bluuebunny/crossref_metadata_2025 huggingface dataset:
Acalculous gall-bladder disease
Authors: Gunn A , Keddie N C , Fox H
Published: March 2007

A prospective study of 130 consecutive unselected patients submitted to cholecystectomy for biliary disease has been made. Nineteen patients (14.6 per cent) were found to have acalculous gall-bladder disease. The clinical history of these patients did not differ significantly from those with calculous disease, whilst the radiological and histopathological findings in this group were variable.

Eleven of these 19 patients were completely relieved of their symptoms by surgery and it appeared that cholecystectomy was most successful in the patients with a history of either severe pain or previous acute cholecystitis. It is concluded that chronic gall-bladder disease may be acalculous and that, despite the lack of a homogeneous pathological background, surgery is of considerable value in a high proportion of such cases.
‘Fruit-stone ileus’
Authors: Weaver Paul C , Trapnell David H
Published: March 2007

Three cases of ‘fruit-stone ileus’ are reported in which ingested plum stones were obstructed in their progress through the bowel by other disease. Over the succeeding months or years the stones enlarged and then began to cause symptoms. Radiological aids to diagnosis are discussed together with the surgical treatment.
The management of upper gastro-intestinal tract haemorrhage
Authors: Hegarty M M , Grime R T , Schofield Philip F
Published: March 2007

Two hundred successive patients with upper gastro-intestinal tract haemorrhage were admitted to a surgical unit for management. One hundred and thirty-five patients (67.5 per cent) had a chronic peptic ulcer, 33 patients (16.5 per cent) had acute lesions (either an erosive gastritis or an acute gastric ulcer), and 32 patients (16 per cent) were a mixture of other diagnoses, of which 13 (6.5 per cent) were simple conditions but 19 (9.5 per cent) were conditions with a bad prognosis, e.g., carcinoma of the stomach, oesophageal varices, aortic aneurysm. Surgery was undertaken for massive, continuing, or recurrent bleeding and was as ‘conservative’ as thought possible. In duodenal ulcer this consisted of suture of the ulcer with vagotomy and pyloroplasty, and suture of the ulcer with vagotomy where possible in cases of anastomotic ulcer. In gastric ulcer only those less than 2 cm. in diameter were treated by suture with vagotomy and pyloroplasty. Ulcers greater than 2 cm. in size requiring surgery were treated by gastrectomy.

In the 181 patients whose underlying condition had a good prognosis there were 7 deaths (4 per cent). In this group 81 operations were carried out; 61 were ‘conservative’ operations for peptic ulcer, 2 were for repair of a hiatus hernia, and there were 18 gastrectomies, usually for a large gastric ulcer. There were 2 deaths among the operated patients; 1 after gastrectomy and 1 after a ‘conservative’ operation. There were 5 deaths among the 100 patients in the group which was treated non-operatively. There were 8 deaths among the 19 patients with underlying conditions of grave prognosis.

The case for the admission of patients with upper gastro-intestinal tract bleeding to a surgical unit is fully discussed and it is advocated together with a selective policy for operation. Where operation is necessary this should be as conservative as possible for bleeding duodenal ulcer, chronic gastric ulcer less than 2 cm. in size (ulcers of larger size may well respond but the method was not assessed for such ulcers), solitary acute gastric ulcer, and anastomotic ulcer. Gastric resection should be retained for the few patients with diffuse erosive gastritis requiring surgery and possibly for patients with a very large chronic peptic ulcer.
Ruptured spleen: A radiological pitfall and a suggested modification
Authors: Leigh Peter G A
Published: March 2007

The diagnosis of splenic injury may be obvious from the outset, or it may either be masked by other injuries or present much later in the phase of convalescence. Delayed rupture may occur as late as 1 month after injury, at which time it may be embarrassing for the doctor and dangerous for the patient. Any additional diagnostic measure is therefore considered appropriate in cases of abdominal trauma. Schorr and Danon (1967) described the value of a film taken in the left lateral decubitus position with barium in the stomach, and noted the significance of a distance of more than 3 cm. from the greater curvature of stomach to the lateral abdominal wall. A case is described in the present paper in which a false-positive result was obtained with the method of Schorr and Danon (1967) owing to interposition of a heavy mobile omentum. A right lateral decubitus film had been taken while the patient had a gas-filled stomach, and had revealed a distance of only 2.2 cm. between the greater curve and lateral abdominal wall. In this projection the mobile omentum had obviously fallen away, allowing the stomach to rise towards the left abdominal wall and thus demonstrating the absence of a fixed mass in this region.

Although it would appear that this technique is more useful in cases of delayed rupture than in acute cases, it is suggested that routine use be made of the right lateral decubitus film with a gas-filled stomach, prior to films being taken according to Schorr and Danon's (1967) method. This modification might also be useful in the diagnosis of diseases of the spleen, and in following the progress of patients after treatment.
The association of peptic ulcer and abdominal aortic aneurysm and its significance
Authors: Bouhoutsos J , Barabas A , Martin Peter
Published: March 2007

Twelve out of 51 consecutive patients who were operated on for unruptured abdominal aortic aneurysm were found to have, in addition, a peptic ulcerr. Of these 12 patients, 7 developed complications (haemorrhage or perforation) in the immediate postoperative period. Eight of the 51 patients died following operation and the commonest cause of death (5 out of 8 patients) was either haemorrhage or perforation of a peptic ulcer.

