Non-coaxial deformation of foreland basement involved in a fold-and-thrust belt: a strain partitioning approach to the Eastern Variscan orogen.

The general SW-NE course of the Variscan orogen in Europe is abruptly bent to the N-S course at its eastern margin, where an oblique convergence occurred. The main suture in this part of the Variscan orogenic belt is called the Moldanubian Thrust, characterized by a dominant dextral strike-slip kinematics and a minor thrust component. The deep level of erosion and the good exposure of this structure allowed us to study the mechanisms of oblique convergence and the incorporation of the foreland basement into the orogenic belt. The combination of small-scale structures with the anisotropy of magnetic susceptibility studies allowed the recognition of two deformations in the studied rocks: dextral simple shearing and drag folding. Due to oblique convergence, the deformations induced by this mechanism were non-coaxial; therefore, their contributions can be easily distinguished. Finally, an overturned, almost recumbent large-scale synformal fold structure in the footwall and an antiformal structure in the hanging wall of the Moldanubian Thrust were formed. These two folds can be interpreted as structures formed by dragging along the Moldanubian Thrust. The previously described sinistral simple shearing in the upper limb of the synform resulted from the original dextral strike-slip shearing, which was overturned during progressive deformation.

Adjuvant radiation after modified radical mastectomy for breast cancer fails to prolong survival.

Recent literature has reported improved local disease control and overall survival in premenopausal node-positive (stage II, and III) breast cancer patients undergoing modified radical mastectomy (MRM) using radiation therapy (RT) combined with chemotherapy. To assess the efficacy of postoperative RT in our own community, we analyzed all patients undergoing MRM for carcinoma utilizing an extensive database from the three major teaching hospitals in Tulsa, OK, between 1965 and 1993. A total of 5257 patients underwent MRM during this time period. One hundred thirty-seven patients were excluded for insufficient data or because they were found to be at stage IV, leaving a total study population of 5125. Overall survival (OS), overall mean survival (MS), disease-free survival (DFS), and locoregional DFS (LRDFS) were analyzed for all patients and were further analyzed according to stage, lymph node involvement, and menopausal status. Median follow-up was 103 months. Statistical analysis was performed using Kaplan-Meier and t-tests. The DFS at 10 years was 65 per cent in the RT group and 80 per cent in the patients who did not receive RT (P = 0.00). No improved DFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. Similarly, the LRDFS at 10 years was 91 per cent in the RT group and 96 per cent in the patients who did not receive RT (P = 0.00). No improved LRDFS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. The overall MS was 97 months in the RT group and 104 months in the patients who did not receive RT (P = 0.00). Comparisons of overall MS rates revealed apparent survival benefits from RT in the premenopausal node-negative group, postmenopausal one to four-positive-node group, and all stage I patients. This apparent survival advantage was not confirmed by Kaplan-Meier curves of OS. No other overall MS differences were detected according to stage, lymph node, or menopausal status. Using Kaplan-Meier survival curves, the OS in the RT group at 10 years was 46 per cent, and 63 per cent in the patients who did not receive RT (P = 0.00). No improved OS was obtained in the radiation-treated patients, regardless of stage, lymph node involvement, or menopausal status. These findings from a large breast cancer database failed to demonstrate any meaningful benefit from RT after MRM and serve to further question the efficacy of this treatment modality in postmastectomy breast cancer patients.

Use of a Marlex fan in the repair of direct and indirect hernias by laparoscopy.

Sixty-seven laparoscopic hernia repairs are described with the use of Marlex mesh in a new fan configuration in 56 cases. This fan is easily constructed and manipulated endoscopically. It offers more surface area of Marlex to the surrounding tissues and occupies more potential space, being conformable to the space left by a hernia sac. In 67 repairs we have had one recurrence at a maximum of 10 months follow-up. One patient had contralateral lower extremity deep venous thrombosis (DVT), one had a palpable inguinal mass, and two patients suffered temporary orchialgia.

Duodenal erosion by aortorenal dacron graft.

Fistulous communications between the bowel and arterial grafts present difficult problems in diagnosis and management. The majority of these cases exhibit retroperitoneal sepsis but in some instances communication between the bowel and the lumen of the arterial graft produces serious hemorrhage. In contrast, the current report describes a patient in whom bleeding occurred twelve years after insertion of an aortorenal graft and the source of bleeding was arterial erosion of an ulcer in the duodenal wall rather than an aortoenteric fistula. Removal of the graft, closure of the ulcer, and nephrectomy were effective in treating the bleeding ulcer and the renovascular hypertension.