bluuebunny/crossref_metadata_2025 huggingface dataset:
Decreased trypsin and bile acids in ileal fistula drainage during the administration of a chemically defined liquid elemental diet
Authors: Hill G L , Mair W S J , Edwards J P , Goligher J C
Published: March 2007

Ten patients with a well-established ileostomy were studied in a metabolic ward and alterations in ileostomy content of trypsin and bile acids were measured during the ingestion of an elemental diet.

After a 4-day control study the patients were given an elemental diet as the sole nutritional source for a 10-day period. For the last 3 days of the study an additional 2 litres of water were consumed with the elemental diet. The mean daily faecal output for the group during the control period was 578 ± 300 ml, and during administration of the elemental diet the fistula output fell to 418 ± 90 ml (P<0·02) and there was a fall in the concentration of sodium in the ileal fluid (104·7 ± 22 mEq/l to 80·2 ± 25 mEq/l, P < 0·01). For the group as a whole there was a fall in the concentration of trypsin (0·671 ± 0·53 i.u./ml to 0·554 ± 0·56 i.u/ml, P< 0·025) and bile acids (0·911 ± 0·56 mmol/ml to 0662 ± 0·53 mmol/ml, P < 0·005) in the ileal excreta.

Although the concentration of amylase in the ileal fluid rose, the total output was not altered. Oral administration of an additional 2 litres of water did not alter the concentration of trypsin or bile acids in the ileal fluid.

It is concluded that elemental diet ingestion produces changes in ileal fistula output which are of benefit to the patient with an enterocutaneous fistula. Output from the fistula of fluid and electrolyte is less and the corrosive nature of the discharge is reduced.
Assessment of the results of surgery for varicose veins
Authors: McAdam W A F , Horrocks Jane C , de Dombal F T
Published: March 2007

Fifty-six patients undergoing primary surgery for unilateral varicose veins by a standardized Trendelenburg procedure were reviewed postoperatively by a panel of three observers. Agreement between the observers was high in assessing symptomatic response (up to 98 per cent), but only moderate in evaluation of any visual changes in affected legs (60 per cent). Moreover, intra-observer agreement comparing symptomatic response and visual impression was very low (30·4 per cent). It is suggested that inter-series comparisons should be made solely upon the response of specific symptoms to treatment.
An unusual case of growing fracture of the skull in childhood
Authors: Rao B Dayananda
Published: March 2007

A case of growing fracture of the skull with an unusually large traumatic meningocele in a child is presented.
Hip pain as a presenting symptom of acetabular metastasis
Authors: Graham D F
Published: March 2007

Three case histories are presented in which each patient developed pain in the hip which was caused by an acetabular metastasis. Resection of an adenocarcinoma of the colon had been performed previously and in only 1 patient were radiographic changes or abnormal gamma-scan pictures obtained.
Kinin levels in the peripheral venous blood of patients with severe vasomotor dumping before and after revisional surgery
Authors: Cuschieri A , Worthington Karen
Published: March 2007

The kinin activity in peripheral venous blood was estimated before and after jejunal interposition in 17 patients with severe vasomotor dumping. In each case the kinin activity was assayed both under fasting conditions and after the oral administration of a liquid hypertonic glucose meal (100 g). No significant difference in the preoperative fasting kinin values was found between patients who were improved of their symptoms (11 cases) as distinct from those who did not derive any benefit from jejunal interposition (6 cases). However, in patients who obtained relief after revisional surgery, the kinin level after glucose administration (56.15k ± 11.19 nglml) was significantly higher (P<0.01) than the release obtained in patients who were not improved by surgery (3.65 ± 2.33 nglml). Furthermore, the kinin release was reduced to near normal levels on re-challenge with glucose 3 months after jejunal interposition in patients who were cured or improved of their symptoms.
Blunt pancreatic and pancreaticoduodenal trauma
Authors: Heyse-Moore George H
Published: March 2007

Three cases of pancreatic injury and I case of pancreaticoduodenal injury caused by blunt trauma are reported. The literature is reviewed with reference to these cases in respect of incidence, mortality, complications, diagnosis and treatment.
Septic complications of pancreatitis
Authors: Grace Stephen G , State David
Published: March 2007

Over an 11-year period 693 patients with acute pancreatitis and 317 with chronic pancreatitis were seen at the Harbor General Hospital. Review of these cases revealed 9 patients with primary pancreatic lesser sac abscess and 11 with secondary abscess.

The appropriate management for pancreatic abscess, whether primary or secondary, is early recognition and drainage; multiple drainage procedures may be necessary. Broad spectrum antibiotics appear to be helpful and should be used until cultures indicate more appropriate antibiotic therapy.

