bluuebunny/crossref_metadata_2025 huggingface dataset:
An experimental study of the healing of secondary abdominal incisions
Authors: Van Noort R , Greaney M G , Smythe Anne
Published: March 2007

An experimental study of the healing of separate secondary abdominal incisions in rats has been performed. After an initial right subcostal incision, a vertical leftsided abdominal wound was made 1 or 2 weeks later. Wound healing was assessed by measurement of changes in mechanical strength and collagen deposition. The results indicate that an increase in mechanical strength was not effected by initial wounding despite alterations in collagen metabolism.
Abdominal wound closure: A trial of Prolene and Dexon
Authors: Cameron A E P , Gray R C F , Talbot R W , Wyatt A P
Published: March 2007

The incidence of wound infection, burst abdomen and incisional herniation after a vertical abdominal incision was studied in a prospective trial comparing polypropylene (Prolene) with polyglycolic acid (Dexon). Wounds were closed by interrupted mass suture with an optional reinforcing continuous closure of the anterior rectus sheath. A total of 347 patients was studied, randomly allocated to suture with either Prolene or Dexon. The two groups were well matched for known risk factors. Dehiscence occurred in 0·6 per cent of patients overall and at 6 months 5·7 per cent of cases had an incisional hernia, although many of these were asymptomatic. There was no difference in the rate of infection, disruption or herniation between the two suture materials.
The effect of prostaglandin synthesis inhibitors and diphosphonates on tumour-mediated osteolysis
Authors: Galasko C S B , Samuel A W , Rushton Stella , Lacey Eve
Published: March 2007

Previous studies have shown that the prostaglandin synthesis inhibitor indomethacin reduced osteolysis produced by the experimental VX2 carcinoma, probably by inhibiting the stimulation of osteoclasts by prostaglandin E2. This study was carried out to determine whether prostaglandin inhibitors affect the tumour osteolysis produced by human mammary carcinoma as the VX2 carcinoma. The effect of diphosphonates on reducing tumour osteolysis was also investigated, since diphosphonates directly affect bone resorption.

The results indicated that various non-steroidal, anti-inflammatory agents which inhibit prostaglandin synthesis reduced the osteolysis produced by human mammary or rabbit VX2 carcinomas. The diphosphonate compounds also produced a significant inhibition of tumour osteolysis.

The results confirm the findings of Powles and his colleagues (1) that aspirin (also a prostaglandin synthesis inhibitor) reduced the osteolysis induced by human mammary carcinoma. It is suggested that these agents be evaluated as adjuvant therapy in patients with apparently ‘early’ mammary cancer in a controlled clinical trial.
Presternal gastric bypass for unresectable carcinoma of the thoracic oesophagus: A preliminary report
Authors: Mannell Aylwyn
Published: March 2007

Presternal gastric bypass was performed on 10 African patients with unresectable carcinoma of the thoracic oesophagus. Where the cancer involved the lower third of the thoracic oesophagus the oesophagus was simply excluded. However, for cancer of the upper and middle third of the thoracic oesophagus the additional step of Roux-en-Y jejunal anastomosis to the intra-abdominal oesophagus was performed to drain away oesophageal secretions from existing or imminent tracheo-oesophageal fistulas. No patient died as a result of the operation, and 9 out of 10 patients were able to eat normally afterwards. Presternal gastric bypass is compared with other methods of palliation for unresectable carcinoma of the thoracic oesophagus.
Prophylactic use of metronidazole in preventing wound sepsis after elective cholecystectomy
Authors: Halsall Andrew K , Welsh Christopher L , Craven John L , Hopton David S , Peel R Nigel
Published: March 2007

The effect of intravenous metronidazole as prophylaxis against postoperative wound infection was studied in a prospective, randomized, double-blind controlled trial of 116 patients undergoing elective cholecystectomy. No significant difference was found in the infection rate between the treated and the control groups.
The value of polymixin B in endotoxaemia due to experimental obstructive jaundice and mesenteric ischaemia
Authors: Ingoldby C J H
Published: March 2007

The role of polymixin B in endotoxaemia due to obstructive jaundice and mesenteric ischaemia has been examined. Rats made jaundiced by common bile duct ligation were challenged with intragastric endotoxin. Rats given polymixin B infusions had improved survival (11/15) compared with controls (4/14).

Mesenteric ischaemia was induced in rats by clipping the mesenteric artery. Limulus assay revealed marked endotoxaemia in controls. Polymixin B infusions reduced the degree of endotoxaemia. Pre-treatment with nonabsorbable intestinal antibiotics markedly reduced endotoxaemia. Polymixin B infusions gave no advantage of survival (3/10) compared with controls (2/10), but all animals pre-treated with intestinal antibiotics survived (12/12).

