bluuebunny/crossref_metadata_2025 huggingface dataset:
Hepatic resection for trauma, tumour and biliary obstruction
Authors: Blumgart L H , Drury J K , Wood C B
Published: March 2007

Hepatic resection was performed in 37 patients. Fifteen emergency procedures were undertaken for blunt trauma and 16 patients had elective resection for hepatic tumour. A further 6 resections were performed for benign biliary tract obstruction. The importance of preoperative assessment and the indications for resection are discussed particularly in relation to resection for biliary obstruction. Operative procedures are outlined and the technique of extended left lobectomy is described in detail.
A new vascularized bone graft transferred by microvascular anastomosis as a free flap
Authors: Sanders Roy , Mayou Bryan J
Published: March 2007

We describe a new, versatile bone and soft tissue compound free flap which may be transferred quickly and simply and describe its use in the treatment of compound fracture of the tibia and fibula with non-union due to loss of bone. The iliac crest and overlying soft tissue is transferred to the leg in one stage by microvascular anastomosis of the deep circumflex iliac vessels to vessels in the leg.
Salmonellosis associated with late rupture of an aortofemoral bypass graft
Authors: Scott A R , Hope D M
Published: March 2007

Salmonella infection is a rare cause of rupture of the atherosclerotic abdominal aneurysm. A case never previously reported is presented in which salmonella infection occurred involving an aortofemoral bypass graft which had been inserted 10 years previously. The infection caused a leak in the region of the graft which presented as a haematoma in the thigh.
Haematemesis in infantile hypertrophic pyloric stenosis: The source of the bleeding
Authors: Spitz Lewis , Batcup Gillian
Published: March 2007

Thirteen infants with haematemesis associated with hypertrophic pyloric stenosis were investigated in order to elucidate the source of bleeding. All 13 patients showed endoscopic evidence of oesophagitis, moderate in 4 and severe in 9. No significant gastric mucosal lesion was found. It was concluded that the site of the haemorrhage was the oesophageal mucosa in all 13 infants. Eleven of the patients experienced troublesome postoperative vomiting.
High bile duct strictures
Authors: Aubrey D A , Chare M J B
Published: March 2007

The diagnosis and surgical treatment of carcinoma of the common hepatic duct present difficult problems. Accurate preoperative localization of the obstructive lesion is essential and slim needle transhepatic percutaneous cholangiography is the investigation of choice. Worth while palliation may be achieved if biliary-enteric flow can be re-established by introducing a plastic stenton through the obstructive lesion in the bile duct. Three patients are reviewed who survive 36, 31 and 26 months after this operation. A further patient died of metastases after 5 months.
A comparative study of methods for the prediction of severity of attacks of acute pancreatitis
Authors: McMahon Michael J , Playforth Michael J , Pickford Ian R
Published: March 2007

Diagnostic peritoneal lavage was carried out in 79 patients with acute pancreatitis, at a mean time of 7 h after admission to hospital. The presence of more than 10 ml of free peritoneal fluid, brown-coloured free fluid or mid-straw-coloured lavage fluid was the criterion used for the prediction of a severe attack by lavage.

Prior to lavage the attack was assessed as mild or severe by the clinician and reassessed by him at 24 and 48 h. All attacks were finally classified as mild or severe by means of a simple clinical grading scheme. There were 61 mild and 18 severe attacks (including 4 deaths).

Initial clinical assessment correctly predicted only 39 per cent of the severe attacks compared with a 72 per cent success rate for diagnostic lavage. All the mild attacks were correctly predicted by clinical assessment but lavage was wrong in 3 out of 61 cases (95 per cent success rate).

By 48 h after admission clinical assessment was comparable to systems using multiple criteria in its predictive value, success rates being 83 per cent and 82 per cent respectively for prediction of severe attacks. We did not find either the presence of methaemalbumin in the serum or the presence of hypocalcaemia to be of additional value.

Diagnostic peritoneal lavage was the most accurate early guide to severity, and correctly predicted all patients who developed shock or died.
Acute caecal volvulus
Authors: Anderson J R , Lee D
Published: March 2007

Forty-one cases of acute caecal volvulus have been analysed. The diagnosis is rarely made on clinical grounds alone but plain radiography of the abdomen should suggest the diagnosis in nearly 90 per cent of cases. Prompt surgery is imperative. When the bowel is viable, simple caecopexy combined with tube caecostomy is effective in fixing and decompressing the bowel in the short term and prevents recurrence.
Severe leg ischaemia caused by anterior resection of the rectum
Authors: Devine T J , Myers K A , Slattery P G
Published: March 2007

A 45-year-old man developed severe leg ischaemia following anterior resection for rectal carcinoma. A previously unrecognized infrarenal aortic occlusion was also present. Division of important collateral arterial pathways during the anterior resection was the cause of ischaemia which contributed to the patient's death. Patients having rectal or colonic resection should be carefully assessed for aortoiliac occlusive disease. Extra-anatomical arterial reconstruction before the bowel resection would avoid this complication.
The management of the open perineal wound using a foam elastomer dressing: A prospective clinical trial
Authors: Macfie John , McMahon Michael J
Published: March 2007

In an attempt to improve the management of the perineal wound after abdominoperineal excision of the rectum we have assessed the value of foam elastomer, a catalysed silicone polymer dressing. This substance has already been used successfully in the treatment of open, granulating wounds at other sites (1).