Successful management involves prolonged hospitalization, but contrary to previous reports the success rate is surprisingly high. Eight out of 9 patients with primary abscess and 8 out of 11 patients with secondary abscess survived.
Transposition of the spleen in rats with portal hypertension
Authors: Bengmark Stig , Borjesson Bengt , Olin Tord
Published: March 2007

Portal hypertension was induced in rats by progressive occlusion of the portal vein or by dimethylnitrosamine (DMNA) cirrhosis. Portasystemic venous connections did not develop in relation to the spleen when this organ was intraperitoneal, but after subcutaneous transposition most of the collaterals were parasplenic and the portal venous pressure fell.
Colitis and diarrhoea: A problem with antibiotic therapy
Authors: Beavis J P , Parsons R L , Salfield Jacqueline
Published: March 2007

During a 19-month study the incidence of diarrhoea and colitis was estimated in 1158 orthopaedic inpatients admitted to the Guy's group of hospitals. The highest incidence of diarrhoea followed the use of lincomycin (22.2 per cent), ampicillin with cloxacillin (17.2 per cent), clindamycin (15.3 per cent) and combined therapy with cloxacillin and tetracycline (12.5 per cent). There were 3 documented cases of colitis; 2 followed lincomycin and 1 clindamycin. The incidence and relationship of antibiotic-related diarrhoea and colitis to possible aetiological factors are discussed. In orthopaedic inpatients, in whom lincomycin and clindamycin are often the antibiotics of choice, their continued use appears to be fully justified by the low incidence of colitis. However, if a patient receiving treatment with either of these antibiotics does develop diarrhoea, the antibiotic should be discontinued immediately, to reduce the risk of' subsequent colitis.
Local hyperalimentation of open wounds
Authors: Viljanto Jouko , Raekallio Jyrki
Published: March 2007

After débridement of necrotized and devitalized tissue in deep burns and large traumatic soft tissue defects, the raw surfaces were covered with separate sheets of viscose cellulose sponge (VCS), each moistened by continuous slow infusion of one of the following solutions: (a) 0 9 per cent NaCI; (b) 10 per cent glucose; (c) Rheomacrodex (dextrane hydrolysate in 0.9 per cent NaCl); (d) 7 per cent Levamin a mixture of essential amino acids and glycin in 5 per cent sorbitol; (e) a combination of two solutions containing amino acids (Le-7402 A) and glucose, electrolytes and vitamins (Le-7402 B). The ceilulose sponges were removed or changed 3–7 days later. Macroscopically, histologically and enzyme histochemically, the most active granulation tissue formation was found under the VCS moistened with amino acid solutions, especially when accompanied by glucose and vitamin supplementation. The results strongly suggest that local cellular hyperalimentation of open raw wound surfaces is possible, permitting a new kind of nutritional support in these patients.
Assessment of wound contamination during surgery: A preliminary report comparing vertical laminar flow and conventional theatre systems
Authors: Sanderson M C , Bentley George
Published: March 2007

As part of an on-going trial comparing wound infection in ‘ultra-clean’ air and conventional theatres, wound contamination is assessed by a simple wash-out technique. The importance of wound contamination in relation to subsequent wound infection is emphasized. The wash-out technique used is simple to perform and minimizes the risk of contamination. The preliminary results confirm that cleaner air does result in less-contaminated wounds.
Complications of Meckel's diverticulum
Authors: Moore T , Johnston A O B
Published: March 2007

This paper reviews the presentation and surgical pathology of 50 Meckel's diverticula encountered in one hospital in a 20-year period. It is concluded that in children with intestinal bleeding or a ‘raspberry tumour’ of the umbilicus a Meckel's diverticulum is usually suspected. In adults with an acute surgical emergency Meckel's diverticulum is unlikely to be considered. However, a Meckel's diverticulum can give rise to surgical problems in many ways and at any age. In particular, the possibility of an attached mesodiverticular band leading to obstruction must be stressed.
Occipital teratoma bearing digits and nails
Authors: Tahilyani N D A , Singh K M
Published: March 2007

A rare case of an occipital teratoma hearing nails and digits is reported in a child.
Pericystogastrostomy: Internal drainage in the treatment of certain hydatid cysts of the liver
Authors: Fagarasanu I
Published: March 2007

The effectiveness and simplicity of drainage of hydatid cysts of the her into the digestive tract are demonstrated. A new technique, pericystogastrostomy, is described.
Bacteriological survey of acute appendicitis in children
Authors: Lari J , Kirk D , Howden R
Published: March 2007

A bacteriological study of 110 emergency appendicectomies is reported. In two-thirds of these the appendix was inflamed or gangrenous, and in 45 cases positive cultures were obtained from swabs taken at operation. Bacteroides were found frequently in these swabs and also in those taken from wound infections. Although this study is too small to draw any definite conclusions, it is felt that bacteroides should be considered an important pathogen in appendicitis and should be taken into account in the few ill patients where antibiotic treatment is contemplated. It was also noted that swabs taken from the surface of the appendix itself were more often positive than those from the peritoneal cavity, and this difference appears to be significant.
Wound infection in a children's hospital
Authors: Doig Caroline M , Wilkinson A W
Published: March 2007

The operation wounds of 20 per cent of the children operated on in one surgical unit of a children's hospital became infected. Infection was commonest in the newly born operated on as emergencies, 50 per cent of whose wounds became infected. No connection was found between infection and nasal carriage of staphylococci. A possible source of injection in the young may be the umbilicus.
Colo-anal sleeve anastomosis in the treatment of diffuse cavernous haemangioma involving the rectum
Authors: Jeffery P J , Hawley P R , Parks A G
Published: March 2007