The difference in results found between obstructive jaundice and mesenteric ischaemia may be due to different degrees of endotoxaemia. Polymixin B may have a place in the prophylaxis of endotoxaemia in clinical obstructive jaundice.
An aid to low restorative anastomosis of the rectum
Authors: Munro Alexander , Krukowski Zygmunt , Swingler Denis H
Published: March 2007

A new suture-holding clamp is described which simplifies single-layer colorectal anastomosis performed deep in the pelvis.
Subclavian and axillary vein compression of musculoskeletal origin
Authors: Daskalakis E , Bouhoutsos J
Published: March 2007

Twenty instances of subclavian–axillary vein compression of musculoskeletal origin in 14 patients are reported. In 9 thrombosis had occurred and in the remainder the compression was intermittent. The cause appeared to be extraluminar factors such as the subclavius muscle, the scalenus anterior, the pectoralis minor and a malunited fracture of the clavicle. Ten cases were treated surgically with satisfactory results.
Venous aneurysm of the axilla simulating a soft tissue tumour
Authors: Owen W J , McColl I
Published: March 2007

A false venous aneurysm of the axilla following minoor trauma is described. The previously reported cases are reviewed and aetiology and diagnosis of this uncommon, condition discussed.
Coeliac artery compression
Authors: Lord Reginald S A , Tracy G Douglas
Published: March 2007

Four women with abdominal pain and compression of the coeliac artery by the median arcuate ligament of the diaphragm are described. Pain was relieved in each case by decompression or reconstruction of the coeliac artery. A case in favour of the existence of the coeliac artery compression syndrome is presented.
Massive haemorrhage caused by left renal vein ligation
Authors: Devine T J , Scott D F , Myers K A , King R B
Published: March 2007

It is common practice to ligate the left renal vein during aortic surgery. Although this does not usually lead to complications we report 2 patients in whom left renal vein ligation caused massive venous congestion of the kidney and major retroperitoneal haemorrhage. Nephrectomy was necessary to control the haemorrhage. In l patient immediate autotransplantation preserved renal function.
Transplantation of contaminated organs
Authors: van der Vliet J A , Tidow G , Kootstra G , van Saene H F K , Krom R A F , Slooff M J H , Weening J J , Tegzess A M , Meijer S , van Boven W P L
Published: March 2007

In cadaveric organ transplantation there is a risk of transfer of infectious agents from donor to recipient.

The consequences can be fatal for immuosuppressed recipients. This is illustrated by a case history in which an infection with the fungus Monosporium apiospermum was transferred from a donor to two cadaveric kidney recipients, of whom one died and the other surviced with the loss of the graft.

These events led to a review of the literature to determine methods of demonstrating possible contamination of donor organs. Analysis of the case history of potential donors, a history taken from relatives or the family doctor, autopsy and laboratory examinations are considered useful. Victims of drowning, patients with severe burns and patients who have been ventilated for a long time are high risk donors.
Evidence for the flutter valve mechanism of the lower oesophageal high pressure zone
Authors: Clark J , Cuschieri A
Published: March 2007

Simultaneous oesophageal manometry and pH monitoring was performed at rest and during abdominal compression in 189 subjects. The force exerted by the high pressure zone (HPZ) and by its intra-abdominal segment was reduced to the same extent in the 102 subjects who refluxed and the 87 who did not. Reflux during abdominal compression occurred in the subjects whose HPZ force fell into a critical range and in whom the contribution by the abdominal segment was reduced to less than 50 per cent of the total force exerted by the HPZ. These results are more in keeping with a mechanical flutter valve theory of lower oesophageal competence than sphincteric reflux control. Furthermore, the results indicate that measurements of oesophageal pressure, length or force in the resting state do not account for reflux or gastrooesophageal competence, but that it is the reserve of pressure, length or force during stress which is responsible.
An experimental study of the relationship between synergistic wound sepsis and suture materials
Authors: McGeehan D , Hunt D , Chaudhuri A , Rutter P
Published: March 2007

In wounds on the back of guinea-pigs an inoculum of 6 × 105 of Escherichia coli and of Bacteroides fragilis produced afrank infection rate of 27 per cent. Addition of a catgut or a braided nylon tie statistically significantly increased the rate to 56 and 48 per cent respectively. Prolene and silk produced much smaller, non-significant rises. The rate with polyglycolic acid was 18 per cent which, though not statistically significant, suggests the possibility that this material produces conditions unfavourable to multiplication of bacteria that produce this type of infection.
Gastrointestinal bleeding, angiodysplasia of the colon and acquired von Willebrand's disease
Authors: Cass A J , Bliss B P , Bolton R P , Cooper B T
Published: March 2007

A 66-year-old man is reported who was found to have acquired von Willebrand's disease, which presented when the patient was 63 with iron deficiency anaemia and gastrointestinal bleeding. He subsequently bled from various sites in the gastrointestinal tract including an angiodysplasia of the right colon, which was successfully treated by right hemicolectomy. This is the second reported association between acquired von Willebrand's disease and angiodysplasia of the intestinal tract.
Gastric pseudolymphoma
Authors: Anderson J R , Lee D , Naysmith A , Busuttil A
Published: March 2007

Six histologically proved cases of gastric pseudolymphoma are described. This uncommon benign condition often simulates ulcerated gastric carcinoma radiologically, and pathologically it may cause considerable confusion with malignant lymphoma. Recognition of this condition is important to prevent unnecessary and often hazardous treatment whether by surgery or radiotherapy and to prevent inclusion in series of malignant gastric lymphoma, so that falsely high survival rates are not recorded.
Abdominal parasitic twin: An unusual cause of duodenal obstruction
Authors: Blumberg N A
Published: March 2007

A 14-month-old child presented with complete duodenal obstruction due to pressure from a fetus-in-fetu. This was relieved by a subtotal excision of the tumour. The features support the diagnosis of FIF rather than abdominal teratoma. On this premise, future development of malignancy in the remnant is not anticipated. The follow-up period at the time of writing is 12 years.
Neural and humoral factors in postoperative ileus
Authors: Rennie J A , Christofides N D , Mitchenere P , Fletcher D , Stockley-Leathard Helen L , Bloom S R , Johnson A G , Rains A J Harding
Published: March 2007

Two inhibitory mechanisms in the human colon which may contribute to postoperative ileus have been studied.

