bluuebunny/crossref_metadata_2025 huggingface dataset:
Peroperative cholangiography
Authors: Ya Myat Thu , Robinson D , Gunn A A
Published: March 2007

Operative cholangiography was performed in 30 patients by a technique using a modified Foley catheter introduced into the common bile-duct after exploration. The visualization was satisfactory with flow into the duodenum, and additional stones, strictures, and congenital abnormalities were detected. This procedure is likely to reduce the incidence of residual stones following choledochotomy.
A method of supportive bandaging for amputation stumps
Authors: Puddifoot P C , Weaver P C , Marshall Sheila A
Published: March 2007

A supportive dressing for amputation stumps as an alternative to conventional bandaging is described. This dressing is effective in controlling oedema and satisfactory healing occurs. It is easily applied by both staff and the patient, and is comfortable to wear.
The technique and possible application of supra-orbital artery blood-pressure estimation
Authors: Wyatt A P , Ratnavel K , Loxton G E
Published: March 2007

An indirect method of measuring systolic blood-pressure in the supra-orbital arteries by an ultrasonic technique is described. The results are repeatable and the expected differences are shown with changes of posture. Calculation of pressure indices has shown significant variation between normal, hypertensive, and arteriosclerotic subjects. The method should-be of value in assessing the significance of occlusive lesions of the carotid vessels.
The surgical management of thyrotoxicosis
Authors: Pegg C A S , Stewart D J , Bewsher P D , Michie W
Published: March 2007

Preparation of selected thyrotoxic patients for partial thyroidectomy can be safely and quickly achieved using propranolol, the duration of preoperative therapy and the number of out-patient attendances being reduced by over 50 per cent. No problems have been encountered during preparation or intra-operatively in patients pretreated with propranolol when compared with patients pretreated with conventional preparations. The commonest form of morbidity following destructive therapy for thyrotoxicosis is hypothyroidism. In surgically treated patients hypothyroidism can be defined within 1 year of operation. The factors influencing postoperative hypothyroidism are discussed.
Lymphoid tissue in the thyroid gland and thymus of patients with primary thyrotoxicosis
Authors: Swanson Beck J , Young R J , Simpson J G , Gray Elizabeth S , Nicol A G , Pegg C A S , Michie W
Published: March 2007

The amount of lymphoid tissue in the thyroid gland and thymus at the time of partial thyroidectomy was measured quantitatively with the point-counting technique.

The normal pattern of age involution of the thymus was established in patients with non-toxic nodular goitre. In all the patients with thyrotoxicosis the thymus is hyperplastic; after pretreatment with antithyroid drugs, such as carbimazole, the pattern of age involution is similar to that in the control subjects, whereas after propranolol therapy very little age involution is seen. Patients treated with antithyroid drugs show much less lymphoid infiltration of the thyroid gland than those prepared with propranolol.
Observations on the treatment of traumatic urethral injuries and the value of the fenestrated urethral catheter
Authors: Turner-Warwick Richard
Published: March 2007

A review of 250 traumatic urethral strictures in our series has provided the basis for a consideration of their management. Techniques that we have adopted or adapted for their resolution are outlined and the principles involved in reducing the effects of the initial injury are discussed. The value of the fenestrated shaft catheter in providing free drainage of periurethral exudates after urethral injury and repair is stressed.
The continent ileostomy
Authors: Cameron A
Published: March 2007

In 1969 Professor Nils Kock of Göteborg published a description of a new kind of continent ileostomy. A pouch is formed of the terminal ileum. The pouch although small at first enlarges with time until its capacity is adequate to contain about one-third of the day's ileal output. The pouch is emptied several times a day by passing a catheter along a short efferent loop of ileum which is brought to the surface as an ileostomy stoma. The pouch is made in such a way that it does not develop expulsive contractions when it fills. It is therefore continent. By constructing a valve mechanism on the efferent loop continence is maintained under the stress of increased abdominal pressure as in coughing, laughing, etc. Since the pouch is continent the patient need wear no apparatus and the ileal stoma may be made flush with the skin.

This paper describes the author's experience with 6 patients in whom this type of ileostomy has been constructed. The results confirm the claim by Professor Kock that the technique is of value in selected patients.
Extensive cervical laminectomy long-term results
Authors: Jenkins D H R
Published: March 2007

It has been possible to follow up 5 patients who underwent complete cervical laminectomy for cervical spondylotic myelopathy between 12 and 17 years ago. The operation was described by Rogers in 1961. Clinical examination findings, together with the radiological appearances, indicate that this procedure does not predispose to instability of the cervical spine. This relatively simple procedure achieved long-lasting improvement in the patients examined.
Basal osteotomy of the first metacarpal in the treatment of arthritis of the carpometacarpal joint of the thumb
Authors: Wilson J N
Published: March 2007

This is a preliminary report of 8 cases of osteoarthritis of the carpometacarpal joint of the thumb treated by a basal abduction osteotomy of the first metacarpal.

Follow-up from 6 months to 9 years has shown a relief of pain and an increased function of the hand.

