bluuebunny/crossref_metadata_2025 huggingface dataset:
Laparoscopic ligamentum teres (round ligament) cardiopexy
Authors: Nathanson L K , Shimi S , Cuschieri A
Published: March 2007

A technique of laparoscopic ligamentum teres cardiopexy for reflux oesophagitis unresponsive to medical treatment is described. The procedure has been performed on five patients and on postoperative testing has been shown to achieve competence of the lower oesophageal sphincter by lengthening of the intra-abdominal segment, accentuation of the angle of His and elevation of the pressure in the high pressure zone. All the patients have been relieved of their symptoms by the operation and have not sustained any adverse effects but the follow-up period is short.
Gastrointestinal mucormycosis
Authors: Thomson S R , Bade P G , Taams M , Chrystal V
Published: March 2007

Twenty patients with gastrointestinal mucormycosis are reviewed. This often fatal opportunistic fungal infection was diagnosed histologically, and was categorized as colonization (five patients), infiltration (seven patients), or vascular invasion (eight patients). There were no fatalities from colonization. In 10 patients, mucormycosis complicated peptic ulcer disease. Seven of these patients had infiltrative or invasive disease. The presentation and operative findings mimicked malignancy in five of these seven patients, and six had successful surgical intervention. The other patient was cured by medical therapy alone. Ten patients had infection associated with other gastrointestinal diseases: post-traumatic peritonitis (four patients), transmural amoebiasis (two patients), tuberculosis (one patient), gastroenteritis (one patient), gastric carcinoma (one patient) and diabetes (one patient). Eight patients had significant infection and only one survived. In this series, mucormycosis had a less aggressive course when complicating peptic ulcer than when it occurred in association with other gut diseases.
Percutaneous flexible choledochoscopy: A simple method for retained common bile duct stone removal
Authors: Menzies D , Motson R W
Published: March 2007

Conventional methods of treatment of retained common bile duct stones found on T tube cholangiography after common bile duct exploration include percutaneous extraction under fluoroscopic control and endoscopic sphincterotomy. Four cases of percutaneous stone extraction under direct vision using the flexible choledochoscope are described. Clearance of the bile ducts was achieved at one sitting in three cases and four sittings in one case. Follow-up tube cholangiography was performed in two cases and confirmed complete clearance. Percutaneous endoscopic stone extraction can be performed by any surgeon with experience of flexible choledochoscopy and offers the advantages of a minimally invasive procedure without the use of specialized equipment.
Accurate intraoperative transhepatic U tube placement
Authors: Krige J E J , Terblanche J , Beningfield S J
Published: March 2007

Cholangiocarcinoma of the main hepatic duct junction is best treated by curative resection, although this is not often possible as most lesions are associated with local infiltration, portal vein invasion or metastases. For unresectable lesions, we advocate the use of a wide bore U tube followed by radiotherapy. Placement of the U tube must be accurate and meticulous. This paper describes a simplified method allowing accurate intraoperative transhepatic U tube placement.
Randomized trial of intra-arterial recombinant tissue plasminogen activator, intravenous recombinant tissue plasminogen activator and intra-arterial streptokinase in peripheral arterial thrombolysis
Authors: Berridge D C , Hopkinson B R , Makin G S , Gregson R H S
Published: March 2007

Sixty patients were recruited into a randomized parallel group comparison of three thrombolytic regimens for acute or subacute peripheral arterial thrombosis. There were no significant differences in age, duration of history, length of occlusion or presence of neurosensory deficit between the groups. Initially successful lysis was significantly greater with intra-arterial (IA) recombinant tissue plasminogen activator (rt-PA) than with either streptokinase (Sk) (P < 0·04) or intravenous (IV) rt-PA (P < 0·01). The duration of therapy varied from a median of 35 h with IA rt-PA to 40 h with Sk (P > 0·5). The median (confidence interval) increase in ankle:brachial pressure index following IA rt-PA of 0·57 (0·33–0·82) was significantly higher than for either Sk of 0·24 (0–0·57) or for IV rt-PA of 0·18 (0–0·41). Limb salvage at 30 days was achieved in 80, 60 and 45 per cent respectively for IA rt-PA, Sk and IV rt-PA. Haemorrhagic complications occurred in six patients following Sk and in 13 following IV rt-PA; only one minor haemorrhage occurred following a catheter perforation in a patient who received IA rt-PA (P < 0·05). IA rt-PA provides a more effective, safer fibrinolytic regimen than conventional therapy with Sk. IV rt-PA has not been as successful and carries a significantly higher risk of haemorrhagic complications.
Infra-inguinal aneurysms: Outcome for patient and limb
Authors: Hands L J , Collin J
Published: March 2007

The outcome of conservative treatment of infra-inguinal (femoral and popliteal) aneurysms was compared with that following vascular reconstruction. Over a 12-year period up to December 1988, 43 femoral aneurysms and 35 popliteal aneurysms presented to the Oxford Regional Vascular Service; 88 per cent of the femoral and 60 per cent of the popliteal aneurysms were treated by vascular reconstruction. The outcome was assessed in terms of limb symptoms or preservation and patient survival at the most recent point of follow-up (median 4·5 years). At least 12 of the 13 initially asymptomatic femoral and popliteal aneurysms which were untreated remained asymptomatic. In contrast, six of the 26 limbs with asymptomatic femoral aneurysms and three of the 11 limbs with asymptomatic popliteal aneurysms developed significant distal ischaemia after vascular reconstruction; four limbs came to amputation after intervention. Aggressive surgical management of all asymptomatic infra-inguinal aneurysms is unjustified and dangerous.
Fibrinolytic activity and calf pump failure
Authors: Gajraj H , Browse N L
Published: March 2007

