bluuebunny/crossref_metadata_2025 huggingface dataset:
Doppler ultrasound in the diagnosis of the popliteal artery entrapment syndrome
Authors: Miles S , Roediger W , Cooke P , Mieny C J
Published: March 2007

Doppler pulse recordings in a patient with asymptomatic popliteal entrapment were compared with those in 25 normal subjects. A drop in pulse amplitude and ankle systolic pressure produced by forcible leg extension and active foot plantar flexion distinguished the patient with the anomaly from the controls, in whom no change was noted during these manœuvres. This simple, non-invasive test thus diagnosed a potentially limb-threatening congenital abnormality in an asymptomatic patient with equivocal arteriographic findings.
The incidence of malignancy in carotid body tumours
Authors: Gaylis H , Mieny C J
Published: March 2007

Twenty-three patients with 24 carotid body tumours are reviewed. A high incidence of malignancy (30 per cent) was encountered. It is recommended that all carotid body tumours be removed unless there are contraindicating medical or technical reasons.
Postoperative depression of lymphocyte transformation response to microbial antigens
Authors: Kehlet Henrik , Thomsen Mogens , Kjær Mogens , Platz Per
Published: March 2007

Cell mediated immunofunction, as expressed by total lymphocyte count, B and T cell count, in vitro blastogenic response to unspecific mitogens (phytohaemagglutinin and poke weed mitogen) and microbial antigens (Candida albicans, purified protein derivative, Staphylococcus aureus and Escherichia coli), was assessed in 8 otherwise normal patients undergoing elective, uncomplicated gastric surgery. The results showed a significant depression in all parameters on the first and/or third postoperative day, except for the blastogenic response to unspecific mitogens, which was unchanged throughout the study. Compared with the preoperative value, the total lymphocyte count decreased by 48 per cent with a similar fall in both T and B cells. The blastogenic response to C. albicans, purified protein derivative, Staph. aureus and E. coli decreased by 45, 42, 75 and 76 per cent respectively. When measured on the seventh and ninth postoperative days all parameters had returned to preoperative levels. Thus, even during clinically uncomplicated surgery, significant cell mediated immunodepression can be demonstrated by the blastogenic response of peripheral lymphocytes to common microbial antigens. The results suggest that this phenomenon may be secondary to the disappearance of specific reactive lymphocytes from the peripheral blood following surgical trauma.
A survey of protein nutrition in patients with inflammatory bowel disease — a rational basis for nutritional therapy
Authors: Hill G L , Blackett R L , Pickford I R , Bradley J A
Published: March 2007

The incidence of protein malnutrition was studied in 74 unselected patients with inflammatory bowel disease who were in the following categories: ileostomy (16), remission (15), elective surgery (12), acute attack (12), urgent surgery (10) and post-surgical complications (9).

Compared with a control group, the patients in the urgent surgery group had low values for plasma albumin, transferrin, pre-albumin and haemoglobin and these values were even lower in the patients who developed a major complication after surgery. There was no evidence of protein malnutrition in the ileostomy patients or in those in whom the disease was in remission.

Nutritional therapy is strongly indicated in patients who are admitted to hospital with a severe attack of colitis and in whom urgent surgery is probable.
Tumour stimulation by anti-oestrogens
Authors: McIntosh I H , Thynne G S
Published: March 2007

Two women who developed tumour progression while taking anti-oestrogens are described and some of the possible mechanisms for this action are discussed.
Lignocaine: Its effects on wound healing
Authors: Morris Tom , Tracey Jocelyn
Published: March 2007

In the light of clinical observations that local anaesthetic impairs wound healing, the effect of lignocaine at various concentrations, with and without adrenaline, on the tensile strength of skin wounds in rats 3, 5 and 7 days after operation was studied. Lignocaine had an adverse effect on wound healing at 5 and 7 days, perhaps due partly to the destructive effect of the intra-and subcutaneous injection, but certainly due also to the lignocaine itself. Adrenaline potentiated this effect.

It was concluded that it is better to use dilute solutions of lignocaine, preferably without adrenaline, for local anaesthesia.
Day care and short stay surgery for hernia
Authors: Ruckley C A
Published: March 2007

The duration of postoperative stay has been falling in recent years as more conditions are considered suitable for outpatient cure. The introduction of short stay surgery not only relieves hospital waiting lists but also represents an economic advantage and has certain social benefits for the patients.

The treatment of more patients as day cases reallocates the workload, putting increased responsibility on to outpatient clinics and general practitioner and community services. It also demands careful consideration of in-hospital operative and anaesthetic techniques to speed recovery and minimize complactions.
Radical mastectomy: A 27-year survey
Authors: Clyne Charles A C , Younghusband J D
Published: March 2007

Records of 736 cases of breast cancer presenting to one of the authors (J. D. Y.) have been kept over 27 years. The principles of treatment have remained the same throughout the survey. A radical mastectomy was carried out for stage I and early stage II cases, and when axillary nodes were histologically involved, immediate radiotherapy was given. The 5-, 10- and 15- year survival figures are reported.
Localization of a phaeochromocytoma situated in the peivis by radionuclide scanning
Authors: Vellar I D A , Chmiel R , Cahill J
Published: March 2007