Dopamine, a possible peripheral neurotransmitter, inhibited isolated colonic smooth muscle strips by a direct effect in longitudinal muscle and by a nerve-mediated mechanism in circular muscle.

Plasma motilin levels were suppressed pre- and peroperatively and elevation of levels postoperatively correlated with the return of normal motility and the severity of the operation.
The serum sodium concentration after surgical operation: Precision permits predictions
Authors: Chan S , Radcliffe A , Johnson A
Published: March 2007

In view of previous conflicting reports, the distribution of a water overload was investigated in 6 healthy volunteers. The fall in serum sodium was predictable from prior measurement of total body water (tritium) confirming that the induced hyponatraemia was dilutional.

Using a standard intravenous fluid regimen, a prospective study for 6 days on 50 patients undergoing major abdominal surgery established a confidence band for change in serum sodium concentration. This band not only enables precise prediction of whether observed sodium values in patients are ‘normal’ for that point in their postoperative course, but also demonstrates that changes are more prolonged than was at first thought. Their dilutional nature following uncomplicated surgery is supported by linear relationships between serum osmolality and serum sodium (s-Osm = 1·86 [s-Na+] + 18·74; P < 0·001) and between observed and calculated osmolality (Obs-Osm = 0·97 [Cale-Osm] + 15·11; P < 0·001). More detailed investigation of 14 patients by isotope dilution provided independent evidence of dilutional change. This conclusion is additionally supported by lesser changes in patients on a more restricted fluid regimen.

As a practical confirmation of the utility of this approach, departures from the simple dilutional relationships were observed in 7 critically ill patients whose postoperative course was complicated. In this group osmolal ‘gaps’ of 20–50 mosmol/kg were identified.

Current standard postoperative fluid regimens cause dilutional changes; these are predictable and provide a vardstick for use in management of both the healthy and the ill surgical patient.
The treatment and preoperative diagnosis of differentiated thyroid carcinoma presenting as a clinically solitary nodule
Authors: Wade Hilary
Published: March 2007

Some papillary and follicular carcinomas of the thyroid present as solitary nodules with no clinical or radiological evidence of metastases. The elective treatment of such early thyroid carcinomas is discussed, with particular reference to the surgical approach to the clinically solitary nodule. The investigations available for establishing a preoperative diagnosis of the pathology of a solitary nodule are also discussed. A high degree of accuracy is obtainable but absolute certainty, only occasionally. If doubt exists, the safe treatment is excision of the nodule and frozen section.
Wound healing after laser surgery: An experimental study
Authors: Cochrane J P S , Beacon J P , Creasey G H , Russell R C G
Published: March 2007

Healing after carbon dioxide laser incisions has been assessed in three animal experiments. Nine incisions in pig skin were found to be significantly weaker after 7 days than similar incisions made with a scalpel, but stronger than those made with a cutting diathermy. Laser excision of skin discs in pigs provided a satisfactory base to take split-skin grafts, but graft take around the edges was less complete than after scalpel excisions. Division and anasto mosis of the colon of 75 rats showed that the laser produced anastomoses that were as strong after 7 days as those produced by scalpel or diathermy division, but the laser did not produce the narrowing of the lumen that occurred with diathermy. It is concluded that if epithelial surfaces are particularly thick and slow to cut with the laser then thermal damage wili impair healing, but that in general epithelial surfaces need not be avoided in laser surgery.
Functional results of rectal excision and endo-anal anastomosis
Authors: Keighley M R B , Matheson D
Published: March 2007

Twelve consecutive patients have been treated by rectal excision and endo-anal anastomosis since March 1978. Eight operations were for invasive carcinoma; extension into perirectal fat was recorded in all except one patient and early recurrence was observed in 3 (6, 9 and 14 months after operation). Two operations were for carcinoma complicating extensive villous adenoma and 2 further patients underwent the procedure for excision of a Crohn's stricture. In the first 6 months after operation, stricture of the ‘neorectum’ was observed in 7 of 8 patients and was associated with urgency of defecation in 6. Manometric studies indicated that although normal sphincter pressures were maintained, the capacity of the ‘neorectum’ was significantly reduced at 6 months compared with preoperative values (P < 0·01). At 12 months only 3 of 6 patients still had a stricture, with urgency in 2. Complete continence was reported in all except one patient.
Solitary rectal ulcer: Always a self-induced condition?
Authors: Thomson Hamish , Hill David
Published: March 2007

Solitary rectal ulcer is a curious and uncommon condition of contentious aetiology. Six patients seen at Gloucestershire Royal Hospital during 5 years have been studied. In 4 self-interference was certain and likely in one other; no information was available concerning the sixth. Our evidence suggests that the disease is self-induced.
Comparison of rubber band ligation and haemorrhoidectomy for second- and third-degree haemorrhoids: A prospective clinical trial
Authors: Murie John A , MacKenzie Iain , Sim Andrew J W
Published: March 2007

One hundred patients with second- or third-degree haemorrhoids were randomly allocated to haemorrhoidectomy (50) or rubber band ligation (50). Forty-two in each group presented with rectal bleeding; haemorrhoidectomy relieved 36 and rubber band ligation relieved 31 of this symptom. All patients had prolapsing haemorrhoids at presentation. One year after treatment 45 haemorrhoidectomy and 43 rubber band ligation patients were assessed. Haemorrhoidectomy relieved 44 of 45 patients and rubber band ligation relieved 34 of 43 (P < 0·05). Haemorrhoidectomy caused pain in all cases, lasting for more than 48 h in 35. Rubber band ligation was painless in 5 and produced pain for more than 48 h in 15. Mean time off work was 32 days for haemorrhoidectomy and 3 days for rubber band ligation (P < 0·001).

