bluuebunny/crossref_metadata_2025 huggingface dataset:
Prospective controlled vagotomy trial for duodenal ulcer: Results after five years
Authors: Hoffmann J , Jensen H-E , Schulze S , Poulsen P E , Christiansen J
Published: March 2007

A prospective, randomized, controlled trial was performed to study truncal vagotomy and drainage (TV), selective vagotomy and drainage (SV) and parietal cell vagotomy (PCV) as elective treatment for duodenal ulcer. Five years postoperatively, 233 patients were available for study: 73 TV, 81 SV and 79 PCV. The ulcer recurrence rates were 13.6, 19.8 and 30.4 per cent respectively. The incidence of severe dumping was 4.9, 10.9 and 1.9 per cent; of severe diarrhoea 4.9, 6.3 and 1.9 per cent; of severe pain/dyspepsia 3.3, 6.3 and 3.8 per cent and of severe nausea/vomiting 0, 1.6 and 0 per cent respectively. Women suffered more postvagotomy symptoms than men. After treatment of recurrences and postvagotomy symptoms, more patients after PCV achieved excellent results than after TV and SV, as recurrences were easier to treat than severe postvagotomy symptoms. The only factor found contributing to the high ulcer recurrence following PCV was the large number of surgical trainees operating in the trial.
Duodenal ulcer perforation whilst on cimetidine therapy
Authors: Sherlock D J , Holl-Allen R T J
Published: March 2007

Nine cases of perforation whilst patients received cimetidine therapy were identified and followed prospectively. There was a high correlation with the other major complications of duodenal ulceration: pyloric stenosis and haemorrhage. Initially, three of the nine patients had simple suture of the perforation, but eventually all required truncal vagotomy and a drainage procedure. The follow-up ranges from 6 months to 2.5 years and the results in the surviving patients are good. The pre-operative identification of this group, being established medical failures with the high probability of requiring necessary definitive surgery, will aid the surgical management of this condition.
Fine needle aspiration cytology, in relationships to clinical examination and mammography in the diagnosis of a solid breast mass
Authors: Dixon J M , Anderson T J , Lamb J , Nixon S J , Forrest A P M
Published: March 2007

The accuracy of clinical examination, mammography and fine needle aspiration cytology in identifying malignancy has been assessed in 1655 breast masses from two time periods. Clinical examination and mammography remained consistent at identifying malignancy but 9 per cent of all breast carcinomas were considered benign by both techniques (sensitivity 91 per cent). Fine needle aspiration cytology, when performed by multiple aspirators in the first study period, had a sensitivity of only 66 per cent for malignancy. During the second period of study, when all aspirates were performed by a single aspirator, sensitivity rose to 99 per cent. The two patients with false negative cytology in this latter period had both clinical and mammographic evidence of malignancy. No patient with malignant cytology was subsequently shown to have benign disease. It is concluded that a combination of clinical examination and mammography, with fine needle aspiration cytology performed by committed individuals with aptitude for the technique and interpreted by experienced pathologists, can identify all patients with breast cancer before surgery.
Inhibition of experimental colorectal cancer by razoxane (ICRF-159)
Authors: Gilbert J M , Thompson E M , Slavin G , Kark A E
Published: March 2007

Large bowel cancer induced in rats by dimethylhydrazine (DMH) closely resembles human disease both histologically and clinically. In this study it has been used to assess the antimitotic drug razoxane (ICRF-159). Dimethylhydrazine induced benign colorectal tumours after 20 weeks and adenocarcinomas from 30 weeks. Razoxane was given from week 25 until the end of experiment (week 35) to see if this drug could inhibit the development of tumours. Animals were randomly allocated to four groups: DMH + razoxane (26), DMH + control (26), control + razoxane (25), control + control (25). There were fewer malignant colorectal tumours in rats receiving razoxane than in the controls (10 vs. 24; P = 0.04). Some animals developed malignant tumours of the small intestine as well as the large bowel and the number of malignant tumours for the whole intestinal tract was also reduced in animals receiving razoxane (15 vs. 32; P = 0.025). This study demonstrates inhibition of the development of malignant tumours in rats by razoxane. This finding may have relevance to colorectal cancer in man where razoxane has been used in disseminated disease and as an adjuvant to surgery.
Return to work following ileostomy
Authors: Whates P D , Irving M
Published: March 2007

The experiences of 1033 members of the 51 English divisions of the Ileostomy Association of Great Britain and Ireland have been analysed in respect of their return to work after construction of an ileostomy. Although there was a fall in the number of patients returning to work after operation this was often for reasons unrelated to surgery. The majority of those returning to work resumed work with the same employer and usually in the same post. Fifty-nine (5.7 per cent) patients began work for the first time after operation, including 33 (3.2 per cent) who were previously inactive although of working age. Analysis of occupational class shows that, although a number of patients initially resumed work within a lower class, once established in employment successful career advancement was possible. Problems in the gaining or resumption of employment were reported by 56 (5.4 per cent) patients. In 22 (2.1 per cent) patients, almost all approaching or above retirement age, successful surgery resulted in a decision not to return to employment. An ileostomy is no barrier to successful return to work in nearly all occupations, and is accomplished by the majority of patients without major difficulty.
Incidence of pathogenic bacteria from mesenteric lymph nodes and ileal serosa during Crohn's disease surgery
Authors: Ambrose N S , Johnson Margaret , Burdon D W , Keighley M R B
Published: March 2007