On the fourteenth postoperative day 50 patients with open perineal wounds were randomized to receive either conventional gauze packing or treatment with a foam elastomer dressing. Patients were received weekly until healing occurred. When no cavity remained, a dry dressing alone was used. Initial wound volume was calculated in all patients by forming a foam dressing the volume of which was measured by displacement of water.

Healing times were shorter in patients who received foam elastomer, but not signficantly so. However, less analgesia (P < 0·01) and fewer district nurse visits (P < 0·001) were required by patients in the foam elastomer group.

This study suggests that foam elastomer dressing is a more comfortable alternative to a gauze pack in the management of the perineal wound and substantially reduces the amount of nursing supervision which is required. We recommend its routine use in the management of the open perineal wound particularly in the young and cooperative patient.
Single and multiple dose cotrimoxazole and metronidazole in colorectal surgery
Authors: Higgins A F , Lewis Adam , Noone Paul , Hole Margaret L
Published: March 2007

Cotrimoxazole and metronidazole were given prophylactically to patients undergoing colorectal surgery as a single peroperative dose or in multiple doses for 5 days. A total of 60 operations randomly divided into two groups showed that the rate of wound infection was low in both groups and there was no statistical difference between them. There were no cases of anastomotic dehiscence in those patients where the anastomosis was carried out from within the abdomen, but 7 out of 9 patients with transsphincteric colo-anal anastomoses developed a suture line dehiscence. A greater degree of post-catheterization urinary tract infection was seen in the single dose group (which lacks statistical significance). There were no toxic effects.
Clindamycin in the treatment of soft tissue infections: A review of 15 019 patients
Authors: Wilson David H
Published: March 2007

A retrospective survey of 15 019 patients treated with clindamycin for a soft tissue infection was carried out to determine whether the incidence of serious side effects was sufficient to preclude the continuing use of this antibiotic. Thirteen patients were found to have had severe diarrhoea and 2 of these required inpatient treatment for pseudomembranous colitis. Certain limitations of the use of clindamycin are suggested but, in view of the recently improved understanding of the nature of pseudomembranous colitis and more effective methods of treatment of this complication, it is concluded that this antibiotic still has a useful role to play in the treatment of acute soft tissue infection.
Alleviation of autotransfusion-induced haematological damage by corticosteroids
Authors: Stillman Richard M , Gottlieb Bruce S , Sawyer Philip N
Published: March 2007

Thrombocytopenia and haemolysis in intraoperative autotransfusion result mainly from extravascular tissue contact and therefore are not correctable by mechanical improvements in the autotransfusion apparatus. Instead, attention must be directed towards prevention of blood ‘recognition’ of extravascular tissue or stabilization of blood components against this damage. Methylprednisolone is shown to be effective in alleviating red cell and platelet damage induced by intraoperative autotransfusion in the canine model.
The use of flexible carbon fibre in the repair of experimental large abdominal incisional hernias
Authors: Johnson-Nurse C , Jenkins D H R
Published: March 2007

Ventral hernia was induced surgically in sheep and either left unrepaired(5 animals), repaired with plastic mesh (20 animals) or with carbon fibre (20 animals). In unrepaired animals the hernia persisted. Three hernias recurred in the group repaired with plastic mesh, 2 as a consequence of sepsis. All the hernias repaired with carbon fibre remained sound over periods varying from 8 months to 2 years. There was a gradual invasion of the carbon fibres by collagenous tissue and thus a transition from one to the other of the stress of maintaining the abdominal wall intact.
Intussusception in infancy and childhood
Authors: Hutchison I F , Olayiwola B , Young D G
Published: March 2007

A total of 209 cases of intussusception treated at the Royal Hospital for Sick Children, Glasgow, in the past decade has been reviewed. The results are compared with similar reports for the two preceding decades from the same hospital. The mortality rate has fallen; there were 5 deaths in this series, 2 of these deaths occurring some months after the presentation with intussusception and death being caused by dissemination of lymphosarcoma. The continuing delay in diagnosis is apparent.
Reversible arteriopathy following an ergotamine overdose in a heavy smoker
Authors: Fielding J W L , Donovan R M , Burrows F G O , Hurlow R A
Published: March 2007

A case of reversible arteriopathy developing in a heavy cigarette smoker taking an overdose of ergotamine is reported. Characteristic radiological changes are illustrated and the aetiology and management of this condition àre discussed.
Influence of orchidopexy for cryptorchidism on subsequent fertility
Authors: Eldrup Jesper , Steven Kenneth
Published: March 2007

The concentration of spermatozoa in ejaculate from testes that had been subjected to orchidopexy during childhood was studied in semen samples taken after unilateral wasectomy of the contralateral normal testis in 4 patients. The counts were extremely low, which suggests that this operation does not improve fertility later in life. Sperm concentration is not influenced by unilateral vasectomy or by inguinal herniotomy during childhood.
Popliteal aneurysm: Sinister harbinger of sudden catastrophe
Authors: Guvendik L , Bloor K , Charlesworth D
Published: March 2007

A series of twenty-eigth aneurysms of the popliteal artery is reviewed. The cases were collected from the records of two large hospitals each with a unit with a special interest in vascular surgery.