Accurate localization of an extra-adrenal (pelvic) phaeochromocytoma was achieved by radionuclide scanning using 99 Tcm-Sn-DTPA. This facilitated the planning of the surgical approach and the subsequent removal of the tumour.
Flow and function in machine-preserved kidneys
Authors: Sampson Derek , Kauffman H Myron , Walczak Peter
Published: March 2007

One hundred machine-preserved cadaver kidneys were transplanted irrespective of their flow rates on the preservation machine. Twenty-five per cent had flows of below 100 ml/min and 11 per cent had flows of below 80 ml/min. There was no correlation between the flow rate and function at 1, 3 or 12 months. There was no difference in the flow rate between those kidneys which functioned immediately and those which never functioned. A fall in flow rate was associated with acute tubular necrosis of longer duration but eventual function was not impaired. There was a higher incidence of early aggressive rejection in kidneys which functioned immediately. Preservation failure per se is a rare cause of primary non-function. Adherence to a policy of ignoring the flow characteristics of machine-preserved kidneys could make up to 25 per cent more kidneys available for transplantation.
Peritoneal lavage in appendicular peritonitis
Authors: Stewart D J , Matheson N A
Published: March 2007

Peritoneal lavage resulted in a significant reduction in the duration of hospital stay in a retrospective series of 189 children with peritonitis secondary to perforation of the appendix. Antibiotic peritoneal lavage also resulted in a significant reduction in the number of children with septic and adhesive complications compared with antiseptic lavage and no lavage, mainly as a result of fewer wound infections. The overall incidence of residual intraperitoneal infection was low, and although differences in this respect were not significant, none of the children treated with antibiotic peritoneal lavage required reoperation for intraperitoneal sepsis.
Rupture of a hydatid cyst of the liver into the biliary tract
Authors: Mustafa Raja , Salih Hazim Hameed
Published: March 2007

The history of a patient with intrabiliary rupture of a hydatid cyst of the liver is reported. The patient presented with a distended palpable gallbladder, which is a most unusual feature of this condition.
Proximal gastric vagotomy without drainage for duodenal ulcer: Results after 5–8 years
Authors: Goligher J C , Hill G L , Kenny T E , Nutter E
Published: March 2007

Experience with proximal gastric vagotomy without drainage in the treatment of 316 men with duodenal ulcer is surveyed, with particular reference to the 117 who have been followed up for 5–8 years and whose results are compared with those obtained after other standard elective operations.

There were no operative deaths. Symptoms suggestive of recurrent ulceration developed in 12·0 per cent of the entire series of 316 cases, but in only 3·8 per cent was the presence of a recurrent ulcer definitely established. In the 117 cases followed up for 5–8 years similar symptoms were noted in 15·4 per cent, but the presence of a recurrent ulcer was proved in only 4·3 per cent.

At 5–8 year follow-up dumping was virtually completely absent and diarrhoea was significantly less than after truncal vagotomy with drainage or antrectomy, whilst there were insignificant reductions in the incidence of post-prandial epigastric fullness and bile vomiting.

Visick grading at 5–8 years rated the result as excellent or very good in 75 per cent of the cases, as fair in 13 per cent and as a failure in another 12 per cent.

The advantages and disadvantages of proximal gastric vagotomy without drainage relative to those of truncal vagotomy with drainage or antrectomy are discussed.
Highly selective vagotomy using tantalum clips
Authors: Salaman John R
Published: March 2007

A technique is described for performing highly selective vagotomy in cases of duodenal ulcer. Tantalum clips are used instead of conventional ligatures for securing the nerves and blood vessels that pass to the lesser curve of the stomach. With this technique the author has found the operation of highly selective vagotomy quicker and easier to perform.
Transection of the trachea secondary to blunt trauma
Authors: Lawhorne Thomas W , Jeyasingham K , Kieffer Richard F
Published: March 2007

Tracheal injuries secondary to blunt trauma are not common and complete tracheal transection is even more unusual. Because the incidence of these treatable, but often lethal, injuries is increasing, more surgeons will encounter them. A report of the treatment of a case of tracheal transection due to blunt trauma with emphasis on avoiding unnecessary tracheostomy is presented, with a review of the literature.
Two cases of giant intestinal gas cyst
Authors: Ingram N P , Holford C P , Ellis W R
Published: March 2007

Large gas cysts of the colon are uncommon and only some 30 cases have been reported (Moss, 1975). They usually arise from the sigmoid colon and are always associated with diverticular disease (Schenken and Cochran, 1972). In view of their rarity, 2 further cases with different presenting factors are discussed.
Cure of intractable watery diarrhoea by excision of a vipoma
Authors: Modlin Irvin M , Bloom Stephen R , Barnes A , Welbourn R B
Published: March 2007

A 56-year-old man suffered unexplained watery diarrhoea for 5 years which ultimately produced quadraparesis due to serve potassium depletion. All investigations were negative until demonstration of elevated plasma vasoactive intestinal peptide (VIP) indicated the presence of a vipoma. Removal of the VIP-producing tumour tissue–an adrenal ganglioneuroma–resulted in complete cure. Plasma VIP measurement is thus a valuable diagnostic screen in such cases and can be used to predict prognosis and to guide further therapy.
Acute non-calculous cholecystitis in burns
Authors: Alawneh I
Published: March 2007

