bluuebunny/crossref_metadata_2025 huggingface dataset:
The value of upper gastro-intestinal fibrescopy
Authors: McColl Ian
Published: March 2007

In a series of 330 fibrescopies of the upper gastrointestinal tract the most usefull all-round instrument proved to be a long end-viewing panendoscope. The nature of the radilogical errors revaled by endoscopy indicated that the latter is essential before embarking on surgery for antral gastric ulcers, radiographically negative dyspepsia, and further gastric surgery.
The importance of bile in reflux oesophagitis and the success in its prevention by surgical means
Authors: Gillison E W , Kusakari K , Bombeck C T , Nyhus L M
Published: March 2007

A study was instituted using the Rhesus monkeyan animal which has been found to resemble man both in respect of the anatomy of the gastrooesophageal region and of the secretion of hydrochloric acid from the stomach—as a model.
Surgery for coronary artery disease
Authors: Bouch D C , Julian D J , Kitchin A H , Oliver M F , Wade J D
Published: March 2007

Direct distal aortocoronary vein-grafts have been used in 20 patients suffering form ischaemic heart disease. In 16 patients the indication for surgery was severe angina pectoris failing to respond to medical measures. Seven patients had angina decubitus and were Class IV according to the New York Heart Association classification and 9 patients were in Class III. Two patients had recurrent myocardial infarctions and 2 were in cardiac failure. There were 14 good results, 2 failures, and 4 deaths. Post-mortem studies of the hearts confirmed the accuracy of selective angiography in identifying the sites of major coronary obstruction. Findings at surgery showed that the absence r presence of extensive peripheral disease beyond a block could not be reliably assessed in all cases. Histological studies of the veno-arterial anastomoses suggested that rigid atherosclerotic arterial disease is a cause of graft thrombosis and that endarterectomy is a useful procedure though its longterm value is uncertain.
An assessment of above- and through-knee amputations
Authors: Green P W B , Hawkins B S , Irvine W T , Jamieson C W
Published: March 2007

Above- and through-knee amputations have been performed in 126 patients at St. Mary's Hospital between 1961 and 1970

Whilst there was a higher operative mortality amongst the above-knee amputees, the local complication rate was much higher in the through-knee group. The mortality rate in the two groups following discharge from hospital was high. The through-knee amputation provides a better functional result than the above-knee type but mobility in both groups might be improved by ‘refresher courses’ in walking training.
Heterologous liver perfusion a comparison of the use of livers from four different species
Authors: Hickman R , Parker J R , Saunders S J , Goodwin N E , Terblanche J
Published: March 2007

Isolated perfusion of livers from calves, pigs, and lambs with human blood resulted in thrombocytopenia within 30 minutes of the establishment of the circuit. No rebound of platelet levels was noted during a further 3 1/2 hours of perfusion. The levels of total complement and the heterophile antibody titres dropped during the same time in all the experiments. Levels of lymphocytotoxic and leuco-agglutinating antibodies decreased in blood perfusing lamb and pig livers but these were not measured in the calf-liver perfusions.

In contrast, isolated perfusion of livers from baboons with human blood did not provoke significant thrombocytopenia and the results of perfusion were similar to those noted in homologous perfusions of the pig liver with pig blood. There were no differences in platelt levels using livers from baboons with blood groups either compatible or incompatible with the human blood. Complement levels and heterophile antibody titres did not drop and no lymphocytotoxic or leuco-agglutinating antibodies were detectable in human blood against baboon cells.

Measurement of electrolytes, glucose, aspartate transaminase, plasma haemoglobin, and lactate and ammonia clearance showed no significant difference in perfusions of the baboon liver when compared with perfusion of the pig liver with pig blood.

Based on these results, clinical hepatic assist procedures in this hospital will in future only be performed with livers from baboons. These animals will be kept in isolation for a period of virological study in order to minimize the hazard of virus transmission to the patient of personnel.
Secondary haemorrhage from the arterial anastomosis of renal allografts
Authors: Robson A J , Evans D B , Calne R Y
Published: March 2007

Four cases of massive secondary haemorrhage from the arterial anastomosis of a renal allograft as a result of infection are described.

It is likely that the infections developed in the donors and that careful selection is necessary to prevent this. Immediate allograft nephrectomy is suggested as the treatment of choice. The external iliac artery may be ligated without necessarily embarrassing the circulation to the leg.
Surgical resection of recurrent Crohn's disease
Authors: Grogono J L , Parks A G
Published: March 2007

The outcome of a group of 24 patients having multiple resections for Crohn's disease is presented by means of ‘life charts’. These show that it is uncommon for a second resection to be the start of a downhill course and about half of the patients remain well over long periods of follow-up. Comparison with other series is difficult for various reasons, but where comparison is possible the results are similar, except that few patients in this series have so far come to a third resection.
‘Curative’ surgery in carcinoma of the colon involving duodenum. A report of 6 cases
Authors: Ellis Harold , Morgan M Naunton , Wastell Christopher
Published: March 2007

