Talc serodesis--report of four cases.

Talc is a known stimulator of fibrosis in biological systems. We present four cases in which instillation of talc in to serous cavities have produced obliteration of these cavities. No side-effects were noted.

A pulsatile gluteal mass due to sciatic artery aneurysm.

A persistent sciatic artery is a rare congenital anomaly where the internal iliac artery and the original axial artery of the embryo continue to provide the major blood supply to the lower limb after birth. Its predisposition to atherosclerosis, aneurysmal degeneration of its gluteal segment and association with other congenital anomalies are important for its management. We report a patient who highlights these aspects and we provide a brief review of this unusual condition.

Laser Doppler velocimetry and platelet-derived growth factor as prognostic indicators for the healing of ulcers and ischaemic lesions of the lower limb.

The prognostic potential of skin blood flow measured by laser Doppler and serum platelet-derived growth factor (PDGF) levels was evaluated in patients with ischaemic lesions or ulceration of the lower limb. The laser Doppler-derived skin blood flow and perfusion pressure were measured in 93 patients with ischaemic lesions or ulceration in 98 lower limbs. Of these lesions, 61% healed spontaneously or with conservative local therapy, while 39% required major surgery. The likelihood for healing was reduced by older age. Comparison of receiver operating curves demonstrated that the optimal sensitivity and specificity were obtained for a combination of skin blood flow and perfusion pressure measured at 44 degrees C rather than at room temperature. If the skin perfusion pressure and blood flow were greater than 15 mmHg and 100 U respectively at 44 degrees C, 91% lesions healed, while if they were less than these values none healed. This provided a sensitivity and specificity of 100% and 83% respectively. The serum PDGF concentration was measured by radioimmunoassay in 48 patients with ischaemic lesions or ulceration of the lower limb, and compared with that in 34 healthy controls and 15 patients who had undergone abdominal surgery 3-5 days previously. The median PDGF level in the control group (83 pmol/l) was significantly less than that in the post-laparotomy group (217 pmol/l). The median PDGF level in the 31 patients whose ulcers healed with conservative therapy (210 pmol/l) was significantly higher compared with that in the 17 patients with unhealed ulcers (70 pmol/l).(ABSTRACT TRUNCATED AT 250 WORDS)

False popliteal aneurysm after femoral embolectomy.

An unusual case with delayed presentation of a false popliteal aneurysm following transfemoral embolectomy is reported. It highlights that arterial embolectomy, despite its well-established merits, may have major complications.

The effect of tecogalan sodium on the development of the collateral circulation after acute arterial occlusion.

The survival of tissues distal to major arterial occlusions is critically dependent on the development of collateral blood vessels. The biochemical events fundamental to their evolution remain undefined. To determine the role of endogenous basic fibroblast growth factor in the development of the collateral circulation we evaluated the dose response to Tecogalan Sodium (DS-4152) in a rat model of hind limb ischaemia. Treatment with DS-4152 inhibited the recovery following acute arterial occlusion and impaired limb viability. The inhibitory effects were more pronounced in the calf than in the adductor muscles and tended to be more marked in the groups treated with the higher dose regimens. The results provide further evidence that collateral development and tissue recovery following acute arterial occlusion are dependent on endogenous basic fibroblast growth factor and that this dependence is greater in the more ischaemic, distal tissues.

The validity of Doppler-derived spectral analysis in the presence of multiple stenoses.

It has been suggested that mathematical analysis of ultrasonic Doppler spectral waveforms allows non-invasive quantification of arterial stenoses proximal to the Doppler probe. Less emphasis has been placed on the influence of distal stenoses or distance to the ultrasonic probe. A bench-top electromechanical model with multiple stenoses was constructed to evaluate the effects on spectral waveforms of variations in the severity of proximal and distal stenosis, length of stenoses, distance between stenoses, and distance between ultrasonic probe and stenoses. The following analytic indices, descriptive of spectral waveforms, were evaluated: pulsatility index, spectral broadening index, Laplace damping factor, mode frequency, mean frequency, arithmetic mean frequency, maximum envelope frequency and minimum envelope frequency. All these indices, except the mode frequency, were influenced by the degree of distal as well as proximal stenosis. They were also affected by the distance between the Doppler probe and the upstream and downstream stenoses. The length of stenoses did not influence the flow waveform. Of the model variables, the distal stenosis had the greatest influence on the calculated indices. However, none of the analytic techniques could detect a stenosis smaller than a 70% reduction in cross-sectional area. It was concluded that Doppler-derived spectral waveforms between sequential stenoses are inevitably influenced by events other than the degree of proximal stenosis alone. Therefore, ultrasonic spectral waveforms obtained at a single point of the arterial tree in patients with multi-segment arterial disease should be interpreted with caution.

The development and enhancement of the collateral circulation in an animal model of lower limb ischaemia.

In an animal model of hind limb ischemia we documented the levels of endogenous basic fibroblast growth factor (bFGF) in control and ischaemic hind limbs, and evaluated the response to the administration of exogenous recombinant bFGF and heparin. Variations in this model were tested for their ability to alter the development of the collateral circulation. Recovery after acute arterial occlusion was significantly delayed by immediate bilateral mirror-image arterial ligations, when compared with either unilateral arterial ligation or delayed contralateral ligations performed after 2 months. If the major veins were also occluded all limbs developed gangrene, tissue loss and a marked delay in the recovery of blood flow, while none of the animals with unilateral arterial ligations developed gangrene. This indicates that the recovery in blood flow during the acute phase in this model is dependent on collateral vessels from the contralateral iliac artery and that major venous occlusion impedes the development of collateral vessels. Lumbar sympathectomy did not alter the recovery of blood flow after arterial occlusion, suggesting that collateral blood flow is not significantly influenced by autonomic neural supply. Following arterial occlusion there was a ten-fold increase in the levels of endogenous bFGF in all ischaemic muscle groups. Intramuscular implantation of bFGF in heparin-sepharose pellets at the time of arterial ligation markedly enhanced the blood flow for 3 weeks compared with untreated ischaemic limbs. A further increment in blood flow occurred if an additional dose of bFGF was administered 4 weeks after ligation.(ABSTRACT TRUNCATED AT 250 WORDS)

The role of PDGF-BB on the development of the collateral circulation after acute arterial occlusion.

