bluuebunny/crossref_metadata_2025 huggingface dataset:
Early discharge despite postoperative pyrexia after inguinal herniorrhaphy in unselected patients
Authors: Belham G J , Emery R J , Cheslyn-Curtis Sarah , Ralphs D N L
Published: March 2007

Although shown to be suitable for selected patients with subsequent community medical and social support early discharge from hospital after inguinal hernia repair is apparently not well established. The application of such a policy may also be inhibited by postoperative pyrexia even though the cause of this is not evident. We report a series of 103 unselected patients presenting consecutively to an inner London hospital for hernia repair in whom early discharge was proposed in 95 per cent and achieved in 79 per cent irrespective of clinically unaccountable postoperative pyrexia and without special community health provision. This discharge policy placed no additional burden on the community health services and did not affect adversely patients' welfare, satisfaction or time off work.
Intrarectal ultrasound and computed tomography in the pre- and postoperative assessment of patients with rectal cancer
Authors: Romano G , De Rosa P , Vallone G , Rotondo A , Grassi R , Santangelo M L
Published: March 2007

The ability of intrarectal ultrasound to recognize the local extent of disease was investigated in 23 patients with histologically proven adenocarcinoma of the lower two-thirds of the rectum before operation. Two probes, 12cm long, working at a frequency of 3.5 and 7.5 MHz, were used. The results were compared with those of pre-operative computed tomography (CT) and with the pathological report of the resected specimens. Sonography correctly staged 20 of 23 tumours with two false negatives and one false positive, while CT correctly staged 19 of 23 tumours with two false negatives and two false positives. The results of ultrasound were found to be as accurate as those of CT; the low cost and simple use of ultrasound makes it preferable in the pre-operative assessment of the depth of invasion of rectal cancer. In addition, intrarectal ultrasound was routinely performed in 42 patients, operated on for rectal cancer by means of sphincter-saving procedures, at variable intervals in the first 2 years postoperatively. Eight local recurrences were recognized and confirmed by CT. Based on the low cost, reliability and simple use, intrarectal ultrasound is proposed as first examination for local recurrence detection in the follow-up of patients with low anterior resection for rectal cancer.
Carotid body tumour: 30 years experience
Authors: Dickinson P H , Griffin S M , Guy A J , McNeill I F
Published: March 2007

Thirty-two patients with 37 carotid body tumours, seen in the Vascular Unit at the Royal Victoria Infirmary, Newcastle upon Tyne between 1956 and 1985 are reviewed. Twenty-six of the tumours were treated by surgical excision. There were no peri- or postoperative deaths, but one patient developed a permanent hemiplegia following surgery (3.8 per cent); cranial nerve palsy occurred in five patients (19.2 per cent). There were no malignant tumours although in one patient, histology of the resected specimen showed the presence of local lymph node invasion (3.8 per cent). In the 7 patients who did not undergo surgery, 3 have been lost to follow-up; the remainder have not shown any significant increase in the size of the tumour. One patient was treated by radiotherapy. It is concluded that surgical excision is the treatment of choice, though observation may be preferred for the older patient with a symptomless, slow-growing tumour. To help reduce the risk of hemiplegia (the most serious complication of surgery) a meticulous surgical technique is necessary and heparin, intraluminal shunting and facilities for arterial repair and grafting must be at hand.
Small bowel necrosis after aorto-iliac reconstruction
Authors: Bergqvist D , Bowald S , Eriksson I , Lannerstad O , Takolander R
Published: March 2007

Small bowel ischaemia causing necrosis is a rare complication after aorto-iliac reconstructive surgery. During a 14-year-period we have seen 6 cases out of 1343 reconstructions, making a frequency of 0.4 per cent. Diagnosis was difficult, causing a delay until re-exploration. Thrombocytopenia was a constant finding, and should raise suspicion. Pathogenesis was multifactorial. In two of our cases diagnosis was made at autopsy and in four at operation. Two patients survived extensive bowel resection but had a long stormy postoperative course.
Role of catabolic hormones in the hypoketonaemia of injury
Authors: Watters J M , Wilmore D W
Published: March 2007

Adaptation to fasting results in ketosis, protein conservation, and diminished energy requirements. To determine whether the attenuation of these responses following injury is due to an altered hormonal environment, we infused the catabolic hormones cortisol, glucagon, and adrenaline into seven fasting subjects for 72 h. Saline alone was administered during a comparable control period. Hormone infusion achieved blood levels typical of moderate injury and resulted in hypermetabolism, hyperglycaemia, hyperinsulinaemia, and marked suppression of fasting ketosis. The hypoketonaemia could not be accounted for by decreased precursor availability, accelerated ketone utilization or increased urinary excretion. The altered hormonal environment associated with critical illness attenuates fasting ketosis by limiting hepatic ketogenesis.
Selective venous sampling for localization of hyperfunctioning parathyroid glands
Authors: Granberg P-O , Hamberger B , Johansson G , Lindvall N , Luthman Marguerite , Öhman U
Published: March 2007

Selective venous sampling with parathyroid hormone assay was used in 46 patients with primary hyperparathyroidism. All patients had previously been operated on in the neck region. In 80 per cent of the patients the method correctly located the position of the hyperfunctioning gland(s). No complications were observed. The method was found to be of great value when evaluating patients with persistent or recurrent hyperparathyroidism.
Short stay surgery for inguinal hernia: Experience of the Shouldice operation, 1970–1982
Authors: Devlin H B , Gillen P H A , Waxman B P , Macnay R A
Published: March 2007