They are uncommon–-only 1 popliteal aneurysm to every 17 aneurysms of the abdominal aorta–-but onethird of our patients had both types of aneurysm present. The majority of patients had symptoms and 7 lost a leg as a direct result of thrombosis or rupture. The results of treatment were best when saphenous vein was used to replace an uncomplicated aneurysm and, since the behaviour of aneurysms is unpredictable, we conclude that this is the treatment of choice.
The influence of heparin on intravenous infusions: A prospective study
Authors: Tanner William A , Delaney Peter V , Hennessy Thomas P
Published: March 2007

In a prospective study of 108 intravenous infusions a significant decrease was noted in the incidence of both cannula-related sepsis and cannula-related phlebitis in those patients on low dose (1000 units/1000 ml infusate) heparin given intravenously. A signficant decrease in the incidence of cannula-related phlebitis was also noted in patients receiving subcutaneous low dose heparin (5000 units 8-hourly). This significant decrease may be due to inhibition of fibrin clot formation around the tip of the indwelling intravenous cannula.
Impairment of skin graft take after CO2 laser surgery in melanoma patients
Authors: Lejeune F J , Van Hoof G , Gerard A
Published: March 2007

Twenty-four patients presenting with primary malignant melanoma of the skin (stage 1) were submitted to wide excision of the tumour, followed by immediate split-skin grafting. In 12 patients a CO2 laser was used to excise the melanoma and only 1 of these patients had a 100 per cent skin graft take, while 9 out of 12 patients whose melanoma was excised with a conventional scalpel had a 100 per cent take. It is concluded that skin excision with the CO2 laser impairs subsequent skin graft take.
Incisional hernia repair: A mechanical approach
Authors: Jenkins T P N
Published: March 2007

Fifty incisional hernias were managed by excision of all scar tissue and approximation of the abdominal wall using continuous doubled nylon inserted with a generous suture length: wound length ratio. There were no major recurrences and only 4 minor ones. The method is theoretically sound and should be more widely used.
Irradiation injury to large arteries
Authors: Butler M J , Lane R H S , Webster J H H
Published: March 2007

Four cases of irradiation injury to large arteries are presented and the literature is reviewed. Three patterns of injury have emerged. Intimal damage resulting in mural thrombosis presenting within 5 years of irradiation.Fibrotic occlusion presenting within 10 years of injury.A predisposition to the development of atheroma together with periarterial fibrosis associated with a latent interval of 20 or more years.

The treatment of choice is a bypass procedure of the arterial lesion.
The effect of naftidrofuryl (Praxilene) on intermittent claudication
Authors: Waters Kenneth J , Craxford Alan D , Chamberlain John
Published: March 2007

In a randomized double-blind controlled trial the effect of naftidrofuryl (Praxilene) 200 mg t.d.s., taken for 6 months, was compared with placebo in intermittent claudication. Whilst there was a significant subjective improvement regardless of age or treatment, patients over 60 on naftidrofuryl experienced a more rapid symptomatic relief than other patients. At six months this age group showed a significant improvement over the placebo group. There was no significant objective evidence of improvement.
Thyroid morphology and function after subtotal resection for hyperthyroidism
Authors: Lundström B , Norrby K
Published: March 2007

Two main patterns of hyperplasia of the thyroid epithelium are seen in hyperthyroidism–toxic diffuse hyperplasia and toxic nodular hyperplasia. Toxic diffuse hyperplasia may affect the entire gland or it may arise in the extranodular tissue in a gland with nodular lesions. A series of patients treated by subtotal thyroidectomy for hyperthyroidism were classified into three morphological groups of goitre: 98 had a toxic diffuse goitre (TDG), 58 toxic nodular goitre with diffuse hyperplasia (TNGDH), and 105 toxic nodular goitre with nodular hyperplasia (TNGNH). The type of goitre was correlated to the development of disturbed thyroid function 1–6 years after surgery. Twenty-two patients with TDG and 18 (31 per cent) with TNGDH developed hypothyroidism; only 3 (3 per cent) with TNGNH showed hypofunction. Six patients with recurrent hyperthyroidism were found; all showed diffuse hyperplasia of the gland.

It is concluded that the development of disturbed thyroid function after surgery is closely related to the histopathological type of goitre.
Oesophageal squamous cell carcinoma: I. A critical review of surgery
Authors: Earlam Richard , Cunha-Melo J R
Published: March 2007

Authors writing on oesophageal cancer include adenocarcinoma to a variable extent–between 1 and 75 per cent–but the true incidence of this histological type is about 1 per cent. Most adenocarcinomas are gastric in origin, involving the lower oesophagus, have a lower operative mortality than in the middle or upper one-third of the oesophagus and poorer prognosis than squamous cell carcinoma, but there is no alternative treatment to surgery. Squamous cell carcinoma of the oesophagus, separated incompletely but as far as possible, has been analysed by reviewing data on 83 783 patients in 122 papers. After trying to standardize the data, it appears that of 100 patients with the condition, 58 will be explored and 39 have the tumour resected, of whom 13 will die in hospital. Of the 26 patients leaving hospital with the tumour excised, 18 will survive for 1 year, 9 for 2 years and 4 for 5 years. Oesophageal resection for squamous cell carcinoma has the highest operative mortality of any routinely performed surgical procedure today.
Presentation of cancer to hospital as ‘acute abdominal pain’
Authors: De Dombal Francis T , Matharu Santokh S , Staniland John R , Wilson David H , Macadam William A F , Gunn Alexander A , Allan Walter R , Bjerregaard Beth
Published: March 2007

In a survey of 5675 patients presenting to five hospitals in England, Scotland and Denmark with acute undiagnosed abdominal pain, 106 patients later proved to have intraabdominal cancer. The risk of cancer was age-dependent: amongst patients over 50 years with ‘non-specific’ pain the risk of cancer was 10 per cent. The commonest primary cancer site (in 57 cases, 53·8 per cent) was the large bowel. Most cancers neither perforated nor obstructed: 73 patients merely presented with a short history of unexplained abdominal pain.

