bluuebunny/crossref_metadata_2025 huggingface dataset:
Anterior highly selective vagotomy with posterior truncal vagotomy: A simple technique for denervating the parietal cell mass
Authors: Hill G L , Barker M C J
Published: March 2007

Anterior highly selective vagotomy with posterior truncal vagotomy was performed in a consecutive series of 20 patients with uncomplicated chronic duodenal ulcer.

After identification of the vagal trunks the anterior leaf of the lesser omentum was separated from the lesser curve of the stomach, carefully preserving the anterior nerve of Latarjet. The distal extent of the dissection was from a point approximately 7–8 cm from the pylorus. After ensuring that all branches of the anterior nerve passing to the lesser curve had been severed, the trunk of the posterior nerve was divided and a segment removed. The lower 6–7 cm of oesophagus were cleared of nerve fibres.

All the patients recovered well from the operation and none suffered from prolonged gastric stasis in the postoperative period. Fourteen patients are well and free of symptoms (follow-up 3–15 months). Four patients have a sense of epigastric fullness and one of these vomits occasionally. Three patients have been troubled periodically by diarrhoea and one has ulcer-type pain although no recurrence has been seen on endoscopy or on barium meal examination.

One week after surgery the mean percentage reduction was 73 per cent in basal acid output and 65 per cent in peak acid output after stimulation with pentagastrin. Five of the patients had late positive insulin tests; 3 of these were the first 3 patients in the series. The other patients were insulin negative. In 10 patients the pattern of gastric emptying of a radionuclide-labelled meal 6 months after surgery was compared with that of 23 controls. The mean half-emptying time was similar in the two groups (71·7 ± 10·1 min v. 71·3 ± 3·8 min).

It is concluded that this new and simpler operation is technically feasible and it may be worth a cautious trial in centres with a special interest in this type of surgery.
Immediate resection in the treatment of large bowel emergencies
Authors: Valerio David , Jones Peter F
Published: March 2007

In a consecutive series of 122 patients who required an emergency operation for disease or injury of the colon or rectum, 80 (65 per cent) had an immediate resection of the diseased segment of bowel, with an operative mortality of 15 per cent. The free use of immediate resection is of benefit to patients, but good results depend on the experience of the surgeon and the use of a number of special techniques.
Evaluation of intended radical surgery in carcinoma of the gallbladder
Authors: Evander A , Ihse I
Published: March 2007

The records of 44 consecutive patients with carcinoma of the gallbladder from 1968 to 1977 were reviewed. All patients were investigated with a view to resection of the tumour and this was carried out in 10 patients, all macroscopic tumour being excised in 6. The basic operation was cholecystectomy, but liver resection (4 patients), liver resection and colectomy (3 patients) and pancreaticoduodenectomy (1 patient) were also carried out. Of these 10 patients, 3 died in hospital, while of the 34 patients in whom a palliative procedure was possible, 15 died during their hospital treatment. The median survival times were 4 months and 3 months respectively. Only one patient in this series is alive and symptom-ree at 36 months.

It is concluded that radical surgery, of itself, does not confer any advantage to the group of patients with carcinoma of the gallbladder. Alternative strategies for diagnosis and treatment of this condition are discussed.
Accuracy of oesophageal brush cytology: Results of a prospective study and multicentre slide exchange
Authors: Mortensen N J Mcc , Mackenzie Elizabeth F D
Published: March 2007

The value of brush cytology has been assessed in the diagnosis of 101 oesophageal strictures in a department with no previous experience of oesophageal cytology. Cytological specimens obtained using a brush gave a correct diagnosis in 86 per cent of 36 malignant strictures with only 2 false negatives; when combined with biopsy, accuracy rose to 92 per cent. Of 65 benign strictures examined there were 3 false positives. In a series of test slides sent to 11 other hospitals the average false negative diagnosis was 4 per cent and false positive 3 per cent. Four of the centres had little previous experience and only two had extensive experience in oesophageal cytology. Therefore, brush cytology as a proved aid to the accurate diagnosis of oesophageal malignancy is within the capability of most pathology departments and should be used more widely.
The incidence and course of perianal complications and arthralgia after intestinal resection with restoration of continuity for Crohn's disease
Authors: Heuman R , Bolin T , Sjödahl R , Tagesson C
Published: March 2007

The influence of bowel resection for Crohn's disease on the frequency of arthralgia and perianal manifestations was evaluated in a follow-up study of 82 patients. Arthralgia and perianal manifestations were analysed according to two separate periods: the preoperative duration of disease (4·2±3·2 years) and the postoperative duration (4·3±2·6 years). In patients operated on more than once, the time before the first and after the latest operation was included in the study. At the time of the follow-up, 19 patients suffered from recurrent disease. The frequency of arthralgia did not change after resection irrespective of whether or not there was recurrence. In patients without recurrence, however, perianal manifestations diminished after resection (P < 0·05). In the postoperative period only 10 per cent of those without recurrence suffered from perianal lesions compared with 47 per cent of those with recurrence (P < 0·001). If perianal lesions were in existence preoperatively, they healed spontaneously in 80 per cent of the patients without recurrence, but were still active among those with recurrence (P < 0·001).