The survival of tissues in the presence of arterial occlusion is critically dependent on the development of collateral blood vessels. Identification of the biochemical mediators and their mechanism of action is fundamental to an understanding of the evolution of the collateral circulation. The ability of PDGF-BB to promote this was evaluated in an animal model of hind limb ischaemia. In order to obtain significant quantities of this mitogen for use in our animal model, human recombinant PDGF-BB was expressed in a Chinese Hamster Ovary (CHO) cell line. The transfected CHO cells produced 544 micrograms/l of PDGF-BB in serum free medium (SFM). The 30 kDa form of PDGF-BB was purified to homogeneity as judged by silver staining and amino-acid sequencing. Purified PDGF-BB was shown to be bioactive by a cell proliferation assay. The exogenous administration of PDGF-BB enhanced the recovery of blood flow after acute arterial occlusion. The results suggest that PDGF-BB may have therapeutic value in promoting collateral development following arterial occlusion.

bFGF enhances the development of the collateral circulation after acute arterial occlusion.

An adequate collateral circulation is crucial to tissue survival subsequent to proximal major arterial occlusion. The precise mechanism of collateral blood vessel development and the biochemical mediators involved in this process are unknown. To evaluate the influence of a number of agents on the development of the collateral circulation, we developed a rat model of severe hind limb ischaemia. The recovery of blood flow after acute arterial occlusion was increased by exogenous basic fibroblast growth factor and heparin, and decreased by protamine. Erucamide (cis-13-docosenamide), an angiogenic lipid, had no effect on collateral blood flow. These results indicate that basic fibroblast growth factor and heparin are potential therapeutic agents in the treatment of peripheral vascular disease.

The conservative management of primary breast cancer.

A comparison was made of the methods used to manage primary breast cancer in Western Australia during 1978 and 1984. It was noted that the incidence of breast-conserving surgery increased from 5% in 1978 (16 out of 313 patients) to 14% in 1984 (59 out of 431 patients). Of the 59 patients in the latter group, 37 (63%) did not receive adjuvant radiotherapy. This is a matter of concern as failure to use adjuvant radiotherapy, subsequent to breast-conserving surgery, may lead to an increased incidence of locally recurrent disease.

The profile of breast cancer in Western Australia.

Information concerning all 435 women who presented with primary breast cancer in Western Australia during 1984 was obtained by a review of the WA Cancer Registry, hospital, histopathological laboratory, and medical practitioner records. The age-standardized and cumulative incidence rates were 55.7 per 100,000 women and 6.4%, respectively. The probability that a woman would develop breast cancer during her lifetime (to the age of 74 years) was one in 15.6. There was a significant seasonal variation in the incidence of breast cancer, with a peak in spring (November) and a low in winter (July). The highest incidence rates occurred in women who had never had any children, those of professional status and those who lived in better socioeconomic areas. Stage-I disease accounted for only 22% of all breast cancers. A younger age was associated with a greater proportion of oestrogen-receptor-negative tumours and a longer symptom interval correlated with larger primary tumours. The findings support the concept that the characteristics of Australian women with breast cancer are similar to those that have been described in British and North American women.

Survey of the management of primary breast cancer in Western Australia.

A postal survey of all general surgeons in Western Australia was undertaken in order to document their current attitudes towards the management of primary breast cancer. The commonest surgical procedure preferred for stages I and II breast cancer was a modified radical mastectomy, although a substantial number (31%) of surgeons favour breast conserving procedures for primary tumours less than 2 cm in size. Few (3%) surgeons still perform a classical radical or extended radical mastectomy. There is a wide diversity of practices regarding pre-operative investigations and postoperative management. Although many surgeons (68%) use aspiration cytology to determine the histologic nature of breast lumps, the majority (62%) do not use mammography to monitor the contralateral breast. After breast conserving surgery, 60% of surgeons would not refer their patients for adjuvant radiotherapy and over 33% would not favour the use of adjuvant systemic therapy for women with stage II breast cancer. It is concluded that the wide diversity in the pattern of management reflects uncertainty regarding the best approach to this disease.

Ranitidine in the control of acute upper gastro-intestinal haemorrhage. A prospective randomized trial.

Fifty patients with acute upper gastro-intestinal haemorrhage were given either oral or intravenous ranitidine ( Zantac ; Glaxo), the route of administration being allocated on a random basis. Two patients were excluded from the oral group and 5 were excluded from the intravenous group. The two groups were similar as regards age, sex, number of patients aged over 60 years and severity of bleeding. All the patients were carefully monitored for rebleeding, which occurred in a total of 7 cases (16,3%), 6 in the oral group (26%) and 1 in the intravenous group (5%). Statistically this represented a marked tendency towards a significantly lower incidence of recurrent haemorrhage in the patients treated with intravenous ranitidine (P = 0,07, tested according to Fisher's exact method). No patient in the intravenous group who bled again came to surgery, while 3 of the 23 patients in the oral group (13%) required surgery.