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The term "irrigation efficiency" has been used extensively during the past 30 years to express the performance of a complete irrigation system or components of a system. Though specifically defined by its users, on occasion, irrigation efficiency is not rigidly defined and has many interpretations. The term is frequently modified to assure specific interpretation such as "water application efficiency," but consistency in the use of modified terms is also lacking. Before considering techniques for improving irrigation efficiencies, terminology involved and the. factors affecting irrigation efficiency will be discussed.

Severe transfusion-dependent uterine hemorrhage is a relatively uncommon complication of induction chemotherapy for acute myeloid leukemia (AML). Even less common is the failure of systemic conjugated estrogens in this setting. We report a case of life-threatening uterine hemorrhage in a 38-year-old woman in the setting of transfusion-refractory thrombocytopenia after completing induction chemotherapy for AML. She experienced dramatic breakthrough uterine hemorrhage despite multiple platelet transfusions, conjugated estrogens, recombinant factor VIIa, epsilon-aminocaproic acid, and intracavitary thrombin-soaked gauze tamponade. At the point of near-exsanguination in the setting of hypotension, hematocrit of 14%, and a platelet count of 3,000/microL, she underwent bilateral uterine artery embolization which proved immediately successful. We review the literature and indications for this procedure in the oncologic patient care setting.

Background: In a significant percentage of patients, radiologic evaluation other than plain abdominal films are required to confirm or exclude the presence of small bowel obstruction. Methods: Over a 1-year period, 55 patients had both computed tomography and small bowel follow-through studies. Patients were classified as having (1) paralytic ileus, (2) low-grade obstruction, (3) high-grade obstruction, or (4) complete mechanical obstruction. The gold standard for diagnosis was celiotomy in 42 patients and clinical follow-up in 13 patients. Results: Thirty-six out of 42 patients had proven intestinal obstruction at the time of celiotomy. Computed tomography identified 32 out of the 36 high-grade and complete mechanical obstructions. Computed tomography was superior to small bowel follow-through in identifying masses, malignancies, and features of strangulation. Small bowel follow-through correctly identified “insignificant obstructions” when contrast reached the cecum within 4 hours in 18 of 19 patients. Conclusions: In patients with equivocal findings of small bowel obstruction, computed tomography should be used initially and then small bowel follow-through if computed tomography is not diagnostic. Computed tomography was superior in this study for detecting the cause of the intestinal obstruction and presence of strangulation.

A 66-year-old woman came to the emergency room presenting with progressive dyspnoea and orthopnoea of 3 weeks’ duration. She arrived in acute respiratory distress with pulse oximetry oxygen saturation of 75% in room air and blood pressure of 70/50 mm Hg. The left hemithorax had no breath sounds and was dull to percussion. She was immediately intubated for respiratory failure. A chest radiograph taken after intubation showed large pleural eff usion in the left lung and mediastinal shifting (fi gure A)—fi ndings that are consistent with tension hydrothorax. Tension hydrothorax is a rare but life-threatening disorder, which can be the initial presentation of metastatic cancer. Although the disorder has been described in carcinomas of the lung, breast, ovary, and thyroid, patients with primary peritoneal carcinoma usually present with abdominal symptoms and ascites. We did emergent left thoracostomy and removed 1·5 L haemorrhagic fl uid. The patient’s blood pressure immediately increased to 120/82 mm Hg, and a repeat chest radiograph showed the return of mediastinal structures to midline. Pleural-fl uid cytology showed malignant cells with psammoma bodies (fi gure B, magnifi cation ×400). CT of the chest, abdomen, and pelvis showed large ascites and minimum residual pleural eff usion without evidence of a mass lesion. Further examination showed very high serum concentrations of cancer antigen 125 (CA 125) of 83·4 U/mL (normal range 0–35 U/mL). The diff erential diagnosis at this point included metastatic epithelial ovarian cancer or metastatic primary peritoneal carcinoma. The patient was extubated the next day, underwent successful talc pleurodesis, and was discharged on day 7 with follow-up with a medical oncologist. She received carboplatin (area under the curve 5) and 200 mg/m 2 paclitaxel given once every 3 weeks for four cycles and underwent cytoreductive surgery. Overall, the uterus, fallopian tubes, and ovaries were healthy. Histopathological examination showed moderately diff erentiated metastatic adenocarcinoma aff ecting the peritoneum with extensive intralymphatic tumour and many psammoma bodies. The ovarian component of the tumour was confi ned to the surface epithelium with no cortical invasion consistent with primary peritoneal carcinoma. 15 months after initial presentation, the patient remains in stable condition and has a normal concentration of CA 125.

