The aim of the present study was to investigate the value of preoperative staging in primary operable breast cancer. This retrospective study included patients presenting between May 1999 and February 2004 with operable primary breast cancer. Of the 221 patients 189 had normal and 32 suspicious or positive bone scans (BS). Of the 189 patients with normal BS 182 had normal liver ultrasound (US), whereas the remaining seven patients underwent computed tomography scan which was normal in five and two confirmed liver metastases (one with abnormal LFTs). Of the 32 patients with suspicious or positive BS 26 were false positive on further investigations and the remaining six patients were confirmed to have bony metastasis (one abnormal bone profile). BS and liver US truly altered treatment in 3% of patients. False-positive results caused delay, psychological upset, and costly investigations in 14% of cases. Preoperative staging with liver US and BS should be reserved for high-risk patients.

A retrospective study of all patients presenting with liposarcoma at Southend General Hospital between the years 1970 and 1979 is presented. There were 13 patients in the group treated with various combinations of surgery and radiotherapy. The histology has been reviewed: 7 patients had myxoid tumours, 2 well differentiated and 4 pleomorphic. The patients were followed up for between 18-109 months with 7 patients followed for more than 5 years. Local recurrence was seen only in myxoid tumours whereas pleomorphic tumours showed a high incidence of distant metastases. The length of survival was found to correlate with the histology, pleomorphic tumours being associated with the shortest survival. The series illustrates that the histological type of liposarcoma predicts the pattern of behaviour of the tumour and is the major determinant in prognosis.

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Strangulated small bowel hernia within a prolapsed colostomy stoma 1 A case is reported of strangulated small bowel occurring in a prolapsed left iliac fossa colostomy: the patient required resection of gangrenous portions of small and large bowel. It appears to be the first recorded example of this condition. The complications of colostomy are reviewed.