A multicenter, prospective study ( = 103) examined the psychological implications of women's decisions for or against breast reconstruction. Recognized measures of anxiety, depression, body image, and quality of life were completed before the operation, and 6 and 12 months later. A reduction in psychological distress over the year following the operation was evident in each surgical group (mastectomy alone or immediate or delayed reconstruction), indicating that reconstructive surgery can offer psychological benefits to some women; however, others report improved psychological functioning without this surgical procedure. In contrast to existing retrospective research, the prospective design enabled the process of adjustment during the first year after the operation to be examined. The results indicate that breast reconstruction is not a universal panacea for the emotional and psychological consequences of mastectomy. Women still reported feeling conscious of altered body image 1 year postoperatively, regardless of whether or not they had elected breast reconstruction. Health professionals should be careful of assuming that breast reconstruction necessarily confers psychological benefits compared with mastectomy alone.

The viability of tumour cells shed into the intestinal lumen was determined in 49 patients with carcinoma of the large bowel. Preoperative colorectal lavage was performed in 19 patients and irrigation of the cut ends of the operative specimen in 30 patients. The resulting cell suspensions were centrifuged on a Nycodenz linear density gradient column so that tumour cells, being larger, were concentrated in a band at the top. In 14 of 19 colorectal lavage cases viable tumour cells were recovered, as assessed by their characteristic morphology and ability to exclude trypan blue. A median of 0.78 X 10(6) viable tumour cells was recovered. The median percentage cell viability in the suspension was 92, i.e. 8 per cent of the tumour cells were dead (stained with trypan blue). In eight specimens viability was confirmed by the ability of tumour cells to hydrolyse fluorescein diacetate. In 17 of 30 proximal resection margin irrigations a median of 0.55 X 10(5) viable tumour cells was recovered, with a median percentage viability of 92.5. In 15 specimens the neoplastic cells showed fluorescence. In 21 of 25 distal resection margin irrigations a median of 1.92 X 10(5) viable tumour cells was recovered with a median percentage cell viability of 79.3, and fluorescence was observed in all specimens. The number of viable tumour cells did not correlate with the stage, differentiation, diameter or fixity of the tumour. However, the number of tumour cells recovered from the distal resection margin was inversely related to the distance of the tumour from that margin (Rank Difference Coefficient R = -0.6). Thus viable exfoliated tumour cells were demonstrated in 52 of 74 specimens (70 per cent). Their presence in large numbers at the site of intestinal anastomoses supports a potential role in the aetiology of suture-line recurrence.