bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in cardiorespiratory and muscle function associated with the development of postoperative fatigue
Authors: Zeiderman M R , Welchew E A , Clark R G
Published: March 2007

An understanding of the factors which contribute to postoperative fatigue may benefit the rehabilitation of patients after surgery. Subjective feelings of fatigue and fatigue measured objectively in the adductor pollicis muscle after ulnar nerve stimulation have been studied in relation to changes in cardiorespiratory function and muscular efficiency both at rest and when walking on a treadmill at a work rate of 20 and 56 kpm min−1. Twelve patients admitted for elective abdominal surgery were studied before operation and again on the third postoperative day. The postoperative period was characterized by an increased feeling of fatigue. Surgery had no effect upon fatigue in the adductor pollicis muscle suggesting that the genesis of postoperative fatigue is partly central in origin. Muscular efficiency (s.d.) fell from 34(6) per cent before operation to 22(3) percent (P<0·05) on the third postoperative day and was accompanied by a 19 per cent rise in the net energy(s.d.) expenditure (7·3(0·8) to 8·6(0·3) kJ min−1; P<0·03) required to perform a given workload. The increased cardiorespiratory effort and reduced muscular efficiency associated with the performance of low-intensity exercise may limit mobilization after surgery and contribute to a greater feeling of fatigue.
Association between transfusion with plasma and the recurrence of colorectal carcinoma
Authors: Marsh J , Donnan P T , Hamer-Hodges D W
Published: March 2007

Data was collected from patients with colonic or rectal tumours undergoing potentially curative surgery. Univariate analysis showed an association between perioperative transfusion with plasma and the earlier recurrence of tumour. Allowing for possible confounding factors the relative risk of recurrence for patients receiving plasma was 2·44 (95 per cent confidence interval= 1·10–5·46, P = 0·041) and for patients receiving whole blood or plasma, it was 2·39 (95 per cent confidence interval =1·19–4·83, P = 0·021). The risk of recurrence for those receiving a transfusion of plasma was, therefore, more than twice that of those not given it. We were unable to demonstrate an independent harmful effect of transfusion with packed cells. These data suggest that the plasma protein, rather than the cellular component of whole blood, mediates the accelerated tumour recurrence.
Clinical assessment and anorectal manometry before postanal repair: Failure to predict outcome
Authors: Scott A D N , Henry M M , Phillips R K S
Published: March 2007

It has been suggested that preoperative measurement of resting anal canal pressure and internal sphincter function can be used to identify those patients with neurogenic faecal incontinence who are unlikely to benefit from the operation of postanal repair. We have therefore analysed the results of the operation in 62 patients (six men and 56 women, mean age 59 years, range 30–83 years) and related clinical outcome to preoperative assessment of: resting anal canal pressure, the presence of gape and a combination of gape and low resting pressure. None of these factors was found to predict a poor result after postanal repair.
The long-term sequelae of ileocolic anastomosis in childhood: A retrospective survey
Authors: Parashar K , Booth I W , Corkery J J , Gornall P , Buick R G
Published: March 2007

The long-term effects of ileocolic anastomosis in children are not known. We therefore carried out a survey of all such patients treated at our hospital between 1971 and 1985. Thirty-seven patients were identified and invited to attend for follow-up. Twenty-seven (73 per cent) were examined and included in the survey. Mean age at survey was 7·8 years (range 1·6–17·6 years) and mean duration since operation was 6·3 years. Necrotizing enterocolitis and intussusception were the commonest indications for operation. As judged by height, weight and skin fold thickness, all patients were well nourished. Seven (26 per cent) had loose stools, five had chronic folic acid deficiency and one was vitamin B12 deficient. We conclude that resection of the ileocaecal region is well tolerated in childhood and does not affect growth. Loose stools are directly related to the length of ileal resection.
Selective conservative management of abdominal gunshot wounds: A prospective study
Authors: Muckart D J J , Abdool-Carrim A T O , King B
Published: March 2007

A prospective study of 111 patients with low velocity gunshot wounds of the abdomen was conducted to determine whether a policy of selective conservative management based on repeated physical examination is a safe form of treatment. Laparotomy was undertaken in 89 patients (80 per cent), seven of which were negative. Of the patients 22 (20 per cent), eight of whom were considered to have peritoneal penetration, underwent conservative management. None required delayed laparotomy. Eight patients (7 per cent) died, all deaths occurring in the positive laparotomy group. The incidence of significant intra-abdominal injury if the peritoneal cavity had been penetrated was 89 per cent. Selective conservative management may be applied safely to a limited group of patients with gunshot wounds of the abdomen.
Prospective study of the value of ultrasound measurements in the diagnosis of acute rejection following renal transplantation
Authors: Nicholson M L , Williams P M , Bell A , Donnelly P K , Veitch P S , Bell P R F
Published: March 2007

In this prospective study we have used ultrasonographic measurements of the cross-sectional area of transplanted kidneys, as an objective assessment of graft size, for diagnosis of acute rejection episodes. Sixty episodes of acute graft dysfunction (serum creatinine rise of ≥ 30 μmol/l) were studied in 40 patients. Tru-Cut® biopsy under ultrasound control was performed in all cases and 36 episodes of acute cellular rejection were identified. An increase in graft cross-sectional area of ≥ 10 per cent was defined as a positive scan, indicative of an acute rejection episode. Using these criteria, ultrasound correctly diagnosed rejection in 29 out of 36 cases (sensitivity 81 per cent) and there were four false positive results (specificity 83 per cent). The investigation had a predictive value of 88 per cent when positive and 74 per cent when negative.
Axillofemoral bypass as a limb salvage procedure in high risk patients with aortoiliac disease
Authors: Naylor A R , Ah-See A K , Engeset J
Published: March 2007

