bluuebunny/crossref_metadata_2025 huggingface dataset:
Bone mineral content in patients with primary hyperparathyroidism: a comparison of conservative management with surgical treatment
Authors: Mole P A , Walkinshaw M H , Gunn A , Paterson C R
Published: March 2007

The management of patients with asymptomatic hyperparathyroidism remains controversial. This study examined the extent to which the presence or prospect of bone disease should influence treatment. Bone mineral content (BMC) of the distal forearm was measured by single photon absorptiometry in 67 patients with mild hyperparathyroidism. Twenty-six patients treated surgically and 17 managed conservatively were reviewed regularly for up to 4 years. Eighty per cent of patients had a baseline fat-corrected BMC within the local reference interval for age and sex, but about 75 per cent of values fell below the mean. BMC at the ‘distal’ site of the surgically treated patients improved or stabilized, but a continuing decline was seen in the patients managed conservatively (P < 0.01). Differences were small and concern about future osteoporotic fracture should seldom be a major factor in making decisions about surgical correction of mild hyperparathyroidism.
Recombinant tissue-type plasminogen activator is superior to streptokinase for local intra-arterial thrombolysis
Authors: Lonsdale R J , Berridge D C , Earnshaw J J , Harrison J D , Gregson R H S , Wenham P W , Hopkinson B R , Makin G S
Published: March 2007

The results of local intra-arterial thrombolysis in 98 patients treated with streptokinase and 69 patients treated with recombinant tissue plasminogen activator (rtPA) have been compared. The two groups of patients were well matched and their treatment protocols were identical except with regard to the thrombolytic agent used. Strict criteria for defining successful thrombolysis were used. Successful lysis was achieved in 40 of 98 patients (41 per cent) receiving streptokinase and 40 of 69 patients (58 per cent) receiving rtPA (P < 0·05). The time to lysis was significantly shorter with rtPA, median time 22h, than with streptokinase, median time 40 h (P < 0·002). There was no diference in the incidence of haemorrhagic complications. These results suggest that rtPA is superior to streptokinase for local intra-arterial thrombolysis.
Experimental study of the protective effect of intermittent hepatic pedicle clamping in the rat
Authors: Isozaki H , Adam R , Gigou M , Szekely A M , Shen M , Bismuth H
Published: March 2007

The tolerance of the liver to ischaemia during intermittent clamping of the hepatic pedicle was compared with that during a continuous Pringle manoeuvre. Three groups of rats undergoing total durations of clamping of 60, 90 and 120 min were studied. A temporary peroperative portacaval shunt was used to exclude the efects of splanchnic venous stasis and allow independent study of the efects of hepatic ischaemia. In each group, three methods of portal clamping were evaluated: a continuous Pringle manoeuvre (n = 10), a 30-min intermittent clamping (n = 10) and a 15-min intermittent clamping (n = 10). The clamp release time between the periods of liver ischaemia was 5 min. Survival at day 7 and postoperative changes in liver function (transaminase enzymes, bilirubin, bromsulphthalein elimination, liver adenosine 5′-triphosphate levels) were recorded. Intermittent clamping of the pedicle was tolerated significantly better than continuous clamping. This method optimizes the ability of the liver to tolerate extended periods of ischaemia. For a given duration of ischaemia, no additional improvement could be produced by shortening the intermittent clamping period from 30 to 15 min. These data suggest that, when the Pringle manoeuvre is used, it should be applied intermittently rather than continuously.
Splenic salvage using an absorbable mesh: Feasibility, reliability and safety
Authors: Fingerhut A , Oberlin P , Cotte J-L , Aziz L , Etienne J-C , Vinson-Bonnet B , Aubert J-D , Rea S
Published: March 2007

Forty-nine adults underwent surgery for splenic injury: 17 (group 1) had salvage with a splenic mesh, seven (group 2) underwent other preservation techniques, and 25 (group 3) underwent splenectomy. There were six, zero and 11 hilar lesions in groups 1, 2 and 3, respectively. Seven of 15 associated lesions involved the digestive tract. There was no significant difference in transfusion requirements, length of operation or postoperative complications. One patient died in each of groups 1 and 2, and eight in group 3. Secondary splenectomy was performed once in groups 1 and 2. The duration of hospital stay was shorter in the preservation groups (1 and 2) than in group 3. Splenic preservation was feasible in 24 of 49 adults with splenic injury requiring surgery. The splenic mesh wrap is safe and reliable, and allows splenic salvage even with hilar injury.
Retroperitoneal necrotizing fasciitis
Authors: Woodburn MrK R , Ramsay G , Gillespiet G , Miller D F
Published: March 2007

Necrotizing fasciitis is a mixed infection of the skin and subcutaneous tissues with a characteristic clinical and pathological appearance. Early radical surgical excision of all affected tissue is the treatment of choice. In a series of 19 patients with necrotizing fasciitis, bacteriological assessment in 15 confirmed the mixed nature of the infection, with Bacteroides sp. isolated from ten patients. All 12 patients who underwent radical surgical excision survived. A subgroup of patients was identified in whom the appearance of necrotizing fasciitis in the abdomen or perineum was indicative of more extensive disease in the retroperitoneal tissues. Surgical resection of all affected tissue was not feasible in these cases and the outcome was uniformly fatal, giving an overall mortality rate for the series of 37 per cent.
Improved technique for polytetrafluoroethylene bypass grafting: Long-term results using anastomotic vein patches
Authors: Taylor MrR S , Loh A , McFarland R J , Cox M , Chester J F
Published: March 2007