An operative technique, involving a colo-anal sleeve anastomosis, is described for the treatment of cavernous haemangioma of the rectum. All the patients with this condition treated since 1930 at St Mark's Hospital are reviewed, and the presentation and results of treatment in the last 5 patients who have had a resection and colo-anal sleeve anastomosis are discussed.
Benign oesophageal stricture following oral potassium chloride therapy
Authors: Peters J L
Published: March 2007

A patient is described who developed a benign oesophageal stricture following cardiac surgery. A brief review of the literature is given and the possible dangers of oral potassium chloride therapy in patients with dysphagia are highlighted.
Functional results of different reconstructive procedures after total gastrectomy
Authors: Huguier M , Lancret J M , Bernard P F , Baschet C , Le Henand F
Published: March 2007

In 181 patients six reconstructive procedures were performed after total gastrectomy: Roux-en-Y (95), Henley (42), omega (21), Tomoda (16), Rosanov (4) and neogastrium (3). The functional results 2–4 months after operation were studied and compared by medical observers independently of the surgeons who had selected and performed the reconstructive procedures. Analysis of the functional results, and consideration of the degree to which the functional disorders associated with the various reconstructive procedures lend themselves to treatment, suggest that the Henley reconstructive procedure is the best, with the Roux-en- Y as a good second-best.
Malignant cold thyroid nodules in hyperthyroidism
Authors: Livadas D , Psarras A , Koutras D A
Published: March 2007

In 65 hyperthyroid patients with a cold nodule a carcinoma was found at operation in 14 cases, i.e. a malignancy incidence of 21·5 per cent. In 859 euthyroid cases with a cold thyroid nodule 104 malignant lesions (12·1 per cent) were found. The difference is statistically significant. Surgery in cases with a cold thyroid nodule is strongly indicated if this occurs in a hyperthyroid gland.
Limb and abdominal injuries: Principles of treatment
Authors: Johnston G W , Kennedy T L
Published: March 2007

In the period reviewed, the Royal Victoria Hospital received over 7000 casualties, representing approximately hay of the civil disturbance injuries for the province. Primary resuscitation did not differ from that of road trafic accidents, but the surgical management did. Extensive débridement was essential, followed by delayed primary suture some days later. Two hundred and nine penetrating abdominal wounds were reviewed, and the necessity of exploring the abdomen in all such injuries is emphasized.
Isolation and preservation of islets from the mouse, rat, guinea-pig and human pancreas
Authors: Ferguson J , Allsopp R H , Taylor R M R , Johnston I D A
Published: March 2007

Viable islets of Langerhans have been isolated from the mouse, rat, guinea-pig and human pancreas using a free hand microdissection procedure. Viability has been assessed by light microscopy of sections stained with Gomori's aldehyde fuchsin and by measuring the insulin release from islets in vitro in response to a glucose stimulus. Ten pieces of human cadaver pancreas have been studied. Islets were isolated from 6 and in 5 cases were shown to respond to a glucose stimulus in vitro. Five pieces of human pancreas removed at operation have been studied. Islets were isolated in all cases but only 2 showed a response to a glucose stimulus.

Isolated animal islets have been subjected to three preservation systems and their viability following storage noted. Simple cold storage in Hank's balanced salt solution at 4°C. At 15 hours 100 per cent survival was noted. This dropped to 10 per cent at 48 hours. There were no survivors at 72 hours.Subzero storage. In group I (freezing rate 1°C/min) histological survival was 35 per cent and frtnctional survival 20 per cent. In group II (freezing rate 5°C/min with a 24-hour culture period after rewarming) histological survival was approximately 87 per cent and functional survival 75 per cent.Organ culture. Islets from the guinea-pig, rat and mouse showed minimal morphological damage when cultured for 21 days in a simple organ culture system. At 28 days histological survival was approximately 30 per cent. We were unable to correlate histological and functional survival in this group.
Inhibitors of gastric secretion: Current progress
Authors: Carter D C
Published: March 2007

Several new compounds have become available recently which are potent inhibitors of gastric secretion. The therapeutic potential of these inhibitors in the peptic ulcer diathesis is reviewed and it is concluded that the histamine H2-receptor antagonists show most promise at present. The prostaglandins and gastro-intestinal polypeptides are of considerable physiological interest but are unlikely to have clinical importance in the immediate future.
Layer closure of laparotomy wounds with absorbable and non-absorbable suture materials
Authors: Irvin T T , Koffman C G , Duthie H L
Published: March 2007

Opinions vary regarding the best suture material for abdominal wound closure. Some surgeons favour non-absorbable sutures while others use absorbable materials, but there is little objective clinical information regarding the relative merits of the different suture materials.

In a randomized prospective clinical trial the synthetic absorbable polyglactin and polyglycolic acid sutures were compared with the non-absorbable polypropylene suture in the closure of 161 laparotomy wounds. A layered closure technique was used in all cases.

The total incidence of wound dehiscence and herniation was 8·1 per cent, and there was no significant difference between polyglycolic acid (9·6 per cent), polyglactin (5·8 per cent) and polypropylene (8·8 per cent). Dehiscence and herniation were significantly more common in wounds closed by surgeons in training.