The interstitial fibrinolytic activity of the upper and lower limbs was investigated in subjects with abnormal calf pump function by measuring the lysis rate of experimentally produced subcutaneous 125I-fibrin clots. Thirty-three subjects with healed venous ulcers, five with varicose veins and 11 controls were studied. 125I-fibrin clots were produced in the subcutaneous tissue of the forearms and legs and clearance half-life was calculated. Calf pump function was assessed by foot volumetry and the ‘gaiter’ skin nutritive circulation by measuring the transcutaneous oxygen tension (PtcO2). Fibrin clearance was prolonged from the subcutaneous tissues of the legs of subjects with varicose veins and healed ulcers compared with controls. Negative correlations were found between fibrin clearance half-life and the half-volume refilling time (P < 0·01) and the PteO2  (P < 0·01).
Fibronectin and collagen gene expression in healing experimental colonic anastomoses
Authors: Braskén P , Renvall S , Sandberg M
Published: March 2007

The temporal and spatial expression of fibronectin and type I and III collagen genes were studied 1–14 days after surgery in the healing rat colonic anastomosis using recombinant deoxyribonucleic acid techniques. Messenger ribonucleic acids (mRNAs) coding for fibronectin and type III collagen synthesis increased from the first day after operation and type I collagen synthesis increased from the second day after operation, as demonstrated by Northern hybridizations. Maximal mRNA production for fibronectin and collagens was seen at 2 and 7 days, respectively, after anastomosis. Activation of type I and III collagen genes in the anastomotic area was confined to tissues developing in the anastomotic line, the serosal surface and the submucosal layer. Strong fibronectin expression was observed in the same areas. The results suggest that genetic events leading to collagen synthesis in the anastomotic area start immediately after surgery. Maximal gene expression is not reached until 1 week after surgery.
Evaluation of palliative surgical procedures in unresectable pancreatic cancer
Authors: de Rooij P D , Rogatko A , Brennan M F
Published: March 2007

To update our experience with palliative surgical procedures in unresectable adenocarcinoma of the pancreas, the records of 297 patients surgically treated at Memorial Sloan-Kettering Cancer Center were reviewed. Between October 1983 and November 1989, 117 patients underwent exploratory laparotomy as a single procedure: 24 patients had gastric bypass, 38 biliary bypass, and 118 both gastric and biliary bypass. The postoperative in-hospital mortality rate was 4.4 per cent. Overall morbidity was 20.9 per cent; the morbidity rate in patients with a double bypass was 29.7 per cent. Median(s.e.m.) survival was 231(20.3) days. Statistical analysis showed a significantly increased risk of morbidity in patients who underwent one therapeutic and one prophylactic bypass. Survival was decreased in patients who had a therapeutic gastric bypass (median(s.e.m.) survival 136(70.2) days) or a combination of two therapeutic bypasses (median(s.e.m.) survival 93(85.9) days). These data emphasize the poor prognosis of patients with pancreatic adenocarcinoma who cannot be resected. The need for therapeutic double bypass is a bad prognostic indicator, and a prophylactic bypass added to a therapeutic bypass increases morbidity without prolonging survival.
Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis
Authors: El Hamel A , Parc R , Adda G , Bouteloup P Y , Huguet C , Malafosse M
Published: March 2007

Spontaneous haemorrhage associated with chronic pancreatitis in 17 patients was related to a pseudocyst in 15 (88 per cent) patients and to pancreatic lithiasis (one patient) or to infarction-rupture of the spleen (one patient). Bleeding was massive in six patients and intermittent in 11. It resulted from erosion of the gastroduodenal or the splenic artery in four patients. Bleeding into the pancreatic duct occurred in four patients and erosion of the duodenum by a bleeding pseudocyst in five. Haemorrhage was confined to a pseudocyst in six patients and was intraperitoneal in two. Of the 15 patients with bleeding pseudocysts, ten underwent primary pancreatic resection (eight proximal and two distal pancreatectomies) with no mortality but four had early complications. Four of the five patients who underwent transcystic ligation of bleeding vessels and pseudocyst drainage had postoperative complications: one died from sepsis and liver failure and three underwent reoperation for severe postoperative bleeding. Of these, two had proximal pancreatic resection with one death. The third patient had further suture ligation and external drainage. The overall postoperative mortality rate was 12 per cent and following emergency surgery 33 per cent. Favourable results were achieved in two-thirds of patients when the primary operative strategy could be directed towards the control of bleeding and removal of the affected pancreatic segment. Primary pancreatic resection, although technically demanding in the presence of haemorrhage, is recommended whenever possible for the treatment of bleeding pancreatic pseudocysts and pseudoaneurysms associated with chronic pancreatitis.
Pulmonary microvasculature in experimental acute haemorrhagic and oedematous pancreatitis
Authors: Kelly D M , McEntee G P , McGeeney K F , Fitzpatrick J M
Published: March 2007