Of those patients with cancer presenting with ‘unexplained’ pain, haaf (37/73, 50·7 per cent) left hospital without a diagnosis of cancer having been made. Subsequently, a computer-aided system was constructed to discriminate (in patients over the age of 50) between those with unexplained acute abdominal pain who did and did not have cancer. Overall accuracy was 84.7 per cent in 138 cases. The most helpful clinical features in making this discrimination are listed.

It is suggested (a) that cancer is now a relatively common cause of acute abdominal pain, (b) that the diagnosis is frequently difficult and (c) that urgent screening of all patients over 50 with non-specific acute abdominal pain may be warranted.
Celestin tube disruption
Authors: MacGowan K M
Published: March 2007

Two cases of disruption of a Celestin tube with distal displacement are described. In each case the tube was removed and the method of treatment is discussed. Regular insertion and retrieval of Celestin tubes using endoscopy is suggested for benign lower oesophageal strictures.
Is pancreatic duct obstruction or stricture a major cause of pain in calcific pancreatitis?
Authors: Bornman P C , Marks I N , Girdwood A H , Clain J E , Narunsky L , Clain D J , Wright J P
Published: March 2007

Forty-seven patients with calcific pancreatitis were submitted to ERCP, 24 of whom were designated ‘painless’ and 23 ‘painful’, according to whether or not pain had occurred during the previous year. The pancreatic duct was cannulated in 39 of these patients. The incidence of pancreatic duct obstruction or stricture was of the same order in the painless (13/20, 65 per cent) and painful (15/19. 79 per cent) groups.

Alcohol was the aetiological factor in 46 patients. Twenty-four (52 per cent) continued to drink, and were equally divided between the painless (12) and painful (12) groups. Four out of 13 in the painless and 7 out of 14 in the painful groups, with a stricture or obstruction, continued. to drink. The difference was statistically not signifcant.

These results suggest that ERCP findings of pancreatic duct obstruction or stricture need not necessarily be pertinent to the pain in patients with chronic pancreatitis.
The clinical significance of invasion of veins by rectal cancer
Authors: Talbot Ian C , Ritchie Sheila , Leighton Monica H , Hughes Anthony O , Bussey H J R , Morson Basil C
Published: March 2007

A histopathological study of 703 surgical specimens from patients with adenocarcinoma of the rectum revealed invasion of veins by primary growth in almost 52 per cent. Follow-up studies on the patients showed that the corrected 5-year survival rate was significantly worse and liver metastases developed more frequently when venous invasion was present. Invasion of extramural veins was particularly significant whereas spread confined to intramural veins was less important. Invasion of large (thickwalled) veins was of greater consequence than invasion of small (thin-walled) veins and spread into thick-walled extramural veins had the greatest adverse influence of all. Venous spread of tumour takes place in parallel with local spread as measured by the Dukes' stage but exerts an influence on prognosis independent of the Dukes' stage. Similarly, vein invasion parallels the number of lymph node metastases but appears to exert an independent influence on prognosis. Observation of venous spread provides a precise assessment of the likely behaviour of rectal carcinoma and supplements, but does not replace indices such as the Dukes' stage or the number of lymph node metastases in routine use. The implications for surgical technique and management are discussed.
Results of surgical staging in Hodgkin's disease
Authors: Gill P G , Souter R G , Morris P G
Published: March 2007

The results of surgical staging in Hodgkin's disease in 107 patients under the care of one surgeon over an 8-year period are presented. The inaccuracy of clinical staging is re-emphasized as 43 per cent of patients had their disease stage altered by surgical staging. Lymphangiography correctly predicted the presence of intra-abdominal disease in only 70 per cent of patients. Spleen size was not an indication of involvement, and furthermore the spleen was involved by disease in the absence of nodal involvement in 6 patients. In 2 cases mesenteric nodes were involved in the absence of pancreatic or coeliac nodal involvement. As a consequence of surgical staging many patients received a more extensive field of radiotherapy, and 18 per cent of patients were treated by combination chemotherapy instead of radiotherapy, There was no hospital mortality and a low operative morbidity following surgical staging. At present surgical staging is an essential part of the overall strategy of management of patients with Hodgkin's disease.
Predictive value of serum complement (C3) in renal allograft rejection
Authors: Kumar Prem , Kodlin Dankward , Marks Charles , Leech Stephen H
Published: March 2007

The purpose of this study was to investigate whether or not changes in serum concentrations of complement component C3 are of value in predicting the long term survival of the transplanted kidney.