Between mid 1970 and mid 1982, 696 patients underwent 718 operations for primary inguinal hernias by the Shouldice surgical technique. Follow-up to 31 December 1983 revealed 6 recurrences, 40 patients died during the follow-up period and 37 were lost to the study. Five patients required re-operation for complications of the suture material. Polypropylene was the most efficacious of the suture materials used during the study. Duration of hospital stay and age at operation do not influence the probability of recurrence. The operation gave consistently good results when performed by either a consultant surgeon or a surgeon in training. Using the Shouldice surgical technique the probability of recurrence of the inguinal hernia at 10 years is only 1 per cent.
Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum
Authors: Lazorthes F , Fages P , Chiotasso P , Lemozy J , Bloom E
Published: March 2007

Rectal resection with colo-anal anastomosis was performed in 65 patients with carcinoma of the lower rectum. In 20 a pelvic colonic reservoir was constructed while in 45 a direct anastomosis was carried out. There were no postoperative deaths and morbidity was comparable in the two groups. Functional results were determined by clinical examination and manometry. The frequency of bowel movements was inversely related to the maximum tolerated volume (P < 0.001). During the first year 60 per cent of the patients with a reservoir and 33 per cent of the patients without had one or two stools per day (P < 0.05). After one year, 86 per cent of the patients with a reservoir and 33 per cent of the patients without had one or two bowel movements per day (P < 0.01). The maximum tolerated volume was increased by the reservoir (P < 0.05). The loss of reservoir capacity of the rectum increases frequency of bowel movements in colo-anal anastomosis. The creation of a colonic reservoir improves function by increasing the maximum tolerated volume without any increase in mortality or morbidity.
Role of the splanchnic nerves in endocrine and metabolic response to abdominal surgery
Authors: Shirasaka C , Tsuji H , Asoh T , Takeuchi Y
Published: March 2007

The splanchnic nerves are inevitably stimulated during upper abdominal surgery and this may produce various responses. To assess the role of splanchnic nerve stimulation on the endocrine–metabolic responses to abdominal surgery, intra-operative splanchnic nerve blockade was carried out in 12 patients undergoing elective gastrectomy under general anaesthesia and the results compared with those of patients undergoing gastrectomy under general anaesthesia or epidural analgesia alone. In the splanchnic blockade group, intra-operative increase in plasma cortisol, glucose, FFA (free fatty acids) and urinary adrenaline excretion were significantly less than that of the general anaesthesia group. This inhibitory effect of splanchnic blockade on these endocrine–metabolic responses was almost the same as, but slightly less remarkable than, that of high spinal epidural blockade. Urinary noradrenaline excretion reached the highest level on the first postoperative day in the general anaesthesia group. This noradrenaline response was significantly inhibited in the splanchnic group as well as in the epidural group. These results appeared to indicate that mechanical stimulation to the splanchnic nerve due to operative manipulation is largely responsible for the endocrine–metabolic responses in abdominal surgery. The results also suggested that, in addition to the splanchnic nerve stimulation, conscious pain perception is responsible for catecholamine release.
Delayed perineal wound healing after proctectomy for Crohn's colitis
Authors: Scammell Brigitte E , Keighley M R B
Published: March 2007

The rate of perineal wound healing was assessed in a series of 112 patients undergoing proctectomy for Crohn's colitis. Healing was impaired in patients with a high fistula-in-ano or a rectovaginal fistula pre-operatively, faecal contamination and postoperative perineal sepsis. Early healing (within 12 weeks) occurred in 63 per cent of the patients. Healing was delayed by over one year in 21 patients, and in 10 patients the perineal wounds never healed.
The presentation and management of presacral tumours
Authors: Stewart R J , Humphreys W G , Parks T G
Published: March 2007

Twenty cases of presacral tumours are presented, nine males and eleven females being affected. Malignancy occurred in 50 per cent of adults and was commoner in men than in women. Diagnosis depends on a careful rectal examination. Computerized axial tomography is the single most useful investigation; however, should it not be available, plain X-rays and ultrasonography give considerable information. For lesions < 10 cm in size a local parasacral approach is often feasible but for larger lesions an abdominal approach or combined approach should be considered.
Surgical biopsy for persistent generalized lymphadenopathy
Authors: Rashleigh-Belcher H J C , Carne C A , Weller I V D , Smith A M , Russell R C G
Published: March 2007

Lymph node biopsy was performed in 39 homosexual men with unexplained persistent generalized lymphadenopathy (PGL). Thirtyseven (95 per cent) of these patients had antibodies to human Tlymphotropic virus type III (HTLV-III), at the time of biopsy. Histology in all but one showed only follicular hyperplasia, the exception showed caseating granulomata typical of tuberculosis. Clinical differentiation between lymphadenopathy associated with HTLV-III and other causes of generalized lymphadenopathy is difficult; however, the presence of antibodies to HTLV-III probably identifies patients in whom surgical biopsy will only occasionally reveal a specific histological diagnosis. It is suggested that the presence of antibodies to HTLV-III in patients with PGLjustifies a more selective approach to lymph node biopsy.
Compliance changes in in-situ femoropopliteal bypass vein grafts
Authors: Beard J D , Fairgrieve J
Published: March 2007

