bluuebunny/crossref_metadata_2025 huggingface dataset:
Conservative parotidectomy by the peripheral approach
Authors: Chan Steven , Gunn Alastair
Published: March 2007

A series of 30 consecutive conservative parotidectomies is reported with a detailed assessment of the extent and duration of facial nerve damage. There was one case of severe temporary facial nerve paralysis but no cases of permanent palsy. All operations were performed using the peripheral approach to the facial nerve and the technique employed is described.
Tuberculosis in patients undergoing maintenance haemodialysis and renal transplantation
Authors: McWhinney N , Khan O , Williams G
Published: March 2007

The difficulty in diagnosis of tuberculosis in patients with chronic renal failure or on immunosuppressive therapy is discussed. Anti-tuberculous therapy was required in 19 out of 315 patients who received a renal transplant in the Urology Unit, Hammersmith Hospital, between February 1961 and December 1979. Twelve patients were from overseas. Their management and the effect of antituberculous therapy on the immunosuppressed patient were also studied. The disease was treated successfully in 18 patients, even though there were problems with diagnosis. The patient who died had active tuberculosis on post-mortem examination. Prophylaxis should be considered in patients who have had tuberculosis in the past and may have received inadequate treatment.
Spleen scanning with 99Tcm-labelled red blood cells after splenectomy
Authors: Spencer G R , Bird C , Prothero D L , Brown T R , Mackenzie F A F , Phillips M J
Published: March 2007

In order to correlate the haematological changes which occur after splenectomy, with the presence or absence of residual splenic tissue, spleen scans using 99Tcm-labelled red blood cells were performed in 36 patients who had had a splenectomy. Positive spleen scans were found in 44 per cent (8 out of 18) of patients who had undergone splenectomy for trauma and in 17 per cent (3 out of 18) of patients who had undergone elective splenectomy. No relationship was found between the presence of Howell-Jolly bodies, platelet counts, the levels of IgG, IgM and IgA and the scan result. It is concluded that these findings are due to the presence of splenunculi, whose incidence is more common than the 12 per cent usually quoted.
The management of colonoscopic and sigmoidoscopic perforation of the large bowel
Authors: Adair H M , Hishon S
Published: March 2007

The treatment of 8 patients who sustained endoscopic perforation of the large bowel at this hospital in the past 5 years is described. Two had signs of general peritonitis and were operated on. One had a laparotomy under the same general anaesthetic as that during which perforation occurred. Of the remainder, 4 were treated conservatively, while no perforation was found at operation in the other case. All recovered. We conclude that when signs of general peritonism are absent and the patient's condition is good, expectant management with nasogastric suction, intravenous fluids and broad spectrum antibiotics should be adopted. Free gas on X-ray is not per se an indication for laparotomy. A defunctioning colostomy is often unnecessary in those patients treated operatively.
Deep venous thrombosis after total hip arthroplasty: A prospective controlled study to determine the prophylactic effect of graded pressure stockings
Authors: Ishak Magdy A , Morley Kenneth D
Published: March 2007

Graded pressure stockings significantly reduced the incidence of venographically determined deep venous thrombosis (DVT) after total hip arthroplasty. Seventysix patients were studied; the incidence of DVT was 54 per cent in 41 control patients and 20 per cent in 35 patients who wore stockings. Administration of blood during the operation and in the first 24 h after operation, if given in excess of blood loss, was associated with a significantly increased risk of developing DVT. The application of graded pressure stockings and the avoidance of unnecessary perioperative blood transfusion are worth while in the management of total hip arthroplasty.
A comparative study of Dextran 70 and a sulphated polysaccharide in the prevention of postoperative thromboembolic complications
Authors: Bergqvist D , Ljungnér H
Published: March 2007

A prospective randomized study has been performed, comparing a semisynthetic polysulphated xylan of vegetable origin (mol. wt ˜ 4000) with Dextran 70 as prophylactic agent against postoperative thromboembolic complications following elective abdominal surgery. A total of 109 patients entered the trial and the analysis after exclusions is based on 86 patients. The overall frequency of125 I -labelled fibrinogen test-detected thrombosis was 2·9 per cent in the polysaccharide group against 19·2 per cent in the Dextran 70 group (P < 0·05). There was no difference in haemorrhage or different complications.
Outpatient flexible fibreoptic sigmoidoscopy, diagnostic yield and the value of glucagon
Authors: Foster G E , Vellacott K D , Balfour T W , Hardcastle J D
Published: March 2007

One hundred patients had flexible fibreoptic sigmoidoscopy in an outpatient clinic after preparation with a phosphate enema but without sedation. Patients were randomized to receive 1 mg of glucagon intravenously or a matching placebo. The discomfort of the patients and the ease of the procedure were similar in both groups. Nine patients were excluded from the final analysis as they had low rectal or anal lesions. In the remaining 91 patients, abnormalities were found in 27 (29·6 per cent) including 16 adenomatous polyps and 1 carcinoma. Only 3 lesions were below 20 cm and might have been easily visualized using a rigid sigmoidoscope.
Identification of risk factors for acute pancreatitis from routine radiological investigation of the biliary tract
Authors: McMahon M J , Playforth M J , Booth E W
Published: March 2007

The size and shape of gallstones, the diameter of the common bile duct and the presence of reflux into the pancreatic duct were studied by examining routine contrast investigations of the biliary tract in 174 patients with gallstones. Patients were divided into two groups: 69 who had been admitted to hospital with an attack of acute pancreatitis (group 1) and 105 patients with gallstones who had not had a known attack of pancreatitis (group 2).

