Carotid body tumour: 30 years experience.

Thirty-two patients with 37 carotid body tumours, seen in the Vascular Unit at the Royal Victoria Infirmary, Newcastle upon Tyne between 1956 and 1985 are reviewed. Twenty-six of the tumours were treated by surgical excision. There were no peri- or postoperative deaths, but one patient developed a permanent hemiplegia following surgery (3.8 per cent); cranial nerve palsy occurred in five patients (19.2 per cent). There were no malignant tumours although in one patient, histology of the resected specimen showed the presence of local lymph node invasion (3.8 per cent). In the 7 patients who did not undergo surgery, 3 have been lost to follow-up; the remainder have not shown any significant increase in the size of the tumour. One patient was treated by radiotherapy. It is concluded that surgical excision is the treatment of choice, though observation may be preferred for the older patient with a symptomless, slow-growing tumour. To help reduce the risk of hemiplegia (the most serious complication of surgery) a meticulous surgical technique is necessary and heparin, intraluminal shunting and facilities for arterial repair and grafting must be at hand.

Carotid endarterectomy in patients with transient cerebral ischaemia.

A randomised controlled trial of endarterectomy in patients with carotid artery disease showed that operation significantly reduced the frequency of transient ischaemic attacks (TIA) in the relevant vascular territory. Because of the high post-operative morbidity in the surgical group, the trial was abandoned before conclusions could be drawn as to the influence of endarterectomy on long-term survival or on the incidence of subsequent strokes.

Hypothyroidism following partial thyroidectomy for thyrotoxicosis and its relationship to thyroid remnant size.

One hundred and twenty-two patients were reviewed 1-7 years after partial thyroidectomy for thyrotoxicosis by two surgeons who had left thyroid remnants of different size. There was no significant difference in the prevalence of hypothyroidism or in the serum levels of thyroxine, tri-iodothyronine or thyroid-stimulating hormone between the two groups of patients. The overall prevalence of hypothyroidism was 16 per cent.

Thyroid function after subtotal thyroidectomy for hyperthyroidism.

Among 76 patients who had had a subtotal thyroidectomy for hyperthyroidism from one to seven years previously recurrent hyperthyroidism was found in three and hypothyroidism in 13. The remaining 60 subjects were clinically euthyroid but a raised level of serum thyroid-stimulating hormone (TSH; greater than 5-0 mu U/ml) was found in 39. Analysis of the data showed that their serum thyroxine was significantly lower than in the subjects with a normal TSH. The serum triiodothyronine (T-3) was similar in both groups. It is concluded that subjects with a raised TSH remain clinically euthyroid by maintaining a normal serum T-3 concentration. There was no evidence of any long-term progressive deterioration of thyroid function after subtotal thyroidectomy.

Spontaneous rupture of the distal large bowel

Six new cases of spontaneous rupture of the normal distal large bowel are described and 19 cases from the literature are reviewed, bringing the total of the recorded cases to 25. The aetiology of these cases is discussed. The ruptures occur in the region of the pelvi-rectal junction, in the sigmoid loop, and in the upper rectum. The tear is considered to be mechanical in origin and to be due to a sudden rise in intraluminar pressure which results from sudden obstruction during active peristalsis. Rupture may occur quite spontaneously but is more likely to occur in the presence of constipation and during def‘cation. The diagnosis, treatment, and mortality are also discussed. (Summary)