Robert A. B. Wood

Videothoracoscopic Ligation of Bulla and Pleurectomy for Spontaneous Pneumothorax

A thoracoscopic technique to ligate pleural bullae and perform parietal pleurectomy is described. The procedure has been performed on 2 patients, allowing definitive treatment of recurrent spontaneous pneumothoraces. Both patients have been cured of their problem and benefited from the decreased trauma of access by reduced postoperative pain, rapid recovery, and decreased scarring of the skin.

Laparoscopic prosthesis fixation rectopexy for complete rectal prolapse.

Five women aged 64–81 years with complete rectal prolapse and incontinence were treated by laparoscopic mobilization of the rectum and posterior fixation to the presacral fascia using Marlex mesh. Mobilization was carried out with standard straight laparoscopic instruments in the first two patients (operating times 3·5 and 4·5 h) and with coaxial curved instruments and ultrasonic dissection in the succeeding three (operating times 2·5, 2·0 and 2·5 h). Restoration to full continence (grade 1) was observed in two patients and to grade 2 in a further two. No recurrence of the prolapse occurred during follow‐up of 4–27 months.

Needle aspiration of the breast with immediate reporting of material.

Needle aspiration with immediate cytological reporting has been practised in a breast clinic for one year. Patients benefit by receiving immediately the provisional diagnosis and, when indicated, appointments for metastatic surveys. Close co-operation between surgeon and cytologist has resulted in increased skill in aspiration, better preparation of samples, and greater accuracy in interpretation of reports. Since 5% of clinically benign lesions have proved malignant, even on immediate reporting, we would recommend cytological examination of all breast lumps.

Percutaneous cervical pharyngostomy: A comfortable and convenient alternative to protracted nasogastric intubation

For patients who require lengthy periods of enteral nutrition or gastrointestinal decompression, the use of a tube placed through a cervical pharyngostomy provides a convenient means of access to the upper gastrointestinal tract. The discomfort and complications of nasogastric intubation can be avoided, and the use of parenteral nutrition can be reduced in many cases where the gastrointestinal tract is functioning but the patient is unable to ingest food normally. The result of this technique in 42 patients over a 4 year period have been described herein. The patients found the method comfortable, cosmetically acceptable, and easily managed both in the hospital and at home. The technique of inserting the tube through the pyriform sinus is easy and safe to perform, and there have been no major complications in using the technique for periods up to 119 days. If accidentally displaced, the tube is easily reinserted through the neck without special equipment and with no discomfort. The method can provide a considerable improvement in the effectiveness of overall patient management. We suggest it could be more widely used in general surgical practice.

Serum proteinase-like peptidase activities and proteinase inhibitors in women with breast disease

The pre-treatment serum activities of several proteinase-like peptidases and the proteinase inhibitors, alpha 1-antitrypsin (alpha 1AT) and alpha 2-macroglobulin (alpha 2M), have been determined in 102 women with breast cancer and compared with those in 20 women with benign disease and in 30 healthy women of cancer bearing age. There were no significant differences in serum proteinase-like peptidase activities associated specifically with breast cancer. However, trypsin-like and plasmin-like activities were significantly lower than normal in women with breast disease. Serum alpha 1AT and alpha 2M levels were higher in patients with breast cancer than in healthy women or women with benign breast disease. These results indicate that, at presentation, breast cancer is not associated with abnormal serum levels of the proteinase-like peptidases studied, possibly as a result of an increase in the concentration of proteinase inhibitors.