Four or more gallstones were present in 38 (78 per cent) of 49 visualized gallbladders in group 1 compared with 45 (52 per cent) of 87 in group 2 (P < 0·005). The smallest gallbladder stone was less than 4 mm in diameter in 69 per cent of group 1 and 44 per cent of group 2 gallbladders (P < 0·005). Twenty-nine per cent of gallbladder stones in group 1 were clearly faceted compared with 20 per cent in group 2.

There were no significant differences in the diameter of the common bile duct or the presence of stones in the common bile duct, although the latter were more common in group 1. Reflux of contrast into the pancreatic duct (on operative or T tube cholangiogram) was more common in group 1 (50 per cent) than group 2 (25 per cent) (P < 0·025).

This study supports the role of numerous small stones and a ‘common channel’ at the ampulla as aetiological factors in patients who develop acute pancreatitis as a complication of gallstones.
Long term follow-up of interposition mesocaval shunting in portal hypertension
Authors: Fletcher M S , Dawson J L , Williams Roger
Published: March 2007

The long term results of 28 interposition mesocaval shunts performed between 1971 and 1975 are analysed over a follow-up period of 5–9 years. There were 6 emergency operations and 22 elective operations, with an overall operative mortality of 14·3 per cent and a 5-year survival for the complete series of 31·5 per cent (class A patients 55·5 per cent, class B 33 per cent and class C 0 per cent). Shunt patency at 7 months was 95 per cent but by 5 years this had fallen to 53 per cent. Further variceal bleeding occurred in 6 patients (31·5 per cent) in 4 of whom shunt occlusion was confirmed.
Whole-body nuclear magnetic resonance imaging: The first report of its use in surgical practice
Authors: Pollet J E , Smith F W , Mallard J R , Ah-See A K , Reid Anne
Published: March 2007

This is the first report of whole-body nuclear magnetic resonance (NMR) imaging being of value in clinical surgery. Following aortobifemoral grafting, a 54-year-old man developed a pyrexia and hypotension which did not respond to antibiotic therapy and which was thought to be caused by early graft infection. Whole-body NMR imaging showed the graft and iliac arteries to be normal and an empyema of the gallbladder to be present. NMR imaging is a safe, non-invasive technique for imaging the body in transverse sections and specifically measures the water concentration of tissues, enabling normal and inflamed tissues to be differentiated.
Aerobic and anaerobic bacteriology of subcutaneous abscesses
Authors: Ghoneim A T M , McGoldrick J , Blick P W H , Flowers M W , Marsden A K , Wilson D H
Published: March 2007

Pus from 84 patients with subcutaneous abscesses was examined for aerobic and anaerobic bacteria: organisms were recovered from 70 (83·3 per cent). In 13 no organisms were seen in the Gram-stained smears and the cultures showed no bacterial growth. Staphylococcus aureus was the most prevalent organism (n = 44), isolated in 43 in pure culture, in marked contrast to the anaerobic organisms which almost invariably were associated with mixed cultures. All patients were treated by the primary suture method. Half of them were not given preoperative antibiotics and 3 developed bacteraemia and 1 septicaemia. Blood isolates were of S. aureus of the same phage type as pus isolates. The other patients received one injection of 300 mg of clindamycin phosphate 30 min to 1 h before surgery. From this group only one patient, with a perianal abscess, developed Escherichia coli bacteraemia. The levels of clindamycin in the abscess aspirate were inhibitory for S. aureus, bacteroides, streptococci and other Gram-positive bacteria but not for E. coli.
Muscular abnormalities affecting the popliteal vessels
Authors: Bouhoutsos J , Daskalakis E
Published: March 2007

Forty-five cases in 33 patients of congenital muscular abnormalities causing vascular compression in the popliteal fossa are reported. Three main types of abnormality were distinguished. In the first, one muscle, either the medial head of gastrocnemius or the plantaris, is abnormal. In the second, both these muscles contribute to the problem, whereas in the third type, the semi-membranosus also is abnormal. In some cases an abnormal course of the popliteal vessel(s) is also found. With only a few exceptions, cases reported in the literature fit into this classification. Twelve patients in this series were affected bilaterally but only 5 had the same anatomy in both legs. In only 14 instances, either with thrombosis or with characteristic shifting of the artery, was routine arteriography sufficient for diagnosis; loss of distal pulses during active plantar flexion was necessary in the majority to demonstrate the abnormality. It is suggested that the condition is more common than has been thought.
Influence of oral mannitol bowel preparation on colonic microflora and the risk of explosion during endoscopic diathermy
Authors: Keighley M R B , Taylor E W , Hares M M , Arabi Y , Youngs D , Bentley S , Burdon D W
Published: March 2007