Thirty-eight patients presenting with severe limb ischaemia and considered unfit for major aortic reconstruction underwent axillofemoral bypass as a limb salvage procedure. Four patients (11 per cent) died, including two who had presented with bilateral ischaemia secondary to acute aortic occlusion. The operative mortality rate for patients presenting with rest pain or ulceration/gangrene was 6 per cent. Cumulative 5-year survival and limb salvage were 44 per cent and 86 per cent respectively. Graft occlusion was the principal cause of worsening symptoms during follow-up (5-year primary patency of 68 per cent) and accounted for all major amputations of the operated limb. Axillounifemoral grafts had a significantly worse 5-year patency (50 per cent) than axillobifemoral grafts (80 per cent, P < 0·05) and three of five patients who developed worsening symptoms in the non-operated limb died or required a major limb amputation as a consequence. Axillofemoral bypass is a valuable alternative to major aortic reconstruction in elderly patients and allows a greater proportion to be offered reconstruction than would otherwise be possible.
Anatomical aspects of the blood supply to the skin of the posterior calf: Technique of below-knee amputation
Authors: Gray D W R , Ng R L H
Published: March 2007

Whether or not the soleus muscle should be excised during below-knee amputation is a point of contention. The anatomical basis for the blood supply to the skin of the posterior calf has been examined by dissection and selective arterial injection of cadavers. The results showed that the skin used to construct the posterior flap for below-knee amputation derives its blood supply from both axial vessels, running with the peripheral nerves, and perforating vessels arising through the gastrocnemius muscle. There is no contribution by blood vessels that pass through the soleus muscle. When a posterior flap for below-knee amputation is constructed the soleus muscle should be completely excised.
Lymph node metastasis from melanoma with an unknown primary site
Authors: Jonk A , Kroon B B R , Rümke Ph , Mooi W J , Hart A A M , Van Dongen J A
Published: March 2007

Twenty-six patients, treated surgically between 1961 and 1986 because of lymph node metastasis from melanoma with an unknown primary, were analysed. Six patients had a history of spontaneous regression of a skin lesion. Following node dissection, the overall actuarial disease-free survival rate was 49 per cent, after both 5 and 10 years. When considered as single factors, female (versus male), one lymph node involved (versus more than one node involved) and site of metastasis in the groin or axilla (versus the neck) were found to have significantly favourable effects on prognosis with 5-year survival rates of 82 per cent (25 per cent), 82 per cent (27 per cent) and 80 per cent (11 per cent) respectively. However, at multifactorial analysis only the site of cervical metastases maintained a significant influence on survival (P = 0·005). As survival in this series is comparable with, or even better than, that of adequately treated patients with lymph node metastasis from a known primary melanoma, a radical node dissection is essential also in these patients.
Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma
Authors: Matsumata T , Kanematsu T , Shirabe K , Sonoda T , Furuta T , Sugimachi K
Published: March 2007

From September 1981 to December 1988, 163 patients underwent hepatic resection for hepatocellular carcinoma. The patients were divided into two groups: those operated on from September 1981 to March 1985 (n = 55) and those operated on from April 1985 to December 1988 (n = 705). There was an increase in the number of relatively small hepatocellular carcinomas in 1987–88. Differences in the incidence of accompanying liver cirrhosis (72 versus 62 per cent) were not statistically significant; however, values of the indocyanine green test (21·5 versus 77·0 per cent, P < 0·01) aided in strict patient selection. In more recent years, initial hepatic hilar dissection for control of vascular structures was undertaken and an ultrasonic dissector was used in about three-quarters of these patients. Consequently, the mean estimated blood loss (2500 versus 1300ml, P<0·001) and mean intraoperative blood replacement (2200 versus 560 ml, P < 0·001) were significantly less than in the earlier period. Among the 58 patients treated in the early period, hospital morbidity and mortality rates were 52 and 29 per cent respectively. In contrast, the rates were 23·8 and 1·9 per cent respectively among the 105 patients operated on during the recent period (P<0·01). The decline in hospital mortality is attributed to the careful selection of patients, use of modern tools, and a diminished blood loss.
Gallbladder cholesterolosis: An aetiological factor in acute pancreatitis of uncertain origin
Authors: Paricio P Parrilla , Olmo D Garcia , Franco E Pellicer , González A Prieto , González L Carrasco , López J Bermejo
Published: March 2007

To investigate the possible relationship between gallbladder cholesterolosis and acute pancreatitis, we studied 3797 cholecystectomy specimens and found 55 cases of gallbladder cholesterolosis unassociated with biliary lithiasis. From the reviewed case notes, 27 of these patients presented with recurrent attacks of acute pancreatitis which disappeared after cholecystectomy (follow-up 65·1 months). A microscopic study revealed frank cholesterolosis in all cases with a pseudopolyp transformation of the mucosa, some polyps reaching a diameter of 2 mm. We postulate that the mechanism could be temporary impaction of cholesterolosis polyps at the sphincter of Oddi and suggest that patients with recurrent attacks of acute pancreatitis and negative aetiological investigation must be considered as at high risk of having gallbladder cholesterolosis and that they could benefit from cholecystectomy.
Gallstone ileus
Authors: Clavien P-A , Richon J , Burgan S , Rohner A
Published: March 2007