Although the osteotomy has been designed to correct the adduction deformity of the first metacarpal, in 2 cases this correction was not achieved and it is possible that a transverse osteotomy might be just as effective.
Subcapital fractures of the neck of the femur treated by double-divergent fixation
Authors: McQuillan W M , Abernethy P J , Guy J G
Published: March 2007

A method of fixation of femoral neck fractures which involves double-divergent fixation using two Watson-Jones nails is described. The method has been compared against nail and autogenous fibular graft fixation and gave results which were better. The method has also been compared against single-nail fixation and has given much better results. There seems to be little place for single-nail fixation of displaced femoral neck fractures.

A clinical series of 90 cases of displaced fractures treated by double-divergent fixation is presented. Failure of fixation occurred in 12 cases (13.3 per cent).

The technique of double-divergent fixation prevents femoral neck collapse or resorption.
Lumbar sympathectomy a retrospective study of 142 operations on 100 patients
Authors: Postlethwaite J C
Published: March 2007

A retrospective survey of 142 lumbar sympathectomies has shown that this operation is of value in the treatment of rest pain and ischaemic ulceration, especially in the 61–70 age-group. It is of less value in claudication. Diabetics fare only slightly less well than non-diabetics. Two cases of ureteric injury are described. Neuralgia occurred in 12·6 per cent of patients.
A review of 174 patients with arterial embolism
Authors: MacGowan W A L , Mooneeram R
Published: March 2007

Experience of 174 patients suffering from arterial embolism is recorded. One hundred and fifty cases occurred in the lower limb and 24 in the upper limb. Embolectomy was performed in 119 patients. The overall limb salvage rate was 62 per cent and the hospital mortality was 27 per cent. Amputation was performed in 13 per cent of the patients in this series. Operative techniques and management are discussed. Delay in diagnosis and effective surgical treatment appears to be a major factor influencing the end-result.
Early and delayed operation in acute gall-stone disease
Authors: Sokhi G S , Longland C J
Published: March 2007

In a review of 157 patients admitted to hospital as emergencies with acute gall-stone disease it was found that 52 cases (33.1 per cent) had undergone definitive operation for gall-stones during the emergency admission in spite of an overall conservative policy in relation to operation. The results of these early operations are compared with those of operations delayed to a second admission in other patients of this series. There was no significant difference in mortality or morbidity, but there was a saving on average of 5 days in hospital for those patients who were operated on at the first admission.
Drill biopsy of the breast–a critical analysis
Authors: McCormick J St C , Shivas A A
Published: March 2007

In a study of drill biopsy carried out in 106 patients with breast lesions, comparing the accuracy of diagnosis with that of clinical examination and excision biopsy, reliability declined as stromal reaction in the tumour increased. Accordingly, a negative result is meaningless. Tumour size did not appear to be an important factor. The significance of these results is briefly discussed.
Pyloric stenosis: Hold-up of enteric coated aspirin tablets
Authors: Harris F C
Published: March 2007

The case is presented of a 68-year-old woman with adult hypertrophic pyloric stenosis who ingested 66 enteric coated 650-mg. aspirin tablets over the course of 11 days immediately prior to her admission to hospital. Most of these tablets remained intact in the hugely dilated obstructed stomach and were recovered at emergency gastrotomy. The mechanism of disintegration of enteric coated tablets and the possible consequences of en masse disintegration of these ingested tablets are discussed.
Carcinoma arising in a duplicated colon: Case report and review of literature
Authors: Heiberg M L , Marshall K G , Himal H S
Published: March 2007

A case of primary adenocarcinoma arising in a duplication of the right colon is reported. The unusual clinical presentation and management are discussed.
Glucose utilization and insulin secretion during surgery in man
Authors: Wright Peter D , Henderson Kathleen , Johnston Ivan D A
Published: March 2007

Intravenous glucose tolerance tests were performed in 18 patients before, during and after surgery. Glucose utilization was found to be significantly depressed during and after operation to a degree which increased with the severity of operation. Suppression of insulin secretion was observed during operation together with increased plasma cortisol levels and an increased urinary catecholamine excretion. It is suggested that a failure of cellular glucose utilization is the primary event in the metabolic response to injury which initiates cellular catabolism and urinary nitrogen loss.
A review of symptoms, haematology and clinical chemistry following a partial gastrectomy
Authors: Brookes V S , Meynell M J , Bold A M , Kingston R D
Published: March 2007

A review of patients following a partial gastrectomy for benign peptic ulceration reveals very satisfactory symptomatic results. Minimal haematological and biochemical disturbances have been produced and all the patients with gastric ulcers were cured. The gastric resection has been limited to two-thirds in all the cases.

One hundred and ninety patients were included in the review, and of these, 99 underwent detailed haematological and biochemical investigation.

Ninety per cent of the patients were graded as Visick I or II. There was a low incidence of severe vomiting (1.5 per cent), diarrhoea (1.5 per cent) and dumping (1.9 per cent)

Anaemia was manifest only in males (18 per cent). Iron deficiency was present in both sexes and increased in severity with time. The deficiency has been readily corrected with oral iron. There was no macrocytic anaemia, 10 per cent of patients having subnormal serum vitamin B12 levels. There was no folate deficiency.