Oral mannitol has been widely accepted as the bowel preparation of choice for colonoscopy and elective colorectal operation because it is well tolerated by patients. Recent concern has been expressed regarding the risk of explosion and sepsis using oral mannitol because it may provide a nutrient for certain gas-producing bacteria in the colon. Samples of colonic contents aspirated at operation were compared in patients prepared by oral mannitol, by whole bowel irrigation, mannitol preceded by 48 h of oral antibiotics (neomycin with metronidazole) and in patients who did not undergo any preparation. Significantly higher counts of gas-producing Escherichia coli were recovered from patients prepared with mannitol alone compared with whole bowel irrigation or mannitol preceded by oral antimicrobials. These data are consistent with the hypothesis that fermentation of mannitol by Escherichia coli is responsible for the production of potentially explosive gas mixtures after oral mannitol preparation and may also explain the increased incidence of sepsis when oral mannitol is used for bowel preparation.
Cimetidine and the potential risk of postoperative sepsis
Authors: Muscroft T J , Youngs Denise , Burdon D W , Keighley M R B
Published: March 2007

The gastric microflora of patients receiving cimetidine for duodenal ulceration has been investigated and the results compared with those from a group of untreated patients. Cimetidine-induced hypochlorhydria allows bacterial proliferation in the stomach; 75 per cent of aspirates from 44 fasting patients taking cimetidine 1 g daily were found to contain bacteria 2–4 h after the last dose. Of 41 patients taking cimetidine 400 mg at night, 34 per cent still had bacteria in their aspirates 12–13 h later. Patients treated with cimetidine are likely to be at an increased risk of postoperative sepsis. The drug should either be withdrawn before gastric surgery is undertaken or patients with gastric contents of pH 4 or above should receive antibiotic cover.
Smoking and arterial reconstruction
Authors: Greenhalgh R M , Laing Susan P , Cole P V , Taylor G W
Published: March 2007

Fasting levels of serum triglyceride, serum cholesterol, lipoprotein, uric acid, fibrinogen and carboxy-haemoglobin (COHb) were measured in 64 patients with stenosing arterial disease before reconstructive surgery, and were compared with those for normal, age- and sex-matched controls. All except fibrinogen were significantly higher in the patients with arterial disease than in the controls. The outcome of arterial reconstruction, assessed both clinically and by Doppler pressure measurements, was compared in terms of these risk factors.

The reconstructions of 12 patients failed between 3 months and 5 years, leaving 52 patients with patent reconstructions at the end of the follow-up period. There was no difference between the two groups in terms of any of the risk factors, except for COHb. The COHb level (associated with inhalation of cigarette smoke) was significantly higher in the reconstruction failure group than in the reconstruction success group. We believe that patients should stop smoking cigarettes before reconstructive arterial surgery is undertaken.
Compression suture of the abdominal wall: A controlled trial in 302 major laparotomies
Authors: Mayer A D , Ausobsky J R , Evans Mary , Pollock A V
Published: March 2007

Monofilament nylon suture material undergoes both plastic and elastic elongation when stretched. Nylon inserted as a continuous suture for approximation of the abdominal musculo-aponeurosis may, therefore, allow early separation of the cut edges, which may predispose to the later development of an incisional hernia.

This hypothesis was tested in a consecutive series of 302 major laparotomies randomized to be sutured with continuous mass nylon either to approximate or to compress the deep layers. The incidence of incisional hernia at 6 months in the group sutured with normal tension was 10.0 per cent, compared with 5.5 per cent in those tightly sutured. There was, however, an increased rate of minor wound infection in the latter group.
Admission policy for patients following head injury
Authors: Weston P A M
Published: March 2007

In the 2 years following a change in the policy of admission following head injury in Nottingham, the number of patients admitted fell from 941 in 1977 to 536 and 460 in 1978 and 1979 respectively. No detrimental effects resulting from this change in policy have been noted. Previously, all patients who had been unconscious (however briefly) had been admitted. The changed policy stated that:

1. Patients who had been briefly unconscious or amnesic would only be admitted if one of the following factors was also present: abnormal neurological signs or obtunded consciousness on arrival at hospital, fits, vomiting, severe headaches or clinical or radiological evidence of a fracture of the skull.

2. Such patients would only be allowed home if instructions issued to the patients on a ‘head injury instruction card’ could be implemented satisfactorily.

It is suggested that the implementation of such an admission policy will avoid the unnecessary admission of large numbers of patients, thus freeing beds for other purposes. The article leaves unanswered the question ‘Which patients should have a skull X-ray?’.
Reconstructive gastric surgery
Authors: Kelly Keith A , Becker James M , van Heerden Jonathan A
Published: March 2007

Among 173 patients undergoing reconstructive gastric operations, including 115 patients who received Roux-en-Y gastrojejunostomy, 25 with jejunal interpositions, 11 with conversion of Billroth II to Billroth I, 8 with closure of gastroenterostomy, 5 with pyloric reconstruction and 9 with other operations, only 2 immediate postoperative mortalities occurred. A perfect or good result was obtained in 108 of 156 patients (69 per cent) at long term follow-up, while a fair result was achieved in 35 patients (22 per cent) and a poor result in 13 patients (9 per cent). We concluded that reconstructive gastric operations were safe and had clearly improved 7 of 10 patients in this series.
Five years' experience in stapling the oesophagus and rectum
Authors: Graham H K , Johnston G W , McKelvey S T D , Kennedy T L
Published: March 2007