Our results indicate that the perianal manifestations are closely connected to the inflammatory process in the intestine. On the other hand, the arthralgia seems to be independent of the inflammatory process of the bowel and may be related to a general defect of the gastrointestinal mucosa in Crohn's disease.
Single dose doxycycline prophylaxis and peroperative bacteriological culture in elective colorectal surgery
Authors: Törnqvist A , Ekelund G , Forsgren A , Leandoer L , Olson S , Ursing J
Published: March 2007

A prospective study was performed on 196 consecutive patients undergoing elective colonic surgery to evaluate the prophylactic effect of a single dose of doxycycline. The patients were randomized into four groups: group I 200 mg i.v. preoperatively, group II 600 mg i.v. pre-operatively, group III 600 mg i.v. postoperatively, and group IV 200 mg i.v. preoperatively and 200 mg i.v. daily 3 days postoperatively. The rate of septic complications for the different groups were: 113 per cent, 117 per cent, III 20 per cent, and IV 19 per cent. There was no statistically significant difference in occurrence of septic complications between the groups.

The degree of bacterial contamination during operation was estimated by culture from wound irrigation fluid and from cotton swabs. Bacteria were recovered from the irrigation fluid in 97 per cent, while culture from cotton swabs proved to be much less sensitive. A high number of bacteria in the irrigation fluid was significantly correlated to a high complication rate. It is suggested that direct plating from irrigation fluid can be used for defining a high risk group of patients in colonic surgery.
Gastric hypermotility and antropyloric dysfunction in gastric ulcer patients
Authors: Liebermann-Meffert D , Müller C , Allgöwer M
Published: March 2007

Impaired gastric emptying in gastric ulcer patients has generally been explained by gastric hypomotility.

The gastric motor response to an electrical vagal stimulus was measured intraoperatively in patients with gastric ulcers (GU, n = 21), duodenal ulcers (DU, n = 25) and combined ulcers (GDU, n = 6).

Amplitude and duration of the contraction and integrated motor response were found to be significantly greater in GU patients than in patients with duodenal and combined ulcers.

Thus, hypermotility of the gastric muscle exists in GU patients and the delayed gastric emptying in GU disease may be the result of antropyloric motor dysfunction rather than of gastric hypotony. Abnormal motility associated with duodenogastric reflux appears to be a key feature in the pathogenesis of gastric ulcer.
A comparison of circular stapling devices in colorectal anastomoses
Authors: Blamey S L , Lee P W R
Published: March 2007

The short term results of colorectal anastomosis using the Russian SPTU and American EEA circular staplers are compared. Anastomoses with these stapling devices were attempted in 61 patients between October 1978 and December 1980. In 1 patient the stapling method failed at operation, so that 60 patients had a stapled anastomosis as their definitive form of anastomosis. Of these, 31 were stapled using the Russian SPTU device and 29 using the American EEA device. Parameters of age, indication for operation, surgical assessment of curability, tumour stage and distance from the anal verge are compared to demonstrate similarity of the groups. Practical aspects of the use of the staplers are discussed. Local complications of dehiscence, anastomotic haemorrhage, stenosis and fistula formation occurred in 17 patients. Complications related specifically to the stapling procedure occurred with similar frequency in both groups: 8 patients treated with the SPTU stapler and 9 patients treated with the EEA stapler. No significant advantage was demonstrated for either stapler with respect to overall local complications; however, the authors have found the EEA stapler both easier to use and easier to maintain.
Carotid artery occlusion following endarterectomy: Evaluation by spectral analysis of Doppler ultrasound signals
Authors: Aukland A , Hurlow R A , Hamer J D
Published: March 2007

The clinical results of carotid endarterectomy are well documented, but there is little objective information on the incidence of postoperative occlusion. We have studied the postoperative patency of the internal and external carotid arteries using continuous wave Doppler ultrasound with spectral analysis (Spectrascribe BOC – Medishield). Seventy-nine patients who had had 89 endarterectomies during the past 5 years entered the study. The mean follow-up was 21 months.

Fourteen patients had an occluded internal carotid artery of whom 4 had suffered an immediate postoperative stroke and 1 a delayed stroke: transient ischaemic attacks occurred in another 4 patients. Of the 60 patients with a patent internal carotid artery one suffered an immediate postoperative stroke and 2 a delayed stroke; 6 patients had recurrent transient ischaemic attacks. None of the 5 patients who had an external carotid endarterectomy developed postoperative symptoms, although there was occlusion in 2. The carotid artery was occluded in 4 of 43 completely asymptomatic patients.

Thus, 18 per cent of all carotid endarterectomies and 9 per cent of asymptomatic patients in this series had postoperative occlusion of the carotid artery.
Intrathoracic gastric bypass for carcinoma of oesophagus found unresectable at exploration
Authors: Lam K H , Wong John , Lim S T K , Ong G B
Published: March 2007

Assessment of the resectability of carcinoma of the oesophagus or cardia may be inaccurate. At exploration, 8 patients in whom resection was contemplated were found to have unresectable lesions. An intrathoracic oesophagogastric bypass was performed without further change of position. Five patients were discharged from hospital and survived between 3 and 20 months before they finally succumbed to metastases. Each of them was able to take an ordinary diet. The aims of palliation were achieved.
The surgical management of primary intrahepatic stones
Authors: Choi T K , Wong J , Ong G B
Published: March 2007