Thirty-seven patients (33 women and four men, median age 78 years) were operated on for gallstone ileus over a 12-year period with a median follow-up of 6·2 years. Twenty-three patients (62 per cent) had serious concomitant diseases. Plain abdominal radiographs performed at admission were diagnostic in only 17 patients (46 per cent) and other procedures such as ultrasonography, gastrointestinal contrast studies and computed tomographic scan were required in ten patients (27 per cent). The diagnosis was made before operation in 27 patients (73 per cent) but in only 17 (46 per cent) at admission. Obstructing stones were located in the terminal ileum in 27 patients (73 per cent), in the proximal ileum or jejunum in five (14 per cent), in the duodenum in two (5 per cent), and in the colon in three (8 per cent). In six instances (16 per cent), more than one stone was involved. Cholecystduodenal fistula was the most frequent fistula type (n = 25, 68 per cent), followed by cholecystcolonic (n = 2, 5 per cent) and cholecystduodenocolonic (n = 2, 5 per cent) types. The site of the fistula was not established in the other eight instances. A one-stage procedure consisting of the removal of the impacted stone, fistula repair and cholecystectomy was performed in eight patients, two of whom died. A second group of six patients underwent a two-stage procedure consisting of enterolithotomy followed by elective biliary surgery, with no mortality. Removal of impacted stones was the only surgical treatment in the remaining 23 patients, with five deaths. Operative mortality and morbidity rates associated with the initial procedure did not differ significantly among the three therapeutic groups, which were comparable in terms of patient age, associated concomitant diseases and APACHE II score. However, later biliary complications were prominent in patients treated only by enterolithotomy. These results support the view that a one-stage procedure is, when feasible, a valid option and may be the procedure of choice. When local or surgical conditions argue against a one-stage procedure, biliary surgery at a second stage should be considered, if residual stones are present. In poor risk patients, non-operative methods should be considered.
Diagnosis of soft tissue tumours by Tru-Cut® biopsy
Authors: Ball A B S , Fisher C , Pittam M , Watkins R M , Westbury G
Published: March 2007

Tru-Cut® biopsies were obtained from 52 consecutive patients referred with soft tissue tumours. Forty-five patients had soft tissue sarcomas; seven had benign soft tissue tumours. Of the biopsies 96 per cent provided adequate material for diagnosis. The histological diagnosis made from the Tru-Cut biopsy was compared with that made from the resected specimen. There were no false positive diagnoses of malignancy. The accuracy of Tru-Cut biopsy was 98 per cent for the diagnosis of malignancy and 94 per cent for the diagnosis of sarcoma. Tumour subtype was correctly specified in 85 per cent of sarcomas and tumour grade in 88 per cent. Tru-Cut biopsy should replace open biopsy as the primary means of diagnosis of soft tissue tumours unless a satisfactory tissue sample cannot be obtained.
Complications and local recurrence following lymphadenectomy
Authors: Shaw J H F , Rumball E M
Published: March 2007

We have retrospectively reviewed the case notes of 208 patients undergoing either cervical, axillary, or inguinal lymphadenectomy with a view to determining the factors that predispose to complications and local recurrence. The most frequent complications were wound infection, seroma formation, paraesthesiae and lymphoedema. The main predisposing factor for complications was anatomical site; wound complications occur with twice the frequency in the inguinal lymphadenectomy group than in the two other sites. Preresection biopsy was also associated with an almost twofold increase in complications, while fine needle aspiration cytology was not. The two major factors influencing the incidence of local recurrence were the stage of the disease process and the use of preresection biopsy. There was a steady increase in the incidence of local recurrence with increasing stage of regional disease. In addition, local recurrence was almost twice as common in patients who had undergone biopsy before resection when compared with patients who either did not have tissue sampling before resection or had fine needle aspiration cytology alone. We conclude that fine needle aspiration cytology is safe and the investigation of choice in patients undergoing lymphadenectomy. In contrast, preresection biopsy should be avoided as it promotes both complications and local recurrence. In addition, wound complications and lymphoedema are frequent following lymphadenectomy, especially following inguinal dissection.
Hyperthermic isolated perfusion with melphalan in the treatment of advanced malignant melanoma of the lower limb
Authors: Skene A I , Bulman A S , Williams T R , Thomas J Meirion , Westbury G
Published: March 2007

A retrospective study of 91 patients with malignant melanoma treated by lower limb isolated hyperthermic regional perfusion was performed. Objective response in patients with evaluable disease was 78 per cent. The role of perfusion as primary treatment of large melanomas of the foot is confirmed and recommended. Control of locoregional disease and limb salvage remains a valuable and attainable therapeutic goal using this technique.
Experimental colonic carcinogenesis after gastric surgery
Authors: Houghton P W J , Owen R J , Henly P J , McC. Mortensen N J , Hill M J , Williamson R C N
Published: March 2007

