PHAEOCHROMOCYTOMA IN QUEENSLAND—1970–83

A statewide survey was conducted in Queensland to record all cases of phaeochromocytoma between the years of 1970 and 1983 inclusive. There were 46 cases giving an incidence of 1.55/million population per year. Twenty-nine patients (63%) were successfully treated while 10 patients (22%) died of the tumour effects. Seven cases (15%) were found incidentally at autopsy, though at least one showed diagnostic clinical features before death. Five patients (11%) had extra adrenal phaeochromocytoma, five patients (11%) had multiple tumours, four patients (9%) had multiple endocrine neoplasia and three patients (7%) had clinically malignant tumours. Of 13 patients suffering a major adrenergic crisis only six survived. Five patients with unsuspected phaeochromocytoma suffered crisis under anaesthesia and only one survived. Only one of the patients dying of benign phaeochromocytoma had adequate ante mortem adrenergic blockade. Of all patients in the series 35% were not diagnosed in life.     

Aortic Trauma in Scotland – A Population Based Study

OBJECTIVES: This population-based study aims to determine the incidence, mechanisms and outcomes of aortic trauma in patients from Scotland between 1992-2002. METHODS: Patients with aortic trauma were identified from the Scottish Trauma Audit Group database. Demographics, mechanism of injury, initial management and outcome were analysed. RESULTS: 165 (0.3%) patients suffered trauma to the thoracic or abdominal aorta. Of these, 130 (79%) patients had an injury of the thoracic aorta, 33 (20%) an injury of the abdominal aorta and two (1%) had injuries of both. There were 123 (75%) men and 42 (25%) women with a median (range) age of 36 (14-90) years. Blunt trauma was responsible for 121 (73%) injuries, of which road traffic accidents were the most common mechanism. A further 44 (27%) aortic injuries were due to penetrating trauma, of which assault was the most common cause. The median (range) Injury Severity Score was 43 (16-75). Ninety (55%) patients died in the emergency department while 59 (32%) underwent attempted operative repair. The operative mortality was 35 (59%) of 59 patients and overall mortality 141 (86%) of 165 patients. CONCLUSIONS: The incidence of aortic trauma presenting to Scottish hospitals is low. The majority of patients do not survive to surgical repair and operative and overall mortality remain prohibitive.     

Trends in hospital admissions and surgical procedures for acquired toe deformities in the West Midlands, England 1988–1997

Background: Acquired toe deformities are relatively common, but there is a relative paucity of epidemiological information. The objective of this study was to describe the epidemiology of hospital admissions for acquired toe deformities. Method: Analysis of National Health Service hospital admissions in the West Midlands (UK) between 1988 and 1997, with a diagnosis of acquired toe deformities. Results: Surgical procedure rates increased over the 1988–1997 study period, there was an increased life-chance of having a surgical procedure (particularly in men) and a falling length of stay. Four-fifths of admissions were in women, and over half were for hallux valgus. The most common surgical procedure for hallux valgus in those under 55 years was osteotomy of the first metatarsal. Keller arthroplasty was most frequent among older people. The most common surgical procedures for hallux rigidus were Keller arthroplasty and fusion. Conclusion: The number of surgical procedures for acquired toe deformities in the NHS in the West Midlands has increased. This is largely because of a 50% rise in the rate of 1st metatarsal osteotomies. The modal length of hospital stay changed from 4 days in 1988–1989 to 1 day in 1996–1997. The economic impact on the NHS is complex.     

CANCER OF THE PANCREAS IN NEW ZEALAND 1970–19741

There were 991 new cases of cancer of the exocrine pancreas in the New Zealand population for the five years 1970-74. The disease had a higher incidence in men than women and in Maoris compared to Europeans. There was no increase in incidence in the period 1950-52 to 1971 -73. Most of the cancers occurred in the head of the pancreas and were described as adenocarcinomas. Seventy seven per cent of the patients had lymph node metastases or advanced disease at the time of diagnosis. Only 7 per cent were able to have resectional surgery and in 90% specific therapy was not given. The estimated crude three-year survival rate of all patients was four per cent and the median survival time was 1.7 months. The crude three year survival rate after resection was 9.8% and the median survival time was 5.8 months. The most important variables affecting survival were stage of disease and age of patient.     

