Biliary drainage endoprostheses: experience with 201 placements.

Two hundred one biliary endoprostheses were inserted transhepatically with a two-step procedure in 162 patients. Teflon endoprostheses were inserted in the initial 95 patients and polyethylene in seven others. Because in vitro experiments and clinical experience have revealed a lower incrustation rate with Percuflex and polyurethane, endoprostheses made of these materials were used in the last 60 patients. The mortality rate directly related to the procedure was 3.7%, and postprocedural complications occurred in 9% of the patients. Delayed complications included cholangitis in 20%, obstruction in 6%, and dislocation in 3% of the cases. The mean survival time of all 162 patients was 20 weeks. It is concluded that endoprostheses offer effective palliative treatment of obstructive jaundice caused by malignancy.

The grading of rectal cancer: historical perspectives and a multivariate analysis of 447 cases.

The grade of a tumour is gauged on the subjective assessment of a number of histopathological parameters. The problems associated with this exercise were viewed from a historical perspective and survival analysis of 447 patients receiving surgery for rectal adenocarcinoma was undertaken. Only deaths from rectal adenocarcinoma were included as events in the survival analysis. Seven grade-related parameters were scored by one observer. A grading system was constructed using the Cox regression model. The variables in the best-fitting parsimonious model comprised lymphocytic infiltration, tubule configuration and pattern of growth. Scores were derived from the model and a four grade system was created in which the groups were of similar size. Good reproducibility of the selected histopathological parameters was demonstrated. Grade-related parameters were then allowed to compete with stage-related parameters in an overall model of pathological prognostic categories. The parameters selected in the best model were number of affected lymph nodes, the presence of lymphocytic infiltration and extent of spread through bowel wall. A set of five prognostic categories was developed from this model.

Mondor's disease associated with metastatic axillary nodes.

Mondor's disease, superficial thrombophlebitis of the breast, is customarily associated with benign conditions of the breast. This article reports a patient in whom an early manifestation of recurrent axillary metastasis from carcinoma of the breast was a symptom of ipsilateral superficial thrombophlebitis of the breast, an unusual association.

Extrahepatic bile duct obstruction in primary carcinoma of the lung: incidence, diagnosis, and non-operative treatment.

Jaundice associated with primary carcinoma of the lung was identified in 19 patients from 1973-1978. Eight of these patients had demonstration of extrahepatic bile duct obstruction (EHBDO). The most frequent histologic type of lung tumor was undifferentiated, occurring in six of the eight patients with proved EHBDO. The EHBDO resulted from metastatic involvement in peripancreatic, periportal, and peribiliary lymph nodes. Metastasis to the common bile duct was rare. However, metastases to the head of the pancreas were a frequent event, being found in six of the eight patients with EHBDO. Discussion of diagnosis and recommendations for treatment are included.

A quantitative measurement of peritoneal drainage in malignant ascites.

With a two-compartment model, a method is described for quantitative determination of peritoneal drainage rates in malignant ascites. Data on twenty-four patients are presented and comparison is made with the qualitative assessment of the integrity of diaphragmatic and mediastinal lymphatics on the basis of lymphoscintigrams. It is concluded that flow rates less than 50 ml/hour are usually associated with abnormalities of the diaphragmatic and mediastinal lymphatics, indicating that tumor permeation of these structures is a significant contributing factor to persistent, intractable ascites in patients with malignant diseases.