Results of peripheral arterial bypass using polytetrafluoroethylene grafts have remained poor in comparison with those using saphenous vein grafts, particularly for anastomoses to tibial and peroneal vessels. A simple modification to the conventional operative technique, involving the incorporation of a vein patch into the distal anastomosis, has enabled considerable improvement. Five-year patency rates of 71 per cent for popliteal and 54 per cent for infrapopliteal grafts have been achieved in a series of 256 patients operated on between 1982 and 1989.
Crohn's disease and nutrition
Authors: Stokes M A
Published: March 2007

Malnutrition was included by Crohn as one of the features of the new disease he described. Most patients with Crohn's disease are malnourished even if their disease is not active. Nutritional factors may be implicated in the aetiology of the disease, but this remains unproven. The role of nutritional support and therapy is discussed and it is suggested that improving the patient's nutritional status may have a primary therapeutic as well as a supportive role in the treatment of the disease.
Comparison of Nissen total and Lind partial transabdominal fundoplication in the treatment of gastro-oesophageal reflux
Authors: Walker S J , Holt S , Sanderson C J , Stoddard C J
Published: March 2007

Fifty-two patients with gastro-oesophageal reflux disease refractory to medical treatment were randomized to undergo a Nissen total (360° wrap) or Lind partial(300° wrap) transabdominal fundoplication. Each group was comparable in number (26 patients), mean age (47 and 48 years) and sex distribution (eight women). Preoperative and postoperative assessment involved a modified Visick score, 22-h intraoesophageal pH monitoring, endoscopy and manometry. Follow-up was at 6 weeks and between 3 and 33 (mean 13) months. The prevalence of heartburn and regurgitation and the results of pH monitoring improved significantly after both operations (P < 0.001). At early assessment eight previously asymptomatic patients (31 per cent) from, the Nissen group and six (23 per cent), from the Lind group experienced difficulty swallowing. Ten patients (38 per cent) in each group complained of ‘gas bloat’. Both complications had improved at late assessment in the majority of patients. No statistically significant advantage could be demonstrated, for either operation.
Bioelectrical impedance analysis in the measurement of the body composition of surgical patients
Authors: Fearon K C H , Richardson R A , Hannan J , Cowan S , Watson W , Shenkin A , Garden O J
Published: March 2007

The evaluation of nutritional status in surgical patients remains a difficult problem. Bioelectrical impedance analysis (BIA) is a new method of body composition analysis which is easily performed at the bedside. This study determined the accuracy of BIA in the measurement of total body water (TBW) and potassium (TBK) in a heterogeneous group of surgical patients. The resistance and reactance components of impedance were measured with a whole body impedance analyser. Tritiated water dilution and whole body monitoring were the reference methods for TBW and TBK analysis. With the BIA technique the coefficient of variation for the estimation of TBW was 8.1 per cent and for TBK was 6.4 per cent. Allowing for the errors of the reference methods these results show that BIA is of limited value in the estimation of TBW but may provide a useful index of TBK.
Effect of antibiotics in fibrin sealant on healing colonic anastomoses in the rat
Authors: van der Ham A C , Kort W J , Weijma I M , van den Ingh H F G M , Jeekel H
Published: March 2007

In 90 rats a colonic anastornosis was constructed with 12 interrupted 7/0 polypropylene sutures. Group 1 (n = 30) served as a control group. In group 2 (n = 30) the anastomosis was sealed with, fibrin adhesive and in group 3 (n = 30) a mixture of fibrin, clindamycin and cefotaxime was used. On days 2, 4 and 7, ten animals in each group were killed. Adhesion formation was significantly increased in groups 2 and 3 compared with the control group. On day 2 the anastomosis was significantly stronger after sealing with antibiotic–fibrin mixture. On day 4 the bursting pressure in group 2 was significantly lower than in groups 1 and 3. At the same time the concentration of hydroxyproline was significantly reduced in group 2, but not in group 3. The addition of antibiotics prevents the negative effect of fibrin adhesive on the healing colonic anastomosis and contributes to a stronger anastomosis on day 2 after operation.
Management of empyema thoracis at Lusaka, Zambia
Authors: Desai G A , Mugala D D
Published: March 2007

Of the 39 consecutive patients with empyema thoracis managed by one of the five general surgical units at Lusaka, Zambia, 26 suffered, from human immunodeficiency virus (HIV) infection and 19 were diagnosed as suffering from pulmonary tuberculosis within 3 years of developing empyema thoracis. Thirty patients were between 16 and 40 years of age; of these, 22 suffered from acquired immune deficiency syndrome (AIDS) and all 19 patients with pulmonary tuberculosis belonged to this age group. Of the four patients with empyema thoracis in the age group of 0–5 years, two were suffering from AIDS. The majority of cases of empyema thoracis associated with AIDS present insidiously and, because of late presentation, rib resection is necessary. After surgery these patients were managed at home with the help of a home care team, thus reducing the burden on hospital resources. The morbidity and mortality rates in these patients are higher than in those in whom empyema thoracis is not associated with AIDS.
Body water compartments in patients with obstructive jaundice
Authors: Sitges-Serra A , Carulla X , Piera C , Martínez-Ródenas F , Franch G , Pereira J , Gubern J M
Published: March 2007