Seven burned patients developed acute cholecystitis within 10-37 days of injury, associated with jaundice in 5. There were 6 males and 1 female, with 5 patients aged 28-40 years, the others being 56 and 69 years. Cholecystectomy was performed in all patients with 1 death. It is suggested that the cause of post-burn cholecystitis is traumatic and septic shock with consequent biliary stasis.
The treatment of haemobilia
Authors: Taylor S A , Dawson J L
Published: March 2007

This paper describes 4 cases of haemobilia. The use of hepatic arterial ligation in its management is discussed. Attention is drawn to the raised serum amylase level in the 2 patients in whom it was measured.
The effect of smoking on the late patency of arterial reconstructions in the legs
Authors: Myers K A , King R B , Scott D F , Johnson N , Morris P J
Published: March 2007

In a retrospective study of 217 patients, smoking habits were related to the late patency rates of arterial reconstructions performed for ischaemia of the legs. Patients who had stopped smoking or who smoked no more than 5 cigarettes per day after the operation had late patency rates of approximately 90 per cent for aortofemoral reconstructions and 80 per cent for femoropopliteal vein grafts. Patients who continued to smoke more than 5 cigarettes per day were approximately three times more likely to block an aortofemoral reconstruction and four times more likely to block a femoropliteal vein graft. The results were similar for males and females, for various age groups, for claudicants and patients with severe ischaemia and for aortofemoral endarterectomy and Dacron grafts.

The late patency rate was approximately inversely proportional to the number of cigarettes smoked per day after the operation. There was no such correlation with the number smoked per day before the operation.
Lord'sprocedure: A critical study of its basic principle
Authors: Ortiz H , Marti J , Jaurrieta E , Masdevall C , Ferrer J , Sitges A
Published: March 2007

In 5 patients affected by second-degree haemorrhoids a biopsy of one of the bands mentioned by Lord was taken and studied by light microscopy using Masson'stechnique. The study proved the structures to be normal smooth and striated muscle fibres. Anal pressure was studied preoperatively in 20 patients with haemorrhoids and postoperatively in 25 patients, 14 after a Lord'sprocedure and 11 after a conventional Milligan and Morgan procedure. A statistical study of the pressure values obtained in the three groups at centimetre intervals showed no significant differences between the three groups except when we compared the values obtained at 1 cm of the anal verge in untreated patients and in those operated on by the Milligan and Morgan procedure.

Sixty patients affected by second- or third-degree haemorrhoids without other anal complaints were randomly allocated to one of two groups. Thirty were operated on by Lord'smethod and the other 30 by the Milligan and Morgan procedure. Fifty-two of the 60 patients were followed up for 1 year or longer post-operatively. Twenty-eight had been operated on by Lord'smethod and the other 24 by the Milligan and Morgan technique. Clinical results were statistically assessed within and between techniques. The study showed that with both methods bleeding, prolapse and pain disappeared but that pruritus was not modified by the operations. On the other hand, the results suggest that Lord'smethod produces flatus incontinence. The results of the statistical comparison between techniques showed that there is no signficant difference between the two methods in respect of prolapse, pain and pruritus. On the other hand, the results obtained for prolapse and incontinence with the Milligan and Morgan technique were significantly better than with Lord'smethod. Our results suggest that stretching of the anal sphincters does not have the physiopathological basis suggested by Lord. From a clinical point of view, the limited number of controlled patients in our series on 1-year follow-up only does not allow final conclusions to be drawn.
The bacterial flora of the biliary tract and liver in man
Authors: Dye M , Macdonald A , Smith G
Published: March 2007

A bacteriological study was made of 106 patients undergoing elective surgery for gallbladder disease and as a control group, of patients with a normal biliary tract but requiring laparotomy for gastrointestinal disease. The isolation rate of all species of bacteria from the gallbladder and common bile duct in those patients with calculi in the duct system and in those with nonfunctioning gallbladders was considerably higher than in patients with a normal biliary system. Surprisingly, the number of isolates from patients with a history of cholsecystitis or cholelithiasis was no greater than in the control group of patients.

Using modern techniques of anaerobic retrieval and culture, only a small number of anaerobes were isolated, and despite the prevalence of Bacteroides species as a normal gut inhabitant and as an opportunistic pathogen, this organism was not recovered from any of the sites investigated. Anaerobic species were Isolated from 8 out of the 106 liver biopsy specimens taken at a very early stage after laparotomy, but in such patients only non-specific liver changes were found by histological examinmation. In 8 patients from whom Escherichia colt or other aerobes were isolated from bile samples, at concentrates ranging from 105 to 107/cm3, the same species of organism were consistently isolated from T tube drainage samples for up to 8 or 9 days despite tetracycline therapy.
Causes of failure in the surgical treatment of primary hyperparathyroidism: Lessons from 51 successful reoperations
Authors: Van Vroonhoven Theo J , Muller Herry
Published: March 2007

A review of 51 successful reoperations for persisting hypercalcaemia due to primary hypeparathyroidism shows that inadequate anatomicla knowledge, inadequate surgical technique and unusual localizations of the parathyroids are the most frequent causes of failure of the primary operation. The majority of these failures are therefore preventable. There is a frequent need for cervical thymectomy in parathyroid surgery. Stenotomy is only very rarely necessary.
Non-operative removal of retained stones in the common bile duct
Authors: Rees B I , Lawrie B W
Published: March 2007