Samples of ileal serosa and mesenteric lymph nodes have been harvested before antibiotic administration during 46 non-contaminated operations for Crohn's disease and compared with 43 operations for conditions other than Crohn's. Potentially pathogenic bacteria were isolated from the serosa in 12 (27 per cent) Crohn's patients, compared with 6 (15 per cent) controls (P = 0.04). Intestinal bacteria were recovered from mesenteric nodes in 15 (33 per cent) Crohn's patients compared with 2 (5 per cent) controls (P = 0.006). These findings suggest that bacteria leak from the small bowel lumen in a high proportion of Crohn's disease patients. This may explain the pathogenesis of abscess and fistula in this disorder as well as the high rate of sepsis following elective surgery even in the absence of macroscopic contamination.
Intraperitoneal antiseptics in experimental bacterial peritonitis
Authors: Platt J , Jones R A , Bucknall R A
Published: March 2007

A model of bacterial peritonitis, using mice infected with Escherichia coli, has been used to assess the protective effects of intraperitoneal treatment with antiseptics. Of the five antiseptics tested, only chlorhexidine gluconate had any protective effect, concentrations of 0.05 and 0.02 per cent reducing the mortality to 14 and 50 per cent respectively. The other antiseptics, taurolin, noxytiolin, povidone iodine and hypochlorite were all ineffective. Delayed treatment with chlorhexidine was not as effective as instillation immediately postinfection.
The effect of pre-operative glucose loading on postoperative nitrogen metabolism
Authors: Crowe P J , Dennison A , Royle G T
Published: March 2007

The nitrogen sparing effect of glucose loading at either 1 mg kg−1 min−1 or 5 mg kg−1 min−1 from the evening before surgery was compared with similar glucose infusions commenced after elective surgery. Thirty-two patients undergoing abdominal surgery of moderate severity were studied. Glucose at 5 mg kg−1 min−1 reduced urea excretion compared with glucose at 1 mg kg−1 min−1. The timing of the carbohydrate infusion was not critical in altering the overall extent of the protein sparing at either rate. High dose glucose infusions markedly reduced overall urea and 3-methylhistidine excretion. This implies a reduction in protein breakdown. A pre-operative high dose infusion of glucose may in particular improve protein synthesis for the first 24 h after surgery.
The effect of resection of the distal ileum on gastric emptying, small bowel transit and absorption after proctocolectomy
Authors: Neal D E , Williams N S , Barker M C J , King R F G J
Published: March 2007

Patients who had undergone proctocolectomy and ileostomy for ulcerative colitis have been studied. One group (contrast group) had undergone resection of only small amounts of terminal ileum (median = 4 cm), the other group of patients (study group) had undergone resection of greater lengths of small bowel (median = 60 cm). Gastric emptying and transit of a standard meal through the small bowel were estimated, whilst the amounts of fat, nitrogen, glucose, sodium and potassium excreted by the ileostomy were simultaneously determined. Significantly greater amounts of fat, nitrogen, sodium, potassium and water were excreted by patients who had undergone resection compared with contrast patients (P <0·01). The rate of gastric emptying was not increased in patients who had undergone ileal resection compared with contrast patients but small bowel transit within 4 hours of ingestion of the meal was significantly faster. A significant correlation between transit times and excretion of fat was also noted in patients (P <0·02). Thus, quite modest ileal resection in addition to proctocolectomy leads to rapid small bowel transit and marked malabsorption of nutrients as well as water and electrolytes.
Hyperlipidaemia, alcohol abuse and acute pancreatitis
Authors: Dickson A P , Neill J O , Imrie C W
Published: March 2007

Of 311 patients with primary acute pancreatitis, seven revealed major and seven minor lipid abnormalities on hospital admission. One pregnant woman suffered acute pancreatitis associated with Fredrickson type I hyperlipoproteinaemia. Twelve of the 13 men with types IV and V hyperlipoproteinaemia suffered alcohol abuse pancreatitis and represented 13·2 per cnt of this aetiological group. However, only one of the 157 patients (0·6 per cnt) with biliary disease had lipid abnormalities. Two of the 13 men died—the oldest, who had gallstones, and one with alcohol related disease. The remaining 11 were subject to follo-up (5–10 years). Six who had improvement of their lipid abnormalities, had abstained from alcohol. The other five had a persistent lipid disorder, and all admitted continuing heavy alcohol ingestion. The clilnical diagnosis of acute pancreatitis was supported by serum amylase elevation in only nine of the fourteen patients Urinary amylase levels were consistent with the diagnosis in 11 of the 12 patients. Estimation of both serum and urinary amlylase gave 100 per cnt support to the clinical diagnosis of acute pancreatitis Hyperlipidaemia associated with acute pancreatitis may be secondary to alcohol abuse but the possible role of HLP cannot be discounted. Urinary amylase is useful in diagnosing acute pancreatitis in the presence of hyperlipidaemia.
The management of acute cholecystitis in the elderly
Authors: van Rensburg L C J
Published: March 2007

