bluuebunny/crossref_metadata_2025 huggingface dataset:
The angiographic anatomy of the coronary arteries
Authors: Raphael M J , Hawtin D R , Allwork S P
Published: March 2007

The angiographic anatomy of the coronary arteries is described and illustrated by three corrosion casts of normal human hearts, photographed in projections comparable to those used in coronary arteriograms. They are accompanied by matched normal coronary arteriograms. The study of casts of the heart and of the coronary arteries in particular facilitates understanding of the radiographic projections commonly employed in coronary arteriography.
Towards fewer colostomies—the impact of circular stapling devices on the surgery of rectal cancer in a district hospital
Authors: Heald R J
Published: March 2007

Circular stapling devices can be used to extend the range of anterior resection of the rectum to encompass most rectal carcinomas. In one district general hospital the number of abdominoperineal resections performed in a 12-month period has been reduced from 27 to 4. A personal series is presented of 40 patients in whom the new technique allowed restorative resection to replace permanent colostomy. Special care is essential in the preparation of the colon for the low anastomosis.
Intussusception due to inflammatory fibroid polyps of the ileum: A report of 12 cases from Africa
Authors: Nkanza N K , King M , Hutt M S R
Published: March 2007

Eleven cases of inflammatory fibroid polyp of the ileum from Malawi and 1 from Sierra Leone are described. All 12 patients presented with acute intestinal obstruction as a result of an intussusception caused by the polyp.

The lesions are characterized by a variable proliferation of fibroblasts and small vessels which may involve the whole thickness of the bowel wall. Tissue mast cells and eosinophils were noted in all the polyps.

The aetiology of these lesions remains obscure but they appear to be reactive rather than neoplastic. The condition appears to occur more commonly in Malawi than in the United Kingdom or North America and is an important cause of small bowel obstruction in that part of Africa.
Perineal wound healing after proctectomy for carcinoma and inflammatory disease
Authors: Baudot Phillipe , Keighley Michael R B , Alexander-Williams John
Published: March 2007

The rate of wound healing after proctectomy was assessed in a series of 105 patients. Early healing was dependent principally on the primary diagnosis, to a lesser extent on faecal contamination and was not related to steroid administration. Early healing (within 3 months) occurred in 72 per cent of patients undergoing operation for cancer and 45 per cent of these operated on for ulcerative or Crohn's colitis.
The use of Silastic foam dressing in the treatment of advanced hidradenitis suppurativa
Authors: Morgan Wyn P , Harding Keith G , Richardson Gill , Hughes Leslie E
Published: March 2007

We describe our experience in the use of a Silastic foam dressing in 17 patients undergoing radical excision of hidradenitis suppurativa whose wounds were allowed to heal by granulation. Axillary excisions were carried out in 9 patients and perineal excisions in 8 patients. The technique permits adequate excision of the disease and results in a cosmetically acceptable scar, superior to that obtained by skin grafting and with little limitation of movement. It avoids the pain of conventional management of granulating wounds by gauze packing.

It is considered that this method of management is superior in most respects to other techniques used to manage the defect resulting from adequate excision of hidradenitis.
Missile injuries of the abdomen in Zimbabwe–Rhodesia
Authors: Dent Roger I , Jena George P
Published: March 2007

One hundred and thirteen patients with missile injuries of the abdomen were seen over a 3-year period at one hospital in Zimbabwe–Rhodesia. The details of these injuries and the results of their treatment are presented.

Twenty-four patients died (21 per cent). Twenty of these patients had sustained high velocity missile injuries, 18 had damaged colons and 3 died from major vascular injuries before surgery. Excluding these last 3 patients, the mortality rate for high velocity wounds of the colon was 52 per cent and that for all other patients was 6 per cent (P < 0·01). More than half the postoperative deaths were due to septicaemia.

The importance is stressed of early and effective resuscitation, including appropriate antibiotic therapy and rapid evacuation to facilities for major surgery.
The value of the new interpretation of the insulin test in predicting duodenal ulcer relapse after treatment with cimetidine
Authors: Maybury N Keith , Carr-Locke David L
Published: March 2007

Twenty-one patients with duodenal ulcer were treated with cimetidine. After 2 weeks they were submitted to an insulin test and the results were compared with a range of secretion previously established in untreated duodenal ulcer patients (1). The secretion of 13 patients fell within this range and so they were predicted to have a high risk of relapse. The patients whose secretion was below the range had a predicted low risk of relapse. After 4 weeks treatment repeat endoscopy showed that 4 ulcers had failed to heal. The secretion of 3 of the patients was within the range of the high risk group. The remaining 17 patients were followed up (range 20–23 months): 9 relapsed and 8 remained symptom-free. Eight of the 9 were in the high risk group and 6 of the 8 symptom-free patients were in the low risk group. In all, 11 out of 13 were correctly predicted in the high risk group and 6 out of 8 in the low risk group.

The performance of the insulin test in predicting liability to relapse following cimetidine treatment was significant (P = 0·0225).
The influence of ischaemia on the biliary tract
Authors: McMaster Paul , Walton Robert M , White Derek G D , Medd Richard K , Syrakos Theodore P
Published: March 2007

Damage of the biliary tract at the end of a period of hepatic preservation prior to liver transplantation has been observed in man. This damage may be important in the development of early biliary complications.