To elucidate the pathogenesis of renal dysfunction associated with obstructive jaundice, body water compartments were measured using a multi-isotope dilution technique in ten patients with biliary tract obstruction and in ten control subjects matched for age, sex, weight, height and body surface area. Expressed as a fraction of body-weight, total body water was reduced in jaundiced patients (41.8 versus 44.2 per cent, P < 0.02). Extracellular water volume was also reduced in patients with jaundice (20.3 versus 24.3 per cent, P < 0.003) owing to a reduction of the interstitial space (16.1 versus 19.5 per cent, P < 0.004) and, to a lesser degree, of the plasma volume (4.2 versus 4.8 per cent, P = 0.1). There was a close correlation in jaundiced patients between plasma volume and the creatinine clearance rate (r2 = 0.56, P < 0.02) and between plasma volume and extracellular volume (r2 = 0.77, P < 0.0001). Extracellular volume in such patients also correlated with the percentage weight loss (r2 = 0.42, P = 0.04). Obstructive jaundice is associated with a contracted extracellular water compartment, although extracellular water, as a percentage of body-weight, increased in proportion to the body-weight lost. Reduction of the interstitial volume and a marginally reduced plasma volume may be determinant factors in the pathogenesis of the renal and haemodvnamic disturbances observed in patients with biliary tract obstruction.
Meconium ileus: A review 1972–1990
Authors: Docherty J G , Zaki A , Coutts J A P , Evans T J , Carachi R
Published: March 2007

This article reviews the management and mortality of 53 neonates with meconium ileus and cystic fibrosis treated in one paediatric surgical centre from 1972 to 1990. Forty-four patients (83 per cent) presented with simple meconium ileus and 26 of 40 patients in this group were successfully treated with Gastrografin enemas. Four patients sufered a perforation as a result of the enema (perforation rate 5 per cent). The 1-year survival rate for simple meconium ileus was 81 per cent andfor complicated meconium ileus 75 per cent.
Evaluation of tissue oximetry in perioperative monitoring of colorectal surgery
Authors: van Esbroeck G , Gys T , Hubens A
Published: March 2007

Twenty patients undergoing elective colorectal surgery were studied during and after operation by means of tissue oximetry measuring the subcutaneous partial pressure of oxygen (Psco2) and by gastric intramural pH measurement. Mean(s.d.) Psco2 recorded 24 h after surgery was significantly lower than the peroperative value: 14(10) versus 24(14) mmHg, P < 0.02. The postoperative Psco2 was also significantly lower than that measured in a control group of ten healthy volunteers: 14(10) versus 34(18) mmHg, P < 0.001. The peroperative Psco2 of the patients who developed a postoperative complication was significantly lower than that of those who had an uneventful postoperative clinical outcome: 16(9) versus 32(14) mmHg, P < 0.02. The peroperative Psco2 of the patient group with complications was also significantly lower than that of the control group: 16(9) versus 34(18) mmHg, P < 0.02. The peroperative Psco2 of the group of patients without complications was almost identical to that of the control group. During operation only one patient developed gastric intramural acidosis. Perioperative oxygen debt and the response of subcutaneous tissue oxygen tension to oxygen breathing seemed to correlate better with clinical outcome than gastric wall pH values and the conventional parameters of tissue perfusion.
Use of Teflon stents for lymphovenous anastomosis
Authors: Shaper N J , Rutt D R , Browse N L
Published: March 2007

The treatment of lymphoedema is difficult; conservative and surgical management show variable results. Lymphovenous anastomoses (LVAs) in experimental animals and patients give poor results in the treatment of primary lymphoedema and variable results in that of secondary lymphoedema. Conventional sutured LVAs were compared with anastomoses using polytetrafluoroethylene (Teflon) stents; 32 sutured and 21 stented LVAs were constructed in 16 rabbits with normal lymphatics. Anastomoses were assessed for quality and patency at 1-16 weeks by direct exposure; 27 cases were further assessed using lymphangiography. Patency in stented and sutured LVAs was 71 and 38 per cent at 1 week, and 38 and 8 per cent at 3 weeks, respectively. After 4 weeks all anastomoses were occluded. The quality of stented LVAs seemed to be higher than that of sutured LVAs. Stented LVAs are feasible and probably superior to conventional sutured LVAs. However, the patency of LVAs is of short duration because of the disadvantageous pressure gradient from lymphatics to veins, and this limits their clinical application.
Abdominal aortic aneurysm, glaucoma and deafness: A new familial syndrome
Authors: Adoki I I , Stoodley B J
Published: March 2007

Several reports have suggested a genetic basis for the distribution of abdominal aortic aneurysm (AAA) in some families. The familial clustering of this disease is further demonstrated in this report of ten siblings, five of whom have confirmed AAA. This is the largest cluster so far reported. The majority of patients in this family group also have glaucoma and/or deafness.
Distribution of aortic diameter in a screened male population
Authors: Lucarotti M E , Shaw E , Heather B P
Published: March 2007

Between September 1990 and August 1991, 2291 men aged 65 years were invited for ultrasonographic screening of the aorta in the Gloucestershire aneurysm screening programme; 1748 (76.3 per cent) attended. An aortic diameter ⩽ 2.5 cm was found in 1547 (88.5 per cent); 174 (10.0 per cent) had diameters in the range 2.6-4.0 cm, and 26 (1.5 per cent) had diameters >4.0 cm. The mean(s.d.) aortic diameter was 2.1(0.55) cm and 97.5 per cent of patients had a diameter ⩽3.3 cm. Any man over the age of 65 years with an aortic diameter >3.3 cm has an aortic aneurysm.
Vascular inflow exclusion and hepatic resection
Authors: Taniguchi H , Takahashi T , Shioaki Y , Itoh A , Oguro A
Published: March 2007

