Defining the rectum: surgically, radiologically and anatomically.

The terminology used in relation to the rectum varies considerably, added to this there is the subjective nature of clinical assessment and variability in the anatomy of the rectum and anus. It is imperative that definitions are clarified and standardized for use by all members of the multidisciplinary team involved in the care of patients with rectal cancer.

The long head of the biceps femoris: anatomic basis for its possible use in the construction of an electrically stimulated neoanal sphincter.

Electrical stimulation of the nerve to the gracilis muscle following its transposition around the anal canal creates an artificial sphincter capable of actively opposing intrarectal pressure. Not all patients have an available or suitable gracilis. This paper describes the anatomic basis for the use of the long head of the biceps femoris as a potential electrically stimulated neoanal sphincter. The muscle was found to have an adequate length and a suitable arc of rotation for transposition around the anal canal. In 75 percent of thighs studied the neurovascular anatomy of the long head of the biceps femoris was compatible with its utilization in this manner as an alternative to the gracilis.

The inferiorly based masseter muscle flap: anatomical basis for its use in head and neck reconstructive surgery.

The aim of this study was to investigate and elucidate the anatomical basis for the use of the inferiorly based masseter muscle flap in the reconstruction of oropharyngeal defects after ablative surgery. The anatomy of the masseter muscle, with particular emphasis on its blood supply, was studied using plain and coloured resin injected dissections and a series of digital subtraction angiograms and external carotid arteriograms. Both techniques were demonstrated to be reliable and effective means of anatomical investigation of blood vessels. The vascular anatomy of the masseter muscle and the anatomical and angiological results as well as a case report are described. The masseter muscle, when used as an inferiorly based flap, provides the necessary bulk for reconstruction of moderate size defects in the lateral border of the tongue, posterior floor of the mouth, retromolar trigone, anterior tonsillar pillars and lateral pharyngeal wall. Although the masseter muscle has small dimensions, it offers a reliable method of reconstruction in selected defects without the disadvantages of cosmetic and functional loss.

Alimentary malignancies in Arabs in the Eastern Province of Saudi Arabia.

A study was made of 89 cases of alimentary malignancies in Arab patients in the Eastern Province of Saudi Arabia. The pattern of alimentary involvement observed was colo-rectum 43%, stomach 34%, oesophagus 19% and small intestine 4.5%. This finding was in contrast to previous studies in Saudi Arabia which had reported the upper alimentary tract, particularly the oesophagus, as the site most frequently affected. Of the patients 80% were Saudis. The male:female ratio was 3.9:1. A striking feature was the youthfulness of several patients, 44% being under fifty years of age. There were only three cases of alimentary lymphoma. Although colo-rectal schistosomiasis was a moderately frequent finding in the population studied, there was no pathological evidence to support an aetiological association between bilharziasis and large bowel malignancy.

The management of the enlarged thyroid.

Goitre is common in the south-west sector of Sri Lanka. The clinical features of 200 patients who underwent surgery for thyroid enlargement at the General Hospital, Colombo, reflect the pattern of presentation of various types of goitre, particularly endemic goitre. Thyroxine therapy controls endemic goitre in the early stages. Subtotal thyroidectomy is required for multinodular goitre causing cosmetic or pressure effects. A previous multinodular goitre antedates the onset of hyperthyroidism in 20 per cent of thyrotoxic patients. Reduction of spirometry time and utilising a linear gradient in analysis enhances the reliability of basal metabolic rate estimation. Subtotal thyroidectomy, carbimazole and radioiodine therapy are used in the management of toxic goitre. A study of 50 clinically solitary thyroid nodules revealed 7.3 per cent of cold nodules to be malignant. Hemithyroidectomy is recommended for solitary nodules. 9.5 per cent of patients undergoing surgery for thyroid enlargement had thyroid carcinoma. The follicular: papillary carcinoma ratio was 1:0.9. Total thyroidectomy for the former and hemi-thyroidectomy with nodal excision for the latter are followed by thyroxine therapy. Thyroidectomy technique includes prethyroid muscle division, recurrent laryngeal nerve identification and separate division of superior thyroid vessel branches. Laryngeal oedema and hypocalcaemia are important postoperative complications.