On the basis of these observations it is suggested that in patients with both an aortic aneurysm and a peptic ulcer vagotomy and pyloroplasty with gastrostomy should be carried out at the same time as aortic reconstruction.
An unusual case of spontaneous perforation of the oesophagus
Authors: Bradbrook R A
Published: March 2007

An unusual case is reported of spontaneous perforation of the oesophagus in which there was a marked absence of intial smptoms. It is suggested that this condition be considered in the differential diagnosis of extensive hydropheumothorax. The importance of early diagnosis as a perequisite to successful treatment is emphasized.
The effect of topical ampicillin on wound-infection rate after cholecystectomy
Authors: Logan C J H
Published: March 2007

No carefully controlled trial of the use of topical ampicillin in cholecystectomy wounds has been described. A series of 100 consecutive cholecystecomies performed by one surgeon using this drug in a double-blind manner is reported. The efficacy of topical ampicillin in lowering the wound-infection rate as shown by other authors is not confirmed.
Problems in acute hyperparathyroidism
Authors: Burcharth F , Vibe-Hansen H
Published: March 2007

The diagnostic and therapeutic problems of acute hyperparathyroidism are discussed on the basis of 4 selected cases. A highly raised serum-calcium level was demonstrated in all 4 cases. Serum-calcium determinations should be undertaken in every case which presents a vague clinical picture. Primary hyperparathyroidism should be treated by operation as soon as the diagnosis has been made, before any other surgical therapy of accompanying disorders is carried out, such therapy being liable to provoke a crisis requiring immediate operation.
The chemofusor: A new apparatus for maintaining continuous intra-arterial infusion chemotherapy
Authors: Burn J I , Gains E
Published: March 2007

A new apparatus for continuous intra-arterial infusion cancer chemotherapy in ambulant patients is described.
Peripheral gangrene as the presentation of myeloproliferative disorders
Authors: Gillespie Gordon
Published: March 2007

Six cases of myeloproliferative disorders (polycythaemia vera in 4, idiopathic thrombocythaemia in 2) are reported. In every case the presenting feature was pain associated with peripheral ischaemia and gangrene. Initial treatment by chemical sympathectomy affords symptomatic relief and improvement in foot circulation, though correction of the haematological abnormality is probably the most important factor in reversing the ischaemic process.
The autogenous saphenous vein loop for haemodialysis
Authors: Calman K C , Quin R O , Paton A M , Briggs J D , Bell P R F
Published: March 2007

Eleven autogenous saphenous vein loops have been used in 9 patients on haemodialysis in order to gain access to the circulation. All the patients lacked peripheral vessels available for alternative procedures. These grafts have functioned satisfactorily for over 18 months and have proved technically easy to construct and efficient to use. Three loops thrombosed after successful renal transplantation, and 1 developed an aneurysm which was repaired. One vein loop failed during dialysis. In 1 patient the graft enlarged considerably and she died of congestive cardiac failure; the part played by the graft in the development of the cardiac failure remains uncertain.
The aetiology of cystic arterial disease
Authors: Shute K , Rothnie N G
Published: March 2007

Two cases of cystic arterial disease of the popliteal artery are described in which a communication with the capsule of the knee-joint was demonstrated. The importance of this finding in the aetiology of the condition is discussed.
The reduction of surgical wound infections by prophylactic parenteral cephaloridine: A controlled clinical trial
Authors: Evans Christine , Pollock A V
Published: March 2007

In a series of 762 general surgical wounds 376 were selected at random to receive three parenteral doses of cephaloridine and 386 remained as untreated controls. In all types of operation, with the exception of wounds in the lower extremities associated with arterial surgery, the rate of wound infection was lowered by the prophylactic use of cephaloridine. The results were statistically significant for total wounds, clean wounds, total contaminated wounds, and contaminated wounds other than in colorectal surgery. We therefore recommend the routine use of three doses of cephaloridine.
The significance of humoral antibodies in the localization of human malignant melanoma
Authors: Lewis Martin G , McCloy E , Blake J
Published: March 2007

A study of patients with malignant melanoma, in various stages of the disease, by means of regular repeated examination of sera for the presence of tumour antibodies is presented.

These antibodies were mostly seen in patients with early or localized tumours and were not related to the total mass or volume of the tumour present. Sequential testing in individual patients showed not only the disappearance of antibodies as the disease progressed from localized to disseminated, but also that the disappearance preceded the appearance of disseminated tumour by several months. It is, therefore, suggested that circulating tumour antibodies are important in preventing or delaying blood-borne metastases.
Streptokinase therapy in deep-vein thrombosis
Authors: Mavor G E , Dhall D P , Dawson A A , Duthie J S , Walker M G , Mahaffy R G , Allardyce M
Published: March 2007

Experience with the use of streptokinase in the treatment of iliofemoral venous thrombosis is described. Streptokinase in a dose sufficient to induce systemic controlled defibrination was administered via an indwelling cannula which was used for repeated phlebography during the course of lysis and for several days afterwards. Of 40 patients treated, 10 had complete clearance and 24 partial clearance of the thrombus with the establishment of an iliofemoral channel. In 5 patients lysis did not occur and in 1 it was followed by early rethrombosis.
Two cases of idiopathic volvulus of the small bowel
Authors: Postlethwaite J C , Dupont P A
Published: March 2007