Rubber band ligation as an outpatient procedure is an effective treatment for second- and third-degree haemorrhoids and should be considered before recourse to surgery.
The effect of local infection upon wound healing: An experimental study
Authors: Bucknall T E
Published: March 2007

Local infection was introduced into rat abdominal wounds using a 108 bacterial/ml inoculum. Three groups of infection were used: Staphylococcus aureus, Pseudomonas aeruginosa and a combination group of Escherichia coli and Proteus mirabilis. Infection was shown to delay healing as judged by bursting tests. Fibroblast proliferation was depressed at the wound edges but there was an increase in the total amount of hydroxyproline present. Small vessel angiogenesis was increased in areas of abscess formation but larger vessels were commonly blocked by thrombus or distorted by surrounding inflamed tissue. The possible causes of these effects are discussed.
A controlled trial to evaluate and compare a sutureless skin closure technique (Op-Site Skin Closure) with conventional skin suturing and clipping in abdominal surgery
Authors: Eaton A C
Published: March 2007

Sutureless wound closure employing a new product, Op-Site Skin Closure, was evaluated in comparison with two standard techniques of skin closure, using interrupted nylon sutures and Michel clips. The trial involved 110 patients undergoing elective and emergency abdominal surgery. The results showed that Op-Site Skin Closure was good as the conventional techniques of skin closure with the advantages that it is easier and quicker to apply, produces a superior cosmetic result and, consequently, has gained excellent patient and nurse acceptance.
An evaluation of cholangiomanometry with synchronous cholangiography
Authors: Ribeiro B F , Williams J T , Lees W R , Roberts M , Le Quesne L P
Published: March 2007

A method of biliary manometry is described which enables simultaneous recording of both the pressure changes in the common duct during perfusion and the cholangiographic appearances. This examination has been performed on 86 patients undergoing cholecystectomy for gallstone disease, 17 of whom had demonstrable stones in the common duct. Ten patients received opiates or similar drugs as premedication and are considered separately. The remaining 76 patients were anaesthetized by a standard technique involving no opiates. On the basis of the pressure tracings they could be divided into two groups: group I (56 patients, 4 with stones in the common bile duct) showed a minimal rise in pressure during infusion of the common bile duct, with a rapid return to basal level: group II (20 patients, 13 with demonstrable stones in the common bile duct) showed a marked rise in pressure, with a delayed and often incomplete return to basal level. In 2 patients in group II a sudden fall in pressure during perfusion was associated with the passage of a stone, and the evidence suggests that 6 of the 7 patients with no demonstrable stones in the duct had in fact small stones in the duct, some of which may have passed during the examination. Clinical follow-up of the patients showed that only 3 of the patients had significant postoperative abdominal symptoms, for which there was an apparent extra-biliary cause in all 3.

This study provides no evidence in support of the hypothesis that there is a condition of sphincteric spasm which can cause symptoms after cholecystectomy, and which can be detected by pressure studies at the time of cholecystectomy.
A mechanism for prostaglandin cytoprotection
Authors: McGreevy James M , Moody Frank G
Published: March 2007

Topical 16,16-dimethyl (dm) prostaglandin E2 produces an alkaline secretion from the canine stomach. This study attempts to assess whether this prostaglandin-induced secretion might have a cytoprotective role. Chambered ex vivo perfused wedges of canine stomach were divided into equal halves: a control and test side. The mucosa of each half was sequentially exposed to isosmotic hydrochloric acid, 20μg, of 16,16 dm PGE2 in acid, 20 mmol aspirin + 20 μg of dm PGE2 in acid then isosmotic acid. The test side received 40 mmHg pneumatic counterpressure to reduce the prostaglandin-induced fluid movement before, during and after the aspirin exposure. The mucosal lesions produced on each side were graded 0 to 4. If prostaglandin exerts its cytoprotective effect by stimulating an alkaline secretion, elimination of that secretion with counterpressure should prevent a cytoprotective action. Nine dogs were studied.

Topical prostaglandin increased transmucosal fluid movement from 10 μl/min to 65 μl/min. Counterpressure decreased this volume flow by 50 per cent (P < 0·01); it also decreased mucosal blood flow on the test side by 20 per cent (P < 0·05). The lesions on the counterpressure side were worse 2·0·0·6 v. 0·8 ± 0·3 (P < 0·01). Thus the greater damage in the counterpressure group could have been caused by diminished fluid movement or by reduced blood flow or a combination of both factors. Although this study cannot distinguish between these possibilities, it seems likely that the prostaglandin-induced alkaline secretion has a cytoprotective role.
Radiological appearances of parotid duct calculi
Authors: Suleiman Suleiman I , Hobsley Michael
Published: March 2007

