bluuebunny/crossref_metadata_2025 huggingface dataset:
Intraoperative ultrasonography and the detection of liver metastases in patients with colorectal cancer
Authors: Olsen A K
Published: March 2007

A total of 213 patients with carcinoma of the colon and rectum were examined to detect liver metastases. The study compared preoperative ultrasonography and inspection and palpation of the liver during surgery with intraoperative ultrasonography. Preoperative ultrasonography, inspection and palpation identified 238 metastases in 42 patients. Intraoperative ultrasonography detected 116 previously unrecognized metastatic tumours during 40 surgical procedures (P < 0·01). High resolution intraoperative ultrasonography is safe and more accurate than preoperative imaging and surgical exploratory methods. The examination is simple to perform and success appears to be related to careful attention to detail.
Anterior lesser curve seromyotomy and posterior truncal vagotomy versus truncal vagotomy and pyloroplasty in the treatment of chronic duodenal ulcer
Authors: Taylor T V , Lythgoe J P , McFarland J B , Gilmore I T , Thomas P E , Ferguson G H
Published: March 2007

In a prospective randomized controlled clinical trial, anterior lesser curve seromyotomy with posterior truncal vagotomy (AMPT, n = 77) has been compared with truncal vagotomy and pyloroplasty (TVP, n = 69) in 146 patients with chronic duodenal ulcer with a mean duration of symptoms of 7 years. The mean follow-up time was 4·5 years with a range of 2–7 years. One elderly patient died from a myocardial infarction in the TVP group. Acid secretory inhibition in response to insulin and pentagastrin stimuli was equal in both groups, indicating a similar degree ofvagaldenervation. Recurrent ulcers were more common after AMPT (five) than TVP (two) (P = 0·29, n.s.). Dumping and diarrhoea were significantly commoner (P < 0·001) after TVP, with 31 instances as opposed to eight with AMPT. The mean operating time was increased by 6 min when AMPT was performed rather than TVP. The results of this study have shown that AMPT is associated with a lower incidence of dumping and diarrhoea and achieves better overall Visick grading. However, continued monitoring is required to assess the long-term incidence of recurrent ulceration after this procedure.
CA72–4: A new tumour marker for gastric cancer
Authors: Byrne D J , Browning M C K , Cuschieri A
Published: March 2007

To date, tumour markers for gastric cancer have proved unreliable. In this study the value of a new serum marker, CA 72–4, was compared with the serum activities of carcinoembryonic antigen (CEA) and CA19-9 in a consecutive series of patients with gastric cancer. The results show that the CAT2-4 assay is significantly better at separating stage I and II disease from normal controls (P < 0·01) than CEA (n.s.) or CA19-9 (n.s.). CA72-4 also gave better differentiation between patients with positive and negative nodes (P < 0·01) and between those who were serosa positive and negative (P < 0·01). CEA differentiated between patients with positive and negative nodes (P < 0·05) but CA19-9 could not. CA19-9 and CEA could not discriminate between patients who were serosa positive and negative. In this study, at a specificity of 95 per cent, the sensitivities of CEA, C A19-9 and CA72-4 were 0·25, 0·41 and 0·94 respectively. These preliminary findings indicate that CA 72-4 is a reliable tumour marker of disease stage and activity in gastric cancer. Further longitudinal studies are required for full evaluation of its clinical utility.
Treatment of adenocarcinoma of the cardia with synchronous chemotherapy and radiotherapy
Authors: Gill P G , Jamieson G G , Denham J , Devitt P G , Ahmad A , Yeoh E , Jones A M
Published: March 2007

Twenty-nine evaluable patients with adenocarcinoma of the cardia were treated with synchronously administered chemotherapy (two cycles of 5-fluorouradl and cisplatin and 30–36 Gy of radiation to determine whether these tumours are responsive to such treatment. Complete regression of tumour was observed endoscopically in 19 patients, and partial regression in four. Fourteen patients had their tumours resected and in six no microscopic tumour was found in the specimen. Nine patients received additional radiotherapy to a total dose of 54–60 Gy instead of surgery. Tumour response was associated with rapid reversal of dysphagia. Only one patient required subsequent intervention for relief of dysphagia due to fibrous stricture. Enhanced survival was associated with a complete endoscopic response to initial chemotherapy and radiotherapy, and a tumour of < 5 cm in length. The median survival of responding patients was 15 months. Synchronous chemotherapy and radiotherapy was of major palliative benefit in this series and merits further evaluation.
Manometric evaluation of jejunal limb after total gastrectomy and Roux-Orr anastomosis for gastric cancer
Authors: Bassotti G , Gullà P , Betti C , Whitehead W E , Morelli A
Published: March 2007

Total gastrectomy with Roux-Orr anastomosis is frequently performed for gastric cancer. Since intestinal motility of the Roux limb has never been evaluated after this operation, pressure activity was investigated in the Roux limb of ten patients (aged 51–77 years) who had undergone total gastrectomy and Roux-Orr reconstruction. Investigations were carried out during a 6-h fast and 3 h after a 605 kcal mixed meal. During fasting only two patients had activity fronts and these were abnormal. All ten patients displayed non-propagating bursts of contractions and three had discrete clustered contractions and high amplitude jejunal contractions. The fed state was characterized by a severely reduced motor activity pattern and other abnormalities. Total gastrectomy with Roux-Orr anastomoses provokes a relatively severe disturbance in intestinal activity.
Single lumen ileum with myectomy: A possible alternative to the pelvic reservoir in restorative proctocolectomy
Authors: Sagar P M , Holdsworth P J , King R F G J , Salter G , Johnston D
Published: March 2007