Peptic ulcer surgery may predispose to the subsequent development of colorectal cancer. This experimental study has investigated the effects of gastric operations on colonic cell proliferation, bile acid excretion and carcinogenesis. Male Sprague-Dawley rats (n = 705) underwent sham operation, Polya partial gastrectomy or vagotomy and pyloroplasty. The carcinogen azoxymethane was administered weekly for 6 weeks thereafter (total dose 60 mg kg−1). When the animals were killed 24 weeks after operation, colons were examined for mucosal mass, crypt cell production rate (CCPR) and tumour yield; faeces were assayed for contents of neutral steroids and bile acids (both total and individual). Morphometric indices and mucosal DNA content were similar in all three groups. Polya gastrectomy reduced: (1) CCPR throughout the colon (by 42–65 per cent, P< 0·002); (2) the number of rats with colorectal tumours (26 per cent versus 63 per cent, P<0·05); (3) faecal levels of neutral steroids and bile acids, notably hyodeoxycholic acid (P<0·01). Although vagotomy and pyloroplasty increased caecal CCPR, there were no consistent differences in faecal steroids and no alteration in tumour yield after the operation. These results fail to support clinical studies suggesting that gastric surgery predisposes to colonic carcinogenesis. Indeed, Polya partial gastrectomy exerts a protective effect, probably by inhibiting colonic cell proliferation.
Prospective randomized controlled trial of hepatic arterial embolization or infusion chemotherapy with 5-fluorouracil and degradable starch microspheres for colorectal liver metastases
Authors: Flowerdew A D S , Birch S J , Williams J D , Mullee M A , Taylor I
Published: March 2007

Survival benefit from hepatic artery embolization (HAE) or hepatic arterial infusion chemotherapy (HAI) in patients with unresectable colorectal liver metastases has not previously been assessed in a randomized controlled trial. Sixty-one patients were randomized, 20 to receive no treatment, 22 to receive HAE, and 19 to receive HAI with 5-fluorouracil and degradable starch microspheres. Both treatments were acceptable to the patients in terms of low treatment morbidity rate. Median survival from diagnosis of metastases was 9·6 months for controls, 8·7 months for the HAE group and 13·0 months in the HAI group. There was no apparent survival benefit for the HAE group. The increased survival in the HAI group was observed in all the subgroups analysed but failed to reach statistical significance. The greatest observed benefit was achieved in the subgroup with < 50 per cent hepatic replacement with tumour at presentation (median survival from diagnosis 10·0 months for controls, 10·2 months for HAE and 23·6 months for HAI); 36 per cent of patients developed extrahepatic disease recurrence. No significant benefit has been shown from either HAE or HAI, but a more carefully selected group of patients with only low volume hepatic disease may benefit from HAI therapy.
Use of thermography in the differential diagnosis of phylloides tumour
Authors: Pierart J , Burmeister R , Steinberg J , Schalper J , Cid L
Published: March 2007

Thermography can be used as a method of diagnosing breast masses. We report our results of its use in the differential diagnosis of fibroadenoma from phylloides tumours (n = 47 and 20 respectively). Thermographic resolution (Th) and the difference in temperature between the tumour and a similar zone in the contralateral breast (δ2) were compared. Thermograms were class Thl (with a similar thermal pattern in both breasts without hypervascularization or hot points) and TH2 (with hypervascularization or a hot area with a thermal difference with the same area in the opposite breast (δ2) of less than 2°C) in most (95·7 per cent) of the patients with fibroadenoma and were class Th5 (having one or more pathological sign) in 85 per cent of the patients with phylloides tumours. Patients with phylloides tumours had a mean δ2 of 2·99°C whereas most of the patients with a fibroadenoma showed no difference in temperature. Their mean δ2 was 0·2°C (P<0·0005). We conclude that thermography helps in differential diagnosis between a fibroadenoma and a phylloides tumour.
Metabolic effects of recombinant human growth hormone: Isotopic studies in the postabsorptive state and during total parenteral nutrition
Authors: Douglas R G , Humberstone D A , Haystead A , Shaw J H F
Published: March 2007

We have performed a series of isotopic studies in 25 adult patients with sepsis and/or trauma in order to determine the metabolic effects of recombinant human growth hormone (rHGH) administration. Twelve of the patients were receiving total parenteral nutrition, and 13 were eating a normal ward diet and were studied postabsorption. Energy and protein kinetics were quantified isotopically before rHGH administration and following a 3-day course of rHGH (20 units subcutaneously daily). In the total parenteral nutrition group the rate of net loss of protein decreased from 0·82(0·17) gkg−1 day−1 to 0·43(0·20) g kg−1 day−1 (P < 0·02) following the administration of rHGH. The rate of appearance of leucine was not altered, suggesting that the improvement in nitrogen balance following rHGH was because of an increased rate of protein synthesis rather than reduced catabolism. In the postabsorptive group, rHGH treatment significantly increased the rate of appearance of free fatty acids (from 7·4(2·2) μmolkg−1 min−1 to 11·1(2·6) μmolkg−1 min−1, P<0·03) and free fatty oxidation (from 1·3(0·4) μmol kg−1 min−1 to 1·7(0·4) umol kg−1 min−1, P<0·06), while the rate of leucine oxidation was reduced (from 0·44(0·05) umol kg−1 min−1 to 0·26(0·03) umol kg−1 min−1, P< 0·005). Glucose appearance and oxidation remained unchanged. These results suggest that fat was being oxidized in preference to protein, which resulted in a reduction in the net rate of loss of protein of 0·3 g kg−1 day−1 (P<0·05). We conclude that rHGH administration is capable of significantly reducing net protein loss in septic or injured surgical patients. Recombinant HGH may be clinically useful in supporting critically ill surgical patients who require intensive nutritional support.
Influence of glucagon on protein and leucine metabolism: A study in fasting man with induced insuiin resistance
Authors: Pacy P J , Cheng K N , Ford G C , Halliday D
Published: March 2007