In the 5-year period from 1976 to 1980, 143 anastomoses were performed using circular stapling devices. In 2 further cases, anastomosis was attempted but failed and operation was completed by orthodox methods. There were 101 oesophageal anastomoses; 70 of these were transections in patients with oesophageal varices and 31 were either oesophagogastric or oesophagojejunal in nature, mainly following excisional cancer surgery. The remaining 42 patients had colorectal anastomoses following anterior resection of the rectosigmoid. Initial results in a follow-up period from 2 months to 5 years have been encouraging. There were 3 cases of complete anastomotic deniscence and 4 cases of leakage. Stricture formation occurred in 10 per cent of patients but was easily controlled in the majority of cases.
Imaging of 111In-labelled platelets—a new method for the diagnosis of deep vein thrombosis
Authors: Grimley R P , Rafiqi E , Hawker R J , Drolc Z
Published: March 2007

A radionuclide method for detecting established thrombi at all sites in the lower limb would have several advantages. Autologous platelets were labelled with 150 μCi (5.5 MBq) indium-111-oxine and re-injected into patients who were imaged with a gamma camera and data processed by a medical computer. Areas of increased uptake on imaging were correlated with the sites of thrombi identified by bilateral ascending venography.

Venography in 27 patients identified 12 unilateral and 5 bilateral thrombi. On the day following the re-injection of labelled platelets, imaging identified thrombi at 13 sites in 24 limbs giving an overall correlation with venography of 84.4 per cent, correlation for the calf and thigh being 79.5 per cent and 89.1 per cent respectively. In the thigh 57.1 per cent of thrombi were identified by imaging and 52.9 per cent in the calf. Activity over thrombi was at least 20 per cent higher than in adjacent areas or at similar sites in the contralateral leg. Herapin therapy is considered to affect the detection of deep vein thrombus adversely by this technique. The technique offers a useful method for the diagnosis of both early and established thrombi at any site in the lower limb.
Laparoscopy in general surgery
Authors: Lewis Adam , Archer T J
Published: March 2007

The results of diagnostic laparoscopy under general anaesthetic in 81 general surgical patients have been reviewed. A tissue diagnosis was achieved in 25 of 42 patients (60 per cent) suspected to have widespread intra-abdominal malignancy with minimal preoperative investigation. Extensive investigation, excluding only computerized tomography, failed to achieve a diagnosis in 25 patients with an intra-abdominal mass. Subsequent laparoscopy allowed diagnosis of 22 of these patients (92 per cent). Severe persistent and unexplained abdominal pain in 14 patients was diagnosed at laparoscopy in only one patient (7 per cent) and the procedure did not influence the subsequent course of events in the remainder. There was no mortality and the morbidity (4·9 per cent) compares well with that of laparotomy in similar patients. Laparoscopy failed in 5 patients (6·2 per cent) due to the presence of dense intraperitoneal adhesions.
The use of dermal antigen testing in predicting the outcome of renal transplantation
Authors: Wedgwood K R , Guillou P J , Leveson S H , Giles G R
Published: March 2007

The responses to dermal antigen testing to a variety of antigens were measured in patients on regular dialysis. Forty-eight patients have received renal allografts and graft survival was assessed at 6 months. The antigens used were mumps, monilia, streptokinase/streptodornase, tuberculin and dinitrochlorobenzene (DNCB). The responses to these antigens were recorded using standard methodology. The responses failed to correlate with graft survival in these patients when compared singly or in combination. Matching at the HLA-B locus was also correlated with graft survival. Of 31 patients with a match at this locus, 22 (71 per cent) have functioning grafts at 6 months, compared with only 4 of 13 (31 per cent) of patients with no match at the B locus (P < 0·05). When matching at the B locus and DNCB scores were taken in combination, it became evident that those patients with no match at the B locus and low DNCB reactivity all rejected their kidneys within 4 months of transplantation.
Assessment of aorto-iliac disease by non-invasive quantitative Doppler waveform analysis
Authors: Demorais Domingas , Wayne Johnston K
Published: March 2007

The results of this study demonstrate that frequency analysis recordings of the femoral artery waveform are of value in the quantitative analysis of the severity of aortoiliac disease. In 45 patients, pulsatility index measurements were found to correlate (r = 0·82) with the pressure gradient measured directly across the aortofemoral segment. The implications and the limitations of this technique are discussed.
A retrospective review of 89 stab wounds to the abdomen and chest
Authors: Donaldson L A , Findlay I G , Smith A
Published: March 2007

This study compared the admission findings in 89 stab victims with the subsequent severity of their injury. The majority of patients were young males who arrived at hospital after 2300 h on a Friday, Saturday or Sunday and had consumed alcohol prior to admission. The presence of ‘clinical shock’ or absent bowel sounds was invariably associated with significant injury. However, 64 of the 89 patients in this study had a normal blood pressure and audible bowel sounds at the time of admission. Thirty of these 64 patients had also suffered significant injury, which frequently was a perforated viscus. A diagnostic laparotomy should be readily performed in such patients in view of the high incidence of occult injury. Experienced anaesthetic support is necessary to ensure a low mortality from the actual laparotomy.
Benign oesophageal strictures: Historical and technical aspects of dilatation
Authors: Earlam Richard , Cunha-Melo J R
Published: March 2007