Changes in wall structure, including neo-intimal proliferation and medial fibrosis, have been implicated as a cause of late occlusion in reversed femoropopliteal vein grafts. These changes can be measured indirectly as a fall in compliance. It has been suggested that long-term patency might be improved by the in situ technique because the nutrient vasa vasorum are left intact and therefore wall structure preserved. We have measured the compliance of 62 in situ vein grafts, with times after operation ranging from 2 days to 6 years, and also compared the compliance changes, in the first 3 months after operation, of 15 undisturbed in situ vein grafts with 15 fully mobilized in situ vein grafts. Compliance was derived non-invasively from the pulse wave velocity using Doppler ultrasound. There was a significant fall in compliance after operation (P < 0·001) and no difference could be found between the undisturbed and mobilized in situ vein grafts (P > 0·1). Histological examination of 6 grafts suggested that the fall in compliance was due to neo-intimal proliferation which still occurred although medialfibrosis was reduced. Any potential improvement in longterm patency rates using the in situ technique must be due to other factors.
Intra-operative fibreoptic enteroscopy for bleeding lesions in the small intestine
Authors: Lau W Y , Fan S T , Chu K W , Yip W C , Poon G P , Wong K K
Published: March 2007

Twenty-five patients with gastrointestinal bleeding proved to have lesions in the small intestine. Intra-operative fibreoptic enteroscopy was performed on seven patients, in six patients through the anus and in one patient through an enterotomy and the anus. The indications for fibreoptic enteroscopy were inability to find the lesions in the 3 patients, multiple small lesions in 3 patients and to rule out suspicious pathology in the jejunum shown on a small bowel enema in a patient with ieal ulcers. In all instances, the fibreoptic enteroscopy was useful in localizing lesions, in detecting additional lesions and in ruling out the suspicious lesions. It can be performed easily and is safe. No complication developed from its use in this series.
Chemical composition of common bile duct stones
Authors: Whiting M J , McK. Watts J
Published: March 2007

The common bile duct stones obtained from 148 patients were analysed chemically for cholesterol, calcium and bilirubin. When stones were present in both the common bile duct and gallbladder at the time of surgery, the common duct stones were similar in chemical composition to gallbladder stones in the majority of cases and were predominantly cholesterol-type stones. However, common bile duct stones from patients whose gallbladders had been removed at least one year before the detection of common duct stones contained less cholesterol and more bilirubin than common bile duct stones which were associated with gallbladder stones. Thirty per cent of these stones contained suture material in the centre of the stone. Overall, the results indicate that common bile duct stones are more likely to be pigment type than gallbladder stones, especially if the common duct stones are large, have formed in the duct and become symptomatic less than 12 years after cholecystectomy. Non-absorbable suture material should be avoided in surgery involving the common bile duct.
Experimental colorectal cancer: The relationship of diet and faecal bile acid concentration to tumour induction
Authors: Galloway D J , Owen R W , Jarrett Freda , Boyle P , Hill M J , George W D
Published: March 2007

Epidemiological studies have consistently suggested an aetiological relationship between certain dietary constituents, faecal bile acid (FBA) concentration and colorectal cancer. This study was designed to examine the effect of the dietary manipulation of fat and fibre on tumour induction and on various faecal characteristics in Albino Swiss rats. A total of 232 animals were maintained on one of four different diets for 4, 20 and 28 weeks respectively. The diets were classified as high fat high fibre, low fat high fibre, high fat low fibre and low fat low fibre. The groups were further sub-divided according to the administration of systemic azoxymethane (10 mg/kg per week) or saline over 12 consecutive weeks. The high fat low fibre diet was associated with the highest risk for tumour production and the low fat high fibre diet with the lowest risk. Statistically significant differences between all the diets were noted with the exception of a comparison between the high fat high fibre and low fat high fibre diets. The highest total concentration of free FBA was found in the faeces from animals fed low fibre containing diets. The results show a clear influence of both fat and fibre on tumour induction while, in this model, fibre was the principle determinant of faecal bile acid concentration.
The association of impaired neutrophil chemotaxis with postoperative surgical sepsis
Authors: Duignan J P , Collinst P B , Johnson A H , Bouchier-Hayes D
Published: March 2007

Postoperative sepsis remains a major problem in current surgical practice. This study assesses the predictive role of neutrophil chemotaxis in the development of sepsis in surgical patients. Neutrophil chemotaxis was measured in 30 cancer patients undergoing gastrointestinal surgery and in 26 healthy age and sex-matched controls. Neutrophil chemotaxis was significantly reduced (P < 0·02) in the patients (mean 79·2 μm ± 2·7 s.e.m.) compared with the controls (mean 86·8 μm ± 1·9 s.e.m.). In the entire patient group neutrophil chemotaxis did not change to any appreciable extent following surgery. However, in the seven patients who developed postoperative septic complications, chemotaxis, which was similar to control levels in the pre-operative stage, declined significantly following surgery. Pre-operative values for the septic group of patients are 92·4 μm ± 4·02 s.e.m. These declined to 73·4 μm ± 3·15 s.e.m. (P < 0·05) and to 68·2 μm ± 2·89 s.e.m. (P < 0·05), 5–8 days (early) and 10–14 days (late) postoperatively respectively. Neutrophil chemotaxis in the non-septic group of patients did not alter over this same period. The data suggest that the onset of postoperative sepsis in patients is accompanied by impairment of chemotactic properties in their neutrophils. However, it is also evident that measurement of this variable in patients before operation does not help to define an ‘at risk’ group for the development of postoperative sepsis.
Prognostic factors in breast cancer and the development of a prognostic index
Authors: Bryan R M , Mercer R J , Bennett R C , Rennie G C
Published: March 2007