It was concluded that none of the suture materials provided satisfactory freedom from wound complications. It is possible that these sutures may prove satisfactory with an alternative technique of abdominal wound closure, but this should be the subject of further clinical studies.
Reconstruction of the breast as a primary and secondary procedure following mastectomy for carcinoma
Authors: Watts G T
Published: March 2007

During a period of 8 years over 200 cases of carcinoma of the breast have had replacement procedures carried out as either a primary or a delayed procedure. The end results do not appear to be in any way inferior to those of conventional treatment of this condition.

Selection of cases is important, but equally vital is meticulous dissection technique, haemostasis and planning of incisions together with preservation of the blood supply.

Recurrence locally appears to be somewhat less than anticipated when compared with other methods of treatment. It can be treated by irradiation or excision without removal of the prosthesis.
Chagas' disease of the colon
Authors: da Silveira Geraldo Milton
Published: March 2007

One hundred cases of chagasic megacolon operated upon in Bahia, Brazil, have been analysed. The principal theories of the pathological physiology of the disease are discussed. The pre- and postoperative radio-graphic features of the colon are presented, and the surgical treatment as well as the incidence of complications and late results are reported.
Surgical treatment of kinked internal carotid arteries
Authors: Vollmar J , Nadjafi A S , Stalker C G
Published: March 2007

Carotid artery insufficiency is caused by an abnormal kinked or coiled internal carotid artery in 15–20 per cent of symptomatic patients. Surgical correction should be considered if other causes for the neurological signs are excluded, a pronounced kinked or coiled area is demonstrated and if there is not a severe neurological deficit. As well as eliminating the elongation, surgical correction should include intralunzinal inspection of the artery as, in 38·5 per cent of cases, a concomitant arteriosclerotic stenosis requires simultaneous correction.
The immunogenicity of starch glove powder and talc
Authors: Grant J B F , Davies J D , Jones J V , Espiner H J , Eltringham W K
Published: March 2007

An antigen responsible for cutaneous delayed hypersensitivity to starch glove powder in guinea-pigs was found to be associated with starch grains. Talc was not immunogenic in this system, and did not cross-react in skin tests with starch glove powder. Additives and protein components in the glove powder did not appear to be antigenic.
Tension pneumoperitoneum: A report of 4 cases
Authors: Addison N V , Broughton A C
Published: March 2007

Four cases of tension pneumoperitoneum are described. In 3 patients this condition followed a perforation of a grossly distended caecum. In 2 of these patients there was an associated malignant neoplasm of the pelvic colon with obstruction. The third patient had a pseudo-obstruction of the transverse colon. The fourth patient had a tension pneumoperitoneum with associated surgical emphysema in the neck and subcutaneous tissues of the abdomen and chest walls, following perforation of a duodenal ulcer. The aetiology, presentation and management, together with the mechanism of tension pneumoperitoneum, are discussed.
Lingual ectopia of the thyroid gland and autotransplantation
Authors: Hilless A D , Black J E
Published: March 2007

A case of lingual ectopia of the thyroid gland in an adult patient is presented. The management by total excision and autotransplantation of the thyroid is described with a brief review of literature.
Malignant lymphoma of the thyroid
Authors: Taylor I
Published: March 2007

Two cases of malignant lymphoma are reported and the clinical features of a further 6 cases collected over a 10-year period are presented. The literature is reviewed and the treatment, prognosis and relationship to Hashimoto's disease are discussed. It is suggested that lymph node biopsy at the time of operation is important in confirming the diagnosis and that the prognosis may be more hopeful than has previously been suggested.
Emergency abdominal surgery in the aged
Authors: Blake Richard , Lynn John
Published: March 2007

The results of 375 emergency abdominal operations in elderly patients over the age of 75 years are presented and discussed in detail. There has been a fourfold increase in the population over the age of 75 years in England and Wales during the 60-year period from 1911 to 1971. The overall mortality of these patients of 31·7 per cent is unrelated to the age of the patient, but appears to be directly related to the severity of the surgical condition and to cardiorespiratory complications. Our approach to these problems is presented and discussed.
An elemental diet as preoperative preparation of the colon
Authors: Gurry J F , Ellis-Pegler R B
Published: March 2007

In a study comparing patients prepared for colonic surgery with an elemental diet (Vivonex) with a control group there was no significant difference in incidence of wound infection or other complications between groups. Furthermore, there was no change in the population levels of the colonic microflora nor were the numbers of species decreased after 2–4 days on the diet. Although in most cases aiding in the mechanical preparation of the colon, the elemental diet has not been shown to confer any other advantage.
Inflammable antiseptics and theatre fires
Authors: Briscoe C E , Hill D W , Payne J P
Published: March 2007

This paper describes an investigation designed to find out if theatre fires could be started by the antiseptic painted on the patient's skin being ignited by cautery or diathermy.

It was found that hot wire cautery or diathermy generated enough heat to ignite all alcohol-based antiseptics even if these contained as little as 20 per cent alcohol. They could also cause iodine to explode in the presence of nitrous oxide, and nobecutane to explode in the presence of nitrous oxide or increased oxygen.