A review of the different bougies used over the years confirms that the dilators presently available are adequate for the conservative management of cesophageal benign strictures. Most of these are of an old but well-tested design. Several additional techniques may have to be tried in difficult patients. Dysphagia can be relieved by the passage of size 39 FG bougies but many will wish to increase this to 60 FG, if it is possible. Failure of conservative management by dilatation only can be defined as (a) technical impossibility to dilate sufficiently to relieve the dysphagia, which is rare, or (b) when the patient or the surgeon considers the procedure is being done too frequently, which must be measured in FG for the bougie and weeks for frequency. The more expert the surgeon becomes at dilatation, the safer it will become, and the necessity for surgical intervention will be less frequent.
Basal cell carcinoma of the anus—a clinical study of 34 cases
Authors: Nielsen Ole Vagn , Jensen Steen Lindkær
Published: March 2007

Thirty-four patients with basal cell carcinoma of the anus were treated in Denmark between 1943 and 1974. The tumours were usually between 1 and 2 cm in diameter and localized to the anal margins. Three tumours had a diameter of 10 cm and extended into the anal canal. In one case the tumour had spread to the regional lymph nodes. Modes of treatment were wide local excision (27 patients), abdominoperineal excision of the rectum (4 patients), colostomy combined with radiotherapy (1 patient) and radiotherapy alone (2 patients). Local recurrence was observed in 8 cases. After retreatment (re-excision: 5 patients), excision of the rectum (1 patient) and radiotherapy (2 patients), no recurrences were observed in the follow-up period (>5 years). The crude 5-year survival rate was 72·6 per cent. The death rate was not higher than in the normal population of the same age and sex and no death was due to the basal cell carcinoma.
Trophic effect of short chain fatty acids on mucosal handling of ions by the defunctioned colon
Authors: Roediger W E W , Rae D A
Published: March 2007

Sodium and water absorption were measured in defunctioned loops of colon of dogs either in the presence or in the absence of the bacterial fatty acid, n-butyrate.

In freshly defunctioned colonic loops n-butyrate enhanced sodium absorption twofold (P < 0·05) and promoted sodium absorption for 48 h. In the absence of n-butyrate, defunctioned loops lost the ability to absorb sodium and water within 48 h. Pre-treatment of colonic loops with fatty acids for 3 h significantly diminished (P < 0·05) sodium and water losses into the colonic lumen compared with loops pre-treated with saline only. Butyrate was absorbed at a steady rate even when no sodium was aborbed.

Results suggest that fatty acids act on the colonic mucosa to exert a trophic effect on absorption of sodium. This trophic effect determines the efficiency of absorption of ions and could have clinical implications in the genesis of postoperative diarrhoea.
Neurovascular traction injuries of the upper limb root
Authors: Batey N R , Makin G S
Published: March 2007

Eight cases of injury to the subclavian and axillary arteries are described. All were accompanied by injury to the brachial plexus. Arterial continuity was restored in all cases. Six young patients sustained high velocity injuries and they showed no neurological improvement. Two elderly patients with low velocity injuries recovered neurological function in the limb. Primary amputation should be considered when nerve damage is obviously very severe.
The effect of sustained venous hypertension on the skin capillaries of the canine hind limb
Authors: Burnand K G , Clemenson G , Whimster I , Gaunt J , Browse N L
Published: March 2007

An increased number of skin capillaries has been found in human skin subjected to sustained venous hypertension. To investigate this observation, venous hypertension was produced in the hind limb of Greyhounds by fashioning an arteriovenous (AV) fistula between the femoral vessels. This caused an increase in the number of capillaries in the skin of the lower leg.

The capillary permeability of normal legs and legs subjected to chronic venous hypertension was then studied by observing the movement of radioactive molecules from the plasma to the fluid within Guyton capsules. Fibrinogen, a large molecule, leaked out of the capillaries significantly faster in the limbs with a high venous pressure and an enlarged capillary bed. It is suggested that the increase in the size and permeability of the dermal skin capillaries secondary to prolonged venous hypertension is the cause of lipo-dermatosclerosis and venous ulceration.
Milk 99Tcm-EHIDA test for enterogastric bile reflux
Authors: Mackie Colin R , Wisbey Malcolm L , Cuschieri Alfred
Published: March 2007

The study and clinical assessment of enterogastric bile reflux has been restricted for want of a simple non-invasive test for its detection and quantification. This paper describes such a test in which biliary excretion scintigraphy has been combined with a milk meal provocation. Two of 10 healthy volunteers studied showed probable reflux of approximately 5 per cent of total initial abdominal field activity. Among 73 patients studied, 37 patients showed definite reflux of up to 47 per cent. Reflux occurred in 19 of 22 post-gastric surgery patients and in 7 of 22 patients with peptic ulcer disease, gastritis or gastro-oesophageal reflux. None of 7 patients with ‘nonspecific’ abdominal pain showed any reflux, but 11 of 22 patients with gallstone disease or previous cholecystectomy showed reflux of up to 35 per cent, including 9 of 11 patients with loss of gallbladder reservoir function.
Early discharge following hernia repair in unselected patients
Authors: Cannon S R , Ralphs D N L , Bolton J P , Wood J J , Allan A
Published: March 2007