The counter-regulatory hormones, including glucagon, may be involved in the generation of postoperative negative nitrogen balance. We examined the influence of glucagon on whole body and forearm muscle protein kinetics, determined by L-[1–13C,15N] leucine, in two matched groups of healthy fasting subjects. In one study somatostatin alone was infused continuously (0·12mgh−1) and in another with glucagon (0·04mgh−1) to generate insulin resistance. Somatostatin infusion increased leucine oxidation (P < 0·05) and reduced the negative protein balance (P < 0·07) across the forearm; the 15 per cent decrease in protein breakdown was not significant. Whole body leucine kinetics showed increased flux (P<0·05) and synthesis (P<0·01) but reduced oxidation (P<0·05). Hyperglucagonaemia caused a threefold enhancement of leucine oxidation (P<0·02), while the negative protein balance further increased (P<0·05) across the forearm. Whole body leucine flux was unchanged; oxidation increased (P<0·01) and synthesis decreased (P<0·01). These studies confirm that physiological hyperglucaganaemia during insulin resistance is catabolic in the short-term and indicates, for the first time, that glucagon may influence muscle protein metabolism acutely in man. We suggest that therapeutic manoeuvres designed to reduce glucagon levels after surgery may ameliorate protein kinetic abnormalities.
Elective abdominal surgery depresses muscle protein synthesis and increases subjective fatigue: Effects lasting more than 30 days
Authors: Petersson B , Wernerman J , Waller S-O , von der Decken A , Vinnars E
Published: March 2007

Ten patients without metabolic disease undergoing elective cholecystectomy were studied before surgery and on days 3, 10, 20 and 30 after operation. Percutaneous muscle biopsies were taken and protein synthesis was determined from the total concentration and size distribution of ribosomes. The subjective feeling of fatigue was estimated using a visual analogue scale. The nitrogen balance was calculated at 20 days following surgery. The mean(s.e.m.) total concentration of ribosomes per milligram of DNA decreased by 27·5(6·6) per cent (P < 0·07), 44·5(6·5) per cent (P < 0·007), 48·3(8·9) per cent (P < 0·007) and 45·0(8·2) per cent (P<0·07) on days 3, 10, 20 and 30, respectively. By 30 days after surgery no sign of restoration of normality was seen. The relative proportion of polyribosomes had decreased by 20·4(6·4) per cent (P<0·05) on the third postoperative day and by 20·4(3·9) per cent (P < 0·07) on the tenth postoperative day and was restored to the preoperative level by day 20. The subjective fatigue score increased after operation and five of nine patients had not regained their preoperative scores 30 days after surgery. The daily nitrogen balance was negative for 5 days. The cumulated nitrogen losses were not restored until after 18 days following surgery. Elective abdominal surgery caused a sustained depression of protein synthesis for over 30 days, a longer period than previously presumed. These results show that long-term follow-up is required when the effect of different postoperative nutritional regimens are to be evaluated.
Late outcome of undersewing alone for gastric ulcer haemorrhage
Authors: Teenan R P , Murray W R
Published: March 2007

Between 1977 and 1988 22 patients requiring urgent surgery for bleeding gastric ulceration were managed by simple undersewing of the ulcer. Long-term follow-up of these patients was undertaken to determine the risk of recurrent gastric ulceration and further gastric ulcer haemorrhage. Two patients died in the immediate perioperative period leaving 20 patients available for long-term follow-up (mean 43·3 months). Three recurrent gastric ulcers were diagnosed, two of these presenting with haemorrhage. No patient presented with further gastric ulceration while on histamine (H2) receptor antagonist therapy. The long-term outcome of undersewing alone, when combined with maintenance H2-receptor antagonist therapy, is satisfactory in terms of low mortality and low risk of ulcer recurrence.
Late sequelae of penetrating cardiac injuries
Authors: Demetriades D , Charalambides C , Sareli P , Pantanowitz D
Published: March 2007

Fifty-four patients who survived a penetrating cardiac injury were assessed for late cardiac complications. The mean follow-up after injury was 23 months. Clinical history and physical examination suggested cardiac complications in nine patients (17 per cent). Electrocardiogram was abnormal, but usually not diagnostic, in 17 (31 per cent). Routine two dimensional Doppler echocardiography revealed abnormalities in 17 (31 per cent). Ten patients (19 per cent) had valvular or septal defects. Other abnormalities includedpericardial effusion, ventricular and septal dysfunction, and ventricular dilatation. Although it is impossible to determine how many of these abnormalities were post-traumatic, it seems that the incidence of late sequelae of cardiac injuries is high, and it is recommended that routine late follow-up of these patients should be done. Assessment should include routine echocardiograms.
Abdominocervical (transhiatal) oesophagectomy in the management of oesophageal carcinoma
Authors: Gotley D C , Beard J , Cooper M J , Britton D C , Williamson R C N
Published: March 2007