Six examples of duodenal involvement by colonic cancer are reported. Two had an associated duodenal fistula. Radical surgery was carried out in all 6 cases, 3 of whom remain alive and free from recurrence up to 6 years later.
Oesophageal perforation during abdominal truncal vagotomy for duodenal ulcer
Authors: Price J J , Powis S J A , Morrissey D M
Published: March 2007

A retrospective survey of patients having truncal vagotomy for duodenal ulceration has been carried out. In this series 41 cases of oesophageal perforation occurred; 29 were recognized at the time of operation, 6 were diagnosed postoperatively, and in the remaining 6 the time of diagnosis was not specified. Two of the 29 patients in whom the oesophageal perforation was recognized at the time of operation died, as did 2 of the 6 cases diagnosed postoperatively. An increase of mortality and morbidity occurred in those diagnosed postoperatively. The importance of confirming oesophageal integrity at the conclusion of vagotomy is stressed.
Circumferential oesophageal myotomy
Authors: Davidson James S
Published: March 2007

Circumferential division of the oesophageal muscle combined with hiatal hernia repair has been carried out in 26 patients, 19 of whom had a peptic stricture. The object of the procedure is to achieve slight elongation and relaxation of the oesophagus so as to make reduction of the hernia easier in the presence of slight degrees of oesophageal shortening and to reduce the likelihood of recurrence. The rationale and technique are described and details of illustrative cases are given. The postoperative radiological appearances, which are somewhat unusual, are illustrated. The indications and contra-indications are discussed. It is claimed that while circumferential myotomy is useless in the presence of gross shortening of the oesophagus it is of value in borderline cases where reduction of the hernia can be effected only by exerting slight tension on the oesophagus.
Arteriovenous fistulae for chronic intermittent haemodialysis: A modified surgical technique
Authors: Hashmonai M , Schramek A , Chaimovitz C , Erlik D
Published: March 2007

A side-to-end technique for arteriovenous fistulae of the wrist vessels for use in chronic intermittent haemodialysis with venepuncture is proposed. A series of 14 patients in whom this technique has been used is presented. A survey of the different shunting techniques described in the literature is given and their advantages and disadvantages are discussed. The problem of turbulence due to a sharp angulation of the flow through the anastomosis and the possibility of its causing aneurysmata and thrombosis of the fistulae are considered. This problem and its sequelae, together with the problem of the use of the sole remaining artery of the hand when the other has been either occluded or ligated in previous operations, and the possibility of creating an arteriovenous fistula with a vein distant from the artery, are all overcome by this technique.
Abdominal actinomycosis
Authors: Davies M , Keddie N C
Published: March 2007

A case of sigmoid actinomycosis is described and the cases of abdominal actinomycosis presenting at the Manchester Royal Infirmary over the past 20 years are reviewed. The whole problem of abdominal actinomycosis is discussed, with special reference to the sites of infection and mode of treatment. The relevant literature is reviewed.
Unabsorbable suture material—a rare cause of recurrent stones in the common bile-duct
Authors: Mackie D B , Haynes Stephen , May Roy E
Published: March 2007

Three cases are reported in which unabsorbable suture material used to ligate the cystic duct at chole-cystectomy was subsequently found within the lumen of the extrahepatic bile-ducts. In 2 cases well-formed gall-stones having a central nucleus of either silk or nylon were removed from the common bile-duct. In the third case two braided nylon sutures were found within the stump of the cystic duct. The use of absorbable suture material for ligating the cystic duct is therefore recommended.
Carcinoma of the ampulla of Vater and duodenum
Authors: Blumgart L H , Kennedy A
Published: March 2007

Thirty-one cases of carcinoma of the ampulla of Vater and duodenum have been classified on the basis of pathological criteria.

Two types of tumour were discernible. Nine were polypoid papillary adenocarcinomas occurring at the ampulla of Vater; 19 were adenocarcinomas without a papillary pattern, of which 4 were duodenal tumours and 15 were ampullary. There were 3 ampullary tumours of mixed type. The carcinomas without a papillary structure were more invasive, more often associated with abdominal pain, more frequently misdiagnosed, and were associated with a higher mortality-rate.

The data were insufficient to draw firm conclusions as to the prognosis but the clinical behaviour was related to the pathology of the tumours.

Lesions in the ampullary region were associated with jaundice which was often intermittent. Lesions outside the ampullary area presented early with vomiting of pyloric type but without jaundice.

The importance of a high index of suspicion in dealing with these lesions and the value of barium-meal examinations are emphasized.

It is noted that pancreaticoduodenectomy for ampullary carcinoma has a mortality of less than 25 per cent if performed by an experienced surgeon and can be considerably lower in clinics specializing in this condition.

We suggest that the pathological classification of these tumours used in this paper may form the basis for further investigations into the diagnostic and prognostic problems which these tumours present.

This classification of ampullary tumours is a factor to be considered in assessing the indications for pancreaticoduodenectomy.
Stercoral perforation of the sigmoid colon
Authors: Carter D C , Kirkpatrick J R
Published: March 2007

Stercoral perforation of the sigmoid colon is probably more common than is generally appreciated. The condition should be considered in patients who present with peritonitis, localizing signs in the left iliac fossa, and a history of chronic constipation. Operation after a period of resuscitation offers the only hope of survival and resection of the affected of sigmoid colon with exteriorization appears to be indicated.

