Aims:To determine ifthere is any correlation between vascular invasion and prognosis in non-small cell carcinoma of the lung; and to look specifically at invasion of vascular channels by tumour cells. Methods: Eighty seven patients undergoing lobectomy or pneumonectomy for adenocarcinoma or squamous carcinoma were followed up for five years. The histological sections were studied for evidence of vascular invasion using an elastic van Gieson stain. The incidence of intimal fibrosis in arteries and veins was noted and the proportion with vascular invasion evaluated using a scoring system. The presence or absence of lymphatic permeation and tumour necrosis were noted. Survival data were analysed using the log rank test. Results: The overall five year survival was 32%. There were 64 squamous cell carcinomas and 23 adenocarcinomas. Vascular invasion was seen in 77% of patients and lymphatic invasion in 44%. Neither the presence nor absence nor the proportion of blood vessels showing vascular invasion showed any relation to prognosis. Intimal fibrosis and tumour necrosis were unrelated to prognosis. Patients with lymphatic permeation had recurrence and died earlier than those without. Conclusion: The presence of arterial or venous invasion by adenocarcinoma or squamous carcinoma of the lung was unrelated to survival; lymphatic permeation was associated with poor prognosis. The two common non-small cell lung cancers behaved differently from other solid tumours, where vascular invasion was a significant factor in determination of prognosis. This study was undertaken to see if there was a similar correlation between vascular invasion and prognosis in carcinoma of the lung and to look specifically at invasion of vascular channels by tumour cells, rather than combining both vascular and lymphatic channels under the same broad heading. MethodsEighty seven patients who had resections for lung cancer between 1979 and 1983, and for whom there was complete follow up data, were studied retrospectively. The operations were all carried out by a single surgeon (RAML) and in each there was no clinical or radiological evidence of metastasis at the time of surgery. The number of histological blocks taken from each tumour ranged between two and six (mean four). In most of the cases studied at least one tumour block had some adjacent lung tissue in the histological section.Slides from each block were stained conventionally with haematoxylin and eosin and elastic van Gieson to permit clear visualisation of blood vessel laminae. " Only patients with squamous cell and adenocarcinoma were studied as it is well recognised that small cell tumours invade the pulmonary vasculature early. "' Undifferentiated tumours were also not considered as it was felt that they comprise a very mixed group and should be studied separately. Lymphatic invasion was recorded as being present only if tumour cells were seen within areas which had a definite and clearly identifiable endothelial lining.Vascular invasion was identified if tumour was seen with...

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The degree of cutaneous sensory deficit in the leg was assessed after removal of the long saphenous vein in 50 consecutive patients undergoing coronary artery bypass vein grafts randomly assigned subcutanous sutures or a single layer of sutures. Removal of the vein and repair of the leg incision were done by the same team of surgeons. In group 1 (25 patients) the leg incision was repaired with "00" Dexon subcutaneous and "00" prolene subcuticular sutures while in group 2 (25 patients) closure was effected by a single layer of interrupted "00" nylon sutures. All had crepe pressure bandage from the base of the toes to the groin for the first 24 hours followed by TED stockings for six to eight weeks. Sutures were removed on the eighth postoperative day. Cutaneous sensation in the leg and ankle was assessed 48 hours, seven days, and six to eight weeks after surgery, and a final comparison of the cosmetic effects and sensory perception after one year or more was made in 37 patients. There were no major differences between the groups at 48 hours in sensory abnormalities (anaesthesia, hyperaesthesia, and pain) but sensory recovery was significantly better in group 2 at the second and third assessments. There was some reduction in sensory abnormalities at the final review in group 1. No appreciable difference was noted in the quality of the scar between the two groups. We conclude that cutaneous sensation is better preserved by repairing the leg incision in a single layer. Subcutaneous sutures may produce neuropraxia of the long saphenous nerve by direct pressure as healing progresses.