Volvulus of the entire small bowel about its mesentery without predisposing anatomical defects is rare in the Western world but more common in less developed countries. Two cases are described, the aetiology is discussed, and a valuable diagnostic sign is highlighted. It is suggested that the high mortality is avoidable by prompt diagnosis and early surgery.
Acute diffuse phlegmonous gastritis
Authors: Williams B L , Beeby D I
Published: March 2007

Phlegmonous gastritis is a rare inflammatory disorder of the stomach and is thought to have first been described by Galen in 1600; its recognition as a bacterial cellulitis of the submucosa and muscularis is attributed to Cruveilhier in 1820. Three hundred and ninety cases were described in the world literature up to 1969. This case is of interest because the patient displayed a number of the typical features of the disease, and also because from a search of the literature of the past 12 years she appears to be only the second of the proven cases to have resolved with conservative management.
The surgical treatment of peptic ulcer. A 15-year review
Authors: Callum K G , Talbot J E
Published: March 2007

A 15-year retrospective study of 713 patients having surgical treatment for peptic ulcer was carried out. A comparison of gastrectomy with vagotomy and drainage was made. The ways in which other factors may affect the outcome were also studied.

The results are discussed and some conclusions drawn.
Bladder function following abdominoperineal excision of the rectum for carcinoma
Authors: Fowler J W
Published: March 2007

Denervation of the bladder was demonstrated in 8 of 28 patients following abdominoperineal excision of the rectum. It is suggested that routine postoperative bladder-function studies be performed to detect this complication and thus to enable suitable postoperative care and long-term follow-up to be undertaken.
Omental transposition in the treatment of radionecrosis
Authors: Cort David F , Collis J Leigh
Published: March 2007

A technique is described for the closure of chestwall defects following radical excision for radionecrosis. Such defects are usually extensive with an avascular bed and often involve an opening into the pleural cavity; surgical closure poses significant; problems. The method described here utilizes a transposed omental flap to provide a vascular bed for a skin-graft, whilst cephalad shifting of the origin of the diaphragm is used to close the pleural defect. This latter innovation has the dual advantages of simplicity and effectiveness, whilst greatly facilitating the passage of the omentum to the chest wall with minimal risk of omental strangulation.
Transection of the oesophagus for bleeding oesophageal varices
Authors: Pugh R N H , Murray-Lyon I M , Dawson J L , Pietroni M C , Williams Roger
Published: March 2007

Emergency ligation of bleeding oesophageal varices using the Milnes Walker technique was performed in 38 patients. Haemorrhage continued or recurred in hospital in 11 patients, all of whom subsequently died. A further 10 patients died in hospital following operation from hepatic failure and a variety of other causes. Five patients were finally considered suitable for elective shunt surgery, but of 12 patients who were discharged without a further operation, only 2 have re-bled. Although the overall 6-month survival was 32 per cent, in patients with good preoperative liver function this rose to 71 per cent, and the simple scoring system for grading the severity of disturbance of liver function was found to be of value in predicting the outcome of surgery.

Since the results of emergency ligation of bleeding oesophageal varices in our hands have been so disappointing we are currently using it less and are trying the mesenteric caval jump graft as an emergency operation for the control of bleeding varices.
Common iliac vein compression syndrome occurring in siblings
Authors: Jones W M , Taylor I , Stoddard C J
Published: March 2007

Two sisters displaying the common iliac vein compression syndrome are reported. It is suggested that this syndrome may be congenitally determined, which would explain the increased familial incidence of deep-vein thrombosis.
Seat-belt injuries of the left colon
Authors: Shennan John
Published: March 2007

Two patients with a particular type of isolated injury to the left colon produced by the lapstrap of a seat belt are described. The literature on this subject is reviewed and the features and management of these injuries are discussed, with particular reference to the delay in presentation often seen in such patients and to the frequent association with ischaemic damage which makes proximal colostomy advisable where primary repair is undertaken.
Gastric secretory response to insulin infusion in vagotomized subjects
Authors: Carter D C , Dozois R R , Kirkpatrick J R
Published: March 2007

The results of the insulin-infusion test carried out after vagotomy in 50 patients are presented. In 25 cases a comparison was made between the insulin-infusion test and the conventional Hollander test. A good correlation was observed between the peak acid output induced by insulin infusion and that noted during the Hollander test. It is concluded that with the present criteria for interpretation the insulin-infusion test may be no better than the Hollander technique for defining patients at risk of recurrent dyspepsia. However, the small amounts of insulin used, the gradual lowering of blood-glucose, and the reduced incidence of profound hypoglycaemia which attend the insulin-infusion test suggest that this technique should be adopted for the assessment of vagotomy in preference to the potentially dangerous Hollander test.
Treatment of combined external iliac artery and vein injury by cross-over femorofemoral arterial and venous grafts with temporary arteriovenous shunt
Authors: Gardner A M N
Published: March 2007

The case is presented of a patient whose left external iliac artery and vein were inadvertently divided during attempted intestinal resection for diverticulitis of the sigmoid colon.

Gangrene of the leg was almost inevitable, direct vascular surgery was impossible, but an indirect approach by thrombectomy and double cross-over femorofemoral arterial and venous grafts with temporary arteriovenous shunt fully restored the life of the limb.

