bluuebunny/crossref_metadata_2025 huggingface dataset:
Fatigue and cardiorespiratory function following abdominal surgery
Authors: Christensen T , Bendix T , Kehlet H
Published: March 2007

Subjective feelings of fatigue were assessed before operation and 10, 20 and 30 days after uncomplicated elective abdominal surgery in 16 otherwise healthy patients, using a constructed fatigue scale model. In addition, all patients had an orthostatic stress test performed at the same times. Six of the patients also underwent a bicycle ergometer test measuring heart rate and oxygen consumption. Subjective feelings of fatigue were increased (P<0·01) at all three postoperative observations, and only 5 of 16 patients returned to their preoperative level. The increased subjective feeling of fatigue correlated positively (Rs = 0·53, P<0·001) with the increased pulse rate seen during orthostatic stress after operation. Heart rate was about 5 per cent higher (n.s.) after operation when bicycling at the same work loads, while oxygen consumption decreased by about 2 per cent (P<0·01) at all three postoperative bicycle tests. It is concluded that even elective uncomplicated abdominal surgery is followed by a pronounced feeling of fatigue, which may persist 1 month after surgery in about one-third of patients. The fatigue scale model seems applicable for future studies on the pathogenesis and treatment of the postoperative fatigue syndrome.
Diagnostic features of early high post-laparotomy fever: A prospective study of 100 patients
Authors: Le Gall J R , Fagniez P L , Meakins J , Buisson C Brun , Trunet P , Carlet J
Published: March 2007

To define the most important diagnostic signs, symptoms and laboratory findings related to intra-abdominal sepsis in the early post-operative period, 15 binary variables were prospectively assessed in 100 febrile (> 39 °C) post-laparotomy patients admitted to an intensive care unit. Intra-abdominal sepsis was found alone in 55 patients and in association with an extra-abdominal focus in 11 patients. Fever was related to an extra-abdominal septic focus in 23 patients and no infectious cause was found in 11. Analysis (χ2) indicated that 6 of the 15 variables were significantly associated with an intra-abdominal focus of infection. The predictive value of each variable, indicated by relative risk, ranked the six variables in order of diagnostic importances: no bacteraemia (1·67), leucocytosis (1·60), ileus (1·50), mental disturbances (1·41), contaminated first laparotomy (1·38), abdominal tenderness (1·22). The absence of bacteraemia was the most important finding separating intra- and extra-abdominal foci of infection. In a febrile post-laparotomy patient with any evidence of sepsis, the absence of bacteraemia should not lull the physician into a false sense of security but rather alert him to the likelihood of an intra-abdominal septic focus.
Does calcitonin cause hypocalcaemia after thyroidectomy?
Authors: Sawers J S A , Kellett H A , Brown N S , Beckett G J , Seth J , Sinclair I S R , Toft A D
Published: March 2007

Plasma calcitonin, parathyroid hormone, total thyroid hormones and calcium were measured in 6 patients before, during and after thyroidectomy for hyperthyroidism. In 4 patients, plasma calcium fell postoperatively by 0·23–0·46 mmol/l, but there was no change in calcitonin or parathyroid hormone levels. In one patient, in whom there was a postoperative fall in plasma calcium of 0·55 mmol/l, thyroid hormones rose to a peak at 1 h and calcitonin to a peak at 12 h after resection. However, the rise in calcitonin occurred 8 h after the initial decrease in plasma calcium. In this patient, parathyroid hormone levels showed a slight rise only. It is concluded that, while thyroid hormones and calcitonin may leak from the damaged thyroid remnant after surgery, it is unlikely that calcitonin is important in the production of postoperative hypocalcaemia. However, impaired parathyroid hormone secretion may be a contributing factor.
The pelvic floor musculature in the descending perineum syndrome
Authors: Henry M M , Parks A G , Swash M
Published: March 2007

We have studied 20 patients with the descending perineum syndrome, half of whom were incontinent of faeces. Objective criteria were established in 103 control subjects for determining the relationship of the perineum to the bony pelvis. The anal reflex latency was increased in the 10 patients in whom perineal descent was associated with faecal incontinence, but not in the 10 without incontinence. However, there was hypertrophy of the muscle fibres in external anal sphincter muscle biopsies in all the patients. Thus, abnormal degrees of perineal descent are associated with changes in the external anal sphincter muscle, consistent with damage to its nerve supply.
The management of the perforated appendix: A controlled clinical trial
Authors: Brennan S S , Smith G M R , Evans Mary , Pollock A V
Published: March 2007

Seventy-one patients with peritonitis due to perforation of the appendix were treated by preoperative rectal metronidazole, appendicectomy and omission of skin closure. They were then randomized to have either no further antibacterial treatment, or rectal metronidazole twice-daily for 5 days. No major wound infections occurred, but 8 patients developed intraperitoneal abscesses. In addition, I died of a pulmonary embolus and 1 required further laparotomy for intestinal obstruction.