Irrigation water requirements for lawn grasses can be estimated by an empirical formula when adequate climatological data are available. The modified Blaney-Criddle formula can be used for this purpose. This procedure is explained and recommendations are made for the use of the results in accordance with the lawn condition desired. Most lawns can be subjected to drought conditions for short periods; if this is done, the irrigation water requirements can be materially reduced. An analysis of the available research data indicates that when the soil is near wilting point, light frequent irrigations at a rate of approximately one-half the normal consumptive use will maintain an appearance rated from fair to good. On certain types of turf, such a practice is allowable if not prolonged too long and if the turf is given good growing conditions at other times. Under these conditions it is believed that common lawn grasses seldom require irrigation to maintain appearance when the monthly net irrigation requirement is less than one-half the consumptive use computed for maintaining a full supply of moisture.

1. 1. A clinicostudy of twelve cases of malignant soft tissue tumors of the lower extremity and pelvis treated by hemipelvectomy has been presented. 2. 2. It is concluded that hemipelvectomy is an effective and safe operation for the surgical management of soft tissue malignant tumors of the thigh and pelvis. Other than tumor size and position, emphasis is directed to the utilization of the tumor's histologic and biologic behavior as a criterion for selecting patients for hemipelvectomy.

No single modality is appropriate for treatment of the huge invasive basal cell carcinoma. Mohs' chemosurgery is perhaps the most efficacious ablative method, but it must be supplemented by a reconstructive procedure in nearly all sizable lesions. A case history is presented of a patient with massive basal cell carcinoma involving the entire posterior scalp and deep tissues in which chemosurgical ablation and major staged reconstruction proceeded concurrently to a successful conclusion. The advantages of this approach are discussed.

The external auditory canal represents an area of high risk for recurrence of tumors. Therefore, carcinomas involving this region should be removed by Mohs chemosurgery. Healing by granulation can result in stenosis of the canal. We report a method of reconstruction to prevent stenosis of the auditory canal after chemosurgery.

A 59-year-old black woman presented with an ill-defined plaque on her nose. This appeared clinically suggestive of a sclerosing type of basal cell epithelioma (BCE). Microscopic sections demonstrated this diagnosis. Multiple excisions employing the microscopically controlled technique of Mohs traced the tumor deep into the nasal cartilage before histologic sections were free of tumor cells. This type of BCE deserves well planned therapy because of its destructive potential.

B ASAL CELL carcinoma of the scaIp has engaged the attention of surgeons and radiotherapists for many years. Its treatment, however, is beset with many difficulties and IocaI recurrences are commonpIace. Because of the Iatter probIem, we began in June 1960 to treat a seIected group of patients with superficia1 skin cancers by the Mohs’ chemosurgery technic [I]. This method introduced by Mohs into the surgica1 Iiterature in 1941 appeared to us to have certain advantages in the treatment of skin cancer that was not apparent in the more conventiona forms of surgery and radiation, nameIy, (I) the tumor is excised by microscopic contro1, (2) the resuItant wound in most cases is permitted to hea by secondary intention, (3) the procedure is bIoodIess and (4) in many instances the patient is treated on an outpatient basis. Because coIIective experience with Mohs’ technic is Iimited, this report represents our experience with this method of therapy in treating basa1 ceI1 carcinoma of the scaIp.

MALIGNANT smooth-muscle tumors (leiomyosarcomas) of soft-tissue origin are rare tumors, as indicated by the fact that in a review of the recent surgical literature, only one series, comprising 36 cases, has been documented.1 Because of the relative infrequency of this type of tumor the present report, which includes an additional 10 cases, provides further information concerning the clinicopathological features of these tumors. Material During the five years 1955 to 1960, 10 cases of leiomyosarcoma of soft-tissue origin were treated at Roswell Park Memorial Institute, Buffalo, New York. Histologic tissue from each patient was available for study, and the diagnosis of . . .

A case is reported of primary venous obstruction in the upper extremity, the Paget-Schroetter syndrome. The literature of this unusual condition is reviewed and the mechanism of its development and its treatment is discussed.