C3 was quantitated by radial immunodiffusion in fresh sera drawn immediately before transplantation and twice weekly thereafter from 10 recipients. Fourteen episodes of acute rejection occurred during the first 3 months post-operatively. These were diagnosed by the demonstration of graft tenderness, fever without evidence of infection and a rise in serum creatinine of 1 mg/dl in the absence of urinary or vascular obstruction.

Five rejection episodes in 3 patients were associated with a fall in C3. In one of these patients, C3 returned to normal levels after the episode was reversed, and the kidney is functioning well 2 years after transplantation. In the other 2 patients, C3 remained at low levels regardless of anti-rejection therapy. Transplant nephrectomy was soon required for irreversible rejection. In contrast, only 1 episode unaccompanied by a fall in C3 was irreversible.

Evidence is provided concerning the value of serial C3 complement determinations as a predictor of rejection in renal allografts. Using the variability measure si, the cumulated standard deviation up to week i, si > 10 not only predicts rejection but does so rather early, providing more than 90 per cent of the ideal lead time. This suggests that loss of a graft may be predicted, but this needs confirmation in additional cases.
Palliation and survival in malignant oesophago-respiratory fistula
Authors: Weaver R M , Matthews H R
Published: March 2007

Survival in the presence of malignant oesophagorespiratory fistula is usually limited to a few weeks.

In this paper we describe our experience with 3 cases treated by retrosternal oesophagogastric bypass with oesophageal exclusion, and review the experience of previous authors using this and other forms of bypass.

The results indicate that both survival and quality of life are considerably better with surgical bypass and exclusion than with any other form of treatment. Indeed, the survival times are frequently better than those achieved after palliative resection of oesophageal carcinoma without fistula.

Retrosternal oesophagogastric bypass with oesophageal exclusion is recommended as a simple method of bypass for this condition.
A trial of suction drainage in inguinal hernia repair
Authors: Beacon J , Hoile R W , Ellis Harold
Published: March 2007

A prospective randomized trial was conducted on 301 adult males undergoing inguinal herniorrhaphy to assess the value of postoperative suction drainage. Hernias were classified into ‘complicated’ and ‘simple’. In the ‘complicated’ group suction drainage for 24 h significantly reduced the incidence of wound haematoma, seroma or infection from 48·7 per cent to 17·6 per cent (P < 0·01); there was also a noticeable effect on the postoperative morbidity in the ‘simple’ hernias, although this just failed to achieve significance (4·5 per cent in the suction group compared with 9·8 per cent in the controls). It is concluded that suction drainage should be employed postoperatively following repair of hernias where dissection may be difficult or where other complicating factors are present.
Vascular complications of anterior dislocation of the shoulder
Authors: Drury J K , Scullion J E
Published: March 2007

Vascular complications are rare in cases of simple anterior dislocation of the shoulder but the axillary and its branches may be damaged. Four cases of axillary artery injury, including 2 cases of complete transection of the artery, are presented. Full upper limb function may return if the vascular damage is recognized and prompt surgical treatment undertaken.
Does β-blockade affect surgical performance?. A double blind trial of oxprenolol
Authors: Foster G E , Makin Carol , Evans D F , Hardcastle J D
Published: March 2007

Heart rates of surgeons rise when they carry out operations and this rise is abolished by β-blockade. In an assessment of the effect of oxprenolol on surgical performance a group of surgeons took double blind either oxprenolol 40 mg or a matching placebo. Oxprenolol abolished increases in heart rate (P < 0·001) but had no effect on a profile of performance tests assessing tremor, suturing accuracy and co-ordination. Reaction time of the surgeons was significantly slowed by oxprenolol (P < 0·01). Using a self-administered visual analogue scoring system the surgeons recorded no subjective changes in mood after β-blockade and were surprisingly unaware of whether they had taken oxprenolol or placebo.
The management of acute cholecystitis and its hospital cost
Authors: Fowkes F G R , Gunn A A
Published: March 2007

This retrospective study compares the hospital costs of early and delayed cholecystectomy in the treatment of patients presenting with acute gallbladder disease. Of patients on the waiting list for delayed cholecystectomy, 27 per cent were readmitted as emergencies. The operating time was the same for early and delayed cholecystectomy. The overall average length of stay in the delayed group (16·1 days) was significantly greater (P < 0·001) than in the early group (12·4 days). The main difference in length of stay was due to the initial medical admission in the delayed group. The hospital costs, calculated on the basis of length of stay and hospital attendances, were £156 cheaper (at 1977/78 prices) for early than for delayed cholecystectomy. Although the numbers were too small for valid statistical analysis, surgical outcome as measured by numbers of deaths, complications and readmissions was similar in the two groups. If more early cholecystectomies were performed, costs might be saved and surgical waiting lists reduced.
Cholelithiasis following peptic ulcer surgery: A prospective controlled study
Authors: Anderson J R , Ross A H McLean , Din N A , Small W P
Published: March 2007

An association between gastric surgery and gallstones has been suggested but conflicting conclusions are found in the literature. A prospective study of 118 patients with proved duodenal ulcer disease has been undertaken to determine the true incidence of gallbladder disease. Sixty-one patients undergoing surgery and 57 patients treated medically were matched for age, sex and weight. All patients had oral cholecystography at entry into the study and at 18 months and 109 were reviewed radiologically at 3 years. Three patients in the surgical group developed asymptomatic gallstones whereas none were detected in the medical group. This gives an incidence of gallstones of 4.9 per cent 3 years after gastric surgery. These findings are discussed.
Plasma suppressive activity and kidney graft survival
Authors: Veitch P S , Shenton B K , Proud G , Taylor R M R
Published: March 2007