Primary intrahepatic stones are commonly found in association with recurrent pyogenic cholangitis. In 115 patients with this condition, the intrahepatic stones were removed by four different methods: common duct exploration (n = 74), transhepatic intubation (n = 10), hepatotomy (n = 5) and hepatic resection (n = 26). The choice of methods was guided by the location of stones and the condition of the bile ducts and the liver. These extraction procedures were combined with drainage procedures, i.e. sphincteroplasty and choledocho-jejunostomy, whenever the proper indications were present. The operative mortality was 4·3 per cent. Long term follow-up (median 7 years and 8 months) on 91 patients revealed that common duct exploration, transhepatic intubation and hepatotomy were associated with high incidences of recurrent symptoms requiring reoperation (23·6 per cent, 37·5 per cent and 75 per cent respectively). In most instances, failures were due to recurrent stone formation in the stenotic intrahepatic ducts. Hepatic resection had the lowest failure rate (4·2 per cent) and none of the patients had recurrent stones.
Results and prognostic factors in salvage surgery for squamous carcinomas of the tongue
Authors: Pittam M R , Thornton Helen , Palmer B V , Chapman P , Shaw H J
Published: March 2007

Fifty-six patients who had undergone salvage surgery for residual or recurrent squamous carcinomas of the tongue between 1967 and 1977 were reviewed. Failure to obtain operative clearance led to certain local recurrence. The tongue or cervical lymph nodes were involved in 27 of the 28 patients who died with recurrent tumour. The overall age-corrected actuarial postoperative survival was 45.1 per cent at 2 years and 35.3 per cent at 5 years. Survival was reduced in women and patients aged over 60 years at operation, and in patients whose tumours were at first biopsy moderately or poorly differentiated, classified as stage III or IV at initial presentation or preoperatively, or recurred within 6 months of completing primary treatment.
Precision in measuring shunt length in jejunoileostomy for morbid obesity
Authors: Miskowiak Jerzy , Andersen Bjørn
Published: March 2007

We performed a prospective assessment of intraoperative precision in determination of shunt length in 138 patients. The variations were slight and of the same order of magnitude in the jejunum and ileum. Precision in per cent of measured length was independent of the actual length and of the surgeons who performed the operations. The results indicate that factors other than errors in the measurements are responsible for variations in weight loss after jejunoileostomy.
Ovulation in a cytogenetically proved phenotypically male fertile hermaphrodite
Authors: Parvin Simon D
Published: March 2007

An unusual case of true hermaphroditism is reported. The patient was a 32-year-old phenotypically male true hermaphrodite. Histology of his removed ovary suggested that ovulation had, at some time, occurred. He had also fathered a child and this is believed to be the first case of a cytogenetically proved true hermaphrodite who is fertile as a male.
Experiences with cadaver renal allograft contamination before transplantation
Authors: Spees E K , Light J A , Oakes D D , Reinmuth B
Published: March 2007

Microbial contamination occurred in 23 (13 per cent) of 177 cadaver donor kidneys prior to renal transplantation. In 16 cases there were no complications directly attributable to the organisms recovered from the preservation media. Three patients developed perinephric infections associated with renal artery anastomotic disruption and required emergency transplant nephrectomy. A fourth patient developed renal artery stenosis and a hypogastric artery aneurysm that required correction 6 months later with preservation of renal allograft function. In 3 cases no follow-up information was available. None of the 154 uncontaminated kidneys developed arterial disruption or aneurysm. Candida albicans and Pseudomonas aeruginosa infections were responsible for the nearly disastrous arterial disruptions and possibly the hypogastric arterial aneurysm. These findings demonstrate the importance of bacteriological surveillance of perfusion media to detect nosocomial infection, to guide antibiotic chemotherapy and to direct surgical management of septic complications. In our experience contamination was not necessarily incompatible with long term satisfactory results; however, when complications did occur they were serious. It is likely that the size of the microbial inoculum, the patient's immune competence and the protective effect of antibiotic therapy administered to the donor and recipient affected the eventual outcome.
Duodenoscopic placement of biliary prostheses to relieve malignant obstructive jaundice
Authors: Cotton P B
Published: March 2007

We have been able to place prosthetic tubes in the bile duct at duodenoscopy in 17 of 23 patients with malignant obstructive jaundice. Initial problems with sepsis and tube migration appear to have been overcome by using tubes with double pigtails, and by inserting two tubes simultaneously. Effective palliation of jaundice has been achieved in 10 of the last 12 patients. The technique has potential advantages over the percutaneous transhepatic route, and is now ready for wider evaluation.
Parastomal haemorrhage from an ileal conduit secondary to portal hypertension
Authors: Hollands M J
Published: March 2007

A case of parastomal haemorrhage around an ileal conduit is presented and the literature reviewed. Simple methods of treatment, such as good stoma care, vitamin K, direct pressure and ligation of individual bleeding points, are effective in the short term, and persistence with these methods is advocated rather than major surgery.
Childhood leukaemia and surgery
Authors: MacKinnon A E , Hann I M , Morris-Jones P
Published: March 2007

In a 9-year period 285 children were treated for leukaemia at the Royal Manchester Children's Hospital. The experience of operating on 72 patients is described and the favourable outcome of elective surgery emphasized. The importance of leukaemic involvement of abdominal organs and the difficulty of diagnosis of abdominal crises is discussed.
Antrectomy for recurrent ulcer after parietal cell vagotomy
Authors: Hoffmann J , Meisner S , Jensen H-E
Published: March 2007