Two additional examples of this condition are described and the salient features are reviewed.
Torsion of the isolated fallopian tube
Authors: Monaghan J M
Published: March 2007

Torsion of the isolated Fallopian tube is a relatively rare condition which has been known for over 65 years. The number of cases reported probably exceeds 300. The cases reported here illustrate different presenting signs and causative pathology.
Atherosclerosis and aneurysm formation in a saphenous vein-graft
Authors: De La Rocha Alberto G , Peixoto Ronald S , Baird Ronald J
Published: March 2007

A case in which a saphenous vein by-pass graft inserted 5 years previously developed atherosclerosis and aneurysm formation 3–4 years later is described.
Carcinoma involving the lower alveolus an appraisal of past results and an account of current management
Authors: Lee E Stanley , Wilson J S P
Published: March 2007

Three hundred and fifty-six cases of carcinoma of the buccal mucosa, lower alveolus, and mouth floor treated under a policy of radiotherapy as the method of first choice are reviewed. Alveolar involvement, whether initial or by extension, greatly reduces the chance of radiotherapeutic success, and is more important in this respect than the exact site of origin of the tumour. A decision to switch to a trial of elective surgery in this group of cases with alveolar in involvement was strengthened by major advances in surgical management, especially the evolution of satisfactory techniques of repair. A cardinal point is that tumour excision and closure of the mouth defect can now be accomplished reliably in one stage. The uses of the ‘island’ forehead flap and of Bakamjian's deltopectoral flap are discussed, as well as the methods of providing mandibular support when necessary. The authors' current techniques are described in detail on the basis of 82 consecutive radical procedures. A preliminary survey of the results suggests that surgery in this group may yield better results than radiotherapy.
Starch and intraperitoneal adhesion formation
Authors: Jagelman D G , Ellis H
Published: March 2007

A series of experiments on surgical gloves, an animal model, and human biopsies is reported. These studies demonstrate that contamination of the peritoneal cavity is inevitable when starch-precoated gloves are used, and that small doses of starch contamination may be responsible for human intraperitoneal adhesion formation.

Previous publications are reviewed regarding the harmful effects of starch in humans.
Traumatic rupture of the ileum
Authors: Evans J P
Published: March 2007

Three cases of patients who sustained rupture of the ileum following blunt trauma to the abdomen are reported. The onset of symptoms was delayed for a period which varied between 5 and 12 hours after the injury.

As so many of these patients are either asymptomatic or have minimal symptoms for the first 6 hours after the injury it might be advisable to admit all cases of abdominal injury to hospital for observation.

Laboratory investigations of the haemoglobin, white-blood count, and serum amylase contributed nothing to the early diagnosis of the condition. Plain radiographs of the abdomen show gas under the diaphragm in only 34 per cent of cases of traumatic rupture of the ileum.

Needle aspiration of the abdomen for liberated intestinal contents was not carried out in this series. In other series this procedure was found to be accurate in 90 per cent of cases of traumatic rupture of the small bowel. This is the only investigation which can be regarded as making a useful contribution to the early diagnosis of the condition.

Laparotomy was carried out between 5 and 15 hours after the injury. There was gross contamination of the peritoneal cavity by intestinal contents. This was due in all 3 cases to a single laceration on the antimesenteric border of the bowel. The lacerations were situated at distances varying between 15 and 22.5 cm. from the ileocaecal valve and were between 1.3 and 2.5 cm. in diameter. These were closed using two layers of chromic catgut. The peritoneal cavity was washed out with saline and Noxyflex.

The death of 1 patient in the series occurred 13 hours after the injury and was due to a myocardial infarct. The mortality-rate of 33 per cent for the series is similar to that described in other reports.
Partial hepatectomy using a carbon-dioxide laser
Authors: Hall R R , Beach A D , Hill D W
Published: March 2007

Partial hepatectomy by means of a carbon-dioxide laser has been performed in 13 dogs. The operative technique is described, and its advantages and the absence of morbidity and mortality during the 10 weeks after operation are discussed.
The effect of increased oxygen in acute limb ischaemia
Authors: Stalker C G , McEwan A J , Ledingham I McA
Published: March 2007

Acute hind-limb ischaemia was produced in anaesthetized, ventilated dogs. During ischaemia the femoral venous oxygen tension fell markedly and both oxygen extraction and consumption appeared to increase. Oxygen at 2 ATA produced a relatively small increase in oxygen availability to the ischaemic tissues; femoral venous oxygen tension rose by 20 mm. Hg but oxygen extraction and consumption remained elevated.
The aetiology and prevention of pancreatitis following biliary-tract operations
Authors: Keighley M R B , Graham N G
Published: March 2007

The incidence of pancreatitis complicating biliarytract operations is reported from a prospective survey of 75 patients. This study confirms that pancreatitis is much more frequent after choledochotomy than after cholecystectomy alone. Biochemical pancreatitis was demonstrated in over a third of the patients in whom the duct was explored.

The validity of elevated serum amylase in the diagnosis of this complication is established provided that clinical evidence of pancreatitis is also present. The significance of amylasaemia in the immediate postoperative period in the absence of clinical signs is questioned.

