 19 trauma centers and included patients with colon resection because of penetrating trauma, who survived at least 72 hours. Multivariate logistic regression analysis was used to compare outcomes in patients with primary anastomosis or diversion and identify independent risk factors for the development of abdominal complications.

RESULTS

Two hundred ninety-seven patients fulfilled the criteria for inclusion and analysis. Overall, 197 patients (66.3%) were managed by primary anastomosis and 100 (33.7%) by diversion. The overall colon-related mortality was 1.3% (four deaths in the diversion group, no deaths in the primary anastomosis group, p = 0.012). Colon-related abdominal complications occurred in 24% of all patients (primary repair, 22%; diversion, 27%; p = 0.373). Multivariate analysis including all potential risk factors with p values < 0.2 identified three independent risk factors for abdominal complications: severe fecal contamination, transfusion of > or = 4 units of blood within the first 24 hours, and single-agent antibiotic prophylaxis. The type of colon management was not found to be a risk factor. Comparison of primary anastomosis with diversion using multivariate analysis adjusting for the above three identified risk factors or the risk factors previously described in the literature (shock at admission, delay > 6 hours to operating room, penetrating abdominal trauma index > 25, severe fecal contamination, and transfusion of > 6 units blood) showed no statistically significant difference in outcome. Similarly, multivariate analysis and comparison of the two methods of colon management in high-risk patients showed no difference in outcome.

CONCLUSION

The surgical method of colon management after resection for penetrating trauma does not affect the incidence of abdominal complications, irrespective of associated risk factors. Severe fecal contamination, transfusion of > or = 4 units of blood within the first 24 hours, and single-agent antibiotic prophylaxis are independent risk factors for abdominal complications. In view of these findings, the reduced quality of life, and the need for a subsequent operation in colostomy patients, primary anastomosis should be considered in all such patients.

Glutathione-linked enzymes in benign and malignant oesophageal tissue

Oxyradicals are involved in multiple mutational events and can contribute to the conversion of healthy cells to cancer cells. Glutathione (GSH) and the GSH-replenishing enzymes keep the antioxidant status of normal cells at a level where they can avert oxyradical derived mutations. The aim of this study was to determine whether in cancer cells the GSH-replenishing, GSH antioxidant and GSH-depleting enzymes were not at appropriate levels and therefore not able to protect cancer cells adequately against oxyradical-induced mutations. Cancer of the oesophagus was chosen since it is the most common gastrointestinal malignancy in South African Blacks. Biopsies and blood from 31 patients with cancer of the oesophagus and 29 non-cancer patients were assessed for these enzymes. The mean activity of the antioxidant and depleting enzyme GSH-peroxidase was elevated significantly by twofold in the cancer tissue compared to normal tissue. However, the activity of the replenishing enzyme GSSG-reductase and the level of the depleting enzyme GSH-s-transferase P1-isoenzyme were significantly reduced by 23% and 33% respectively. As in a previous paper we found that GSH was depleted and gamma-glutamine transpeptidase was diminished in oesophageal cancer. There can be two reasons for GSH depletion. Firstly, elevated GSH-peroxidase will use more GSH in an attempt to cope with the excessive production of oxyradicals as revealed by elevated lipid peroxidation; this was, as shown by us before, elevated sixfold in oesophageal cancer. Secondly, if little replenishment of GSH occurred the level of GSH would become lower. This was confirmed by our findings that the activities of the replenishing enzymes were significantly diminished in oesophageal cancer tissue. Contrary to what was expected, the other depleting enzyme GSH-s-transferase P1 was not elevated in cancer tissue but was significantly lower. However, in the blood of the same patients it was significantly elevated. An explanation for this phenomenon is that, although the production of GST-P1 was enhanced in cancer, it did not show because it was rapidly extruded into the blood by an unknown mechanism operational only in cancer cells.

Laparoscopic inguinal hernia repair by an intraperitoneal onlay mesh technique using expanded PTFE: a prospective study

This prospective trial was initiated to assess laparoscopic inguinal hernia repairs by an intraabdominal intraperitoneal onlay mesh (IPOM) technique. An IPOM method utilizing 10 x 7.5-cm expanded polytef (PTFE) patches was used to repair 52 inguinal hernias in 50 patients. There were two patients with bilateral defects. Fourteen were direct and 38 were indirect hernias. There was one patient with bladder perforation, one with strangulation of the small bowel that entered the sac of a recurrent defect, and five patients with other minor complications. There were two recurrences. The follow-up period ranged from 7 to 31 months. The operating time ranged from 35 to 180 min and was 35-60 min in 40 patients. The postoperative pain was minimal in 40 patients. Our conclusions are as follows: This IPOM method was less time consuming in theater time than other laparoscopic methods. There was minimal postoperative pain in the majority of cases. The hospital stay was shorter in comparison with the standardized stay for conventional methods. The case with recurrence and strangulation raises some questions as to the safety of this method. Hospital costs of conventional herniorrhaphies were lower (63%) than those of this laparoscopic method.