No biochemical abnormality was noted.

Eight patients treated for duodenal ulcers developed recurrent ulcers but 6 of these followed Billroth I gastrectomy. Recurrence following a Poly a gastrectomy was 2 per cent. No gastric ulcer recurred.

These findings justify treatment of both duodenal and gastric ulcers by partial gastrectomy.

A modification of the Billroth I operation was used to overcome technical problems. Operation details are given and it is suggested that this operation is ideal for gastric ulcer.
Preoperative pulmonary evaluation of surgical patients using the vitalograph
Authors: Appleberg M , Gordon L , Fatti L P
Published: March 2007

A prospective study of 100 patients was undertaken in order to assess whether or not, in apparently normal clinical subjects undergoing surgery, postoperative pulmonary complications could be predicted by the use of simple preoperative pulmonary function tests obtained by the use of the vitalograph.

We have found, using a multiple statistical regression technique, that the addition of the vitalograph significantly increases the ability to predict postoperative pulmonary complications.
Laminectomy in paraplegia due to infective spondylosis
Authors: Kemp H B S , Jackson J W , Shaw N C
Published: March 2007

About 6 per cent of the patients with infectious diseases of the spine admitted to the Spinal Unit of the Royal National Orthopaedic Hospital have been previously submitted to laminectomy. The purpose of this paper is to re-emphasize the futility of this operation for paraplegia due to spinal infection. Exceptions to this principle are described and methods of management are also considered.
Thyroid cancer in young patients in Great Britain
Authors: Richardson J E , Beaugié J M , Brown C L , Doniach I
Published: March 2007

Recent collective experience with thyroid cancer in children in Britain is reported. Fifteen out of 16 patients with papillary carcinoma treated in the years 1962–7 are still living at least 5–10 years later; the sixteenth patient died of an unrelated cause. Two patients with follicular carcinoma also survived. Seven deaths between 1957 and 1970 were due to anaplastic or medullary carcinomas and 1 death was caused by a papillary carcinoma.

These data emphasize that in the treatment of papillary carcinoma we should take account of its prolonged natural history. Radical operations which have serious associated morbidity do not appear to be indicated.
Symptomatic non-parasitic cysts of the liver
Authors: Jones William Lloyd , Mountain John C , Warren Kenneth W
Published: March 2007

Eighteen patients with symptomatic non-parasitic cysts of the liver were seen and treated at the Lahey Clinic Foundation between 1950 and 1970.

A review of the world literature indicates that the incidence of non-parasitic cystic disease of the liver is undoubtedly higher than is indicated by the number of clinically diagnosed cases.

No specific symptom complex was observed. When symptoms do eventually occur they are almost always, in the absence of complications, the result of the space-occupying effect of the cyst either on the liver itself or on adjacent viscera. When biochemical studies of liver function are abnormal it is the result of coincidental or associated liver disease and not of the cyst itself.

Although cystic disease of the liver is rarely diagnosed clinically, the possibility should be seriously considered in any patient with an enlarged liver that is associated with few symptoms and little or no impairment of hepatic function.

Although radio-isotope scanning and coeliac axis arteriography are being used with increasing frequency and may be of value in the evaluation of this entity, the diagnosis at the present time depends on exploratory laparotomy.

The safety of surgery in this series, together with the excellent long-term results, supports our view that symptomatic cysts of the liver should be treated surgically; whenever possible the lesion should be removed by either local excision or formal hepatic resection. In view of this, the authors feel that the management of such cases should only be undertaken by those familiar with the techniques of hepatic resection.
Accidental intra-arterial injection during sclerotherapy of varicose veins
Authors: Fegan W G , Pegum J M
Published: March 2007

Five cases of accidental intra-arterial injection of sodium tetradecyl sulphate during the treatment of varicose veins are presented and compared with 3 previously reported cases. Severe ischaemic damage with gangrene may occur. Immediate treatment with heparin and low molecular weight dextran may be of value in the management of this situation.
Adrenal hyperplasia in rats with Walker carcinosarcoma 256
Authors: Coombs R R H , Castro J E , Sellwood R A
Published: March 2007

The effect of the growth of Walker carcinosarcoma 256 on the weight and morphology of the adrenal glands of Wistar rats was studied, and the effect of adrenalectomy on the growth of this tumour was investigated.

The size and combined weight of the adrenals from tumour-bearing rats were significantly greater than those of non-tumour-bearing controls both at 7 and 14 days after tumour inoculation. This adrenal enlargement resulted from widening of the adrenal cortex, particularly the zona reticularis. Histological examination of the enlarged adrenal glands showed increased vascularity and extramedullary haematopoiesis.

Adrenal enlargement in tumour-bearing rats was not influenced by hypophysectomy but the florid histological changes were no longer apparent.