An alternative procedure to construction of a pelvic ileal reservoir was assessed which avoids the need for a pouch, while providing an adequate rectal substitute and good continence. Thirty-six female adult beagles were allotted randomly to undergo total colectomy with (a) ileo—anal anastomosis alone, (b) ileo-anal anastomosis with two 15 cm myectomies, (c) ileo-anal anastomosis and myectomy with an ileo-ileal valve, or (d) ileo-anal anastomosis with a duplicated J pouch. The animals were studied before operation and at 4-weekly intervals for 20 weeks after operation. Mortality rates were similar. Ileal compliance was increased significantly by myectomy from 0·64 ml/mm Hg (median, interquartile range 0·49–0·78) after ileo-anal anastomosis alone to 1·65 mmHg (1·16–1·93), P < 0·01, an increase which was maintained. Heal capacity was also increased both by myectomy and by the J pouch: ileo-anal anastomosis = 85 ml (75–100 ml), ileo-anal anastomosis and myectomy = 139 ml (116–156 ml), ileo-anal anastomosis and myectomy and ileo-ileal valve = 125 ml (range 85–145 ml), ileo—anal anastomosis and J pouch = 130 ml (range 75–165 ml) (P < 0·01). Bowel function in the other three groups was markedly superior to ileo—anal anastomosis alone. Mean transit time was significantly less after ileo—anal anastomosis, 5·2 h (2·6–8·2 h) than after both ileo—anal anastomosis and myectomy, 10·5 h (9·6–13·9 h), P < 0·05 and ileo-anal anastomosis and J pouch, 11·0 h (8·4–13·0 h), P < 0·05, but addition of an ileo-ileal valve did not produce a further increase in transit time, 12·9 h (range 10·5–14·5 h), P = n.s‥ Myectomy of single lumen ileum may be a useful alternative to a pelvic Heal reservoir in restorative proctocolectomy.
Elective resection for diverticular disease of the sigmoid colon
Authors: Moreaux J , Vons C
Published: March 2007

From 1966 to 1987, 177 consecutive patients were operated on electively for diverticular disease of the sigmoid colon. The indications for surgery were: colovesical fistula (n = 12), suspicion of residual abscess (n = 39), two or more previous attacks of acute inflammation (n = 52), chronic symptoms (n = 72) and suspicion of carcinoma (n = 2). An abscess was found at operation in 76 patients (43 per cent) and this was extracolic with local peritonitis in 5 2 patients (29 per cent). An unsuspected abscess was found in 25 of the 72 patients operated on for chronic symptoms. Colonic resection with primary anastomosis was performed in 95 per cent of the 177 patients and in 94 per cent of those 52 patients with an extracolic abscess. There were no postoperative deaths and no clinical anastomotic leakages. Long-term results were very good in 85 per cent of the 177 patients and in 82 per cent of the 72 patients operated on for chronic symptoms. The results of this series suggest that a one-stage procedure can be safely performed with some technical precautions in most patients operated on electively for diverticular disease, even if an extracolic abscess is found. The good long-term results in patients operated on for chronic symptoms suggest that such symptoms should be taken into account with respect to surgical indications.
Gracilis muscle transposition for faecal incontinence
Authors: Christiansen J , Sørensen M , Rasmussen O Ø
Published: March 2007

Transposition of the gracilis muscle for faecal incontinence was performed in 13 patients. Six gained satisfactory continence, four were improved, two did not benefit from the operation and one patient died from intercurrent disease before closure of a pre-existing colostomy. Anal manometry compared with a control group showed no alteration in resting anal pressure at a median of 35 mmHg (range 5–63 mmHg), whereas maximum squeeze pressure increased from a median of 38 mmHg (range 5–79 mmHg) to 59 mmHg (range 10–143 mmHg) (P = 0·041) which was, however, significantly lower than 130 mmHg (range 81–236 mmHg) in the control group. All patients who benefited from the operation had an increase in maximum squeeze pressure. The ability to retain a viscous fluid in the rectum was measured in seven patients, four of whom had gained satisfactory continence and three of whom had improved continence. They were able to retain a median volume of 200 ml (range 50–225 ml) without leakage compared with 325 ml (range 250–400 ml) in the control group. These patients could retain the maximum amount of viscous fluid for 5–8 min, whereas all control subjects could do so for more than 15 min. It is concluded that, although gracilis transposition never results in normal continence, acceptable continence may be achieved in selected patients provided careful attention is paid to the technical details of the procedure and provided that systematic postoperative exercises are performed.
Survey of the use of thrombolysis for acute limb ischaemia in the UK and Ireland
Authors: Earnshaw J J , Shaw J F L
Published: March 2007