Patients in the 5-day-metronidazole group suffered fewer intraperitoneal abscesses and less pyrexia, but the differences did not achieve statistical significance. This series shows a considerable improvement over a previously published series in terms of morbidity, duration of pyrexia and length of hospital stay.
Ischaemia and partial resection for control of splenic hyperfunction
Authors: Witte C L , van Wyck D B , Witte M H , Corrigan J J , Zukoski C F , Pond G D , Woolfenden J M
Published: March 2007

Patients with blood dyscrasia are particularly susceptible to fulminant sepsis after splenectomy. We therefore examined the therapeutic response to partial splenic amputation in 2 patients and transcatheter splenic artery occlusion or embolization in 3 patients with splenic hyperfunction. Partial splenectomy relieved associated symptoms and corrected peripheral cytopenias while preserving a substantial splenic remnant on radionuclide scintiscan and preventing appearance of Howell–Jolly bodies in the peripheral blood. Gelatin sponge embolization promoted selective splenic infarction and also corrected peripheral cytopenias, thereby facilitating immunosuppression to prevent renal allograft rejection. Steel coil occlusion of the main splenic artery in a patient with hepatic cirrhosis, however, although initially reducing splenic inflow, ‘decompressing’ the mesenteric portal system and ameliorating pancytopenia ultimately proved of only temporary benefit, confirming the results of prior attempts to curtail splenic hyperfunction by interruption of the extrasplenic arterial supply alone. Partial splenic preservation or hyposplenism is preferable to total splenectomy but, depending on the mass of splenic tissue left behind and the nature of the stimulus for hypersplenism, a fine line may exist between haematological recurrence and increased risk of overwhelming sepsis.
The Monark bicycle ergometer in screening arterial patients
Authors: De Cossart Linda , Marples M , Cloherty G , Marcuson R W
Published: March 2007

In patients with peripheral arterial disease, maximum walking distance on a treadmill is commonly used for studying the effect of exercise on ankle systolic pressure. Exercise on the Monark bicycle ergometer for 1 min at a workload of 1 kp and cycling at 20 kph has been compared with treadmill walking in 30 patients presenting with calf pain on exercise at the vascular clinic and in 6 normal volunteers. The bicycle test produced a significant fall in ankle systolic pressure in all patients with advanced arterial disease. There was no statistical difference in the results obtained on the bicycle compared with the treadmill. There was better patient compliance with the bicycle test. The Monark bicycle ergometer, a simple inexpensive instrument, is a viable alternative to the treadmill for exercising arterial patients.
Bacteriological implications in the pathogenesis of secondary aortoenteric fistulas
Authors: Wilson S E , Bennion R S , Serota A I , Williams R A
Published: March 2007

The role of bacterial infection in the pathogenesis of aorto-enteric fistula was examined by a collective review of the clinical features and bacteriology in 213 patients. The most common presentation, gastrointestinal bleeding, occurred in 49 per cent of patients, although 32 per cent had systemic or local signs of infection as a presenting symptom. Results of intraoperative cultures were available in 115 patients, 33 of whom had two or more isolates. The predominant organisms were Escherichia coli, Staphylococcus aureus, group D Streptococcus and Bacteroides spp. The Gram-positive aerobic cocci predominated in fistulas developing within the first postoperative year which is compatible with a primary infection due to intraoperative contamination with skin flora. The Enterobacteriaceae and anaerobes showed no predilection for early or late occurring fistulas, suggesting that infection in these patients may be secondary to mechanical erosion of the graft through the adjacent duodenum. In either event, the likelihood that the aorto-enteric fistula is complicated by prosthetic infection should be seriously considered by the surgeon in planning the operative procedure.
Skew flap myoplastic below-knee amputation: A preliminary report
Authors: Robinson K P , Hoile R , Coddington T
Published: March 2007

A preliminary report is made of a modified technique of below-knee amputation using skewed sagittal skin flaps, combined with a posterior myoplasty. The satisfactory initial shape eliminates any delay for maturation of the stump and allows early casting of the socket for a prosthesis which can be worn within 3 weeks of operation for non-vascular amputations and within 4 weeks for vascular amputations. Forty-seven of these amputations have been performed; 4 patients required re-amputation at a higher level and 6 required secondary minor revision before full healing was achieved. In the remaining patients healing was uneventful.
Long term results of a consistent policy of sphincter preservation in the treatment of carcinoma of the rectum
Authors: Jones P F , Thomson H J
Published: March 2007

With increasing emphasis on sphincter preservation in the treatment of low carcinomas of the rectum, it is important to know whether such a policy results in satisfactory rectal function and long term survival. In 368 patients operated upon for carcinoma of the rectum between 1958 and 1980, a consistent policy of sphincter preservation was followed, and resulted in 222 (61 per cent) patients having a restorative resection (RR), whilst 132 (37 per cent) had an abdominoperineal excision (APE); 271 (76 per cent) had a radical operation with a hope of cure. Overall operative mortality was 5 per cent (2·6 per cent in the radical group) and the leakage rate in the 222 restorative anastomoses was 5 per cent. Follow-up of 98 per cent of patients treated over 5 years ago has been possible. Special attention has been paid to the late results in patients having a restorative resection of tumours at and below 8 cm: all these patients are continent and there is no excess of late pelvic recurrence. Corrected 5-year survival rates are 72 per cent for abdominoperineal excision and 84 per cent for restorative resection.
Intraluminal versus humoral factors in intestinal cell proliferation
Authors: Li A K C , Jeppsson B W , Jamieson C G
Published: March 2007

Since both intraluminal and humoral factors have been implicated in postresectional intestinal hyperplasia, we investigated the relative importance of these factors by using cutaneous parabiotic rats with shared gut. Paired cutaneous parabiosis with a common peritoneal cavity was established in inbred Fischer rats. One month later, in one group of animals one member of the pair had a 64 per cent small bowel resection, while in the control group transection alone was performed. Immediately all the rats underwent intestinal crossover, achieved by anastomosing the proximal small bowel of each rat to the distal small bowel of its partner.