The likelihood of these combinations causing fires is discussed, and it is recommended that when diathermy or cautery is to be used near the surface of the body, either an aqueous-based antiseptic is used or if spirit solutions are required they are carefully dried of before proceeding.
Comparison of pulmonary artery pressures and mixed venous oxygen tension with other indices in acute haemorrhage: An experimental study
Authors: Pardy B J , Dudley H A F
Published: March 2007

A pulmonary artery cannula allows the determination of free and wedge pulmonary artery pressures and mixed venous oxygen tension. These indices have been reported to provide useful information in the assessment of the haemodynamic status of the ill patient. The purpose of this study was to compare them with systemic arterial and central venous pressures as predictors of cardiac output during acute continuous haemorrhage in the dog. Pulmonary artery pressure changed almost linearly with cardiac output, and the percentage changes in each were similar; by contrast, systemic arterial pressure was an inferior predictor of cardiac output. Pulmonary artery wedge pressure fell rapidly in the initial phase of bleeding, but right atrial pressure more gradually. The oxygen tension of blood in the pulmonary artery fell steadily during haemorrhage. These findings suggest that data derived from the use of a pulmonary artery cannula may be more useful than systemic arterial and central venous pressures in the detection of hypovolaemia and reduced cardiac output; more frequent use of a pulmonary artery cannula should be made in patients in whom blood volume may fluctuate rapidly.
The pathophysiological changes of experimental fat embolism: Early pre-hypoxaemic changes
Authors: Sikorski J , Pardy B J , Bradfield J W B , Dudley H A F
Published: March 2007

Glyceryl trioleate has been injected into greyhounds as a model of the fat embolism syndrome. Pulmonary vascular pressures, systemic arterial pressure and cardiac output were determined at regular intervals over an 8-hour period. It has been shown that glyceryl trioleate causes an increased pulmonary vascular resistance and a fall in cardiac output. These effects are mediated partly by a direct mechanical block of pulmonary vessels and partly through a thrombogenic property of the injected fat. The relevance of these findings to the clinical situation is discussed and a sequence of events for the fat embolism syndrome is proposed.
Experimental fat embolism: A dynamic assessment of pulmonary fat-handling characteristics
Authors: Sikorski J M , Pardy B J , Dudley H A F
Published: March 2007

Injection 125I-glyceryl trioleate (0.5 mg/kg) into the right atrium of anaesthetized greyhounds caused the following changes: sequestration of fat in the right side of the heart; 95 per cent removal by the lungs in a single passage through the pulmonary circulation; subsequent release of fat into the systemic circulation; rapid overall turnover of fat trapped in the lungs and slow removal of recirculating fat by other tissues.

We believe that if there is release of unemulsified fat into the circulation in traumatic fat embolism these findings are of significance in interpreting the subsequent pulmonary events.
Effect of truncal vagotomy on gastroduodenal content of gastrin
Authors: Malmstrøm J , Stadil F , Christensen K C
Published: March 2007

The vagal influence on gastroduodenal content of gastrin was studied in duodenal ulcer patients. Endoscopic biopsies were assayed for total concentrations of gastrin, and fractionated for measurements of gastrin components before and after total vagotomy. Antral concentration was 17.0±2.0 μg gastrin/g mucosa (mean±s.e.m.) in 52 unoperated patients compared with 25.2 ± 3.2 μg in 32 vagotomized patients. In 14 patients studied before and 3 months after vagotomy antral content was almost doubled (10.9 ± 2.3 and 20.4 ± 2.9 μg respectively). In the duodenal bulb the concentration was 2.4 ± 0.3 μg in 37 unoperated patients and 2.2 ± 0.4 μg in 19 vagotomized patients. In 6 patients in whom measurements were made throughout the duodenum, gastrin concentrations were slightly but significantly lower 3 months after vagotomy. Fractionations of pooled homogenates on Sephadex G-50 showed that gastrin component III (gastrin-17) made up 95 per cent of the antral gastrins before and after operation. In the duodenum component III constituted more than half of the gastrins preoperatively but only one-third postoperatively. The total amount of gastroduodenal gastrin was considerably increased by vagotomy, and it is well established that in serum the gastrin concentration is also higher postoperatively. The most likely implication of these findings is that in man the vagus, directly or indirectly, suppresses gastrin production.
Recurrent ulcer after proximal gastric vagotomy for duodenal and pre-pyloric ulcer
Authors: Holst-Christensen J , Hansen O Hart , Pedersen T , Kronborg O
Published: March 2007

Factors thought to be important in the development of recurrent ulcer after proximal gastric vagotomy were investigated 1–4 years after operation in 211 patients with duodenal ulcer and in 49 with pre-pyloric ulcer. Recurrent ulcer was found in 25 patients with duodenal ulcer (12 per cent) and in 6 with pre-pyloric ulcer (12 per cent). Recurrence was not related to age, sex, duration of dyspepsia, radiological findings or peak acid output before and 10 days after vagotomy. Fiftysix patients were operated upon by the method of Amdrup and Jensen (1970), including skeletonization of about 2 cm of the oesophagus. The remaining 204 patients were operated on by a technique in which the dissection of the lesser curve was begun at the ‘crow's foot’ and the oesophageal dissection was extended, in most cases, to more than 4 cm above the cardia. Recurrence was more frequent among the 56 patients in the first group than among the remaining patients with duodenal ulcer. Recurrence was positively related to basal acid output after vagotomy. An increase of peak acid output of 50 per cent was seen in a smaller group with recurrence and patients with dyspepsia within 18 months of vagotomy.