A total of 156 vascular surgeons from the UK and Ireland responded to a postal questionnaire on the use of thrombolysis in acute limb ischaemia. Almost half had used thrombolysis in the previous 12 months. Low dose intra-arterial streptokinase (89 per cent) was the regimen most frequently used, but 33 per cent had used intravenous streptokinase. Detailed results for 103 patients (limb salvage rate 60 per cent, amputation rate 35 per cent, mortality rate 5 per cent) were similar to those of previously published reports. Complications in most series were infrequent, but in the entire survey there were six bleeding-related deaths and one death from anaphylaxis. A total of 67 per cent of surgeons with working experience indicated that selected patients with acute arterial thromboses were most suitable for thrombolysis, particularly if there was no neurological deficit and no run-off for surgical bypass. Distal or late emboli and graft occlusions were regarded as appropriate by some surgeons. This study demonstrated that many vascular surgeons currently use thrombolysis, although sparingly and in selected cases. Patients with acute limb ischaemia should be managed by experienced vascular surgeons who are aware of the new therapeutic alternatives, an ideal supported by almost three-quarters of respondents to this survey.
Intraoperative air testing of colorectal anastomoses: A prospective, randomized trial
Authors: Beard J D , Nicholson M L , Sayers R D , Lloyd D , Everson N W
Published: March 2007

A total of 145 consecutive patients receiving a colorectal anastomosis were randomized to ‘test’ or ‘no test’ once the anastomosis had been completed. Anastomotic testing was performed with the pelvis filled with saline and the rectum distended by sigmoidoscopic insufflation of air. Any leaks demonstrated were oversewn. A water-soluble contrast enema was performed on the tenth postoperative day. Seventy-four patients were randomized to ‘test’ and 71 to ‘no test’ but one patient was withdrawn from each group leaving a total of 143 for analysis. The two groups were well matched for age, sex, diagnosis and operative details. Eighteen (25 per cent) air leaks were detected and repaired in the ‘test’ group. After operation there were three (4 per cent) clinical leaks in the ‘test’ group and ten (14 per cent) in the ‘no test’ group (Fisher's exact test, P = 0.043). There were eight (11 per cent) radiological leaks in the ‘test’ group and 20 (29 per cent) in the ‘no test’ group (P = 0.006). Intraoperative air testing and repair of colorectal anastomoses significantly reduces the risk of postoperative clinical and radiological leaks.
Malignant left-sided large bowel obstruction managed by subtotal/total colectomy
Authors: Stephenson B M , Shandall A A , Farouk R , Griffith G
Published: March 2007

Of 60 patients presenting with acute obstructing carcinoma of the left colon, 49 underwent immediate resection either by radical subtotal/total colectomy (31 patients, group I) or by radical segmental resection (18 patients, group II) of whom three had immediate anastomosis after on-table bowel irrigation and 15 had a planned staged procedure. The operative mortality rate was 3 per cent in group I and 11 per cent in group II (not a statistically significant difference). However, substantial differences were found for major morbidity (6 versus 44 per cent in groups I and II respectively; P < 0.01) and mean length of hospital stay (17 days in group I versus 35 days in group II; P<0.05). All three patients who had on-table lavage developed anastomotic leaks which necessitated a second operation to form a stoma. Six patients (19 per cent) in group I required antidiarrhoeal medication in the immediate postoperative period. However, subsequent improvement in stool frequency was noted in all patients. It is concluded that subtotal/total colectomy is an acceptable means of managing patients with obstructing carcinoma of the left colon in that it is associated with a low morbidity and mortality rate and good functional results.
Blood transfusion and recurrence of colorectal cancer: The role of platelet derived growth factors
Authors: Lawrance R J , Cooper A J , Loizidou M , Alexander P , Taylor I
Published: March 2007

Efforts to explain the possible effects of blood transfusion on the recurrence of colorectal cancer have been based entirely on the immunosuppressive effects of blood transfusion. However, the relationship between solid tumour development and the immune system is inconclusive. We have investigated an alternative mechanism involving the potential role of growth factors in this phenomenon. Using a human fibroblast: [125I]deoxyuridine uptake mitogenesis assay, the relative amounts of growth factor in the plasma of stored blood were measured. There was a progressive increase in mitogenesis from day 0 (n = 6) to day 28 (n = 6; P< 0.001, Mann-Whitney U test). The effect of growth factors on the development of liver and intraperitoneal metastases was studied in Hooded Lister fats. Following an intraportal injection of 105 MC28 tumour cells, the experimental group (n = 25) received 2 ml of syngeneic serum intravenously for 4 days. Likewise, colonic anastomoses were performed on omentectomized rats and the peritoneal cavity seeded with 103 cells. The experimental groups (n = 20) received either 2 ml serum intravenously repeatedly or 3 ml serum intraperitoneally (n = 19). There was no significant increase in liver metastases or peritoneal disease following intravenous infusion of serum but serum delivered intraperitoneally resulted in a significant increase in tumour from 22 per cent in the controls to 89 per cent in the study group (P<0.01). Growth factors released from platelets following blood loss into the peritoneal cavity may be important in enhancing local recurrence of colorectal cancer.
Mastalgia refractory to drug treatment
Authors: Gateley C A , Maddox P R , Mansel R E , Hughes L E
Published: March 2007