The results of antrectomy for recurrent ulcer after parietal cell vagotomy are reviewed. Eighteen patients underwent precise antrectomy between 6 months and 7 years after their primary operation. Fourteen patients were reconstructed with a gastroduodenostomy and 4 with a gastrojejunostomy. Eighteen patients were available for follow-up of between 18 months and 10 years. One patient (6·25 per cent) developed a recurrent ulcer 1 year after antrectomy. There was no operative mortality. Six patients (33 per cent) had minor complications in the immediate postoperative period, and one (5·5 per cent) had a major complication. According to Visick grading, 75 per cent had good or excellent results and 25 per cent poor results. Antrectomy following parietal cell vagotomy can be achieved with a low operative mortality, a low ulcer recurrence rate and a satisfactorily low incidence of post-gastrectomy problems.
Early return to work after repair of a unilateral inguinal hernia
Authors: Taylor E W , Dewar E P
Published: March 2007

Ninety-seven Royal Naval and Royal Marine officers and ratings undergoing repair of a unilateral inguinal hernia were randomized postoperatively into two groups: A, those who returned to full working duties 21 days after operation; B, those who returned to light duties 21 days after operation and to full duties at 3 months. Patients were reviewed at 3 and 12 months. One patient was withdrawn because of the development of late sepsis. Two patients in group B developed a recurrence of hernia within 1 year. No patient who returned to full duties at 21 days was unable to do any duty assigned to him. In a concurrent trial 119 male civilian patients were treated in the same hospital under identical conditions. All patients were reviewed 21 days after operation and were randomized into two groups: C, those advised to return to work immediately; D, those given no advice. Patients in group C returned to work in a mean of 38 days (range 14–96 days), whereas those in group D returned in a mean of 71 days (range 14–280 days). There was no recurrence of hernia in either group within the review period. It is concluded that there is no contraindication to resuming physical work 3 weeks after the uncomplicated repair of a unilateral inguinal hernia, and that active encouragement shortens the interval before return to work.
Prophylaxis of postappendicectomy sepsis by metronidazole and cefotaxime; a randomized, prospective and double blind trial
Authors: Lau W Y , Fan S T , Yiu T F , Poon G P , Wong S H
Published: March 2007

A randomized, prospective and double blind trial was conducted on 308 patients. Thirty-one out of 102 patients receiving metronidazole developed wound infection compared with 13 out of 103 patients receiving cefotaxime and 14 out of 103 patients receiving metronidazole and cefotaxime. The reduction in the wound sepsis by the use of cefotaxime or a combination of metronidazole and cefotaxime was statistically significant when compared with patients who received metronidazole only. For early cases including normal, acutely inflamed and gangrenous appendices, we gave a single dose of antibiotics just before operation. For late cases with perforation and abscess formation, the antibiotics were continued for 5 days. There was no statistical difference in wound infection between patients who received cefotaxime alone and these who received a combination of metronidazole and cefotaxime.
Growth enhancement of implanted human colorectal cancer cells by the addition of fibroblasts in vivo
Authors: Loizidou M C , Carpenter R , Laurie H , Cooper A J , Alexander P , Taylor I
Published: March 2007

The effect of fibroblasts on the growth of HT29 human colorectal cancer cells was used to study stromal modulation of tumour growth dynamics. Fibroblasts were isolated from rat livers 1, 2.5 and 4 days after two-thirds partial hepatectomy and from normal livers. Cells harvested 2.5 and 4 days after hepatectomy (‘fast’ fibroblasts) had a significantly faster growth rate in vitro than those harvested on day 1 or those from normal livers (P<0.02). The fibroblasts were inoculated with HT29 colorectal cancer cells into nude mice: Controls received cancer cells with or without a fibroblast cell line (C3H10T 1/2). At 3 weeks both tumour take and growth (size) were significantly greater in the group inoculated with cancer cells and ‘fast’ fibroblasts than in the other groups (tumour take 100 versus 42–75 per cent, P<0.03; median tumour size 3.5 versus 0.3–0.4 g, P<0.02). In conclusion, tumour growth is enhanced by fibroblasts, especially by those derived from actively regenerating liver. It is suggested that the stimulation is not only mechanical but may also involve a humoral mechanism.
Prospective study of hand-sutured anastomosis after colorectal resection
Authors: Mann B , Kleinschmidt S , Stremmel W
Published: March 2007

A total of 370 patients underwent colorectal resection: 320 had a primary single-layer seromucosal anastomosis without a protective colostomy, 22 had Hartmann's procedure and 28 abdominoperineal resection. There were 260 elective procedures and 110 patients had peritonitis and/or bowel obstruction at the time of surgery. Overall the mortality rate was 2.7 per cent, the morbidity rate was 18.3 per cent and clinical anastomotic leak rate 3.4 per cent. After elective operation, the leak rate for intraperitoneal anastomosis was 0.6 per cent and for low extraperitoneal anastomosis 7 per cent. The mortality rate was 1.2 per cent and morbidity rate 11.9 per cent. Patients with peritonitis had a significant increase in morbidity rate (46 per cent) in comparison with those having elective surgery (χ2= 31.5, 1 d.f., P<0.0001). Patients who had bowel obstruction and no bowel preparation had a significantly higher morbidity rate of 26 per cent and mortality rate of 7 per cent, compared with those having an elective procedure (χ2 = 11.2, 1 d.f., P<0.001; χ2 = 8.7, 1 d.f., P<0.005 respectively). Patients having palliative surgery had the highest mortality rate (19 per cent), compared with those operated on with curative intent (1.5 per cent) (χ2 = 28.7, 1 d.f., P< 0.0001). Cost-saving hand-sutured anastomosis is effective and, in experienced hands, technically feasible after all kinds of colorectal resection and should remain the standard in colorectal surgery.
Failure of the unopened colostomy to protect high-risk rectal anastomoses
Authors: Dixon A R , Thomson W H F
Published: March 2007