Seventy-nine patients undergoing hepatic resection without manipulation of the vena cava were divided into three groups. Group 1 consisted of 32 patients in whom hepatic hilar vascular exclusion was not performed. Group 2 (20 patients) had vascular inflow exclusion performed at the operative site only (right or left unilateral exclusion). Group 3 (27 patients) had total inflow exclusion during hepatic resection. There were no significant differences between the groups in blood loss or blood transfusion requirement. On the third day after operation, the serum glutamic-pyruvic transaminase level in group 3 was significantly higher than that in group 1 (P < 0.01). Vascular inflow exclusion may not be essential for successful hepatic resection.
Mesosigmoplasty as a definitive operation for sigmoid volvulus
Authors: Subrahmanyam M
Published: March 2007

In a prospective study, 126 patients with sigmoid volvulus were treated by mesosigmoplasty during a 12-year period. Patients with sigmoid volvulus with no clinical evidence of gangrene were selected for study, and all were given a trial of non-operative reduction by proctoscopy and passage of a rectal tube. Reduction was achieved in 48 patients (38 per cent), who were subsequently treated by mesosigmoplasty as an elective procedure 1–2 weeks later. For the remaining 78 patients (62 per cent) who were not relieved by the non-operative method, emergency mesosigmoplasty was performed. There was one death in the emergency group, and two patients had a recurrence after 2 and 6 months respectively in the elective group, in whom resection was carried out. In the other 123 patients during a maximum follow-up of 12 (mean 8.2) years no recurrence was detected. Mesosigmoplasty has the advantage of low rates of mortality, morbidity and recurrence; it can be carried out as either an emergency or an elective procedure.
Council of the British Journal of Surgery Society
Authors: Williamson Robin
Published: March 2007

Continuing our report on the Officers and Members of Council of the Society that administers the Journal, we present the three privileged Members who represent our three afiliated bodies: the Royal Colleges of Surgeons in the British Isles, the Association of Surgeons of Great Britain and Ireland, and the Surgical Research Society.
Systemic cytokine response after major surgery
Authors: Baigrie R J , Lamont P M , Kwiatkowski D , Dallman M J , Morris P J
Published: March 2007

The systemic cytokine response to major surgical trauma was studied in 20 patients undergoing elective aortic surgery and five patients after inguinal hernia repair. Tumour necrosis factor alpha and interferon gamma were not detected in these patients. An early and short-lived interleukin 1 beta (IL-1β) response to major surgery was detected only by intensive sampling in the perioperative period. The IL-1β peak preceded a more marked interleukin 6 (IL-6) response that peaked 4–48 h after surgery. IL-6 levels had fallen sharply by 48–72 h in all patients who had an uneventful postoperative course. The IL-6 peaks were significantly lower after hernia surgery than after major aortic operations (P < 0.001); IL-1β was not detected in any samples. Three patients undergoing aortic surgery developed unexpected major postoperative complications. IL-6 levels in this group were significantly higher than those of the other patients undergoing aortic surgery within 6–8 h of skin incision, and remained elevated for longer. These rises in plasma IL-6 levels preceded the clinical onset of major complications by 12–48 h. The systemic IL-1β and IL-6 response to surgical trauma increased with the severity of the surgical insult. An early, exaggerated IL-6 response was associated with the subsequent clinical development of major complications.
Continuing experience with transaxillary excision of the first rib for thoracic outlet syndrome
Authors: Carty N J , Carpenter R , Webster J H H
Published: March 2007

The results of transaxillary excision of the first rib for thoracic outlet syndrome are reported. During a 3-year period, 40 transaxillary rib resections were performed on 32 patients. The symptoms in 33 limbs were completely relieved and in a further four symptoms were improved. These results confirm that transaxillary excision of the first rib is the operation of choice in the management of thoracic outlet syndrome.
Breast cancer in Nigerian women
Authors: Ihekwaba F N
Published: March 2007

A combined retrospective (1971–1980) and prospective (1981–1990) study of the epidemiology, clinical characteristics and pathology of breast cancer in a black African population was carried out. There were 1946 biopsy-proven cases, with a rate frequency of 33.6 per 100 000 patients per year. The age range was 14-96 years but 70 per cent of patients were between 26 and 50 years old. The cumulative frequency of cancer was 0.8 per cent at age <20 years and 3.3 per cent at age <25 years: the peak age range for disease was 36–45 years. Of 1842 evaluable patients, 17.2 per cent presented with stages I or II cancer and 73.8per cent with stage III disease. The dominant histopathological type was infiltrating ductal cancer (49.2 per cent), followed by undiferentiated anaplastic carcinoma (33.3 per cent). Burkitt's lymphoma occurred in five patients and developed concurrently and rapidly during lactation in four. The prospective study did not demonstrate that age at menarche or first full-term pregnancy, duration of breast feeding or parity were risk factors in black women.
Mechanism of action of injection therapy for bleeding peptic ulcer
Authors: Rajgopal C , Lessels A , Palmer K R
Published: March 2007