Management of the patient with mastalgia who fails to respond to first line therapy is a difficult problem and there is a group of patients who do not respond to any therapy. A group of 126 patients with mastalgia who failed to respond to first line therapy and completed further treatment options was studied. The response rate of those with cyclical mastalgia fell to 57 and 25 per cent for second and third line therapy respectively. Equivalent figures for non-cyclical mastalgia were 24 and 21 per cent. Danazol maintains a high response rate after the failure of other drugs, whereas the second line response to bromocriptine and evening primrose oil is poor. Unresponsive patients were matched to a group of patients who responded to first line therapy, and reproductive and historical factors were compared using the x2 test, but failed to identify which patients would respond to therapy.
Pulse oximetry: A new non-invasive assessment of peripheral arterial occlusive disease
Authors: Joyce W P , Walsh K , Gough D B , Gorey T F , Fitzpatrick J M
Published: March 2007

Peripheral skin perfusion reflects the level of vascularity and viability of a limb and may help in planning the site of amputation or bypass surgery in patients with vascular disease. This study used peripheral pulse oximetry in 20 healthy volunteers and in 20 patients with limb ischaemia. Pulse oximetry saturation levels (Psa,O2) were compared with ankle artery Doppler pressures and transcutaneous oxygen measurements (Ptc,O2)- Recordings were taken at two standard sites distally and referenced to finger and forearm to calculate an index. A significant correlation was found between Ptc,O2 and Psa,o2 in patients with ischaemia (r = 0.68, P<0.01). A further group of 12 patients with acute limb ischaemia was similarly assessed before and after revascularization. After revascularization mean(s.d.) Ptc,O2 increased from 38(13) to 44(1) mmHg (P>0.05) and mean(s.d.) Psa,O2 increased from 86(3) to 90(4) per cent (P<0.01). These data suggest that pulse oximetry is a more sensitive index of peripheral perfusion than Ptc,O2 or ankle artery Doppler pressure and that, because of its accuracy and simplicity, it merits further use.
Graft stenosis: Justification for 1-year surveillance
Authors: Taylor P R , Wolfe J H N , Tyrrell M R , Mansfield A O , Nicolaides A N , Houston R E
Published: March 2007

In all, 412 femorodistal grafts (femoropopliteal and femorocrural), performed between 1984 and 1988, have been prospectively studied at 6 weeks and 3, 6, 9 and 12 months after operation and at intervals of 6 months thereafter by duplex scanning and intravenous digital subtraction angiography. The overall incidence of stenoses was 16 per cent (femorocrural 20 per cent, femoropopliteal 15 per cent). All stenoses were detected in the first year after operation and none occurred after this. Twenty-four non-haemodynamically significant stenoses were not treated but were followed at intervals of 3 months. Forty-two haemodynamically significant stenoses were detected and secondary procedures were performed in 30 grafts at a mean of 8 months after surgery. Thirteen had percutaneous balloon dilatation and six (46 per cent) remain patent at a mean follow-up of 22 months. Two grafts which occluded within 30 days and three which restenosed at a mean of 8 months had tertiary procedures. Seventeen grafts were surgically revised, nine with patch grafts and eight with bypass grafts. Eleven of these remain patent at a mean follow-up of 30 months. One occluded immediately and three occluded late. Two grafts which restenosed at a mean of 19 months had successful tertiary procedures. In total, seven grafts had tertiary procedures (two had balloon dilatation and five had surgery) and six of these remain patent at a mean follow-up of 13.5 months. In conclusion, 37 procedures have been performed on 30 grafts, of which 23 (77 per cent) remain patent at a mean follow-up of 12 months. Approximately one-quarter of femorodistal grafts will develop graft-related stenoses and graft surveillance is worthwhile, but only for the first year after operation.
Recent changes in the treatment of aortoiliac occlusive disease by the Oxford Regional Vascular Service
Authors: Davies A H , Ramarakha P , Collin J , Morris P J
Published: March 2007

Over the four years from 1 January 1985 to 31 December 1988, 192 patients were treated for aortoiliac occlusive disease by the Oxford Regional Vascular Service. The number of patients treated by percutaneous transluminal angioplasty increased from two in the first year of the study to 34 in the third year of the study. This increase was accompanied by a decrease in the proportion of patients treated by aortobifemoral bypass but the proportion of patients treated by extra-anatomic bypass remained constant at around 30 per cent. Twice as many patients were treated in the fourth year as in the first year of the study so that the number of surgical operations increased despite many patients being treated exclusively by percutaneous transluminal angioplasty. The number of patients requiring mandatory treatment for limb salvage increased by 109 per cent and optional treatment for intermittent claudication by 85 per cent. The introduction of percutaneous transluminal angioplasty in Oxford has coincided with an increase in the number of patients presenting with symptomatic aortoiliac occlusive disease and has allowed twice as many people to be treated while the number of aortobifemoral bypass operations has remained unchanged. It is concluded that the introduction of percutaneous transluminal angioplasty has not only generated its own workload but has also led to an increased demand for surgical reconstruction for aortoiliac occlusive disease.
Conservative management of asymptomatic popliteal aneurysm
Authors: Bowyer R C , Cawthorn S J , Walker W J , Giddings A E B
Published: March 2007