During the operation severe bleeding occurred through the mesh of the woven Teflon prosthesis.
Cardiac sequelae of haemorrhagic shock
Authors: McArdle C S , Fisher W D
Published: March 2007

Using selective cardiac catheterization and a 133Xe wash-out technique, myocardial blood-flow and oxygen utilization were studied in greyhounds during and following brief and prolonged haemorrhagic hypotension. The progressive fall in myocardial oxygen extraction as the shock period was prolonged and the subsequent failure of myocardial oxygen consumption to rise during re-infusion suggested the presence of a metabolic defect in the myocardial cell.

The use of a special ‘elemental’ diet was shown to eliminate the intestinal blood-loss typical of canine haemorrhagic shock models; despite this the apparent myocardial cellular metabolic defect persisted.

In addition, a myocardial depressant factor which depressed myocardial function in vitro was isolated from ultrafiltrates of post-shock plasma.
The intestinal complications of radiotherapy
Authors: Wellwood J M , Jackson B T
Published: March 2007

The clinical features of 38 patients with intestinal complications after radiotherapy are recorded. Intestinal complications are commonly progressive and in this series led to the death of 14 patients (37 per cent). Nine of these patients had no sign of recurrent tumour. ‘Spontaneous’ necrosis of the irradiated bowel and necrosis of intestinal anastomoses after surgical operation carried a particularly high mortality. Only 3 patients (8 per cent) became completely asymptomatic after treatment of their bowel disease. Apparently localized radiation lesions in the small bowel were sometimes associated with severe malabsorption. Radiographs showed distinctive radiological patterns in the small bowel. A combined radiotherapy/surgical follow-up clinic is advocated.
Abdominoscrotal hydrocele
Authors: Tanga M R , Avaradi P R , Gandhi G Mohandas
Published: March 2007

Four cases of abdominoscrotal hydrocele presenting within a short span of 5 months are reported. In one of our patients there was associated an incompletely descended testis and this testis had a seminoma. Such an association has not been reported previously. Abdominoscrotal hydrocele may be more common than is generally believed.
A new venous thrombectomy technique
Authors: Kiely P E
Published: March 2007

This paper describes a new technique whereby a specially designed thrombectomy catheter can be passed distally in the venous tract without trauma to or hindrance by the venous valves. The catheter is advanced distally on the end of a guide-wire which has been threaded proximally along the vein to be thrombectomized. The technique enlarges the scope of surgery in relation to deep-vein thrombosis. A possible use in arterial thrombo-embolectomy is discussed.
Carcinoma of the duodenum: Comparison of surgery, radiotherapy, and chemotherapy
Authors: Sakker Samuel , Ware C C
Published: March 2007

Three cases of infra-ampullary carcinoma of the duodenum are presented, and in each case the management was different.

A new method of reimplantation of the common bile-duct and pancreatic duct is described.

One hundred and twenty-six cases from reports in the past decade have been reviewed, and the distribution, sex ratio, clinical features, investigations, management, and prognosis are discussed.

In polyposis investigation of the upper gastrointestinal tract is advised.

The use of radiotherapy and chemotherapy is discussed and advocated.
The ‘iced-glove’ method of treatment of paraphimosis
Authors: Houghton G R
Published: March 2007

A new method of reduction of paraphimosis, using a rubber glove filled with iced water, is described. The method is simple to carry out and causes little discomfort to the patient. Successful reduction was performed in 9 out of 10 eases, often when manual reduction had failed. Reasons for the single failure are put forward, and alternative treatment is suggested for such complicated cases.
Ruptured non-traumatic aneurysms of the descending thoracic aorta
Authors: Brightmore T G J , Drew C E
Published: March 2007

Two cases of ruptured non-traumatic aneurysm of the descending thoracic aorta and a third in which rupture was imminent are discussed with regard to two simple operative techniques, both of which were employed with success. Partial aneurysmectomy was employed in one case and a temporary to permanent shunt graft in the other two. The simplicity of the techniques is such that they may be used in hospitals which are not equipped for extracorporeal perfusion.
A hypothesis on some factors governing the behaviour of short segments of the small bowel
Authors: Jenkins D H R
Published: March 2007

A hypothesis is advanced in which it is argued that variations in the extrinsic autonomic innervation of short small-bowel segments are responsible for the unpredictable behaviour of such segments. Experimental evidence is offered to substantiate the hypothesis.
Pancreatic reflux during operative choledochography
Authors: Cuschieri A , Hughes J Howell
Published: March 2007

Reflux of dye into the pancreatic duct was studied during operative choledochography performed in 211 conservative cases undergoing elective cholecystectomy. Reflux occurred with the same frequency whether the dye was injected by hand or by a constantflow electrically driven pump. The outlined pancreatic duct was abnormal in 27 per cent of cases where a pancreatogram was obtained. No association was found between ductal stones and reflux of dye into the common bile-duct. Pancreatic reflux was associated with a low biliary pressure and segmental duodenal activity.
Pyloroplasty versus gastrojejunostomy: Results of a double-blind, randomized, controlled trial
Authors: Kennedy T , Johnston G W , Love A H G , Connell A M , Spencer E F Anne
Published: March 2007