Reflux of duodenal contents into the pancreatic duct may be provoked by operative damage to the sphincter of Oddi. In these patients clinical pancreatitis invariably occurred. The avoidance of sphincterotomy in the prevention of this potentially serious postoperative complication is advised. Since pancreatitis was more common after negative exploration of the common bile-duct the value of operative cholangiography in the avoidance of this complication is discussed.
Adenocarcinoma developing in an ileocystoplasty
Authors: Leedham P W , England H R
Published: March 2007

Multifocal adenocarcinoma and carcinoma-in-situ arising in the suture line of an ileocystoplasty are reported in a 52-year-old woman who presented with haematuria 15 years after bladder reconstruction for tuberculosis. An origin in the ileal mucosa was established by microscopy. There are similarities with a transitional-cell carcinoma in an ileocystoplasty which has recently been recorded. Both cases are related to tumours associated with ureterosigmoidostomy where the site, tumour types, and latent period are similar. Aetiological factors seem to include a long latent period (15 years or more) and possibly the direct action of urine, recurrent infection, and mucosal ulceration. It is concluded that all patients with gastro-intestinal urothelial anastomoses must be followed up indefinitely.
The effect of innervation, denervation, and muscle type on the reunion of skeletal muscle
Authors: Webb P
Published: March 2007

The left plantaris and soleus and the right and left sternohyoid muscles of rats were transected surgically and cross-repaired to form conjoined muscle bellies composed of two innervated muscles, two denervated muscles, and one denervated and one innervated muscle.

Subsequent maceration of the conjoined muscle belly showed that regeneration had taken place by inoculation of the growing tips of the regenerating fibres in the doubly denervated muscle belly and in the innervated-denervated muscle belly but not in the case of the doubly innervated muscle belly.

Muscle type was not found to influence this process.

The significance of these findings is discussed.
The arterial complications of polycythaemia vera
Authors: Barabas A P , Offen D N , Meinhard E A
Published: March 2007

Of 200 patients referred for management of polycythaemia vera, 98 (49 per cent) had presented with vascular complications and 68 (34 per cent) of these involved arteries. Transient but recurrent cerebrovascular accidents and digital artery occlusions were the typical arterial complications. If polycythaemia was not promptly treated there was a risk of perimanent hemiplegia, monocular blindness, and severe ischaemia of the leg.

Embolism may have accounted for some of the arterial complications. A possible source for emboli—a proximal mural thrombus—was demonstrated in all 5 patients who were examined with femoral arteriography and in 2 patients who underwent surgery. In selected cases thrombectomy may be indicated to prevent further embolism.
Mechanical sutures in surgery
Authors: Steichen Felicien M , Ravitch Mark M
Published: March 2007

Following the original introduction of an automatic stapling instrument producing B-form staples by de Petz (1924, 1927), there has been derived from the very important first generation of Soviet stapling instruments a second generation of American stapling instruments characterized by: (1) the use of preloaded, pre-sterilized, and disposable staple cartridges; (2) the adaptability of one instrument to a variety of cartridges for use in a variety of tissues and operative situations; (3) the transfer from the instrument itself to the disposable cartridge of delicate and fragile moving parts simplifying the maintenance and operation of instruments. The instruments have found wide and satisfactory application in numerous areas of thoracic, vascular, gastro-intestinal, and gynaecological surgery.
Further progress with reconstruction of the exstrophied bladder
Authors: Williams D Innes , Keeton James E
Published: March 2007

Two series of primary reconstructions of the classic exstrophied bladder are reviewed and a brief description of the operative procedure is given.

There has been a significant improvement in the results since 1963 and a discussion of the possible reasons is given along with a policy for the future.
Coeliac and hepatic nerve function following selective vagotomy
Authors: McKelvey S T D , Toner D , Connell A M , Kennedy T L
Published: March 2007

In the intact patient insulin hypoglycaemia increases the output of amylase and bile-acids despite the exclusion of acid from the duodenum. This effect is abolished by truncal vagotomy. After selective vagotomy a partial response from the pancreas occurs consistent with preservation of a direct route in the coeliac nerve and the loss of vagally released pancreatic secretagogues. A similar effect in the biliary system could not be demonstrated.
Closed liver injury: An assessment of prognostic factors
Authors: Faris I B , Dudley H A F
Published: March 2007

The records of 65 patients with closed liver injuries were studied in order to determine which of 19 variables might be important in predicting the outcome. The statistical technique of multiple regression analysis was used. The presence of hypotension and of head injury were the most important prognostic factors; on the other hand, the number of associated injuries was not a significant factor. The major problem was the patient with the isolated severe liver injury.
The coagulum pyelolithotomy
Authors: Patel V J
Published: March 2007

Coagulum pyelolithotomy is mainly indicated in cases of multiple stones, soft and crumbly stone or stones, small, mobile caliceal stones, and as an aid to fixing caliceal stone or stones in the calix prior to partial resection of the kidney or nephrolithotomy. Its main advantages are:— Trauma to the kidney is minimized.All the free stones in the pelvicaliceal system may be removed, thus reducing the incidence of so-called ‘recurrent’ stones.Fragmentation of the stone during removal is avoided.Surgical mobilization of the kidney is not necessary since it is sufficient to expose the pelvis.