A number of different factors are known to be correlated with survival of patients with breast cancer. Among these are lymph node status, tumour size, oestrogen receptor (ER), progesterone receptor (PR) and androgen receptor (AR) status. The purpose of this study was to investigate the relative significance of these factors and use this information to construct a prognostic index capable of predicting survival. These factors together with age and menopausal status were studied and correlated with prognosis in 796 women with primary breast cancer. The data were analysed in a stepwise manner by the Cox proportional hazards regression technique. Statistically, >3 nodes involved gave the worst prognosis (P <0·001). This was followed by ER if <10 fmol/mg cytosol protein (P < 0·001), PR if < 10 fmol (P < 0·01), > 0 lymph nodes involved (P <0·01) and the number of years over age 65 (P <0·01). When these factors were accounted for, tumour size, menopausal status and AR did not significantly improve prediction of survival. The significant factors were incorporated into a prognostic index: I = N + E + P + A, where N = 0 if no nodes involved, 13 if 1–3 nodes involved and 31 if > 3 nodes involved, E = 15 if ER <10 fmol, P = 12·5 if PR <10 fmol and A = number of years over 65. Using this index five year survival curves were constructed corresponding to groups of patients with widely differing prognoses. Predicted five year survival ranged from 96 to 12 per cent.
Increased activities of thymidine kinase isozymes in human mammary tumours
Authors: Sakamoto S , Iwama T , Ebuchi M , Tsukada K , Sagara T , Kawasaki T , Murakami S , Kasahara N , Kudo H , Okamoto R
Published: March 2007

Thymidine kinase, the enzyme in the pyrimidine salvage pathway, and its isozymes were examined in 10 specimens of normal mammary gland, 10 fibroadenomas and 11 adenocarcinomas in human breasts. The average thymidine kinase activities in fibroadenomas and adenocarcinomas were about 3 and 8 times that in normal mammary gland. The mammary thymidine kinase isozymes were separated into two types by diethylaminoethyl (DEAE) cellulose column chromatography. The activity of the thymidine kinase isozyme eluted with 0·1 m sodium chloride in buffer was twofold higher in fibroadenomas and fourfold higher in adenocarcinomas than that in normal tissue. In adenocarcinomas, but not fibroadenomas, the activity of the other isozyme eluted with buffer alone was increased to 22-fold that in normal tissues. As the activity of the latter isozyme was not affected by deoxycytidine triphosphate, it may be involved closely in DNA replication.
Multifactorial study of prognostic factors in differentiated thyroid carcinoma and a re-evaluation of the importance of age
Authors: Bacourt F , Asselain B , Savoie J C , D'Hubert E , Massin J P , Doucet G , Leger A , Garnier H
Published: March 2007

A multivariate analysis of prognostic factors has been carried out with 375 cases of differentiated thyroid cancer (DTC) treated in the same centre by total thyroidectomy and 131I therapy. The patients have been followed for 5 to 23 years. The isolated prognostic roles of age, sex, clinical stage and histology were confirmed, but these factors were found to be strongly interrelated. Multifactorial analysis was conducted following Cox's model. It demonstrated that the prevalent role of clinical staging (nodular versus labar or massive form) is as important as the initial presence of metastases (P = 0·0001). Histological assessment of differentiation, age and sex were of lesser importance. Thus, the most significant prognostic variable is clinical stage. These data must be taken into account when formulating management protocols for DTC.
Familial medullary thyroid carcinoma without associated endocrinopathies: A distinct clinical entity
Authors: Farndon J R , Leightt G S , Dilley W G , Baylin S B , Smallridge R C , Harrison T S , Wells S A
Published: March 2007

In an evaluation of 213 patients from 15 kindreds with familial medullary thyroid carcinoma (MTC), we detected 41 subjects from two kindreds (L and O) who had MTC but no extra-thyroidal manifestations (hyperparathyroidism, phaeochromocytomas or mucosal neuromas) of multiple endocrine neoplasia (MEN) type 11a or 11b. In screening 178 members of the L and O kindreds, we found no evidence that any of them had died from MTC. To assess whether the malignancy was relatively indolent in these families, 20 selected subjects from the two kindreds were compared with 33 MEN IIa subjects. Both groups had clinically occult disease which was diagnosed biochemically by documenting elevated plasma calcitonin (CT) levels following stimulation with intravenous calcium and pentagastrin. There were no differences in the peak stimulated plasma CT levels at the time of diagnosis (1055 ± 236 pg/ml versus 1096 ± 191 pg/ml) or the incidence of regional lymph node metastases (0/20 versus 1/33) in the two groups. The mean age at diagnosis, however, was significantly higher in patients of the L and O kindreds than in patients with MEN 11a (43·1 ± 3·4 years versus 21·1 ± 2·2 years; P < 0·001) indicating that in the two kindreds the MTC either developed at a later age or grew more slowly. This study demonstrates that MTC may occur in a familial pattern distinct from its presentation as MEN IIa or MEN IIb. In this setting it appears to be the least aggressive form of MTC yet described.
Incidence of bile reflux in gastric ulcer and after partial gastrectomy
Authors: Poxon Valerie , Hogg Barbara , Youngs Denise , Morris D L , Keighley M R B
Published: March 2007

