Notable names in the history of surgery: 2. William Arbuthnot Lane (1856–1943)

Surgery today owes much to the services of early practitioners who made their advances as a result of wide clinical experience and compassion. This two‐part series explores the careers of Percivall Pott and William Arbuthnot Lane. Sir William Arbuthnot Lane was the most brilliant technical surgeon in Britain during the first half of the 20th century. He was one of the many famous physicians and surgeons to train at Guy's Hospital in London since its founding in 1724. Although some of his ideas may be controversial, he had made many original contributions and innovations in a variety of surgical techniques. He introduced mastoid drainage in purulent otitis media with specially designed chisels and gouges; resection of the cervical oesophagus for cancer and reconstruction by skin graft; and the repair of cleft lip and palate in neonates. His greatest contribution must be the introduction of the ‘no‐touch technique’ in open reduction and plating of long bone fractures by Lane's steel plates. In later life, Lane became obsessed with the role of regular bowel motion in health. To combat various real or imagined ailments, he first short‐circuited and later resected the whole large intestine. When surgery failed to resolve the problem, Lane advised regularly taking paraffin oil for the relief of constipation. He was a firm believer as well as a pioneer in alternative or homeopathic medicine. Lane's concept of chronic intestinal stasis is a classic case of a flawless surgical technique subservient to a faulty hypothesis.      

Prophylactic cranial irradiation revisited: cost-effectiveness and quality of life in small-cell lung cancer.

PURPOSE: To investigate the therapeutic usefulness and cost-effectiveness of prophylactic cranial irradiation (PCI) in patients with limited-stage small-cell lung cancer (SCLC) who had achieved a complete remission. METHODS: A retrospective chart review was undertaken of all patients diagnosed in Saskatchewan with SCLC between 1987 and 1998 inclusive. Patients who achieved a complete remission were divided into two groups, depending on whether they underwent PCI (PCI+ and PCI-, respectively). The quality-of-life-adjusted survival was estimated by the Q-TWiST method (quality time without symptoms and toxicity). The mean incremental costs per month of incremental OS were calculated in a cost-effectiveness analysis. RESULTS: Among the 98 complete remission patients, the median OS for PCI+ and PCI- patients was 20.0 and 19.0 months, respectively (p > 0.05, nonsignificant). The median disease-free survival was 14.7 and 10.0 months, respectively (p < 0.05). The difference in the mean Q-TWiST survival was significant (p < 0.01). The mean marginal cost was $18,834/PCI+ patient and $17,885/PCI- patient (p > 0.05, nonsignificant). The cost-effectiveness ratio was $70/mo of incremental OS if u(tox) and u(rel) (the utility coefficients to reflect the value of time in health states of toxicity and relapse) were assumed to be 1.0. CONCLUSION: PCI is a cost-effective treatment that improves the quality-of-life-adjusted survival for patients with a complete remission of SCLC.     

Polymorphic locus in the 5'-flanking region of human insulin gene and non-insulin-dependent diabetes mellitus

The etiology of non-insulin-dependent diabetes mellitus (NIDDM) is still unclear, but appears to involve some genetic factors. There have been disputes over the association between DNA sequences flanking the insulin gene and NIDDM. In order to characterize insulin gene polymorphism in the Chinese population and elucidate its association with NIDDM, 100 unrelated Chinese subjects living in Taiwan were observed for polymorphism of this hypervariable region. Most of them were descendants of immigrants from the southern part of mainland China. Among them, 52 were nondiabetic controls, and 48 were subjects with NIDDM. Insulin gene polymorphism was classified into classes 1, 2 and 3 alleles according to Bell et al. Neither the class 2 allele nor the genotype for the homozygous class 3 allele was not observed in this study. The allelic frequencies of class 1 and 3 genes were 97% and 3% in the nondiabetic subjects, and 99% and 1% in the NIDDM group, respectively. The frequencies of genotypes 1/1 and 1/3 were 94% and 6% in nondiabetics and 98% and 2% in the NIDDM group, respectively. No significant association was found between insulin gene polymorphism and NIDDM. It is concluded that DNA marker flanking the insulin gene may not be associated with the development of NIDDM in Chinese subjects.     

Y Chromosome Specific DNA Probe in the Diagnosis of a Patient with mos 45, X/46, XYnf

In a patient with mos 45,X/46,XYnf, the diagnosis was confirmed with a Y chromosome-specific DNA probe, Y-190. The patient was a phenotypic female without Turner syndrome stigmata other than short stature. She showed some evidence of virilization and high serum testosterone. Her peripheral blood karyotype was mos 45,X/46X, +mar. Although this marker chromosome resembled a Y chromosome, there was no quinacrine bright region on its long arm. Southern blot analysis of her peripheral blood mononuclear cell DNA with Y-190 as a probe showed strong hybridization with this probe. Gonadectomy was performed, and bilateral gonadoblastomas were found.     

Congenital bile duct dilatation: review of 35 cases

Thirty-five patients with congenital bile duct dilatation or choledochal cyst were seen in the General Hospital, Kuala Lumpur, during a 10-year period from 1981 to 1990. The highest incidence occured in the group less than 1 year of age. Jaundice was the commonest symptom, occuring in 69% of patients. In most it was mild and intermittent, but a small group (29%) had persistent jaundice and acholic stools. These patients were all less than 1 year of age and represented a poor-prognosis group (30% mortality). Ultrasonography was the most useful diagnostic procedure, having an accuracy of 94%.The treatment of choice was total excision of the cyst and Roux-en-Y hepaticojejunostomy. Internal drainage procedures are not recommended because of the high incidence of cholangitis and the potential for malignancy occuring in the remnant cyst later in life. Operative mortality and morbidity were uncommon, and a good prognosis can be expected on long-term follow-up. Correspondence to: H. K. Goon     

Severe congenital absence of skin in a preterm infant

A severe case of aplasia cutis congenita in a preterm infant is described. Although major problems with thermoregulation and fluid balance were anticipated, these parameters were relatively easy to control once the patient was stabilized. Meticulous skin care and rapid formation of a membranous-like fibrous tissue layer covering the denuded areas probably played an important role in minimizing excessive fluid and heat loss. The prognosis in aplasia cutis congenita is determined by the underlying associated anomalies, the severity of skin lesions and, in our case, the maturity of the infant who died from complications of prematurity.     

Effects of camphorated parachlorophenol on human periodontal ligament cells in vitro

To date, there has been very little research into the possible effects of endodontic therapy on regeneration of a lost periodontal attachment. The objective of this study was to examine the effects of the endodontic medication, camphorated parachlorophenol (CMCP), on human periodontal ligament cells in vitro. The cytotoxic effects of CMCP were evaluated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide colorimetric assay and cell proliferation using a [3H]thymidine incorporation assay. CMCP inhibited the human periodontal ligament cells viability and proliferation in a dose-dependent manner (p < 0.05). These data indicate that the use of CMCP in a root canal could cause periodontium damage. Although this study was conducted in vitro, the findings suggest that it may not be advisable to use CMCP as an interim medication when a periodontal surgical procedure, especially an attempt at regeneration or a new attachment procedure, is being considered in tissues adjacent to the endodontically involved tooth.