Fifty-four patients have undergone abdominocervical oesophagectomy for oesophageal carcinoma as an alternative to a conventional transthoracic approach. Their median age was 69 years, with a range of 38–90 years, and 39 per cent of patients had chronic cardiorespiratory disease. Lymph node metastases were found in 80 per cent of patients and transmural tumour spread in 91 per cent. Median duration of operation was 2·2 h (range 1·75–6·0 h), and median transfusion requirement was 2·5 units (range 0·8 units). Respiratory complications were common (41 per cent) and caused all six postoperative deaths (11 per cent). Other complications were atrial fibrillation (26 per cent), transient recurrent laryngeal nerve palsy (11 per cent), cardiac failure (2 per cent), stroke (2 per cent), subphrenic abscess (2 per cent) and empyema (2 per cent). There were two anastomotic leaks (4 per cent), clinically manifest as temporary salivary flstulae. There have been 32 deaths from recurrent carcinoma, with a median duration of survival of 14 months (range 4–53 months). Fifteen patients are still alive, with a median survival of 16·5 months (range 3–49 months); the current 3-year survival rate is 10 per cent. All patients resumed normal swallowing after operation, but 11 of them developed anastomotic strictures requiring a median of three dilatations. Avoidance of formal thoracotomy by the abdominocervical approach may allow more rapid oesophagectomy without increasing the risk of postoperative death and gives a quality of palliation at least equivalent to that of conventional transthoracic oesophageal excision.
Surgical therapy of oesophageal carcinoma
Authors: Müller J M , Erasmi H , Stelzner M , Zieren U , Pichlmaier H
Published: March 2007

During the past 10 years, postoperative mortality associated with surgical treatment of oesophageal carcinoma has been reduced by one-half. However, it appears that all efforts to improve long-term survival with extensive excisional procedures and adjuvant chemotherapy and radiotherapy have failed. Fifty-six of 100 patients presenting to the surgeon with an oesophageal carcinoma have resectable disease. Recent studies suggest that seven of them will die from postoperative complications and 49 patients will be discharged from the hospital after an average of 3 weeks. Of these patients, 27 will survive the first, 12 the second, and ten the fifth year. Although it may be possible to further reduce postoperative complications and mortality, the chances of improving the long-term prognosis of patients with oesophageal carcinoma seem small.
Surgical pathology of HIV infection: Lessons from Africa
Authors: Bayley A C
Published: March 2007

Human immunodeficiency virus has resulted in a major change in the presentation and behaviour of certain common diseases in Africa. This review descibes some of the important changes and discusses the implications for management.
Endorectal ultrasonography for the assessment of invasion of rectal tumours and lymph node involvement
Authors: Glaser F , Schlag P , Herfarth Ch
Published: March 2007

Sophisticated therapies for rectal carcinoma, such as sphincter preserving operations, pouch-anal anastomosis, preoperative irradiation or adjuvant chemotherapy, require an exact pretherapy assessment of the tumour and its lymph node involvement. A 7·0 MHz transducer was used before operation in the staging of 117patients with rectal carcinoma or villous adenoma. In 90 per cent of cases it was possible correctly to stage the tumour before operation. Sensitivity for detection of perirectal fat infiltration was 97per cent. Lymph node involvement was accurately identified in about 80 per cent of cases. Six carcinomas, which had developed within 31 examined tubulovillous adenomas, were detected by endorectal ultrasonography. No carcinoma remained undetected. Endorectal ultrasonography is a highly accurate tool for the staging of rectal carcinoma before operation and for the detection of lymph node involvement. Malignant change in tubulovillous adenomas are also detectable.
Low anterior resection of the rectum using a double stapling technique
Authors: Varma J S , Chan A C W , Li M K W , Li A K C
Published: March 2007

Using a double stapling technique in 30 patients, anterior resection of the rectum was attempted for low rectal carcinoma (n = 28), giant rectal adenoma (n = 1) and radiation-induced rectal stricture (n = 1). There were three emergency operations. The rectum was stapled transversely more than 3 cm below the tumour using the adjustable-angle linear stapler (Roticulator®). Colorectal or coloanal anastomoses were constructed using the EEA® circular stapler introduced per anum through the anorectal stump staple line. Ten coloanal and 19 low rectal anastomoses were achieved. A protecting transverse loop colostomy was fashioned in one patient with coloanal anastomosis who developed a vaginal tear during the procedure. In one patient technical failure necessitated conversion to abdominoperineal excision of the rectum. All staple rings and resection margins were intact and free from tumour. There were two clinical anastomotic leaks, both treated successfully with a defunctioning transverse loop colostomy. One patient developed a small infective pelvic haematoma 2 weeks after surgery which required drainage. Hospital stay ranged from 6 to 15 days (mean 8 days). Continence was normal in all patients at 8 weeks. One soft coloanal anastomotic stricture required dilatation. No recurrences have been detected during a follow-up of between 10 and 22 months.
Surgery for Crohn's disease in childhood: Influence of site of disease and operative procedure on outcome
Authors: Davies G , Evans C M , Shand W S , Walker-Smith J A
Published: March 2007