Bilateral adrenalectomy significantly inhibited tumour growth, but had no signifcant effect upon body weight or pituitary size. It is suggested that growth of the Walker tumour may be a suitable model upon which to study the endocrine dependence of tumours.
Agenesis of the gallbladder and cystic duct: A report of 3 cases
Authors: Allan S , Hurrell T A
Published: March 2007

Three further cases of agenesis of the gallbladder and cystic duct are described. The surgical presentation and management of the condition is outlined. The English literature is reviewed, and it is suggested that the condition may be more common than previous reports indicate.
The effect of antral denervation on gastric secretion in the dog
Authors: Nundy S , Baron J H
Published: March 2007

The effect on gastric secretion of cutting the antral nerves was studied in dogs with a previous complete proximal gastric vagotomy, with an incomplete proximal gastric vagotomy and with otherwise intact vagi. There was no change in insulin- and pentagastrin-stimulated acid output in dogs with a previous vagotomy. The dog with otherwise intact vagi showed no change in insulin-stimulated acid output but there was a diminished acid response to low doses of pentagastrin. These results, if confirmed in man, would suggest that the antral vagal nerves have no clinically significant effect on gastric acid secretion.
Amoebic perforation of the intestine in children
Authors: Cade David , Webster G D
Published: March 2007

Three cases of small children with perforations of the large intestine due to Entamoeba histolytica who subsequently died are presented. They highlight the misleading symptomatology and the severe prognosis.
Differential free fatty acid response to heparin in diabetics
Authors: Printen Kenneth J , Paulk Stephen C , Liebschutz David , Mason Edward E
Published: March 2007

Deleterious effects of elevated free fatty acids have been demonstrated in both diabetic and non-diabetic patients. Recent studies have shown drastic and prolonged elevations of free fatty acids following heparin injection in postoperative diabetic patients. This study demonstrated no significant difference in response of two groups of preoperative diabetics maintained on either insulin or oral hypoglycaemic agents, but it has revealed that individual diabetics who respond to heparin with a massive elevation of free fatty acids can be easily identified with a simple preoperative injection of 5000 units of intravenous heparin.
The surgical treatment of reflux oesophagitis: Results of surgical repair over a 12-year period
Authors: Wilson M G , Bailey I S , Penry A B
Published: March 2007

The results of surgical treatment of 81 cases of reflux oesophagitis during the period 1958–70 are reported.

From 1958 to 1966 a simple repair, i.e. repair of the hiatus and reconstruction of the oesophagogastric angle, was done. From 1966 to 1970 a fundoplication was substituted. About half of the cases with simple repairs also had vagotomy and pyloroplasty, and some had cholecystectomy for associated gallstones.

Of the entire series, 92 per cent had a good clinical result and 78 per cent were good radiologically. Comparing simple repair with fundoplication, 92 per cent of the cases in both groups were good clinically, but radiologically 97 per cent of the fundoplications were good compared with 60 per cent of the simple repairs.

Two of 44 simple repairs have required further surgery for recurrent oesophagitis. There has been no recurrent oesophagitis in the fundoplication group, but dysphagia has been a problem requiring reoperation in I case and repeated bouginage in 3 others. Postprandial discomfort due to dificulty in belching occurs. Vagotomy has not had a beneficial effect, the group without vagotomy being superior both clinically and radiologically.

To conclude, simple repair by the abdominal route has given good clinical results in 92 per cent of 44 patients followed for 6–12 years. Neither fundoplication nor vagotomy has improved these results and both can add complications.
The influence of the lower oesophageal sphincter pressure on the outcome of hiatus hernia repair
Authors: Brennan T G , Trindade L M , Rozycki Z J , Giles G R
Published: March 2007

Thirty-six patients who had undergone a simple repair of a hiatus hernia were examined with regard to the postoperative symptomatology, persistence of reflux as judged by radiological means and the pressures of the lower oesophageal sphincter. One-third of these patients had persistent symptoms although these were usually mild. It has not been possible to correlate the persistence of symptoms with either the demonstration of radiological reflux or reduced lower oesophageal sphincteric pressures.
Are silicone rubber T-tubes better than latex rubber tubes in the common bile duct? A Rhesus monkey model
Authors: Nundy S , Bell G D , Cowley D J , Melrose D G
Published: March 2007

A retrospective comparison of latex and silicone rubber T-tubes draining the common bile duct in the Rhesus monkey shows that both tubes excite an adequate local tissue reaction. However, latex rubber degenerated more rapidly than silicone rubber, the interval between insertion of the tube and onset of complications being significantly shorter (7.2 ± 0.9 (s.e.) weeks against 17.6 ± 6.2 weeks). It is suggested that silicone rubber T-tubes have a place in human biliary surgery, especially when long-term drainage of the biliary tract is required.
Radical total glossectomy
Authors: Kothary P M , Paymaster J C , Potdar G G
Published: March 2007

