Intraductal hepatocellular carcinoma treated by intralumenal brachytherapy.

Hepatocellular carcinoma (HCC) rarely presents as biliary tract occlusion [1,2]. Intralumenal iridium-192 brachytherapy has been used to treat extrahepatic bile duct carcinoma and may be curative if the macroscopic tumour has been resected surgically [3]. We describe a rare event, a case of HCC presenting with biliary tract occlusion treated with intralumenal iridium-192 brachytherapy.

The reversed gastric esophagoplasty in palliation of carcinoma of the esophagus.

The reversed whole stomach was used in 29 patients to bypass nonresectable carcinoma of the esophagus. The mobilized distal stomach, after duodenal transection immediately beyond the pylorus, was placed in a substernal and anterior mediastinal tunnel and the prepyloric area was anastomosed to the cervical esophagus. Lengthening of the stomach was obtained by division of the lesser curve. In this series, the operative mortality rate was 4 per cent, morbidity was minimal and the whole procedure proved relatively easier to perform than the conventional isoperistaltic gastric esophagoplasty. There is no expected improvement in life expectancy, but morbidity decreased because of preservation of the esophagogastric drainage, thus avoiding a mucocele of the excluded esophagus and preservation of the vagus nerves.

Foreign-body ileitis. A case report.

A patient who ingested a soft-drink bottle top and stones, which resulted in a chronic active ileitis, is described. Histological examination revealed a chronic active inflammatory process, probably indicating long-term ingestion of foreign material. The histological features in some respects resembled those of Crohn's disease.

Cirrhosis of the liver associated with inferior vena-caval obstruction.

Seven patients with inferior vena-caval obstruction associated with cirrhosis of the liver are described. Inferior vena-caval obstruction is suggested when an enlarged azygous vein is seen on chest radiography, or when superficial collateral veins draining upwards are visible on the abdomen and chest. When a short obstruction or 'web' is present, this should be treated surgically. Venous thrombosis below the obstruction may result in occlusion of a long segment of the vena cava. Chronic suprahepatic venous obstruction may cause macronodular cirrhosis and predispose to the development of hepatocellular carcinoma.

Low back pain as the presenting symptom of renal artery aneurysm. A case report.

Hypertension of recent onset in a 29-year-old woman was associated with low pain radiating to the right groin. Angiography showed the presence of a large aneurysm of the right renal artery. Resection of the aneurysm and nephrectomy cured the hypertension.

Postpartum veno-occlusive disease treated with ascitic fluid reinfusion.

Three patients presenting in the postpartum period with veno-occlusive disease not related to the ingestion of pyrrolizidine alkaloids are described. The patients were treated by intravenous reinfusion of the ascitic fluid. This form of therapy has, to our knowledge, not previously been reported in the management of this condition.

Diagnostic peritoneal lavage in blunt and penetrating abdominal trauma.

Peritoneal lavage as a diagnostic aid is described in a small series which includes both blunt and penetrating abdominal trauma. Its value for blunt injuries has been confirmed, and it is recommended for penetrating injuries, when the diagnosis of visceral injury is in doubt.

Pathology of malignant melanoma of the skin in Black Africans.

Follow-up data (over a 3-year period) and the histological appearances of primary lesion were studied and related in 40 Black patients with malignant melanoma. This to our knowledge is the first study in Black African patients. It was found that they present with large deeply invasive lesions, particularly on the foot. The prognosis is poor, with an over-all 3-year survival rate of 35%. The histological features used to assess the prognosis of malignant melanoma in Whites, that is histogenetic pattern, size and shape of the lesion, level of invasion, presence of ulceration and mitotic activity would seem to be equally applicable in Black patients. In addition, marked cellular pleomorphism, haemorrhage, necrosis and fibrosis within the tumour are bad signs. In this series lymphocytic infiltration, either within the tumour or at the edge, possibly indicative of an immune response, seemed to be of favourable prognostic import. Surprisingly, a lesion histologica-ly that of lentigo maligna melanoma was found on the feer of some blacks and could be related to much more favourable survival figures.

Malignant melanoma of the skin in Black Africans.

Malignant melanoma of the skin in Blacks in formidable and sinister tumour. This study is concerned with the epidemiology of malignant melanoma, as seen in both urban and rural Black Africans. A smaller series in which follow-up on the patients was available is included. To our knowledge, this is the first study of its kind in which follow-up, and hence survival figures, can be quoted. Although the numbers are relatively small, they provide a valuable indication of the behaviour of melanomas in this group. The difficulties of follow-up cannot be overemphasised, and follow-up on 79 cases out of 100 could be obtained only by the employment of an able and enthusiastic Black social worker for 3 years. The first recorded survival figures in a Black population show a 3-year survival rate of only 28,4%. Prognosis is related to the size and extent of the tumour with larger and more widespread tumours faring worse than others. The incidence of malignant melanoma in Johannesburg Black was 1,2 per 100 000 and accounted for 2% of all cancers. The largest number of cases occurred in the 50- 70-year age group and there was a female preponderance. As in previous studies, the sites predominantly affected were the foot and the hand, mainly on the plantar and palmar surfaces.