Duodenogastric bile reflux (DGBR) is reported to be increased in patients with gastric ulcer (GU) and following Billroth I partial gastrectomy (BIPG). pH, total bacterial counts, and total and free bile acids were measured in gastric juice aspirated hourly for 24 h in 6 patients with GU, 7 patients with a BIPG performed for GU and in 8 healthy normal controls. Intragastric pH was significantly higher in the BI PG group during the day (P < 0·001) and at night (P < 0·001) compared with normals and the GU group. There were no differences between GUs and normal patients. Bile acid concentrations in the gastric juice were not significantly different between GU and control groups over the 24 h. Median and range values were 0·14 (0·06–0·52) mmol l−1 in GU patients and 0·14 (0·05–0·67) mmol l−1 in the normals. However total bile acid concentrations were significantly greater in the BIPG group (0·23, 0·04–0·84) compared with GU or controls. (P = 0·04, P = 0·02). Our data do not support the role of DGBR in the pathogenesis of GU, but deoxycholic acid was detected in significantly greater amounts in BIPG subjects than controls (χ2 = 12·94, P <0·001) or GU subjects (none detected) and may be important in the pathogenesis of gastric stump cancer.
Metabolic changes in the non-insulin-dependent diabetic undergoing minor surgery: Effect of glucose—insulin—potassium infusion
Authors: Thompson J , Husband D J , Thai A C , Alberti K G M M
Published: March 2007

We have compared the metabolic response to minor surgery in the non-insulin dependent diabetic patient with that in the non-diabetic, using transurethral surgery under general anaesthesia as a model. Pre-operative blood glucose and 3-hydroxybutyrate concentrations were higher in the diabetic patients, but the response to surgery did not differ. The postoperative cortisol response was lower in the diabetic patients. Glucose insulin potassium infusion (GIK) resulted in lower plasma non-esterified fatty acid, and blood 3-hydroxybutyrate and glycerol concentrations, with markedly higher serum insulin levels compared to patients managed with a ‘no insulin’ regimen. Blood glucose however was not significantly different except at 2 h postoperatively. Blood metabolite and serum insulin concentrations in the diabetic patients were closer to those in non-diabetic patients in the group not given insulin, than in those given GIK. Rather than rendering the diabetic patient the same as the non-diabetic, GIK produces a further abnormal state which is probably of little benefit. We conclude that there is no indication for the use of insulin in the well or moderately well-controlled non-insulin dependent diabetic patient undergoing minor surgery, provided that glucose containing fluids are not given.
Stripping the long saphenous vein: Peroperative retrograde saphenography in patients with and without venous ulceration
Authors: Sutton R , Darke S G
Published: March 2007

Peroperative retrograde saphenography was used to study 80 incompetent long saphenous veins (LSV) in 60 patients with primary varicose veins. In 53 limbs presentation was uncomplicated (group A, 40 patients); in 27 limbs there was ulceration (group B, 20 patients). All limbs in group B had a normal deep system as shown pre-operatively by ascending and descending venograpy. Varicose changes were found in 52 (65 per cent) of 80 LSV; the overall mean length of normal vein seen was 16cm. The incompetent LSV appears unlikely to be suitable for arterial replacement. All valves identified on operative saphenography above the knee appeared incompetent. In only 9 LSV of group B were there recognizable valves either above or below the knee, significantly fewer than 34 of group A (P <0·05). This finding suggests that a deficiency of saphenous valves may contribute to the development of venous ulceration. Hunterian perforators of variable size were seen on 70 saphenograms (87 per cent) passing directly from the LSV to the superficial femoral vein. Stripping of the incompetent LSV will disconnect such perforators from an incompetent system and may thus reduce the incidence of both recurrent varicose veins and persistent ulceration.
Radiation-induced soft-tissue sarcoma
Authors: Davidson T , Westbury G , Harmer C L
Published: March 2007

Twenty patients with soft-tissue sarcomas arising within previously irradiated fields have been analysed. The initial radiation dose ranged from 8·8 to 70 Gy, comprising either orthovoltage or megavoltage treatment. The latent interval following radiotherapy ranged from 7 to 45 years (mean 16·8 years). The commonest histological subtype was malignant fibrous histiocytoma. Four patients required forequarter amputation. The 5-year survival was only 14 per cent. The high morbidity and mortality accompanying post-radiation sarcomas must be borne in mind when the choice between therapeutic options for potentially curable cancers is finely balanced.
Intragastric bile acids and histological changes in gastric mucosa
Authors: Houghton P W J , Mortensen N J McC , Thomas W E G , Cooper M J , Morgan A P , Burton Patricia
Published: March 2007