The effects of intramucosal injection of 1: 100 000 adrenaline, 5 per cent ethanolamine and normal saline were determined in experimentally created, acutely bleeding gastric mucosal wounds in rabbits. The mean(s.d.) bleeding rate was decreased from 2.3(0.4) to 0.2(0.02) ml/min by adrenaline (P < 0.01), but increased by 1 ml 5 per cent ethanolamine to 4.0(0.6) ml/min (P < 0.05). Normal saline had no haemostatic effect, suggesting that local tamponade is not important. In separate experiments endoscopic injections of 5 per cent ethanolamine, 1: 100 000 adrenaline and normal saline were made in the gastric antrum of rabbits. After 48 h the degree of inflammation was greatest with ethanolamine but, despite tissue necrosis and venous thrombosis, neither endarteritis nor arterial thrombosis occurred. Injections of 5 per cent ethanolamine and 80 per cent ethanol placed next to the ear arteries of rabbits caused local ulceration and necrosis, but endarteritis and arterial thrombosis were again absent.
Management of common bile duct stones using a second-generation extracorporeal shockwave lithotriptor
Authors: Nicholson D A , Martin D F , Tweedle D E F , Rao P N
Published: March 2007

Fifty-four patients with common bile duct stones (8–36 mm in diameter) that could not be removed after endoscopic sphincterotomy, even with the use of mechanical lithotripsy, underwent extracorporeal shockwave lithotripsy (ESWL) using a Siemens Lithostar. Their median age was 75.5 (range 34-89) years. Patients received 4000–6000 shocks per session over approximately 60 min. Seventeen underwent two sessions and two patients three or more. Thirty-seven patients had one stone, ten had two, and seven had three or more. Spontaneous clearance of fragments occurred in only three patients before further endoscopic retrograde cholangiopancreatography was performed to remove fragments. Stones were removed and ducts cleared endoscopically in 35 patients, giving a total of 38 of 54 patients (70 per cent) with complete duct clearance. Fragmentation in response to lithotripsy was dependent on stone size; the number of stones had little efect. ESWL was well tolerated without any haematological or biochemical abnormality. Computed tomography in the first 20 patients showed no hepatic or pancreatic change after treatment. ESWL combined with endoscopic extraction of fragments is an alternative to surgery when preliminary endoscopic extraction and mechanical lithotripsy have failed.
Paediatric intussusception
Authors: Stringer M D , Pablot S M , Brereton R J
Published: March 2007

Intussusception is one of the commonest causes of intestinal obstruction in infants and accounts for about 700 hospital admissions each year in England and Wales. Improved results of treatment have followed recent technological developments, which include ultrasonographic imaging and pneumatic reduction techniques. Most intussusceptions can be reduced successfully without the need for operation but close cooperation between surgeon and radiologist is essential. Mortality and morbidity rates from the condition have progressively declined in recent decades but avoidable deaths still occur.
Editorial Committee of the British Journal of Surgery
Authors: Williamson Robin
Published: March 2007

The overseas membership of the Editorial Board has increased steadily over the past two decades, reflecting the international flavour of The British Journal of Surgery. In 1989, to foster closer links with continental Europe, the Council of the BJS Society appointed the first surgeon from outside Britain to join the Editorial Committee, the body with executive control over the monthly publication of the Journal. There are now three representatives from mainland Europe on the Editorial Committee, and their profiles are given below.
Cytokines in tumour therapy
Authors: Hill A D K , Redmond H P , Croke D T , Grace P A , Bouchier-Hayes D
Published: March 2007

Cytokines are low molecular weight proteins released by cells of the immune system that have therapeutic potential in cancer. They include the interleukins, the interferons, tumour necrosis factor and the colony-stimulating factors. Cytokines are capable of producing significant and sustained responses against a number of tumours. Clinically, the highest response rates to cytokine immunotherapy have been seen in melanoma and renal cell cancer. Current efforts aim to reduce treatment-related toxicity while maintaining the efficacy of cytokines. The therapeutic potential of these agents may be increased with genetic manipulation by introducing genes encoding cytokines into tumour-infiltrating lymphocytes and certain tumour cells. However, immunotherapy remains time consuming and expensive, and further developments are necessary before it can have a definitive role in tumour management.
The electronic information revolution and how to exploit it
Authors: Cox J J , Dawson K J , Hobbs K E F
Published: March 2007

Medical information is increasingly stored in electronic format, enabling faster and more flexible access to the literature. Online, compact disc and floppy disc databases are widely available. The origins and development of these different database media are described. The strengths and weaknesses of each, and the ways in which they complement each other, are examined. Ease of access to medical information can result in data management problems; the role of bibliographic software in ensuring full exploitation of the electronic information revolution is therefore emphasized.
Quality of life following surgery for abdominal aortic aneurysm
Authors: Mageae T R , Scott D J , Dunkley A , St Johnston J , Campbell W B , Baird R N , Horrocks M
Published: March 2007

