Acute abdomen during adjuvant chemotherapy: superior mesenteric artery thrombosis associated with CMF chemotherapy.

We report a case of superior mesenteric artery thrombosis in a 57-year-old woman undergoing chemotherapy for T1N1M0, breast cancer. Although cancer itself is associated with an increased risk of thrombotic events, treatment with chemotherapy and/or tamoxifen in breast cancer patients increases this risk. Most cases reported are of venous thromboembolism; arterial events are rare.

Surgical audit: do numbers provide good training?

There has been a growing realisation that good resource planning requires effective measurement of surgical workload by good surgical audit. This paper examines the general surgical workload at the Army's tertiary referral centre, utilising the ratio of operative workload expressed as Intermediate Equivalents to total Service Equivalent Value of a Surgical team. A suggested format to enable inclusion of specialist non-surgical therapies is proposed. The limitations of "number crunching" when assessing the value of higher surgical training are discussed.

Long-term sequelae of Palmar-Plantar erythrodysaesthesia syndrome secondary to 5-fluorouracil therapy.

Palmar-Plantar erythrodyasesthesia syndrome has been reported as a temporary complication of 5-fluorouracil therapy consisting of a debilitating erythema and tenderness of the skin of hands and feet. The syndrome has previously been observed to respond rapidly to either temporary cessation of chemotherapy or pyridoxine with little residual disability. We report a case which was characterized by persistent morbidity necessitating prolonged discontinuation of treatment.

Eosinophilic gastroenteritis.

Eosinophilic gastroenteritis is an uncommon cause of abdominal pain which may mimic other causes of acute abdominal pain and result in unnecessary laparotomy. In many cases clues to the diagnosis are available prior to surgery; however a high index of suspicion must be maintained if the condition is to be identified at presentation. Two cases are described followed by a review of the disease entity.

Reversal of vasectomy: vasovasostomy.

The increasing popularity of bilateral vasectomy as a method of contraception has resulted in an increased request for reversal (vasovasostomy). The technique is described and the results presented. The implications of these results to the Serviceman in particular and the current advice regarding vasectomy counselling is discussed.

PIP: The increasing demand of bilateral vasectomy as a method of contraception has resulted in an increased request for reversal (vasovasostomy). There have been 20 attempts at reversal at Queen Elizabeth Military hospital in England since 1983. The patients were 20 soldiers aged between 30-41 years and in whom bilateral vasectomy had been carried out for contraceptive purposes. The interval between vasectomy and reversal varied between 3-11 years. The primary method used is the technique of end-to-end anastomosis of the divided vas over a nylon splint, using fine interrupted sutures. Of the 20 operations, 5 were unavailable for study because they had left the service. Of the 15 others, 11 (73%) produced sperm count greater than 5 million/ml, but only 4 (26.6%) had achieved a pregnancy in the 6-12 month period. There have been many reports of reversal procedures and the best attained a 53% pregnancy rate and 88% reappearance of sperm, and those using microsurgical techniques attained 71% pregnancy rates. Poorer results in 1 study were attributed to the age at reversal being over 35 years. It was found that the chances of success are much greater if the reversal is performed within 2 years of the vasectomy; there is much less chance of pregnancy 7 years post vasectomy. The policy is not to perform a vasectomy on men below 30 because of emotional and service factors which result in marital disharmony.

Pseudocyst of the pancreas in childhood.

Pancreatic cysts are uncommon in childhood. Over half of those reported are caused by trauma. A case report is presented and the management of this patient discussed with reference to information from previous reports.