A model of hepatic biliary ischaemia in the pig has been developed which permits comparison between the influences of warm and cold ischaemic damage on the biliary tract. The major damage to the biliary tract in the pig in this model appears to occur after prolonged cold preservation.
A controlled trial of naftidrofuryl (Praxilene) in the treatment of intermittent claudication
Authors: Clyne C A C , Galland R B , Fox M J , Gustave R , Jantet G H , Jamieson C W
Published: March 2007

We present the results of a double-blind trial of naftidrofuryl (Praxilene) in the treatment of intermittent claudication. One hundred and twenty-eight patients were subjected to a standard walking test 3 and 6 months after treatment. There was no significant objective improvement attributable to the drug. Although both groups significantly increased their walking time to the onset of pain, those patients over 60 years old taking naftidrofuryl showed a significant improvement over their pretreatment walking times to onset of pain, whereas their controls did not.
Retardation of wound healing by procaine
Authors: Morris Tom , Appleby Rachel
Published: March 2007

Lignocaine has previously been shown to retard wound healing; the retardation is directly related to the concentration of the drug used and is enhanced by the addition of adrenaline. The study described in this paper aimed to determine whether procaine has a similar effect and, if so, whether the effect is enhanced by adrenaline. We measured the effect of sterile water alone and of procaine in various concentrations on the tensile strength of skin wounds in rats, 5 and 7 days after operation. At 5 days sterile water had produced a significant retardation of wound healing. All concentrations of procaine produced significant retardation of healing at 5 days and adrenaline enhanced this effect. By 7 days the effect was greatly diminished and only those rats injected with 2 per cent procaine with adrenaline had significantly weaker wounds. The study suggests that 2 per cent procaine with adrenaline is better avoided and even when lower concentrations are used sutures should be retained for 7 days.
Percutaneous catheter drainage of liver abscess: An alternative to open drainage?
Authors: Kraulis J E , Bird B L , Colapinto N D
Published: March 2007

Percutaneous catheter drainage is still a new concept. Only 4 cases have been reported thus far and this paper reports 2 further cases. The technique of percutaneous catheterization of a liver abscess under CAT scan control is described, and the management of the catheter by a closed irrigation system is set out. Unless there is another compelling reason to do a laparotomy, we feel that this procedure is well worth a trial in view of the high mortality still associated with open drainage. Further experience may well prove percutaneous catheter drainage to be the procedure of choice for liver abscess.
Diagnosis of intestinal duplication by 99Tcm-pertechnetate scanning
Authors: Waterston Tony , Lyall M H , Longrigg Neil , Wisbey M L
Published: March 2007

A case is described of a 19-month-old boy who presented with melaena. Intestinal duplication was diagnosed by 99Tcm-pertechnetate scanning and was confirmed at operation 2 years later, when the child was admitted with intestinal perforation.

The technique is a reliable, non-invasive method for diagnosing ectopic gastric mucosa and is recommended in all cases of unexplained rectal bleeding in children.
The appearance of endotoxin following urethral instrumentation
Authors: Sim A J W , McCartney A Christine
Published: March 2007

The Limulus amoebocyte lysate test was used to detect the presence of endotoxin in the venous blood of 10 patients following urethral instrumentation. The test was negative in all patients before instrumentation, became positive in 9 immediately after instrumentation and in 1 30 min after instrumentation. In 6 patients endotoxin reappeared between 1.5 h and 4.5 h after instrumentation. All blood samples, cultured aerobically and anaerobically, were sterile. Escherichia coli were cultured from one midstream specimen of urine and from one urethral swab in the same patient taken before instrumentation. There were no significant changes in either pulse rate or axillary temperature following instrumentation.
The natural history of malignant thyroid lymphomas
Authors: Grimley R P , Oates G D
Published: March 2007

Twelve patients with malignant thyroid lymphomas seen over a 12-year period were reviewed. Two of these patients developed intra-abdominal lymphoma and a third, adult coeliac disease. Treatment by radiotherapy and thyroxine was effective, with thyroid excision mainly reserved for obstructing lesions. Prognosis was not affected by local metastases. A plea is made for open thyroid biopsy and accurate clinical staging of patients with this disease.
Serum lipids and high density lipoprotein cholesterol in peripheral vascular disease
Authors: Trayner M , Mannarino E , Clyne C A C , Thompson G R
Published: March 2007

Serum lipids and high density lipoprotein (HDL) cholesterol concentrations were measured in 32 patients with peripheral vascular disease (PVD) and 38 control subjects. Hypertriglyceridaemia (>1·8 mmol/l) was significantly more common in PVD patients of both sexes than among controls but mean serum triglyceride levels were significantly higher only among males. Hypercholesterolaemia (>7 mmol/l) was not more common in PVD patients nor did mean serum total cholesterol or HDL cholesterol levels differ significantly from control subjects. The HDL ratio, however, was significantly reduced in both males and females with PVD. These results suggest that expressing the amount of cholesterol carried in HDL in relative terms is a better index of vascular risk than is its absolute concentration. The HDL cholesterol level and the HDL ratio were both significantly lower in controls who smoked than in non-smokers; this may explain the reduced HDL ratio in PVD patients, most of whom were smokers.
The Celestin tube in the treatment of benign oesophageal strictures
Authors: Wilson Michael G , Bristol James B , Mortensen Neil J , John Howell T
Published: March 2007