Repair of abdominal aortic aneurysm (AAA) carries a xconsiderable rate of morbidity and mortality, but little information exists on the quality of life following this procedure. During 1988 and 1989, in two hospitals, 211 patients (186 men and 25 women; median age 74 (range 48--87) years) underwent surgery for AAA. There were 77 ruptured aneurysms and 134 electively repaired. Of these, 38 patients died in hospital (27 ruptured, 11 elective); by the time of review a further eight (one ruptured, seven elective) had died from unrelated causes. Of the 165 survivors, 131 (45 ruptured, 86 elective) were reviewed and questioned as to their physical and mental state before and after surgery. Using the Rosser index, a value for quality of life before and after surgery was calculated (1.0, good; 0, dead). The value for the elective group was 0.94 before operation and 0.96 after, but in the ruptured group fell from 0.98 before surgery to 0.87 afterwards. This study shows that patients undergoing elective surgery for repair of AAA retain good quality of life. By contrast, patients surviving emergency surgery following this procedure seem to suffer a deterioration in life quality, which must be endured for the same expected lifetime as that for the elective group. These results support the need for a national AAA ultrasonographic screening programme.
Role of topical lignocaine during carotid endarterectomy
Authors: Welch M , Tait W F , Durrans D , Carr H M H , Jackson P W , Walker M G
Published: March 2007

Forty carotid endarterectomies were undertaken in 34 patients. Operations were prospectively randomized to periarterial application of either 1 per cent lignocaine (n = 19) or normal saline (n = 21), and detailed measurements taken of intraoperative pulse rate and blood pressure. Patients receiving lignocaine demonstrated a lower pulse rate, and lower systolic and mean blood pressures than those receiving placebo, with significance in relation to clamp application and shunt removal (P < 0.05). It was particulary noticeable that patients receiving lignocaine demonstrated less intraoperative variation in pulse rate and blood pressure. Topical lignocaine stabilizes pulse rate and blood pressure during carotid endarterectomy.
Diagnostic and therapeutic aspects of fine-wire localization biopsy for impalpable breast cancer
Authors: Hastrich D J , Dunn J M , Armstrong J S , Davies J D , Davies Z D , Webb A J , Farndon J R
Published: March 2007

During the first 2 years (July 1989 to July 1991) of the Avon Breast Screening Service, fine-wire localization biopsy was indicated in 213 impalpable breast lesions. A total of 144 lesions were benign and 69 malignant. Only four of 213 lesions (1.9 per cent) were not excised at the first localization. Factors influencing reoperation in the 69 patients with malignant impalpable lesions were examined. There was a significant association (P < 0.001) between parenchymal disturbances on mammography and invasive carcinoma, and between non-invasive carcinoma and microcalcification (P < 0.001). In 31 patients the localization biopsy was the only surgical procedure. Thirty-eight patients required further surgery: 12 underwent further local excision and 26 mastectomy. Reoperation was more frequent in patients with calcification than in those with parenchymal disturbance (P < 0.001). The most frequent indications for mastectomy were inadequate excision of widespread comedo ductal carcinoma in situ or invasive ductal carcinoma combined with extensive ductal carcinoma in situ. Fine-wire localization biopsy was a combined therapeutic and diagnostic procedure in 31 of 69 women with impalpable screen-detected lesions. The majority of patients required further surgery because radiological abnormalities underestimated the extent of disease.
Symptom index as a marker of gastro-oesophageal reflux disease
Authors: Johnston B T , McFarland R J , Collins J S A , Love A H G
Published: March 2007

Forty per cent of patients with heartburn may have no evidence of oesophagitis or of abnormal oesophageal acid exposure. The symptom index correlates symptoms that occur during pH monitoring with episodes of acid reflux, being the number of symptoms during reflux divided by the total number occurring during monitoring. This index was assessed in 61 patients with heartburn. In 39 patients with endoscopic evidence of oesophagitis or abnormal acid exposure times on pH monitoring, the symptom index had a sensitivity of 90 per cent. Of the 22 patients with no objective abnormality, the index was ≥ 50 per cent in five (23 per cent) whose symptoms were presumably due to acid reflux despite results of other investigations being normal, suggesting an acid-sensitive oesophagus. The symptom index is a useful additional measure in the investigation of patients with suspected gastro-oesophageal reflux disease.
Ambulatory measurement of oesophageal function: Clinical use of a new pH and motility recording system
Authors: Barham C P , Gotley D C , Miller R , Mills A , Alderson D
Published: March 2007

Conventional oesophageal manometric studies are open to criticism in that they take place on fasted immobile subjects in the artificial setting of a motility laboratory. A new 24-h pH and motility recording system combined with computerized data analysis was used to study patients with gastro-oesophageal reflux disease and oesophageal motor abnormalities under ambulant conditions. Acid reflux episodes were found to be precipitated by a variety of events with recognizable pressure patterns. Acid clearance abnormalities were demonstrated in patients with erosive oesophagitis but were confined to those with abnormal oesophageal motor function. Improved diagnostic accuracy was demonstrated in the recognition of oesophageal motor disorders.
Inguinal herniotomy in young infants
Authors: Fung A , Barsoum G , Bentley T M , Wild K , Klidjian A M
Published: March 2007

Ninety-two consecutive infants aged up to 12 months underwent primary inguinal herniotomy over a 5-year period. All were treated in a district hospital paediatric surgical unit according to recommendations of the British Association of Paediatric Surgeons. After a mean follow-up of 45.8 months, one patient had a failed repair and four (4 per cent) a hernia recurrence. One infant developed a wound infection. Infantile hernia can be managed safely and efficiently in a district hospital.
Comparative audit: An experimental study of 147882 general surgical admissions during 1990
Authors: Dunn D C , Fowler S
Published: March 2007