A method of removal of retained common bile duct stones under radiological control is described and its use in 16 patients reported. The case of the method, the minimal associated morbidibity and the inexpensiveness of the equipment suggest that this should be the primary method of removal of retained stones when a T tube has been placed into the common bile duct.
A method of treating post-irradiation rectovaginal fistulas
Authors: Parks A G , Allen C L O , Frank J D , McPartlin J F
Published: March 2007

A sphincter-saving operative method of treating post-irradiation rectovaginal fistulas is presented. The technique involves the peranal anastomosis of healthy colon to the mid-anal canal using a ‘sleeve’ anastomosis. Four patients have been treated with cure of the fistula and a return to normal bowel habit. A fifth, with an irradiation ulcer causing intractable pain, also obtained complete relief of symptoms.
Unusual small intestinal obstuction in adolescent girls: The abdominal cocoon
Authors: Foo K T , Ng K C , Rauff A , Foong W C , Sinniah R
Published: March 2007

Ten cases of small intestinal obstruction seen over a period of 6 years (1971-6) in young girls within the narrow age range of 13-18 years are described. The patients were all within 2 years of menarche.

In all these cases the obstruction was due to a membrane encasing the small intestine in the manner of a cocoon. There was no previous history of abdominal operation, peritonitis or prolonged drug intake.

The clinical features, operative findings and management of the cases are presented. Possible causes of the condition are discussed. In view of the similar clinical presentation in all these patients, their conditions can be grouped as a clinical entity–‘the abdominal cocoon’.
Adenocarcinoma of the oesophagus and of the oesophagogastric junction
Authors: Webb J N , Busuttil A
Published: March 2007

The clinical and pathological features of 52 adenocarcinomas invading the oesophagus and the oesophagogastric junction are reviewed. The relationship of these tumours to the presence of a concomitant hiatal hernia and the histogenesis of primary oesophageal adenocarcinomas are discussed. Adenocarcinomas of the cardio-oesophageal junction appear to have distinctive prognostic and pathological features and there may be a case for their classification into a separate category of alimentary neoplasms.
Diminished cellular immunity due to impaired nutrition in oesophageal carcinoma
Authors: Haffejee A A , Angorn I B , Brain P P , Duursma J , Baker L W
Published: March 2007

The nutritional status of 15 Negro patients suffering from unresectable carcinoma of the midthoracic oesophagus was evaluated before and after palliative pulsion intubation. All were shown to be in negative nitrogen balance and to have a compromised nonspecific cellular immune response. Correction of protein-calorie malnutrition and the achievement of positive nitrogen balance were associated with an increase in absolute lymphocyte and T lymphocyte numbers and a significant increase in lymphocyte response to PHA. The improvement in immunological reactivity occurred without any attempt at therapeutic reduction in tumour bulk.
Thyroglossal cysts in children
Authors: Brereton R J , Symonds Elizabeth
Published: March 2007

Of 69 cases of midline cervical swelling in children, the correct diagnosis was made in only 38 (55 per cent). Fifty cases of thyroglossal cyst or abscess were treated and 38 per cent suffered recurrence. Apart from failures in diagnosis, the main reasons for preventable recurrence were delay in surgery, failure to resect part of the body of the hyoid bone and a tendency to excise that portion of the duct above the level of the hyoid with insufficient surrounding muscle. In cases without florid abscess formation, the aim should be to perform a radical operation as soon as possible, then cure can be guaranteed at the first operation. Recurrence may occur many years after an apparent cure. Cysts in the submental region are not often recognized as being of thyroglossal duct origin.
Depot penicillin as prophylaxis in accidental wounds
Authors: Hutton P A N , Jones B M , Law D J W
Published: March 2007

A series of 285 patients attending an accident and emergency department with wounds which required suturing was divided at random into two equal groups. The first group received a single dose of depot penicillin at the time of suture and the second group received no antibiotic cover. The incidence of subsequent wound infection was not significantly reduced in patients who received penicillin.
Use of the carbon dioxide laser in an abdominoperineal resection for epidermoid anal carcinoma: A case report
Authors: Shafir Raphael , Zweig Amiel , Slutzki Sam , Bornstein Leo A
Published: March 2007

An abdominoperineal excision of the rectum was performed on a 52-year-old male who had epidermoid anal carcinoma. A steel scalpel was utilized for the abdominal component, but the entire perineal resection was accomplished with a carbon dioxide laser beam. We believe this to be the first reported case of an abdominoperineal resection using this new modality, which may become a useful and modern adjunct in extirpative surgery. The haemostatic effects of the laser were well demonstrated in our patient.
The effect of reversed jejunal segments on the myoelectrical activity of the small bowel
Authors: Tanner W A , O'Leary J F , Byrne P J , Hennessy T P J
Published: March 2007

Short reversed jejunal segments increase intestinal transit time clinically. In view of the correlation between motility and myoelectrical activity, we have investigated the effect of jejunal reversal and transention on the latter in 10 mongrel dogs. There is a significant decrease in the basic electrical rate in and below both transected and reversed jejunal sergments. There is a 3 per cent incdence of retrograde electrical activity within a transected segment and a 24 per cent incidence in the intestine distal to it. In reversed segments the incidence of retrograde activity is 60 per cent within the reversed segment and 61 per cent in the jejunum distal to it.
Peritoneal dialysis in obstructive jaundice: An experimental study
Authors: Kaushik S P , Subrahmanyam M , Kumar M , Chakravarty R N
Published: March 2007

Rats were subjected to common bile duct ligation, after which intermittent peritoneal dialysis with a buffered solution containing rat plasma proteins was carried out in an attempt to reduce plasma bilirubin levels.