Celestin tubes have been used in two groups of patients with advanced benign oesophageal strictures. Group 1 consisted of 22 elderly, poor risk patients in whom intubation alone, via a gastrotomy, has provided good symptomatic relief of dysphagia. In 11 younger, better risk patients (group 2), it has been used as a temporary indwelling dilator in combination with repair of the hiatus hernia and has been removed at a mean of 5 months postoperatively. Seventy-three per cent of patients have remained free of recurrence when followed up for 2 years.
The importance of personality measurement in the assessment of response to treatment for ischaemic rest pain
Authors: Wong Andrew L , McBain Gordon C
Published: March 2007

The purpose of the study was to investigate the relationship between personality and ischaemic rest pain. Twenty-four patients with peripheral vascular disease unsuitable for surgery and suffering from ischaemic rest pain were treated equally with 14 days of bed rest and intravenous naftidrofuryl and their pain analogue scores and personality structures were analysed.

There was a general trend of improvement in their analogue pain scores and patients with high neuroticism (N) and extroversion (E) levels had a better response to treatment, but which only became significant on one occasion when both N and E levels were high.

Levels of N and E were compared with those of the normal population both before and after treatment and were found to be similar even after amputation.
Bilateral carcinoma of the breast
Authors: Bailey M J , Royce C , Sloane J P , Ford H T , Powles T J , Gazet J-C
Published: March 2007

Among the 911 cases of carcinoma of the breast treated between 1969 and 1978 there were 39 cases of bilateral primary cancer. Of these, 17 were synchronous tumours defined as cancers diagnosed and treated during the same primary hospital admission. The remaining 22 patients had tumours that were diagnosed separately (metachronous tumours), with a mean time interval of 5 years and 8 months between presentation of first and second primaries (range 6 months to 20 years). Of the metachronous tumours, 20 had presented within 7 years of the diagnosis of the first primary (2·2 per cent of all patients). The patients with synchronous disease fared badly, but patients in the metachronous group had a good prognosis. This is due, at least in part, to the inherent selection of patients in the metachronous group who have to survive the first primary tumour in order to develop the second. However, careful follow-up after the first primary may also account for the relatively good prognosis of this group. We therefore recommend continuing regular out-patient follow-up, with careful examination of the second breast, for all patients having undergone treatment for cancer of the breast.
The complications of arteriovenous grafts for vascular access
Authors: Guillou Pierre J , Leveson Stephen H , Kester Ralph C
Published: March 2007

An analysis has been made of the complications occurring in 86 arteriovenous grafts performed for vascular access over a 5-year period ending in July 1979. Synthetic grafts provide significantly more complication-free dialyses than do biological grafts. They are less susceptible to sepsis and aneurysm formation and, when thrombosis does supervene, synthetic grafts can more readily be retrieved than biological grafts. Dacron velour in particular appears to have a low primary and secondary failure rate compared with other types of graft. Grafts implanted in the straight configuration have lower thrombosis rates than looped grafts. While the forearm remains the site of choice for the insertion of an arteriovenous graft, equally good results may be obtained with a graft interposed between the femoral artery and vein.
Proctocolectomy with ileal reservoir and anal anastomosis
Authors: Parks A G , Nicholls R J , Belliveau P
Published: March 2007

A technique of proctocolectomy avoiding an ileostomy has been developed for patients with ulcerative colitis or polyposis coli. After excision of all diseased tissue a reservoir of terminal ileum is constructed which is brought through the rectal stump denuded of mucosa; an ileo-anal anastomosis is then carried out.

Twenty-one patients (17 ulcerative colitis, 4 polyposis) have been treated and 20 followed for from 2 to 34 months (mean 13·5 months). There was no mortality but early complications occurred in 9 patients. All are currently well, with no disturbance of urinary or sexual function. Continence of faeces is complete in all during the day, but 1 patient evacuates unconsciously at night. The average frequency of evacuation is 3·8 times in 24 h. Ten patients void spontaneously. All patients tolerate a full diet and only 2 use medicaments to reduce frequency.

This operation appears to be a satisfactory alternative to proctocolectomy with a permanent ileostomy.
A physiological study of elastic compression stockings in venous disorders of the leg
Authors: Jones N A G , Webb P J , Rees R I , Kakkar V V
Published: March 2007

The physiological effects of elastic compression stockings on venous disorders of the leg have been studied in three groups of 10 patients. These patients were divided by examination and ascending venography into those with: (a) a normal venous system in the leg, (b) superficial varicose veins and (c) a post-phlebitic limb.

In a randomized cross-over trial each group wore Eesiness NHS two-way stretch or Sigvaris medium compression below-knee stockings for three weeks. In the post-phlebitic limb group a further comparison was made with Sigvaris strong compression below-knee stockings after a 6-week rest period. The effects were objectively compared using foot volumetry and sodium (24Na) subcutaneous tissue clearance.