A method of coagulum pyelolithotomy is described in detail and discussed. The operation has been performed in 22 cases with good results. Two cases are described in detail. It is suggested that this method could be utilized for common bile-duct stones.
Horseshoe kidney and abdominal aortic aneurysm
Authors: Symes J M , Eadie D G
Published: March 2007

A case of horseshoe kidney and an abdominal aortic aneurysm is presented. The 32 previously described cases are reviewed and the diagnosis and management are discussed. The major factors influencing the operative approach to an aortic aneurysm associated with a horseshoe kidney concern the site of origin of the renal arteries, their number, and the portion of the kidney which each supplies.
Carcinoma of the prostate. A retrospective analysis of conventional management in 110 cases
Authors: Aubrey D A , Peeling W B
Published: March 2007

This paper reports a retrospective analysis of the results of conventional management of prostatic carcinoma in 110 patients. The 5-year probability survival was 23 per cent. A correct initial diagnosis was made in only 53 per cent of the patients. Indices of prostatic carcinoma as opposed to benign prostatic hypertrophy would appear to be a higher age-group, the occurrence of retention without preceding prostatism, and obstructive uropathy disproportionately severe in relation to symptoms. A normal serum prostatic acid phosphatase does not preclude the diagnosis of carcinoma of the prostate.

Treatment with oestrogenic hormones produced regression of the primary neoplasm in 60 per cent of the patients but rarely affected metastatic lesions. The principal cause of death was not metastatic disease but lower urinary-tract obstruction or operations for its relief.
Regeneration of parietal and visceral peritoneum a light microscopical study
Authors: Raftery A T
Published: March 2007

The healing of visceral and parietal peritoneum has been investigated using conventional light microscopy, Hautchen preparations, and by using 1 μ sections of epoxy-resin-embedded material to follow the activity of peritoneal macrophages labelled with polystyrene spheres (0.79 μ in diameter). Healing has been found to occur rapidly and for the most part without adhesion formation. Parietal peritoneum and caecum are covered by a new mesothelial membrane in 8 days, while the liver is covered in 7 days. It has not been possible to support the theory that peritoneal macrophages are transformed into mesothelial cells via fibroblasts. The results obtained in the present investigation suggest that the new mesothelial layer is derived directly from the subperitoneal fibroblast.
Maximal gastric secretion in patients with chronic airway obstruction
Authors: Hassan M A , Hobsley M
Published: March 2007

It has been suggested that patients with chronic obstructive chest disease have greater maximal gastric secretion than normal subjects. This problem was studied in 30 subjects using the histamine infusion test with phenol red as a marker to correct for pyloric loss. Clinical, radiological, and physiological criteria were used to define two groups: (1) 13 subjects with normal chests; (2) 14 subjects with unequivocal chronic airway obstruction.

The two groups did not differ significantly in maximal gastric secretion, and this conclusion was not altered by taking stature into account because stature was statistically comparable in the two groups. However, age was significantly different and correction of the secretory data for the diminution of maximal secretion with age improved the correspondence between the groups.

The failure to take stature and age into account may be responsible for conflicting evidence in the past.
Torsion of a gastric leiomyoma
Authors: Walrond E R , Sahoy R R
Published: March 2007

A patient with an extraluminal gastric leiomyoma, which presented as an emergency because of torsion, is reported. This is thought to be the first report of such an occurrence. The diagnosis was not made preoperatively in spite of intensive investigation.
Tetraplegia in rheumatoid arthritis with complete recovery after surgery
Authors: Polyzoides A J , Pearson J R
Published: March 2007

A patient with tetraplegia caused by subluxation of the lower cervical spine in rheumatoid arthritis is presented. The clinical history, early complication, and delayed diagnosis are described. Compression of the dura mater by rheumatoid granulation tissue and vertebral subluxation are suggested to be responsible for the cord damage. Failure of conservative treatment after a week is a strong indication for surgery. Posterior decompression of the cervical spine and splitting of the dura mater are recommended.
Internal pudendal arteriography after priapism
Authors: Evans I Lynn , Young A E
Published: March 2007

A case of postpriapic impotence which was investigated by internal pudendal arteriography is described and the possible therapeutic application of intra-arterial vasoconstrictors in the management of priapism is considered.
Ureterocele
Authors: Shaw Richard E
Published: March 2007

Ureterocele occurs more frequently in the female than in the male and may present at any age. The ectopic ureterocele must be distinguished from the orthotopic variety. Small ureteroceles are often symptomless, but larger ones may cause loin pain, retention of urine, and external prolapse. There is an increased incidence of duplication in cases of ureterocele. Attention is drawn to the significance of dilatation of the intramural ureter which leads to reflux after incision of a ureterocele.

