Bascom's operation for pilonidal sinus.

During 1985 in England and Wales, 7000 patients were treated for pilonidal disease with an average hospital stay of 5 days. The aim of this paper is to report our early experience with Bascom's operation for pilonidal sinus--a procedure relatively untried in the UK.

Oesophageal varices: evaluation of injection sclerotherapy without general anesthesia using the flexible fibreoptic gastroscope.

A technique of injecting oesophageal varices through a flexible fibreoptic gastroscopic is described and its value in controlling haemorrhage and eradicating varices in 34 patients is considered prospectively. Twenty-five per cent of the patients re-bled during the first emergency admission after injections, but control was achieved in all. Subsequent re-bleeding occurred in 46% and varices were ultimately eradicated in 59%. It ic concluded that the procedure is associated with fewer serious complications compared with rigid oesophagoscopic techniques and may be as effective.

Ability of CEA blood levels to reflect tumour burden: a study in a human xenograft model.

The relationship of serum carcinoembryonic antigen (CEA) levels to tumour size and antigen content was studied in artificially immune-deprived mice bearing human colonic, breast and lung tumour xenografts. Size was measured as in vivo volume and tumour weight at post-mortem. A multiple implant technique combined with early harvest was used to minimize centrilobular tumour necrosis. CEA was extracted from resected tumours with perchloric acid. A radioimmunoassay using chemical precipitation was used to estimate CEA in blood samples. A correlation was found between CEA blood levels and tumour size in half the tumour lines, in contrast to a recent report (Lewis & Keep, 1981). The CEA content was found to be constant for one tumour line but not another. The possibility that central necrosis in xenograft tumours may account for the discrepancies is discussed. There may be serious limitations for the use of xenograft tumour models for studying the biology of CEA.

Tumour lysis as a factor affecting blood levels of CEA.

A hypothesis is proposed that tumour lysis may be an important factor affecting blood levels of CEA. This has been explored in an experimental study with a model tumour system, consisting of immune-deprived mice bearing human CEA-producing tumours. Using agents such as irradiation, chemotherapeutic drugs, diphtheria toxin and techniques such as cryosurgery, it has been shown that tumour lysis is important when it is both rapid and extensive. The extent to which this may occur in patients remains uncertain, except in rare instances of dramatic response of malignant disease to treatment.

Sexual function after bilateral lumbar sympathectomy and aorto-iliac by-pass surgery.

Sexual function has been assessed in 44 patients under 60 years old after bilateral lumbar sympathectomy. 21 had lumbar sympathectomy alone, but in 23 it was combined with by-pass aorto-iliac surgery. Half these patients produced seminal fluid for analysis and spermatozoa were present in all. In those patients who also had aorto-iliac surgery, sexual function was impairedin 40%, ejaculation and erection difficulties occurring in the same proportion. In patients who had only bilateral sympathectomy, these complications occurred in 24% and mainly consisted of ejaculation disturbances. Only three patients became impotent, each having had aortic surgery. Serious sexual complications caused by lumbar sympathectomy alone seem relatively rare and should only preclude its use in young men wishing to reproduce.

A useful procedure in the treatment of chronic olecranon bursitis.

An operation for chronic olecranon bursitis is described and the results of 11 cases reviewed. It is suggested that a number of patients with this condition have a prominent olecranon process or spur. The technique involves excision of the olecranon process only, the bursa itself is preserved. The overlying skin remains undamaged and this manoeuvre avoids the unpleasant sequelae that may follow its removal. The operation appears to give satisfactory results.

Diabetic autonomic neuropathy in patients with vascular disease.

An attempt has been made to determine the effect on vasomotor tone and sweating of peripheral neuropathy in the feet of diabetics with vascular disease. There was a loss of vasomotor tone in 48 per cent of patients with peripheral neuropathy and in 12 per cent of those without neuropathy (P less than 0.01). Complete loss of sudomotor activity was rare in both groups.

An operation for chronic prepatellar bursitis.

An operation for chronic prepatellar bursitis is described in which only the posterior wall of the bursa is excised, thus preserving, undamaged, healthy and normally sensitive skin. This procedure is easier and less traumatic than complete excision of the bursa and results in fewer complications. It is suggested that removal of tha anterior wall of the bursa results in unnecessary and harmful interference with the underlying skin. The operation described gives a good functional and structural result; leaving the anterior wall of the bursa does not predispose to recurrence.