Biomedical subjects
Publications and source records attributed to V C Lees.
Traditional teaching suggests that a transverse colostomy should be sited in the right upper quadrant. This study of 67 colostomies (26 right upper quadrant and 41 right iliac fossa) indicates that they should be placed in the optimum position for each patient, which is usually the right iliac fossa.
A retrospective review of the early complications of primary cleft lip and palate surgery in one Plastic Surgery Unit was conducted and the results are presented. Out of 164 primary procedures performed there was an overall complication rate of 26.2%. The life-threatening complications were all related to the respiratory system and all but one of these occurred within 2 days of operation.
An example is reported of a burn caused by cutaneous exposure to 3,5-dichloro 2,4,6-trifluoropyridine (DCTFP) involving 25 per cent of the body surface. A striking feature was the development of the appearance of the burn over the first 72h postinjury. Healing was nevertheless spontaneous. The management of the injury is discussed.
After treatment for primary clinical Stage 1 invasive cutaneous malignant melanoma, 1086 patients were followed for a minimum of 5 years from initial operation. Patient data were retrieved from the unit's melanoma registry; 96 (8.8 per cent) were treated initially by incisional biopsy, 292 (26.9 per cent) by narrow margin excision biopsy and 698 (64.3 per cent) by wide margin excision. Logistic regression analysis was performed to assess the statistical significance of the association between the various factors. The method of initial biopsy was related to maximal tumour thickness, age, and sex. Incisional biopsy rendered 38 out of 96 (40 per cent) lesions not fully assessable on current histopathological criteria, significantly higher than for the other biopsy techniques (P less than 0.0001). Incisional biopsy did not adversely affect prognosis in terms of local recurrence and mortality. Prognosis was related to tumour thickness, age and sex of the patient, and not to biopsy technique. We recommend that all suspicious lesions should be submitted to excisional rather than incisional biopsy to avoid compromising the histological assessment, given the importance of maximal tumour thickness in determining treatment and prognosis.
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