The feasibility and safety of early discharge from hospital following inguinal hernia repair in selected patients is well established. The following is an account of 104 unselected patients who presented consecutively to an Inner London hospital with inguinal hernias. The intention was to discharge all patients 48 h after operation, but for a variety of reasons a later discharge day was planned preoperatively in 50. Of the 104 patients, 62 (60 per cent) were discharged on the planned day, but only 23 per cent left hospital 48 h after operation. The factors which accounted for this are discussed. It was possible, however, to discharge over 85 per cent within 5 days of operation.
Radiography of breast biopsy specimens
Authors: Philip John , Harris W G , Rustage J H
Published: March 2007

The radiological features of breast biopsy specimens can be visualized clearly if the specimens are X-rayed in water. This makes it possible to demonstrate on specimen radiographs lesions causing tissue distortions without calcification. By positioning the specimen correctly in water and by obtaining radiographs in two planes, the exact site of a small lesion within a large tissue mass can be demonstrated and the site marked to guide the pathologist to the suspect area.
Infantile hypertrophic pyloric stenosis: A review
Authors: Spicer R D
Published: March 2007

Infantile hypertrophic pyloric stenosis is a relatively common condition and there is some recent evidence that the incidence is increasing in this country. Gastric outlet obstruction is caused by hypertrophy of the pyloric smooth muscle and the clinical presentation is with non-bilious vomiting starting at the age of 3–4 weeks. The diagnosis can usually be made by palpation of the hypertrophied pylorus. Operation has now superseded medical treatment as the treatment of choice but meticulous assessment and correction of fluid and electrolyte imbalance is essential preoperatively. The operation of pyloromyotomy as described by Ramstedt in 1912 is simple and effective, but attention to detail is necessary if minimal morbidity and zero mortality are to be achieved. Untreated, the mortality is high but, after successful treatment, these babies are healthy and normal, so that treatment is both worth while and gratifying. The aetiology is obscure; a polygenic pattern of inheritance has been shown to be a predisposing factor, but the postnatal precipitating factors are less defined. Early hopes that the hormone gastrin might prove to be the key have not been sustained by more recent research, but the role of other gastrointestinal hormones awaits clarification.
A prospective trial comparing a silicone elastomer intravenous cannula (Visis) with a polytetrafluoroethylene cannula (Cathlon)
Authors: Dabir Reza , Moore Peter J , Price Kathrine J , Clark Ronald G
Published: March 2007

Post-infusion phlebitis remains one of the most frequent causes of hospital morbidity with an incidence varying between 13 and 39 percent (1–4). A recent study indicated that a silicone elastomer cannula (Visis) had desirable properties (5). We have carried out a prospective trial comparing the value of such a cannula with a Teflon cannula (Cathlon) already in routine use.
Colloid osmotic pressure and serum albumin following surgery
Authors: Moore P J , Clark R G
Published: March 2007

The fall in serum albumin which occurs after operation can be modified by an intraoperative infusion of 20 g salt-poor human albumin, and the associated fall in colloid osmotic pressure is also corrected. There is a decrease in postoperative oliguria following a colloid infusion but no significant effect has been demonstrated on urinary sodium excretion. The alteration of fluid and electrolyte metabolism after surgery does not appear to be a direct effect of lowered plasma colloid osmotic pressure. It is suggested that the effect of intraoperative albumin infusion is predominantly haemo-dynamic.
Rectal strictures associated with the intra-uterine contraceptive device
Authors: Rogers K , Hughes L E
Published: March 2007

Two cases of stricture of the mid-rectum following extensive pelvic cellulitis due to the use of an intra-uterine contraceptive device (IUCD) are presented. The resulting dense circumferential extrarectal strictures failed to respond to treatment by proximal colostomy and antibiotic therapy and required difficult corrective resection. These are contrasted with an example of the more common upper rectal strictures associated with intraperitoneal sepsis of gynaecological origin, in this case pyosalpynx. Circumferential and transmural spread of inflammation tends to be limited by peritoneal reaction and the resulting strictures (which may be radiologically as severe as those in the mid-rectum) are often readily managed by simple removal of the source of infection. Thus, it appears that simple anatomical factors may be responsible for the differing pathologies seen in the two sites, and different management problems encountered within the two types of strictures.
The pattern of metastatic disease in patients with pleural effusions secondary to breast cancer
Authors: Fentiman I S , Rubens R D , Hayward J L
Published: March 2007

The pattern of pleural metastases in women with effusions secondary to breast cancer was evaluated by thoracoscopy in a series of 46 patients with previously untreated effusions. Metastases involving the visceral pleura were seen in 59 per cent of patients wheras parietal deposits were found in only 15 per cent. No tumour deposits were seen in 26 per cent of cases. No patients had both visceral and parietal tumour secondaries. Patients within each of these groups showed differences in rates of positive effusion cytology, chest wall recurrence and previous evidence of recurrent breast cancer.
Acute complications of metastatic melanoma to the gastrointestinal tract
Authors: Klausner J M , Skornick Y , Lelcuk S , Baratz M , Merhav A
Published: March 2007