Historical review shows that the treatment of popliteal aneurysm has developed by trial and error and there is disagreement about the proper management of the symptomless patient. In 1981 a policy of conservative management for asymptomatic popliteal aneurysm was adopted in this unit. Since that time we have also managed nine patients with thrombosed popliteal aneurysms by arteriography and low-dose intra-arterial streptokinase. Six patients treated within 72 h of occlusion achieved significant (70–100 per cent) lysis, but streptokinase was ineffective in those treated 10 or more days after the thrombosis. Of the six patients with significant lysis, three were treated by elective reconstruction and two by anticoagulation. One patient who had significant lysis died. Vascular patency of all five successfully treated limbs was maintained and no limb loss occurred in those who presented late and failed to achieve significant lysis. These results reinforce the view that thrombolysis is the treatment of choice for thrombosed popliteal aneurysms. The low complication rate for asymptomatic popliteal aneurysm and the advent of safe, effective thrombolysis indicate that operation for symptomless popliteal aneurysm is no longer required.
Acute limb ischaemia: The place of intravenous streptokinase
Authors: Earnshaw J J , Cosgrove C , Wilkins D C , Bliss B P
Published: March 2007

Intravenous streptokinase infusions (100 000 units/h) have been used to treat 48 patients, with 50 episodes of acute limb ischaemia who were unlikely to benefit from a surgical approach. These included 17 acute thromboses, 14 late or distal emboli and 19 bypass graft occlusions. Overall, 17 (34 per cent) instances had complete lysis with reappearance of distal pulses and a further 28 per cent had clinical improvement without change in pulse status. Final outcome after 30 days was limb salvage in 60 per cent, amputation in 24 per cent and death in 16 per cent, but this was achieved after eight patients without lysis had vascular reconstructive surgery. Serious complications were infrequent, but included a fatal stroke, a haematemesis and two episodes of distal embolization. The outcome was not related to the duration of ischaemia or the site of occlusion. Lysis was more frequent with emboli (50 per cent) and graft occlusions (47 per cent) than arterial thromboses (6 per cent). Limb salvage was more likely in patients with no neurological deficit in the limb (70 per cent) than if a deficit was present (37 per cent). In conclusion, intravenous streptokinase produced a moderate benefit with low morbidity and has a role in acute limb ischaemia if surgery is inappropriate and intra-arterial lysis unavailable. In particular, selected patients with emboli or graft occlusions without a neurological deficit may be most suitable.
Trauma centres and the efficient use of financial resources
Authors: O'Kelly T J , Westaby S
Published: March 2007

The economic aspects of trauma centres were examined using published results and local financial data to discover if such institutions are an efficient use of resources. The cost of trauma centre care depends upon the number of centres built. An ‘ideal’ system in the UK of eight centres will cost £31268 per life saved compared with £45 661 for the system proposed by the Royal College of Surgeons of England. Trauma centre care will be expensive but will generate benefits in return. Survivors will be young (mean age 30 years) and most (70–80 per cent) will regain their pre-injury functional/work status. When considered in terms of Quality Adjusted Life Years (QUALYs), trauma centres are a relatively efficient use of resources. An expected cost per QUALY of £942–1376 is inexpensive compared with many health pursuits currently funded within the UK National Health Service.
Stress in surgeons
Authors: Green A , Duthie H L , Young H L , Peterst T J
Published: March 2007

A sample of 1000 members of the Association of Surgeons of Great Britain and Ireland was circulated with a postal questionnaire relating to their occupational stressors, their type A coronary-prone behaviour and their mental health. Six hundred and seventy-two (67 per cent) useable forms were returned anonymously. The major individual stressors were: (1) the interference of the job with personal life, (2) general administration, and (3) the number of patients in clinics. Type A behaviour was similar to that of other professional groups. Surgeons showed mean scores significantly higher than the general population on two subscales of the mental health index (free-floating anxiety and hysterical anxiety). The findings for the few female surgeons (2 per cent) were similar to those in men but they did not exhibit raised free-floating anxiety levels.
Parathyroid autotransplantation
Authors: Senapati A , Young A E
Published: March 2007

This paper reviews the technique, indications and results of parathyroid autotransplantation. Autotransplantation is most commonly indicated following parathyroidectomy for renal osteodystrophy, but can also be used in primary hyperplastic hyperparathyroidism, re-exploration of the neck and radical neck surgery. The success of the technique ranges from 75 to 100 per cent.
Fine needle aspiration biopsy in the diagnosis and management of fibroadenoma of the breast
Authors: Walters T K , Zuckerman J , Nisbet-Smith A , Hudson E , Chia Y , Burke M
Published: March 2007

Cytological and histological biopsies were obtained on 75 breast lumps clinically diagnosed as flbroadenomas. Of these, 95 per cent of lesions were benign. In 51 (68 per cent) confirmed as flbroadenomas histologically, cytology was benign in 78 per cent, but inadequate for diagnosis in 16 per cent. The remaining 24 lesions included three breast cancers and one lymph node with Hodgkin's disease. In this group cytology was inadequate for diagnosis in 54 per cent, including one breast cancer. No lesion with benign cytology was subsequently shown to be malignant. The study supports the view that clinical diagnosis and cytology are accurate in the diagnosis of benign breast disease of this type. Breast cancer may rarely present with the clinical features of a flbroadenoma and too few lesions have been studied to assess fully the performance of cytological biopsy in detecting these small mobile lesions. A non-excisional policy should therefore include prolonged follow-up and repeat biopsy.
Meakin adjuvant regimen in premenopausal patients with breast cancer
Authors: Smith D , Dewar J A , Horobin J M , Scott J S , Preece P E
Published: March 2007