The physiological benefits of Sigvaris medium and strong compression stockings were comprehensively demonstrated by both methods of assessment in patients with the post-phlebitic limb. Benefit from Sigvaris medium compression stockings was also demonstrated in the patients with varicose veins. In the group with normal veins there were negligible physiological benefits from compression stockings. Eesiness stockings failed to produce a significant physiological effect in each group.
Management of the amputated thumb
Authors: Leonard A G , Colville J
Published: March 2007

Two cases are described, one of replantation of an amputated thumb, the other of late reconstruction by toe transfer. A possible reason for the good results in thumb replantation is mentioned, and the advantages of toe transfer in thumb reconstruction are discussed. Suggestions are made as to the course of action to take when confronted with a patient with an amputated thumb.
Wilkie's syndrome—a rarity?
Authors: Lundell Lars , Thulin Anders
Published: March 2007

Six cases are reported of vascular compression of the duodenum giving rise to duodenal and gastric dilatation, a condition which may be more common than generally recognized. The pathophysiology, difficulties of diagnosis and treatment are also discussed. Recognition of this disease is essential otherwise it may be fatal.
Spontaneous perforation of the extra-hepatic bile ducts in neonates and infants
Authors: Lloyd D A , Mickel R E
Published: March 2007

Biliary ascites due to ‘spontaneous’ perforation of the extra-hepatic bile ducts is uncommon, and should be suspected in an infant who, after a period of good health, develops jaundice and progressive abdominal distension. When the presentation is acute without jaundice the diagnosis is unlikely to be considered unless paracentesis is performed. The perforation is typically located in the common bile duct near its junction with the cystic duct and simple peritoneal drainage without suture is recommended unless the bile duct is obstructed, in which case T tube drainage or a bypass procedure is required. The prognosis is good.

Four patients are presented who illustrate the spectrum of clinical presentation and the different methods of management. Two patients in whom the perforation was in the cystic duct were successfully treated by cholecystectomy.

In most cases the aetiology is not apparent, but important factors may be weakening of the common bile duct wall due to ischaemia or pancreatic juice reflux, associated with a rise in choledochal pressure. In older children the onset of biliary ascites may be preceded by an acute gastrointestinal illness, which, may be a predisposing factor.
Excision of mid-rectal lesions by the Kraske sacral approach
Authors: Christiansen John
Published: March 2007

Thirteen patients had a benign and 4 patients a malignant growth of the mid-rectum excised by the Kraske sacral procedure. Two patients developed a faecal fistula, one of which closed spontaneously. Recurrence of a villous adenoma occurred in 2 patients. There was no operative mortality and no thromboembolic or cardiovascular complications.
The place of isolated rectal excision in the treatment of ulcerative colitis
Authors: Clark C G , Ward M W N
Published: March 2007

Four patients with ulcerative procrocolitis apparently confined to the rectum had incapacitating diarrhoea which was treated by rectosigmoid resection and a left iliac colostomy. In 3 patients disease recurred within a year, but responded well to conservative management. One of the patients required colectomy and ileostomy 5 years after the initial operation.
Anorectal pressure and rectal compliance after low anterior resection
Authors: Suzuki Hiroshi , Matsumoto Ko'Ichi , Amano Shin'Ichi , Fujioka Masaki , Honzumi Makoto
Published: March 2007

Measurements of the resting pressure profile of the anorectum, recto-anal reflex and of rectal compliance (reservoir function of the rectum) were made in 24 normal subjects and 16 patients who had undergone low anterior resection for cancer of the sigmoid colon or upper half of the rectum.

In the early postoperative period (<6 month) frequent bowel movements and occasional soiling were experienced by most patients. Fifteen of 16 such patients had regular bowel movements and no soiling after six months.

The present studies disclosed that there was a close correlation between control of bowel movements and rectal compliance, but not between the resting pressure profile of the anorectum or the recto-anal reflex and control of bowel movements after low anterior resection.
Peritoneovenous shunting for ascites in cancer patients
Authors: Oosterlee J
Published: March 2007

Twenty patients with malignant ascites were treated by insertion of a peritoneovenous shunt. Twelve had a Le Veen shunt, 7 a Denver shunt and 1 patient had a Le Veen shunt subsequently replaced by a Denver shunt. Overall survival was poor, which reflects the advanced stage of the patients' disease. Function of the Denver shunt seemed to be better than that of the Le Veen shunt, None of the 8 Denver shunts inserted was a complete failure, while 4 out of 13 Le Veen shunts were of no benefit. With a satisfactorily functioning shunt, good palliation was always achieved. A Denver shunt has become our first choice.
Reliability of axillary lymph node scintiphotography in suspected carcinoma of the breast
Authors: Christensen B , Blichert-Toft M , Siemssen O J , Nielsen S L
Published: March 2007

The ability of axillary lymph nodes to take up 99Tcm-labelled antimony sulphide colloid in suspected carcinoma of the breast was investigated in 111 consecutive patients. Eight out of 17 patients with histologically confirmed carcinoma of the breast had a low colloid uptake on the affected side, i.e. a positive scintiphoto. Eighty-two out of 94 patients with benign breast disease had an equal colloid uptake on the two sides or increased uptake on the symptomatic side, i.e. a negative scintiphoto. The reliability of the test is low and the test can neither be recommended for screening to select patients for further investigations nor as a routine examination.
Postoperative deep vein thrombosis caused by intravenous fluids during surgery
Authors: Janvrin S B , Davies G , Greenhalgh R M
Published: March 2007