The pulmonary microvasculature was examined in two experimental models of acute pancreatitis by scanning electron microscopy of microvascular corrosion casts. Haemorrhagic pancreatitis was induced in eight male Sprague—Dawley rats using an intraductal injection of 5 per cent sodium taurocholate. Oedematous pancreatitis was induced in seven male Spague—Dawley rats using an intravenous infusion of supramaximal doses of caerulein (5 m̈g/kg per hour). The pulmonary vessels were cast using a polymer resin and the cast studied by scanning electron microscopy at 3 and 12 h in those with haemorrhagic and at 1 and 4 h in those with oedematous pancreatitis. Vascular abnormalities were present in both models at the initial study time with abruptly terminating vessels being more prominent in the caerulein model. At the later times, however, the abnormalities in the sodium taurocholate model were much more severe, with a substantial loss of vascular density, tortuosity and abrupt terminations of those vessels present. Micro-vascular abnormalities may be responsible for some of the pulmonary changes seen in oedematous and haemorrhagic pancreatitis.
Spontaneous perforation of the bile duct in infants
Authors: Davenport M , Heaton N D , Howard E R
Published: March 2007

Spontaneous perforation of the bile duct is a rare but well documented condition of infants. Six infants are described, five presenting within 2 months of birth without apparent antecedent factors and one associated with an ‘acquired’ type I biliary atresia at 8 months. All infants underwent definitive surgery, which included decompression of the biliary tree with cholecystenterostomy or T tube drainage. There was no morbidity or mortality associated with such surgical intervention.
c-myc protein product is a marker of DNA synthesis but not of malignancy in human gastrointestinal tissues and tumours
Authors: Rew D A , Taylor I , Cox H , Watson J V , Wilson G D
Published: March 2007

c-myc is a conserved cellular gene. The gene product is a nuclear-bound 62000 molecular weight phosphoprotein (p62c-myc). Although p62c-myc levels have been measured in colorectal cancers, little is known about the expression of the protein in upper gastrointestinal tumours and tissues. Studies were performed on tumour and mucosal specimens from 87 patients with colorectal cancer, from two with polyposis coli, from six with squamous oesophageal carcinomas and from 18 with gastric carcinomas. The mean p62c-myc content was measured in units of fluorescence in the G1 diploid and G2 diploid peaks of the cell cycle by multiparameter flow cytometry using the 6E10 antibody. The nuclear p62c-myc content increased with DNA synthesis in tumours and mucosa. G2 levels of p62c-myc were higher in glandular mucosa than in adenocarcinomas. No differences in peak nuclear c-myc expression were found in relation to histological grade or to anatomical site of colorectal tumours. There was a broadly inverse relationship between G2 p62c-myc levels in tumours and mucosa and their in vivo 5-bromo-2′-deoxyuridine labelling indices. Nuclear p62c-myc levels are cell cycle related but the protein has not been shown to be a marker of increased tissue proliferation or of gastrointestinal malignancy. The reduction of the nuclear p62c-myc content of many adenocarcinoma cells compared with glandular mucosa cells suggests that reduced synthesis or nuclear retention of the normal protein may be a factor in the development of gastrointestinal adenocarcinomas, although the mechanism by which this may occur is not clear.
Nutritional status after total and partial gastrectomy with Roux-en-Y reconstruction
Authors: Staël Von Holstein C , Walther B , Ibrahimbegovic E , Åkesson B
Published: March 2007

Dietary intake and nutritional status were studied in two groups of patients after total gastrectomy (n = 10) and after partial gastrectomy (n = 10). All patients were reconstructed with a Roux-en-Y loop. Investigations were carried out 4–17 years after the operation. Eight patients in the group undergoing total gastrectomy and four patients undergoing partial gastrectomy had gastric carcinoma and were without recurrent disease 5–15 years after the operation. A clinical dietician conducted an anthropometric evaluation. All patients underwent an upper gastrointestinal endoscopy, clinical examination, [14C]triolein breath test and a blood chemistry profile. The median weight loss from operation to investigation was 2.1 kg in the partial gastrectomy group and 6.7 kg in the total gastrectomy group (n.s.). After partial gastrectomy three patients had a subnormal body mass index (n.s.). This was not found in the total gastrectomy group. Energy intake was below that recommended in seven patients in the partial gastrectomy group (three of them had a subnormal body mass index) and in two in the total gastrectomy group (n.s.) [14C]triolein breath testing revealed fat malabsorption in three patients after partial gastrectomy and in five patients after total gastrectomy (n.s.).
Surgery improves defective oesophageal peristalsis in patients with gastro-oesophageal reflux
Authors: Escandell A Ortiz , De Martinez Haro L F , Paricio P Parrilla , Aguayo Albasini J L , Marcilla J A Garcia , Morales Cuenca G
Published: March 2007

Postoperative manometry was carried out in 12 patients with gastro-oesophageal reflux associated with hypomotility of the oesophageal body. A Nissen fundoplication was carried out in all patients. After a median follow-up of 3.5 years, patients underwent clinical, endoscopic, radiological, manometric and pH-metric evaluation. Manometric results revealed an overall improvement in oesophageal motor function with an increase in the amplitude of deglutition waves and a decrease in the percentage of deglutitions without response. Six of the patients (one with complete motor failure) recovered normal peristaltic function. Non-specific oesophageal motor disorders may be secondary to gastro-oesophageal reflux and are reversible in nature.
Effect of initial biopsy procedure on prognosis in Stage 1 invasive cutaneous malignant melanoma: Review of 1086 patients
Authors: Lees V C , Briggs J C
Published: March 2007