Factors influencing outcome after surgery have been studied in 67 children requiring bowel resection or diversion of the faecal stream for Crohn's disease. Patients were divided into four groups on the basis of disease location at time of surgery, and mean follow-up was 4–5 years. All three children with panenteric disease (group 1) have relapsed. Best results were observed in cases with disease confined to the small bowel (group 2) and ileocaecal region (group 3), in whom surgery was followed by sustained remission in six out of seven and 24 out of 30 patients respectively. In the 27 children with colitis (group 4), results were mixed. Six of the seven patients who had staged colonic resections with a primary anastomosis relapsed, as did three out of four patients given a loop ileostomy to divert the faecal flow; in contrast, 15 out of 16 children who had a subtotal colectomy with ileostomy as the primary procedure have remained well, with only minor problems involving the rectal stump. An acceleration in growth velocity was observed during the first year after operation in 89 per cent of 40 children studied. Outcome after surgery for Crohn's disease in childhood depends mainly on disease location, but is influenced by the type of primary operation performed. In addition to symptomatic relief the principal early benefit of surgery is improved growth.
Ambulatory anorectal physiology in patients following restorative proctocolectomy for ulcerative colitis: Comparison with normal controls
Authors: Miller R , Orrom W J , Duthie G , Bartolo D C C , Mortensen N J McC
Published: March 2007

The purpose of this study was to determine the manometric activity of ileoanal W pouch reservoirs following restorative proctocolectomy for ulcerative colitis and to compare the results with normal controls. Thirty-one studies were carried out; there were 15 controls (median age 52 years (range 29–80 years), 10 men, 5 women) and 16 pouch patients (median age 40 years (range 28–52 years), 13 men, 3 women). Mid-anal sphincter pressure and ‘rectal’ pressure were measured with a microtransducer catheter. The signals were digitalized and recorded in a portable electronic memory for later computer display and analysis. The system allowed the study of patients with minimal constraints while fully ambulant. The frequency of sampling (rectal pressure ⩾ sphincter pressure), sensation of flatus present and flatus being passed were 7(1–41), 3(1–7) and 1(0–3·5)per hour in the normal controls and 0(0–3), 0(0–1) and 0(0-1) respectively per hour in the pouch patients (P<0·001). Compared with the highly dynamic nature of the anorectum in normal subjects the patients with a pouch had very little activity. The sensation of pouch filling and the desire to defaecate were noted on 12 occasions and in six were associated with a rise in pouch pressure greater than 20 mmHg. One patient had nocturnal soiling and this was the only patient in whom frequent pouch contractions were noted. The results suggest that ileoanal pouch motility is usually quiescent and that incontinence in this group may be related to increased pouch activity.
Evaluation of herniography in the diagnosis of an occult abdominal wall hernia in symptomatic adults
Authors: Hall C , Hall P N , Wingate J P , Neoptolemos J P
Published: March 2007

Outpatient herniography as a means of confirming or refuting the presence of an occult abdominal wall hernia was performed in 50 symptomatic patients, including 13 who had previously undergone hernia repair. Altogether 30 occult hernias were detected in 27 patients, only one of which was considered to be unrelated to the presenting symptoms. On the basis of herniography, 17 patients were spared surgical exploration and, of these 17, 16 obtained a good result. One further patient with a clinically apparent hernia on one side but with contralateral symptoms was spared unnecessary surgery because the contralateral side was radiologically normal. There was one false negative and no false positive examinations. There were three minor complications: two cases of sigmoid colon puncture and one of abdominal wall haemorrhage (all managed conservatively). There were two technical failures. These results support the Scandinavian experience that herniography has a useful role in the management of patients who may have occult hernias as the underlying cause of abdominal wall symptoms.
Peripheral lymph node tuberculosis: A review of 80 cases
Authors: Dandapat M C , Mishra B M , Dash S P , Kar P K
Published: March 2007

One hundred and ninety-two patients with peripheral lymphadenopathy were screened and 80 patients with tubercular lymphadenitis were studied. Their ages ranged from 1 to 65 years; most were younger than 30 years and there was a slight female preponderance (1·2:1). Seventy per cent of patients were of low socioeconomic status. Of the 80 patients, 56 had affected cervical nodes, seven had inguinal nodes, five had axillary nodes and 12 had multiple sites of lymph node involvement. All had enlarged nodes which were matted in 44 cases and discrete in 18 cases, while the rest had either an abscess or a discharging sinus. Fifty-nine cases (74 per cent) showed a positive Mantoux test and four cases (5 per cent) had associated pulmonary tuberculosis. Fine needle aspiration cytology gave a positive diagnosis in 66 cases (83 per cent). Fifty-two cases showed a positive culture for Mycobacterium tuberculosis of human type in Lowenstein-Jensen medium. Short-term chemotherapy (9 months) consisting of rifampicin, isoniazid and ethambutol gave an excellent result. Surgery was not required in any of the cases.
Comparison of flow cytometry with static densitometry in papillary thyroid carcinoma
Authors: Cusick E L , Macintosh C A , Krukowski Z H , Ewen S W B , Matheson N A
Published: March 2007

