Severe lower limb ischaemia with pulses: cholesterol embolisation--a little known complication of aortic surgery.

Cholesterol embolisation is a little known complication of aortic surgery and radiological procedures with a mortality of 81%. Treatment has been poorly described and inadequate. We report a case in which we have followed an aggressive policy of treatment using modern vascular techniques not previously described in this condition.

Treatment of combined brachial plexus and subclavian artery trauma.

Five cases of combined brachial plexus root avulsion and subclavian artery trauma are presented. A policy of preoperative myelography and minimal vascular reconstruction in the presence of root disruption is discussed.

Abdominal pain as a cause of acute admission to hospital.

Between 1 January 1988 and 31 December 1989, 525 patients were admitted to one hospital with a diagnosis of acute abdominal pain. Of these, 182 (34.7%) underwent an emergency operation and 14 (7.7%) of these patients subsequently died within 30 days. Death was due to intestinal obstruction in 69%, and there was a 28% mortality rate for emergency colonic resection. Non-specific abdominal pain (NSAP) was the most common diagnosis (36.0%), followed by appendicitis (14.9%) and urological causes (12.8%). There was an unnecessary appendicectomy rate of 25.0%. Admission with pain because of urological causes was over twice that of previous reports. Duration of stay increased greatly with age. Results from this study confirm the high mortality rate in the elderly from emergency colonic resection. Greater care in diagnosis and a conservative approach to appendicitis, with laparoscopy in females of reproductive age, may produce a lower unnecessary appendicectomy rate without an increase in morbidity. If the diagnosis of NSAP could be made earlier and patients discharged sooner, a large saving in resources would result. This early diagnosis is not yet possible.

Liposarcoma of the cord presenting at vasectomy counselling.

A case of liposarcoma of the cord is reported in a patient presenting for vasectomy. This paper discusses such tumours and illustrates the importance of a careful clinical examination during counselling.

PIP: A case of liposarcoma, a rare malignancy of lipoblasts derived from mesenchyme, in a 36-year old man applying for vasectomy is described. The subject reported nagging scrotal pain for 14 years. Examination revealed a soft mass above the left testis, thought to be an epididymal cyst. During exploration under general anesthesia, a partly encapsulated fatty lesion was found encircling the testis and the cord. The tumor was dissected and excised. Some parts of the tumor resembled a vascular lipoma, others contained multivesiculated primitive cells and hyperchromatic multi-nucleated and granular lipoblasts. The man was treated with left radical orchidectomy with high ligation of the cord 10 days later, and biopsies of lymph nodes, retroperitoneal fat and skin were taken for examination. He has remained recurrence free for 4 years by CT scans. This case dramatizes the need to consider paratesticular tumors in any case of a mass found in a vasectomy candidate.