After treatment for primary clinical Stage 1 invasive cutaneous malignant melanoma, 1086 patients were followed for a minimum of 5 years from initial operation. Patient data were retrieved from the unit's melanoma registry; 96 (8.8 per cent) were treated initially by incisional biopsy, 292 (26.9 per cent) by narrow margin excision biopsy and 698 (64.3 per cent) by wide margin excision. Logistic regression analysis was performed to assess the statistical significance of the association between the various factors. The method of initial biopsy was related to maximal tumour thickness, age, and sex. Incisional biopsy rendered 38 out of 96 (40 per cent) lesions not fully assessable on current histopathological criteria, significantly higher than for the other biopsy techniques (P<0.0001). Incisional biopsy did not adversely affect prognosis in terms of local recurrence and mortality. Prognosis was related to tumour thickness, age and sex of the patient, and not to biopsy technique. We recommend that all suspicious lesions should be submitted to excisional rather than incisional biopsy to avoid compromising the histological assessment, given the importance of maximal tumour thickness in determining treatment and prognosis.
Impalpable testis: Testicular vessel division in treatment
Authors: Lawson A , Gornall P , Buick R G , Corkery J J
Published: March 2007

Between 1984 and 1989, 110 boys with 130 impalpable testes were investigated and treated. One hundred and six boys underwent laparoscopy. Twenty had bilateral impalpable testes and 13 had a palpable, but maldescended, testis on the other side. Forty-nine testes were absent and one atrophic testis was found in the scrotum. Twelve orchidectomies were performed. One child had a microvascular transfer procedure. The remaining 67 testes were treated by orchidopexy: 28 single-stage and 39 two-stage procedures. One of the single-stage and 29 of the two-stage orchidopexies included division of the testicular vessels. Twenty-three testes examined 12 or more months after staged testicular vessel division revealed a good result in 15.
Retrograde femoral angioplasty: A new technique
Authors: Shanahan D , Grieve N W T , Bennett C E , Thomas M H
Published: March 2007

Percutaneous transluminal angioplasty cannot be used for lesions of the superficial femoral artery when the origin of the vessel is occluded. A new technique, retrograde femoral angioplasty, is described in which angioplasty is performed from below via the exposed popliteal artery. In four out of six patients retrograde femoral angioplasty was successfully completed, and three of the four vessels remain patent up to 1 year later. The method provides an alternative to the femoropopliteal bypass graft in some patients.
Objective assessment of high ligation without stripping the long saphenous vein
Authors: McMullin G M , Smith P D Coleridge , Scurr J H
Published: March 2007

Non-invasive methods of venous assessment were used to assess the procedure of high ligation plus multiple avulsion of varicosities for the treatment of varicose veins in 54 limbs. Duplex scanning before operation confirmed saphenofemoral incompetence and excluded short saphenous incompetence. After operation it revealed that in two limbs the saphenofemoral junction was still patent and incompetent. In the 52 limbs in which the junction had been ligated there was persistent reflux down the long saphenous vein in 24 cases. In only two limbs was this attributable to mid-thigh perforating veins. Photoplethysmography was also performed before and after operation and the venous refilling time measured. Improvement in refilling time produced by application of above knee tourniquets before operation was measured (predicted improvement) and the change in refilling time after operation was also recorded (observed improvement). There was a statistically significant correlation between observed improvement and predicted improvement in refilling times in the limbs with no reflux in the long saphenous vein after operation (Pearson's correlation coefficient, r = 0.6, P<0.001). There was no correlation between predicted and observed refilling times in the limbs with persisting reflux in the long saphenous vein after operation. In conclusion, this operation fails to control functionally significant reflux within the long saphenous vein in a high proportion of cases.
Seton treatment of high anal fistulae
Authors: Williams J G , MacLeod C A , Rothenberger D A , Goldberg S M
Published: March 2007

Seventy-four patients who underwent seton treatment of high anal fistulae over a 6-year period have been reviewed. Four different techniques were used: staged fistulotomy (n = 24), cutting seton (n = 13), short-term seton drainage (n = 14) and long-term seton drainage in patients with Crohn's disease (n = 23). Recurrence developed in two patients (8 per cent) undergoing two-stage fistulotomy; two patients (14 per cent) undergoing short-term drainage and nine (39 per cent) of the patients with Crohn's disease. Three patients with Crohn's disease required proctectomy for progressive perianal disease. The remaining 11 patients with Crohn's disease (48 per cent) obtained a good result. None of the patients treated with a cutting seton developed a recurrence. Minor incontinence developed in 13 patients (54 per cent) undergoing two-stage fistulotomy and seven patients (54 per cent) treated with a cutting seton. When sphincter muscle was not divided, five patients (36 per cent) undergoing short-term drainage and six patients (26 per cent) undergoing long-term drainage developed minor incontinence. High complex fistulae can be successfully treated with only minor loss of continence using different seton techniques. In high Crohn's fistulae, long-term seton drainage preserves sphincter function, but recurrence is common if the seton is removed.
Reversal of Hartmann's procedure: Timing and operative technique
Authors: Roe A M , Prabhu S , Ali A , Brown C , Brodribb A J M
Published: March 2007