This paper assesses the value of hepatobiliary scanning and surgical treatment of acute cholecystitis in patients above the age of 60 years over a 3 year period (1980–1982). During this period 382 cholecystectomies for biliary disease were performed in 257 women and 125 men with mean ages of 55·6 and 61·1 years respectively. Of the 382, 208 were older than 60, with a female to male ratio of 1·3:1. Acute cholecystitis occurred in 74 of the 208 patients; they were subjected to early cholecystectomy. Biliary tract imaging using 99 m technetium-labelled diisopropyl-IDA (DISIDA) proved valuable in confirming the diagnosis of acute cholecystitis. Of 85 patients over 60 years who underwent hepatobiliary scanning with a presumptive diagnosis of acute cholecystitis, 74 had positive scans and acute cholecystitis was confirmed at subsequent operation in these cases. There were two false positive and nine negative scans showing that biliary scintigraphy proved to be a rapid non-invasive and sensitive method of diagnosing acute cholecystitis. The advent of hepatobiliary scanning has strengthened our surgical strategy in the management of acute cholecystitis in the elderly and allows early elective surgery with an acceptable morbidity and in this series no mortality.
Cutaneous seeding of malignant tumours after insertion of percutaneous prosthesis for obstructive jaundice
Authors: Shorvon P J , Leung J W C , Corcoran M , Mason R R , Cotton P B
Published: March 2007

Three cases of cutaneous malignant deposits at the site of skin puncture for insertion of percutaneous biliary prosthesis are described. Tumour dissemination casts doubts on the value of percutaneous intubation of the biliary tree when preparing patients for curative resection of pancreatic or biliary tumours.
Bilateral primary breast cancer: A prospective study of disease incidence
Authors: Chaudary M A , Millis R R , Hoskins E O L , Halder M , Bulbrook R D , Cuzick J , Hayward J L
Published: March 2007

A prospective study was carried out, between January 1980 and March 1982, of all women who presented to the Breast Cancer Unit, Guy's Hospital, with a second primary breast cancer. The percentage of new simultaneous tumours detected clinically or by mammography was approximately 3 per cent. Routine mammographic screening of the contralateral breasts of patients with unilateral disease increased the rate of detection, fivefold, of simultaneous bilateral cancers. The incidence of nonsimultaneous bilateral disease was 7·6 second cancers per thousand patients at risk per year. The annual rate of occurrence of second primary cancers was a constant event and showed no trend either to increase or to decrease with follow-up. However, the risk of a nonsimultaneous second cancer was strongly correlated with age at first primary. Women who developed their first breast cancers under the age of 40 years had three times the risk of developing a second breast cancer compared with those who developed their first cancer after the age of 40. The risk of a second nonsimultaneous primary was 5·9 times that of the risk of occurrence of cancer in the first breast in the general female population.
Towards a rational approach to the treatment of peritonitis: An experimental study in rats
Authors: McAvinchey D J , McCollum P T , Lynch G
Published: March 2007

Peritoneal infection progresses through defined stages: contamination, inflammation and abscess formation. An experimental model of established peritonitis without adjuvant in the rat was used to test the effect of various local and systemic agents on survival. There was significant improvement in all treatment groups except those treated with antiseptic lavage using PVP-I and noxythiolin. Intramuscular ampicillin improved survival from 40 to 60 per cent while intramuscular amikacin combined with local irrigation with metronidazole reduced mortality to nil (P <0·001). Both cephradine and metronidazole used as peritoneal lavage solutions improved survival (P <0·005) when compared with the controls but the difference was not significant when compared with irrigation with Hartmann's solution. Metronidazole given rectally also improved survival from 40 to 60 per cent but this difference was not significant. We conclude that survival in established peritonitis depends upon adequate antibiotic therapy.
Empyema following intra-abdominal sepsis
Authors: Ballantyne K C , Sethia B , Reece I J , Davidson K G
Published: March 2007

Over the past 9 years, ten patients have presented to the Thoracic Unit, Glasgow Royal Infirmary, with 12 empyemas secondary to intra-abdominal sepsis. In eight patients, the presenting signs and symptoms were wrongly attributed to primary intra-thoracic pathology. All were subsequently found to have intra-abdominal sepsis. The presence of empyema after recent abdominal surgery or abdominal pain strongly suggests a diagnosis of ipsilateral subphrenic abscess. Adequate surgical drainage is essential. In our experience, limited thoracotomy with subdiaphragmatic extension offers the best access to both pleural and subphrenic spaces and provides the greatest chance of eradicating infection on both sides of the diaphragm.
Prevention and treatment of intestinal dehiscence by an intraluminal bypass graft
Authors: Ger R , Ravo B
Published: March 2007

The most important cause of morbidity and mortality in the surgery of the colon, rectum and oesophagus is dehiscence. An experimental study to investigate a method of protecting intestinal anastomoses/dehiscences by an intraluminal bypass graft was carried out. This was accomplished by the implantation of a soft tube (graft) in the proximal intestine above the proposed anastomosis/dehiscence, which conducts the salivary, gastrointestinal secretion, food and faecal stream past the anastomosis/dehiscence into the distal intestine; these contents are thereby prevented from coming in contact with the anastomosis/dehiscence. Intestinal continuity is then completed. The graft is expelled spontaneously after a varying time. In the face of gross anastomotic dehiscences, faecal peritonitis and mediastinitis, primary healing without leakage occurs. A clinical study has been instituted.
Islet cell transplantation in diabetic dogs: Studies of graft function and storage
Authors: Alderson D , Walsh T N , Farndon J R
Published: March 2007