Plasma bilirubin increased significantly (P <0.01) on the seventh day and was still rising 12 days after ligation of the common bile duct. Dialysis was performed during the second postoperative week. Provided that rat plasma protein was present in the dialysing fluid, dialysis significantly reduced (P <0.01) the levels of total plasma bilirubin, conjugated bilirubin and serum GPT in the experimental animals.
Non-operative treatment of retained bile duct calculi in patients with an indwelling T tube
Authors: Christiansen L A , Nielsen O V , Efsen F , Hasner Eivin
Published: March 2007

The results of combined instrumental and chemical treatment of retained bile duct calculi in 18 patients with an indwelling T tube are reported. The instrumental extraction of stones was carried out through the T tube channel using a modified Dormia apparatus. The chemical method involved continuous infusion through the T tube of heparin in saline alternating with sodium cholate. The treatment was successful in 16 of 18 patients with from 1 to 14 residual stones. The instrumental extraction of stones in recommended as the treatment of choice 5-6 weeks after choledochotomy in patients with residual stones and an indwelling T tube. Subsequent chemical treatment is recommended if remnants of stones are left in the bile duct after instrumental treatment.
Technical aspects of injection sclerotherapy of acute oesophageal variceal haemorrhage as seen by radiography
Authors: Barsoum Maged Sami , Khattar Nabil Youssef , Risk-Allah Mounir Azmy
Published: March 2007

Certain aspects of the technique of injection sclerotherapy are illustrated in a series of 15 patients presenting with acute oesophageal variceal haemorrhage due to bilharzial hepatic fibrosis. The results of this form of treatment are fibrosis. The results of this form of treatment are shown. The actual process of variceal injection was done under visual fluoroscopic control, using a mixture of 76 per cent Urografin and 5 per cent ethanolamine oleate. The findings showed that: (a) the sclerosant did not reach the gastric varices which could be a possible source of re-bleeding; (b) intravariceally injected material rapidly escaped from the submucosal varices, where it should stay, to the peri-oesophageal veins; (c) selerosant remaining on the variceal walls was minimal by the time the Sengestaken tube was inflated.
Topical noxythiolin in colonic healing
Authors: Rosin R D , Exarchakos G , Gilmore O J A , Ellis H
Published: March 2007

Rats were subjected to division and anastomosis of the colon just proximal to the rectum to study the healing of colonic anastomoses. The effect of noxythiolin irrigation of the divided colon before and after anastomosis was investigated and compared with controls. Healing was assessed using five variables–macroscopic and microscopic inspection, bursting pressure and tensile strength estimations and angiography for new vessel formation. The study shows that noxythiolin irrigation of the colon in the rat significantly increases the chance of a sound anastomosis without interfering with healing. Furthermore, it inhibits the formation of adhesions.
The effect of elective surgery on 3-methylhistidine excretion
Authors: Gross E , Holbrook I B , Irving M H
Published: March 2007

Elective surgical operation in normally nourished patients is associated with an increase of up to 40 per cent in the urinary excretion of 3-methylhistidine during the first three postoperative days. This increase was statistically significant (P<0.01) on the second and third postoperative days. This probably represents a minor degree of increased muscle proteolysis, principally due to the operative trauma. The possible effect of postoperative starvation requires further elucidation.
Intraoperative autotransfusion for elective aortic surgery
Authors: Greenhalgh R M , Kirk C J C , Bartoll A , Owen J , Mitchell T R , Gerken A , Master B , Gregory I C
Published: March 2007

Intraoperative autotransfusion using the Bentley ATS 100 was used in 23 patients requiring Dacron replacement of their abdominal aorta. An average of 2000 ml of blood was reinfused and a total heparinization dose was given. The mean haemoglobin fell 2·8 g/dl and on average 2 pints of banked blood were given in the post-operative period. Coagulation studies performed before and after surgery showed minimal alteration. We feel that further evaluation of this system is essential so that an alternative is established for when banked blood is not available. The system is particularly useful at the present time for such emergencies as a leaking abdominal aortic aneurysm and severe trauma to the live.
Parathyroid hormone and calcium homeostasis in acute pancreatitis
Authors: Imrie C W , Beastall G H , Allam B F , O'Neill Jennifer , Benjamin I S , McKay A J
Published: March 2007

Sequential daily measurements of plasma parathyroid hormone (PTII) have been performed in 89 patients with acute pancreatitis. A total of 439 PTH assays was obtained during 98 episodes of the disease. Three main patterns of PTH response were found. These responses were correlated with severity of disease graded by objective criteria and also to corrected serum calcium levels. The first type of PTH response was characterized by significantly elevated PTH levels soon after hospitalization with a subsequent decrease in levels to within the normal range by the third or fourth day of illness. This type of response was specifically associated with transient severe hypocalcaemia (corrected calcium <2·0 mmol/1). It was also associated with the most severe forms of disease and 6 of the 7 deaths. The second type of PTH response revealed initial PTH values in the upper level of the normal range (400–600 ng/l) while persistently low PTH levels were characteristic of the third type of response. Persistently low PTH levels were associated with normocalcaemia, and no patient in this group died. None of a group of 14 control patients exhibited the type 1 PTH response. An effective PTH response to an unidentified hypocalcaemic stimulus results in satisfactory calcium homeostasis in most patients with acute pancreatitis.
Aneurysm of the popliteal artery secondary to trauma from an osteochondroma of the femur: A case report and review of the literature
Authors: Shah P J R
Published: March 2007