In the jejunum 2 weeks later there was an 18 per cent increase in DNA content and a 26 per cent increase in wet weight in the animals with resection compared with their parabionts (P < 0·05). There was no difference between the parabionts without resection and the control animals. Because of the intestinal crossover, the more proximally placed ileum from the rats without resection showed a 53–58 per cent increase in DNA content, 28–29 per cent increase in RNA content and 51–57 per cent increase in wet weight compared with the normally placed ileum from the partners that had resection and with the control (P < 0·001). There was no difference between the control and the normally placed ileum from the animals that had resection. The position of the ileum after resection appeared to be the major influence on hyperplasia, since no measurable difference in nucleic acid contents was detected between the ileum of the animals with resection and the control. However, humoral factors do operate locally and may play a permissive role because the jejunum of the animals with resection showed DNA increase when compared with the control.
Operative approach to cancer of the head of the pancreas and the peri-ampullary region
Authors: Obertop H , Bruining H A , Schattenkerk M Eeftinck , Eggink W F , Jeekel J , Van Houten H
Published: March 2007

A retrospective study was made of 75 consecutive patients treated for a tumour of the head of the pancreas and the peri-ampullary region from January 1978 to August 1981. These patients underwent either pancreatic resection—pancreatoduodenectomy (n = 24) and total pancreatectomy (n = 10)—palliative procedures (n = 29) or exploratory laparotomy (n = 12). Clinical signs and diagnostic procedures, such as ultrasonography and coeliac arteriography, were studied for their value in preoperative assessment of operability. Vaso-invasion, as revealed by arteriography and, to a lesser extent, ultrasonographic signs of a tumour and the absence of jaundice were poor prognostic signs.

The operative mortality was 8 per cent for the group as a whole, but somewhat higher (13 per cent) for the group that underwent pancreatoduodenectomy. No patient died after total pancreatectomy. The operative mortality was 27 per cent in all patients aged 70 years or older, but only 3 per cent in patients under 70 years. One-year patient survival was 94 per cent after pancreatoduodenectomy for peri-ampullary cancer and 57 per cent after resection for cancer of the head of the pancreas.

The results of this study point to pancreatic resection as the treatment of choice for resectable tumours of the peri-ampullary region and the head of the pancreas in patients under 70 years of age. Coeliac arteriography and ultrasonography have been found to be useful for preoperative classification of tumour stage.
The treatment of autonomous functioning thyroid nodules
Authors: Eyre-Brook I A , Talbot C H
Published: March 2007

The clinical features and management of 90 thyrotoxic and 11 euthyroid patients with a single autonomous hot nodule in the thyroid have been reviewed to assess the results of surgery and radio-iodine therapy. Symptoms and signs of thyrotoxicosis were often minimal but histories were frequently long with cardiac complications predominating. Thyrotoxicosis was permanently eradicated in the 60 patients treated surgically, although hypothyroidism occurred in 6·6 per cent. Twelve of the 37 (32 per cent) thyrotoxic patients receiving radio-iodine needed further definitive treatment for persistent or recurrent thyrotoxicosis, but only 2 patients (5 per cent) became hypothyroid. Early surgery for the autonomous toxic thyroid nodule ensures control of the thyroid overactivity and minimizes the risk of permanent cardiac damage. The absence of morbidity justifies surgical excision of autonomous hot nodules in patients who are euthyroid to eliminate the risk of thyrotoxicosis supervening.
Late follow-up of highly selective vagotomy with excision of the ulcer compared with Billroth I gastrectomy for treatment of benign gastric ulcer
Authors: Reid D A , Duthie H L , Bransom C J , Johnson A G
Published: March 2007

We present the late results of a prospective randomized trial of highly selective vagotomy with excision of the ulcer (HSV + E) (n = 26 cases) versus standard Billroth I partial gastrectomy (BI) (n = 30). The operations were performed by registrars, senior registrars or consultants. Results of postoperative morbidity, functional outcome and recurrence rates have previously been reported at an average follow-up period of 4 years (1), at which stage neither operation offered a distinct advantage. At an average follow-up period of 8 years, 54 of the original 56 patients have been reassessed, using a standard Visick grading. HSV + E offers a better symptomatic result. There is an increased recurrence rate in both groups with time, 6 following HSV + E and 5 following BI gastrectomy.
The value of the small bowel enema to the general surgeon
Authors: Keddie N , Watson-Baker R , Saran M
Published: March 2007