Soft-tissue tumors of fibrous tissue origin can generally be classified into 3 main groups: ( a ) tumors of fibrous tissue hyperplasia (scars and keloids); ( b ) tumors of fibrous tissue proliferation (plantar fibromatosis and juvenile fibromatosis), and ( c ) fibrosarcoma. It is the purpose of this report to describe our experiences with tumors of the third category, and only those confined to the superficial soft parts of the body. Because of the importance of histologically distinguishing fibrosarcoma as a tumor entity, a brief resume of its microscopical features is presented below. Fifteen years ago, the nomenclature and histological criteria for fibrosarcoma were far from standardized, and it was not uncommon to find such terms as "neurogenic sarcoma" or "spindle-cell sarcoma" describing a supposedly malignant tumor of fibrous tissue origin. In 1948, Stout, 7 in a paper devoted to fibrosarcoma, pointed out the inadequacy of these terms, and cited examples of liposarcomas and rhabdomyosarcomas

Fifty-five children with 83 cutaneous capillary hemangiomas who received no treatment were followed up for periods ranging from 3 to 9 years. Of the 83 lesions, 54 regressed completely; and 24 lesions were still undergoing active regression. Five lesions failed to regress, but remained stationary in size and caused the patients little discomfort. These findings indicate the wisdom of conservative management of the majority of cutaneous capillary hemangiomas in infants and children.

The development of collapsible and non-collapsible synthetic cloth prostheses, suitable for replacing segments of the arterial tree, has led us to investigate their use in conditions that favor angulation and kinking of the graft. We have selected for comparison study ( a ) a collapsible prosthesis, ( b ) a flexible prosthesis, and ( c ) a preserved artery homograft. As this problem of graft angulation has been afforded little emphasis with respect to the selectivity of some of the newer cloth prostheses, this study is presented to emphasize the importance of graft flexibility in order to delineate further the criteria in selecting the proper artery substitute. Method of Study Adult mongrel dogs were used. Intravenous pentobarbital (Nembutal) anesthesia and sterile technique were employed for each operation. Through separate incisions, the common iliac artery and femoral artery were isolated. The former was divided approximately 2 cm. below the aortic bifurcation; the latter, 3 cm. distal to

Experimental studies concerning the replacement of arteries with arterial and venous grafts—autogenous, homologous, and heterologous—and various cloth prostheses have been well-documented in the surgical literature. 1-4 In the majority of these reports, a fixed artery, such as the abdominal aorta, has been the principal artery replaced, while only a few publications have been concerned with the behavior of grafts when they are used to replace an artery that crosses a flexion crease. The purpose, therefore, of this report is to present a series of laboratory experiments in which arteriography was employed to study the effect of flexion on various implanted arterial substitutes. Methods Thirty-eight mongrel dogs weighing 20-30 kg. were anesthetized with intravenous sodium pentobarbital. Under sterile operating conditions the common iliac artery and femoral artery of each animal were mobilized through separate incisions, and a tunnel connecting the 2 sites was made by forcible dilatation of the infrainguinal area

The clinical features of an acute peripheral arterial embolus are considered to be a rigidly fixed series of events, namely, sudden, abrupt, excruciating pain followed by numbness, pallor of the extremity, and absent pulsations. However this sequence of events may be the exception rather than the rule, inasmuch as the onset of pain may be insidious and, in some instances, preceded by paresthesias of the involved extremity. In many instances the diagnosis of a peripheral arterial embolus depends on the assessment of minor signs and symptoms. Next to pain, the vascular disturbances manifested by absent arterial pulsations and color and temperature changes in the involved extremity are prominent features of an acute arterial occlusion. The frequent association of cardiac abnormalities with peripheral arterial embolus should be well known. In addition there is a prevalence of emboli involving the femoral artery.

Superficial basal cell carcinomas of the chin and cheek are currently treated by electrical and chemical dissection, surgical excision, and radiation therapy. Each of these methods has proved its usefulness in the management of basal cell carcinoma; however, each has certain limitations as attested by the number of reports that have been published concerning the management of recurrent lesions. In our opinion, the principal factor responsible for the recurrence of a basal cell carcinoma is the failure of the initial method of therapy to totally eradicate the tumor. Because of this problem, we began in 1960 to treat a selected group of basal cell carcinomas of the face by Mohs' chemosurgery technique,1as it was our belief that this method offered certain advantages of insuring total tumor removal that were not apparent in the more conventional forms of therapy. Because collective experience with Mohs' chemosurgery technique is limited, it