A total of 42 patients presenting with recurrent unilateral parotid gland swelling was studied. Plain radiology of 38 patients with proved calculi showed that the lateral view is valueless. The anteroposterior view was positive in 58 per cent, and when coupled with an intrabuccal view 71 per cent of the calculi were radio-opaque. The overwhelming majority of calculi were visible as filling defects on sialography, while in 4 patients an area of narrowing with dilatation of the parotid duct proximal to it represented the site of the calculus. In the remaining 4 patients with the latter sign, repeat sialography showed normal appearances in 2, suggesting that the calculi had passed.
Pseudomembranous colitis after whole gut irrigation with neomycin and erythromycin base
Authors: Weidema W F , von Meyenfeldt M F , Soeters P B , Wesdorp R I C , Greep J M
Published: March 2007

An unprecedentedfatal case of pseudomembranous colitis (PMC) is described, associated with the use of topical antibiotics (neomycin and erythromycin base) during whole gut irrigation. This case was one of a cluster Offive, occurring within a period of 4 months in 1978. These observations tend to support the hypothesis that disturbances in bacterial flora give rise to PMC and furthermore that the short-term use of antibiotics does not prevent the occurrence of PMC.
Splenectomy for hypersplenism in malignant lymphomas
Authors: Gill P G , Souter R G , Morris P J
Published: March 2007

Splenectomy has been performed in advanced malignant lymphomas in an effort to correct haematological cytopaenias in 41 patients since 1975. In both Hodgkin's disease and a variety of non-Hodgkin's lymphomas the operation has been associated with a high percentage of haematological correction (90 per cent overall). In many of these patients the haematological defect had prevented or led to the cessation of treatment and in those cases where chemotherapy was resumed after splenectomy worthwhile remission was achieved in 87.5 per cent of patients. There were no postoperative deaths and morbidity was considered acceptably low. We conclude that splenectomy is a valuable adjunct to treatment in advanced malignant lymphomas and should be considered at the first suggestion of splenic overactivity and reduced bone marrow reserves.
Reversible ischaemic colitis in young adults
Authors: Duffy Terence J
Published: March 2007

Ischaemic colitis, while well recognized in older patients, is rare in patients under 30 years of age. Four such patients with transient ischaemic colitis are presented and the literature is reviewed.
Repeated aspiration of breast cysts—a safe procedure
Authors: Hinton C P , Hughes R G
Published: March 2007

We have made a retrospective study of 197 patients who underwent 367 breast cyst aspirations and in whom the fluid obtained was sent for cytological examination between January 1974 and August 1976.

Four specimens were reported as showing malignant cells in the aspirate. All of these were excised and 3 were confirmed to be malignant. A further 8 showed bizarre or atypical appearances, of which four were excised and I was malignant. The other 4 were subjected to repeat aspiration, at which time typical benign appearances were reported and no further action taken. No tumour developed in the follow-up period of at least 2 years.

Of the patients whose initial cytology was benign, 51 were subjected to repeated aspiration of clinically recurrent cysts, 28 on 3 or more occasions. Ten patients underwent excision biopsy of histologically benign lesions. None of these 51 patients developed a malignant tumour at the site of the cyst in the 2-year follow-up period.
Computed tomography (CT) of abdominal aortic aneurysms: determination of longitudinal extent
Authors: Dixon A K , Springall R G , Fry I Kelsey , Taylor G W
Published: March 2007

The aim of this study was to evaluate computed tomography (CT) in the assessment of abdominal aortic aneurysms with particular reference to their longitudinal extent. Twenty-nine patients were examined by CT, 21 of whom came to surgery. Sixteen of these 21 patients were also examined by ultrasound. At CT the relation of the aneurysm to the renal arteries proximally and the bifurcation distally was noted, along with the definition of the aortic outline. At subsequent surgery the longitudinal relations of the aneurysm and evidence of localized stretching of or leakage from the sac were assessed by an observer without knowledge of the CT scan report. Correct extent of the aneurysm in relation to the renal arteries was predicted by CT in 20 out of the 21 patients who underwent surgery. CT assessment with respect to the bifurcation was correct in 16. The CT findings proved correct in one patient with localized stretching of one part of the aneurysm and in one patient where leakage was occurring. CT scanning was found to be superior to ultrasound in our preoperative assessment of the superior extent of abdominal aortic aneurysms. CT is considered to be the investigation of first choice when evaluating an abdominal aortic aneurysm.
The effect of intravenous aprotinin (Trasylol) on intraperitoneal adhesion formation in the rat
Authors: Young Howard L , Wheeler Malcolm H , Morse David
Published: March 2007

A randomized controlled trial to assess the effect of intravenous Trasylol on postoperative intraperitoneal adhesion formation has been performed in rats. Before undergoing a standard left colonic resection, animals received i.v. Trasylol 10 000 KIU. This dose was repeated 8-hourly for 3 days postoperatively. Control animals received saline placebo. The mean percentage circumference of the anastomosis covered with adhesions in the Trasylol group animals was 20.86±6.08 compared with 45.24±5.97 in the control group (P < 0.01).