A study of 26 cases of advanced carcinoma of the tongue treated by radical total glossectomy is presented. The selection of cases, the operative technique and the postoperative management are described. As seen from the follow-up of this series this procedure is able to effect a cure in some cases and give good palliation in the majority of cases of localized advanced carcinoma of the tongue. None of our patients needed postoperative laryngectomy for the complication of aspiration pneumonia.
The value of mechanical methods of preventing postoperative calf vein thrombosis
Authors: Browse N L , Jackson B T , Mayo M E , Negus D
Published: March 2007

The value of elevation of the leg and elastic stockings for the prevention of deep vein thrombosis has been studied in two groups of patients using the fibrinogen uptake test for diagnosis. Neither method appears to haw any effect on the incidence of thrombosis.
Late results of bilateral selective vagotomy and pyloroplasty for duodenal ulcer: 5–9-year follow-up
Authors: De Miguel Jacinto
Published: March 2007

From July, 1964, to July, 1968, bilateral selective vagotomy and pyloroplasty were performed in 135 patients for duodenal ulcer, without postoperative mortality. Two unrelated deaths occurred during the period of the survey and 2 other patients were lost to follow-up. The remaining 131 patients were followed up for a minimum of 5 years and a maximum of 9 years.

The most frequent symptoms were epigastric fullness, early dumping and mild diarrhoea. Only I case of moderate diarrhoea was observed, and none of severe diarrhoea. Food vomiting, bile vomiting and hypo-glycaemia-like attacks were uncommon. Recurrent duodenal ulcer was proved in 4.6 per cent and highly suspected in 1.5 per cent. Gastric ulcer was proved in 3.1 per cent. Approximately 91 per cent of the patients were classed as having a satisfactory result and 9 per cent were unsatisfactory.

It is concluded that bilateral selective vagotomy is clearly effective in controlling the ulcer diathesis in the long term. In addition, it seems to lessen some of the side-effects of gastric surgery. For these reasons, consideration should be given to its use in the surgical treatment of duodenal ulcer.
The effect of zinc deficiency on wound healing
Authors: Rahmat A , Norman J N , Smith G
Published: March 2007

The place of the trace element zinc in wound healing has been the subject of much recent discussion. Since it is theoretically possible that seriously ill surgical patients may become zinc deficient it seems of importance to establish the relationship between zinc and wound healing. In the experiments described here zinc deficiency has been created in rats and two parameters of wound healing, namely the rate of epithelialization of excised wounds and the development of tensile strength in incised wounds, have been measured and compared with similar measurements in control animals. It has been shown that there was a significant delay in the healing of excised wounds in zinc-deficient animals, and the development of tensile strength in incised wounds was also significantly less when measured at the same time as the wounds of control animals. Histologically there was no difference in the wounds of zinc-deficient or control animals.
Protection of the facial nerve in radical neck dissection
Authors: Ramsden R T , Maran A G D
Published: March 2007

Measurements made on cadavers showed that the facial nerve is usually less than a centimetre from the classic line of transection used in a radical neck dissection. The use of the transverse process of CI as a landmark is presented as a reliable method of avoiding a facial nerve paralysis in the operation.
Peroperative evaluation of the viability of ischaemic colon in primates
Authors: Moossa A R , Skinner D B , Zarins C K , Rhodes B A
Published: March 2007

An experimental model of ischaemic colitis was produced in 14 rhesus monkeys by complete vascular occlusion to the splenic flexure for periods varying from 4 to 8.5 hours. Clinical assessment of bowel viability following revascularization was inaccurate in 10 monkeys. Reactive hyperaemia was quantitatively measured using 99mtechnetium-tagged albumin micro-spheres and this correlated well with autopsy findings – a marked hyperaemic response suggested a transient form of ischaemic colitis; a diminished or absent hyperaemic response predicted the development of strictures or gangrene of the colon segment. A clinical trial is currently being organized to assess the viability of ischaemic bowel at laparotomy.
The solitary thyroid nodule
Authors: Sachdeva H S , Wig J D , Bose S M , Chowdhary G C , Dutta B N
Published: March 2007

Seventy-three cases of solitary thyroid nodule have been analysed in detail, including their clinical presentation and operative and histological features. Females were more frequently affected than males in a ratio of 6:1. A considerable number of solitary nodules diagnosed clinically turned out to be multinodular at operation (164 per cent).The incidence of malignancy in the present series was 6·8 per cent while that of toxicity was 6 per cent.

Drill biopsy was found to be a useful diagnostic aid with a high accuracy rate. Thyroid lymphography has not been found to be of much help.

In view of the low incidence of malignancy a plea for excision of the solitary thyroid nodule is made.
Permanent cardiac pacing through the subclavian vein
Authors: Jachuck S J , Gill B S , Petty A H
Published: March 2007

A technique for the insertion of an intracardiac electrode through the subclavian vein and implanting the generator in the axilla for permanent endocardia1 pacing is described in 30 patients. Provided that adequate precautions are taken and the procedure is carried out by experienced personnel, complications are uncommon.