Anastomotic breakdown, the most serious complication of restorative rectal resection, is responsible for half the postoperative morbidity rate and one-third of deaths1. While many surgeons defunction low anastomoses2, others consider this unnecessary3. A tube caecostomy can be used after on-table orthograde bowel lavage to avoid a stoma4. An obstructing unopened loop ‘colostomy’ offers potential advantages5. It can be returned to the abdomen if the anastomosis heals soundly or opened into a colostomy if it leaks. This method was evaluated in seven patients.
Anorectal angle enhances faecal continence
Authors: Hajivassiliou C A , Carter K B , Finlay I G
Published: March 2007

This study was performed with an In vitro model to assess the relative importance of sphincter pressure and anorectal angulation in maintaining faecal continence. Water and semisolid material were infused separately into porcine intestine compressed by an inflatable cuff until leakage was observed. Angulation of the bowel with respect to the cuff was 180° and then 90° With water, holdback pressure was independent of angulation. In contrast, when semisolid material was used, angling the bowel to 90° increased holdback pressure by at least 100 per cent. Measurements taken in solid tubes demonstrated that both a restriction in the tube and an unconstricted 90° bend produced a resistance to flow of the semisolid material which was dependent on flow rate. These data suggest that liquid is retained in the rectum by occlusion pressure alone, whereas the retention of semisolid material is enhanced by angulation.
Anastomotic leakage and functional outcome after anterior resection of the rectum
Authors: Hallböök O , Sjödahl R
Published: March 2007

Nineteen patients with symptomatic anastomotic leakage after anterior resection were compared with 19 without leakage. The two groups were closely matched according to age, sex, height of anastomosis and follow-up. No patient had any sign of anastomotic stricture or neoplastic recurrence at the time of the study. After a median of 30 (range 12–87) months there was no difference in sphincter function as measured by manometry. Neorectaf volume at distension pressures of 40 and 50 cmH2O and compliance at sensation of filling, urge to defaecate and maximum tolerated volume were significantly reduced in patients with leakage. This reduction in neorectal reservoir function was reflected in impaired anorectal function, measured by a combination of: (1) frequency of bowel movements; (2) degree of urgency; (3) incontinence score; and (4) degree of impaired evacuation. Long-term functional outcome may be impaired by anastomotic leakage.
New technique for subcuticular suture in lengthy wounds
Authors: Tantawy H S
Published: March 2007

Subcuticular sutures used for cosmetic skin approximation usually produce a satisfactory scar. Non-absorbable monofilament sutures further increase the advantages of subcuticular closure1,2, but in lengthy wounds it is difficult to use fine material such as 3/0 or 4/0, as it may break on withdrawal.

Several methods have been employed to secure the loose ends of running subcuticular stitches. Beads and bulky knots may produce an unsightly scar at the ends of the suture line. For several years the author has used a technique for non-absorbable subcuticular sutures that allows sound wound approximation, minimal scarring and can be applied to lengthy wounds.
Thoracic and thoracoabdominal aortic aneurysm and dissection: An investigation based on autopsy
Authors: Svensjö S , Bengtsson H , Bergqvist D
Published: March 2007

The city of Malmö (population approximately 230 000) has a fairly stable urban population and a high autopsy rate (83 per cent of all deaths). Autopsy records for the period from 1958 to 1985 were scrutinized and three groups of patients were defined: those with asymptomatic thoracic aortic aneurysm (TAA), those with rupture of the thoracic aorta, and those with dissection. The findings were used to calculate prevalence and incidence according to age and sex. Asymptomatic TAA was found in 205 patients (109 men). There was a predominance of men in higher age groups and about 5 per cent of the lesions were thoracoabdominal. Rupture of the thoracic aorta was the cause of death in 63 patients; no age difference between the sexes was observed. Death as a result of dissection occurred in 216 patients, women dying on average 7 years later than men. The incidence of rupture was 0.9 per 100 000 for men and 1.0 per 100 000 for women; the incidence of dissection was 3.2 per 100 000 for both sexes. Prevalence and incidence of fatal complications of TAA are low; this may influence decisions about where these patients should be treated.
Role of cimetidine in the prevention of intimal hyperplasia in rat carotid artery
Authors: Low J D , House A K , Norman P E
Published: March 2007