An unusual case of a popliteal aneurysm due to an osteochondroma of the femur in a young adolescent is presented. The clinical management and surgical treatment are described.
Highly selective vagotomy or truncal vagotomy and pyloroplasty for chronic duodenal ulceration: A randomized, prospective clinical study
Authors: Stoddard C J , Vassilakis J S , Duthie H L
Published: March 2007

The results of a randomized, prospective clinicol trial of highly selective vagotomy (HSV) versus truncal vagotomy and pyloroplasty (TVP) in 126 male patients undergoing elective surgery for chronic duodenal ulceration are presented. The operations were performed by surgeons of all grades of experience. At a mean follow-up time of just over 3 years a satisfactory result was obtained in 93 per cent of patients following HSV and 78 per cent of patients following TVP, the difference being probably statistically significant (P<0.05). The incidence of early and late dumping, bile vomiting, flatulence, post-prandial epigastric discomfort and wound infection was statistically significantly less after HSV than after TVP. Three patients have developed a recurrent duodenal ulcer after each type of operation (5.4 per cent). At this early stage HSV has advantages over TVP; it will be interesting to see if these are maintained with the passage of time.
Metronidazole prophylaxis for elective large bowel surgery in children: A prospective trial
Authors: Khan Omar , Nixon H H
Published: March 2007

In a controlled trial in children aged 2 days to 16 years undergong large bowel surgery a group of 15 patients had preoperative mechanical bowel preparation and oral neomycin while a second group of 15 patients was similarly prepared but also had preoperative and postoperative metronidazole medication.

Five of the 9 postoperative infections in the first group involved Bacteroides spp. but no anaerobe was found in the 3 wound infections in the metronidazole group.
Tuberculosis of the peritoneal cavity
Authors: Khoury George A , Payne Christopher R , Harvey David R
Published: March 2007

The clinical presentation and management of 30 consecutive patients with tuberculous pertonitis are reviewed. Seventy per cent of the patients were aged 40 years or less and 80 per cent were immigrants. The main clinical features of abdominal pain, loss of weight, vomiting and sweating at night had been present in a large number of patients for several months before presentation to hospital. The clinical diagnosis of tuberculous peritonitis was difficult in the absence of extraperitoneal tuberculosis. Laboratory investigations were of little value in establishing the diagnosis. An elevated ESR was found in 80 per cent of patients. At laparotomy omental biopsy was performed and was diagnostic in all cases. Laparotomy was a safe and fast method of obtaining tissue for confirmation of the diagnosis in suspected cases, particularly when presenting acutely. Ascitic fluid cultures and guinea-pig inoculations were positive in only 6 out of the 15 patients in whom they were performed. Only 1 patient died.
A review of 158 gunshot wounds to the chest
Authors: Ferguson D G , Stevenson H M
Published: March 2007

One hundred and fifty-eight gunshot wounds to the chest treated at the Royal Victoria Hospital, Belfast, between August 1969 and July 1976 are reviewed. The dplace of open operation in the treatment is discussed.
Talc granuloma of the ureter: A case report
Authors: Joannides J I
Published: March 2007

A patient presented with symptoms of ureteric colic. At laparotomy a ureteric stricture was found which was presumed to be tuberculous, but histological examination proved it to be a talc granuloma, the talc having been introduced as a glove powder 20 years previously during a hysterectomy operation.
Spinal epidural abscess presenting as acute abdomen in a child
Authors: Tyson G W , Grant A , Strachan W E
Published: March 2007

Spinal epidural abscess is seldom encountered in children and rarely occurs in the absence of spinal pain. A case is described in which a child with a thoracic epidural abscess presented with abdominal rather than spinal pain. Thoracolumbar radicular inflammation and visceroparietal refexes initiated by a ‘spinal ileus’ probably produced the symptoms and signs of acute intra-abdominal disease. Consideration of intraspinal disease is advisable in all cases of acute abdomen which exhibit atypical features.
Toxic dilatation of the colon in salmonella colitis and inflammatory bowel disease
Authors: Schofield Philip F , Mandal B K , Ironside A G
Published: March 2007

Toxic dilatation of the colon may be due to inflammatory bowel disease, either ulcerative colitis or Crohn's disease of the colon, but recent experience has shown that infective colitis due to salmonella can produce this complication. We present 13 cases with toxic dilatation (9 inflammatory bowel disease and 4 salmonellosis) and outline the diagnostic features and treatment in these patients. It is important to distinguish salmonellosis at an early stage because, whilst toxic dilatation in inflammatory bowel disease is an absolute indication for surgical treatment, cases with this complication due to salmonellosis may be treated conservatively in the majority of instances.
A clinical trial of endolymphatic therapy in malignant melanoma: Interim report of the progress of the Medical Research Council trial
Authors:   MRC working party on endolymphatic therapy in malignant melanoma, Bush R W
Published: March 2007

This report presents the interim results of the MRC trial on the treatment of Stage I melanoma of the lower limb by endolymphatic therapy.