Islet cell transplantation is a potential treatment for insulin-dependent diabetes (IDD), assuming that physiological hormone release results in biochemical normality which, in turn, reduces the incidence of long-term diabetic complications. These experiments sought to create a metabolic model of IDD in a large animal and investigate the effects of insulin therapy and islet transplantation. After demonstrating the success of transplantation, further studies examined the feasibility of creating multiple grafts from a single donor and their long-term preservation. The totally pancreatectomized dog, treated with suboptimal insulin therapy was biochemically identical to human IDD and, when more appropriate doses of insulin were administered, metabolic improvements occurred without restoring normality. Islet cell autotransplants rendered such animals metabolically normal apart from persisting impairment of glucose tolerance. The isolation technique permitted the production of at least two recipient grafts and some success was achieved after graft cryopreservation. The experiments confirm the theoretical background to islet transplantation and demonstrate its applicability in a large animal model before allotransplantation.
What has happened to perforated peptic ulcer?
Authors: Watkins R M , Dennison A R , Collin J
Published: March 2007

The number of elective operations for chronic peptic ulceration has decreased substantially with the widespread use of H2-receptor antagonists. We have reviewed all cases of perforated peptic ulcer in Oxford over the last 18 years (1965–82) to see if a similar change in the incidence of this major complication of peptic ulceration has occurred. Since 1976 there has been a fall in the incidence of perforated peptic ulcer from 8.7 to 6.9 cases per 100 000 population per year. The male to female ratio decreased over the review period from 4.9:1 to 1.9:1 owing to a reduced incidence of perforation in men and an increased incidence in women. The mean age of men with perforated duodenal ulcer increased from 52.3 years in 1965–70 to 59.0 years in 1977–82. One hundred and sixty-six patients treated between 1977 and 1982 have been reviewed in detail. The overall mortality in this 6 year period was 12.7 per cent with an operative mortality rate of 8.9 per cent. The majority of perforations (65 per cent) are now of acute ulcers and therefore are unlikely to be prevented by improved therapy for chronic peptic ulceration.
Transurethral ureteroscopic stone extraction
Authors: Ford T F , Wickham J E A
Published: March 2007

Transurethral ureteroscopy has now been used for stone retrieval in 31 patients with ureteric calculi. Four stones were located in the upper third, nine in the middle third and eighteen in the lower third of the ureter. The stones varied in size from 4 to 10 mm in diameter. Successful retrieval of the stones was achieved at the first attempt in 17 and at a second attempt in 3. Of the 11 failures (due to impaction, dislodgement into the pelvis or failed instrumentation), 4 have required open ureterolithotomy, 2 percutaneous nephroscopy and 2 ureteric meatotomies; 3 have been successfully disintegrated in situ. There have been no significant complications to date. Transurethral ureteroscopy appears to offer an alternative to existing therapeutic options.
The effect of malignant and inflammatory fixation of rectal carcinoma on prognosis after rectal excision
Authors: Durdey P , Williams N S
Published: March 2007

Fixity of colorectal carcinoma at operation seems an important prognostic indicator, perhaps equally as significant as lymph node invasion. A proportion of tumours are, however, tethered by inflammatory adhesions only and, although patients with these tumours should fare better than those with tumours fixed by extramural malignant spread, available data is contradictory. With the recent interest in pre-operative radiotherapy for patients with fixed rectal tumours and in order to clarify the above points we studied 625 patients who had undergone rectal excision a minimum of 10 years previously. Excluding those with disseminated disease, 169 (27 per cent) were fixed, 124 (20 per cent) by direct malignant spread, 45 (7 per cent) by inflammatory tissue. Survival and recurrence rates in these patients were compared with an equivalent number who had mobile lesions. The groups were matched for age, sex and Dukes' stage. The degree of differentiation and height of the lesion above the anal margin were similar. Corrected 5 year survival rates were 28.5 per cent in patients with malignant fixation, 68.9 per cent (P < 0.01) in those with mobile tumours and 64.6 per cent (P < 0.01) where the lesion was tethered by inflammation. The incidence of local recurrence in the three groups was 41.3, 15.1 and 20.0 per cent respectively. Five year survival rate in patients with fixed Dukes' B lesions was 43.5 per cent and in patients with mobile C lesions was 62.9 per cent (P < 0.01). Thus, patients with fixed carcinomas of the rectum have a poor prognosis but only if contiguous spread of the tumour has occurred. These findings have important implications for patients in whom fixity is used as an indication for adjuvant therapy.
Polyamines in colorectal cancer
Authors: Kingsnorth A N , Lumsden A B , Wallace Heather M
Published: March 2007

Polyamine levels (putrescine, spermidine and spermine) in colorectal cancers (n = 25) were measured in order to assess their importance as markers of cellular proliferation. Colonic mucosa from healthy resection margins of patients with diverticular disease (n = 5) was used as control material. Polyamine levels (expressed as nanomoles per 100 mg tumour) in cancers ranged from 0.8 to 7.9 for putrescine (mean: 2.3±0.7), from 6.5 to 22.8 for spermidine (mean: 13.9±0.9) and from 13.0 to 37.5 for spermine (mean: 22.1±1.3). Mean spermidine and spermine content of cancers was more than three times mean spermidine (3.92±0.8), and more than four times mean spermine (5.0±1.2), content of normal colonic mucosa (P < 0.01). Polyamine content of colorectal cancers was independent of tumour site, Dukes' stage, histological grade and the presence of palpable liver metastases at laparotomy. Because colorectal cancers contain such high levels of spermidine and spermine, polyamines may play an essential role in the regulation of their growth.
Changes in intestinal blood flow during the development of chronic large bowel obstruction
Authors: Coxon J E , Dickson Caroline , Taylor I
Published: March 2007