The generator is implanted after the pacing threshold has been found to be satisfactorily stable. Drainage is not used and routine antibiotics are not given to any patient unless secondary infection of the wound complicates the procedure. Advantages of this technique over the other conventional methods are described.
Management of villous tumours of the rectum
Authors: Butler M J , Southwood W F W
Published: March 2007

The villous tumours of the rectum seen during a 7-year period are reviewed. The majority of these have been treated by ligature and excision or by diathermy snare. Both these methods have been used for localized turmours and the papillomas have been destroyed with a low rate of recurrence. Fulguration has not been used as a primary method of treatment but has been kept for the treatment of small residual foci of tumour. Larger papillomas require more extensive surgery, and an example of trans-sphincteric excision is described.
The somatotopic representation of the micturition pathways in the cervical cord of man
Authors: Hitchcock E , Newsome D , Salama M
Published: March 2007

Bladder function has been studied in a group of patients submitted to open and percutaneous high cervical cordotomy. It is concluded that the vesicomotor pathway lies within 3 mm of the cord surface in the region of the dentate ligament. Vesicosensory pathways probably lie in the posterior columns. The investigation supports the thesis that visceral frtnctions such as respiration and micturition are associated with appropriate somatic innervation.
The effect of trauma on colonic healing
Authors: Irvin Thomas T , Hunt Thomas K
Published: March 2007

Clinical studies have shown that bloody or traumatic colonic operations are associated with a high incidence of anastomotic dehiscence, and it has been suggested that trauma has important systemic effects on colonic healing. However, intra-abdominal trauma may have important local effects on colon healing, and the pathogenesis of anastomotic disruption in traumatized subjects remains uncertain.

The effects of local and remote trauma were studied in colonic anastomoses in rats. Local trauma consisted of a retroperitoneal dissection and biopsy of the psoas muscle, and some animals were given peritoneal drains. Remote trauma consisted of a comminuted fracture of the femur.

Remote trauma had no effect on the tensile strength and collagen content of colonic anastomoses, but local trauma in the vicinity of anastomoses resulted in loss of colonic tensile strength and a significant incidence of anastomotic disruption. The incidence of anastomotic disruption was not significantly affected by peritoneal drains.

Anastomotic dehiscence in traumatized animals was accompanied by a significant reduction in the collagen content and collagen concentration of anastomoses. It is concluded that sepsis is the most probable cause of the failure of anastomotic healing in traumatized animals.
Carcinoma of the male breast
Authors: Hudson M J K , Smart C J
Published: March 2007

Sixteen new patients with carcinoma of the male breast presented to St Bartholomew's Hospital in the 20-year period from 1952 to 1971. Twelve (75 per cent) had Stage III or Stage IV disease. Seven of those in Stage III were thus classified by reason of the advanced (T3) local lesions and were treated by radical mastectomy. Results of treatment are recorded. The most significant prognostic factor is probably lymph node involvement. Orchidectomy is recommended in the management of disseminated disease and hormone assay studies may help to determine whether subsequent adrenalectomy will be benefit. Two stiking remissions following orchidectomy are presented.
Gastropericardial fistula-a complication of hiatus hernia
Authors: Monro J L , Nicholls R J , Hately W , Murray R S , Flavell G
Published: March 2007

A case is reported of a pneumopericardium in a 69-year-old woman caused by the rupture into the pericardium of a gastric ulcer situated in a hiatus hernia. Gastrografin studies were used to confirm the diagnosis and her initial conservative management was successful. However, she died at the operation to close her fistula, probably largely as a result of multiple unsuspected pulmonary emboli compounding her acid pericarditis.
Combined transpleural exploration and extraserous drainage of subphrenic abscess
Authors: Halliday P , Grant A F , Nicks G R , Leckle B D , Loewenthal J
Published: March 2007

Combined transpleural exploration and extraserous drainage of subphrenic abscesses offer the advantages of transpleural exploration for location of a subphrenic abscess with the safety of extraserous drainage. In addition, thoracic complications can be treated simultaneously. The method was employed with success in 18 of 20 patients, in 12 of whom serious thoracic complications were present.
Repair of burst abdominal incisions
Authors: Young Donald
Published: March 2007

A technique is described for the repair of burst abdominal incisions which ensures that pressure from below the incision tends to bring together the walls of the wound. This technique is most useful for fat flabby abdomens.
A rational basis for management of patients with the Buerger syndrome
Authors: Hill G L
Published: March 2007

The clinical course of 97 patients with the Buerger syndrome has been studied. Risk factors and prognostic factors which have a bearing on the development and course of the syndrome have been determined.

From these data a management programme for patients with the Buerger syndrome has been developed. The clinical course is characterized by acute attacks and long remissions. Thus the management programme is primarily aimed at preventing attacks and, when they occur, in limiting their extent.