Trends in colon cancer surgery in Ontario: 2002–2009

Aim The safety and efficacy of laparoscopic surgery for colon cancer is well established but its uptake in the province has not been previously explored. We report an investigation of the trends of open and laparoscopic surgery for colon cancer in Ontario, Canada. Method A retrospective cross‐sectional time‐series analysis examining population‐based rates of elective surgery for colon cancer among 10.5 million adults in Ontario was conducted from 1 April 2002 to 31 March 2009. Databases were linked to assess quarterly elective procedure rates over time. Results During the study period, 3950 laparoscopic and 13 048 open elective colon cancer operations were performed in Ontario. The overall quarterly rate of colon cancer surgery remained stable at an average of 5.8 per 100 000 population (P = 0.10). From the first and last quarter, the rate of laparoscopic operations increased nearly threefold from 0.8 to 2.2 per 100 000 population with a notable increase after 2005 (P < 0.01). In contrast, open surgery decreased by more than 30% from 5.3 to 3.5 per 100 000 population (P < 0.01). If current trends continue, the projected proportion of laparoscopic colon operations is estimated to reach 41% by 2015. Patients receiving open surgery had a significantly higher preoperative comorbidity (Charlson comorbidity score ≥ 3) than those having laparoscopy (47.8%vs 39.1%, standardized difference 0.26). Conclusion Trends in Ontario of laparoscopic colon cancer surgery show an increase between 2002 and 2009, but the incidence remains lower than for open surgery.     

Paediatric brain tumour,a 10‐year local experience (1992–2001)

Objective: To report our local experience on incidence and outcomes of different paediatric brain tumour. Methods: A detailed data search was carried out from our operative records and histopathology database. A total of 48 paediatric patients bearing 49 brain tumours (one patient had two tumours) within the period between 1992 and 2001 was retrieved. The discharge summary, out‐patient follow‐up record was examined for each patient. The data was grouped according to different pathology type. Results: The results were mainly concentrating over several selected pathologies: (i) low‐grade glioma; (ii) high‐grade glioma; (iii) germ cell tumour; (iv) medulloblastoma; and (v) craniopharyngioma. Conclusions: The most prevalent pathology in our experience is low‐grade astrocytoma, followed by germ cell cell tumour and medulloblatoma. The highest mortality rate is high‐grade glioma.      

CANCER OF THE STOMACH IN NEW ZEALAND: 1970–74 1

A total of 1,891 new cases of cancer of the stomach occurred in New Zealand (1971 population 2,862,631) in the five years 1970–74. There was a higher incidence in men than women and in Maoris compared to Europeans. The disease had declined in Incidence by about 50% in 20 years. Most of the cancers occurred in the distal stomach and were described as adenocarcinomas. Seventy percent of the patients had a lymph node metastases or advanced disease at the time of diagnosis. Only 39% were able to have resectional surgery and in 57% speciic therapy was not given. The estimated crude five year survival rate of all patients was 7.8% (relative rate 10.2%) and the crude five year survival rate after resectional surgery was 18.7% (relative rate 24.7%). The most important variables affecting survival were the stage of the disease and the age of the patient.     

DIVERTICULAR DISEASE: A RETROSPECTIVE STUDY OF SURGICAL MANAGEMENT 1970–1980 1

At Concord Hospital during the period 1970–1980, there were 2,530 admissions for diverticular disease. One hundred and twenty nine patients required operative treatment, 80 patients had a ‘planned’ resection and of the 56 patients admitted with peritonitis, 49 came to operation. The hospital mortality following resection was 7.5% and following operation for peritonitis was 14%. The morbidity after planned resection was 36% and after operation for peritonitis was 51%. Measures adopted to improve these results are discussed.     

MELANOMA IN NEW SOUTH WALES 1970–76: SURGICAL THERAPY AND SURVIVAL

From a survey of melanoma cases in New South Wales, a random sample was selected for histopathological review and follow up concerning surgical therapy and survival. It was found that the principal factors influencing survival were tumour thickness, level of mitotic activity and the age of the patient. The form of treatment in many cases bore little relationship to the severity of the tumour, as determined by its thickness, or to survival. It is hypothesised that survival rates would be higher and unnecessarily extensive surgery avoided if treatment were chosen with greater regard to established prognostic indicators.