Multiple gastric biopsies and gastric juice aspirates were taken in 108 patients undergoing routine or review gastroscopy for a variety of upper gastrointestinal disorders. The gastric juice was measured for free and total bile acids and the biopsies examined for premalignant mucosal changes. Total bile acid levels were significantly higher in patients with atrophic gastritis, intestinal metaplasia and dysplasia but not chronic gastritis. There was no correlation between the severity of the dysplasia and total bile acid levels. Free bile acid levels were significantly higher in patients with atrophic gastritis but not in patients with chronic gastritis, intestinal metaplasia or dysplasia. These results suggest that intragastric bile acids may be implicated in premalignant histological changes of gastric mucosa and thus play a part in gastric carcinogenesis.
The role of pelvic floor denervation in the aetiology of idiopathic faecal incontinence
Authors: Womack N R , Morrison J F B , Williams N S
Published: March 2007

Weakness of the muscles of the pelvic floor and external anal sphincter may in theory be caused by a traction injury to the pelvic nerves incurred as a result of the excessive perineal descent that accompanies straining in the descending perineum syndrome (DPS). To investigate the role of this weakness in the aetiology of idiopathic faecal incontinence (IFI), measurements of perineal position, puborectalis mean fibre density (MFD), anal canal pressures, rectal sensation, capacity, and compliance were made in continent (DPS alone, n = 20) and incontinent (DPS + I, n = 19) patients with DPS, and a group of age and sex matched control subjects (n = 20). Perineal descent on straining was greater in DPS alone than in DPS + I. Puborectalis MFD was raised by similar degree in both DPS groups compared with the control subjects, and external anal sphincter function, assessed as voluntary squeeze pressure, was impaired by similar degree in DPS + I and DPS alone compared with the control subjects. Maximal basal anal canal pressure and rectal compliance were significantly reduced in DPS + I compared with DPS alone and the control subjects. Thus IFI did not result from progression of neurogenic muscle weakness, but occurred when there was also diminished internal anal sphincter tone and reduced rectal compliance.
Use of ERCP to identify the site of traumatic injuries of the main pancreatic duct in children
Authors: Hall R I , Lavelle M I , Venables C W
Published: March 2007

Major pancreatic injuries in children are uncommon but potentially very serious. They usually occur in active young boys following characteristic accidents. Despite this they frequently go unrecognized for prolonged periods. Four patients with delayed recognition of blunt pancreatic trauma are described. The presence of pancreatic injury was identified by hyperamylasaemia in every case. Ultrasound and CT scanning were helpful in identifying pseudocysts but accurate pre-operative diagnosis of main duct disruption required endoscopic retrograde cholangio-pancreatography (ERCP). Surgical treatment involved a full exploration of the lesser sac with drainage of the cyst contents and identification of the site of extravasation. Two patients with proximal duct lacerations were treated by internal drainage into a Roux-en-Y loop with the addition of a distal pancreaticojejunostomy in one case. Two patients with distal lacerations were treated by distal pancreatectomy and oversewing of the remnant. All four patients recovered and were well at follow-up. Early ERCP is the only reliable method of identifying duct injuries which require urgent surgery. It should be considered in all children with blunt pancreatic trauma.
Simple suture with or without proximal gastric vagotomy for perforated duodenal ulcer
Authors: Ceneviva R , Silva O De Castro E , Castelfranchi P L , Módena J L P , Santos R F
Published: March 2007

To assess the results of proximal gastric vagotomy (PGV) in the definitive treatment of perforated duodenal ulcers, a prospective study was carried out comparing PGV in association with omental patch suture (PGV + S) with the simple omental patch suture procedure (S). The PGV + S series consisted of 38 consecutive patients with perforated duodenal ulcer and the S series consisted of 38 survivors of a similar series of 41 consecutive patients. Surgical mortality was zero in the PGV + S series. The patients were followed up for 1 to 7 years. No cases of dumping or diarrhoea were observed. Thirty-three patients in the PGV + S series (87 per cent) were classified as Visick grade I and only two (5 per cent) as Visick grade IV. In contrast, 11 patients (29 per cent) were Visick grade I and 22 (58 per cent) were Visick grade IV in the S series. Recurrent ulcer was detected endoscopically in 58 per cent of the patients who had been treated with simple suture and in only 5 per cent after suture plus PGV. PGV is a safe operation with a negligible morbidity rate and with a significant rate of effective control of ulcer disease. Depending on the general condition of the patient and on the surgeon's skill, it appears preferable to treat not only the acute perforation but also the ulcer disease by PGV.
Clinicopathological features of mucosal carcinoma of the stomach with lymph node metastasis in eleven patients
Authors: Korenaga D , Haraguchi M , Tsujitani S , Okamura T , Tamada R , Sugimachi K
Published: March 2007

Of 568 patients with mucosal carcinoma of the stomach, only 11 (1·9 per cent) had a lymph node metastasis. The clinicopathological findings in these 11 patients are reviewed. Diameters of the lesions were over 2·0 cm. Seven were located in the body of the stomach and four in the antrum. Nine showed depressed lesions comprised of poorly differentiated adenocarcinoma and two were classed as elevated lesions consisting of well and moderately differentiated adenocarcinomas. There were six with accompanying peptic ulcers, all of which revealed depressed lesions with poorly differentiated adenocarcinoma. Metastases to proximal perigastric lymph nodes were found in eight while there were three with involvement of distant lymph nodes. All patients were surgically treated and all are doing well except for one who died of hepatic failure one month after operation. We recommend that the standard operation with lymph node dissection is essential, even in cases of mucosal carcinoma.
Filarial lymphoedema and elephantiasis of lower limb: A review of 44 cases
Authors: Dandapat M C , Mohapatro S K , Mohanty S S
Published: March 2007