A double-blind, randomized, controlled trial of Finney pyloroplasty and gastrojejunostomy, each with selective vagotomy, is reported. There were no operative deaths but 5 patients have subsequently died or have been lost to follow-up, leaving 94 patients, with a mean follow-up time of 3 1/2 years. There has been 1 proven recurrence after gastrojejunostomy and 2 after pyloroplasty, with 1 further suspected recurrence in each group. The clinical grading marginally favoured gastrojejunostomy. There was no significant difference in the incidence of bilious vomiting, dumping, diarrhoea, or other disturbances, but there was a significantly greater increase in bowel frequency after pyloroplasty. Weight changes were similar, and there was no gross anaemia or calcium deficiency in either group. Gastrojejunostomy is reversible and pyloroplasty is not, and therefore we recommend gastrojejunostomy as the drainage procedure of choice when drainage is necessary after vagotomy.
Comparison of two electrolyte solutions for short perfusion and hypothermic storage in experimental renal preservation
Authors: Grenier J F , Dauchel J , Jaeck D , Kachelhoffer J , Stock C
Published: March 2007

In recent years the need for preserving kidneys has become of great importance because of the development of renal transplantation. The most effective and practical method yet described to preserve kidneys outside the body appears to be immersion in a cooled solution combined with initial perfusion. The aim of the present study was to compare two perfusates routinely used in this procedure: Collins solution and Perfudex. A total of 22 kidneys was removed and stored with one of these perfusates and then autotransplanted.

Renal function was monitored by radio-isotope measurements: 197HgCl2 uptake and radio-hippuran renography. An assessment of the histological evidence of renal damage was made on preserved kidneys 3 months after transplantation.

As judged by the results of these investigations the most satisfactory preservation of kidneys was obtained with the Collins solution. The use of this perfusate allows a storage time of 24 hours without decreased function or morphological changes in the kidneys. Other investigators have also confirmed the efficacy of the Collins solution and have provided further evidence for its superiority over conventional perfusates for kidney preservation. The current use of the Collins solution, as now recommended by the France Transplant Association, makes the future of clinical kidney transplantation more hopeful.
Pinworm infestation of the appendix
Authors: Boulos P B , Cowie A G A
Published: March 2007

Eight cases of pinworm infestation of the appendix presenting with symptoms simulating acute appendicitis are reported from a study of 293 appendicectomy operations performed at University College Hospital, London, in the past 2 years.

In each case a diagnosis of appendicitis was made on clinical grounds but in 6 patients the appendix was normal histologically.

Symptoms mimicking appendicitis but caused by Enterobius vermicularis infestation merit recognition as a disease process and treatment to eradicate the worm must not be overlooked.
Liver function in the pig: 1. The effects of 30 minutes' normothermic ischaemia
Authors: Battersby C , Hickman Rosemary , Saunders S J , Terblanche John
Published: March 2007

A preparation was developed in the pig in which transhepatic samples could be taken, and the duration for which the pig liver would tolerate ischaemia was studied. Total occlusion of the hepatic artery, portal vein and inferior Venn cava was caused after studies of the effects of occlusion of the portal vein or the vena cava alone. Adequate splanchnic decompression was provided by a splenojugular bypass.

Reversible changes were noted in the acid/base status and potassium levels after ischaemia. Aspartate transaminase (SGOT) levels rose and remained elevated during the hour of study following occlusion. Alkaline phosphatase and glucose levels changed but remained within normal laboratory limits, although there appeared to be a release of glucose from the hepatic veins after occlusion. Portal pressure increased reversibly after ischaemia and returned to normal within 1 hour. Bile flow ceased during inflow occlusion and resumed 15 minutes after the release of the clamps.
Can a heterotopically placed segmental liver graft be life-supporting? An affirmative finding
Authors: Maki Takashi , Slapak Maurice
Published: March 2007

The feasibility of using a segmental auxiliary liver graft comprising some 40 per cent of the total liver mass fed by the renal vein rather than the portal vein is studied. An autotransplantation technique is described which has the advantage of excluding the problems associated with rejection. Two groups of dogs are investigated in one of which an orthotopically placed segment of liver is also retained. Data are presented which show that a heterotopically placed segment comprising only 40 per cent of the total liver mass can be transplanted heterotopically and in the absence of portal vein influence can maintain animals in good health for months. Furthermore, the presence of an orthotopically situated segment with a normal haemodynamic supply does not inhibit the function of a heterotopic one. The results suggest that in the absence or inhibition of the rejection mechanism heterotopically placed partial liver grafts can function well and be life-supporting.
Preliminary experience of bone scanning with 99mTc-labelled polyphosphate in malignant disease
Authors: Citrin D L , Greig W R , Calder J F , Bessent R G , Tuohy J B , Blumgart L H
Published: March 2007

Reliable bone scans were obtained in 70 patients and 17 control subjects using 99mTc-labelled poly- or pyrophosphate with a minimum of patient disturbance.

Using these radiopharmaceuticals and a gamma camera system a practical facility for efficient skeletal imaging is now available for nuclear medicine departments in general hospital practice.
Long-term preservation of fresh viable aortic valve homografts by freezing
Authors: Al-Janabi Nawal , Ross Donald N
Published: March 2007

A method of long-term storage of fresh homograft heart valves in liquid nitrogen (−195 °C) is described. The object is to preserve them in a viable state with unchanged structure. Five groups of valves were studied. Viability before and after freezing was assessed quantitatively by the use of autoradiography.

