Francis C. Au

Preoperative nuclear scans in patients with melanoma

One hundred forty‐one liver scans, 137 brain scans, and 112 bone scans were performed in 192 patients with clinical Stage 1 melanoma. One liver scan was interpreted as abnormal; liver biopsy of that patient showed no metastasis. There were 11 suggestive liver scans; three of the patients with suggestive liver scans had negative liver biopsies. The remaining eight patients were followed from 4 to 6 years and none of those patients developed clinical evidence of hepatic metastases. All of the brain scans were normal. Five patients had suggestive bone scans and none of those patients had manifested symptoms of osseous metastases with a follow‐up of 2 to 4.5 years. This study demonstrates that the use of preoperative liver, brain and bone scan in the evaluation of patients with clinical Stage 1 melanoma is virtually unproductive.

Long-term follow-up of patients with Grave's disease treated by subtotal thyroidectomy

This long-term follow-up study of 83 patients with Graves disease who were treated by subtotal thyroidectomy reemphasizes the fact that postoperative hypothyroidism occurs primarily in the first postoperative year (27 percent of the study patients). In addition, there was no evidence of progressive increase in the incidence of hypothyroidism in subsequent years. Patients treated with radioactive iodine have a reported incidence of hypothyroidism of 70 percent 10 years postoperatively [4]. The 6 percent incidence of recurrent hyperthyroidism is much less than a reported incidence of 90 percent in patients treated with long-term antithyroid drugs [7]. Subtotal thyroidectomy continues to be an excellent method of treatment for patients with Graves disease and compared favorably with both radioactive iodine and long-term antithyroid drugs.

Tissue CEA in colorectal carcinoma

Immunoperoxidase method can be used to detect cellular or tissue CEA. Forty formalin-fixed paraffin-embedded specimens of colorectal carcinoma, 19 from patients who survived for five years after resection, and 21 from patients who died within five years were studied. Cellular CEA was present in 100 per cent of the specimens. Accurate quantitative evaluation of cellular CEA is currently not feasible. Therefore, the mere presence of cellular CEA has no prognostic value.

In extremis use of a Foley catheter in a cardiac stab wound.

A case is discussed of a patient who presented in extremis after a stab wound to the right ventricle. He underwent successful resuscitation using a Foley catheter both for hemostasis and for administration of resuscitation fluids. While not commonly employed in cardiac trauma management, this technique may permit increased salvage due to its simplicity and speed.

Radionuclide venography in subclavian vein thrombosis complicating parenteral nutrition

Subclavian vein thrombosis and thrombophlebitis are common complications of subclavian vein catheterization for parenteral nutrition. We report two cases that demonstrate that radionuclide venography can be used to diagnose subclavian vein obstruction before classic clinical signs develop.

Carcinoembryonic antigen levels in colonic lesions

We evaluated the likelihood of tissues to be positive for carcinoembryonic antigen and the intensity of carcinoembryonic antigen staining in specimens of villous adenomas, mixed polypoid villous adenomas, polypoid adenomas, and diverticulitis using the peroxidase-antiperoxidase technique. The presence of carcinoembryonic antigen could be demonstrated in all of the specimens; however, the intensity of staining varied. Villous adenomas were the most intensely stained, followed by mixed polypoid villous adenomas, polypoid adenomas, and diverticulitis. We conclude that (1) the intensity of tissue levels of carcinoembryonic antigen parallels the malignant potential of these different groups of lesions, (2) carcinoembryonic antigen intensity of mixed polypoid villous adenomas is more similar to villous adenomas than polypoid adenomas, and (3) the presence of carcinoembryonic antigen in diverticulitis is not a result of dysplasia.

Benign Ulcer of the Cecum

Benign cecal lesions, although not frequently encountered, are often difficult to differentiate from carcinomas. With the general availability of colonoscopy, cecal lesions can be visualized and a biopsy can be done. If the biopsy specimen reveals inflammatory changes only, the patient should be managed nonoperatively and colonoscoped again in four weeks.

Intraoperative Ultrasonic Localization of a Small Pancreatic Pseudocyst

Intraoperative pancreatic ultrasound can be useful to identify small masses or cysts that are not readily palpable at surgery. In our case, a small (2.0 cm diameter) pseudocyst was demonstrated preoperatively by ultrasound and computed tomography, but could not be palpated at surgery. Intraoperative ultrasound located and helped to guide needle aspiration of the pancreatic pseudocyst. Other indications for intraoperative pancreatic ultrasound are reviewed.