Twenty patients with early lymphoedema due to filariasis and twenty-four patients with elephantiasis of the lower limb were subjected to lymph nodovenous shunt (LNVS) and Charles' operation respectively. In 62 per cent of cases subjected to LNVS operation, there was a rapid relief of lymphoedema followed by slow reduction, 24 per cent had slow and gradual reduction and 14 per cent had very slight reduction in volume and circumference. Patients subjected to Charles' operation had immediate volume and circumference reduction and skin graft ‘take’ was 88 per cent. There were no operative and a few minor postoperative complications in both the procedures, infection being most notable in those who had undergone Charles' operation. The hospital stay was 7–10 days in LNVS and 21–36 days in Charles' operation. There was no mortality. The long-term results of the present study in terms of volume and circumference reduction, skin condition and freeness of joint movement were encouraging. It is concluded that, while excisional surgery such as Charles' operation becomes necessary for late states of lymphoedema which have progressed to elephantiasis, nodovenous shunt alone is sufficient to relieve early stages of lymphoedema due to filariasis.
Fine needle aspiration biopsy cytology in the diagnosis of thyroid cancer: Comparative study of 213 operated patients
Authors: Harsoulis P , Leontsinit Maria , Economout A , Gerasimidis T , Smbarounis C
Published: March 2007

Between 1982 and 1984, fine needle aspiration biopsy cytology (ABC) was performed in 1100 patients (aged 14–80, 993 women), with nodular goitre, who had either a solitary cold nodule or dominant hypofunctioning nodule(s) within a multinodular or diffusely enlarged gland. Surgery was performed in 213 patients based on clinical and cytological criteria, and the histology of the surgical specimens was correlated with the cytological findings. ABC specimens were sufficient for cytological diagnosis in 190 patients and were classified as malignant (positive), suspicious or benign. In 37 patients who had a final histological diagnosis of malignancy, cytology was positive or suspicious in 33 and benign in 4. In the remaining 153 patients with benign histology there were 7 positive or suspicious aspirates, and 146 benign. The 37 malignancies included papillary carcinomas in 26 patients (24 positive or suspicious and 2 benign on cytology), Hürthle-cell tumours in 6 (6 positive), follicular carcinoma in 1 (negative), anaplastic carcinoma in 1 (suspicious), medullary carcinoma in 2 (1 positive, 1 negative), and lymphoma in 1 (positive). Our results indicate that the overall sensitivity rate of the ABC method for cancer was 89·2 per cent, the diagnostic specificity 95·4 per cent, the false-positive rate 17·5 per cent and the false negative rate 2·6 per cent. The overall accuracy of the method was 94·2 per cent. It is concluded that papillary and Hürthle-cell carcinomas can be diagnosed accurately with ABC but we recommend that the method be used in conjunction with clinical information and other conventional diagnostic procedures.
The clearance of 125I-labelled fibrin from the subcutaneous tissue of limbs with lipodermatosclerosis
Authors: Leach R D , Browse N L
Published: March 2007

The clearance of radioactive fibrin from the subcutaneous tissues has been measured in the rat and in the limbs of normal subjects, patients with varicose veins, and patients with lipodermatosclerosis. The animal experiments showed that the most effective way of producing a subcutaneous deposit of fibrin was by the simultaneous injection of labelled fibrinogen and thrombin. The clearance of these clots was delayed when fibrinolysis was depressed with ε-aminocaproic acid. Clearance of subcutaneous fibrin in man was significantly slower in the arms of patients with varicose veins and lipodermatosclerosis. Similarly clearance in the legs of patients with lipodermatosclerosis was significantly slower than that of the normal subjects and those with uncomplicated varicose veins. The clearance of fibrin from the legs of patients with lipodermatosclerosis was significantly slower than the clearance from their arms but there was no difference between arm and leg clearance in the normal subjects and those with uncomplicated varicose veins. The patients with lipodermatosclerosis had a significantly longer dilute blood clot lysis time. The inability to clear subcutaneous fibrin may be an aetological factor of lipodermatosclerosis.
Differential effects of sacral anterior root stimulation on anal sphincter and colorectal motility in spinally injured man
Authors: Varma J S , Binnie N , Smith A N , Creasey G H , Edmond P
Published: March 2007

The motility responses of the sigmoid colon, rectum and external anal sphincter to sequential electrical stimulation of the anterior sacral roots (S2, S3 and S4) were studied in five patients with traumatic spinal cord injury. Identical and reproducible results were obtained. S2 stimulation provoked isolated low-pressure colorectal contractions. S3 stimulation initiated high-pressure colorectal motor activity which appeared peristaltic and was enhanced with repetitive stimuli. This response appeared to be frequency-dependent. S4 stimulation increased colonic and rectal tone. External sphincter activity was stimulated in increasing order from S2 to S4. These observations directly elucidate the central control of colorectal motility and may have implications in the treatment of severe constipation following spinal injury.
Decreased interleukin−2 production in patients with gastrointestinal cancer
Authors: Monson J R T , Ramsden Carol , Guillou P J
Published: March 2007

