Aneurysms of the popliteal artery.

A retrospective study of 13 patients with 18 popliteal artery aneurysms has been undertaken. The patients were seen under a period of 12 years. Six of the patients had extrapopliteal aneurysms as well. Seven of the popliteal aneurysms presented as vascular emergencies, due to occlusion of the popliteal artery. In this group the amputation rate was 57%. In the elective group no amputation was necessary nor did any patient suffer from claudication during follow-up. Ultrasonography is a good tool for demonstrating the nature of the disease. Usually a short exclusion bypass is enough to reconstruct the area. A popliteal aneurysm, if not occluded and asymptomatic, is an indication to operate because of the threat to the limb in case of embolism or thrombosis.

Carotid artery surgery in patients with minor stroke.

Of 229 carotid artery reconstructions, 67 were performed in patients after a minor stroke. In this group of patients the operative mortality was 5.9 per cent, compared with 1.8 per cent in the group of patients without preoperative minor stroke operated upon during the same period of time. The 5-year survival in the stroke group was 86 per cent and in the non-stroke group it was 65 per cent. Excluding the postoperative mortality, the survival increases to 90 and 68 per cent respectively. The difference, which is significant at 6 years (P less than 0.05), is explained by a higher incidence of coronary artery disease in the non-stroke group. The postoperative annual stroke frequency was 2.3 per cent in the stroke group and 2.4 per cent in the non-stroke group. The stroke frequency on the operated side during follow-up was 1.6 per cent per year for both groups together. It seems that a minor stroke is no contraindication to carotid artery reconstruction provided the timing of the operation is correct and other contraindications are considered.

Intracerebral haemorrhage after internal carotid endarterectomy.

This paper reports three fatal cases of intracerebral haemorrhage after internal carotid artery thrombendarterectomy, one in a patient operated on four weeks after a cerebral infarction and two in patients operated after a transient ischemic attack. Two other late intracerebral haemorrhagic events are reported in patients submitted to internal carotid artery surgery, one from a ruptured intracerebral aneurysm and another probably due to anticoagulation medication. It is emphasized to make a clear distinction between haemorrhagic and ischemic events when reporting stroke frequency in patient materials after internal carotid artery surgery.

Reconstruction of the carotid artery. A review of 167 operations.

During an 8-year period 149 patients underwent 167 carotid operations. TIA or amaurosis fugax was the operative indication in 60% of the cases and TIA-IR (minor strokes) in 25%. The operative mortality was 4.2%. New neurological permanent deficits appeared in connection with the operation in 4.2%. They were all of benign character. The mean follow-up time was 23 months with a range from 4 months to 8 years. The postoperative follow-up revealed a 10% frequency of strokes during a 6-year period, i.e. 1.6% per year. The 5-year survival for the whole material was 71% and for patients without signs of coronary artery disease, operative mortality excluded, it was identical with the 5-year survival for the "normal population" in the same area, i.e. 85%.

Aortoduodenal fistula after surgery for renal artery stenosis.

An unusual case of aortoenteric fistulation, 5 years after surgery for renal artery stenosis, is presented. A stenotic right renal artery had been reimplanted into the aorta in a 4 1/2 year old boy. No signs of infection had been present, nor had any synthetic material been used. The fistula was found to originate from the ligated renal artery, not from the reconstruction. It was successfully corrected without compromising the kidney.

Diagnostic value of biopsies in villous papilloma of the colon and rectum.

The correlation between the histopathological diagnosis of biopsies from colorectal villous tumours and that of the excised tumour (in 16 cases of carcinoma only clinical diagnosis, autopsy or death certificate) was investigated. In the persent retrospective study 235 biopsies were taken from 134 tumours where the final diagnosis had been established. In the benign groups the grade of the biopsy was the same as that of the surgically excised tumour in about 50%. However, 25% of the biopsies with a benign diagnosis were in fact taken from carcinomas. Not even multiple biopsies exclude the presence of cancer in a villous papilloma. The tumour should be totally excised and histologically examined.

Roentgenological features in villous papilloma of the colon and rectum.

With good technique it is possible to detect small polyps in the large intestine with a barium enema examination. The radiological appearences and visibility of villous papillomas in 84 barium enema examinations from patients with both benign and malignant villous papillomas in the rectum, rectosigmoideal junction and the sigmoid loop were studied. In 75% of the examinations the tumour was visible. A specific radiological diagnosis of non invasive villous papilloma was made in 33% and the correct malignant diagnosis in 8/13 cases. There were both false positive and false negative diagnoses of malignancy. Patients with a villous papilloma should undergo barium enema study with double contrast technique of the whole large intestine. Benign looking tumours can always have islands of invasive carcinoma. But the criteria for malignancy are more reliable than the diagnostic signs for the villous papilloma.

Villous papilloma of the colon and rectum. Part I. A clinical study of 213 patients.

Of the benign colonic epithelial neoplasms the villous papilloma, although rare, is reported to become malignant in 30--50%. This paper reports a retrospective study of 213 patients with a colorectal villous papilloma. The tumours were subdivided histologically according to Wheat and Ackerman (1958) into four different groups. 20% of the tumours contained either focal or invasive carcinoma. The histology of the tumour correlated significantly (p less than 0.01) with the size of the tumour with a more malignant grading of the larger tumours in general. Blood in the stool, diarrhoea, and mucoid discharge from the anus were the most frequent complaints. Malignant change of the tumour was found especially in older patients (eighth decade of life) and among women. Patients with a malignant villous papilloma complained significantly more of pain on defecation than patients with a benign tumour. Over 30% of the malignant tumours were already incurable at the time of discovery because of invasion of surrounding tissues and metastases.

Villous papilloma of the colon and rectum. Part II. A follow-up study of 213 patients.

A follow-up study of 213 patients with colorectal villous papillomas was performed to assess different methods of treatment and the prognostic value of several factors. Recurrences appeared in 26%. Segmental resection of the intestine gave no recurrences. The choice of surgical method had little or no influence on the 5-year survival rate. The 5-year crude survival rate for the whole series was 61% with a relative survival of 80%. The larger tumours had the poorest 5-year survival rates. Tumours with invasive carcinoma in the villous papilloma had a crude 4-year survival of 16% whereas tumours which did not originally show invasive features had a 5-year crude survival rate of 68%. Of the whole series 48 patients (22%) eventually died from colorectal cancer. It is possible that the invasive character of the tumour had been missed originally so thorough microscopic examination of the whole tumour is essential.