Small symptomless ureteroceles need no treatment. Although perurethral diathermy incision may be followed by reflux there is a place for this treatment in adults. Large ureteroceles and those presenting in childhood should be treated by open excision employing a reflux-preventing technique.
An evaluation of the strength of the posterior wall of the inguinal canal in women
Authors: Glassow F
Published: March 2007

In the period 1945–71, 124 women with primary direct inguinal hernia were operated upon. During the same period indirect inguinal hernias in women were noted to be thirteen times more common than the direct type. The commonest site of protrusion of the direct hernia was immediately medial to the inferior epigastric artery. In contrast, in a series of 110 women with recurrent inguinal hernia the majority of the hernias were direct and, of these, most were either situated medially in the posterior wall of the inguinal canal or involved the whole posterior wall.
Intraperitoneal noxytiolin as an experimental chemotherapeutic agent
Authors: Desai S , Jamieson C W
Published: March 2007

The effect of intraperitoneal noxytiolin on the growth of Ehrlich's ascites tumour in mice has been studied. A dose of 1 g. per kg. body-weight produced a significant slowing of the growth of ascites tumours. However, systemic administration (subcutaneous) had no significant chemotherapeutic effect in this tumour model.
Torsion of the gall-bladder in the aged
Authors: Bothra R
Published: March 2007

Torsion of the gall-bladder in 2 women in the tenth decade of life is described. The aetiology of the condition is discussed and the importance of keeping the diagnosis in mind in this age-group is stressed.
An epidemiological study of regional enteritis in the gloucester area
Authors: Tresadern J C , Gear M W L , Nicol A
Published: March 2007

An epidemiological study has been made of regional enteritis in the Gloucester area during the period from 1 Jan., 1966, to 31 Dec., 1970. There were 19 cases in an average population of 253,000, giving an average incidence of new cases of 1.5 per 100,000 per year. There was a significant peak of cases in the 15–24 age-group. The incidence in men was slightly higher than in women. There was a family history of ulcerative colitis in 2 cases. There were 3 cases of regional enteritis of the large bowel only, all occurring in women. Extensive large- and small-bowel involvement occurred predominantly in the younger patients.
Management of the thrombosed external and internal arteriovenous shunts
Authors: Hadjiyannakis E J
Published: March 2007

Two methods for salvaging thrombosed internal and external arteriovenous shunts are described. Thrombosed external shunts have been cleared by phlebotomy or arteriotomy, while internal shunts have been reconstructed by end-to-end anastomosis of the artery and vein proximal to the occlusion.
An unusual thyroid gland
Authors: Leatherdale B A
Published: March 2007

A patient is described in whom the only thyroid tissue present was a mass approximately 4 cm. in diameter situated high up in the neck and just lateral to the laryngeal prominence of the thyroid cartilage. Degenerative changes in this ectopic gland were marked. An ectopic gland in such a position has not previously been described in euthyroid adults. The embryological development, functional activity, and pathology of ectopic thyroid glands are discussed.
Metabolism after injury: 2. Effect of a dryish and warm environment on skin temperatures and electrolyte responses
Authors: Cuthbertson D P , Rahimi A G
Published: March 2007

Patients with moderate to severe fractures of the major long bones of the lower limb had generally warmer extremities if nursed in cubicles with a dryish (35–45 per cent relative humidity) and warm (29–30° C.) environment than if maintained at a normal temperature of 20–24° C. The additional heat was applied soon after the period of shock was over and was then provided for a further 10–12 days thereafter. The effect of a higher temperature in reducing the protein catabolic response to injury–which seems mainly to involve an increase in the catabolism of some muscle proteins accompanied by increased urinary excretions of potassium, creatine, and zinc–has already been described (Cuthbertson, Fell, Smith, and Tilstone, 1972). The effects of a warmer atmosphere on oral and skin temperatures over various surfaces are described in the present paper and these effects are compared with those found when extra bed coverings are applied under normal ward environmental conditions (20–22° C.). By the application of such heat the skin temperature of the extremities can be raised several degrees; that of the large toes by as much as 12° C. By the use of extra bed coverings conductive losses can undoubtedly be diminished, particularly at normal temperatures.

Oral, axillary, and frontal and mastoid process temperatures are not apparently influenced by a higher environmental temperature but appear to be mainly related to the degree of traumatic fever.

The advantage of the higher environmental temperature over extra bed coverings is presumed to be mainly in reducing total resting heat production from resting to basal values by providing thermoneutral conditions.

Apart from a significant reduction in the rise in serum potassium around the fifth day after injury and a reduction in the normal increased urinary excretion of potassium previously noted, there were no significant changes in the concentration of other serum electrolytes as a result of the higher environmental temperature, nor were the other characteristic electrolyte patterns of urinary excretion altered by the change in the ambient temperature. There were also no distinctive differences in the pattern of urinary amino-acids at the two temperatures.
An operation for large scrotal hydrocele
Authors: Wilkinson J L
Published: March 2007

A relatively minor operation of partial eversion in which some residual sac is left in situ has been performed in over 500 cases of large tropical hydrocele. The method is applicable to smaller hydroceles, and also provides a method of treating recurrent testicular torsion.
Comparison of single-layer inverting, two-layer inverting, and everting anastomoses in the rabbit colon
Authors: Irvin T T , Edwards J P
Published: March 2007

Inverting methods of suture should be used in colonic anastomosis. A two-layer inverting anastomosis is usually recommended but it has been suggested that a single-layer technique is preferable and safer.