Audit of acute appendicitis in a black South African population

This is a prospective study of 212 black South African patients operated on with a pre-operative diagnosis of acute appendicitis. There were 143 male and 69 female patients. Forty-four patients had normal appendices and 122 non-perforated and 46 perforated acute appendices. The appendix was normal in 12 male and 32 female patients. Most presenting signs had a high positive predictive value but few had a high negative predictive value. There was no significant difference in the systemic response between perforated and non-perforated groups. Delay in presentation accounted for the majority of perforated appendices, while there was no causal relationship between in-hospital observation and perforation. The complication rate was higher and hospital stay longer in the perforated group. We concluded that the presentation and clinical course of acute appendicitis in the population of black South Africans catered to by our hospital is not very different from that in the white population elsewhere in the world.

Comparison of the effects of the interposition of 'narrow' cycloperistaltic v. antiperistaltic segments on fluid perfusion through isolated loops of jejunum

Experimental studies in dogs showed a delaying action of the cycloperistaltic (C-P) segment when interposed in isolated loops of jejunum ('narrow' C-P segments) and between stomach and duodenum after Billroth I gastrectomies ('wide' C-P segments). This study was designed to establish whether there were any differences in the delaying action on the passage of perfused fluids between isolated loops of jejunum with C-P and antiperistaltic (A-P) segments interposed. The latter is the surgical technique that is currently considered the gold standard for such actions. Two isolated segments of jejunum with the ends exteriorised as jejunostomies (Thiry-Vella (T-V) loops) were created in each of 4 dogs. Towards the end of one, a C-P segment with a diameter 70% that of the jejunum ('narrow' C-P segment) was interposed. Towards the end of the other, a reversed A-P segment was interposed. Fluid containing 14C-labelled polyethylene glycol was infused at a rate of 4 ml/min through all the 8 loops (4 dogs) for 1 hour (6 experiments per dog). Descriptive statistics (means and standard errors) show that no obvious differences in volume of output, absorption and pooling existed between T-V loops with 'narrow' C-P and A-P segments. The delaying effect in the passage of fluids of the C-P segment, shown in previous experiments, does not appear to be superior to that of the A-P segment. This statement is made with some reservation as the number of animals involved was relatively small and analytical statistics could not be used.

Gunshot arterial injuries to the groin: comparison of iliac and femoral injuries

In a prospective study of 69 patients with gunshot arterial injuries to the groin, there were 18 patients with iliac and 51 with femoral artery injuries. In the former group, the majority of patients were admitted with gross physiological derangement that did not respond to pre-operative resuscitation, so were taken directly to theatre. There was a 39 per cent peri-operative mortality. A prompt operation is mandatory to improve the chances of survival of patients with this injury. In the latter group all patients responded to pre-operative resuscitation and in the great majority, the diagnosis was established by the presence of 'hard' signs of arterial injury alone. There was a 4 per cent amputation rate and no mortality.

Interposition of 'wide' cycloperistaltic segments into isolated segments of jejunum--influence on fluid perfusion

Two isolated jejunal segments (Thiry-Vella (T-V) loops) were created in 7 dogs. One contained a 'wide' cycloperistaltic (C-P) segment while the other, acting as a control, did not. The C-P segment had the same diameter as the jejunum. Fluid perfusion experiments showed that there were no changes in the volume of output, absorption and pooling of the fluid in the T-V loops containing the 'wide' C-P segment. This was in contrast with significant changes shown in earlier experiments using 'narrow' C-P segments.

Interposition of 'narrow' cycloperistaltic segments into isolated segments of jejunum--influence on fluid perfusion

Two isolated segments of jejunum with the ends exteriorised as jejunostomies were created in each of 8 dogs. Towards the end of one of the two, a cycloperistaltic (C-P) segment, with a diameter 70% of that of the jejunum, was interposed. Fluid containing C-labelled polyethylene glycole [corrected] was infused at 4 ml/min through each of the 16 preparations and the results were compared. The presence of a C-P segment significantly reduced the volume of output (with C-P segment--mean (+/- standard deviation) 155.27 +/- 14.81 ml/h v. without C-P segment--210.09 +/- 19.41 ml/h) (P < 0.001) and increased absorption (with C-P--45.44 +/- 20.86 ml/h v. without C-P--20.48 +/- 8.42 ml/h) (P < 0.001) and pooling (with C-P--39.29 +/- 16.99 ml/h v. without C-P--9.42 +/- 17.16 ml/h) (P < 0.001). The C-P segment therefore delayed the passage of the perfused fluid.