Using a new method of measuring whole blood clotting time, we have confirmed the findings of others, that blood clots faster when diluted with saline. A prospective trial was designed to test the hypothesis that intravenous saline peroperatively causes hypercoagulation and increases the risk of venous thrombosis. Sixty patients admitted for routine laparotomy were randomly allocated to either a group receiving intravenous fluids during or after operation (Wet), or a group receiving no intravenous fluids (Dry). The Wet patients became significantly more haemodilute and hypercoagulable than the Dry (P < 0·001), and these changes correlated. A postoperative deep vein thrombosis occurred in 30 per cent of the Wet patients, but in only 7 per cent of the Dry (P < 0·05). The need for intravenous fluids during uncomplicated surgery is probably unproved, and their greater use may have contributed to the increasing prevalence of venous thromboembolism.
The human tumour xenograft—a valid model in experimental chemotherapy?
Authors: Shorthouse A J , Smyth J F , Steel G G , Ellison M , Mills J , Peckham M J
Published: March 2007

The chemotherapeutic response of a series of patients with bronchial carcinoma has been compared with the response of their xenografts established in immune-suppressed mice.

The in situ endpoint of growth delay in subcutaneous tumours was the main parameter used to assess xenograft response, but clonogenic cell survival studies were also performed to assess the extent of cell kill associated with in vivo responses.

Histology, chromosome analysis and demonstration of ectopic hormone production indicated that the xenografts retained human morphology and functional behaviour. Clinical response was assessed by serial measurement of metastases. The chemotherapeutic validity of xenografts is supported by this study in which 21 separate responses in 16 patients and their respective xenografts were similar. Metastases regressed completely in 5 out of 7 patients with oat cell carcinoma. Xenografts derived from these were also highly responsive to similar chemotherapy. In contrast, minimal responses were observed in xenografts established from two chemoresistant patients.

One large cell anaplastic, 3 squamous and 4 adenocarcinomas were universally chemoresistant in patients and their xenografts.

It is concluded that the bronchial carcinoma xenografts broadly retained human morphology and functional behaviour, and reproduced the pattern of chemotherapeutic response of their source tumours. The present work suggests that the incorporation of human tumour xenografts into drug development programmes is justified, although their usefulness in a predictive capacity to select appropriate chemotherapy for individual patients remains limited.
Assessment of the secretin provocation test in the diagnosis of gastrinoma
Authors: Primrose John N , Ratcliffe John G , Joffe Stephen N
Published: March 2007

The effect of intravenous secretin on plasma immunoreactive gastrin is presumed to improve diagnostic accuracy in patients with a gastrinoma. To investigate this further, the secretin provocation test was performed in control patients (n = 10), patients with a primary duodenal ulcer (n = 10), patients who had previously had surgery for a duodenal ulcer (n = 20), patients with symptomatic recurrent peptic ulceration (n = 50) and 2 patients with a histologically proved gastrinoma. It was found that the secretin test gave a false positive result in 3 out of 10 symptomatic duodenal ulcer patients, 2 out of 20 patients who had had previous duodenal ulcer surgery and were now asymptomatic and 15 out of 50 patients with recurrent peptic ulceration. Both gastrinoma patients had positive secretin tests but there were no obvious criteria that separated the gastrin response of a gastrinoma patient from those with primary or recurrent peptic ulceration. It is concluded that the secretin test is probably of little value in both the screening and the diagnosis of a gastrinoma.
An assessment of anorectal motility in the management of adult megacolon
Authors: Taylor I , Hammond P , Darby C
Published: March 2007

Anorectal motility measurements have been performed on 19 patients with adult megacolon and the results compared with 12 normal subjects. Adult Hirschsprung's disease (4 patients) was recognized by the absence of anal canal inhibition on rectal distension (normal mean inhibition 21·9 ± 2·3 mmHg).

Seven patients with non-Hirschsprung's megacolon (idiopathic) had an elevated anal canal pressure (mean 90·4 ± 7·0 mmHg). These patients were treated with repeated anal dilatation. Eight further patients had normal anal canal pressures (mean 33·2 ± 11·7 mmHg) and were treated with enemas and regular suppositories. Little overall clinical improvement resulted in this group and 1 patient underwent subtotal colectomy.

Measurements of anorectal motility have been found to assist in the management of adult megacolon.
Benign breast disease and cancer
Authors: Chetty U , Wang C C , Forrest A P M , Roberts M M
Published: March 2007

A study of 7000 women attending a diagnostic breast clinic and the Breast Screening Clinic in Edinburgh has failed to show a significant relationship between the occurrence of previous symptomatic breast disease and a risk of cancer.
An improved method for primary repair after spontaneous oesophageal perforation
Authors: Westaby S
Published: March 2007

Spontaneous perforation of the oesophagus is a rare but lethal condition requiring prompt surgical repair. Diagnosis is often delayed and this may lead to considerable morbidity or mortality. This report describes primary repair of the tear using a diaphragmatic pedicle graft and emphasizes the need for detailed pre- and postoperative care.
Cystic adventitial disease of the popliteal artery
Authors: Hunt Bernard P , Harrington Mary G , Goode John J , Galloway John M D
Published: March 2007

A 62-year-old man with intermittent claudication but normal foot pulses at rest had no altheroma shown on femoral arteriography. There was evidence of external compression of the artery at the level of a popliteal cyst which was demonstrated by arthrography on films taken after sufficient exercise to be in communication with the knee joint.