Significantly more animals treated with Trasylol were completely free of adhesions than those receiving saline. Bursting pressures did not differ between the two groups. Intravenous Trasylol clearly inhibits intraperitoneal adhesion formation in this model.
Peroperative colonoscopy in massive rectal bleeding
Authors: Batch Andrew J G , Pickard Robert G , De Lacey Gerald
Published: March 2007

Massive rectal bleeding can pose a difficult problem in management. We describe a new technique employing peroperative colonic irrigation and direct colonoscopy to identify the source of the bleeding, so avoiding blind colonic resection.
Total parenteral nutrition versus gastrostomy in the preoperative preparation of patients with carcinoma of the oesophagus
Authors: Lim S T K , Choa R G , Lam K H , Wong J , Ong G B
Published: March 2007

Castrostomy feeding has been a well established form of nutritional support for patients presenting with total dysphgia for carcinoma of the oesophagus. More recently, total parenteral nutrition has proved to be efficient and safe, offering an alternative to gastrostomy feeding. Twenty-four patients were randomly selected into two groups to compare the efficacy of total parenteral nutrition and gastrostomy feeding with respect to nitrogen balance and weight gain.

Total parenteral nutrition was found to be superior to gastrostomy feeding in achieving an earlier positive nitrogen balance and greater weight gain during a 4-week period. However, gastrostomy feeding is still preferred as it is cheap, simple and safe, and allows patients to be active, mobile and self dependent. Total parenteral nutrition is reserved for those patients in whom an earlier operation is advisable.
Peroperative frozen section and cytology to assess proximal invasion in gastro-oesophageal carcinoma
Authors: Keighley M R B , Moore Janet , Lee J R , Malins D , Thompson H
Published: March 2007

Peroperative frozen sections and cytological material have been obtained in 39 consecutive gastro-oesophageal resections between October 1978 and February 1980. Material from the proximal edge of the resected specimen was unreliable because of 3 false positive cytology results and 1 false positive frozen section report. Frozen section (no errors) was shown to be significantly more accurate than cytology (6 errors) when material was obtained from the distal oesophagus. Fatal anastomotic dehiscence occurred in only 1 of 30 resections when the excision was adequate. Where the results of frozen section were acted upon, in 5 of 9 patients with an inadequate excision, only 1 fatal dehiscence occurred compared with fatal dehiscence in all 4 patients where a second excision was not performed. These results indicate that frozen section of the distal oesophagus should be used to determine the extent of oesophageal resection in operations for gastrooesophageal cancer.
Does osmotic control of gastric emptying persist after truncal vagotomy?
Authors: Gough Michael J , Humphrey Christopher S , Giles Geoffrey R
Published: March 2007

Gastric emptying of 5 per cent and 10 per cent glucose test meals has been measured in 43 patients with a duodenal ulcer prior to surgery and in 52 patients with an unsatisfactory result following truncal vagotomy and a drainage procedure. Seventeen patients had a recurrent ulcer and incomplete vagotomy while 35 patients were symptomatic with complete vagotomy. In both the preoperative and postoperative patients the 10 per cent glucose test meal emptied significantly more slowly than the 5 per cent glucose test meal regardless of the completeness of vagotomy. Thus, osmotic control of gastric emptying persists after vagotomy.
Bowel motility after primary resection for colonic obstruction
Authors: Fraser Ian D , Condon Robert E , Schulte William J , Decosse Jerome J , Cowles Verne E
Published: March 2007

The duration of postoperative ileus and changes in contractile frequency of circular muscle were recorded in the colon of monkeys before and after primary resection for distal large bowel obstruction. Obstruction was induced gradually by an implanted device. Resection and primary anastomosis resulted in reduced contractile frequency (postoperative ileus) lasting less than 48 h, significantly shorter than the period of ileus after a control laparotomy.
The wound fibroblast and macrophage. II: Their origin studied in a human after bone marrow transplantation
Authors: Stewart Richard J , Duley John A , Dewdney Janet , Allardyce Randall A , Beard Michael E J , Fitzgerald Peter H
Published: March 2007

The origin of the wound fibroblast and macrophage was studied in a patient following bone marrow transplantation, using sex chromosome markers. Fibroblast-like cells emigrating from explants of a 5-day-old skin wound had the host karyotype, whereas macrophages had donor markers. These results suggest that the wound fibroblast in man is of local tissue origin, whereas wound macrophages are derived from haemopoietic tissue.
111Indium-abelled leucocyte scintigraphy in the diagnosis of inflammatory disease—first results
Authors: Rövekamp Mechelien H , Hardeman M R , Van Der Schoot J B , Belfer A J
Published: March 2007

In 61 patients, 66 scans were performed with 111In-abelled autologous leucocytes to evaluate this method in the diagnosis of inflammatory disease. All scintigraphic results were compared with clinical, operative or postmortem findings.

In the first 20 examinations in 19 patients, 2 scintigrams were true positive, 9 true negative and none false positive, whereas 9 scintigrams had to be considered as false negative. These false negative results were probably due to loss of viability of the labelled cells.