In vitro studies have revealed that histamine increases smooth muscle cell proliferation and migration, an effect abolished by the H2 antagonist cimetidine. This study examined the effect of cimetidine on intimal hyperplasia in vivo. Thirty male Wistar rats underwent endothelial denudation of the left carotid artery; 15 received cimetidine 350 mg per kg per day for four weeks and 15 received vehicle only. Four weeks after injury the left carotid arteries were perfusion fixed and harvested. Morphometric analysis revealed that there was no significant difference between the intima: media ratio of rats treated with cimetidine (median (interquartile range (i.q.r.)) 1.69 (0.59)) and those treated with vehicle (median (i.q.r.) 1.59 (0.59), P = 0.28). Similarly, the percentage luminal reduction was not significantly different between the groups (median (i.q.r.) 54.7 (19.9) per cent and 45.8 (13.4) per cent respectively, P = 0.30). It is concluded that treatment with cimetidine does not reduce the formation of intimal hyperplasia in rat carotid arteries de-endothelialized with a balloon catheter.
Real and apparent mortality from congenital diaphragmatic hernia
Authors: Jaffray B , Mackinlay G A
Published: March 2007

Some 50 cases of congenital diaphragmatic hernia (CDH) born in the authors' regional referral area over the 14 years from 1980 to 1993 were reviewed, contrasting 7 years when management included preoperative ventilatory stabilization with the preceding 7 when urgent surgery was performed. Six children experienced no respiratory distress and suffered no mortality. For infants with respiratory distress in the first 6 h of life, ventilatory stabilization improved survival rates of those who reached the surgical centre from 45 per cent between 1980 and 1986 to 59 per cent between 1987 and 1993. A larger proportion of the total number of patients, however, continued to die without reaching the surgical centre. The improvement in survival rate based on the true incidence of CDH was from 28 per cent in the first period to 38 per cent in the second. The apparent poor survival rate of patients born in central obstetric units compared with those born in peripheral units (37 versus 75 per cent) can be attributed to patient selection; a larger number of children born in central units were transferred for surgery (70 versus 57 per cent). There is no evidence that paediatricians have altered their referral practice to include prolonged ventilation outside the surgical unit since delayed surgery was advocated. Assessment of the impact of altering the management of CDH cannot be made without knowing the number of patients who die before transfer to a neonatal surgical unit. Any serious attempt to reduce the mortality rate of CDH must be directed to neonates who are not presently referred to the surgical service.
Ultrasonographically guided excisional biopsy of non-palpable breast lesions
Authors: Di Giorgio A , Alessi G , Arnone P , Canavese A
Published: March 2007

Excision of small non-palpable breast lesions can be difficult and may result in the unnecessary removal of excessive surrounding breast tissue1. With this in mind a simple excisional biopsy technique for such lesions has been developed which employs intraoperative ultra-sonography to guide the extent of excision.
Effect of a low-fat, low-protein, high- carbohydrate diet on gallstone formation in the hamster
Authors: Pausawasdi A , Siwawetkul W , Watanapa P
Published: March 2007

Many epidemiological studies support the assumption that diet is of great importance in the pathogenesis of cholesterol gallstones1, but its role in the origin and development of non-cholesterol gallstones is less clear. In humans, a low-fat, low-protein, high-carbohydrate diet seems to increase the development of pigment gallstones2. The purpose of this study was to explore therefore the effect of a low-fat, low-protein, high-carbohydrate diet on the formation of gallstones and their composition. Hamsters were used because gallstones induced in these animals can be either cholesterol or pigment, depending on dietary constituents3.
Intra-arterial lignocaine in embolectomy
Authors: Campbell W B , Ballard P K
Published: March 2007

Acute limb ischaemia is now commonly treated by thrombolysis, but embolectomy remains a good and appropriate operation in certain cases of embolism. The patient with an acutely bloodless limb, sensory loss and an obvious source for embolus (such as atrial fibrillation) may be best treated by this means. Embolectomy is usually done under local anaesthesia, infiltrating the groin or antecubital fossa to expose the femoral or brachial artery. The one part of the operation that often causes pain is withdrawal of the inflated embolectomy balloon along the arteries to remove thrombus and clot. Although it is common practice to warn patients that they may feel discomfort during this manoeuvre, it can still prove quite distressing to some patients.

Guided by the work of van Niekerk and Coetzee1 on regional analgesia, the authors have used 0·5 per cent lignocaine during arterial embolectomy to relieve the pain of balloon withdrawal.
Aetiology and treatment of anal fissure
Authors: Lund J N , Scholefield J H
Published: March 2007

Anal fissure is a common problem that causes significant morbidity in a young and otherwise healthy population. Treatment has remained largely unchanged for over 150 years and the pathogenesis of this condition is not yet fully explained. Acute fissures should be treated conservatively with dietary modification. Chronic fissures do not respond to conservative treatment. The current recommended surgical treatment for chronic fissure is lateral internal sphincterotomy. However, there is a disturbance of continence in a sizeable proportion of those undergoing this procedure. As yet there is no proven non-surgical treatment for chronic fissure. Although local injection of botulinum toxin and the topical application of nitrates show early promise, further controlled trials are needed.
Influence of different collagenase solvents and timing of their delivery on porcine islet isolation
Authors: White S A , Contractor H H , Hughes D P , Johnson P R V , Clayton H A , Bell P R F , London N J M
Published: March 2007