At operation the cyst was continuous with changes of cystic adventitial disease of the popliteal artery. Both the main cyst and the cystic changes in the artery were removed. Postoperatively the patient's claudication disappeared.

Evidence is presented that synovial cysts play a part in the production of arterial cystic adventitial disease.
Loop ileostomy for protection of the newly constructed ileostomy reservoir
Authors: Hultén Leif , Fasth Stig
Published: March 2007

Sixteen patients submitted to reservoir ileostomy were at the same time given a proximal loop ileostomy to defunction the reservoir for 2–3 months. All made smooth recoveries in the immediate postoperative period both before and after the closure of the loop ileostomy. During follow-up of at least 12 months the function of the reservoir ileostomy has been excellent except in one patient who developed dysfunction of the nipple valve requiring reoperation. On the basis of this experience, it is suggested that a temporary defunctioning loop ileostomy is a wise precaution in connection with reservoir ileostomy, which may lessen the incidence of complications and reduce the risks of later valve extrusion.
Arteriovenous malformation of the stomach treated by embolization
Authors: Sellu David P , Fagan E , Allison D J , Wood C B
Published: March 2007

A case of gastric arteriovenous malformation, successfully treated by selective arterial embolization, is described. The advantages of embolization in comparison with surgery are considered.
Arteriovenous fistula following lumbar disc surgery
Authors: May A R L , Brewster D C , Darling R C , Browse N L
Published: March 2007

Injury to the aorta, vena cava and iliac vessels is a recognized hazard of lumbar disc surgery (1–4). Haemorrhage may be manifest at the time, or postoperatively false aneurysm or arteriovenous fistula occurs. Four cases of arteriovenous fistula, 2 with associated false aneurysm, are described. Presentation varied between immediately postoperatively and 8 years later. In none of these was injury suspected at the time of surgery.
Blood viscosity, Raynaud's phenomenon and the effect of fibrinolytic enhancement
Authors: Ayres M L , Jarrett P E M , Browse N L
Published: March 2007

The whole blood and corrected blood viscosity of 17 patients with Raynaud's phenomenon (8 with idiopathic Raynaud's phenomenon and 9 with sclerodermaassociated Raynaud's phenomenon) have been compared with 12 normal controls. Viscosity has been measured with a Contraves LSV1 rotating viscometer and the Wells—Brookfield microviscometer at 37°C and 25°C and shear rates ranging from 0.775 s−1 to 230 s−1. Blood viscosity was higher at both the lower temperature and the lower shear rates but this change was the same in the patients as in the normal subjects.

There was a significantly higher level of plasma fibrinogen in the patients with scleroderma with a significant increase in the corrected blood viscosity, but not the whole blood viscosity, at both temperatures and all shear rates. The percentage increase of viscosity at low temperatures in the patients was the same as the controls.

No evidence was found to substantiate the hypothesis that Raynaud's phenomenon is caused by an excessive increase of blood viscosity at low temperatures.

Treatment of 10 patients with stanozolol, a stimulator of fibrinolysis, reduced the plasma fibrinogen and increased the haematocrit but did not change the whole blood viscosity. Hand blood flow increased. The improvement of hand blood flow was not therefore caused by change in blood viscosity secondary to the reduction of plasma fibrinogen.
Alanine metabolism in patients with chronic infection
Authors: Royle G T , Kettlewell M G W
Published: March 2007

Alanine metabolism was studied in surgical patients with chronic infection and non-infected control subjects by means of an intravenous infusion of alanine. Septic patients had low basal blood concentrations of alanine compared with control subjects but alanine half-life was similar in both groups. This suggests that low basal alanine concentration in the septic patients was due to decreased release from muscle rather than increased hepatic uptake. Alanine infusion in septic patients caused a fall in the blood concentration of ketone bodies which was initially raised. Similar increases in blood concentrations of glucose, lactate, pyruvate and insulin occurred in both septic and control patients after alanine infusion. Hyperketonaemia may limit muscle breakdown and alanine release in patients with chronic infection.
Duplications of the alimentary tract
Authors: Hocking M , Young D G
Published: March 2007

A review of 53 patients with 60 duplications of the alimentary tract treated at the Royal Hospital for Sick Children, Glasgow, from 1947 to 1978 has been made. This consisted of 19 foregut, 32 midgut and 9 hindgut duplications. The experience with these patients has been recorded and discussed with reference to the literature.
Emergency surgery for acute colonic haemorrhage—A retrospective study
Authors: Eaton A C
Published: March 2007

This paper reports a retrospective study of 28 patients undergoing emergency laparotomy and colonic resection for acute colonic haemorrhage out of a total of 292 patients admitted with the condition. The paper concludes that in those cases where the bleeding site cannot be accurately localized angiographically prior to laparotomy, the preferred surgical procedure should be total abdominal colectomy with ileoproctostomy as more limited colonic resection leads to an unacceptably high morbidity and mortality.
The management of acute sigmoid volvulus
Authors: Anderson J R , Lee D
Published: March 2007