The gastrointestinal tract is a favoured site for metastatic melanoma. Complications such as obstruction, bleeding or perforation should be alleviated by surgery in order to improve the patient's condition for further systemic therapy. Six patients with melanoma involving the gastrointestinal tract are presented: 3 were operated upon for metastatic lesions in the small bowel causing intussusception, 2 patients were treated for perforation of the small bowel and 1 patient with massive bleeding from metastatic melanoma in the stomach underwent gastrectomy. Two of the patients are alive 6 months and 4 years respectively after these operations. The other 4 survived between 6 months and 2 years.
The effect of prophylactic heparinization on the venous blood flow using the Doppler ultrasonic flowmeter
Authors: Barsoum Maged Sami , Boulos Fathi Iskander , Ramzy Adel Fouad , Nassef Amir Imam , Aly Abdel Moatty Hussein , Farag Adel Naguib
Published: March 2007

The effect of prophylactic heparinization on the postoperative venous blood flow was prospectively studied in 100 lower limbs of 50 patients. Patients were randomized into two groups of 25 patients each: a control group and a heparin group. Changes in the venous blood flow were monitored using the Doppler ultrasonic flowmeter. The study illustrated the protective role of prophylactic heparinization in maintaining a near normal venous blood flow after surgery. The postoperative reduction in venous blood flow in heparinized patients was significantly less than the decrease in blood flow in non-heparinized patients during the same postoperative period. This significant difference between the two groups of patients applied to the steady and the augmented blood flow rates.

The beneficial role of prophylactic heparinization was shown to act significantly in patients undergoing minor surgery, in obese subjects and in those suffering malignant disease. Patients undergoing major surgery also benefited significantly from prophylactic heparinization apart from their steady venous blood flow during the first postoperative day.
Treatment of persistent perineal sinus with vaginal fistula following proctocolectomy for Crohn's disease
Authors: Ward M W N , Morgan B G , Clark C G
Published: March 2007

The utilization of a myocutaneous flap based on the gracilis muscle is described in two patients who had a persistent perineal sinus following proctocolectomy for Crohn's disease. In each case the posterior vaginal wall had eroded to form a fistula. This flap provided a cutaneous surface with good sensation to replace the posterior vaginal wall and tissue bulk to fill the excised cavity. A good functional result was obtained in each patient. This technique provides a useful contribution to the management of this unusual complication.
A simple parameter for accurate detection of severe carotid disease
Authors: Knox R A , Breslau P J , Strandness D E
Published: March 2007

The value of the ratio of the peak systolic velocity in the internal carotid artery to the end diastolic velocity in the common carotid artery in quantifying the severity of carotid arteriosclerosis has been investigated in 86 diseased vessels and 30 normal vessels. The ratio permitted gradation of disease into 60 per cent stenosis and greater with 95 per cent accuracy, 65 per cent stenosis and greater with 97 per cent accuracy and greater than 90 per cent stenosis with 100 per cent accuracy. The values for 30 normal sides studied fell below those of the 60 per cent stenosis group. The ratio has a value in predicting the severity of disease in the internal carotid artery in those with a 60 per cent stenosis and greater.
The causes and prevention of intestinal adhesions
Authors: Ellis Harold
Published: March 2007

Although intestinal obstruction from intra-abdominal adhesions is a relatively common surgical emergency, the vast majority of adhesions are harmless and may be protective or even life-saving. The causes of intestinal adhesions are presented, and various methods advocated to prevent adhesions are discussed. The surgeon is advised to reduce unnecessary adhesion formation by meticulous surgical technique, control those adhesions which inevitably form to obtain their beneficial effects, and to avoid the risk of subsequent obstruction.
Radical restorative surgery for poorly differentiated carcinoma of the mid-rectum
Authors: Elliot Michael S , Todd Ian P , Nicholls R J
Published: March 2007

A retrospective study was made to compare the results of restorative surgery with those of total rectal excision in the treatment of patients with a poorly differentiated adenocarcinoma of the middle third of the rectum (between 8 and 12 cm from the anal verge). Of 1163 patients presenting between 1963 and 1975, 42 with poorly differentiated tumours at this level were followed up after treatment by a radical (i.e. curative) operation. Twenty-eight underwent total rectal excision and 14 anterior resection. Examination of the preoperative biopsy correctly established the histological grade in 17 (40 per cent) of 42 cases. Pathological examination of the resected specimens showed a slightly higher proportion of Dukes' C2 tumours and those with venous invasion removed by total rectal excision, but the extent of local spread among tumours removed by either operation was similar.

There was no operative mortality. Ten out of 28 patients treated by total rectal excision (36 per cent) and 6 out of 14 treated by anterior resection (43 per cent) were alive at 5 years. One patient developed a histologically proved local recurrence after anterior resection; no other proved local recurrence was recorded. It would appear, therefore, that where radical surgery is possible, anterior resection offers as good a prospect of cure as total rectal excision for poorly differentiated tumours of the mid-rectum.
Local recurrence after low anterior resection using the staple gun
Authors: Hurst P A , Prout W G , Kelly J M , Bannister J J , Walker R T
Published: March 2007

Eleven early anastomotic recurrences have occurred after 34 low anterior resections for carcinoma of the rectum performed during the past 2 years using the EEA staple gun. These recurrences all occurred after resection of locally advanced tumours and caused distressing symptoms, and it is suggested that this technique might be best reserved for more favourable growths.
Gallium-67 scanning in patients with Crohn's disease: An aid to the diagnosis of abdominal abscess
Authors: Holdstock Greg , Ligorria J E , Krawitt E L
Published: March 2007