Lesions of the small bowel are notoriously difficult to diagnose, many only coming to light at laparotomy. At this hospital the small bowel enema has been used for radiology of the small bowel for many years. The procedure is uncomfortable for the patient, as intubation of the proximal small bowel is essential, and for the radiologist it can be very time-consuming. A review of patients referred by the general surgeons over the past 5 years has demonstrated the value of the technique. It has proved to be accurate in over 90 per cent of cases with only 2 per cent false negative and I per cent false positive results. The most common diagnosis has been Crohn's disease which can be very accurately assessed. Other lesions diagnosed include lymphoma, involvement by metastases, benign stricture and adhesions. A normal result has prevented an unecessary laparotomy in several patients. It is concluded that this technique is the most satisfactory method for radiology of the small bowel and it should be much more widely available.
The lateral paramedian incision—experience with 850 cases
Authors: Donaldson D R , Hegarty J H , Brennan T G , Guillou P J , Finan P J , Hall T J
Published: March 2007

We present our experience in 850 consecutive patients who had a laparotomy through a lateral paramedian incision during the period 1977–1981. These patients underwent both elective and emergency procedures covering a wide range of intra-abdominal conditions, and had a high incidence of factors known to predispose to wound dehiscence and incisional hernia formation. Follow-up in each case for at least 1 year revealed no wound dehiscences and 3 incisional hernias (0·37 per cent). We conclude that the lateral paramedian incision is inherently strong and that this strength is due to the splintage of the wound by the rectus abdominis muscle and the wide shutter mechanism that this provides.
Parotid fistulas: a review
Authors: Ananthakrishnan N , Parkash S
Published: March 2007

A series of 17 cases of parotid fistulas seen at one hospital over a 10-year period is presented with detailed analysis of aetiological factors, clinical presentation and therapy. Distinctions between glandular and ductal fistulas have been enumerated and the poorer prognosis of the ductal fistulas, especially of the proximal part, is emphasized. Two-thirds of the fistulas were iatrogenic. Malignancy and oral leucoplakia were unusual causes. Direct duct suture is rarely successful. Ablative surgery carries a significant risk of facial nerve injury. A wide choice of treatment exists for glandular and distal duct fistulas, while for the proximal duct injuries excision is usually necessary. A new alternative operation of vein grafting for such cases is described. Successful closure is obtained in only 50 per cent of patients with long standing fistulas with any method of treatment.
The influence of delayed feeding on postoperative vomiting in hypertrophic pyloric stenosis
Authors: Leahy A , Fitzgerald R J
Published: March 2007

The influence of delayed feeding on postoperative vomiting after Ramstedt's pyloromyotomy was investigated. Two feeding regimens were compared, both of which involved a gradual increase in the strength of feeds: regimen A incorporating a 4-h fasting period and regimen B one lasting 24 h. Of the 67 patients who underwent Ramstedt's pyloromyotomy in 1978 and 1979, 33 were fed by regimen A and 34 by regimen B. Postoperative vomiting was significantly reduced both in incidence and severity in group B. This decrease in vomiting was accomplished without any increase in postoperative stay.
Testicular venography for the localization of the impalpable undescended testis
Authors: Khan O , Williams G , Boley N B , Allison D J
Published: March 2007

An undescended abdominal testis has a high potential for the development of malignancy. Surgery may require both an inguinal and an abdominal exploration. We have used selective testicular venography in 7 men for preoperative testicular localization. In 5, the origin of the testicular vein was identified using this technique and the information acquired proved to be of considerable assistance to the surgeon. We recommend that this technique is used routinely in the localization of the impalpable undescended testis.
Leucocyte mobilization and function in vitro of blood and exudative leucocytes after inguinal herniotomy
Authors: Wandall J H
Published: March 2007

The effect of surgical trauma on leucocyte mobilization in vivo and the function of blood and exudative leucocytes was studied in 15 patients after inguinal herniotomy. Mobilization of leucocytes to skin windows with chambers was reduced 48h after anaesthesia (P < 0·01) compared with 21 healthy volunteers. Blood leucocyte chemotaxis was reduced during the period of anaesthesia (P < 0·05). Serum independent phagocytosis was increased from 24h after anaesthesia (P < 0·01) but without a corresponding increase in the serum dependent phagocytosis. The oxidative metabolic activity of resting leucocytes in terms of Nitro Blue Tetrazolium (NBT) reduction decreased 24–48h after anaesthesia without any change in NBT reduction during phagocytosis. In contrast, exudative leucocytes exhibited reduced phagocytosis independent of serum factors (P < 0·5) and increased NBT reduction by resting leucocytes. It is concluded that a diminished accumulation of leucocytes at inflammatory lesions occurs postoperatively and that changes in the function of circulating leucocytes do not always reflect the changes in function of the exudative leucocyte.
Prognostic factors in breast cancer
Authors: Palmer M K , Lythgoe J P , Smith Alwyn
Published: March 2007

Data relating to 1022 patients with early breast cancer who were entered into a clinical trial have been analysed to assess the importance of various factors in predicting prognosis. Clinical stage was the major determinant of prognosis, and in each stage patients with a breast tumour 2 cm or less in maximum diameter had a significantly better survival than patients with larger tumours. Patients aged between 40 and 49 years and premenopausal patients had relatively favourable prognosis. Site of the tumour within the breast, whether it was situated on the left or the right side, the patient's marital status and the number of pregnancies did not appear to have any influence.
Gardner's stigmas in patients with familial adenomatosis coli
Authors: Järvinen H J , Peltokallio P , Landtman M , Wolf J
Published: March 2007