Penetrating external injuries of the oesophagus and pharynx

Fifty-one instances of oesophageal perforation were discovered when the records of 10,143 [corrected] patients with external penetrating injuries of the neck, chest and abdomen were reviewed. Of these, 33 resulted from stab wounds, 17 from bullets and one from hyperextension of the neck. There were 15 perforations of the pharynx and 36 of the oesophagus. Oesophagography in a lateral decubitus position demonstrated the perforation in all 16 patients in whom it was used. In 45 patients simple repair within 24 h of injury was performed (mortality rate 11 per cent). In six patients with a delay of more than 24 h in the repair of the thoracic oesophagus, special techniques were preferred. In two patients an oesophageal diversion-exclusion method was used; one such patient died. In four patients repair over a large-bore T tube was carried out with one death. The main cause of mortality was associated spinal injury (four deaths).

Iatrogenic oesophageal perforations in patients with cancer of the oesophagus

The records of 780 patients who had 917 sessions of rigid oesophagoscopy and instrumentation for advanced cancer of the oesophagus were reviewed. Forty-three cases of iatrogenic perforation of the oesophagus were identified. Of 19 patients who were treated with immediate Celestine tube introduction, 13 survived. Only 2 of 9 patients treated conservatively survived. Routine oesophagography after rigid instrumentation of the oesophagus should probably be added to our protocol.

Tension pneumopericardium following penetrating trauma: case report

We report a patient who developed tension pneumopericardium following penetrating trauma to the chest. Lung adhering to the pleura due to previous infection prevented the lung from collapsing and resulted in diversion of the air leak into the anterior mediastinum and from there through a breach into the pericardium.

Penetrating injuries of the diaphragm

This study involved 163 patients with penetrating injuries of the diaphragm (knife, 139; bullet, 24). Intra-abdominal injuries were present in 122 patients (75 per cent) and this resulted in early diagnosis and treatment of the associated diaphragmatic injury (mortality 3.2 per cent). In the remaining 41 patients (25 per cent) the injury was confined to the diaphragm, and the diagnosis was missed during the initial admission in 10 patients who returned at a later stage with diaphragmatic hernia. A diaphragmatic hernia was found in 24 cases (14.7 per cent). Fourteen of these were diagnosed during the initial admission (mortality 7.1 per cent) and the remaining ten were diagnosed during a subsequent admission (mortality 30 per cent). The initial chest radiograph was diagnostic of diaphragmatic injury in 13 per cent, abnormal but not diagnostic in 76 per cent, and completely normal in 11 per cent. The importance of early diagnosis in reducing mortality, morbidity and hospital stay is emphasized. A high index of suspicion, careful clinical examination, and serial chest radiographs remain the best way of making the diagnosis.

Lesser-curve ischaemic necrosis mimicking a gastric ulcer--a complication of highly selective vagotomy. A case report

Ischaemic necrosis of the lesser curve of the stomach is thought to be a specific but rare complication of highly selective vagotomy. While it commonly presents as a free perforation, it may also present as sloughing of the mucosa only, a gastric fistula or a sealed perforation of the lesser curve mimicking a chronic gastric ulcer. We describe a case in which ischaemic necrosis of the lesser curve presented as a chronic gastric ulcer from a sealed perforation.

Surgical approaches to vertebral artery injuries

Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6.1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.

The management of penetrating injuries of the back. A prospective study of 230 patients

This is a prospective study of 230 patients with penetrating injuries of the back. The decision to operate or observe was taken exclusively on the abdominal physical findings. One hundred ninety-five patients (85%) did not require operation, 30 (13%) underwent a therapeutic laparotomy, four (1.7%) an unnecessary operation, and one patient (0.4%) had a completely negative laparotomy. The diagnosis and management was delayed in five (2.2%) patients with no serious consequences. Mortality rates were not recorded in this series. The initial physical examination was accurate in 95.2% of the patients. We suggest that penetrating injuries of the back should be assessed in the same way as anterior abdominal injuries. Physical abdominal examination is reliable in detecting significant intra-abdominal injuries.

