Quadrantic excision and axillary node dissection without radiation therapy: the long-term results of a selective policy in the treatment of stage I breast cancer.

The results of a selective policy of conservative surgery without radiation over a 14-year period with a minimum 5 year follow-up indicates that routine postoperative radiotherapy can be safely omitted in certain cases. Eighty-one patients were studied, the overall survival at 5 years and 10 years was 88% and 73% respectively. The risk of local recurrence within the treated breast or axilla was 10% at 5 years and 11% within the total follow-up period. Most (91%) local recurrences were noted within 5 years. The rate of dying from breast cancer did not change over 10 years of follow up. The risk of recurrence was significantly higher in younger (less than 46 years) patients (P less than 0.05) and premenopausal patients (P less than 0.005) compared with older, post menopausal patients. The risk of dying from breast cancer was also significantly greater in the younger premenopausal women. At 10 years the rate of dying from breast cancer was unchanged from that seen soon after diagnosis. In postmenopausal patients with tumours less than 2 cm and uninvolved axillary nodes after pathological assessment, radiotherapy can be safely omitted. In these patients there is a low risk of local recurrence (10%), similar to that reported following segmental mastectomy and radiation.

Treatment of post-radiotherapy telangiectasia by injection sclerotherapy.

A new treatment for post-radiotherapy telangiectasia is reported. Five patients were successfully treated by injection of a dilute solution of sodium tetradecyl sulphate. Several (4-7) half hour sessions of injection sclerotherapy at 5-weekly intervals were necessary.

Granular cell tumour of the breast.

Four cases of granular cell tumour of the breast reflecting the lifetime experience of one surgeon are presented. Recent advances in the pathology of this condition suggest that the customary term 'myoblastoma' is inappropriate, and that 'granular cell tumour' is preferable. The clinical and pathological features are reviewed and the differential diagnoses discussed, with emphasis on the distinction from carcinoma which may be mimicked both clinically and on frozen examination. The diagnosis may be made by pre-operative aspiration cytology, and a conservative surgical approach is recommended.

A tumour gauge to measure breast lumps for use with mammograms.

A new tumour gauge is described for the measurement of breast lumps. Mammographs or xeroradiographs are taken and opacities that have a definite border are suitable for assessment. The tumour gauge is made of a transparent plastic with concentric lines. A classification of tumour size T (TMN staging) can be made by placing the tumour gauge over the mammogram/xeroradiogram. Tumour diameter is measured with the gauge and the volume of a sphere and so tumour bulk can be calculated. This may be of greater clinical relevance than tumour diameter. The tumour gauge may be applied in the difficult clinical situations of the post-irradiated breast or the obese patient. A primary or recurrent tumour that has not been excised and is visible on the mammogram may be used as a marker to assess response to treatment.

Frey's syndrome after parotid surgery.

The operative records of seventy-one patients who had parotid surgery carried out in the ten year period from 1964 to 1973 were reviewed. Forty-one (67%) of the operations were suprafacial parotidectomies. Of the fifty patients who agreed to reassessment in a special clinic, seventeen had a noticeable degree of Frey's syndrome, and of these fourteen were submitted to further investigations. Minor's test in these fourteen patients showed the greater auricular nerve to be involved in six patients, the ariculotemporal nerve in four, and both nerves in two. The results in two patients were inconclusive. Because the starch test reveals only the distribution of the gustatory sweating, a useful adjunct is described for investigating Frey's syndrome. By blocking of the contralateral greater auricular nerve in the neck and mapping out of the anesthetized area, its sensory distribution is demonstrated. We conclude that it is manifestly unwise to avulse the auriculotemporal nerve if the sweating occurs in the distribution of the greater auricular nerve.

A controlled trial of drainage after cholecystectomy.

A prospective controlled trial of drainage after cholecystectomy has been carried out. In a consecutive series of 143 patients undergoing cholecystectomy, 50 patients were randomly allocated to a drainage group and a further 50 patients to a non-drainage group. The remaining 43 patients were drained electively because the common bile duct was explored or because of infection or incomplete haemostasis. There was no significant difference in the incidence of wound infection or other complications between the drainage and the non-drainage groups. The duration of postoperative pyrexia, the number of analgesic injections and the length of postoperative hospital stay were the same in both the randomized groups. One patient in the randomized drainage group had a reactionary haemorrhage from the drain site requiring transfusion. There was no mortality but one patient in the elective drainage group had to be re-explored for a subhepatic abscess. Three patients in this group drained bile from the drain for 3-9 days but all had a T tube in place. This trial fails to demonstrate any advantage or disadvantage in draining the gallbladder bed after cholecystectomy.