Extracolonic lesions compatible with Gardner's syndrome were studied in 34 patients from 17 unrelated families with established familial adenomatosis coli. Thirteen patients (38 per cent) had the complete syndrome and 12 patients (35 per cent) a bisymptomatic syndrome. Bone lesions were found in 79 per cent of the patients examined, epidermoid cysts in 35 per cent, desmoid tumours in 18 per cent and dental changes in 18 per cent. One extracolonic manifestation of the triad in at least one affected family member was detected in 14 families (82 per cent). The findings provide additional evidence for the view that all cases of familial adenomatosis coli belong to a single genetic entity. The usually innocent extracolonic signs of Gardner's syndrome serve as valuable markers for early detection of asymptomatic family members at risk. Panoramic X-ray of the jaws seems to be especially suitable for this purpose.
What is the place of lumbar sympathectomy?
Authors: Lindenauer S M , Cronenwett J L
Published: March 2007

Although sympathetic innervation of the extremities has been studied voluminously, the clinical efficacy of sympathectomy remains controversial. This review will be limited to a consideration of the appropriate role of lumbar sympathectomy for primary treatment of intermittent claudication and skin ischaemia manifested by rest pain or superficial tissue loss.
Transient ischaemic attacks: The static and dynamic morphology of the carotid artery bifurcation
Authors: Lusby R J , Woodcock J P , MacHleder H I , Ferrell L D , Jeans W D , Skidmore R , Sheddon E J , Baird R N
Published: March 2007

Studies evaluating the static and dynamic characteristics of the common carotid bifurcation are described. Slow motion angiographic frames, real time B-mode images and time position M-mode tracings have demonstrated appreciable vessel wall motion with an increase in distensibility at the carotid bulb compared to the proximal common carotid artery. Histopathological studies suggest that changes in the carotid artery elastin and collagen structure may contribute to the increased distensibility at the carotid bulb. The presence or absence of a cervical bruit did not correlate with the ultrasonic demonstration of plaque or blood flow turbulence. Mechanical factors relating to the development of symptoms of cerebral ischaemia are discussed.
Surgical treatment of post-phlebitic syndrome
Authors: Taheri S A , Lazar L , Elias S M
Published: March 2007

The post-phlebitic syndrome which succeeds deep vein thrombophlebitis may be treated by various surgical interventions. Removal of incompetent perforating veins and excision of any concomitant skin ulcer with grafting is a usual course of therapy. However, if the skin ulceration and symptoms are actually due to deep venous incompetence then a more direct approach should be attempted.

Numerous procedures have been advocated, such as valvoplasty, homologous vein transplant, synthetic valve procedures and autogenous vein valve transplant.

It has been demonstrated that autogenous vein valve transplant yields a satisfactory haemodynamically stable result with high valve competency rates.

The authors have operated on 10 patients utilizing an autogenous vein valve with good results. Pre- and postoperative data including ascending and descending venography indicate that valvular competence is restored and ulcers heal.
Femorotibial bypass for limb salvage using human umbilical vein
Authors: Klimach O , Charlesworth D
Published: March 2007

A series of 112 consecutive femorotibial bypasses was reviewed in which glutaraldehyde-stabilized human umbilical vein was used for the bypass. The duration of follow-up was between 6 months and 2 1/2 years. Cumulative patency at 2 years for the entire group was 9 per cent. The state of the pedal arteries, site of the distal anastomosis and age of the patient influenced the results. The difference in the patency rates at 1 year between patients with 3 patent pedal arteries and those with only 1 is significant (P < 0·001) as is that between those with 3 and those with 2 (P = 0·024). Of 49 patients with pre-gangrene, in whom the bypass worked for a period in excess of 2 months, only 7 eventually required amputation in contrast to 32 of a group of 39 similar patients in whom the bypass failed early.
Carotid artery surgery in patients with minor stroke
Authors: Takolander R J , Bergentz S-E , Ericsson B F
Published: March 2007

Of 229 carotid artery reconstructions, 67 were performed in patients after a minor stroke. In this group of patients the operative mortality was 5·9 per cent, compared with 1·8 per cent in the group of patients without preoperative minor stroke operated upon during the same period of time. The 5-year survival in the stroke group was 86 per cent and in the non-stroke group it was 65 per cent. Excluding the postoperative mortality, the survival increases to 90 and 68 per cent respectively. The difference, which is significant at 6 years (P < 0·05), is explained by a higher incidence of coronary artery disease in the non-stroke group. The postoperative annual stroke frequency was 2·3 per cent in the stroke group and 2·4 per cent in the non-stroke group. The stroke frequency on the operated side during follow-up was 1·6 per cent per year for both groups together. It seems that a minor stroke is no contraindication to carotid artery reconstruction provided the timing of the operation is correct and other contraindications are considered.
Pilonidal sinuses of the anal canal
Authors: Walsh T H , Mann C V
Published: March 2007

Pilonidal sinuses which open through a primary communication into the anal canal are extremely uncommon. We here report 3 cases. The pathogenesis of these and other hair-containing sinuses in the anal region is discussed.
The anal dilator in the conservative management of acute anal fissures
Authors: McDonald P , Driscoll A M , Nicholls R J
Published: March 2007