The effect of chronic progressive distal large bowel obstruction on intestinal blood flow was studied in 12 mini-pigs. Blood flow was measured by the techniques of xenon133 clearance and intracardiac injections of radiolabelled microspheres. Intestinal blood flow was increased in the left colon and ileum but decreased in the caecum. Blood was shunted from the mucosa to the muscle layers. The results suggest that primary anastomosis of the obstructed left colon is not contraindicated by haemodynamic considerations.
Does a water soluble contrast enema assist in the management of acute large bowel obstruction: A prospective study of 117 cases
Authors: Stewart J , Finan P J , Courtney D F , Brennan T G
Published: March 2007

We have performed a prospective study on 117 patients in order to assess the value of a single contrast water soluble enema in acute large bowel obstruction. In 99 cases where the plain films suggested a diagnosis of mechanical obstruction, the Diodone enema confirmed its presence in 52, and relocated its site in 11. There was free flow of contrast to the caecum in the remaining 35, 11 of whom were shown to have idiopathic pseudoobstruction. The plain films suggested a diagnosis of pseudo-obstruction in 18 patients. The Diodone enema confirmed this diagnosis in 15, but revealed an unsuspected mechanical obstruction in two. The examination failed in two cases. We conclude that the water soluble single contrast enema is of value in the management of large bowel obstruction. It will confirm the diagnosis of mechanical obstruction and prevent unnecessary surgery in patients with pseudo-obstruction.
Infusion cholecystography in the early diagnosis of acute gallbladder disease
Authors: Dykes Evelyn H , Stewart I , Gray H , Simpson C , Davidson S , McArdle C S
Published: March 2007

The value of infusion cholecystography 99mTc HIDA cholescintigraphy and ultrasonography was compared in 51 patients presenting with a clinical diagnosis of acute cholecystitis. Of the 35 patients with proven gallbladder disease, the presence of gallstones was correctly predicted in 31 (88 per cent) by infusion cholecystography, 32 (90 per cent) by 99mTc HIDA cholescintigraphy and 27 (77 per cent) by ultrasonography. There were no false positive investigations. Infusion cholecystography may be of particular interest to surgeons with no ready access to isotope scanning techniques.
Incidence and prognosis of N4 node involvement in gastric cancer
Authors: Keighley M R B , Moore Janet , Roginski Claudia , Powell Jean , Thompson H
Published: March 2007

We have undertaken a prospective study of the frequency and prognosis associated with N4 node metastases in gastric cancer in 136 patients referred for surgical treatment between 1976 and 1983. N4 node metastases (pre-aortic or hepatic hilar nodes) were present in 20 of 31 patients who had a laparotomy without resection (64 per cent), in 2 of 8 patients who had a ‘palliative’ resection in the presence of distant metastases (25 per cent) and, in 19 of 85 patients who had a ‘curative’ resection (22 per cent). The median survival in patients having a “curative” resection with N4 nodes was 4.5 months which was only marginally longer than in patients having a ‘palliative’ resection (median survival 3 months). In view of these findings and since immediate imprint cytology can be used to detect nodal metastases at operation, involvement of N4 nodes might be a contra-indication to extensive gastric resection in non-obstructing gastric cancer.
CAPD—a risk factor in renal transplantation?
Authors: Guillou P J , Will E J , Davison A M , Giles G R
Published: March 2007

Theoretical considerations suggest that patients undergoing continuous ambulatory peritoneal dialysis (CAPD) may fare less well after renal transplantation than their haemodialysed (HD) counterparts. Review of 121 consecutive cadaveric renal allografts performed in this centre indicate this to be the case with graft survival rates at 1 year of 63·5 per cent in the HD group compared with 35·5 per cent in the CAPD-treated patients. This difference appeared to be independent of the duration of dialysis and, although a significant blood transfusion effect was seen in the HD group, no such trend was evident in the CAPD group. Studies of T cell subsets (using monoclonal antibodies) in the two groups suggests that, in part at least, the differences in graft survival rates may be attributable to the maintenance or restoration of immunological integrity in the CAPD group.
A controlled trial of bipolar electrocoagulation in patients with upper gastrointestinal bleeding
Authors: Kernohan R M , Anderson J R , McKelvey S T D , Kennedy T L
Published: March 2007