A modified labelling technique, in which a much lower concentration of oxine was used, was employed for a further 46 examinations in 42 patients. Twenty-our scintigrams were true positive and 22 true negative, while no false positive or false negative results were observed. These results suggest that this modified technique is useful in the diagnosisof inflammatory disease.
The PO2 in venous valve pockets: Its possible bearing on thrombogenesis
Authors: Hamer J D , Malone P C , Silver I A
Published: March 2007

The Po2 in the lumen and valve pockets of veins in 2 patients and 8 dogs was measured during streamline blood flow and in conditions of intermittent pulsatile flow. The blood within the valve pockets became rapidly hypoxicwhen undisturbed during streamline flow (i.e. when ‘static’), but the Po2 in the pockets rose to that of the lumenal blood when the column of venous blood was made to pulsate and so empty the valve pockets at short intervals. The observations suggest that the endothelium covering the valve cusps is entirely dependent on pocket or lumenal blood for its oxygen supply. The endothelium facing the pocket can therefore become hypoxic during non-pulsatile blood flow when that facing the lumen is adequately oxygenated. Early thrombus formation was seen to develop on a valve cusp after only 2 h non-pulsatile flow. The demonstration that localized hypoxaemia occurs readily and can produce endothelial damage, in circumstances and situations where thrombi are commonly found to originate, is additional circumstantial evidence that hypoxia may trigger thrombogenesis.
A tube system for the management of ruptured oesophagus
Authors: Hinder R A , Baskind A F , Le Grange F
Published: March 2007

In a patient who has ruptured his oesophagus a major objective should be to prevent access of swallowed material or refluxed gastric contents to the area of the rupture. We describe a tube system, introduced into the oesophagus via a cervical oesophagostomy, which prevents swallowed material from getting to the lower oesophagus and allows a tube to be passed into the stomach for continuous aspiration of gastric contents. To discontinue the diversion, a surgical procedure is not required. The successful use of this tube system in 3 patients is described.
The effect of topical povidone-iodine on the incidence of infection in surgical wounds
Authors: Walsh J A , Watts J McK , McDonald P J , Finlay-Jones J J
Published: March 2007

A randomized stratified clinical trial of topical povidone-iodine in 627 patients undergoing abdominal procedures demonstrated a reduction in postoperative wound sepsis in female patients, in patients receiving subcutaneous low dose heparin and during the first quarter of the trial when the infection rate in control subjects was high. Overall, there was no significant reduction in wound sepsis after administration of povidone-iodine due mainly to a high infection rate in povidone-iodine treated male appendix operations where, by chance, there was an increased incidence of contamination with Bacteroides fragilis.

Postoperative stay in those developing wound infection was significantly reduced in the povidone-iodine group. This is considered as indirect evidence for a decrease in severity of wound infection.
Highly selective vagotomy and pyloric dilatation for duodenal ulcer with stenosis
Authors: Dunn D C , Thomas W E G , Hunter J O
Published: March 2007

This paper presents the results obtained in 15 patients with duodenal ulcer and stenosis who were treated more than 3years ago by highly selective vagotomy (HSV) and dilatation of the stenosis without a gastric drainage procedure. Patients were taking solid food 3–6 days postoperatively and were discharged after 7–14 days. There have been no recurrent stenoses. Fourteen of the 15 patients were Visick grade 1 or 2 at their last visit. One patient has a recurrent ulcer, but no restenosis. Barium meals performed on 6 patients with severe stenosis preoperatively showed satisfactory gastric emptying 1–3 years postoperatively. HSV and pyloric dilatation seems to be a safe and effective procedure for the treatment of pyloric stenosis due to chronic duodenal ulceration.
Excision of bullae without pleurectomy in patients with spontaneous pneumothorax
Authors: Ferguson L J , Imrie C W , Hutchison J
Published: March 2007

In a retrospective review of 294 patients with spontaneous pneumothorax (398 episodes), 45 patients came to surgical treatment. The period of the study was 7½ years, with a mean follow-up of 3 years in which there was no recurrence of pneumothorax after surgery. Operation consisted of simple excision of bullous lesions, usually located at the apexof the upper lobe, without pleurectomy. This simplified surgical approach has met with excellent results, indicating thatpleurectomy is unnecessary in the treatment of this disease.
A randomized trial to compare rubber band ligation with phenol injection for treatment of haemorrhoids
Authors: Greca F , Hares M M , Nevah E , Alexander-Williams J , Keighley M R B
Published: March 2007

A prospective randomized trial has compared rubber band ligation with phenol injection in 82 patients with symptomatic haemorrhoids. The symptomatic results in all patients 12 months after treatment were indistinguishable, 64 per cent being improved after rubber band ligation, compared with 70 per cent after injection. Complications of treatment were recorded in 5 patients after rubber band ligation, 3 of whom required hospital admission compared with one minor complication after injection. However, repeated treatment was necessary in 13 patients after phenol injection compared with only 4 following rubber band ligation (P<0·05). Additional treatment was necessary in 6 patients from each group. Two-thirds of patients with third-degree piles required additional therapy. It is concluded that rubber band ligation and injection provide similar results, but rubber band ligation is more liable to complications with inexperienced operators.
A comparison of the traumatic effects of vascular clamps
Authors: Harvey J G , Gough M H
Published: March 2007

The nature and extent of damage to the walls of the femoral artery of the dog caused by five different vascular clamps is reported. This is related to the ability of the clamp to both occlude the vessel and to hold the wall without slipping. Intimal damage was assessed by supravital staining, scanning electron microscopy of the surface and the histological appearance of sagittal sections of the arterial wall. The Atraugrip, Satinski and Potts clamps caused more apparent damage to the vessel wall and achieved occlusion by holding of the vessel at higher pressures than did the Blalock and Fogartyclamps. There is a difference between the damage produced when closure is sufficient to just occlude the vessel and that produced when the clamp is fully closed.
The salvage of occluded Dacron grafts
Authors: Macpherson D S , Bell P R F
Published: March 2007