Patients presenting with acute anal fissure were randomized into two treatment groups in a prospective clinical trial. Both groups received treatment for 3 weeks with a stool softener and lignocaine jelly. Those entered in group 1 (35 patients) were asked in addition to insert an anal dilator (no. 2) twice daily while those in group 2 (31 patients) applied the anaesthetic jelly without a dilator. At 6 weeks 11 (31·4 per cent) patients in group 1 and 12 (38·7 per cent) patients in group 2 had been referred for sphincterotomy owing to failure of the treatment. At 6 months this figure had risen to 14 (40 per cent) in group 1 and 15 (48·4 per cent) in group 2. This difference was not statistically significant, suggesting that the addition of a dilator to the conservative treatment regimen did not diminish the likelihood of surgery.
The grading of sepsis
Authors: Elebute E A , Stoner H B
Published: March 2007

A simple system for grading the severity of sepsis has been developed by scoring the attributes of sepsis under four headings: local effects of infection, pyrexia, secondary effects of sepsis and laboratory data. The information needed should be readily available at district general hospital level. The system produces a number which indicates the severity of sepsis and which varies with the patient's condition. This system could be useful in comparing patients with sepsis and studies on such patients in different centres.
Extracellular fluid volume expansion and third space sequestration at the site of small bowel anastomoses
Authors: Chan S T F , Kapadia C R , Johnson A W , Radcliffe A G , Dudley H A F
Published: March 2007

Intestinal surgery is usually associated with the parenteral administration of sodium and water, sometimes in amounts considerably in excess of excretory capacity. We have studied the effect of this situation on the water content of the gut at and 5 cm from a single-layer end-to-end anastomosis in the rabbit. Water content was measured by desiccation. One group of animals (group 1) did not receive intravenous therapy. The second group (group 2) received 5 ml kg−1 h−1 of Hartmann's solution during the operative period and thereafter to a total volume of 200 ml by 48 h. In group 1 there was a 5–10 per cent increase in tissue weight both at the anastomotic site and at 5 cm (P < 0·01, Mann-Whitney U test) on the first 3 days. Thereafter, water content at the anastomosis persisted, but resolved in normal gut. In group 2 a further 5 per cent increase in weight over group 1 occurred (P < 0·01), persistent at the anastomotic site over 5 days, though resolving elsewhere after 2 days. Extracellular fluid volume expansion exaggerates an anatomical third space present in the region of an anastomosis. At the suture line, oedema so induced is persistent and could be deleterious.
The rectus abdominis myocutaneous island flap in breast cancer
Authors: Webster D J T , Hughes L E
Published: March 2007

The use of 30 rectus abdominis flaps in patients with breast cancer is described. In 7 patients the flap has been used to repair the defect following ablation of recurrent disease or radionecrotic ulcers. In the remaining 23 the flap has been used as part of a primary reconstruction at the time of mastectomy. The technique is described together with the results in these patients. The cosmetic results have been satisfactory. The technique as described has proved completely reliable. Follow-up to 18 months has shown that fears of incisional hernias developing are unfounded.
Dieulafoy's disease: A distinctive arteriovenous malformation causing massive gastric haemorrhage
Authors: McC. Mortensen N J , Mountford R A , Davies J D , Jeans W D
Published: March 2007

Dieulafoy's disease is a distinctive arteriovenous malformation of the gastric fundus, which presents with massive or recurrent gastrointestinal bleeding. The lesion is very small and easily overlooked even at laparotomy, and can only be correctly diagnosed by endoscopy or arteriography if the patient is actively bleeding. A wedge resection will stop bleeding and give histological confirmation of the characteristic submucosal vessels.
The effect of isotonic amino acid infusions on serum proteins and muscle breakdown following surgery
Authors: Garden O J , Smith A , Harris N W S , Shenkin A , Sim A J W , Carter D C
Published: March 2007

Twenty patients undergoing major surgical procedures received constant infusion (2 l/day) of either 3·5 per cent amino acid (AA) or 5 per cent dextrose (D5W) solutions in addition to other fluid requirements for 4 postoperative days. Ketosis was evident in A A patients as a mean daily β-hydroxy butyrate excretion of 2·16 ± 1·39 mmol and respiratory quotient of 0·708 ± 0·013 compared with 0·28 ± 0·45 mmol/day and 0·754 ± 0·015 respectively in the D5W group. The serum total protein and albumin concentrations (but not those of transferrin and prealbumin) were significantly higher in the A A than the D5W group on day 4. However, the mean fluid balance for days 3 and 4 was significantly less positive in AA patients. The mean daily nitrogen balance of −6·6 ± 7·7 gN/day in A A patients and −9·5 ± 5·8 gN/day in D5W patients was not significantly different. Mean daily 3-methyl histidine excretion (38·2 ± 12·3 μmol/mmol creatinine) in A A patients was significantly higher than in D5W patients (31·2 ± 10·8 μmol/mmol creatinine). With no improvement in nitrogen balance, an increase in muscle protein breakdown and the possibility that decreased fluid retention explains the higher serum total protein and albumin levels, this study fails to demonstrate improved protein sparing by isotonic amino acid infusions following surgery.
The action of glucagon and commonly used antispasmodics and analgesics on the canine ureter
Authors: Stower M J , Wright J W , Hardcastle J D
Published: March 2007

Ureteric peristalsis has been studied using extraluminal bipolar electrodes and metal foil strain gauges in both the unanaesthetized and anaesthetized dog. Electrical activity of the ureter was characterized by bipolar action potentials, which always preceded mechanical activity. In the acute studies glucagon 44 μg/kg i.v. was given during the unstimulated phase and again during a forced diuresis. Complete inhibition of ureteric activity was seen for 19·50 (± 3·76 s.e.) and 16·25 (± 1·59 s.e.) min respectively. During this period there was no change in the rate of urine flow.