Over the past few years many centres have shown that blood transfusions given to potential renal transplant patients are beneficial to subsequent graft survival. Results from this centre have shown that an elevated ability of plasma to suppress lymphocyte reaction to antigen is associated with blood transfusions in chronic renal failure patients. In a prospective study, plasma suppressive activity was measured at the time of transplantation in 49 patients who were followed for between 3 and 15 months. Results showed that patients with a low level of plasma suppressive activity were at risk from early graft loss due to acute rejection. Furthermore, most of the suppressive activity was related to the naturally occurring plasma protein, α2-macroglobulin.

This prospective study reports a significant association between low plasma suppressive activity and early kidney graft loss through rejection, and suggests an explanation for the beneficial effects of blood transfusion on graft survival.
Whole body protein turnover, synthesis and breakdown in patients with colorectal carcinoma
Authors: Carmichael Michael J , Clague Malcolm B , Keir Mike J , Johnston Ivan D A
Published: March 2007

As a basis for assessing protein metabolism in cancer patients, whole body protein turnover, synthesis and breakdown were measured preoperatively using a constant rate infusion of L-(1−14C) leucine in patients with differing stages of colorectal carcinoma. The levels of protein synthesis and breakdown were correlated with the extent of disease as measured by the percentage incorporation of the labelled amino acid into plasma protein (1) and the subsequent modified Dukes' classification (2). Eleven apyrexial patients were divided into two groups; 6 of whom had normal appetites while 5 were anorectic. Protein synthesis increased with advancement of disease in both groups, as did protein breakdown. Protein synthesis and breakdown were lower in the anorectic group, suggesting some degree of starvation adaptation. All patients were in positive balance, despite anthropometric data to support loss of host body protein. This suggests translocation of protein stores from muscle to areas of more rapid protein synthesis such as tumour. Remodelling of body protein is an important facet of metabolism in cancer patients.
Possible tests for selection of adjuvant systemic therapy in early cancer of the breast
Authors: Cooke Timothy , George W D , Griffiths K
Published: March 2007

The oestrogen receptor content and the thymidine labelling index have been correlated in a series of primary cancers of the breast. Receptor was assayed in tumours of 409 patients with operable breast cancer. Recurrence rates were significantly higher in patients whose tumours did not contain receptors than in those whose tumours did. Women without axillary node involvement whose tumours lacked oestrogen receptors showed the same high rate of recurrence as all women with axillary involvement. The oestrogen receptor status of metastases was similar to that of the primary tumours. The thymidine labelling of 83 tumours was inversely related to their receptor content. Tumours without receptors had the highest indices and therefore the highest potential tumour growth. These results have been discussed in relation to selection of systemic adjuvant therapy.
Oesophageal resection with pharyngogastrostomy for corrosive stricture of pharynx and oesophagus
Authors: Ti T K
Published: March 2007

A personal experience of 4 patients with combined pharyngeal and oesophageal stricture treated by total oesophagectomy with pharyngogastrostomy is reported. Postoperative recovery was smooth without any instance of anastomotic leakage and swallowing was restored. The major complication was recurrent dysphagia in the first 2 patients because of construction of too narrow an anastomosis, aggravated by postoperative scarring. Recurrent dysphagia did not occur during a 1-year follow-up in the subsequent 2 patients in whom a large pharyngogastrostomy anastomosis was established to the posterior pharyngeal wall. Minor tracheal aspiration occurred but even in the 2 patients with associated laryngeal injury, the symptoms subsided once swallowing was restored. Regurgitation was a problem only in one patient who developed gastric stasis; however, the symptoms subsided after pyloroplasty.

Reconstruction of pharyngo-oesophageal stricture by pharyngogastrostomy restores almost normal swallowing provided that laryngeal function is adequate and a large pharyngogastrostomy anastomosis is established.
The diagnosis of acute gallbladder disease by technetium-99m-labelled HIDA hepatobiliary scanning
Authors: O'Callaghan James D , Verow Peter W , Hopton David , Craven John L
Published: March 2007

A series of 105 patients with upper abdominal pain suggestive of biliary colic who had hepatobiliary scans within 48 h of admission to hospital is presented. Fifty of the 65 patients with abnormal scans had operative treatment and gallbladder pathology was found in every case. Fourteen of these patients had hepatobiliary scans which also showed delayed excretion of tracer into the duodenum, and of these, 12 were found to have common bile duct stones and one a stricture of the distal end of the common bile duct. Of the 40 patients who had normal scans, 7 were found to have gallstones on further investigation.