Mitotic activity of the fibroblasts declined at a very slow rate in groups 1, 2, 3 and 4, in which the valves were stored at +4 °C in a nutrient/antibiotic solution for periods between 24 hours and up to 6 weeks before freezing. The percentage of metabolically active fibroblasts declined more rapidly in valves from group 5, in which the valves had been stored for 8 weeks at +4 °C before freezing.
Observations on the pathogenesis of peritoneal adhesions: a light and electron microscopical study
Authors: Milligan D W , Raftery A T
Published: March 2007

Observations have been made by light and electron microscopy of the development of peritoneal adhesions in the rat following abdominal surgery. Essentially the changes which occurred were those which are seen in healing by fibrosis, except that in many areas of adhesions numerous eosinophils were observed by electron microscopy. In areas where eosinophils were numerous little proliferation of fibro-blasts was seen. Conversely in sites where fibroplasia and collagen formation were well advanced no eosinophils were seen. The role of the eosinophil in the development of adhesions is discussed and it is suggested that the presence of eosinophiis with their associated anti-histamine activity may hold in check the proliferation of fibroblasts while a new mesothelium is formed and thus prevent adhesion formation.
Aetiology and prevention of wound infection in appendicectomy
Authors: Gilmore O J A , Martin T D M
Published: March 2007

A study at the Reading District Hospitals on 451 consecutive patients undergoing appendicectomy through grid-iron incisions sought to determine factors influencing wound infection and the effects of a prophylactic wound-spraying procedure. Wound infection increased with the severity of appendicular inflammation and was well correlated with the degree and nature of bacterial contamination at the time of wound closure.

The infection rate was reduced by about one-half when either an aerosol dry-powder formulation of povidone iodine (Disadine D. P.) or an aerosol antibiotic powder spray containing neomycin, bacitracin and polymixin (Dispray) was sprayed on the wound before and after closure. The reduction of infection achieved by spraying with pouidine iodine was statistically significant (P < 0.025). The results of the polyantibiotic spraying did not quite reach significance (P < 0.06).

The povidone iodine dry powder was better overall since it reduced infection in all degrees of appendicular inflammation, in all age groups and in enlarged, drained, contaminated and non-contaminated wounds without the attendant disadvantages of antibiotics.
Bacteroides bacteriaemia in surgical patients
Authors: Mackenzie Iain , Litton Adrian
Published: March 2007

In a general surgical unit, during a 6-year period between June, 1967, and May, 1973, anaerobic bacteriaemia was noted in 23 patients, of whom 4 had Gram-positive clostridial bacteriaemia. Nineteen patients had Gram-negative Bacteroides species in their blood. In these patients the infection appeared to have come from bacteria that were normal commensals of the patients' gastro-intestinal tracts. The use of antibiotics to which Bacteroides species were resistant may have suppressed more invasive bacteria, allowing the selective proliferation of bacteroides.
Life-threatening haemorrhage in Crohn's disease
Authors: Sunkwa-Mills H N O
Published: March 2007

An unusual presentation of Crohn's disease is reported. Massive rectal haemorrhage threatening the life of the patient resulted in emergency right hemicolectomy. No further bleeding has since occurred.
Diverticulitis and ulcerative colitis
Authors: Bates T , Kaminsky V
Published: March 2007

The association of diverticulitis and acute ulcerative colitis is uncommon but carries a high mortality. Four cases are described with diverticular disease who developed fulminating ulcerative colitis. The double diagnosis was not initially recognized in any of these cases and in 2 the diagnosis of ulcerative colitis was only made at laparotomy.

Three of the 4 patients died following surgical treatment and the difficulties of their diagnosis and management are discussed. It is suggested that sigmoidoscopic examination before emergency bowel surgery is important.
The variable course of primary hepatocellular carcinoma
Authors: Davidson A R , Tomlinson S , Calne R Y , Williams Roger
Published: March 2007

Analysis of the clinical course in 85 patients with histologically proved primary hepatocellular carcinoma showed that 73 followed the classic pattern of the disease with a rapid onset and a quick demise. Howeoer, in I2 patients the course was longer in that the duration of illness was over 2 years. This was largely accounted for by the duration of symptoms prior to diagnosis. No clinical differences could be discerned between these 12 patients and the other 73, and survival once diagnosis had been made was no different. The frequency of an underlying cirrhosis in the whole series was 58 per cent. The course of these patients differed in no way from those without cirrhosis except that the age hepatocellular carcinoma presented was older. One patient who received no specific therapy lived for 4 years from the time of diagnosis, and in each of the treatment groups there were occasional patients surviving for several years.
Amoebic liver abscess: Syndromes of ‘pre-rupture’ and intraperitoneal rupture
Authors: Ramachandran S , Goonatillake H D
Published: March 2007