It was concluded that the risk of recurrence is not related to the number of parietal cells, as expressed by peak acid output to histamine. The risk may probably be reduced by extension of the oesophageal skeletonization. A marked increase in peak acid output may be seen during the first year after proximal gastric vagotomy in patients with recurrence or dyspepsia.
Anal fistulas at St Mark's Hospital
Authors: Marks C G , Ritchie Jean K
Published: March 2007

This paper presents the application of a classification of anal fistulas to an unselected consecutive series of 793 patients treated for this condition at St Mark's Hospital front 1968 to 1973 inclusive. The fistulas were divided into five categories on jheir anatomical relationships: superficial (16 per cent), intersphincteric (54 per cent), trans-sphincteric (21 per cent), suprasphincteric (3 per cent) and extrasphincteric (3 per cent), with the remaining cases multiple or unclassified (3 per cent).

There was good correlation between the categories and presentation, physical signs and treatment of the fistulas.

Two hundred and forty-nine patients had potentially difficult fistulas. Follow-up of these patients revealed healing of almost all the fistulas, but the functional results were less satisfactory (incontinence of loose stool in 17 per cent and of flatus in 25 per cent, soiling in 31 per cent).
Intestinal changes after jejuno-ileal shunt in obesity: A report of 2 cases
Authors: Grenierj J F , Dauchel J , Marescaux J , Eloy M R , Schang J C
Published: March 2007

Two cases of end-to-end and end-to-side jejuno-ileal bypass for the treatment of obesity are reported in which both patients underwent reoperation 17 and 23 months later respectively. Macroscopic examination and measurements of length of the various segments of the small intestine have been performed twice in each patient: at the time of the bypass and at the second surgical procedure. In one patient a histological study of both the excluded and functioning small intestine was carried out at the time of each surgical procedure. The functioning intestine had increased in size while the excluded segment had become narrowed. The height of the villi had increased slightly in the functioning ileum and more so in the functioning jejunum compared with the preoperative measurements. In contrast, the height of the villi was moderately reduced in both the bypassed jejunal and Heal segments. These findings confirm the results of experimental studies in animals.
Gas gangrene and related infection: Classification, clinical features and aetiology, management and mortality. A report of 88 cases
Authors: Darke S G , King Ann M , Slack W K
Published: March 2007

The clinical features of gas gangrene and related infection seen in 88 patients over a 10-year period are described. It is suggested that clostridial infection could be simply classified as either ‘gas-forming’ or ‘non-gas-forming’. The gas-forming group represents the more severe form of infection. Non-clostridial gas gangrene may present in a variety of forms. The anaerobic streptococcus was the organism most frequently responsible, but these cases were indistinguishable from clostridial infection on clinical grounds.

The treatment of gas gangrene in this series of patients is reported. Emphasis is laid on the importance of adequate prophylaxis with penicillin in patients at risk. The value of antibiotics in established infection remains equivocal. The evidence supporting the value of hyperbaric oxygen therapy is assessed and an attempt made to quantify the response to this treatment. Benefit was apparent in only a proportion of patients. A favourable response indicated clostridial infection and guaranteed immediate survival. Extensive debridement or amputation is unnecessary in this group. No response following hyperbaric oxygen therapy indicated widespread mixed clostridial and non-clostridial infection, or infection due to organisms other than clostridia. Urgent and extensive debridement and amputation remain the predominant measures in this group.
Diagnosis of a leiomyoma of the small intestine by selective angiography
Authors: Burrows F G O , Dodds W N , Thompson H
Published: March 2007

A case is reported in which a leiomyoma of the jejunum was diagnosed by mesenteric angiography after two negative barium meal examinations. TJie tumour was resected and recovery was uneventful.
Pulsion intubation for palliation of carcinoma of the oesophagus
Authors: Hegarty M M , Angorn I B , Bryer J V , Henderson B J , Le Roux B T , Logan A
Published: March 2007

One hundred and eighty-one patients with carcinoma of the upper thoracic oesophagus were intubated perorally using a Procter Livingstone tube. The mortality was 16·6 per cent but, in the patients who survived, the palliation achieved, as judged by improved swallowing, was considered satisfactory. Factors influencing the success of intubation are also considered.
Agenesis of the vermiform appendix in a thalidomide child
Authors: Shand J E G , Bremner D N
Published: March 2007

A case of congenital absence of the appendix occurring in a child with severe thalidomide deformities is described. The literature on agenesis of the appendix is reviewed. The frequency and significance of internal abnormalities in thalidomide children are discussed.
Herniation through the foramen of Morgagni in children
Authors: Thomas G G , Clitherow N R
Published: March 2007

Eight cases of herniation through the foramen of Morgagni are described. They fell into two distinct groups presenting either as neonatal respiratory distress or as an incidental finding in older children. Diagnosis is essentially radiological, stressing the importance of a lateral film. Surgical repair is advocated, the abdominal approach being preferred. Pneumopericardium is a rare but severe complication.
Wound infection following appendicectomy: The effect of extraperitoneal wound drainage and systemic antibiotic prophylaxis
Authors: Everson N W , Fossard D P , Nash J R , Macdonald R C
Published: March 2007