Over a 10-year period a group of 146 patients has been entered into the trial. Although total recurrence rates were not significantly affected by endolymphatic therapy, recurrence in the lymph nodes was largely prevented. More patients in the standard treatment group needed the more major procedure of block dissection.

The survival rates for the endolymphatic and standard treatment groups did not differ significantly.
Internal fixation versus primary prosthetic replacement in acute femoral neck fractures: A prospective, randomized clinical study
Authors: Söreide Odd , Mölster Anders , Raugstad Tor Steinar
Published: March 2007

A prospective, randomized clinical study has been performed on 104 patients with an acute femoral neck fracture, comparing internal fixation (von Bahr screws) with primary prosthetic replacement (Christiansen endoprosthesis). Immediate weight bearing was allowed in both groups.

The postoperative mortality rate was similar in the two groups.

Internal fixation proved to be a less time-consuming operation, gave a shorter hospitalization time and was associated with a significantly reduced morbidity rate compared with prosthetic replacement. No blood transfusion was needed in the internal fixation group.

Primary prosthetic replacement was associated with earlier postoperative mobilization, probably gave a more definitive treatment with fewer reoperations, and showed better results at 1-year follow-up.
Changing pattern in aetiology of pancreatitis in an urban Swedish area
Authors: Svensson J-O , Norbäck B , Bokey E L , Edlund Y
Published: March 2007

Two groups of patients admitted with a first attack of acute pancreatitis are reviewed. The first group, consisting of 105 patients, was admitted between 1968 and 1969; the second group of 204 patients was admitted between 1974 and 1975. These groups were compared with one of 454 patients admitted between 1956 and 1960 whose details were published earlier by our unit (Edlund et al., 1968). The aim of this study was to determine whether the incidence of factors associated with pancreatitis within the population of the city of Göteborg had changed in the 20-year period. In the 1956–60 group gallstone disease was the main associated factor (68 per cent), but in the later groups alcohol-induced pancreatitis assumed the leading role (68 and 66 per cent respectively). Alcohol-induced pancreatitis tended to occur at a younger age than gallstone pancreatitis. Thirty-one per cent of 449 patients admitted with an acute attack of alcoholic pancreatitis in the two last periods of study had previous attacks.
The role of grey scale ultrasonography in the investigation of jaundice
Authors: McKay A J , Duncan J G , Lam P , Hunt D R , Blumgart L H
Published: March 2007

Sixty-seven patients were prospectively studied using grey scale ultrasound (GSU) to assess its possible role as part of a jaundice investigation programme. All scans were performed by one radiologist, without clinical information. When intrahepatic ductal dilatation was found an attempt was made to establish the level and cause of obstruction. The calibre of the intrahepatic bile ducts was correctly reported in 66 patients (98 per cent). Forty-three proved to have extrahepatic cholestasis, 24 had intrahepatic cholestasis. No patient with intrahepatic cholestasis had dilated ducts seen on ultrasound.

In 43 patients with obstructive jaundice, GSU accurately detected the level of obstruction in 28. This accuracy varied with the cause of obstruction. A direct indication of diagnosis was possible in 45 of the 67 patients.

In a unit specializing in the management of complicated hepatobiliary problems, GSU has been shown to be accurate in differentiating extra- from intrahepatic jaundice. Being non-invasive, it appears ideally suited for use as a screening procedure, permitting selection of appropriate invasive investigations to provide complete preoperative imaging of the biliary tree. In patients with jaundice due to gallstones, GSU may be the only imaging technique required before surgery provided good operative cholangiography is available.
The ultrasonic demonstration of portacaval shunts
Authors: Berger L A , Sagor G , George Phyllis
Published: March 2007

This study explores the use of ultrasound in the management of patients with portacaval anastomosis. Ten patients were studied; in 8 of these the status of the anastomosis was well demonstrated. It is suggested that ultrasound should be the initial investigation to determine the patency of a shunt.
Infusion cholecystography in the diagnosis of acute cholecystitis
Authors: Pinto D J , Burke M , Wilkins R A , Kark A E
Published: March 2007

The use of infusion cholecystography as an aid in the diagnosis of acute cholecystitis was investigated in 21 patients. Seventeen of 18 patients (94 per cent) with positive cholecyst-tomograms who underwent laparotomy had confirmation of acutely inflamed gallbladders both macroscopically and histologically. These findings suggest that infusion cholecystography can make a significant contribution in reducing the incidence of misdiagnosis in acute cholecystitis, and that the investigation should be part of the management of patients in whom early surgery is planned.
Operative choledochoscopy
Authors: Kappas A , Alexander-Williams J , Keighley M R B , Watts G T
Published: March 2007

We have reported the results of 121 examinations with the rigid choledochoscope performed by 13 different surgeons between 1969 and 1977. Pre-exploratory choledochoscopy was performed in 48 patients with a diagnostic accuracy of 94 per cent.