In the conscious dog glucagon was given as a bolus of 22 μg/kg followed by an infusion for 45 min. An infusion of 88 μg/kg h produced complete inhibition for 39·2 (± 2·41 s.e.) min. Propantheline, hyoscine, morphine, pethidine and buprenorphine were given in equivalent therapeutic human doses, but no consistent effect on ureteric peristalsis was seen. Glucagon may have a role to play in the management of ureteric colic.
Small bowel volvulus following total hip replacement
Authors: King P M , Crawshaw H M , Ross A H McLean
Published: March 2007

A fatal case of volvulus of the small bowel following total hip replacement is reported. Thermal damage, caused by polymerizing bone cement which had penetrated the peritoneal cavity, is thought to have resulted in this previously unreported complication.
Traumatic pericardiophrenic hernia: A report of 3 cases
Authors: Adamthwaite D N , Snyders D C , Mirwis J
Published: March 2007

Three cases of traumatic intrapericardial diaphragmatic hernia are reported. The defect was limited to the central tendon of the diaphragm in all 3 cases with herniation of the transverse colon (n = 2) or small bowel (n = 1) into the pericardial sac. A correct preoperative diagnosis was made in all 3, using a dilute barium meal in 2 patients, and from the chest X-ray examination alone in 1. Successful operative repair was performed. Previous reports suggest that barium studies of the gastrointestinal tract are the most accurate method of diagnosis but should be used with caution as they may precipitate cardiac tamponade through distension of herniated bowel.
A comparison of Nissen fundoplication and Boerema gastropexy in the surgical treatment of gastro-oesophageal reflux in children
Authors: De Laet M , Spitz L
Published: March 2007

The results of surgical treatment of gastro-oesophageal reflux in 133 infants and children clearly demonstrated the superiority of the Nissen fundoplication over the Boerema gastropexy. The failure to control reflux in the gastropexy group (50 patients) was 42 per cent compared with a 9·6 per cent failure rate in the fundoplication group (83 patients). This resulted in a reoperation rate of 24 per cent for the gastropexy procedure compared with 8 per cent for the fundoplication. There was no difference in the incidence of postoperative complications.
Latissimus dorsi breast reconstruction—refinement and results
Authors: Mendelson B C
Published: March 2007

The surgical objectives for an improved breast reconstruction are defined. In 30 latissimus dorsi flap breast reconstructions only 1 major flap complication occurred. There were 7 lesser complications involving the donor wound on the back (n = 4), the flap (n = 2) and the mastectomy skin (n = 1). Several refinements in the technique provide for a more accurate replacement of the missing breast yet minimize complications on the back. A one-stage reconstruction (with immediate insertion of the prosthesis) is shown to be safe, except in the presence of recognizable damage to the thoracodorsal vascular pedicle. It is concluded that refinements in the use of the flap allow for a better breast reconstruction and that major complications are avoidable.
Reappraisal of the 5 centimetre rule of distal excision for carcinoma of the rectum: A study of distal intramural spread and of patients' survival
Authors: Williams N S , Dixon M F , Johnston D
Published: March 2007

Fifty consecutive specimens, obtained in the course of potentially curative abdominoperineal resection for rectal carcinoma situated 5–10 cm from the anal verge, were examined for the presence of microscopic distal intramural spread. Thirty-eight patients (76 per cent) were found to have no distal intramural spread. Seven patients (14 per cent) had spread for 1 cm or less and only 5 patients (10 per cent) had spread of more than 1 cm. Each of these 5 patients had a poorly differentiated Dukes' C carcinoma and each was dead or dying from distant metastases within 3 years of the operation. The results of anterior resection for carcinoma of the rectum were reviewed a minimum of 5 years after operation, to find out whether patients with a wide distal margin of resection had fared better than patients with a small margin. Seventy-nine patients had undergone a potentially curative resection, 48 with a distal margin of less than 5 cm (mean 2·8 cm; group 1) and 31 with a distal margin greater than 5 cm (mean 6·5 cm; group 2). The two groups were well matched for age, sex, degree of differentiation of the tumours and distance of the lesion from the anal verge, but 54 per cent of patients in group 1 had Dukes' grade C tumour whereas only 23 per cent of the patients in group 2 had Dukes' C tumours. Despite the higher proportion of unfavourable tumours in group 1, the outcome, in terms both of survival and of recurrence, was as good in the patients with the small distal margin as in the patients with the wide distal margin of clearance. The rigid, routine application of the 5 centimetre rule' of distal excision may cause patients with low rectal cancer to lose their anal sphincter unnecessarily.
Extrahepatic biliary atresia: A review of current management
Authors: Howard E R
Published: March 2007