We have assessed the value of the BICAP electrocoagulation probe in reducing the incidence of further bleeding in patients with upper gastrointestinal haemorrhage. One hundred and twenty-nine patients were studied in a prospective randomized controlled trial. There were 85 male and 44 female patients, age range 16–92 years. Forty-five patients had stigmata of recent haemorrhage (visible vessel or spot) and were randomized during endoscopy to 24 control and 21 treatment patients. Seven control patients rebled compared with nine treated patients (Fisher's exact probability test P = 0·44). The transfusion requirements of control patients (3·9±3·2 units) was not different from that of treated patients (5·7 ± 3·7 units): Mann Whitney U test, P = 0·06. In the treatment group there was no difference in the operation rate. Also, the number of probe applications between patients with further bleeding and those with no further bleeding was similar (11·6 ± 5·5 and 11·0 ± 5·75 respectively). Access with the probe was considered inadequate in 50 per cent of lesions, but this did not correlate with the incidence of rebleeding. Stigmata of recent haemorrhage were significant in predicting rebleeding (P = 0·0019 Fisher's exact probability test). Overall mortality rate of 3·2 per cent was low and was not influenced by electrocoagulation or presence of stigmata of recent haemorrhage. We have not shown that BICAP bipolar electrocoagulation reduces the incidence of rebleeding in upper gastrointestinal haemorrhage.
The surgical management of typhoid perforation in children
Authors: Keenan J P , Hadley G P
Published: March 2007

Typhoid perforation still has a high mortality rate (19–59 per cent) and controversy regarding the management of patients with this complication still abounds. We report our experience of 26 children with histologically proven typhoid perforation with an operative mortality of 9·0 per cent. Timed surgery with ulcer excision, simple two-layer closure of the defect and copious peritoneal lavage were used.
Surgical approaches to thrombo-embolism
Authors: Greenfield L J , Langham M R
Published: March 2007

Management of angiographically confirmed pulmonary thrombo-embolism in 313 patients has been based on a physiological classification system. Patients in shock (Class IV) are managed either by catheter embolectomy (26 patients) with 27 per cent mortality rate or by open embolectomy during active resuscitation (6 patients) with a 33 per cent mortality rate. High-risk patients with transient hypotension (Class III) are managed by anticoagulation and filter insertion. The most common indication for filter placement is a contra-indication to anticoagulation (37 per cent). Filter placement was infrarenal in 268 patients (86 per cent) and intentionally suprarenal in 19 patients (6 per cent). Misplacement has occurred into the iliac veins, renal veins and the heart but has not been seen since the guide wire technique for insertion was developed. The 30 day mortality for patients receiving filters was 14 per cent and due to other disorders. Only one death was suspected from recurrent embolism. One hundred and thirteen venacavagrams at intervals up to 99 months in 110 patients showed long-term patency in 97 per cent. Recurrent embolism was seen in five patients (2 per cent) but caused no deaths.
Surgical management of reflux-induced oesophageal stenoses: Results in 101 patients
Authors: Payne W S
Published: March 2007

One hundred and one patients with benign, reflux-induced oesophageal stenosis were surgically treated at the Mayo Clinic during a recent 6 year period by the author. In 71 patients, the stenosis was readily dilated and treated by a variety of antireflux procedures, depending on presence or absence of oesophageal peristalsis or acquired shortening of the oesophagus. Thirteen additional patients were managed by gastric secretion suppression with duodenal diversion using the Roux-Y principle. Seventeen patients with undilatable stenoses were managed by resection and a variety of reconstructions. The modified Ivor–Lewis procedure with or without thoracotomy was the procedure employed in 12 of the 17 with the remainder managed with either substernal colon or upper digestive secretion suppression-diversion. These 101 operations were accomplished without mortality and all but one patient have resumed an oral diet and returned to their usual occupation. While 91 per cent of the 101 patients are free of reflux symptoms or demonstrable stenosis and are considered improved, only 83 per cent of all patients have ‘excellent’ to ‘good’ late results in terms of both oesophageal and gastrointestinal symptoms.
A review of treatment of spinal cord injury
Authors: Collins W F
Published: March 2007

Spinal cord injury remains a devastating event to the person sustaining the injury. Not only the cost of acute and rehabilitation care, but also the loss of productivity of the victims who are often young men injured at a highly productive period of their lives are a costly illness for society as a whole. In the past 20–30 years, there has been continual improvement in the morbidity and mortality from spinal cord injury with the improvement in prevention of a second injury, prevention of secondary renal, pulmonary and cutaneous complications, better techniques for stabilization of the spinal column, and more effective utilization of remaining neurological function with improved rehabilitation therapy. It remains, however, difficult to demonstrate an effect from a wide range of ‘acceptable’ medical or surgical care on the resultant loss of spinal cord function. The lack of improvement in preventing or reversing the loss of spinal cord function in spite of marked variations in acute spinal cord injury care indicate that acceptable data are still lacking to determine the role of aggressive and conservative management. The need for a more organized approach to the problem is obvious.
Current achievements and challenges in adrenal surgery
Authors: Hunt T K , Roizen M F , Tyrrell J B , Biglieri E G
Published: March 2007

Adrenal surgery is now done in almost ideal circumstances. Mortality and complications are rare except in Cushing's syndrome. All major adrenal hormones and their stimulators are measurable and discriminating tests abound. Imaging techniques detect small masses. Inhibitors of hormone synthesis and cell receptors allow amelioration of metabolic hazards pre-operatively. Primary aldosteronism is first medically controlled, and patients are selected for operation if difficult to control and if the type of disease is responsive to adrenalectomy. Cushing's disease usually requires pituitary adenomectomy, but some of the 15–30 per cent failures, those with ectopic adrenocorticotrophic hormone (ACTH) producing tumours, or adrenal adenomas warrant adrenalectomy. Metabolic hazards are controlled pre-operatively by aminoglutethimide. Benefits of adrenalectomy are uncertain and many challenges remain. Hazards of phaeochromocytomectomy are avoided by pre-operative adrenergic blockade. Myocardial disease warrants delay. Small unilateral lesions of all types are best removed through unilateral approaches. Small masses found on imaging and without apparent effect can be observed.
Towards the Belfast immunosuppressive regimen: A prospective trial of low versus high dose steroids and once versus twice daily immunosuppression
Authors: Griffin P J A , Salaman J R
Published: March 2007