Methods to minimize the effect of cold ischaemia on porcine islet isolation were investigated. Forty pancreata were randomized to intraductal collagenase delivery in University of Wisconsin solution (UW) or Hanks balanced salt solution (HBSS) (control) both before and after 65 min of cold pancreas storage. Collagenase was also administered in a specially designed cold storage solution (University of Leicester solution, ULEIC), before cold storage. Median islet yield was significantly greater if the pancreas was distended with collagenase in either UW (21 524 islet equivalents (IEQ) per g) or ULEIC (19 814 IEQ/g) before cold storage, compared with that after distension with HBSS (6924 IEQ/g) following cold storage (P<0·05). Islet fragmentation, islet purification and glucose-stimulated insulin release were not significantly different after collagenase delivery in either UW or ULEIC compared with those after administration in HBSS. It is concluded that porcine islet yields can be improved significantly by intraductal collagenase administration in either UW or ULEIC immediately after excision of the pancreas.
Incidence and nature of bile duct injuries following laparoscopic cholecystectomy: An audit of 5913 cases
Authors: Richardson M C , Bell G , Fullarton G M
Published: March 2007

The rapid introduction of laparoscopic cholecystectomy has been associated with an apparently increased incidence of bile duct injury which has provoked worldwide concern. The true incidence and mechanism of iatrogenic ductal injury during the development of this procedure remain unclear. To assess this, the introduction of laparoscopic cholecystectomy in the West of Scotland has been audited prospectively over a 5-year period. All cases of biliary ductal injury have been independently reviewed. Some 48 surgeons undertaking laparoscopic cholecystectomy in 19 hospitals submitted prospective data between September 1990 and September 1995. A total of 5913 laparoscopic cholecystectomies were attempted with 98·3 per cent completion of data collection. During this period 37 laparoscopic bile duct injuries occurred. The annual incidence peaked at 0·8 per cent and has fallen to 0·4 per cent in the final year of audit. Injuries occurred after a median personal experience of 51 (range 3–247) laparoscopic chole cystectomies in 22 surgeons. Major bile duct injuries occurred in 20 of 37 patients, giving an incidence of 0·3 per cent. Five mechanisms for laparoscopic ductal injury were identified, including tenting, confluence and diathermy injuries as well as the classical and variant classical types. Ductal injuries were discovered at operation in 18 patients with consequent repair giving a good clinical outcome in 17. Contributory factors (severe inflammation, aberrant anatomy and poor visualization) were present in only 13 of 37 cases. This audit suggests that, at least in the introductory period, laparoscopic cholecystectomy is associated with an overall bile duct injury rate higher than that reported previously after open cholecystectomy, although the incidence of major ductal injury is similar. The late downward trend in bile duct injury, however, suggests there may be a prolonged learning curve for this procedure. Improved understanding of the mechanism of injury may lead to yet further reductions in this complication.
Colour duplex ultrasonography in the rational management of chronic venous leg ulcers
Authors: Grabs A J , Wakely M C , Nyamekye I , Ghauri A S K , Poskitt K R
Published: March 2007

Colour duplex ultrasonographic imaging has largely replaced venography in the assessment of lower-limb venous disorders. This is a study of the use of duplex in the management of patients with chronic venous ulceration in community ulcer clinics. Patients with chronic leg ulceration and an ankle: brachial pressure index of 0·85 or greater were studied. Assessment of venous competence in both the deep and superficial systems of the affected and unaffected legs was performed using colour venous duplex imaging. Reflux was defined as reverse flow for greater than 1 s after manual calf compression. One hundred consecutive patients were assessed over 15 months. Of 111 ulcerated legs, 96 had active ulceration, while 15 had been ulcerated within the previous 6 months. Fifty-seven (51 per cent) of the 111 ulcerated legs had superficial incompetence alone (88 per cent long saphenous system or its perforators, 12 per cent short saphenous system). Six legs (5 per cent) had isolated deep venous incompetence. Forty-two legs had mixed superficial and deep venous reflux; 22 of these had undergone previous venous surgery. Colour venous duplex assessment demonstrated superficial venous disease in approximately half of limbs with chronic leg ulceration. Venous dysfunction in these patients is potentially curable by surgery.
Still missing the boat with fatal pulmonary embolism
Authors: Gillies T E , Ruckley C V , Nixon S J
Published: March 2007

Deaths from pulmonary embolism during 1994 among surgical inpatients in three Scottish regions were identified through the Scottish Audit of Surgical Mortality and reviewed to identify the risk factors for thrombo-embolic disease and the thromboprophylaxis received. Fifty-seven deaths were studied (3 per cent of total deaths); 25 (44 per cent) of the patients had received prophylaxis. Thirty-six patients were in a high-risk group, 19 were at moderate risk and two at low risk. Patients admitted as an emergency, those managed conservatively and those judged to be at moderate risk of thrombo-embolic disease were most likely not to have received thromboprophylaxis.
Sequential systemic platelet-activating factor and interleukin 8 primes neutrophils in patients with trauma at risk of multiple organ failure
Authors: Botha A J , Moore F A , Moore E E , Peterson V M , Silliman C C , Goode A W
Published: March 2007