Macroscopic examination of the extrahepatic bile ducts in infants with biliary atresia reveals fibrous occlusion of variable extent from an inflammatory process of unknown aetiology. Histological studies have shown that bile duct remnants at the porta hepatis frequently contain small epithelium-lined channels which communicate with intrahepatic ducts and through which effective bile drainage may be established by the operation of portoenterostomy. The 4-year survival rate in untreated cases is 2 per cent, but surgical treatment can improve the outlook and recent reports suggest that a 5-year survival rate of over 35 per cent can be achieved with portoenterostomies performed before 10 weeks of age. Complications after surgery include progressive liver disease, ascending bacterial cholangitis and portal hypertension.
Diagnosis and outcome of testicular torsion
Authors: Thomas W E G , Williamson R C N
Published: March 2007

In a prospective study of 80 patients with acute testicular pain, static and dynamic scans of the scrotum were obtained by radionuclide imaging. Seven patients with acute testicular torsion were identified by gross reductions in isotope uptake. Enhanced uptake (indicating hyperaemia) was seen in 37 patients with acute epididymitis, testicular tumour or resolved torsion. Late torsion and some tumours demonstrated a ‘halo’ sign, with central necrosis and a peripheral increase in blood supply. A group of 22 patients with previous orchidopexy for torsion was reviewed 2–5 years postoperatively. In 15 the previously twisted testis was > 10 per cent smaller than its opposite member and 12 patients showed severe abnormalities of seminal analysis. Hormonal profiles were generally normal. Retention of testes damaged by ischaemia may risk autoimmunization against spermatogenesis.
Torsion of testis after previous testicular surgery
Authors: Thurston A , Whitaker R
Published: March 2007

Five cases of torsion of the testis are described in which scrotal surgery preceded the torsion. Suggestions as to the best surgical procedure are made.
Oesophageal carcinoma associated with corrosive injury—prevention and treatment by oesophageal resection
Authors: Ti T K
Published: March 2007

Six patients (5 from Kuala Lumpur and 1 from Singapore), who had a history of corrosive injury in late adolescence and early adult life, developed oesophageal squamous cell carcinoma. The association between corrosion and carcinoma was probably causal in 5 women who developed oesophageal cancer 25–50 years after corrosive injury and coincidental in a 35-year-old man with a recent history of corrosive ingestion. The 5 patients from Kuala Lumpur were among a series of 49 patients treated over a 10-year period for dysphagia from corrosive injury. Excluding the patient with coincidental association, the 4 patients with corrosive-induced carcinoma represent an 8 per cent incidence of malignancy in the series of 49 patients. Reference is made to the safety of oesophageal resection in 28 patients with associated carcinoma. Oesophageal resection during reconstructive surgery for severe corrosive stricture would have a preventive role in corrosive induced carcinoma. However, these cases suggest that patients with relatively mild corrosive injury not requiring reconstructive surgery are also at risk of oesophageal carcinoma. An awareness of this risk should lead to earlier diagnosis of carcinoma and an increase in the number of curative resections.
Urachal carcinoma: Two case reports and a review of the literature
Authors: Parker M
Published: March 2007

Two cases of adenocarcinoma of the urachus are reported. The tumour is rare and carries a poor prognosis because of lack of awareness of the condition, difficulty in making a preoperative diagnosis, characteristically late presentation and early spread.
Axillofemoral and femorofemoral grafts: A 6-year experience with emphasis on the relationship of peroperative flow measurement to graft survival
Authors: Graham J C , Cameron A E P , Ismail H I , Hamilton W A P , Law Y F , Roberts V C , Cotton L T
Published: March 2007

Over a 6-year period 64 axillofemoral bypass and femorofemoral crossover grafts have been performed in 58 patients, most of whom were considered unfit for intra-abdominal surgery. Indications were peripheral ischaemia in 78 per cent and disabling claudication in 22 per cent. The limb salvage rate at 3 years was 75 per cent. No claudicants lost limbs, but only one-third of patients presenting with forefoot gangrene or ulceration avoided amputation. Most patients presenting with ischaemic symptoms at rest had associated femoropopliteal and distal disease, confirmed by the ankle pressure index measurements, and this influenced graft patency. Although the cumulative patency at 3 years for all grafts combined was 57 per cent with similar patencies for both the axillofemoral and femorofemoral grafts, early occlusion was more common in axillofemoral grafts and this may be reduced in bifemoral grafts by the increased flow rate in the vertical limbs. Peroperative electromagnetic flowmeter measurements were made after reconstruction on 55 femoral arteries in 46 of the patients and graft flow velocities were derived from these measurements. Comparison between velocities from those grafts remaining patent and those subsequently occluding showed a high incidence of occlusion in grafts with a maximal velocity after distal vasodilatation of < 8 cm/s. Graft occlusion after the first postoperative month was more commonly associated with other factors such as continued smoking, severity of distal disease and perigraft infection.
Oesophagitis in patients undergoing oesophageal transection for varices—a histological study
Authors: Spence R A J , Sloan J M , Johnston G W
Published: March 2007

Thirty-one oesophageal rings from patients undergoing transection for varices were examined histologically for oesophagitis. Four cases showed neutrophil infiltration but all had recent oesophageal intubation. Fifteen patients had significant morphological epithelial changes of oesophagitis assessed by two sets of criteria. Only 4 of these patients (13 per cent) had no other likely causative factor such as recent sclerotherapy or recent insertion of a Sengstaken tube. Therefore there appears little evidence for oesophagitis as a major aetiological factor in bleeding oesophageal varices.