Gallium-67 scans correctly distinguished abdominal abscess from mural inflammation in 6 patients with Crohn's disease in whom abscess was suspected. Interpretation of the 48-h scan proved easiest and was aided by the use of bowel preparation to remove marker from lumen of the gut.
Gastric blood flow, mast cell degranulation and micromorphology of gastric mucosa following experimental haemorrhagic shock in dogs
Authors: Kokoschka R , Göber I , Gebhart W
Published: March 2007

Ischaemia of the gastric mucosa in haemorrhagic shock appears to be one of the principal factors underlying acute bleeding from the upper gastrointestinal tract. In the present experimental study on dogs the changes of blood flow in the upper gastrointestinal tract were recorded by direct flow measurement in the pertinent vessels. Fourteen mongrel dogs were subjected to haemorrhagic shock lasting for 3 and 4 h. A decline of 46 per cent cardiac output was observed while coeliac artery blood flow decreased by 40 per cent and gastric artery blood flow by 60 per cent. All stages of stress ulcers were documented by light and electron microscopy. In addition, pronounced degranulation of mast cells preceding major tissue damage was observed. In the light of these findings a cascade of events is thought to be present resulting in the development of stress ulcer.
Laparoscopy in the prevention of unnecessary appendicectomies: A prospective study
Authors: Deutsch Alexander A , Zelikovsky Avigdor , Reiss Raphael
Published: March 2007

More than one-third of all appendicectomies are unnecessary. A study was directed towards reducing the misdiagnosis of appendicitis, thus preventing needless operations. Thirty-six women in the fertile age group and with a diagnosis of appendicitis were subjected to laparoscopy before surgery. All women had undergone a gynaecological examination to rule out disease of the female genitalia. As a result of the laparoscopy, surgery was cancelled in one-third of the cases, which were found to have acute gynaecological disease not requiring surgery.
The consequences and effectiveness of intubation in the palliation of dysphagia due to benign and malignant strictures affecting the oesophagus
Authors: Pfleiderer A G , Goodall P , Holmes G K T
Published: March 2007

In a study of 66 patients intubated to relieve dysphagia, 52 (79 per cent) survived the procedure and were discharged home. Of these, 23 (44 per cent) developed further dysphagia due to tube dysfunction, and 19 patients (37 per cent) were readmitted for further procedures to restore swallowing. With early intervention, the periods of dysphagia were short and the palliation so achieved was effective. Overall, intubation proved to be an effective method of relieving dysphagia in patients unsuitable for curative treatment.
Ileal pelvic reservoir: A correlation between motor patterns and clinical behaviour
Authors: Rabau M Y , Percy J P , Parks A G
Published: March 2007

An attempt has been made to correlate motility patterns of the pelvic ileal reservoir with patients' clinical experience. In order to evaluate the motility characteristics of the ileal reservoir, we have related its behaviour to the motility pattern observed in ileum proximal to an ileostomy. Seven patients with an ileostomy and 11 patients with a pelvic ileal reservoir have been investigated. The ileum and ileal reservoir were found to behave similarly during the fasting state and in response to distension and eating; however, a quantitative functional difference was discovered. Distension with 30 ml was enough to produce forceful contractions in the normal ileum, while a mean of 322 ml was necessary to initiate similar activity in the ileal reservoir. The ileal reservoir thus behaves as a capacitance organ with the ability to distend without contraction before a considerable volume has accumulated within it. When it does contract, it initiates a sensation of impending evacuation, but escape of ileal content is opposed by active contraction of the intact external anal sphincter.
The clinical staging of rectal cancer
Authors: Nicholls R J , Mason A York , Morson B C , Dixon A K , Fry I Kelsey
Published: March 2007

The ability of rectal digital examination to recognize significant stages of local extent and lymph node involvement in adenocarcinoma of the lower two-thirds of the rectum was investigated. Seventy patients with a palpable rectal cancer were examined by 2 or 3 out of a panel of 10 clinicians including 2 consultants and 8 registrars. A defined protocol was used and the results were recorded on a proforma. Clinical findings were compared with the results of pathological examination of the resected specimen or the final surgical assessment when the growth was not removed. In 38 patients computed tomography of the primary growth was performed and the results were also compared to the pathological findings. Four groups of cases with different degrees of extent of spread were recognized by digital examination in 67–83 per cent by consultants and in 44–78 per cent by registrars. Computed tomography correctly identified growths with extensive local spread in 89 per cent of cases, but was no more reliable than digital examination in the assessment of other degrees of spread or of lymph node involvement.

Based on the results, a clinical staging system is proposed, comprising four stages of local extent as follows—stage 1: confined to rectum; stage 2: confined to rectum or slight extrarectal spread; stage 3: moderate or extensive extrarectal spread; stage 4: involvement of other organs or unresectability. Two stages of lymph node involvement are also proposed: namely, node negative and node positive. Each stage corresponds to different survival and local recurrence rates after surgery. Combined with other factors, such as level and size of tumour, histological grade and the general state of the patient, the clinical staging system may facilitate the choice of treatment. It might extend the use of major sphincter-saving procedures, indentify many patients suitable for local treatment and define those with a considerable risk of local recurrence where combined surgery and radiotherapy might be considered.