One hundred and thirty-four patients with acute sigmoid volvulus are analysed. When the diagnosis is made preoperatively, decompression per rectum is effective in 85 per cent of cases, and should be the initial treatment of choice unless gangrene of the bowel is suspected. In this situation emergency laparotomy should be performed and where gangrenous bowel is confirmed a Hartmann resection appears to be associated with a low mortality and least complications. When the sigmoid loop is found to be viable, it should still be resected. The merits and pitfalls of various procedures in this situation are discussed.
Endometriosis of the appendix
Authors: Langman J , Rowland R , Vernon-Roberts B
Published: March 2007

The clinical and pathological features of 6 cases of appendiceal endometriosis are reported. The appendix alone was involved in 3. The findings have been compared with previously reported cases. One of the largest deposits caused intussusception but otherwise the microscopic size of deposits did not correlate with symptomatology. The diagnosis may be suspected when the abdominal pain does not shift from the peri-umbilical region to the right iliac fossa in the manner of classic appendicitis and when the symptoms begin during or are exacerbated by menstruation.
A modified circular stapler for gastrointestinal anastomosis
Authors: Papachristou Dimitri N , Fortner Joseph G
Published: March 2007

A circular stapler, which avoids the use of a purse-string suture, is described. The gut to be anastomosed is kept in position by a series of hooks. To avoid anastomotic bleeding two rows of B-shaped staples are inserted. The instrument is loaded manually with individual staples to reduce the cost. Experience with oesophageal anastomoses in 40 dogs showed that bleeding did not occur from the suture line and that there was only one leak from the anastomosis. Late stricture formation occurred in 1 dog.
Splenic abscess diagnosed with the aid of abdominal computerized tomography: Report of 2 cases
Authors: Baruch Y , Levy Y , Brook J G , Kleinhaus U , Hashmonai M
Published: March 2007

Two patients with splenic abscess successfully diagnosed and treated are described. The first case, a diabetic, developed a pyogenic abscess caused by klebsiella, while the other suffered a splenic infarct complicated by splenic abscess. Although relatively easy to treat, solitary abscess of the spleen is a potentially lethal condition due to diagnostic difficulties. In both present instances the final diagnosis was easily achieved before surgery by the aid of computerized tomography (CT). This investigation seems to be more accurate than 99Tcm-sulphur colloid scan and ultrasound scan, which failed in both cases to diagnose splenic abscess clearly. The use of this investigation is suggested in every suspected case and will, no doubt, confirm the diagnosis at an early stage of the disease. Splenectomy with antibiotic cover will usually result in cure.
Expanded polytetrafluoroethylene grafts for severe lower limb ischaemia
Authors: Kidson I G , Stoney D W , Tibbs D J , Morris P J
Published: March 2007

Three years' experience with the use of expanded polytetrafluoroethylene grafts for severe lower extremity ischaemia are reported; 44 femoropopliteal bypasses were performed, 35 for limb salvage. The prosthesis was used when no saphenous vein was available (23) or to shorten operation time in infirm patients (21). Of 41 patients with a mean age of 70 years,19 had significant ischaemic heart disease and 10 were diabetic.

The mean follow-up period for patent grafts is now 16 months (4–39 months), and the overall life-table cumulative patency is 59 per cent at 6 months, 52 per cent at 1 year and 40 per cent at 2 years. No correlation wasdemonstrated between patency and run-off, diabetes or smoking, but above-knee grafts may do better than those below the knee. Twenty grafts have occluded leading to 12 amputations, 3 further reconstructions and 1 death. Nine other deaths have occurred from causes not directly related to the lower limb ischaemia, 4 perioperatively and 5 later.

The grafts described were used in elderly unfit patients, most of whom would have had amputations before the introduction of polytetrafluoroethylene grafts. The results presented support the continued evaluation of this prosthesis in suchselected cases.
Retroperitoneal fibrosis—an association with hyperuricaemia
Authors: Cullen T H
Published: March 2007

A review of a small series of cases with idiopathic retroperitoneal fibrosis revealed that two of the patients had been under treatment for gout prior to developing retroperitoneal fibrosis. Investigation showed that other patients in theseries had hyperuricaemia. Examination of the retroperitoneal fibrotic tissue demonstrated the presence ofurate crystals in unusually high numbers. It is suggested that the pathological process of retroperitoneal fibrosis in these cases may have been initiated by the deposition of urate crystals in the retroperitoneal connective tissue and that the same process may be related to the causation of idiopathic hydrocoele.
Glutamate metabolism in malnutrition and sepsis in man
Authors: Kingsland Penelope A , Kingsnorth A , Royle G T , Kettlewell M G W , Ross B D
Published: March 2007