In 1991,1025 general surgical Fellows of The Royal College of Surgeons of England were circulated with a pro forma and asked to submit local audit results for admissions during 1990 to a confidential comparative audit service. The individual topics of cholecystectomy and colorectal resection were studied. Data returned by 160 surgeons concerned 147882 admissions including 122620 operations. Overall mortality rates ranged from 0 to 5 per cent and morbidity rates from 0 to 22 per cent. Laparoscopic cholecystectomy was associated with one-quarter of the mortality rate and two-thirds the morbidity rate of open cholecystectomy. Of the 33 surgeons who responded to a survey after the presentation of results, all wished to continue the exercise in future years; 39 per cent had been stimulated to perform further analyses and 15 per cent had changed practice habits as a result. Comparative audit involving large numbers of patients and surgeons is feasible and seems beneficial to participants.
Presentation of abdominal tuberculosis to general surgeons
Authors: Underwood M J , Thompson M M , Sayers R D , Hall A W
Published: March 2007

Abdominal tuberculosis (TB) continues to give rise to diagnostic and therapeutic challenges. A total of 24 patients with abdominal TB who presented to general surgeons over a 9-year period have been reviewed. Most (92 per cent) of these patients were Asian; only one had a past history of pulmonary TB. The most common presenting complaint was abdominal pain in 21 patients (88 per cent) with the associated symptoms of weight loss in 18 (75 per cent), anorexia in 15 (62 per cent) and night sweats in 13 (54 per cent). A tissue diagnosis was obtained in 18 patients (75 per cent) and 17 patients (71 per cent) underwent laparotomy. These results show that the diagnosis of abdominal TB is still difficult to establish, and that many patients undergo laparotomy despite the existence of less invasive diagnostic procedures.
Prevention of cardiovascular effects of endotoxaemia by monoclonal antibodies specific for core endotoxin
Authors: Reidy J , Wright I , Boom S J , Barclay R , DiPadova F , Ramsay G
Published: March 2007

Passive immunization with antibody to the core region of endotoxin (core lipopolysaccharide (LPS)) has been reported to reduce mortality in severe sepsis. A rat model of endotoxaemia that reproduces the hyperdynamic cardiovascular state seen in early sepsis was developed to test monoclonal antibodies specific for core LPS. A thermodilution technique of measuring cardiac output was adapted for use in rats. Twenty-five animals were anaesthetized and mechanically ventilated with monitoring of central venous pressure and mean arterial pressure. Fluid replacement was adjusted to maintain the central venous pressure. Controls (n = 10) and antibody-treated animals (n = 5) showed no significant change in cardiac output. Animals given 0.1 mg kg−1 R2 endotoxin over 1 h (n = 5) showed a significant rise in cardiac output of 65 per cent (P < 0.01). This was abolished in rats given both antibody and endotoxin (n = 5). This study provides evidence that a monoclonal antibody against core LPS abolishes the hyperdynamic state induced by endotoxin infusion.
Prognostic significance of regional lymph node reaction after curative resection of advanced gastric cancer
Authors: Oka M , Yoshino S , Hazama S , Shimoda K , Suzuki M , Suzuki T
Published: March 2007

The prognosis of patients with advanced gastric cancer who undergo curative resection is still unsatisfactory. The relationship between prognosis and various factors such as stage, lymph node metastasis, serosal invasion and regional lymph node reaction (follicular hyperplasia and sinus histiocytosis) was evaluated. Of the factors studied, the only one that correlated well with survival was sinus histiocytosis. Lymph node metastasis was related weakly to prognosis. No correlation between prognosis and stage, serosal invasion or follicular hyperplasia was observed. Sinus histiocytosis may represent the morphological tumour-host immune reaction. Lymph node metastases or histological types were not related to regional lymph node reaction. These results suggest that sinus histiocytosis could be a useful prognostic factor for gastric cancer. Intensive postoperative follow-up for recurrence may be necessary even for patients with low-grade sinus histiocytosis in whom curative surgery is attempted.
Nasogastric intubation and elective abdominal surgery
Authors: Sagar P M , Kruegener G , MacFie J
Published: March 2007

The use of nasogastric tubes after elective abdominal surgery remains standard practice for many surgeons. Such tubes, however, cause much discomfort and are associated with significant morbidity. This paper reviews the arguments for and against nasogastric intubation, and finds little evidence to support its continued routine use.
Prevalence of abdominal aortic aneurysm in the offspring of patients dying from aneurysm rupture
Authors: Bengtsson H , Sonesson B , Länne T , Nilsson P , Solvig J , Loren I , Bergqvist D
Published: March 2007

The prevalence of abdominal aortic aneurysm (AAA) is high in the brothers of patients with aneurysm. A genetic component in the development of AAA has, therefore, been postulated. In this study the offspring of patients who had died from AAA rupture were invited to undergo ultrasonography of the abdominal aorta. The attendance rate was 69per cent. Thirty-nine sons of median age 60 (range 45–75) years and 23 daughters of median age 62 (range 42–80) years were examined. Abdominal aortic dilatation was found in eight men and one woman. The presence of aortic dilatation in these nine cases was not related to age, hypertension, smoking or symptoms of occlusive arterial disease. It is concluded that the sons of those who have died from ruptured AAA constitute a high-risk group for the development of this condition and should be considered for further screening.
Prostacyclin production from seeded prosthetic vascular grafts
Authors: Budd J S , Allen K , Hartley J , Walsh A , James R F L , Bell P R F
Published: March 2007