A review of closure of Hartmann's colostomy was undertaken to establish guidelines for the timing and technique of reversal. Between 1984 and 1990 there were 69 reversals; 48 patients originally had diverticular disease and 21 had carcinoma. One-third underwent reversal before 4 months and two-thirds after this time. The operative mortality rate was 3 per cent and the anastomotic leak rate 4 per cent. Significant morbidity occurred in 30 per cent. There was no advantage in delayed closure. Complications occurred in 24 per cent of patients undergoing reversal before and 35 per cent undergoing reversal after 4 months. Thirty-five anastomoses were hand-sewn and 34 stapled. There were no differences in operating time for the two techniques, but a greater number were stapled after 4 months than before (P < 0·05), which may reflect increased rectal stump shrinkage with time. There were no differences in complication rates whether the anastomosis was hand-sewn (34 per cent) or stapled (26 per cent). Closure of Hartmann's colostomy is a safe procedure but has a significant morbidity in nearly one-third of cases. On the basis of these results, there is no indication to delay closure after 4 months have elapsed, and earlier reversal, when the rectal stump is most accessible, is recommended.
Risk of strangulation in groin hernias
Authors: Gallegos N C , Dawson J , Jarvis M , Hobsley M
Published: March 2007

Although the elective repair of groin hernias is advised to prevent strangulation, the likelihood of this complication occurring is unknown. To quantify this risk, the cumulative probability of strangulation in relation to the length of history has been calculated for inguinal and femoral hernias presenting to this hospital between 1987 and 1989. Of 476 hernias (439 inguinal, 37 femoral), there were 34 strangulations (22 inguinal, 12 femoral). After 3 months the cumulative probability of strangulation for inguinal hernias was 2·8 per cent, rising to 4·5 per cent after 2 years. For femoral hernias the cumulative probability of strangulation was 22 per cent at 3 months and 45 per cent at 21 months. The rate at which the cumulative probability of strangulation increased was in both cases greatest in the first 3 months, suggesting that patients with a short history of herniation should be referred urgently to hospital and given priority on the waiting list.
Surgical management of the thoracic outlet compression syndrome
Authors: Davies A H , Walton J , Stuart E , Morris P J
Published: March 2007

There is some disagreement about whether the first rib should be excised in the presence of a cervical rib for the relief of the thoracic outlet compression syndrome (TOCS). Over a 14-year period (1975–1988) 58 patients have undergone surgery for TOCS. Forty-four patients (76 per cent) had vascular symptoms, 28 (48 per cent) with a neurological component; 11 (19 per cent) had only neurological symptoms. Thirty-six patients (62 per cent) had the first rib excised; 19 (33 per cent) had a cervical rib excised; two (3 per cent) had a division of fibrous bands; and one patient had a large transverse process resected. Follow-up details were available on 53 patients (91 per cent). Overall 38 (72 per cent) were cured of their symptoms, 11 (21 per cent) had a significant improvement, and four (8 per cent) showed no improvement. There was no significant difference between the results following excision of a cervical rib or of a first rib in terms of relief of symptoms. In patients with TOCS who have a cervical rib, excision of the cervical rib alone without excision of the first rib would appear to be an appropriate treatment.
Current management of trauma to the pancreas
Authors: Wilson R H , Moorehead R J
Published: March 2007

This review examines pancreatic trauma and its management in the light of recent experience. The incidence, mechanism, classification, diagnosis, treatment and complications of pancreatic trauma are discussed. The difficulty in establishing the diagnosis is addressed and possible solutions are provided. The case for conservative surgery in the absence of pancreatic duct damage is outlined. The importance of draining all pancreatic injuries is emphasized.
Anti-epithelial membrane antigen monoclonal antibodies and radioimmunolocalization of colorectal cancer
Authors: Yiu C Y , Baker L A , Boulos P B
Published: March 2007

The monoclonal antibodies LICR-LON M8 and 77-1, which react with epithelial membrane antigen, showed a strong reaction with colorectal cancer on immunohistochemistry. In a radioimmunolocalization study in patients with colorectal cancer, 111In-labelled M8 detected 13 of 16 tumour sites present in 16 patients. 111In-labelled 77-1 detected 10 of 15 tumour sites present in 14 patients. The high radioactive background in the liver prevented the detection of hepatic metastases in eight patients (five in the M8 and three in the 77-1 group). The mean(s.d.) tumour to normal colon ratio was 2·5(1·2) for M8 and 1·6(0·5) for 77-1 at day 6 after antibody administration. The mean(s.d.) tumour to blood ratio was 4·9(3·7) for M8 and 3·6(1·5) for 77-1. There was no statistical difference between these results. All scan-positive cancers reacted with M8 and 77-1 on immunohistochemistry. The results suggest that these monoclonal antibodies may have a role in the immunolocalization of colorectal cancer.
Management of haemangioma of the liver: Comparison of results between surgery and observation
Authors: Yamagata M , Kanematsu T , Matsumata T , Utsunomiya T , Ikeda Y , Sugimachi K
Published: March 2007

