Parastomal hernia in relation to site of the abdominal stoma

Parastomal hernia is a common late complication of enterostomy, especially colostomy, and sometimes requires surgical treatment. A possible contributory factor, location of the stoma in relation to the rectus abdominis muscle, was studied by examination of 130 patients with permanent intestinal stoma. The bowel had been brought out through the rectus abdominis muscle in 107 patients and lateral to it in 23 patients. The respective prevalence of parastomal hernia in these groups was 2.8 per cent and 21.6 per cent. The highly significant difference indicates that enterostomy should be constructed through the rectus abdominis muscle, not lateral to it.     

Treatment of stomach cancer, a national experience

A total of 1165 patients with stomach cancer were entered into a prospective, observational national study. They represented 54 per cent of all stomach cancer patients reported to the Cancer Registry in Norway during the study period, and data are analysed for three hospital levels (local, county and university hospitals). The median age was 71 years (range 18-96 years). The median pretreatment delay was 113 days, and 46 per cent of patients had a performance status (Karnofsky index) of less than or equal to 80. The diagnosis was confirmed by pre-operative histology in 88 per cent of cases. In all, 88 per cent of patients underwent surgery, the resectability rate was 67 per cent and 50 per cent had a potential curative operation. Total gastrectomy was most commonly performed. Lymph node dissection was performed in 14 per cent of those undergoing a curative resection. The postoperative complication rate was 27 per cent but varied with the type of operation, being highest in proximal resection (55 per cent) and lowest after distal resection (19 per cent). A total of 7 per cent of the patients died postoperatively. Most patients had advanced disease at the time of treatment and only 6 per cent had stage I tumours. There were significant differences in patient and treatment characteristics between the three hospital levels. In conclusion, patient selection bias which will influence results does occur. A fairly aggressive attitude towards local disease was found, but the low proportion of patients undergoing lymph node dissection not only leads to questions regarding the efficacy of this treatment policy, but also casts doubt on the validity of staging of stomach cancer. Morbidity and mortality rates are still high. The consequences of the differences revealed between hospital groups are difficult to interpret. Proponents of both regionalization of treatment and small hospital care may find arguments for their case in the data.     

Technic of fine needle aspiration cytology of the thyroid gland: coagulation inhibiting and stabilizing additives

In the fine needle aspiration cytology of the thyroid gland by the moistening of cannule and syringe with heparin or citric sodium rather disadvantages for the evaluation are the result. Artificial changes are most clearly to be seen in heparin. ACD-buffer does indeed not bring about any artefacts, does, however, also not show any provable advantages. In the fine needle biopsy the additives mentioned are entirely avoidable.     

Quality of life after cystectomy. Comparison between patients with conduit and those with continent caecal reservoir urinary diversion

A questionnaire survey was carried out to assess the quality of life of 60 patients who had undergone cystectomy because of bladder carcinoma. Urinary diversion was by a continent caecal reservoir in 20 patients and by a conduit in 40. The patients' replies showed that cystectomy could cause severe problems in all aspects of life. Diversion with a continent caecal reservoir was associated with fewer stoma-related problems and seemed to allow the patients greater freedom to continue activities such as sport, travel and social life. Sexual problems, disturbed relationships with partners and emotional and mental problems were common and did not differ between the two groups of patients. It is recommended that patients judged to be prone to mental and emotional disturbance after cystectomy should be identified pre-operatively and given extra psychological support.