The metabolism of intravenous glutamate has been studied for its usefulness as a nutrient in intravenous feeding regimens. Intravenously infused monosodium Lglutamate was rapidly removed from the blood with a halflife of 10·7 and 9·1 min in healthy control and malnourished septic patients, respectively. Under the same conditions, alanine was metabolized much more slowly, with a half-life of 35 min (1). After the infusion of glutamate, blood lactate fell and glucose was increased in the control patients but not in the sick patients. Blood pyruvate, ketone bodies, glutamine, aspartate and alanine levels did not change after the infusion of glutamate in either group of patients. Increased urinary excretion of aspartate was observed in the control patients following the infusion of glutamate, but in the sick patients there was an increased excretion of glutamine. Insulin concentration in the blood rose after the infusion of glutamatein the control patients but not in the sick patients. Although the glutamate half-life was similar in thetwo groups of patients, glutamate was metabolized differently in the sick. Deamination predominates over transamination. We conclude that glutamate, in the amounts provided in intravenous feeding, is safe, although its effectiveness may be less than previously thought.
Yersinia and viruses in acute non-specific abdominal pain and appendicitis
Authors: Morrison James Dougall
Published: March 2007

Four out of 24 patients presenting as an emergency with acute non-specific abdominal pain showed serological evidence of infection with Yersinia pseudotuberculosis. Two out of 13 patients presenting with acute appendicitis during the same period also had evidence of Yersinia infection. Viral infection was present in only 1 patient in each group. Since it is rare to find antibodies to yersinia in healthy individuals, it seems likely that yersinia is a cause of some cases of non-specific abdominal pain. Viral infection does not appear to be an important aetiological factor in patients over 12 years of age.
The effect of topical povidone iodine on wound infection following abdominal surgery
Authors: Gray J G , Lee M J R
Published: March 2007

The effect of povidone iodine on wound sepsis following gastrointestinal surgery was studied in a trial involving 153 patients of whom 72 had their wounds sprayed with povidone iodine dry powder (Disadine DP) and 81 acted as a control group. The infection rate of 9·9 per cent in the patients treated with povidone iodine was significantly lower than that of 24·4 per cent in the control group (P<0·05). Bacterial contamination of the wound at the time of operation was shown to be of importance, being associated with a 52 per cent infection rate in the control group. However, spraying of contaminated wounds with povidone iodine reduced the infection rate to the significantly lower level of 11 per cent (P<0·05). We conclude that povidone iodine is a safe and effective means of reducing wound sepsis following gastrointestinal surgery.
A new method for the assessment of gut viability
Authors: Piasecki Christopher
Published: March 2007

A surface polarographic oxygen electrode was modified so that on the basis of physical considerations its reading became dependent on blood flow. The preliminary results show that when applied to the serosal surface of the bowel under operative conditions, readings correlated well with total blood flow to the segment measured by electromagnetic flowmetry. Graded local ischaemic areas could also be detected. Readings from the serosal surface appeared to be independent of those from the mucosa. The instrument may therefore provide a useful surgical tool for detecting partially ischaemic areas of bowel.
Presentation and outcome of strangulated external hernia in a district general hospital
Authors: Andrews N J
Published: March 2007

Two hundred consecutive emergency hernia operations are reviewed. Mortality from this condition has not significantly altered in the past 30 years. Half of the patients presented 48 h or more from the onset of symptoms. Mortality and bowel resection were clearly linked with the duration of symptoms prior to admission. There were no reliable clinical signs to predict the likelihood of bowel strangulation. Recurrent incisional and femoral hernias were associated with high resection rates and mortality. Right-sided hernias appeared to strangulate more frequently than left-sided hernias.
Abdominal emergencies in a tropical African population
Authors: Ajao Oluwole G
Published: March 2007

A decade ago intestinal obstruction was the commonest cause of general surgical abdominal emergency admissions in many tropical African countries. Recently, there has been a change in this pattern and acute appendicitis has become the major cause of emergency admissions.

Most cases of intestinal obstruction are due to obstructed (strangulated or incarcerated) groin hernia. Intestinal ascariasis is a declining cause of intestinal obstruction while colorectal cancer is now an important differential diagnosis. Trauma due to road traffic accidents is increasing in frequency. Gallbladder disease is not a major problem; symptoms suggestive of acute gallbladder disease are more likely to be due to an amoebic abscess in the West African environment.
Suprapubic bladder drainage in colorectal surgery
Authors: Christensen P Borup , Kronborg O
Published: March 2007

Seventy-six consecutive patients were studied prospectively in order to assess the value of suprapubic bladder drainage following surgery of the rectum and sigmoid colon. An Argyle—Ingram catheter (ICI) was inserted after the laparotomy incision had been made and the bladder was drained continuously for 24 h after which the catheter was closed and opened only every 6h for 10 min. The patients were invited to void at will after the first 24 h. The catheter was removed when the post-voided volume became less than 50 ml on each of two subsequent measurements. The longest period of drainage was necessary after rectal excision, while rectosigmoid resections demanded shorter periods. The catheter did not function in one patient and urethral catheterization became necessary after removal of the suprapubic catheter in 4 patients. The method of suprapubic bladder drainage is recommended because it permits spontaneous voiding, allows measurement of residual volume without urethral instrumentation, gives little discomfort to the patient and has few complications.
Recurrence of pancreatic ascites due to a second leak demonstrated radiologically
Authors: Russell D Mcr , Roberts-Thomson I C , Macrae F A , Kitchen P R B , Sherson N D
Published: March 2007

A case of recurrent pancreatic ascites is reported in which both episodes were investigated by endoscopic retrograde pancreatography.