A radioimmunometric assay for the detection and characterization of lung cancer-associated antibodies in sera of lung cancer patients

A radioimmunometric assay was developed from P3 lung carcinoma target cells to detect anti-lung cancer antibodies. Of 100 sera from lung cancer patients tested, 80 (80%) were positive. However, only 6/30 (20%) sera from cancer patients with other cancers, 1/25 (4%) of sera from patients with nonmalignant lung disease, and 0/20 sera from healthy donors were positive. Quantitative absorptions showed that sera from lung cancer patients cross-reacted with other lung cancers, gastrointestinal cancers, and/or fetal lung tissues, but not with breast carcinomas, melanomas, sarcomas, fetal skin, or normal lung tissues. Two lung cancer antigens were defined: LCA-1, which shared antigenic determinants with GI tumors and fetal lung tissues, and LCA-2, which showed cross-reactivity only with GI tumors.

Agenesis of the diaphragm. A case report

A case of agenesis of the right hemidiaphragm in a 6-year-old child is reported. The rarity, aetiological differences in comparison with other diaphragmatic hernias, and other embryological aspects of this anomaly are discussed. The diagnostic and therapeutic approach to this entity is also presented.

Granulomas in melanoma patients treated with BCG immunotherapy

Autopsy slides from 22 melanoma patients who received bacille Calmette-Guérin BCG immunotherapy and who had a postmortem examination at the UCLA Center for the Health Sciences were examined for the presence of granulomas. Granulomas were found in six patients (29%) who received BCG but not in a group of 25 melanoma patients who did not have BCG immunotherapy. A number of factors were tested for correlation with the presence of granulomas in the autopsy material. Fifty-five percent of the patients who received BCG by both intralesional and time technique developed granulomas. No patients given BCG by the tine technique alone developed granulomas. No correlation was found between granulomas and the presence of symptoms after the administration of BCG, the duration of BCG immunotherapy, the patient's age, the number of BCG administrations, treatment with immunosuppressive agents, the length of survival after the last BCG administration, the presence of a positive PPD reaction, a positive history for granuloma-forming diseases and tests for immunocompetence. However, these results provide evidence that the route of BCG administration strongly influences the frequency of granulomas in melanoma patients who received BCG immunotherapy.

Human hyperthermic therapy: relation between tumor type and capacity to induce hyperthermia by radiofrequency

There is mounting evidence that hyperthermia of 42 degrees C or greater is tumoricidal to cell cultures and to animal and human tumors. However, temperatures of 45 degrees C or greater may have greater potential therapeutic benefit. The ability to selectively achieve such highintratratumor temperatures without injury to normal tissue may be due to the relatively poor blood flow in tumors compared with that in normal tissues. While vascularity and blood flow are known to vary significantly among tumors, we found that of 52 tumors evaluated, temperatures of 42 degrees C or greater in 42 tumors (81 per cent) and of 45 degrees C or greater in 23 tumors (44 per cent) appeared to be independent of the histologic type of tumor. Therefore, therapeutic hyperthermia may be possible for most varieties of human solid cancer.

The incidence of urolithiasis in peptic ulcer patients

Two hundred patients suffering from peptic ulcer have been examined for urinary stones. Two hundred healthy controls have been similary studied. In 14 patients from the first group (7%) urinary calculi were found, whereas the percentage in the second group was only 1%. This difference is statistically significant (P less than 0.01) (x2 distribution test). The increased incidence of peptic ulcer was attributed to the consumption of calcium in combination with easily absorbable alkalis (sodium bicarbonate). These findings must be considered in therapy for peptic ulcer diathesis.

Diagnosis of pancreatic cancer

Fifty-five patients underwent thorough laboratory and clinical investigations for pancreatic cancer. The disease was diagnosed in 32 patients. Thirty of these plus three others who did not undergo the sequence of tests underwent exploratory surgery. Pancreatic cancer was found in all. The high diagnostic accuracy was mainly due to the secretin test. We used Dreiling's technic for this test, which we think is the most popular and accurate technic.

Modified pancreatoduodenectomy for carcinoma of the head of the pancreas: preliminary report

A new technic for restoration of gastrointestinal continuity following pancreatoduodenectomy for cinoma of the head of the pancreas is described and the advantages discussed. We believe this method prevents any leakage of the anastomosis and reduces mortality and morbidity because of better drainage. Also, by avoiding stasis, infection, which is a common complication in this kind of surgery, is prevented.

Liver actinomycosis: a case report

A case of liver actinomycosis successfully treated with high doses of penicillin for a long period after surgery is reported. The unusual location of the disease and early detection difficulties delayed the diagnosis and establishment of proper treatment, causing additional liver damage. Serum globulin levels, alkaline phosphatase and turbidity tests were of diagnostic significance. Adequate drainage of the lesion and long-term antibiotic treatment with penicillin proved therapeutically satisfactory.