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Biomedical subjects

D C Glenn

Publications and source records attributed to D C Glenn.

5 recordsLinked to original sources

Gracilis myocutaneous flap to reconstruct large perineal defects.

Large perineal defects can occur after surgery for recurrent malignancy particularly after adjuvant radiotherapy or in complex chronic perineal inflammatory conditions. Quality of life can be severely impaired by perineal wounds or chronic sinuses. Muscle and myocutaneous flaps can be used to close large defects, increase vascular supply to poorly healing wounds, and provide bulk for sitting. We report 5 cases where the gracilis flap was used to repair large perineal defects. The defects were created after wide perineal excision for recurrent tumours associated with radiation damaged skin (2 cases) and after excision of chronic sinuses complicating the perineal wounds after abdominoperineal excision of the anus for inflammatory bowel disease (3 cases).

Adult

Surgical management of breast cancer. Experience of the Central Sydney Area Health Service Breast X-ray Programme, 1988-1991.

OBJECTIVE: To review the breast cancers detected in the first three years of the Central Sydney Area Health Service Breast X-ray Programme, their histopathology and their surgical management within the program. DESIGN: Between March 1988 and March 1991, women screened in the program who had a suspicious lesion were referred for surgical assessment at the program assessment centre at Rachel Forster Hospital. These women were seen by staff of the assessment centre, including program surgeons, and were then treated at either Rachel Forster Hospital or Royal Prince Alfred Hospital. Features examined include cancer detection, clinical findings, diagnostic techniques, histopathological diagnosis of the lesions and surgical management. RESULTS: One hundred and eight cancers were detected in 105 women, with 59% of the cancers impalpable. The benign to malignant ratio was 1.0:1.5. Twenty-four cancers (22%) were ductal carcinoma-in-situ with or without microinvasion, and 84 (78%) were frankly invasive. Of the 86 axillary dissections, 63 (73%) showed no node involvement on histological examination. At the time of diagnosis, 27% of the women had axillary node involvement proven by axillary dissection. The overall mastectomy rate was 58%. Radiotherapy, chemotherapy and tamoxifen were used in both stage I and stage II disease. CONCLUSION: The surgical management of cancers reflects similar findings reported in other screening programs. There is an increasing trend towards breast conservation surgery and up to 90% of the women in this study present with favourable prognostic factors for long term survival.

Adult

Mesenteric cyst.

Mesenteric cyst is one of the rarest abdominal tumours, with approximately 820 cases reported since 1507. The incidence varies from 1 per 100,000 to 250,000 admissions. The lack of characteristic clinical features and radiological signs may present great diagnostic difficulties. The cyst may present in one of three ways: (i) non-specific abdominal features; (ii) an incidental finding; or (iii) an acute abdomen. Abdominal pain is the major presenting symptom. Abdominal mass is found in more than 50% of cases and 40% of cases are discovered incidentally. More than one aetiological mechanism is probably involved in the development of mesenteric cysts. Mesenteric cysts have been reported from the duodenum to the rectal mesentery but are most commonly located in the ileal mesentery. Malignant cysts occur in less than 3% of cases. Enucleation of the cyst is the treatment of choice. Knowledge of these tumours is important due to the various complications associated with suboptimal surgical management. Two cases of mesenteric cysts are presented including a recurrent mesenteric cyst in a post-partum woman demonstrating the inferior technique of internal marsupialization. The association of mesenteric cyst with pregnancy is discussed.

Abdomen, Acute

Spontaneous perforation of the common bile duct: report of a case.

A case is reported of spontaneous perforation of the common bile duct in a 59-year-old woman. Recurrent episodes of epigastric and right hypochondriac pain over one year culminated in the onset of obstructive jaundice. There were not signs of peritonitis, and laparotomy revealed an abscess surrounding a perforation in the common bile duct just distal to the cystic duct. A cholesterol gallstone was present at the site of perforation. A paracolon bacterium, providence alcalifaciens, was isolated from the abscess. The patient made an uncomplicated recovery after cholecystectomy and drainage of the bile duct.

Abscess