Post-exploratory choledochoscopy was used in 73 patients to define whether the common bile duct had been adequately cleared of stones. Fifty-one patients were correctly assessed as having a clear duct and unsuspected residual calculi were demonstrated by choledochoscopy in 13 patients. However, choledochoscopy failed to identify 9 patients with retained stones. The accuracy of post-exploratory choledochoscopy alone was 87 per cent and the accuracy of post-exploratory cholangiography was 82 per cent, but when choledochoscopy was combined with post-exploratory cholangiography there were no errors. We conclude that the addition of choledochoscopy to conventional radiological techniques is likely to reduce the incidence of residual calculi after choledochotomy.
A study of arterial prostheses by scanning electron microscopy
Authors: Conway P F , Simmens S C , Charlesworth D
Published: March 2007

Scanning electron micrographs were taken of ten different vascular prostheses. The micrographs showed that some prostheses were damaged and some had traces of chemicals on their surface. The application of standard vascular clamps damaged most grafts and some showed remarkable changes on resterilization.
A comparison between disposable and non-disposable suction drainage units: A report of a controlled trial
Authors: Britton B J , Gilmore O J A , Lumley J S P , Castleden W M
Published: March 2007

A randomized trial of high vacuum Redivac drains and low vacuum Portovac drains has been conducted in 46 female patients undergoing simple mastectomy through a transverse skin incision. The Redivac units drained less fluid, stayed in place for a day less than the Portovac units and were emptied once less often.
Late infection of a total hip prosthesis presenting as an ischiorectal abscess
Authors: Briggs R D , McLauchlan J , Davidson A I
Published: March 2007

Late infection of a total hip arthroplasty recently presented as an ischiorectal abscess. A likely pathogenesis is suggested and the literature on late infection in prosthetic joints is reviewed.
Angiodysplasia as a cause of colonic bleeding in the elderly
Authors: Bogokowsky H , Slutzki S , Alon H
Published: March 2007

Angiodysplasia is being recognized as a major causal factor of colonic haemorrhage in the elderly. Superior mesenteric arteriography in an 86-year-old lady with recurrent haemorrhage revealed the lesion. Confirmation of the diagnosis was made possible by the injection of contrast material into the blood vessels of the removed intestine and subsequent histological examination.
Ambulatory calf volume plethysmography in the assessment of venous insufficiency
Authors: Fernandes Fernandes J E , Horner J , Needham T , Nicolaides A
Published: March 2007

Ambulatory calf volume plethysmography has been used to study venous insufficiency in 50 lower limbs. The results demonstrate that it is possible to determine the presence of venous insufficiency and differentiate between normal limbs, limbs with superficial venous insufficiency only, limbs with deep venous insufficiency and limbs with deep venous insufficiency and occlusion by determining the ambulatory volume change and maximum venous outflow or venous volume.
The treatment of major liver trauma by primary packing with transfer of the patient for definitive treatment
Authors: Calne R Y , McMaster P , Pentlow B D
Published: March 2007

Four patients are reported in whom massive haemorrhage from severe hepatic trauma was managed initially by conservative surgery and packing. The patients were then transferred by ambulance to Addenbrooke's Hospital where further treatment involved elective surgery and removal of packs. All 4 patients were discharged from hospital and have made full recoveries. It is felt that the management of liver trauma should be to do the minimum that is necessary to staunch bleeding, by suture, arterial ligation, lobectomy, resectional débridement or simply by packing. This allows the patient's haemodynamic state to be restored to normal before further surgery is attempted.
Renal function and other factors in obstructive jaundice
Authors: Allison M E M , Prentice C R M , Kennedy A C , Blumgart L H
Published: March 2007

Renal function and other factors that possibly affect the outcome of operation were measured in 24 patients with obstructive jaundice and in 15 non-jaundiced controls. The preoperative features that were associated with a poor postoperative recovery from obstructive jaundice were a raised serum fibrinogen/fibrin degradation product concentration, infection, hypoalbuminaemia and a low glomerular filtration rate. Preoperative serum fibrinogen/fibrin degradation product concentrations were raised in 4 of the 6 jaundiced patients who died after surgery but in none of the controls, in whom there was no mortality.

In the jaundiced patients there was a greater incidence of postoperative renal impairment than in the controls. All patients were given mannitol during operation. Further mannitol was required after surgery in 13 of the 24 jaundiced patients in order to maintain urine flow rate despite adequate intravenous fluids being given. In contrast, only 1 of the 15 control patients required postoperative mannitol.

It is emphasized that repeated doses of mannitol can lead to a profound natriuresis and adequate intravenous saline should be given.
Primary hydatid cyst of the gallbladder
Authors: Rigas A M , Karatzas G M , Markidis N C , Bonikos D S , Sotiropoulou G G , Skalkeas G
Published: March 2007

An unusual case of hydatid cyst of the gallbladder is presented. The difficulties in diagnosis are discussed. There is no other report of such a cyst in the world literature.
H2-antagonists in the treatment of recurrent ulceration after vagotomy
Authors: Clark C G , Boulos P B , Haggie S J , McDonald A M
Published: March 2007

Twenty-two patients with recurrent ulceration following vagotomy with and without a drainage procedure have been treated with histamine H2-antagonists and followed for up to 3 years. Four of a group of 6 patients responded to a single therapeutic course. Ten of 16 patients assigned to long term maintenance treatment remain symptom-free. Cimetidine may be an alternative to further surgery in the treatment of some patients with recurrent ulceration after vagotomy.