The prognostic accuracy of flow cytometric and static densitometric DNA analysis was compared in 31 patients who had undergone surgery for papillary thyroid carcinoma between 1959 and 1978 (median follow-up 18 years'). There were five deaths from papillary thyroid carcinoma. Three of six patients with DNA aneuploid tumours onflow cytometry died (P>0·05, Fisher's exact test) compared with four of eight patients whose tumours were found to be aneuploid by static densitometry (P<0·02). When quantitative analysis was applied to the static densitometry data, all five patients who died from papillary carcinoma were distinguished, with no false positives (P<0·002). The prognostic accuracy of flow cytometric DNA analysis is less than that of static densitometry in which morphological selection of malignant cells permits quantitative measurements. DNA analysis may add refinement to existing scoring systems in predicting the risk of death from papillary thyroid carcinoma. Such information could provide the basis for controlled prospective evaluation of bilateral resection as opposed to lobectomy in defined high risk patients. At present there is insufficient evidence upon which aneuploidy should be used as a determinant of the extent of operation for papillary thyroid carcinoma.
Plasma chloride and alkalaemia in pyloric stenosis
Authors: Goh D W , Hall S K , Gornall P , Buick R G , Green A , Corkery J J
Published: March 2007

Fifty infants with infantile hypertrophic pyloric stenosis were studied prospectively to evaluate the reliability of plasma chloride estimation in the assessment of the acid-base status on admission and during correction of alkalaemia. Four cases were subsequently excluded because of a breach of the study protocol, leaving 46 cases in the study. Seventeen (37 per cent) were normoacidaemic on admission; 13 had plasma chloride concentrations of ⩾106 mmol/l and four had chloride concentrations of 100–105 mmol/l on admission. Twenty-nine (63 per cent) were alkalaemic on admission; six cases had chloride concentrations of 100–105 mmol/l and 23 cases had concentrations of < 100 mmol/l. Of those 29 cases requiring correction of alkalaemia, normoacidaemia was achieved at a plasma chloride concentration of ⩾ 106 mmol/l in 21 cases (72 per cent) and at a concentration of 100–105 mmol/l in eight cases (28per cent). Plasma chloride is a reliable parameter in the assessment and correction of alkalaemia in infantile hypertrophic pyloric stenosis provided that a concentration of at least 106 mmol/l is the goal.
Which balloon embolectomy catheter?
Authors: Niblett P G , Fleischl J M , Campbell W B
Published: March 2007

This study compared seven makes of balloon embolectomy catheter currently available, testing the most commonly used 4 Fr catheters. The volume of fluid and inflation pressure required to burst balloons of each type were measured. All balloons showed a similar shape of inflation curve, but compliance varied considerably, and the pressure required to burst different balloon types varied from 1060 to 1920 cmH2O. Two balloon types consistently fragmented when they burst in free space. On a specially designed mechanical rig balloon catheters were pulled through a 6 mm tube containing a fixed stenosis, with continuous measurement of traction force and intraballoon pressure. Traction force varied from 34 to 129 g (median 40 g) during passage along the tube, and from 254 to 463 g (median 350 g) during passage through the stenosis. The shear force imparted by the balloon to the tube wall was also calculated. This study provides comparative data which may help to guide surgeons in their choice of balloon embolectomy catheter.
Reappraisal of the oxygenation of blood in varicose veins
Authors: Scott H J , Cheatle T R , McMullin G M , Smith P D Coleridge , Scurr J H
Published: March 2007

Raised oxygen tension in the blood of varicose veins has led to arteriovenous communications being implicated in the pathogenesis of varicose veins. The aim of this study was to compare the oxygen tension of blood from varicose veins with that from normal legs, and to observe the effect of posture on these measurements. Twenty-six subjects (13 normal controls and 13 with uncomplicated varicose veins) had blood sampled from the long saphenous vein or a varicose vein near the ankle. Samples were taken after 30 min in the supine position and repeated after 30 min standing. Samples were also taken simultaneously from the arm. Transcutaneous oxygen measurements of the gaiter skin were performed continuously throughout the experiment. In the supine position, blood from varicose veins had a significantly higher oxygen tension (median = 6·09 kPa) than that from normal veins (median = 4·54 kPd) (P = 0·022). In all subjects, there was a higher oxygen tension in leg vein blood when lying (varicose vein median value = 6·09 kPa, control median value = 4·54 kPd) than while standing (varicose vein median value = 3·93 kPa, control median value = 3·74 kPa) (P<0·002, varicose vein group; P = 0·005, normal group). Changes in transcutaneous oxygen tension correlate poorly with changes in venous blood. It is concluded that the theory of arteriovenous anastomoses is only one among a number of possible explanations for the pathogenesis of varicose veins.
Eradication of oesophageal varices recurring after portal non-decompressive surgery by injection sclerotherapy
Authors: Hashizume M , Kitano S , Yamaga H , Wada H , Sugimachi K
Published: March 2007

The results of injection sclerotherapy for oesophageal varices which recurred after portal non-decompressive surgery were analysed retrospectively to evaluate its efficacy. We treated 60 consecutive patients with portal hypertension; 19 were treated on an emergency basis, seven electively and 34 on a prophylactic basis. All acute bleeding was controlled with one session of sclerotherapy using a transparent overtube. After eradication by sclerotherapy, no bleeding episodes occurred and there was no recurrence of the varices, except in three uncompliant patients, during a mean follow-up period of 33·1 months. Bleeding from a gastric ulcer and gastritis occurred in one patient each. Oesophageal stenosis occurred in nine (15 per cent) patients and gastric varices developed in two (3 per cent) patients. Twelve patients died, Jive from liver failure and six with hepatoma, but there was no bleeding from the gastrointestinal tract. The overall 4-year survival rate was 80 per cent. We recommend the use of sclerotherapy as the primary treatment for recurrent oesophageal varices.