Abstract

The principle of regional perfusion using cytostatic drugs resulted from a study by Klopp et al. who found that pain was alleviated and tumor size reduced when small doses of nitrogen mustard were injected into the regional arterial blood flow. The best results were obtained when venous return from the area involved was blocked. In 1956, the meeting of a cardiothoracic surgeon, a plastic surgeon and an oncological surgeon in the Department of Surgery at Tulane University, New Orleans, Louisiana, resulted in the introduction of a new concept in the treatment of regionally re current malignant disease. It was postulated that if an area of the body could be isolated from the systemic circulation and sustained by an extracorporeal circuit utilizing a heart lung machine, it would be possible to produce a high concentration of a chemotherapeutic agent in the isolated perfusion circuit limited only by the toxicity to the sensitive structures within that area. At the end of the perfusion, the unbound drug could be removed, the circulation restored and any excisional surgery carried out as necessary. The patient would benefit by a maximal tumor chemotherapeutic exposure in the treated area while being protected from systemic toxicity. Ryan et al.? developed techniques in the laboratory for isolation perfusion of the hind limb, mid gut, and liver of a dog. It was found that the dosage of nitrogen mustard tolerated in the hind limb was the equivalent of a single whole body systemic dose.

Abstract

The discovery of modern techniques of breast reconstruction paralleled two major advancements in plastic and reconstructive surgery. The first was the identification of areas of cutaneous perfusion through underlying muscles, and the recognition that entire muscles could be rotated into new positions on a vascular pedicle of one dominant artery and vein. The use of the latissimus dorsi musculocutaneous flap and a silicone breast implant to simulate the breast mound was the first truly elegant solution to a problem that had perplexed reconstructive surgeons for centuries. The second discovery was the Radovan tissue expander. The placement of the tissue expander underneath the chest wall muscles and its gradual expansion with stretching of the overlying tissues also provided a theoretically simple technique for breast mound reconstruction.

Abstract

Laparoscopic herniorrhaphy has been gaining popularity along with other minimally invasive surgical techniques. With the sophistication of instruments, evaluation of techniques and longer follow-up of patients, the outcome of such repair s is changing. Many authors are reporting a variety of techniques, complications, and results compared to conventionalsurgery.

Abstract

Right-sided sliding inguinal hernias usually involve the cecum and occasionally the ascending colon. Colocutaneous fistulas secondary to diverticular disease are rare and usually present with a short tract to the anterior abdominal wall. The authors describe a case of colocutaneous fistula secondary to diverticular disease in an inguinal hernia and review fistula formation after diverticular disease.