Primary sclerosing cholangitis.

Six patients with primary sclerosing cholangitis are described. It is an uncommon disease of uncertain aetiology following an unpredictable course but often progresses to secondary biliary cirrhosis, portal hypertension, and premature death from liver failure. Ulcerative colitis is commonly associated with primary sclerosing cholangitis. Endoscopic retrograde cholangiography is the investigation of choice. Liver biopsy may support the diagnosis but is not pathognomonic. There is no effective treatment but symptoms may be controlled.

To strip or not to strip the long saphenous vein? A varicose veins trial.

A double blind controlled trial of surgery for varicose veins was conducted on the legs of patients with bilateral symmetrical varicose veins. The two treatments, saphenofemoral ligation and avulsion of varices, with and without stripping of the long saphenous vein from ankle to groin, were randomly allocated among the legs of individual patients. At follow-up, between 2.5 and 3.5 years, an objective (observer) assessment was that stripping conferred a significant advantage, but the incidence of paraesthesia and pain biased patient's opinion against stripping.

Piperacillin Sodium (a phase III clinical trial).

Twenty-one patients with a variety of clinical infections were treated with Piperacillin Sodium intravenously. One case was considered to be a therapeutic failure. Two further cases were incapable of scientific assessment with respect to their response as no satisfactory pathogen could be identified in spite of a significant febrile illness. In all the other patients in the study a good clinical response was deemed to have been achieved. In nine of these patients, a microbiological cure was also achieved. In the remainder, because of the nature of their clinical problem, no final microbiological sample was available for culture due to the absence of any infective material. Only one adverse incident was encountered (a thrombo-phlebitis, in relation to the intravenous avenue of administration.

Cancer of the large bowel in a defined population: Canterbury, New Zealand, 1970--4.

A total of 1024 new cases of cancer of the large bowel occurred in Canterbury, New Zealand (population 400,796), in the 5 years 1970--4. Of these, 992 were diagnosed before death and are reviewed in this paper. The high incidence of this disease in New Zealanders of European origin is illustrated. A significant difference in site distribution of primary tumours between the sexes was found, with a female preponderance of cancer of the proximal colon gradually changing to a male preponderance of cancer of the rectum. In all, 61.5 per cent of the patients had lymph node metastases or advanced disease at the time of diagnosis or treatment. Largely as a consequence of this, only 65 per cent were able to have potentially curative treatment. The estimated crude 5-year survival rate of the whole group was 32.7 per cent (relative rate 42.8 per cent) and the crude 5-year survival rate after potentially curative surgery was 48.4 per cent (relative rate 62.4 per cent). The results are compared with those of other authors. They emphasize the generally unsatisfactory outcome of treatment.

Subtotal thyroidectomy for thyrotoxicosis: a reassessment, including TRH responsiveness.

Thyroid function was assessed in patients treated surgically for thyrotoxicosis in Christchurch between 1965 and 1972. Seventy-eight of the 89 thyrotoxic patients were available for reassessment. Seventy-one were clinically and biochemically euthyroid. Seven patients had received radioiodine therapy for post-operative relapse and 10 patients were receiving thyroxine replacement therapy. At the time of the survey five patients were clinically thyrotoxic and two patients were hypothyroid and an additional nine patients had grossly elevated TSH levels. TRH tests performed on 31 clinically euthyroid patients with normal baseline thyroid parameters demonstrated that more than a third had excessive TSH responses consistent with reduced thyroid reserve and only one patient showed a lack of response consistent with persistent thyroid autonomy.

Operative cholangiography in two hundred consecutive cholecystectomies.

The records of two hundred consecutive patients undergoing cholecystectomy for gallstones in the university department of surgery, Christchurch Hospital, were reviewed to evaluate the benefit and standard of operative cholangiography. The main benefit lay in the avoiding of unnecessary common bile duct exploration. Of the cholangiograms later reviewed by an independent radiologist, only 70 percent were considered satisfactory.

The pituitary-thyroid axis following surgery for thyrotoxicosis: thyrotrophin-releasing hormone tests in diffuse thyroid hyperplasia and toxic uninodular goitre.

The pituitary-thyroid axis was assessed 1 month after surgery by thyrotrophin releasing hormone (TRH) testing in thirty thyrotoxic patients treated by subtotal thyroidectomy and eleven patients with toxic uninodular goitre. All toxic nodule patients gave essentially normal TRH responses and have remained clinically and biochemically euthyroid at follow-up. Only seven of the thirty subtotal thyroidectomy patients had normal TRH tests when assessed 1 month post thyroidectomy -sixteen patients showed increased response, six gave flat responses, and one showed an anomalous minimal response. Follow-up TRH tests 12 months postthyroidectomy have shown a tendency for TRH responsiveness to return towards normal, but two patients with flat TRH tests have required radioiodine for relapse and four TRH hyperresponders are currently receiving thyroxine replacement therapy.

Correlations between staff, peer and self assessments of fourth-year students in surgery.

Self, peer and staff assessments were made for 138 of 141 students, in two fourth-year surgery classes. Self assessments were significantly lower than peer assessments, which in turn were significantly lower than staff assessments. The highest correlation was between peer and staff assessments. Students with serious psychological problems identified themselves with failing self assessments. The study stimulated interest in assessment procedures amongst staff and students and the latter responded with an assessment of teachers and courses throughout the faculty.

Perianal vaccinia: a case report.

Accidental perianal vaccinia is a rare condition, presenting acutely with severe pain and characteristic superficial ulceration. There is no specific treatment, and complete resolution occurs. A case is described of autogenous perianal vaccinia occurring in an adult.

Christchurch traffic trauma survey: Part 1, Blood alcohol analysis.

Some accurate information concerning the drivers involved in traffic accidents was obtained in a survey at Christchurch Hospital. Investigation of these drivers' occupations revealed that a significant proportion came from the semi-skilled and unskilled occupational groups. Alcohol is confirmed as an important factor in traffic accidents and a number of other characteristics of the drivers are described. The dangers of relying on officially-acquired statistics for research work are revealed.

Christchurch traffic trauma survey: Part 2, victims and statistics.

The results of a survey carried out at Christchurch Hospital examining the problem of traffic trauma are described. The majority of casualties were in the 15-24 age group and motorcyclists were especially prominent. The type and severity of injuries is discussed for each role, e.g., driver, passenger etc. The availability and use of safety equipment (seat belts and crash helmets) by the victims who came to hospital is also detailed. Accidents were found to occur predominantly (88 percent) in urban areas and very close to the victim's home.

Metastatic Melanoma in the Small Bowel.

An account is presented of seven cases of metastatic melanoma in the small bowel, of which five were treated by resection and two were found at necropsy. The reputed rare incidence of this condition is challenged, the clinical features discussed and the literature on the subject reviewed. Its incidence is also presented in relation to all small bowel neoplasms occurring during the period under review.

Tumours of the Small Bowel1.

A series of small bowel neoplasms, benign, primary malignant and metastatic, representing the total local experience of a fourteen-year period, is reviewed. The problems of diagnosis and management are presented and discussed. Argentaffin carcinoma is the most frequently encountered primary malignant tumour. The mode of presentation is considered to be related to the biological behaviour of the various tumours rather than to bear upon the attendant prognosis. It is apparent from our observations that knowledge of the epidemiology of these lesions must still be considered deficient.