In these patients abnormal hepatobiliary scans have shown a 100 per cent correlation with gallbladder disease. We suggest that this is the investigation of choice for the surgeon contemplating early cholecystectomy on patients with suspected acute gallbladder disease.
The effect of skin preparation and care on the incidence of superficial thrombophlebitis
Authors: Smallman Lesley , Burdon D W , Alexander-Williams J
Published: March 2007

Fifty patients having a variety of intra-abdominal operations necessitating postoperative infusion were randomly allocated to receive antiseptic skin preparation and daily care of the cannula site or no skin preparation either before or after cannula insertion. The study shows that without skin preparation superficial thrombophlebitis is inevitable after about 3 days. However, simple skin preparation and daily care of peripheral infusion sites significantly reduces the incidence of superficial thrombophlebitis.
Veno-venous internal saphenous crossover graft for phlegmasia caerulea dolens
Authors: McNeill A D , Sorour N N
Published: March 2007

Two cases of phlegmasia caerulea dolens treated by early saphenous vein crossover graft are reported. The value of this procedure is discussed.
A nutrient survey in elderly women with femoral neck fractures
Authors: Older M W J , Edwards Delyth , Dickerson J W T
Published: March 2007

This survey was undertaken to study the nutrition of elderly women following surgical treatment for a femoral neck fracture.

The voluntary food intake of 19 patients was measured 3, 7 and 14 days after operation. When the nutrient content was calculated and compared with DHSS recommended values for healthy women of the same age, only the intakes of vitamin A and calcium were adequate. The mean intakes of protein, energy, vitamin D, riboflavin, vitamin C, thiamin and niacin fell short of the recommendation.

The evidence suggests that whilst adequate food intake may be provided in hospital, the actual nutrient intake of elderly female patients recovering from a femoral neck fracture is often inadequate.
Abdominal tuberculosis
Authors: Lambrianides Andreas L , Ackroyd Nigel , Shorey Brian A
Published: March 2007

In Britain abdominal tuberculosis is an uncommon condition and most cases come to laparotomy for diagnosis. A high index of suspicion is required in areas with a large immigrant population and in areas which are overcrowded and nutritionally deprived. Nine of 28 patients presented acutely and a wide variety of preoperative diagnoses were entertained. Most of the remainder had a long history of vague constitutional symptoms and laparotomy was required for diagnosis in all but 5. Histology proved the surest way of establishing the diagnosis.
Possible antagonists to gastrin in parathyroid adenomas
Authors: Mollerup C , Cartensen H E , Bruun E , Christiansen L A , Stage G
Published: March 2007

The high incidence of gastroduodenal ulcers in patients with hyperparathyroidism has been ascribed to gastric hyperacidity induced by hypercalcaemia. In a clinical study comprising 40 patients with solitary parathyroid adenoma, a negative correlation between serum calcium and spontaneous gastric acid secretion was found. At the same time a positive correlation was found between serum calcium and gastrin. It is concluded that gastric hyperacidity is not part of the syndrome provoked by parathyroid adenomas, and that a mechanism inhibitory to gastrin is active in these patients. It is suggested that the inhibitor could be calcitonin.
Renal transplantation—15 years' experience
Authors: Marshall Vernon
Published: March 2007

In Australia, it has been logistically possible, with integrated programmes of dialysis and transplantation, to use finite resources optimally for the treatment of patients presenting with terminal renal failure (30 per million population per year), Transplantation is offered as definitive treatment in most instances. Transplantation rates (20 per million per year) will need to increase to meet the continuing demand, if the results of transplantation remain unchanged.

Patient survival after transplantation is approximately 80 per cent at 1 year, 50 per cent at 5 years and 20 per cent at 15 years. Most grafts are from cadavers. Graft survival of 60 per cent at 1 year thereafter declines steadily with a 3 per cent graft loss per year. Patient and graft survival are adversely affected by increasing age, and the use of cadaver rather than living donors. Graft survival is superior with a 4 antigen match on HLA A and B matching, and is significantly lower in patients receiving no blood transfusions prior to transplantation.

Long term morbidity is significant in two-thirds of patients receiving grafts. Problems include chronic rejection and toxic effects of immunosuppression. The increased tumour risk after transplantation (which in Australia has been mostly skin tumours) is of major concern; 30 per cent of patients by 10 years have developed cancer.
Arterial graft maturation: The duration of thrombotic activity in Dacron aortobifemoral grafts measured by platelet and fibrinogen kinetics
Authors: McCollum C N , Kester R C , Rajah S M , Learoyd P , Pepper M
Published: March 2007

Dacron is thrombogenic, hence small arterial grafts of this material frequently thrombose in the period prior to graft maturation. Anti-thrombotic therapy may therefore be indicated to preserve patency during this risk period. To evaluate the thrombogenicity of immature Dacron grafts, platelet and fibrinogen kinetics using 51Cr and 125I respectively were measured before operation and at 3, 6 and 9 months in 10 patients following aortobifemoral bypass and in 6 age-matched volunteers.

Platelet survival was reduced from 8.8±0.2 d before surgery to 7.4±0.24 d at 3 months. This was accompanied by an increase in platelet turnover from 39±2.4 × 109 l−1 d−1 to 46.9±2.9 × 109 l−1 d−1. Fibrinogen t1/2 fell from 3.72±0.13 d preoperatively to 3.36±0.11 d at 3 months, while fibrinogen fractional catabolic rate rose from 0.27±0.014 to 0.34±0.014. These changes were all significant (P < 0.01). Fibrinogen consumption had returned to normal by 6 months following surgery but platelet kinetics only equated to pre-operative levels at 9 months. We suggest that Dacron grafts are thrombogenically active for about 9 months. When anti-thrombotic therapy is indicated it should be continued throughout this period.
Leucomethylene blue staining during vagotomy
Authors: Wille-Jørgensen Peer , Jensen Hans-Eric
Published: March 2007

Sixty patients were evaluated 10 years after vagotomy for duodenal ulcer. In 31 the stain leucomethylene blue had been used peroperatively to visualize remaining nerve twigs on the distal oesophagus when the surgeon had deemed the vagotomy to be complete and in 29 cases the staining technique was not used.

