Assessment of the use of disposable skin staplers in bowel anastomoses to reduce laparotomy time in penetrating ballistic injury to the abdomen.

Laparotomy and anastomosis of the small bowel after penetrating injury to the abdomen is a lengthy procedure. This paper describes the use of skin staplers for bowel anastomosis and presents the results of a short series of experiments upon dead pigs to compare the staple technique with conventional handsewn anastomosis. The time taken to perform each small bowel anastomosis, the integrity of the anastomosis and the skill required were assessed. The staple technique was considerably faster (mean construction time: 5.4 min, range 4-6 min) than the handsewn technique (mean construction time: 12 min, range 10-14 min), at least halving the anastomosis time (Kolmogorov two-sample test P = 0.05). In addition, the stapled anastomosis had a higher intraluminal failure pressure (mean failure pressure: 65 cmH2O, 6.37 kPa, range 30-70 cmH2O) than the handsewn anastomosis (mean failure pressure: 38.6 cmH2O, 3.78 kPa, range 10-70 cmH2O).

Long distance travel for routine elective surgery: questionnaire survey of patients' attitudes.

OBJECTIVE: To carry out an audit and assess the acceptability of long distance travel to patients on a lengthy surgical waiting list. DESIGN: Audit and questionnaire survey. SETTING: Military hospital in Wiltshire. PATIENTS: 116 Patients on a general surgical waiting list at Leighton Hospital near Crewe. INTERVENTIONS: Preselection for medical fitness at a waiting list review clinic. RESULTS: Roughly half of patients offered the facility of travelling 120 miles (190 km) for their routine elective operation at the health authority's expense accepted. The average waiting list time declared by the patients who travelled was 28 months, and 13 patients stated that their condition prevented them from working. Only four patients regretted their decision to participate in the scheme. Lack of visitors did not cause undue concern. CONCLUSIONS: Some patients did not agree to travel for their operation but almost all of those who did so found the scheme satisfactory. Some minor problems were encountered but these could probably be overcome by ensuring use of appropriate transport, extending the postoperative stay when necessary, and more careful selection of patients for an anaesthetic. For efficient use of theatre time in such schemes it is crucial that the operating consultant surgeon should be in charge of case selection.

The trends of vasectomy reversal in the forces.

A reversal of a vasectomy is required in about 3% of men who undergo vasectomy. We set out to examine the relationships between the age at which vasectomy was performed and the interval before subsequent reversal within the context of the armed forces. Thirty seven patients were identified from hospital records, as having undergone a reversal of vasectomy in the preceding two years, and thirty one sets of notes were available for inspection. Ages at vasectomy and at reversal were recorded and, where stated in the notes, if there had been a change in partner prior to the reversal request. Twelve (39%) men were under the age of thirty years at the time of their vasectomy, with a mean time to reversal of 4.4 years. Nineteen (61%) were over the age of thirty years at time of the vasectomy and their mean time to reversal was 7.2 years. Where recorded, the reason for requesting a reversal was a change in partner in 90% of men. Men who had their vasectomies before reaching the age of thirty were more likely to undergo reversal in a significantly shorter period of time when compared to those over thirty years. The disseminated criteria for vasectomy should be adhered to and appropriate preoperative counselling by surgeons may be useful.

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.

Testicular torsion in the armed services: twelve year review of 179 cases.

All cases of testicular torsion occurring in the Armed Services between 1972 and 1983 have been reviewed. All cases were post-pubertal. The incidence in older age groups is higher than previously reported. No cases were seen in undescended testes. No seasonal variation in presentation was detected. Recurrent scrotal pain before acute presentation occurred in 29 per cent of cases. The testicular salvage rate was 75 per cent. The salvage rate in patients with pain for greater than 24 h was 46 per cent. Patients with a history of intermittent scrotal pain should be explored as a matter of urgency. Operation should still be considered in patients who have had pain for greater than 24 h.

Early experience of intra-ureteric capsaicin infusion in loin pain haematuria syndrome.

OBJECTIVES: To evaluate early results of the intra-ureteric instillation of capsaicin for the treatment of loin pain haematuria syndrome (LPHS). PATIENTS AND METHODS: Ten patients with LPHS were treated using intra-ureteric capsaicin instillation. A solution of capsaicin was infused into the affected ureter through an embolectomy catheter, under anaesthesia. The success of the treatment was assessed using patient questionnaires and the quantitative reduction in the patients' analgesic requirements measured. RESULTS: During a mean follow-up of 6 months, six of the 10 patients had short- to medium-term symptomatic relief after one or more treatments; four had no relief from their symptoms. One patient had a mucosal ulceration in the bladder after extravasation of the capsaicin solution. Two patients subsequently underwent simple nephrectomy for symptomatic nonfunctioning kidneys. CONCLUSION: These results are consistent with other preliminary reports of the efficacy of capsaicin treatment in LPHS and such treatment therefore has a definite therapeutic role in this difficult condition. We are uncertain if the treatment contributed to the deterioration of the excised kidneys. This early experience suggests a need for careful consideration when contemplating this treatment, with attention directed to both the initial diagnosis and possibly the technique of capsaicin/instillation. We include a protocol to follow when preparing patients for capsaicin treatment.

Radioimmunoassay for prostatic acid phosphatase in early prostatic carcinoma.

A radioimmunoassay procedure has been used to measure prostatic acid phosphatase in the serum of 46 patients with intracapsular carcinoma of the prostate. The results obtained did not differ significantly from those obtained in a control group of similar size. It is concluded that the radioimmunoassay procedure for measurement of prostatic acid phosphatase has no advantage over enzyme activity measurements for the detection of early prostatic carcinoma.

The value of cystourethroscopy in the investigation of microscopic haematuria in adult males under 40 years. A prospective study of 100 patients.

Microscopic haematuria is a common finding in young men. Controversy exists as to its significance and how it is best investigated. A prospective study of 100 young men under the age of 40 with microscopic haematuria has been performed. A positive diagnosis was made in 32 patients. Cystourethroscopy was of diagnostic value in only 3 patients and of therapeutic value in a further 3. It was concluded that cystourethroscopy is of minimal diagnostic value in young men with microscopic haematuria. Its routine use is unnecessary and should be reserved for those patients in whom investigation suggests that a treatable cause may be found in the lower urinary tract.