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For the surgical palliation of massive ascites, a LeVeen or Denver shunt may be implanted to drain ascitic fluid from the peritoneal cavity into the circulation. But all commercial shunts are costly and depend on a synthetic valve to prevent blood refluxing into the peritoneal cavity. We report here the first patient with a malignant ascites that was successfully palliated by peritoneovenous shunting using the great saphenous vein as a biological valve.

Within a month, we saw two young national servicemen with adenocarcinoma of the caecum. Both presented to use as emergencies and both had a right hemicolectomy performed. This literature review is to promote a greater awareness of the potential for colorectal cancer in young adults less than 40 years of age. The incidence ranged from 2% to 16.8% of all cases of large bowel cancer. About two-thirds of the tumours were Dukes' C and D at the time of presentation. There was a preponderance of poorly differentiated carcinoma and the mucinous type of carcinoma. Early diagnosis and attempts at curative resection are of utmost importance. Radical extirpation of advanced primary disease is well worthwhile and can be associated with long term survival in the young. Family history is important to identify a group of patients with cancer family syndrome.

The unpredictable behavior of histologic types and the disputable results of particular surgical procedures have contributed to the controversies surrounding phyllode tumors. The therapeutic issue is further compounded by an imprecise preoperative diagnosis. This is illustrated in our series of 106 patients, in whom 71.7% were mistakenly operated on for fibroadenoma. Since only 15.8% of this group developed local recurrence, it may be acceptable to adopt a watchful policy, unless detailed microscopic assessment of tumor margins provides evidence of inadvertent transection. Reoperation would then be logical advice, as with one of our patients. In patients clinically suspected of having phyllode tumors, tissue diagnosis is preferable to investigative procedures, which are seldom definitive. Our experience has been with frozen-section diagnosis, although trucut core biopsy is certainly an attractive procedure. In 18 patients only 50% were positively identified as having phyllode tumors. The logistic and therapeutic issues related to use of frozen-section diagnosis are discussed. Wide excision has been recommended by many investigators as an appropriate measure, as long as it is technically possible to remove the lesion with an adequate rim of normal breast tissue. This applies especially to young female patients (less than 20 years), in whom conservation of the breast is particularly desirable and whose tumors behave in a more benign manner. On the other hand, mastectomy is necessary if the phyllode tumor is large compared with breast morphologic size,when histologic transformation has taken place, or when clinical behavior takes a more aggressive course. In this retrospective study, conservative surgery is generally practiced for both primary and recurrent tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Man has acquired helminth infections at different times during his evolutionary history and animals have and do serve an important role in supplementing these acquisitions. Helminth species are divided into those which accompanied man as he emerger as a species and those which he has since acquired from domestic, wild and domiciliated animals by breakdown of ecological, physiological and immunological barriers (Sprent 1969). With particular reference to helminth zoonoses transmitted through domesticated animals, the role played by dogs and cats in disease transmission to man (in urban environments) has been largely overlooked. In the Australasian region, the most important helminth zoonoses transmitted by dogs and cats in heavily urbanised areas as Toxocara sp., Ancylostoma sp. and Dirofilaria immitis. The prevalence, geographic distribution and major epidemiological considerations for each parasite are discussed with the view that future control and/or eradication programs should be based on a sound epidemiological understanding of the natural life history of the helminths concerned.

The anthelmintic efficacy of fenbendazole (methyl 5-(phenylthio)-2-benzimidazole carbamate) was tested in sheep against standardised strains of Hcaemonchus contortus and Trichostrongylus colubriformis, known to be resistant to thiabendazole (LD90 for thiabendazole against H ontortus was 200 mg/kg bodyweight and against T colubriformis was 150 mg/kg). Fenbendazole at dose rates of 5, 10 and 20 mg/kg per os reduced total worm counts in H contortus infected sheep by 66, 90 and 100 per cent respectively, with similar reductions recorded for worm egg outputs. For the thiabendazole resistant strain of T colubriformis, fenbendazole reduced total worm counts in infected sheep by 4, 44 (40-48), 79 (75-83), 96 and 100 per cent at dose rates of 5, 10, 20, 40 and 80 mg/kg per os. Significant suppression of worm-egg production by thiabendazole resistant T colubriformis was obtained with fenbendazole at dose levels of 5 mg/kg and above. The implications of these results are discussed in the light of the increasing occurrence of strains of trichostrongylid nematodes resistant to currently available benzimidazole anthelmintics.

Cystosarcoma phyllodes afflicting 106 female patients in a multiracial Asian society is reviewed and some interesting variations are noted when compared with Western patients. The incidence of phyllodes tumour is 3.83% of surgically removed breast tumours compared with 0.5-2.5% in Western series. This lends weight to the belief that non-Caucasians are more prone to this enigmatic breast disease than the Caucasian population. The profile of the Asian phyllodes patient is that of a young female, aged 25-30 years, whereas her Western counterpart is in her 40s. As a result, she is liable to be mistaken clinically as having fibro-adenoma. The disease is notably rare among the females below 20 years of age but in the Asian context, as much as one-quarter-one-third may be in the adolescent group. There were only three malignant and six borderline phyllodes tumours out of 106 cases, and this incidence is far below that of many other studies in which the malignant cases are believed to constitute 23-27%. However, this may not be a racial variation but explicable by the fact that the present study is an unselected cohort from a general surgical unit. The presence of associated benign breast disease in 25.5% cases helps to reinforce the widely held belief that fibro-adenoma and phyllodes tumour are related to some degree.