A 10-year experience using ovarian ablation and prednisolone as adjuvant therapy for premenopausal patients with breast carcinoma, emphasizing tolerability and morbidity is reported. Thirty patients (15 aged <45 years, 15 aged ≥ 45 years; range 28–54 years) underwent mastectomy I lumpectomy with axillary clearance (with or without local irradiation) followed by ovarian irradiation and prednisolone therapy (2.5 mg three times daily for 5 years). Patients were reviewed every 3 months for the first 3 years and every 6 months thereafter. Follow-up was between 1.5 and 10 years (median 5 years). Twenty-four patients are still alive. Three patients stopped therapy because of side-effects. There was a mean(s.e.m.) weight gain of 8.46(1.69) per cent on therapy. Nineteen patients have been weaned off prednisolone over a period of 0.5–7.5 months (median 2 months) and the median length of time off steroids is now 3 years (range 0.5–5 years). This regimen appears to be associated with an acceptable level of patient tolerability and a low chronic morbidity rate and should be considered as an alternative to adjuvant systemic cytotoxic therapy.
Association between extent of colonic mucosal sialomucin change and subsequent local recurrence after curative excision of primary colorectal cancer
Authors: Dawson P M , Habib N A , Fane S , Rees H C , Wood C B , Allen-Mersh T G
Published: March 2007

Two interrelated studies were carried out to determine whether extent of sialomucin change adjacent to a primary colorectal carcinoma predicted local tumour invasiveness and risk of local recurrence. In the first, depth of tumour penetration was correlated with the length of the sialomucin band adjacent to 72 primary colorectal cancers. There was a significant (P < 0.05) increase in sialomucin band length adjacent to tumours invading adjacent structures compared with those which had not (Mann-Whitney U test), although there was no overall correlation between depth of penetration, Dukes' classification or degree of differentiation (Kruskal-Wallis test). A sialomucin band of > 3 cm was associated with a 70 per cent probability of adjacent structure (T4) invasion. These observations were then testedprospectively in a second study involving 256 patients to determine whether the presence of a > 3 cm sialomucin band could predict local recurrence. Presence of a > 3 cm sialomucin band was a significant (χ2 = 7.12, d.f. = 1, P < 0.001) and independent predictor of local but not distant recurrence. In addition both the interval to local recurrence and survival were significantly shorter if a > 3 cm sialomucin band was present. However the accuracy of > 3 cm sialomucin band as a predictive test for local recurrence was only 70 per cent. The extent of sialomucin adjacent to a primary colorectal cancer does provide a crude assessment of tumour invasiveness and risk of local recurrence.
Effect of hydrocele on testis and spermatogenesis
Authors: Dandapat M C , Padhi N C , Patra A P
Published: March 2007

One hundred and twenty cases of big unilateral hydrocele of the tunica vaginalis testis have been studied to ascertain the effect on the structure and function of the testis, taking the normal side as control. There was no pressure effect from the hydrocele on the structure of the testis in 70 per cent, a flattening of testis in 22 per cent, and atrophy of testis in 8 per cent of cases. There was partial arrest of spermatogenesis in JO per cent and total arrest of spermatogenesis in 8 per cent of cases. The remaining 82 per cent showed normal spermatogenesis.
Thallous chloride uptake and DNA profile in parathyroid adenomas
Authors: Carlson G L , Farndon J R , Shenton B K , Clayton C B , Johnston I D A
Published: March 2007

Thallium isotope scintigraphy is used to localize parathyroid adenomas but the mechanism underlying the technique is poorly understood. While larger adenomas are reliably localized the results are less certain for small tumours. This study explores the relationship between cellular DNA profile and thallium uptake (localization accuracy) in 24 parathyroid adenomas. The DNA profile was assessed using flow cytometry and standard subtraction thallium scintigraphy was performed before surgery. Fifteen of the 24 adenomas demonstrated excessive mitotic activity and 13 of these glands were accurately localized. Of the remaining nine glands, only five were localized accurately (P < 0.01, χ2 test including Yates' correction). This difference in thallium uptake could not be accounted for on the basis of gland weight. Thallium localization of parathyroid adenomas is related to mitotic activity. This may explain some of the limitations of this technique.
Duodenogastric reflux and gastric histology after cholecystectomy with or without sphincteroplasty
Authors: Lorusso D , Pezzolla F , Montesani C , Giorgio P , Caruso M L , Cavallini A , Guerra V , Misciagna G
Published: March 2007

Sixteen patients who had undergone cholecystectomy plus sphincteroplasty, 14 cholecystectomized patients and ten control patients were studied to evaluate whether differences existed in duodenogastric reflux and whether these were related to morphological damage of the gastric mucosa. Duodenogastric bile reflux during fasting was evaluated by measuring the concentration of total bile acids (by an enzymatic method) and single bile acids in the gastric juice by high performance liquid chromatography. The damage was evaluated histologically by systematic endoscopic biopsy of the antrum and body of the stomach. There was a statistically significant difference in fasting bile reflux between the three groups (Kruskal-Wallis test, P < 0.001), and the group that underwent cholecystectomy plus sphincteroplasty had a significantly higher median value than the cholecystectomized group (P < 0.05) and the control group (P < 0.01). The distribution of chronic antral atrophic and superficial gastritis was different in the three groups (χ2 test, P < 0.005). Chronic atrophic gastritis was associated with cholecystectomy plus sphincteroplasty (P < 0.01), while chronic superficial gastritis was more frequent in cholecystectomized patients. These results suggest that there may be more duodenogastric reflux after cholecystectomy plus sphincteroplasty than after cholecystectomy alone, and that there may be a correlation between the amount of duodenogastric reflux and the severity of mucosal damage.
Stercoral perforation of the colon
Authors: Serpell J W , Nicholls R J
Published: March 2007