There appears to be no constant relationship between the modes of clinical presentation and the varying pathological processes in patients with amoebic liver abscesses who present with or develop the abdominal manifestations suggestive of peritonitis. In a proportion of the patients (37 per cent)there is no evidence of a leakage from or rupture of the abscess. In spite of the abdominal manifestations there is no pus, either localized or generalized, in the peritoneal cavity. These patients constitute the group with the syndrome of ‘pre-rupture’. The cases with ‘pre-rupture’ invariably have superficial abscesses situated in the right lobe of the liver, together with fibrinous adhesions between the visceral and parietal peritoneum over the abscess site. It appears that the hepatic lesion responsible for the syndrome is at a stage just prior to leakage or frank rupture of the abscess. The pathogenesis of the syndrome is discussed and valuable physical signs in the diagnosis of the syndrome are described. By recognizing the existence of this syndrome a laparotomy could be avoided, as closed aspiration of the liver abscess and amoebicidal therapy are the only measures necessary in the management of these patients.
Endoscopic retrograde cholangiopancreatography
Authors: Liguory C , Gouerou H , Chavy A , Coffin J C , Huguier M
Published: March 2007

Direct non-operative injection of radio-opaque material through a cannula introduced at the duodenal papilla by means of a fibre-optic duodenoscope achieved opacification of the bile ducts, the pancreatic duct or the entire biliary pancreatic ductal system in 392 (89 per cent) of 439 patients in whom it was attempted. The desired ducts were opacified in 75 per cent of cases; the bile ducts in 206 out of 278 and the pancreatic duct in 120 out of 161 cases. The anatomical conditions found were: long common biliary pancreatic channel, 30 per cent; short common biliary pancreatic channel, 28per cent; two orifices in the hepatopancreatic ampulla, 24 per cent; two orifices on the duodenal papilla, 18 per cent; two orifices on the duodenum, there being no papilla, less than I per cent. Morbidity resulting from the procedure consisted of infectious reactions in 20 out of 295 patients in whom the bile ducts were opacified and hyperamylasaemia and abdominal pain in 28 out of 300 patients in whom the pancreatic duct was opacified. The method is of value in diagnosing the cause of cholestatic jaundice. In non-jaundiced subjects it may complement or clarify inconclusive cholangiograms or cholecystograms obtained by other techniques. If it shows dilated bile ducts operation should not be delayed, otherwise there is a risk of cholangitis. Pancreatic carcinoma may be revealed by stenosis, partial or total, of the pancreatic duct or by filling defects in the pancreatic parenchyma. Both chronic pancreatitis and pancreatic carcinoma may cause partial stenosis of the pancreatic duct. A filiform appearance of the pancreatic duct suggests chronic pancreatitis.
Visual identification of an insulinoma using methylene blue
Authors: Gordon Donald L , Airan Mohan C , Suvanich Sunant
Published: March 2007

Intravenous infusion of methylene blue stained an insulin-secreting islet cell adenoma a reddish-blue colour. It appears that certain vital dyes localize in pancreatic islet cells.
Renal hydatid disease
Authors: Ramus N I , Mitchell J P
Published: March 2007

Despite the well-recognized danger of scolices seeding into the peritoneal cavity or even into the wound as a result of spill occurring during operative removal of a hydatid cyst, the mucosal lining of the bronchial tree appears to resist these scolices which are frequently coughed up when a hydatid of the lung ruptures. Similarly, scolices were seen in large numbers in the urine of a patient whose renal hydatid had ruptured into three calices, and yet there is no evidence of seeding on the urothelium within I5 months of follow-up.
Preliminary report on the comparative use of lyophilized homograft and xenograft in the closure of raw areas
Authors: Hackett M , Bowen J
Published: March 2007

Lyophilized allograft and xenograft appear to be equally effective for the temporary cover of raw areas1.

Lyophilized allograft has the disadvantage of occasionally separating into two layers when removed. One layer can easily be missed and inhibit the take of a subsequent autograft.

Lyophilized xenograft is easier to handle and more easily available. In spite of the many advantages shown to be associated with this method of treatment, it is still virtually unused in Great Britain and in many other parts of the world.
Postoperative chest infection
Authors: Presley A P , Alexander-Williams J
Published: March 2007

Postoperative chest infection occurred in 65 of 200 patients, 100 of whom had biliary disease and 100 duodenal ulcer. As might be expected the incidence of chest infection was significantly higher in males, in those with duodenal ulcer, in industrial workers and those with preoperative chest symptoms, particularly if they smoked. Contrary to what might be expected it was not significantly higher in smokers in general, obese patients and those having longer operations. Although the incidence is high in the 40–60 age group it is not directly related to age. There appears to be a seasonal variation.
Hyperinfection with Strongyloides stercordis in Great Britain
Authors: Royle G , Fraser-Moodie A , Jones M Wansbrough
Published: March 2007

A Jamaican who had been in England for 13 years was successfully treated for hyperinfection with the nematode Strongyloides stercoralis. She presented as an emergency with acute abdominal pain, developed paralytic ileus and responded well to a long course of thiabendazole. A review of the literature revealed reports of 3 other cases of hyperinfection in Great Britain, all of whom had died, 2 afrer laparotomy.
Effect of allopurinol on tissue ATP, ADP and AMP concentrations in renal ischaemia
Authors: Cunningham S K , Keaveny T V , Fitzgerald P
Published: March 2007

The effect of allopurinol on the concentrations of ATP, ADP and AMP in rat kidneys during ischaemia and postischaemic recovery was studied. Significantly higher concentrations of ATP, ADP and AMP were maintained in the allopurinol-treated animals as compared with the control animals during ischaemic and postischaemic recovery.
The termination of the common bile duct
Authors: Keddie N C , Taylor A W , Sykes P A
Published: March 2007