Cavernous haemangioma of the liver was diagnosed in 33 patients using hepatic angiography between 1978 and 1988. Thirteen of these patients underwent surgery. There were no deaths after operation; morbidity included upper gastrointestinal bleeding in two patients and liver dysfunction in one. The follow-up study showed no evidence of recurrence in any of the 13 patients up to 143 months after operation. In the operated patients, a small haemangioma was left in the liver of two for anatomical reasons, but the size of these tumours showed no change over 3 years. The remaining 20 patients had no specific treatment for haemangioma and were followed up for between 18 months and 8 years. Of these 20 patients, 19 had tumours of < 5 cm in size. As there was no enlargement or rupture of haemangiomas of < 5 cm, it was felt that these could be observed. Cases having a potential for exposure to trauma, rapid tumour growth, or displaying severe symptoms should be considered for surgical treatment; this can be justified due to low morbidity and no mortality.
Operative choledochoscopy in patients with acute cholangitis: A prospective, randomized study
Authors: Lau W Y , Li A K C , Chu K W , Yuen W K , Poon G P , Hwang J S T
Published: March 2007

A prospective, randomized evaluation of operative choledochoscopy was carried out during emergency surgery in patients with acute cholangitis or acute suppurative cholangitis when conservative management had failed. After common bile duct exploration, 79 patients were randomized to have choledochoscopy and 78 patients to the control group. Laboratory and clinical parameters showed that choledochoscopy did not increase the incidence of septicaemia, acute pancreatitis, persistent cholangitis, postoperative wound sepsis, intraperitoneal sepsis and hospital mortality. The incidence of retained common bile duct stones detected by T tube cholangiography performed in the second postoperative week was significantly reduced (P < 0·01) after choledochoscopy. Choledochoscopy detected stones missed by conventional common bile duct exploration in ten patients. It is concluded that choledochoscopy is a safe and effective technique in patients with acute cholangitis and acute suppurative cholangitis.
Pancreatic tissue and ductal pressures in chronic pancreatitis
Authors: Jalleh R P , Aslam M , Williamson R C N
Published: March 2007

To assess the contribution of parenchymal hypertension to pain, pancreatic tissue pressures were measured intraoperatively in 17 patients with chronic pancreatitis and in four other patients undergoing pancreatic surgery (reference group). The technique involved direct fine needle cannulation of the pancreas using a flow infusion system, which measured parenchymal resistance to this infusion. Three to six recordings were obtained at each site. In chronic pancreatitis the pressure (mean ± s.e.m.) was substantially elevated in all regions of the pancreas compared with reference subjects: head (257 ± 59 versus 19 ± 5 mmHg, P < 0·05); body (201 ± 51 versus 13 ± 6 mmHg, P < 0·05) and tail (161 ± 45 versus 11 ± 3 mmHg, P < 0·05). Elevation was greater in areas of calcific disease (281–383 mmHg) than in non-calcific disease (81–120 mmHg, P < 0·05). Mean pancreatic ductal pressure in 10 patients (seven with calcific disease) was 20 ± 4 mmHg. Differential pressure measurements within the pancreas helped determine the extent of resection in six patients with diffuse disease. The greatly increased tissue pressures in chronic pancreatitis, especially in the presence of calcification, suggest a possible ‘compartment syndrome’.
Structural and functional smooth muscle injury after surgical preparation of reversed and non-reversed (in situ) saphenous vein bypass grafts
Authors: Sayers R D , Bell P R F , Watt P A C , Thurston H , Muller S
Published: March 2007

Intimal hyperplasia and isolated stenoses are major factors in determining the long-term patency of reversed and in situ vein grafts. Surgical handling causes functional endothelial damage in reversed vein grafts but the effects of valvulotome use are unknown. Saphenous vein samples were taken after minimal dissection (control), distension with saline, or after the passage of a valvulotome. Rectangular strips of vein were mounted in an organ bath and cumulative noradrenaline (10−8–10−5M) dose contraction curves were performed. Compared with controls there was a significant reduction in the contractile response of both the distended and valvulotome-prepared veins (P < 0·05). Histological studies revealed partial endothelial cell loss in the distended group and total endothelial cell loss with patchy necrosis of the smooth muscle in the valvulotome group. These results suggest that the current use of a valvulotome not only renders the valves incompetent but also seriously damages the function of the smooth muscle layer.
Oxerutins in the prevention of recurrence in chronic venous ulceration: Randomized controlled trial
Authors: Wright D D I , Franks P J , Blair S D , Backhouse C M , Moffatt C , McCollum C N
Published: March 2007

The value of oxerutins [O-(β-hydroxyethyl)-rutosides] in the prevention of venous ulcer recurrence was investigated in a double-blind randomized controlled trial of 138 patients with recently healed chronic venous ulcers. Oxerutins in the form of Paroven 500 mg twice daily or identical placebo were given, and all patients were provided with elastic compression stockings. At follow-up 3 months later, patients were assessed for re-ulceration and for tablet and stocking compliance. Oxerutins (n = 69) and placebo (n = 69) groups were well matched for age, sex, duration of previous ulceration and deep vein thrombosis. Cumulative re-ulceration by life-table analysis at 12 and 18 months was 22 and 32 per cent respectively for placebo, and 23 and 34 per cent respectively for oxerutins (P = 0·93). Recurrence was more frequent in patients who complied with both tablets and stockings, suggesting that compliance was influenced by continued symptoms (P = 0·006). This trial failed to demonstrate that oxerutins influenced ulcer recurrence.
Prospective audit of vascular surgical emergencies in a District General Hospital
Authors: Michaels J A , Galland R B
Published: March 2007