The technical details of unblocking occluded Dacron grafts in 8 patients are described. The early results in 4 unilaterally occluded bifurcation aortic grafts and 1 unilateral iliofemoral graft are encouraging with all 5 grafts patent 8–16 months postoperatively (mean 9 months). We recommend this operation as the procedure of choice in symptomatic patients presenting with a graft occlusion of this type before resorting to the insertion of a new prosthesis, and emphasizethe importance of improving the outflow, usually by a profundaplasty. Only 1 out of 5 axillofemoral grafts remains patentat 8 months in spite of vigorous attention to operative detail. In this situation, an alternative procedure is suggested in the long term.
The management of anal carcinoma
Authors: Madden M V , Elliot M S , Botha J B C , Louw J H
Published: March 2007

In a 20-year survey of anal carcinoma at Groote Schuur Hospital 55 cases were studied retrospectively. Patientsof mixed race with anal margin carcinoma had a median age 29 years below that of Whites with anal margin carcinoma. Patients in these two groups with anal canal carcinoma had the same median age. Anal margin tumours were smaller than anal canal tumours at presentation and had a substantially better 5-year survival rate. The approach to treatment of theseconditions is outlined.
The excretion of cefuroxime in human bile
Authors: Thomas M H , Dash C H , Burnand K G , Woodyer A B
Published: March 2007

Cefuroxime is a broad spectrum cephalosporin antibiotic. An intravenous injection of cefuroxime 1·5g was administered to 25 patients after induction of anaesthesia for cholecystectomy. Concentrations of antibiotic were measured andthe mean levels in μg/ml found to be: serum 120·5, common bile duct bile 42·8, gallbladder bile 5·4, gallbladder wall 39·2. The drug levels exceeded the minimum inhibitory concentrations for most organisms commonly encountered in the biliary tract. There was no difference in cefuroxime levels in bile from functioning or non-functioning gallbladders. It is suggested that the diffusion of antibiotic into and out of the inflamed gallbladder is similar to that in abscesses and in experimental tissue cages. No side effects, toxicity or wound infections occurred.
The relationship between the number of capillaries in the skin of the venous ulcer-bearing area of the lower leg and the fall in foot vein pressure during exercise
Authors: Burnand K G , Whimster I , Clemenson G , Thomas M Lea , Browse N L
Published: March 2007

The changes in foot vein pressure during exercise have been measured in 30 normal legs and 109 legs with varicose veins or postphlebitic changes and correlated with the number of capillaries visible in a histological section of skin from the ulcer-bearing area. There was a significant correlation between the inability of the calf pump to reduce foot vein pressure during exercise and the number of capillaries in the skin. It is suggested that the increased number of capillaries secondary to venous hypertension during exercise may be the prime cause of the nutritional abnormalities that eventually cause a venous ulcer.
Tetanus in phlegmasia caerulea dolens
Authors: Duffy Terence J , Pentlow B D
Published: March 2007

A case of phlegmasia caerulea dolens is reported. Thrombolytic therapy was instituted. The patient developed tetanus. Adequate tetanus prophylaxis under such circumstances is advised.
Penetration of a prophylactic antibiotic into peritoneal fluid
Authors: Corbett C R R , Hollands M J , Young A E
Published: March 2007

The ability of an antibiotic, given for prophylaxis, to enter the peritoneal fluid was measured in 40 patients having abdominal operations. Cefuroxime, the antibiotic studied, attained a satisfactory level (4 mg/1) in the peritoneal fluid of 34 of the 40 patients (85 per cent). There was no difference between emergency and elective operations, suggesting that peritoneal inflammation does not enhance the penetration of cefuroxime into peritoneal fluid.
Does ‘intestinal angina’ exist? A critical study of obstructed visceral arteries
Authors: Croft Rodney J , Menon G P , Marston Adrian
Published: March 2007

A study of the mesenteric arteries was carried out in 203 unselected autopsies. Although mild degrees of stenosis were common, the incidence of a ‘critical stenosis’ was rare and no correlation between degrees of stenosis and previous gastrointestinal symptoms could be found. Radiological demonstration of stenosed or blocked visceral arteries remains therefore of doubtful clinical significance.
Bile reflux and gastric emptying in patients with combined gastric and duodenal ulceration
Authors: Gough Michael J , Humphrey Christopher S , Feather David B , Giles Geoffrey R
Published: March 2007

Measurements of duodenogastric reflux of bile and gastric emptying of a 5 per cent glucose liquid test meal have been made in 8 patients with combined gastric and duodenal ulcers and the results compared with those found in 21 patients with a diagnosis of uncomplicated duodenal ulceration. It was not possible to demonstrate any differences between the two groups of patients in respect of these studies and it is suggested that gastric stasis and duodenogastric reflux may not be important factors in the aetiology of combined ulcer disease.
Local tumour invasion as a prognostic factor in colorectal cancer
Authors: Wood C B , Gillis C R , Hole D , Malcolm A J H , Blumgart L H
Published: March 2007

A prospective study was carried out of 404 patients with colorectal cancer who were followed up for a mean period of 42 months. Macroscopic extramural tumour invasion was found at laparotomy in 46 patients undergoing apparently curative surgery and the survival rate was significantly reduced in these patients. The site of primary tumour in the colon or rectum did not influence the incidence of local tumour spread, but local invasion was related to the incidence of lymph node metastases and histological grading of the tumour. A staging classification has been proposed based not on lymphatic metastases, but on the extent of local tumour penetration. This modified staging system combines the operative findings with pathological grading of the tumour and emphasizes the prognostic significance of local tumour invasion.