Endothelial cell seeding has been proposed as a method of improving potency rates in small-calibre prosthetic vascular grafts. In vivo, endothelid cells normally produce prostacyclin (PGI2), a potent antiplatelet agent. The aim of this study was to determine whether seeded grafts show significant PGI2 production after in vivo implantation. Grafts were seeded with either autologous canine venous endothelial cells or autologous microvascular endothelial cells. After 12 weeks, PGI2 production was assessed under basal and stimulated conditions. Seeded grafts were compared with non-seeded controls and the corresponding aorta. The overall patency rate in seeded grafts was 80 per cent compared wiih 10 per cent in non-seeded grafts (P < 0.01). Grafts seeded with cells from either source produced significantly more PGI2 than unseeded grafts in both basal cind stimulated states (P < 0.05). The aorto produced significantly more PGI2 than seeded grafts under both conditions (P < 0.01). Endothelial cell seeding produces a functional graft and leads to an improved patency rate.
Parotidectomy for parotid tumours: 19-year experience from the Netherlands
Authors: Debets J M H , Munting J D K
Published: March 2007

A total of 150 patients were treated for parotid tumours over a period of 19 years. In 94 per cent superficial or total parotidectomy was performed. Histological diagnosis of the resected specimen revealed pleomorphic adenoma in 92 patients (61 per cent), Whartin's tumour in 30 (20 per cent), various benign neoplasms in 11 (7 per cent) and malignant tumour in 17 (11 per cent). After a mean. follow-up of 7.7 years, no recurrence of a benign tumour was seen. Malignant tumours recurred in five patients. Permanent partial facial paralysis was seen in 4 per cent of patients after surgery, for benign lesions. Frey's syndrome was observed in 43 per cent of patients, and was not prevented by resection of the auriculotemporal nerve.
Meal area index: a new technique for quantitative assessment in achalasia by ambulatory manometry during eating
Authors: Stuart R C , Byrne P J , Lawlor P , O'Sullivan G , Hennessy T P J
Published: March 2007

Ambulatory non-perfused oesophageal manometry was used to study oesophageal body function during consumption of a full meal in patients with achalasia. A measure of oesophageal body activity (the meal area index) was developed by calculating the total area under the pressure curve during eating, above the preprandial baseline oesophageal pressure, per meal minute. Untreated patients with achalasia (n = 13) were compared with normal subjects (n = 42) patients with benign stricture (n = 9) and patients with achalasia who had undergone Heller's myotomy (n = 17). The results showed a high meal area index in achalasia, due to a rise in baseline oesophageal pressure and frequent high-amplitude contractions during eating. This was not seen in normal subjects or patients with stricture. The high meal area index was abolished by successful Heller's myotomy but remained in two patients with persisting dysphagia. Sustained high intraoesophageal pressure is generated during consumption of a solid meal in untreated achalasia, resulting in a unique manometric profile. Manometry during eating using the meal area index permits quantitative assessment of oesophageal body function in achalasia and may aid in the assessment of response to treatment.
Evaluation of routine upper digestive tract endoscopy before laparoscopic cholecystectomy
Authors: Ure B M , Troidl H , Spangenberger W , Lefering R , Dietrich A , Sommer H
Published: March 2007

Endoscopy of the upper digestive tract was performed in 376 patients with symptomatic gallstone disease before elective laparoscopic cholecystectomy. Abnormalities were found in 60 patients (16.0 per cent); these included peptic ulcer (n = 14), gastric erosions (n = 15) and oesophagitis (n = 11). Thirty patients were treated medically and two by endoscopic polypectomy. In four patients endoscopy led to cancellation of cholecystectomy; in two the complaints have persisted. Statistical analysis of 28 variables showed few significant differences in symptoms between patients with normal and those with abnormal appearances at endoscopy. It is concluded that routine endoscopy before laparoscopic cholecystectomy is neither clinically useful nor cost effective in patients with symptomatic gallstone disease. This conclusion is related exclusively to patients with typical gallstone symptoms according to the definition used in this department.
Open method versus capsulorrhaphy without drainage in the treatment of children with hepatic hydatid disease
Authors: Wu X , Tan J Z , Yang J H , Shi T H , Zhou S N
Published: March 2007

A recognized major postoperative complication of hepatic hydatid disease is accumulated hydrops leading to secondary infection in the residual cavity of the excised cyst. This study examined two methods of treating cystic hepatic hydatid disease in 43 children. A group of 22 children were treated by a new method of open drainage; 21 underwent capsulorrhaphy without drainage. There was no mortality or morbidity. The open method was associated with more rapid resolution of hydrops and quicker shrinkage of residual cavities, with efficacy over a median follow-up of 42 months.
Toxic dilatation of the colon in Chagas' disease
Authors: Kobayasi S , Mendes E F , Rodrigues M A M , Franco M F
Published: March 2007

Toxic megacolon occurs in colitis of differing aetiology. This report describes 15 patients with chagasic megacolon with this complication. The clinical signs and symptoms in all patients were pain and progressive abdominal distension accompanied by fever, severe toxaemia and shock. Seven patients developed this clinical pattern after manual removal of faeces. The remaining patients had pain and abdominal distension followed by signs of severe toxaemia when first examined. Nine patients underwent total colectomy with ileostomy (one death), four partial colectomy (all died) and two received medical treatment (both died). At autopsy, three of the four patients undergoing partial colectomy had residual colitis and enteritis. The surgical procedure of choice for this complication of chagasic megacolon is total colectomy.