Single-layer inverting, two-layer inverting, and everting anastomoses were compared in the unprepared rabbit colon. Everting anastomoses gave inferior results by comparison with both inverting methods with respect to tensile strength, anastomotic leakage, and histological evidence of healing, but no difference was found between the single-layer and two-layer methods using these criteria and measurement of colonic collagen.

It was concluded that single-layer inverting methods of anastomosis had no particular advantages over the standard two-layer inverting method.
Aetiology of disruption of intestinal anastomoses
Authors: Irvin T T , Goligher J C
Published: March 2007

Various factors have been cited in the aetiology of disruption of intestinal anastomoses but their relative clinical importance is uncertain.

A retrospective study was made of 204 patients treated by resection and standard end-to-end anastomosis of the intestine.

Clinical evidence of anastomotic dehiscence occurred in 14 per cent of cases and the incidence of dehiscence was significantly increased in cases where faecal loading of the bowel obtained and after operations involving low anterior resection of the rectum or surgery for fixed tumours. The presence of a defunctioning colostomy did not remove the threat of anastomotic complications. A significant reduction in preoperative plasma proteins was found in patients who developed anastomotic dehiscence and the incidence of disruption was highest in patients over the age of 60 years.
Assessment of acute blood-loss by determination of change in red-cell volume
Authors: Smith T , Northfield T C
Published: March 2007

A method is described for the quantitative measurement of acute blood-loss from any source by determination of change in the red-cell volume. The accuracy and sensitivity of this method have been assessed in 23 patients admitted to hospital with acute gastro-intestinal bleeding. The method was sufficiently sensitive to detect a change in red-cell volume of 3 per cent. Reproducible results were obtained, duplicate measurements of red-cell volume deviating from the mean by less than 4 per cent. Completely separate daily measurements, in subjects not undergoing further haemorrhage, deviated from the mean by less than 5 per cent.
Traumatic aneurysms of the superficial temporal artery
Authors: Bailey I C , Kiryabwire J W M
Published: March 2007

Six patients with aneurysm of the superficial temporal artery are reported from Africa. The presenting symptom was a pulsating swelling in the temporal region, and blunt trauma to the side of the head was the aetiological agent in every case. Treatment by surgical excision is advocated. It is suggested that aneurysms of the superficial temporal artery occur more frequently than reports in the literature suggest.
Anorectal suppuration: The results of treatment and the factors influencing the recurrence rate
Authors: Buchan R , Grace R H
Published: March 2007

One hundred and eighty-three patients admitted to hospitals in the Cardiff teaching group (1961–5) with a diagnosis of anorectal abscess were studied; 147 of these patients were traced in 1969. It is shown that when the diagnosis was that of an ischiorectal abscess and that when a ‘deroofing’ procedure was used, the in-patient stay and the time lost from work were increased.

It is also shown that recurrence was related to a previous history of multiple abscesses, but not to the duration of the presenting history or the type of the presenting abscess or the initial drainage procedure employed. However, the detection and laying open of a ‘fistula’ at a second examination under anaesthesia within 2 weeks reduced the incidence of recurrence.

It is suggested that incision and drainage, followed by a second examination under anaesthesia within 2 weeks, should be the treatment of choice, and that there is now no place for saucerization or ‘deroofing’ procedures.
Significance of rectal bleeding in diverticular disease in patients at St. Mark's hospital
Authors: Penfold J C B
Published: March 2007

The site of the rectal bleeding in diverticular disease was sought by examination of the surgical specimen and found in 28 of 49 cases examined. It was related to the diverticular disease in 9 cases and to other pathological conditions in 19 (39 per cent), 16 of which were polyps. Fourteen of the polyps were demonstrated by preoperative barium-enema examination.

Adequate clinical and radiological examination demonstrated these other colonic conditions preoperatively in most of the patients.
Pressure measurements in the cervical portion of the thoracic duct in man
Authors: Kinnaert P
Published: March 2007

Pressures were measured in the cervical portion of the thoracic duct during a surgical procedure performed to drain lymph in 8 male patients. Cyclic variations depending on respiration were observed. Smaller oscillations in pressure were synchronous with the pulse-rate and result from rhythmic compression of the thoracic duct by the aorta in the thorax. In 2 patients the recordings showed superimposed pressure waves which were independent of breathing and the heart-rate and which are thought to be due to spontaneous contractile activity of the duct.
The surgical management of primary hepatocellular carcinoma in Uganda
Authors: Harrison N W , Dhru D , Primack A , Bhana D , Kyalwazi S K
Published: March 2007

Hepatocellular carcinoma is a common tumour in Uganda. Thirty-six of 120 patients with hepatoma admitted during a 2 1/2-year period were submitted to surgery. Major hepatic resections were performed in 10 patients and a further 10 cases had placement of a hepatic artery catheter for regional infusion chemotherapy. In the surgically resected and regionally infused patients survival was improved compared with those receiving either systemic chemotherapy or no treatment. Hepatic resection offers a chance of cure for a small minority of patients with hepatoma, whilst regional chemotherapy via a directly placed arterial catheter at the time of exploratory laparotomy may benefit others and is being further evaluated by a controlled trial.
Haemangiopericytoma of the pre-sacral space
Authors: Hart Stewart , Sisely Lorna
Published: March 2007