Stercoral perforation of the colon is rare. The 64 reported cases are reviewed to define the syndrome of Stercoral perforation, and to facilitate accurate diagnosis and treatment. Features of localized or generalized peritonitis were universal; however, only 11 per cent were correctly diagnosed before operation. Recognition that the disease involves a segment of colon rather than only the focal point of perforation is essential to adequate surgical treatment. It is postulated that this is the reason for the higher postoperative mortality following closure of the perforation and proximal colostomy (57 per cent) or exteriorization alone (43 per cent), compared with resection of the diseased segment and exteriorization (32 per cent). Resection and exteriorization is therefore the treatment of choice is most situations.
Surgical strategy for early gastric cancer
Authors: Hioki K , Nakane Y , Yamamoto M
Published: March 2007

The diagnostic and therapeutic options in early gastric cancer are reviewed. In Japan, the rate of detection of early gastric cancers has increased so that minute gastric cancers can now be identified as a result of advances in diagnostic methods. The results of histopathological staging of a large number of resected specimens have led to three surgical options based on size and depth of the primary lesion, namely classical R2 resection, radical resection with limited lymphadenectomy and endoscopic surgery.
Adrenal insufficiency in the cancer patient: Implications for the surgeon
Authors: Ihde J K , Turnbull A D M , Bajorunas D R
Published: March 2007

Aspects of acute and chronic adrenal insufficiency of interest to surgeons who treat cancer patients are reviewed. Clinical features and the management of both primary and secondary types are considered with reference to classification, aetiology, diagnosis and treatment. Specifically considered are the management of patients with Addison's disease and metastases. Prompt recognition and treatment of adrenal insufficiency can avert potentially life-threatening situations.
Disordered colorectal motility in intractable constipation following hysterectomy
Authors: Smith A N , Varma J S , Binnie N R , Papachrysostomou M
Published: March 2007

Colorectal and anal sphincter motility and electrophysiology were investigated in 14 women with profound constipation following hysterectomy and compared with an asymptomatic group of control subjects. Twelve patients complained of significant urinary symptoms. No differences in the motor function of the anal sphincters were detectable. The latency of the pudendoanal reflex was unchanged after hysterectomy. Proctometrograms demonstrated significantly increased rectal volumes and compliance in the hysterectomy group together with deficits of rectal sensory function. In the basal state a significant proximal-to-distal sigmoid colon motility gradient existed only in the control group. Following stimulation with Prostigmin®, this gradient was enhanced in the control group but paradoxically reversed in the hysterectomized patients, thus constituting a functional obstruction. Denervation supersensitivity was demonstrable in two patients tested with carbachol provocation but not in control subjects. These findings suggest dysfunction in the autonomic innervation of the hindgut in some patients who had undergone hysterectomy, resulting in severe constipation.
Intersecting staple lines and blood flow in oesophagojejunal anastomoses
Authors: Zilling T L , Walther B S , Ranstam J
Published: March 2007

Total gastrectomy and oesophagojejunostomy with linear stapling devices were performed on 22 pigs to evaluate whether intersecting staple lines reduce the blood flow with an increased risk of anastomotic leakage. The blood flow at intersecting staple lines and single row staple lines of the anastomosis was studied with the reference organ method 24 h after the first operation. The mean blood flow in intersecting staple lines was 0·305 ml min −1 g −1tissue and 0·307 ml min −1 g −1 tissue for single row staple lines. The confidence interval for the reduction in blood flow for intersecting staple lines compared with non-crossing staple lines was from −16 to +17 per cent. In one animal the reduction in blood flow was 37 per cent; in all other animals there was no reduction in blood flow or a reduction less than 25 per cent. An equivalence test shows that if a reduction in blood flow exists it is most likely to be less than 30per cent (P < 0·001). Our data confirm that intersecting staple lines in oesophagojejunal anastomoses do not reduce mean anastomotic blood flow to a dangerous level.
Surgical results of intrathoracic gastric volvulus complicating hiatal hernia
Authors: Haas O , Rat P , Christophe M , Friedman S , Favre J P
Published: March 2007

From 1981 to 1988, 138 patients with hiatal hernia were treated surgically at our centre. Twenty-one (mean age 76.6 years, 17 women, four men) had an associated intrathoracic gastric volvulus. Eleven patients (mean age 73.2 years), of whom eight were asymptomatic, had an elective procedure. Ten patients (mean age 80.3 years) had emergency surgery, six for acute complications of the volvulus (five cases of strangulation and one of perforated ulcer) and four because of other, unrelated causes of acute abdomen. There were four deaths after operation, all in the emergency surgery group. Four other patients had significant morbidity, all in the emergency group. In the elective cases, all hernias were easily reduced. In one emergency case a gastrotomy was necessary for decompression, and in another gastrectomy was necessary because of gastric gangrene. Our results indicate the need for elective intervention when intrathoracic gastric volvulus is first diagnosed.
Early tracheostomy for primary airway management in the surgical critical care setting
Authors: Rodriguez Jorge L , Steinberg Steven M , Luchetti Frederick A , Gibbons Kevin J , Taheri Paul A , Flint Lewis M
Published: March 2007