Abnormal terminations of the common bile duct, as demonstrated by operative cholangiography, occurred in 23 per cent of 120 patients with biliary tract disease. The importance of this observation in biliary surgery is discussed.
Penetrating injuries of the heart
Authors: Rasaretnam Rudra , Paul A T S
Published: March 2007

Thirty consecutive patients with penetrating cardiac wounds were treated surgically during a period of 6.5 years. There were 6 deaths, giving a survival rate of 80 per cent. Delay in undertaking repair was associated with a friable myocardium. Cardiac arrest, either before or during operation, occurred in 5 patients, 4 of whom subsequently died. Left ventricular wounds were associated with a higher mortality than those affecting the right ventricle. Perforating cardiac injuries had a mortality of 43 per cent in comparison with 13 per cent for penetrating injuries. Coexistent intraperitoneal injuries were present in 4 patients, 2 of whom underwent successful repair.
Deficient fibrinolysis associated with rapidly progressive arterial disease
Authors: Barrie William W
Published: March 2007

A case of rapidly progressive, obliterative arterial disease in a non-smoking young male is described. The only predisposing factor found was a substantial impairment of fibrinolytic activity. Treatment with an anabolic steroid increased fibrinolysis but had to be discontinued because of side effects.
Traditional treatment of 194 cases of tetanus
Authors: Busuttil Anthony , Pace John B , Muscat Joseph A
Published: March 2007

A retrospective survey of tetanus was undertaken for the decade 1957–66 in the Maltese islands. The 194 cases of tetanus reported were treated solely along the conservative lines of sedation, antitoxin and antibiotics. The mortality rate of 22 per cent for the whole series compares favourably with that from other centres. Intermittent positive pressure respiration and complete muscular relaxation are essential in order to decrease further the mortality from severe tetanus, although traditional treatment is still deemed to be very valuable in the milder forms of the disease.
The prediction of the outcome of portacavel shunt using bromsulphthalein (BSP): A retrospective aspect
Authors: Turner Jean , Cuschieri A , Shields R
Published: March 2007

A series of 17 patients is presented in whom compartmental BSP kinetics were determined before portacaval shunt operations. The results suggest that calculation of the equivalent liver volume is a valuable aid in the safer selection of patients, by providing a more accurate prediction of outcome than do conventional preoperative criteria.
Choledochal cyst: A review of 18 cases
Authors: Yue Paul C K
Published: March 2007

Eighteen cases of choledochal cyst affecting Chinese patients are reported. The clinical picture may be one of four types. In infancy, jaundice may be the only feature. In children and adults there may be the classic triad of features or an abdominal mass without jaundice. Terminally, there may be bleeding from oesophageal varices due to biliary cirrhosis. Barium meal examination is the most useful radiological investigation. Intravenous cholangiography is sometimes helpful. The various methods of operative treatment are discussed. Ten cases of cyst excision were performed without mortality.
Disseminated intravascular coagulation with peripheral gangrene complicating acute appendicitis
Authors: Fredlund P E , Göransson G
Published: March 2007

A case is reported of acute appendicitis complicated by disseminated intravascular coagulation and spasm of the peripheral arteries, which led to bilateral amputation of the feet. The cause of the complication is supposed to be endotoxaemia. The possibility of inhibited function of the patient's reticirlo-endotheliai system is suggested.
Deep vein thrombosis: Preclinical diagnosis by thermography
Authors: Cooke E D , Pilcher M F
Published: March 2007

A raised temperature and delayed cooling on exposure of the thrombosed limb is an early sign of deep vein thrombosis (DVT). This sign can be detected by using thermography when not apparent clinically.

The grey tone thermograph has a characteristic appearance in DVT.

Of 53 cases of DVT demonstrated by phlebography, 51 were previously suspected on thermographic examination.

The method is non-invasive and can be repeated at will.
Relationship between changes in plasma gastrin and lower oesophageal sphincter pressure after meals
Authors: McCall I W , Harvey R F , Owens Caroline J , Clendinnen B G
Published: March 2007

Changes in plasma gastrin and lower oesophageal sphincter pressure were measured in 20 subjects after a standard protein meal. Significant increases in both gastrin and sphincter pressure were seen. Peak gastrin response occurred an average of 19.5 minutes and peak lower oesophageal sphincter response 43.0 minutes after the meal. Both gastrin and sphincter pressure showed a wide spectrum of response. In 5 subjects there was no appreciable rise (< 5 pg/ml) in plasma gastrin after the meal, and 3 of these had symptoms of oesophageal reflux. In this group there was only a small but nevertheless significant rise in lower oesophageal sphincter pressure (mean pressure rise 18.0 per cent of fasting value, P < 0.05). Greater increases in sphincter pressure (mean rise 54.2 per cent, P < 0.005) were seen in subjects with a moderate (up to 50 pg/ml) rise in plasma gastrin, and those with the most marked gastrin response (> 50 pg/ml) showed the greatest rise in pressure (mean rise 80.3 per cent, P < 0.0025).

These results suggest that endogenous plasma gastrin is the main stimulus to the rise in lower oesophageal sphincter pressure after food. Subjects with a poor gastrin response to the meal have only a small increase in sphincter pressure and as a result may be more liable to develop gastro-oesophageal reflux.