The Transplant Unit in Belfast achieves the highest survival rates in Great Britain for renal transplants. The immunosuppression used comprises azathioprine and very low doses of steroids administered just once a day. The importance of these features has been examined in two clinical trials using (a) high or low dose steroids with azathioprine, (b) low dose steroids with azathioprine given once or twice daily following cadaveric renal transplantation. Low dose steroids were no more effective than were high dose steroids in preventing graft rejection and there was no advantage in administering immunosuppression once daily in the morning as opposed to twice daily in divided doses. None the less, with low doses of steroids the complications of cushingism and obesity were markedly reduced. Neither trial achieved the degree of success in transplant survival that has been usual in Belfast.
Non-seminomatous germ cell testicular tumours: Residual masses after chemotherapy
Authors: Levitt M D , Reynolds P M , Sheiner H J , Byrne M J
Published: March 2007

Twenty-three consecutive patients with metastatic non-seminomatous germ cell testicular tumours were treated with a combination of cisplatinum, vinblastine and bleomycin. Nineteen had elevated serum tumour marker levels (α-fetoprotein and βT-subunit HCG) prior to chemotherapy. In 11 of the 19, residual masses were present on the completion of induction chemotherapy despite normal serum tumour marker levels (residual mass after chemotherapy). The management of these 11 patients was based on a policy of observation rather than routine resection of residual deposits and all are currently alive (32-58 months) with ten free of active disease. Two of the eleven required additional chemotherapy when serial tumour marker levels became elevated during follow-up. Another six have been observed without further intervention and have remained well with stable or diminishing deposits. The remaining three have required resection of residual masses, in each case because of mass enlargement despite persistently negative tumour marker levels. None of the masses showed histological evidence of malignancy. A more selective approach to resection of residual masses after chemotherapy is advocated.
The value of ultrasound in the diagnosis and treatment of small hepatocellular carcinoma
Authors: Kanematsu T , Sonoda T , Takenaka K , Matsumata T , Sugimachi K , Inokuchi K
Published: March 2007

Thirty-two patients with a solitary hepatocellular carcinoma of less than 4 cm diameter were treated during the 13 years from 1971 to 1983, two-thirds of them since 1981. Serum α-fetoprotein levels proved to be an excellent diagnostic tool for these early stage carcinomas which are generally asymptomatic. Ultrasonography forms an invaluable test for the detection of occult liver cancer and has enhanced the ability to detect small sized lesions. The accuracy of this method increased from 25 per cent for the period 1971-1980 to 89 per cent for the period 1981–1983. The cumulative survival rates for the 32 patients treated by hepatic resection at 1, 2 and 5 years were 85, 70 and 22.2 per cent (excluded from these figures are four operative deaths giving a 12.5 per cent operative mortality).
Villous adenomas in the duodenum
Authors: Haglund U , Fork F-T , Genell S , Rehnberg O
Published: March 2007

Five patients with villous adenomas in the duodenum are described. In one patient malignant degeneration had occurred at the time of diagnosis. This patient was treated with a pancreaticoduodenal resection and is doing well 2 years postoperatively. The other four patients all had a duodenotomy and a local excision of the tumour. One patient had a recurrence with malignant degeneration within 1 year. The other three patients are doing well without signs of recurrence 1–4 years postoperatively. It is concluded that duodenal villous adenomas are potentially malignant. The strategy of surgical treatment is discussed.
Evaluation of surgical treatment of carcinoma of the oesophagus in the elderly: 20 years' experience
Authors: Sugimachi K , Matsuzaki K , Matsuura H , Kuwano H , Ueo H , Inokuchi K
Published: March 2007

The results of 231 oesophageal resections and reconstruction in 395 patients with thoracic oesophageal carcinoma presenting in the last 20 years are reported. In patients over 70, the incidence of multiple pathology and postoperative complication was high. The most frequent causes of death after surgery were pulmonary complications, and anastomotic leakage. As the mortality rate in the aged group exceeded that of the younger groups, careful pre-operative assessment, the indication for surgery and postoperative care should be carefully considered, even though only surgery offers a hope of cure for patients with oesophageal carcinoma. If the elderly can tolerate the surgical procedures, the 5 year survival rate equals that of the younger patients.
Quality of life after restorative proctocolectomy with pelvic ileal reservoir
Authors: Pezim M E , Nicholls R J
Published: March 2007