During a 12-month period, 264 patients with multiple injuries who required mechanical ventilation were admitted to the surgical intensive care unit. One hundred twenty patients (46%) were disengaged from the ventilator, and 38 patients (14%) died. Of the remaining 106 patients (40%) 51 patients (group I) were to receive tracheostomy within 1 to 7 days, and 55 patients (group II) underwent late (8 or more days after admission) tracheostomy. Multiple variables in four categories (admission, operative, ventilatory, and outcome) were analyzed prospectively to define the impact that early tracheostomy had on duration of mechanical ventilation, intensive care stay, and hospital stay. Morbidity and mortality rates of the procedures were assessed. Early tracheostomy, in a homogeneous group of critically ill patients, is associated with a significant decrease in duration of mechanical ventilation, as well as shorter intensive care unit and hospital stays, compared with translaryngeal endotracheal intubation. There were no deaths attributable to tracheostomy, and overall morbidity of the procedures was 4%. We conclude that early tracheostomy has an overall risk equivalent to that of endotracheal intubation. Furthermore, early tracheostomy shortens days on the ventilator and intensive care unit and hospital days and should be considered for patients in the intensive care unit at risk for more than 7 days of intubation. (Surgery 1990;108:655–9.)
Proximal gastric vagotomy: Follow-up at 10–20 years
Authors: Johnston G W , Spencer E F A , Wilkinson A J , Kennedy T L
Published: March 2007

From August 1969 to December 1989, 600 patients had elective proximal gastric vagotomy for duodenal ulceration with an operative mortality of 0·2 per cent. Of these, 372 patients had surgery over 10 years ago. Three hundred and forty-two patients survived for more than 10 years and, in a prospective study, 305 were reviewed, forming the basis of this 10–20-year follow-up report. Forty-six (15 per cent) have had recurrent ulceration; 80 per cent of these developed symptoms within 5 years and no patient has had recurrence after 13 years. Although 29 patients required reoperation for recurrent ulceration, the current patient satisfaction rate for Visick grades I and II is 92 per cent. Only two patients required reoperation because of gastric stasis. It is concluded that proximal gastric vagotomy is a safe and satisfactory first choice operation for duodenal ulceration.
Gastric adaptive relaxation and symptoms after vagotomy
Authors: Hartley M N , Mackie C R
Published: March 2007

Gastric adaptive relaxation is reported to be impaired after vagotomy. This abnormality has been implicated in the pathogenesis of postvagotomy symptoms, but no association has previously been demonstrated between the two. Gastric adaptive relaxation was measured in 15 healthy volunteers and 33 patients more than 1 year after highly selective vagotomy or truncal vagotomy and drainage. Seventeen patients were asymptomatic. The remainder were symptomatic including seven patients with persistent diarrhoea. Fasted subjects were intubated with a Ryle's tube containing a pressure microtransducer within a flaccid (800 ml) plastic bag. Gastric corpus-fundus pressure was recorded during distension of the bag with air (15 ml/s) over 30 s. Pressure indices were derived from the areas under the pressure curves. Median (range) pressure indices were: healthy volunteers 12·7 (7·5–17·1) cmH2O, highly selective vagotomy 14·0 (9·8–15·9) cmH2O (n.s.), truncal vagotomy and drainage 14·5 (8·6–26·8) cmH2O (P = 0·04). All patients with diarrhoea had abnormally high pressure indices (P < 0·001). Pressure indices in all other patient groups were within the normal range. We conclude that gastric adaptive relaxation remains abnormal in patients with postvagotomy diarrhoea but not in those who are asymptomatic or who have other symptoms.
Peptic ulcer surgery during the H2-receptor antagonist era: A population-based epidemiological study of ulcer surgery in Helsinki from 1972 to 1987
Authors: Paimela H , Tuompo P K , Peräkylä T , Saario I , Höckerstedt K , Kivilaakso E
Published: March 2007

To evaluate the effects of improvements in medical therapy on the incidence of, indications for and operative methods used in peptic ulcer surgery, all cases of primary peptic ulcer surgery among adults in the city of Helsinki in the years 1972, 1977, 1982 and 1987 were analysed. There was a total of 565 such cases in a population which consisted of 5·2 × 105 individuals in 1972 and 4·8 × 105 individuals in 1987. The introduction of H2-receptor antagonists in 1979 was associated with a fall in the annual incidence of elective duodenal ulcer operations, from 15·5 to 6·7 per 105 individuals, and a fall in the annual incidence of elective gastric ulcer operations, from 9·4 to 3·1 per 105 individuals (P < 0·05). The decrease was greatest among males with duodenal ulcer. In contrast, the annual incidence of emergency surgery for ulcer haemorrhage and perforation (all types of ulcers) remained relatively stable, varying from 7·2 to 10·2 per 105 inhabitants over the observation period (n.s.). The mean age of patients undergoing elective surgery remained essentially unchanged. The mean age of patients undergoing emergency surgery increased. The decrease in the annual incidence of elective duodenal ulcer surgery occurred mainly in relation to proximal gastric vagotomy. There was a concomitant relative increase in the incidence of gastric resection. The types of operative procedures used in cases of pyloric, prepyloric and gastric ulcer remained unchanged over the years 1972 to 1987.