Plasma from 33 patients at risk of multiple organ failure (MOF) after major trauma was tested for a priming effect on neutrophils, and for the presence of platelet-activating factor (PAF) activity and interleukin (IL) 8. Plasma sampled at 3, 6, 12 and 24 h after injury significantly primed normal neutrophils to release mean(s.e.m.) 1·26(0·19), 1·33(0·26), 1·04(0·14) and 0·86(0·13) nmol superoxide per min per 1·3 × 106 neutrophils respectively (P<0·05). Priming at 3 h after injury was inhibited by mean(s.e.m.) 63·8(7·0) per cent by the PAF antagonist, WEB 2170 (P<0·01). Mean(s.e.m.) plasma IL-8 was raised at 6 and 12 h after injury to 785(183) and 836(175) pg/ml (P<0·01). At 12 h after injury the plasma IL-8 level correlated directly with the number of units of red blood cells transfused (r=0·64, P<0·01), and was significantly higher in the group of six patients who developed MOF (P<0·05). These data suggest that after trauma the mediators PAF and IL-8 appear sequentially in the circulation, are potential mechanisms of circulating neutrophil priming, and that IL-8 may also be an early biochemical marker predicting the onset of MOF.
Use of covered expandable metal stents in the treatment of oesophageal carcinoma and tracheo-oesophageal fistula
Authors: Cook T A , Dehn T C B
Published: March 2007

Palliation for malignant dysphagia has relied on oesophageal dilatation, insertion of rigid prostheses and laser treatment. All three methods have substantial risk of perforation. Displacement of the tube is also well described. Seventeen expandable polyethylene-covered metal stents were inserted in 15 patients with oesophageal carcinoma; there were 11 men and four women, of median age 70 years. Thirteen stents were inserted for dysphagia and four for tracheo-oesophageal fistula (TOF). Stents were inserted endoscopically under fluorosopic control. Seven patients died from their disease a median of 5 (range 1–11) months after stent insertion. Median follow-up in the remainder is 6 (range 1–11) months. Median dysphagia scores before and after insertion were 3 (range 2–4) and 1 (range 1–2) respectively. Stent insertion provided cure of symptoms in patients with TOF. Median hospital stay following insertion was 2 (range 1–20) nights. There were no deaths and no perforations associated with the procedure. Two patients complained of retrosternal chest pain for 2 days after stent insertion. One patient presented with dysphagia related to later stent migration. There has been no deterioration in symptoms of dysphagia in the remainder. Expandable oesophageal stents offer a safe alternative to traditional methods of palliative treatment for oesophageal carcinoma. In the long term they may provide a cost-effective alternative to standard treatments.
Port-site metastases in patients undergoing laparoscopy for gastrointestinal malignancy
Authors: Cook T A , Dehn T C B
Published: March 2007

Laparoscopic colonic resection and laparoscopy for the assessment of malignant disease have been advocated. Metastatic deposits at port sites are recognized but the incidence of these is poorly defined. Forty-six patients, of median age 65 (range 19–90) years, with gastrointestinal malignancy underwent laparoscopy. Eighteen patients died a median of 4 (range 1–28) months after laparoscopy, four following colonic resection and 14 with gastro-oesophageal malignancy; ten had undergone resection. Median follow-up of the 28 survivors is 8 (range 2–39) months. Five of the 46 patients developed port-site recurrence giving an early incidence of port-site recurrence in this cohort of patients of 11 per cent. Five of 20 patients with tumour involving serosal surfaces developed port-site recurrence compared with none of 26 without serosal involvement (P = 0·022, Fisher's exact test). Port-site recurrence may be related to serosal involvement with tumour.
Radical lymphadenectomy in the management of early gastric cancer
Authors: Hayes N , Karat D , Scott D J , Raimes S A , Griffin S M
Published: March 2007

Lymph node metastasis in patients with early gastric cancer was evaluated prospectively to determine whether radical (D2) lymphadenectomy is appropriate in such cases. Twenty-eight (18 per cent) of 156 patients having surgery for gastric cancer had early disease. Lymph node metastasis was found in 12 of the 28 patients. Metastasis was more likely in submucosal than mucosal early gastric cancer (nine of 14 versus three of 14; P = 0·024, Fisher's exact test). In two of three patients with metastasis at the N2 level, the N1 nodes were entirely clear. This study shows a higher incidence of lymph node metastasis than has been reported previously in both the UK and Japan. The high incidence of lymph node metastasis in early gastric cancer supports the continuing use of radical lymphadenectomy in patients who are fit for such major surgery.
Accuracy of laparoscopic ultrasonography in the staging of upper gastrointestinal malignancy
Authors: Anderson D N , Campbell S , Park K G M
Published: March 2007

Laparoscopic ultrasonographic staging was compared prospectively with conventional computed tomography (CT) and ultrasonographic staging of 24 lower-third oesophageal tumours and 20 gastric malignancies. Following laparoscopic ultrasonography, seven patients regarded as being resectable after conventional imaging were excluded from surgical exploration because of ascites with peritoneal deposits (four patients), liver metastases (one), advanced local disease (one) and poor tolerance of general anaesthesia (one). Preoperative T and N stages were compared with the pathological staging following resection in 34 patients. Laparoscopic ultrasonography was significantly more accurate than conventional CT and ultrasonography in assessment of the primary tumour (91 versus 64 per cent, P< 0·01) and nodal status (91 versus 62 per cent, P<0·05). The addition of laparoscopic ultrasonography to conventional procedures for staging upper gastrointestinal malignancy improved the overall accuracy of staging. Although this may have future implications for the selection of patients for multimodality treatment, management decisions are currently based on laparoscopic findings, which in this study resulted in a resection rate of 97 per cent.