The known risk factors and prognostic factors demonstrate the overwhelming importance of smoking in both the development and prognosis of the syndrome.
Phlebography in the management of pulmonary embolism
Authors: Corrigan T P , Fossard D P , Spindler J , Armstrong P , Strachan C J L , Johnston K W , Kakkar V V
Published: March 2007

The value of phlebography in the management of 102 patients presenting with clinical features suggestive of pulmonary embolism was assessed. Ascending phlebograms, chest x-rays and pulmonary perfusion scans were performed in all the cases. Of 33 patients with a high probability of pulmonary embolism, 29 (87 per cent) had thrombi in the peripheral veins shown by phlebography. Of 45 patients with no evidence of pulmonary emboli on lung scan, the deep veins were normal in 30, while in the remaining 15 (33 per cent), phlebograms showed the presence of thrombi. In all 7 patients where pulmonary angiography confirmed the presence of extensive emboli, phlebograms showed thrombi in the peripheral veins. Phlebography was of considerable help in deciding whether to give anticoagulant therapy.
The role of bile acids in the pathogenesis of postvagotomy diarrhoea
Authors: Allan J G , Gerskowitch V P , Russell R I
Published: March 2007

The fecal excretion of bile acids was estimated in patients with postvagotomy diarrhoea, normal control subjects and a control group who had undergone truncal vagotomy and drainage but who did not have diarrhoea. The total daily bile acid excretion in the feces was significantly increased in the postvagotomy diarrhoea group: 2538 ± 632 mg (s.e.m.) compared with 799 ± 117 mg in the normal controls. There was no significant difference between the total daily bile acid excretion in the patients with postvagotomy diarrhoea and that of patients who had undergone vagotomy and drainage but who did not have diarrhoea. A significant increase in the fecal excretion of chenodeoxycholic acid was found in the postvagotomy diarrhoea group compared with the two control groups. This increase may be a factor in the pathogenesis of postvagotomy diarrhoea.
The distribution of gastritis in carcinoma of the stomach
Authors: du Plessis D J
Published: March 2007

Twenty-one stomachs resected for carcinoma were studied histologically using the ‘Swiss-roll’ technique. Chronic gastritis with epithelial hyperplasia was present in all.

There were two types of distribution of the gastritis. In 17 instances it extended continuously from the pylorus proximally up to or beyond the carcinoma. This type of gastritis could be due to reflux of duodenal contents into the stomach. In 4 stomachs the gastritis occurred only in the vicinity of the tumour but did not extend from the pylorus and could therefore not be the result of duodenal reflux.

It is postulated that there may be two kinds of carcinoma. One type is associated with the epithelial hyperplasia of chronic gastritis, possibly resulting from duodenal reflux into the stomach, The other is also associated with chronic gastritis but the distribution does not suggest duodenal reflux.
Posterior rupture of the knee joint in septic arthritis: Case report
Authors: Good C J , Jones M A
Published: March 2007

A case of septic arthritis of the knee joint which had ruptured posteriorly and presented as a swollen calf is described.
Kidney preservation by hypothermic perfusion with albumin versus plasma and with pulsatile versus non-pulsatile flow
Authors: Abouna George M , Pashley David H , Ginsbury Jack M , Delong T Greggory , Sobel Robert E , Jeske Arthur H
Published: March 2007

Four groups of canine kidneys were preserved by hypothermic perfusion for 24 hours in an attempt to compare the relative merits of using cryoprecipitated plasma or albumin as perfusates and of using pulsatile or non-pulsatile flow. All the kidneys were subsequently autotransplanted At 0, 3 and 24 hours during preservation the following parameters were measured: perfusate and urine flow, renal vascular resistance, perfusate serum glutamic oxaloacetic transamianase, lactic dehydrogenase, acid and alkaline phosphatases, ammonia, free fatty acids, clearances of creatinine, 131I hippuran, Na+ and K+. After reimplantation similar renal clearance studies were carried out. After transplantation overall kidney viability was assessed by recipient survival and by serum creatinine levels. The results obtained were subjected to statistical analysis and compared between the groups. It was found that perfusion with albumin solution gave a significantly higher perfusate flow rate (P<0·02) and lower vascular resistance (P< 0·001) than perfusion with plasma. With albumin as the perfusate there was no significant difference in perfusion characteristics or in the post-implantation renal clearances regardless of whether pulsatile or non-pulsatile flow was used. With plasma as the perfusate there was significantly higher perfusate flow (P<0·01), lower vascular resistance and higher post-implantation creatinine and hippuran clearances (P<0·02, P<0·001) with pulsatile than with non-pulsatile flow. In 24-hour renal preservation overall recipient survival and graft function after transplantation were similar regardless of the nature of the perfusate or the type of perfusion.
Facial incisions and approaches
Authors: Saad M N , Maisels D O
Published: March 2007

In this paper the basic principles are laid down for the design and technique of incisions in the face and neck. Adherence to these simple precepts will be well rewarded in terms of patients' and surgeons' satisfaction.
Intraspinal hibernoma
Authors: Shuangshott Samruay , Menakanit Wit
Published: March 2007