The value of extraperitoneal wound drainage and a 3-day course of prophylactic systemic cephaloridine used both separately and together have been assessed in a prospective controlled randomized trial involving 246 patients undergoing appendicectomy at the Leicester Royal Infirmary. Extraperitoneal wound drainage was shown to reduce significantly the incidence of post-operative wound infection in patients with a gangrenous or perforated appendix (P<0·025). Prophylactic cephaloridine significantly reduced the overall incidence of wound infection (P<0·02) and was also effective when the appendix was gangrenous or perforated (P<0·01). A highly significant reduction in wound infection was achieved when the appendix was gangrenous or perforated by the addition of wound drainage to the antibiotic regimen (P<0·001).
Surgical treatment of sclerosing peritonitis caused by practolol
Authors: Jackson B T
Published: March 2007

A detailed and illustrated account is given of the surgical operation needed to treat practolol-induced sclerosing peritonitis, based on the personal experience of 6 patients.
Adult Hirschprung's disease
Authors: Todd Ian P
Published: March 2007

Hirschprung's disease (aganglionosis) in the adult is a rare condition but needs to be considered as a diagnosis in any case of intractable constipation. A series of 35 cases of probable aganglionosis seen at St Mark's Hospital since 1954 is reviewed. Diagnosis is discussed and operative management evaluated.
The implications of scrotal interference for the preservation of spermatogenesis in the management of testicular tumours
Authors: Thomas P R M , Mansfield M D , Hendry W F , Peckham M J
Published: March 2007

Seminal analyses have been performed in 14 patienrs who have received radiation therapy following unilateral orchidectomy for testicular tumours. In patients receiving scrotal in addifion to para-aortic and pelvic lymph node irradiation azoospermia occurred in 17 out 18 specimens examined, whereas in those patients not requiring scrotal irradiation, restoration of spermatogenesis occurred. The difference is a result of the increased dose of radiation received by the remaining testicle when the contralateral side of the scrotum is irradiated.

Following scrotal aspiration, trans-scrotal biopsy or scrotal orchidectomy for testicular tumour, the scrotum becomes a possible site of recurrence and it should be electively irradiated. In order to give the patient the best chance of preserving fertility it is essential that scrotal interference in the management of testicular tumours must be avoided.
Postoperative hypoxaemia and oxygen therapy
Authors: Parfrey P S , Harte P J , Quinlan J P , Brady M P
Published: March 2007

To observe the duration of hypoxaemia 8 patients were monitored every day for the first 7 days following upper abdominal surgery. Three of these patients who had failed to regain their preoperative Po2 value by the seventh postoperative day were further monitored on alternate days until the fourteenth postoperative day. A further 3 patients were similarly monitored on alternate days for 14 days. In another group of 10 patients blood gases were monitored every 4 h for the first 48 h following major abdominal surgery, during which time the patients were given 35 per cent oxygen for the first 24 h after operation. (All patients in this group had a diminished respiratory reserve preoperatively to a sufficient degree to warrant admission to the intensive therapy unit postoperatively, and these patients were treated with oxygen for 24 h, as is the practice in our unit and in other surgical units).

Oxygen was administered using a Ventimask at 8 l/min (British Medical Journal, 1972). Nine of the 10 patients did not show postoperative hypoxaemia while being treated with 35 per cent oxygen, although the Po2 values attained were lower than expected. On withdrawal of oxygen after 24 h, the Po2 decreased below preoperative levels in all patients. The Po2 of 7 patients in this group decreased below 8 kPa during the second 24 postoperative hours, in 4 of whom the level fell below 6·7 kPa. Some recommendations to improve the respiratory care of the surgical patient are presented.
The medical dissolution of phytobezoars using cellulase
Authors: Lee S P , Holloway W D , Nicholson G I
Published: March 2007

Phytobezoars are plant fibre concretions occurring in the stomach as a complication following some types of gastric surgery. Symptoms include distension, pain and vomiting. Ulceration, gastric bleeding and even perforation can occur. If untreated, they result in a significant mortality.

Dissolution of the phytobezoar can be achieved with-out operative intervention. Enzymes and especially cellulase help to break up the mass and it can then be aspirated or allowed to pass on. Five patients with phytobezoars were thus treated and the cellulase method was confirmed to be simple, safe and effective.
Recurrent massive haemorrhage from benign hepatic tumours secondary to oral contraceptives
Authors: Bein Norman N , Goldsmith Harry S
Published: March 2007

Liver cell adenoma as a cause of spontaneous haemoperitoneum has been noted with increasing frequency since Baum's initial report (Baum et al., 1973). The relationship between the use of oral contraceptives and bleeding from a hepatic tumour makes awareness of this condition mandatory for the physician involved in the differential diagnosis of the acute abdomen. The report presented here is that of a woman who, while taking oral contraceptives, subsequently bled from her liver 3 years after an initial hepatic haemorrhage.
Recurrence after proximal gastric vagotomy without drainage for duodenal ulcer: A 3–6-year follow-up
Authors: de Miguel Jacinto
Published: March 2007