A prospective clinical audit was carried out to assess the volume and distribution of workload generated by vascular surgical emergencies over a 3-month period in a single health district in the UK. Of 53 consecutive patients referred as surgical emergencies with peripheral vascular problems, 45 were referred to a single vascular surgeon, 36 directly from a general practitioner or other specialist and nine from another general surgeon. A total of 39 operations and six radiological procedures were carried out, including 26 vascular reconstructions. To accommodate the 27 non-urgent operations, nine were performed ‘out of hours’ and 17 planned cases were cancelled. A median of five general surgical beds were required throughout the period studied and 11 patients required intensive therapy unit admission for a total of 39 days. It is concluded that vascular surgical emergencies constitute a substantial workload and are being dealt with mainly by a single vascular surgeon who effectively works a one in one rota. Inadequate facilities for urgent vascular surgery lead to a large number of cases being dealt with out of hours and frequent cancellation of routine operations.
Peptide growth factors and wound healing
Authors: Kingsnorth A N , Slavin J
Published: March 2007

Growth factors and cytokines are important signal transducers in wound microenvironments. Experimental data are accumulating rapidly which demonstrate their ability to influence populations of polymorphs and macrophages to migrate to the wound, subsequently to be replaced by synthetic cells which produce collagen and matrix; these events are controlled sequentially at cell receptor level by a variety of locally delivered (paracrine and autocrine) peptides. Preliminary results from clinical trials using recombinant human growth factors to improve cutaneous healing are encouraging. Current research aims to produce growth preparations which can be applied to a wound to accelerate healing.
Recurrence of colorectal cancer after sutured and stapled large bowel anastomoses
Authors: Akyol A M , McGregor J R , Galloway D J , Murray G , George W D
Published: March 2007

The purpose of this study was to compare surgical stapling and manual suturing techniques with respect to the incidence of tumour recurrence in patients with colorectal cancer: 294 patients undergoing potentially curative resections for colorectal cancer were randomly allocated to receive sutured (n = 142) or stapled (n = 152) anastomoses. The mean(s.e.m.) incidence of tumour recurrence at the end of 24 months was 29.4(4.4) per cent in the sutured group, compared with 19.1(3.9) per cent in the stapled group (P<0.05). The corresponding rates for cancer-specific mortality at 24 months were 22.3(4.1) per cent and 10.9(3.0) per cent respectively (P<0.01). A multiple regression analysis revealed that the influence of anastomotic technique on recurrence and mortality rate was independent of tumour stage. These results suggest that in colorectal cancer surgery the use of stapling instruments for anastomotic construction could be associated with a reduction in the incidence of recurrence and mortality rate by as much as 50 per cent.
Mucosal function after ileal mucosal fenestration and colonic autotransplantation
Authors: Campbell F C , Smith D , Waldron B , Tait I , Shirazi-Beechey S , Mullins J , Hopwood D
Published: March 2007

A method of small bowel mucosal augmentation called ileal mucosal fenestration and colonic autotransplantation (IMFCA) was devised and tested in pigs. In this technique, a vascularized mucosal graft was harvested from a 12-cm ileal loop, fenestrated by serial incision and then expanded to 20 cm. A 20-cm colonic loop was isolated and surgical mucosectomy was carried out. The fenestrated ileal mucosal graft was then autotransplanted into the prepared colon and the resulting composite structure was exteriorized as a Thiry-Vella loop. With this technique, ileal mucosal fenestrations healed by lateral epithelial in-growth, giving a new mucosal continuum within the recipient colon. At 60 days after surgery, the surface area of transplanted mucosa exceeded that within the original ileal loop by approximately 85 per cent. At this time, the transplanted mucosa had morphology and capacity for Na+-dependent glucose transport which were indistinguishable from those of control ileal mucosa.
A safe new procedure for high-risk patients with symptomatic gallstones
Authors: Leahy A L , Darzi A W , Murchan P M , O'Gorman S , Tanner W A , Keane F B V , Hamilton S
Published: March 2007

Cholecystectomy is associated with an appreciable mortality rate in elderly high-risk patients. Patients aged over 60 years with symptomatic gallstones, at high operative risk, underwent cholecystotomy under local anaesthesia through a 3-cm incision. Stones were removed and clearance was demonstrated endoscopically and by tube cholecystography. Catheter drainage was continued for 7 days until a further cholecystogram confirmed clearance. The procedure was attempted in 26 patients with concomitant cardiovascular, respiratory or malignant disease. Successful removal of all gallbladder stones was possible in 24 patients. Four patients had common bile duct stones demonstrated on cholecystography, all of which were successfully treated by endoscopic sphincterotomy. All patients are symptom-free at a mean follow-up of 36 weeks with no recurrent stones on ultrasonography.
Effect of biliary infection on common bile duct healing in the rat
Authors: Rozga J , Ahrén B , Andersson R , Emody L , Bengmark S , Wadström T
Published: March 2007

