25, 50 and 75 years ago

Lam KH. The role of neck dissection in head and neck mucosal squamous cancer. ANZ J. Surg. 1999;69:865–870. The most clinically useful system of classification of neck lymph nodes is grouping into levels I–V (Fig. 1). Anatomical, clinical and pathological studies demonstrate that although generally lymphatic flow is from above downwards, level I is often bypassed and level V is seldom involved. Neck dissection is classified into radical, modified radical, selective and extended radical neck dissections. Recent studies demonstrate that elective neck dissection is beneficial to the outcome of oral cancer patients, but not necessarily to laryngeal and pharyngeal cancer patients. Modified radical neck dissection is as effective as radical neck dissection when performed in the elective situation. Selective neck dissection in the form of supra-omohyoid neck dissection is useful as a staging procedure. Modified radical neck dissection is acceptable for the N1 neck provided postoperative radiotherapy is given. Lam YH, Chan A, Lau J, Lee D, Ng E, Wong S, Chung S. Self-expandable metal stents for malignant dysphagia. ANZ J. Surg. 1999;69:668–671. The use of self-expandable metal stents in relieving dysphagia for patients with incurable malignant oesophageal strictures was retrospectively evaluated. Between September 1993 and August 1996, 66 male and 16 female patients with a median age of 72 years received self- expandable metal stents for malignant dysphagia. Six patients had concurrent trachea-oesophageal fistulas. All patients were stented under sedation and stent insertion was performed under fluoroscopic guidance. Stent placement was successful in 80 patients (98%). There were seven early complications (inaccurate positioning (n = 3), migration (n = 1), incomplete expansion (n = 1), intractable pain (n = 1), and perforation (n = 1)). Two complications were lethal and three were treated endoscopically. Mean dysphagia grade improved from 3.2 ± 0.7 to 1.8 ± 0.9 (P < 0.05) after implantation. All tracheo-oesophageal fistulas were successfully occluded. Upon a median follow-up of 8 weeks (range: 2–20 weeks), 30 complications developed in 21 patients [tumour overgrowth (n = 15), food bolus obstruction (n = 7), tumour ingrowth (n = 2), buckling of stent (n = 2), tracheo-oesophageal fistula (n = 2), bleeding (n = 1), and gastric wall herniation through metal coils (n = 1)]. Median survival was 13 weeks (range: 1–82 weeks). Self-expandable metal stents provide useful palliation in patients with incurable malignant dysphagia. Isbister WH, Campbell CB. Colonoscopy: experience with the first 100 examinations at the Royal Brisbane Hospital. ANZ J. Surg. 1974;44:89–95. The first 100 colonoscopies performed at the Royal Brisbane Hospital are reviewed. The indications for the examinations and the findings both on endoscopy and biopsy are discussed. Colonoscopy provides useful clinical information in more than half of the patients examined. It is of particular value in patients with doubtful radiological appearances, but of less help in elucidating the cause of lower gastrointestinal haemorrhage. Colonoscopy is a useful gastrointestinal investigative technique, which should be established in most teaching hospitals. It should not be regarded as a screening procedure, but should follow complete routine investigation by conventional procedures. Indications include both persistent unexplained clinical features and demonstrated radiological abnormalities. Complications following the procedure are infrequent. The histological features of biopsy specimens must he interpreted with caution and in context with the clinical picture and the endoscopic findings. Ryan P. Emergency resection and anastomosis for perforated sigmoid diverticulitis. ANZ J. Surg. 1974;44:16–20. Wyndham N. On the diagnosis of malignant testicular tumours. ANZ J. Surg. 1949;18:256–263. During the last three and a half years, we have had the opportunity of studying 35 cases of testicular tumour. Such a wealth of clinical material has been made available by the generosity of colleagues, but even more so because, for half that time, many patients were evacuated to a large military base hospital here the writer was a member of the staff. At first sight, it might appear that tumours of the testicle were very common. This is not so, but they occur with sufficient frequency for it to behove everyone to be able to diagnose them with certainty. Although only 50 patients with testicular tumours were treated at the Royal Prince Alfred Hospital, Sydney, in 30 years, American authorities have found that these tumours form 0.58% of all malignant neoplasms in males. Dean places the incidence as high as 2.09%. This paper deals in greatest detail with those features which are not usually considered characteristic. A heavy, rather insensitive, smoothly lobulated, testicular swelling occurring in a man between the ages of 20 and 40 years is almost certain to be a seminoma or teratoma. If there are no signs of inflammation, if the Wassermann test gives no reaction and if the Aschheim-Zondek test gives a positive result, then the diagnosis is indeed easy. I want to point out that all these diagnostic criteria may lead to error at some time or another. Further, so urgent is orchidectomy in the case of teratomata that it is sheer folly to await the effect of irradiation in the hope that the condition is a seminoma.