Mitogen-stimulated basal and maximal interleukin-2 production has been measured in 60 control subjects and 45 patients with gastrointestinal cancer (14 localized and 31 advanced). Peripheral blood T cell subsets in these subjects were also measured. In patients with advanced gastrointestinal cancer interleukin-2 production (mean ± s.e.m. units/ml) is impaired when compared with that of control subjects (26·5 ± 7 versus 61·1 ± 9, P < 0·0001) or patients with localized cancer (26·5 ± 7 versus 59·4 ± 13, P < 0·02). This cannot be restored to normal by in vitro irradiation of the lymphocytes, suggesting that the impaired function is not due to IL-2 suppressor cells. Using monoclonal antibodies the percentages of T cell subsets were similar in all groups and we therefore conclude that the reduced production of IL-2 in these patients is due to deficient helper T cell function. These results provide a rational basis for the administration of exogenous IL-2 in the future management of patients with advanced gastrointestinal cancer.
Subtotal versus total gastrectomy for cancer of the lower two-thirds of the stomach: A new approach to an old problem
Authors: Gennari L , Bozzetti F , Bonfanti G , Morabito A , Bufalino Rosaria , Doci R , Andreola S
Published: March 2007

Many surgeons favour total gastrectomy (TG) ‘de principe’ in the treatment of gastric cancer, but final demonstration of its advantage over subtotal gastrectomy (SG) is still lacking. We analysed survival after curative TG or SG within groups of patients stratified according to the main prognostic variables as found in multivariate analysis, i.e., nodal status, degree of invasion of the gastric wall, patient age and sex. Our series consisted of 361 patients treated by curative SG and 41 by curative TG, admitted to the Istituto Nazionale Tumori of Milan between 1965 and 1979. In patients with lymph node involvement survival appeared to be significantly better (P = 0.0005) after SG. However, stratifying for age it was found that the benefit was limited to patients over 60 years old. No significant difference in survival was found in the group without nodal involvement (N —) and invasion of the wall to the serosa or beyond. No statistical comparison was possible in N — groups with invasion confined to mucosa, submucosa or muscularis propria because of the small number of such patients who underwent TG. We conclude that SG still represents the standard reference operation for gastric carcinoma provided that a safe proximal margin of resection is guaranteed.
Clinical and immunological results of segmental splenectomy in schistosomiasis
Authors: Kamel R , Dunn M A , Skelly R R , Kamel I A , Zayed M G , Ramadan M , Cahill R A , el Maharakawy S , Ismail A , Ahmed A
Published: March 2007

We evaluated segmental splenectomy in 51 patients who required splenectomy to relieve the symptoms of schistosomal splenomegaly, and compared their course with that of 44 patients who underwent total splenectomy in an unrandomized study. We describe a minor modification of our initial technique. Patients having segmental splenectomy had a similar postoperative course to those having total splenectomy. Conversion of a segmental to a total splenectomy was required in two cases due to technical faults. No regrowth of the spleen has occurred in up to 4 years of observation. We noted an increased percentage of T lymphocytes with an increased ratio of T helper to T suppressor cells in patients having segmental splenectomy. Our cumulative experience supports adoption and wider evaluation of segmental splenectomy in schistosomiasis.
Synchronous abdominotrans-sphincteric resection of low rectal cancer: New technique for direct colo-anal anastomosis
Authors: Lazorthes F , Fages P , Chiotasso P , Bugat R
Published: March 2007

Sixty-five patients with low rectal cancer 4–9 cm from the anal margin were treated by rectal resection and direct colo-anal anastomosis. The procedure simultaneously combined abdominal dissection with the patient in the lateral position with a trans-sphincteric approach. In 57 cases a temporary defunctioning colostomy was performed. There were no postoperative deaths. Six patients (9 per cent) developed pelvic sepsis or anastomotic leakage. Faecal continence was normal in 46 of 51 patients (91 per cent) who were operated on at least 1 year previously. The remaining 5 complained of occasional minor soiling. No patients require a permanent colostomy for incontinence. Of 29 patients treated for potential cure > 3 years previously, 24 (82 per cent) were alive without recurrence. Local recurrence occurred in four patients (6 per cent). Direct colo-anal anastomosis using a combined abdominotrans-sphincteric approach has produced good functional results without impairing the patient's life expectancy.
Conservative management of breast cancer
Authors: Sarrazin Danièle , Dewar J A , Arriagada R , Benhamou Simone , Benhamou Ellen , Lasser P , Fontaine Franc̨oise , Travagli J P , Spielmann M , le Chevalier T , Contesso Geneviève
Published: March 2007

Between 1970 and 1982, 592 patients with T1 and small T2 breast cancers were treated at the Institut Gustave-Roussy by a combination of conservative surgery and radiotherapy. Mean follow-up was 78 months. The actuarial survival rate at 5 and 10 years was 92 per cent and 80 per cent respectively. There were 36 locoregional relapses of which 26 were within the treated breast. The actuarial relapse rate within the breast was 5 per cent at 5 years. If operable, a relapse within the breast did not significantly affect overall survival. The efficacy of conservative management of small breast tumours is confirmed.