A case is reported of a spinal subdural hibernoma arising in the lumbar region of a boy aged 14 years who also had a lumbar spina bifida. The circumscribed and encapsulated tumour was attached to the leptomeninges, extended into the dud sac and compressed upon the cauda equina. Severe pain in the calves was relieved after extirpation of the mass. The pathogenesis of the tumour is suggested to be associated with aberrant differentiation of the mesenchyme or its derivatives towards adibose tissue.
Organization of valve pocket thrombi and the anomalies of double thrombi and valve cusp involvement
Authors: Sevitt Simon
Published: March 2007

Organization and resolution were studied histologically in 48 valve pocket thrombi from femoral veins. The great majority were essentially single structures and the overlying cusps were normal and uninvolved, Thrombus adherence to the distal part of the vein wall in the pocket is followed by cellular and vascular invasion and progressive organization. At the same time many thrombi continue to grow by proximal addition, whilst others regress fully to fibrous intimal plaques. Central fibrinolytic changes are frequent. Focal organic fragmentation following endothelial cell surfacing is not uncommon and is a potential cause of thrombus detachment.

Eight thrombi differed in that 5 were anchored to part of the cusp and 4 had a double structure resulting from two demarcated thrombotic events. One thrombus showed both features. In 3 thrombi with anchored cusps scarred intimal remnants of old thrombosis were present nearby. In 3 double structures recent thrombus had been laid down on organizing or organized thrombus, whilst the fourth was unique in that one part was composed solely of a large mass of platelets. The role of endothelium-induced fibrinolysis in preventing cusp adherence and of intact endothelium in preventing second thrombi are discussed.
Prostatectomy and deep vein thrombosis in Sudanese patients
Authors: Hassan M A , Rahman E A , Rahman I A
Published: March 2007

One hundred and four Sudanese patients who had undergone the operation of prostatectomy (transvesical or retropubic but not transurethral) in Khartoum Civil Hospital were investigated for evidence of postoperative deep vein thrombosis (D VT) by the use of the 125 1-fibrinogen test. Of these 104 patients, 10 had evidence of DVT, i.e. an incidence of 9.6 per cent. This differs sharply from the incidence (21-47 per cent) reported from Swedish and British hospitals, and further confirms our previous findings that the incidence of postoperative D VT in Sudanese patients is significantly lower than in European patients.
The fate of elderly amputees
Authors: Harris P L , Read Frances , Eardley Anne , Charlesworth D , Wakefield John , Sellwood R A
Published: March 2007

The results of amputation of the lower limb in 75 elderly atherosclerotic patients are presented. Less than 50 per cent of the patients survived for more than 6 months after operation. The average time spent in hospital after the operation was 57.6 days. When the present study was started only 26 (35 per cent) of the patients were still living. Seventeen of the survivors were using artificial limbs to some extent.

A plea is made for special rehabilitation units which could provide the progressive care that these patients need.
Circulatory and biochemical effects of whole body hyperthermia
Authors: Pettigrew R T , Galt Jean M , Ludgate C M , Horn D B , Smith A N
Published: March 2007

The physiological effects of whole body hyperthermia to 42 C° have been studied in 12 subjects. There was a sustained increase in the heart rate and an initial increase in the arterial and central venous pressures. Sweat and electrolyte losses were high. The serum bilirubin remained normal if the temperature did not exceed 41.8 C°. Above this temperature the serum enzymes lactate dehydrogenase, alanine aminotransferase and aspartate aminotransferase rose, as did the serum bilirubin. While the latter effect might be due to liver damage, it could also be related to thermal destruction of red cells. A leucocytosis develops during the hyperthermic state.
Gastric phycomycosis
Authors: Lawson H H , Schmaman A
Published: March 2007

Seven fatal cases of invasive gastric phycomycosis are reported. Four surgical patients presented with perforated gastroduodenal ulcer. Three medical cases were diagnosed at autopsy.

Two surviving surgical cases are reported with non-invasive colonization of gastric ulcers, where operation was carried out for bleeding.

When gastric phycomycosis presents as an invasive fungal infection the prognosis is extremely poor. Alternatively, the fungus may colonize the gastric mucosa without deeper invasion of the blood vessels, when the prognosis is good. A definite distinction between invasion and colonization can only be made histologically. Invasion should, however, be suspected at operation by the hardness of the tissues, their black discoloration and a hyperaemic zone between normal and abnormal areas.

The fungus can invade the mucosa through a chronic gastric ulcer, when it usually occurs in relation to the lesser curvature. It is suggested that it may also gain access to the mucosa as a result of ulceration, occurring in the course of a debilitating disease. In this case the ulcer may occur anywhere within the stomach, and not infrequently multiple ulcers are present.

The treatment of choice if the patient is fit is resection of the affected part of the stomach, as the basic lesion is tissue necrosis.

Supportive treatment should include amphotericin B and antibiotics such as cephaloridine and gentamicin to control the associated bacterial infection which is often present.
Non-osseous eosinophilic granuloma presenting as acute transverse myelitis
Authors: Cardozo L J , Bailey I C , Billinghurst J R , Poltera A A
Published: March 2007

A patient with non-osseous eosinophilic granuloma presenting as acute transverse myelitis is documented. This is believed to be the first recorded case with such a presentation. Some aspects of the disease are discussed.