A slowly growing tumour in the pre-sacral space is described. On surgical excision this proved to be a haemangiopericytoma which has since recurred locally. The difficulty and necessity of adequate removal are discussed.
The use of the arterial sling tourniquet in surgical practice
Authors: Dunn D C
Published: March 2007

An inflatable sling tourniquet has been developed to control arteries during surgical procedures and has been assessed clinically and experimentally. It has been found to give precise and reliable control over normal and arteriosclerotic arteries and to be extremely atraumatic in practice. It is particularly useful when catheters or shunts are to be passed up the occluded artery.
Diagnostic yield of fibre-optic endoscopy in the operated stomach
Authors: Cotton P B , Rosenberg M T , Axon A T R , Davis M , Pierce J W , Price A B , Stevenson G W , Waldram R
Published: March 2007

Fibre-optic instruments have been used on 212 occasions to examine 177 patients who were symptomatic after peptic ulcer surgery. A diagnosis other than gastritis was reached in 83 patients, including 46 ulcers. Five ulcers were not seen–4 as a result of using inadequate equipment early in the series. Radiology detected only 60 per cent of the ulcers and raised many false-positive diagnoses. Expert review of the radiographs corrected many originally mistaken interpretations. Retained suture materials were seen by endoscopy and removed using biopsy forceps. Gastric mucosal congestion and gastritis were common in the operated stomach, but the clinical significance of these changes remains obscure in the absence of a control series. Fibre-optic endoscopy is now an essential part of the investigation of patients who are symptomatic following ulcer surgery.
Reversed autogenous saphenous vein by-pass from the common to the deep femoral (profunda femoris) artery
Authors: Berguer R , Cotton L T
Published: March 2007

Extended deep femoral angioplasty is an invaluable method of saving a limb especially where a femoro-popliteal vein by-pass is not possible because of a poor run-off. Atherosclerosis in the deep femoral artery often extends for more than 10 cm. In such cases we have preferred to perform a short vein by-pass than an extensive endarterectomy and patch graft. Our experience is described of 6 such cases, in 5 of whom amputation was avoided.
Carcinoid tumours of the colon
Authors: Scott J E
Published: March 2007

Four cases of carcinoid tumour of the colon are presented together with a brief review of the literature.
The management of villous tumours of the large bowel
Authors: Parks A G , Stuart A E
Published: March 2007

Thirty patients with villous tumours of the rectum are described. With the criterion that invasion of the muscularis mucosae is necessary to make a diagnosis of malignant change the incidence of malignancy was 17 per cent. The technique of local excision per anum using submucosal infiltration is described, and the management of large mucosal defects and of total papillomatosis of the rectum is discussed. Local infection and incontinence have not been features in this series and every patient has had a sphincter-conserving operation. The recurrence rate was 10 per cent and recurrences can be treated by further local excision.
Management of uncomplicated diverticular disease by colonic resection in patients at St. Mark's Hospital, 1964-9
Authors: Penfold J C B
Published: March 2007

One-hundred and thirty-nine resections were performed for diverticular disease at St. Mark's Hospital, London, during the period from 1964 to 1969. One hundred and three of the resections were done on selected cases before any of the clinically recognized complications of the disease had occurred. In 46 of the resected specimens no evidence of inflammation could be found despite meticulous examination by the pathologist.

The surgical procedures were accompanied by no mortality, moderate morbidity, and a gratifying relief of symptoms, which are contrary to the generally held belief that surgery for diverticular disease is hazardous.
An evaluation of the fluorescein test and phlebography in the detection of incompetent perforating veins
Authors: Callum K G , Gray L J , Thomas M Lea
Published: March 2007

A study has been made of the accuracy of clinical assessment, the fluorescein test, and phlebography in the localization of incompetent perforating veins using an extensive subfascial exploration as the method of assessing the results. Clinical assessment was found to be 48 per cent accurate, the fluorescein test 39 per cent accurate, and phlebography 69 per cent accurate. Although phlebography is the most useful investigation we do not feel that it can be used to restrict a full surgical exploration of the medial side of the leg. However, it is valuable in drawing attention to the presence of incompetent perforating veins on the lateral aspect of the legs which in this series occurred in I of every 2 patients.
The use of gastrografin in the relief of residual and late bowel obstruction in cystic fibrosis
Authors: McPartlin J F , Dickson J A S , Swain V A J
Published: March 2007

The incidence, pathology, and standard surgical management of meconium ileus are described. In uncomplicated cases an 80 per cent survival rate can be expected. The indications for instillation of Gastrografin into the bowel as an alternative to operation, either as an enema or through an ileostomy, are discussed. Three instances of its successful use to relieve late obstruction are reported. The probable method of action of Gastrografin is suggested, and the precautions to be observed in its use are listed. By avoiding the pulmonary and surgical problems associated with laparotomy the use of Gastrografin should decrease morbidity and mortality.