During the period December 1970 to August 1973, 99 patients with duodenal ulcer underwent proximal gastric vagotomy without drainage, and 93 per cent of the patients were followed up for 3–6 years after the operation. A proved recurrent duodenal ulcer was noted in 4·3 per cent and a strongly suspected recurrent duodenal ulcer in 2 per cent. It is suggested that this rate of recurrence on medium term follow-up is compatible with the continued use of proximal gastric vagotomy in the surgical treatment of duodenal ulcer.
Bile composition in bilharzial hepatic fibrosis
Authors: El Masri S H , Lewin M R , Gumaa K
Published: March 2007

At operation for haematemesis in bilharzial hepatic fibrosis, the gallbladder was always found to be diseased but devoid of stones. This led to a study of gallbladder bile composition in a group of bilharzial patients and comparison with a group of cholelithiasis patients. When values for biliary lipid composition were plotted on triangular coordinates, both groups fell well outside the line of maximum cholesterol solubility. The bilharzia group had significantly more cholesterol and less phospholipid than the gallstone group. The absence of stones in patients with bilharzial hepatic fibrosis was possibly due to their early demise and the suggestion is that, in this condition, it is the disease of the gallbladder itself which renders the bile lithogenic.
Umbilical pilonidal sinus
Authors: Colapinto Nicholas D
Published: March 2007

A rare case of umbilical pilonidal sinus is reported—the only documented case of barber's pilonidal of the umbilicus. Possible mechanisms of formation are described. It is suggested that this possibility should be considered in cases of resistant or recurrent omphalitis. Definitive treatment consists of sinus excision with cosmetic umbilical reconstruction. Total omphalectomy is probably only justified for recurrence.
Intestinal obstruction after excision of the rectum
Authors: Hamer-Hodges D , Matheson N A
Published: March 2007

Over a 5-year period, 33 patients underwent excision of the rectum in the same unit of Aberdeen Royal Infirmary. Six patients in whom the abdominal contents were allowed to fall into the denuded pelvis showed a uniform pattern of delayed intestinal transit. Two of the patients required reoperation and one died. A similar pattern was not seen in patients managed by other methods. Even if leaving the pelvic peritoneum open were to improve the likelihood of primary perineal healing, for which there is no good evidence, the risks are such that the practice must be regarded as unacceptable unless omentum is mobilized to occupy the pelvic cavity.
Abdominal aneurysm in South African Negroes due to intimomedial mucoid degeneration
Authors: Decker G A G , Samson I D , Schmaman A
Published: March 2007

Nine South African Negroes with abdominal aortic aneurysms due to intimomedial mucoid degeneration are described. These occurred in a younger age group than atherosclerotic aneurysms and with a female predominance. The aneurysms are not syphilitic in origin and are unlike atherosclerotic aneurysms. This form of abdominal aneurysm constitutes a distinct entity which is relatively prevalent in South African Negroes and which has hitherto received little or no emphasis and attention.
Phenol lumbar sympathectomy for severe arterial occlusive disease in the elderly
Authors: Keane F B V
Published: March 2007

Phenol chemical lumbar sympathectomy is an additional aid in the management of ischaemic rest pain and incipient gangrene. This technique was used in 132 elderly patients in Bath between September 1972 and March 1975 and the results are presented here. The patients were unfit for reconstructive arterial surgery. In this series an image intensifier was used in order to make the procedure safer.

One hundred and twenty-six patients were available for review, their average age being 71·5 years. The average period of follow-up was 16·3 months. Of the 126 patients, 111 were not diabetic, and of these 45 (41 per cent) had satisfactory results while 17 (15·4 per cent) had persistent symptoms but had avoided amputation. Thirty (27 per cent) patients required amputation and 12 of these died as a direct result of this procedure. A further 19 patients in the non-diabetic group died during the period of follow-up.

However, of the 15 diabetic patients, only 3 (20 per cent) improved whilst one patient with persistent symptoms avoided amputation. The remainder either died (8) or had an amputation (5) during the period of fellow-up. Two died after amputation.
Submucosal arterial malformation of the stomach as the probable cause of recurrent severe haematemesis in a 16-year-old girl
Authors: Gough Malcolm H
Published: March 2007

A 16-year-old girl who had previously been in good health suffered recurrent life-threatening haematemesis. The cause of this bleeding appeared to be the spontaneous rupture of an abnormally large submucosal artery in the stomach. The site of bleeding was eventually localized by coeliac angiography via an indwelling percutaneous femoral catheter.
Congenital anal duplication: A cause of para-anal sinus
Authors: Tagart R E B
Published: March 2007

Four cases of recurring para-anal sinus originating, it is suggested, as congenital duplication of the anal canal, are described. The diagnosis depends upon the finding of columnar mucus-secreting epithelium in a sirus? ack which does not communicate with the bowel lumen. The sinus may or may not penetrate the levator ani muscle. Treatment should be by excision of the sinus, rather than by laying it open into the anal canal. If the sinus is superficial, the latter operation will result only in delayed healing and prolonged convalescence, but if it runs deep, there is a danger, of causing incontinence or an extra-sphincteric fistula. Untreated lesions may eventually be the site of malignant change. This complication was not encuntered in the present series.
Iatrogenic injury to the phrenic nerve in infants and young children
Authors: Mearns A J
Published: March 2007

Five cases of iatrogenic phrenic nerve injury in infants are presented. The difficulties of diagnosis and treatment are outlined and reference made to the possible sites of injury. The necessity for early recognition of the injury, and its prompt relief if indicated, are stressed.