It has been postulated that biliary infection plays a role in bile duct stricture formation. The aim of this study was to verify this hypothesis and to evaluate the effect of biliary infection on common bile duct healing. A 3-mm longitudinal choledochotomy was performed in 120 rats and closed with a continuous 11/0 Ethilon® suture. Common bile duct division with end-to-end anastomosis using interrupted 11/0 Ethilon sutures was performed in another 30 rats. Biliary infection was achieved in half of the animals with retrograde injection of living 046:K1:H31 strain Escherichia coli recovered from the rat colonic content. All rats with choledochotomy, including those with biliary infection, showed no bile leakage at the suture line, and the bursting pressure at the site of choledochotomy exceeded 40 mmHg as early as 24 h. Rats with common bile duct anastomosis alone showed no stricture formation for up to 6 months after operation. All rats with biliary sepsis developed complete occlusion at the anastomosis. On scanning electron microscopy, the biliary epithelium was well preserved in all rats. The study suggests that in rats with biliary sepsis the risk of bile leakage after primary closure of the common bile duct is negligible, but biliary infection may play a critical role in common bile duct stricture formation.
Postgastrectomy osteoporosis
Authors: Tovey F I , Hobsley M , Hall M L , Ell P J
Published: March 2007

Osteoporosis is a recognized complication following partial gastrectomy and is more common than osteomalacia. Recent improvements in the measurement of bone mineral status (dual energy X-ray absorptiometry, DEXA) have assisted in measuring osteoporosis. Sixteen men who had undergone gastrectomy more than 30 years previously were examined. This study reports the effect of calcium supplementation in six patients in whom osteomalacia had been excluded and who showed abnormally low bone mineral densities on DEXA scanning. Calcium supplementation for 6 months (microcrystalline hydroxyapatite, Ossopan® 8–32 g per day) produced no significant advantage for the treatment group at any site measured.
Trauma audit: experience in north-east Scotland
Authors: Crawford R
Published: March 2007

The management of 125 patients with trauma treated at Aberdeen Royal Infirmary from 1 January 1988 has been analysed using a microcomputer-based hospital trauma registry incorporating trauma and injury severity scores (TRISS) methodology. These patients fulfilled the North American Major Trauma Outcome Study (MTOS) inclusion criteria and were the first for whom data were available. Sixty-six patients had multiple injuries, of whom 52 were suffering from major trauma (defined as an injury severity score of 16 or greater). There were 14 deaths in the series, three (21 per cent) of which were considered to be preventable. Surgery was required in 84 (67.2 per cent) patients, of whom 59 (70 per cent) were operated on by a consultant or senior registrar. Five of six critically injured patients who died from their injuries were operated on by a consultant.
Factors influencing local recurrence and survival in patients with soft tissue sarcoma of the upper limb
Authors: Serpell J W , Ball A B S , Robinson M H , Fryatt I , Fisher C , Thomas J M
Published: March 2007

Fifty-one patients with soft tissue sarcoma of the upper limb were studied to identify risk factors for local recurrence and survival. More than half (53 per cent) of the patients referred had locally recurrent disease. The flexor aspect of the forearm was the most common site of origin. The majority of patients were managed by a combination of conservative surgery and radical radiotherapy. Wide or radical excision was achieved in 49 per cent of cases. One-third of patients required partial resection of bone or neurovascular structures; 75 per cent of them had presented with local recurrence after treatment elsewhere. Skin grafts and flap repairs were used more often in patients with local recurrence (P = 0.013) and 20 (74 per cent) of those referred with locally recurrent disease have had no further local relapse. The overall 5-year survival rate of 80 per cent (95 per cent confidence interval 61–90 per cent) supports a policy of conservative surgery. Factors associated with a lower survival rate were deep fixation, origin in the flexor aspect of the forearm, and previous local recurrence. Deep fixation was also associated with an increased risk of local recurrence. Referral to a specialist unit at the time of initial presentation may result in lower rates of local recurrence and may improve the survival rate.
In situ femorodistal bypass: Novel technique for angioscope-assisted intraluminal side-branch occlusion and valvulotomy. A preliminary report
Authors: Stierli P , Aeberhard P
Published: March 2007

To allow and facilitate complete endoluminal vein preparation under angioscopic guidance for in situ femorodistal bypass grafting, a novel instrument was constructed. In experiments in cadavers we developed the occluder valvulotome, consisting of a modified Mills' valvulotome containing a laterally-ending working channel, a retrograde cutting blade and an advanceable Teflon® tube within the working channel. Using this instrument in combination with commercially available wire coils, we successfully performed five femorocrural in situ reconstructions with endoluminal valvulotomy and embolization of a total of ten thigh tributaries. The technique allows angioscope-assisted valvulotomy and simultaneous endoluminal tributary occlusion, making long skin incisions and extensive vein dissection obsolete.
Quantitative measure of small vessel anastomotic contour using corrosion resin cast models: An aid to surgical training
Authors: John L C H , Hornick P , Rees G M , Edmondson S J
Published: March 2007

A surgeon who had not previously carried out a small vessel anastomosis performed 20 consecutive anastomoses between human long saphenous vein and the left anterior descending artery of a pig's heart. Corrosion resin cast models were made of the anastomoses and subjected to a quantitative analysis of the anastomotic contour. A trend of improvement in contour parameters was found with increasing experience. This model may be useful for surgeons in training.