The frequency of recurrent ulcer was not influenced by the use of the staining technique.

A series of 48 patients who had a parietal cell vagotomy performed for duodenal ulcer was randomized into staining and control groups. There was no significant difference in the reduction of the preoperative peak acid output after pentagastrin stimulation between the two groups. Only 33 per cent of specimens stained contained nerve tissue.

It is concluded that the colouring of the distal oesophagus with leucomethylene blue is of no clinical value in achieving completeness of vagotomy.
A comparison of the Burge and Grassi intraoperative tests for completeness of nerve section in parietal cell vagotomy
Authors: Pendower J E H
Published: March 2007

The Burge and Grassi tests were compared in 22 patients after parietal cell vagotomy. Dissection was continued until the Burge test was negative or until no further nerve fibres could be found. Three Burge-negative patients were Grassi-positive, 2 due to inadequate division of the terminal branches of the nerve of Latarjet at the ‘crow foot’ and 1 due to epiploic fibres. One Burge-positive patient was also Grassi-positive but the latter test indicated the position of an undivided oesophageal nerve fibre. It is concluded that the Grassi intraoperative test for completeness of vagotomy is superior to the Burge procedure because it shows how much stomach needs to be vagotomized to denervate the parietal cells and abolish gastric acid secretion and also indicates the position of residual fibres if vagotomy is incomplete.
The place of hepatobiliary isotope scanning in the diagnosis of gallbladder disease
Authors: Hall Andrew W , Wisbey M L , Hutchinson F , Wood Robert A B , Cuschieri Alfred
Published: March 2007

The present trend towards a more aggressive operative policy in acute cholecystitis has led to a search for more accurate methods of diagnosis. A possible contender in this field is hepatobiliary isotope scanning.

Ninety-nine patients with right-sided upper abdominal pain were studied after the intravenous injection of 99Tcm-pyridoxylideneglutamate. In addition, contrast radiology was performed in 87 of these. Subsequently 23 were shown to have acute cholecystitis, 45 to have other gallbladder disease and 31 to have no evidence of cholecystic pathology.

Isotope scanning was found to be reliable when negative at excluding acute cholecystitis (predictive value 100 per cent) and when positive at confirming gallbladder disease (predictive value 100 per cent). In these respects it compared favourably with contrast radiology (corresponding predictive values 80 per cent and 94 per cent) but was greatly inferior for the exclusion of cholelithiasis.

A practical method of scanning for routine clinical use is outlined and it is suggested that the method may be clinically useful as a first investigation in those patients presenting with acute right-sided upper abdominal pain. It may also be helpful in confirming pathology in a nonfunctioning gallbladder on oral cholecystography. When the isotope scan is negative (normal) contrast radiology is still required to exclude cholelithiasis. By a combination of the two techniques the correct diagnosis was arrived at in each of the 99 patients studied, suggesting that the methods may have complementary roles.
Studies with bombesin in the Zollinger—Ellison syndrome
Authors: Basso Nicola , Lezoche Emanuele , Materia Alberto , Jun Edward Passaro , Speranza Vincenzo
Published: March 2007

Preliminary data showed that bombesin stimulated serum gastrin levels in patients with the Zollinger—Ellison syndrome (ZES). In this study, the total immunoreactive gastrin and the different molecular forms of gastrin were measured in 16 patients with ZES (11 with proved pancreatic gastrinoma, 2 with proved duodenal gastrinoma and 3 with uncertain tumour localization) following bombesin infusion and following calcium infusion in 13 patients.

In all patients with gastrinoma (both pancreatic and duodenal) bombesin augmented serum gastrin levels. In patients with pancreatic gastrinoma calcium infusion was a more potent stimulator of gastrin secretion than bombesin. In the 2 patients with duodenal gastrinoma bombesin was more potent than calcium in stimulating serum gastrin levels with a basal/stimulated gastrin level ratio similar to the ratio found in patients with incomplete antrectomy. These data suggest that gastrin-producing cells from duodenal gastrinomas may be more closely related to the normal antral G cells than to the gastrin-producing cells from pancreatic gastrinomas. Furthermore, the comparison between the basal/calcium and the basal/bombesin stimulated gastrin levels may help in differentiating preoperatively patients with pancreatic gastrinoma from patients with retained antral mucosa.

In all the patients studied, bombesin augmented the concentration of all of the gastrin components considered.

These data support the hypothesis that G 34, G 17 and the N-terminal G 17 fragment are all present in gastrinomas.
Viscid faecal masses and acute appendicitis
Authors: McLellan Douglas R
Published: March 2007

The luminal contents of 200 consecutive appendicectomy specimens were examined prospectively to see if there was any association between viscid faecal matter and acute appendicitis. Faecaliths were found in 13·5 per cent of appendices and were associated with acute inflammation. Viscid faecal masses were present in 28·5 per cent of appendices, but were found more frequently in normal appendices. It is concluded that there is no relationship between acute appendicitis and viscid faecal matter in the lumen.