Fifty-five patients who had undergone restorative proctocolectomy with a pelvic ileal reservoir between 3 and 82 months previously were sent a detailed questionnaire to assess their quality of life. All patients had experienced an ileostomy at some time. Fifty-one (94 per cent) returned completed questionnaires. The average frequency of evacuation from the reservoir was four times per 24 hours. Antidiarrhoeal medication was required by 14 (27.4 per cent). Continence was normal in 32 (62.7 per cent) and only 3 (5.9 per cent) had troublesome faecal leakage. Twenty-two (43.1 per cent) evacuated stool spontaneously, while 24 (47.1 per cent) needed to catheterize the reservoir for each evacuation. Four patients who had had the reservoir removed were added to the 51 responders to give a total number of 55 whose quality of life was considered in this study. The reservoir was preferred to an ileostomy with regard to confidence (87 per cent), cleanliness (89 per cent), sexual self-image (87 per cent), social (85 per cent) and sport activity (87 per cent), and ease of carrying out work (84 per cent). The overall preference was 87 per cent. Thirty-four (66.7 per cent) felt there was no significant disadvantage associated with the reservoir, while 10 (19.6 per cent) saw the long convalescent period and 9 (17.6 per cent) the requirement for catheterization as drawbacks.
Local recurrence after potentially curative resection for rectal cancer in a series of 1008 patients
Authors: McDermott F T , Hughes E S R , Pihl E , Johnson W R , Price A B
Published: March 2007

Local recurrence and its related mortality after potentially curative resection for rectal cancer have been analysed in a series of 1008 patients managed by one of the authors. Nine hundred and thirty-four were available for analysis of recurrence. One hundred and seven (11 per cent) patients developed local recurrence without evidence of systemic spread and 84 (9 per cent) both local and systemic recurrence. Local recurrence was less common (14 per cent) after resection of tumours of the upper third of the rectum compared with the middle (21 per cent) (P = 0.02) or lower thirds (26 per cent) (P < 0.001). Local recurrence was related to both tumour stage and differentiation (P < 0.001). There was no significant relationship between local recurrence and tumour size or the type of curative resection performed, restorative or non-restorative. The distal margin of clearance after restorative resection did not influence the local recurrence rate. Of patients who developed metastases recurrence was evident within 2 years in 60 per cent. Three hundred and thirty-two patients died from recurrence, 91 (27 per cent) with evidence of local recurrence only, 80 (24 per cent) with combined local and systemic recurrence and 161 (48 per cent) with evidence of systemic spread only. The corresponding median survivals were 35, 34 and 39 months.
The establishment of a microcomputer-based diagnosis and operations index in the Department of Surgery of a district general hospital
Authors: Prout W G , Blood P A
Published: March 2007

The development and running of a microcomputer-based index of diagnoses and operations in the surgical department of a district general hospital is described. Many major problems have occurred, leading to malfunction or failure of the system, but it appears that these difficulties have now been resolved. In one year 4360 records have been fully processed with 4775 diagnoses, and 3968 operation codes have been permanently recorded. A further 560 patient records have been entered and await admission. The day-to-day running of the computer has been achieved by established secretarial staff without increase in number. The advantages and disadvantages of this system are outlined.
A study of rat intestinal wound healing in the presence of radiation injury
Authors: Ormiston M C E
Published: March 2007

Anastomotic dehiscence is a common complication following the resection of intestine with late radiation damage, and can occur even after wide resection of obviously compromised tissue. In this study using male rats, exteriorized segments of terminal ileum and/or the fatty appendages of the testes were exposed to single doses of irradiation (10, 15 and 20 Gy) producing early and late damage of varying severity. Wounds made at intervals from 2-24 weeks after irradiation in normal or irradiated ileum were repaired immediately and wrapped in normal or irradiated appendages. Post mortem examination of the wounds 4-7 days later showed that, in general, control wounds made in unirradiated tissues healed soundly. The incidence of wound breakdown in irradiated tissues was dose-dependent. After irradiation of the ileum alone, the frequency of suture line dehiscence increased with the interval between irradiation and wounding. When the ileum and appendages or appendages alone had been irradiated, the frequency of dehiscence was increased from 2 weeks post-irradiation onwards. This study emphasizes the important role played by adhesions in rat intestinal wound healing and shows that dehiscence may occur if irradiated tissues are positioned next to a suture line made in normal rat intestine. The findings suggest that, in clinical practice, it may be advisable to ensure that anastomoses at risk from radiation damage area wrapped in unirradiated tissue such as omentum.
Influence of pre- and intra- operative factors on the occurrence of postoperative fatigue
Authors: Christensen T , Hougård F , Kehlet H
Published: March 2007

Subjective feeling of fatigue was assessed before and 10, 20 and 30 days after uncomplicated abdominal surgery in 52 patients and after minor otological surgery in 15 patients. In major surgery fatigue increased from 3.0 ± 0.2 (mean±s.e.m.) arbitrary units pre-operatively to 6.1±0.3, 5.3±0.3 and 4.1±0.3 on day 10, 20 and 30, respectively (P < 0.001). In contrast, after minor surgery fatigue did not change from before surgery (2.1±0.3) to day 7 (2.9±0.5) (P>0.05), day 20 (2.3±0.4) (P<0.4), or day 30 after surgery (2.1±0.3) (P<0.9). Differences in fatigue between groups were significant postoperatively (P<0.001), but not pre-operatively (P<0.05). Mean duration of surgery was similar in the two groups. In the abdominal group an increase in postoperative fatigue did not correlate with age, sex, pre-operative degree of fatigue, actual body weight, triceps skinfold thickness (TSF), arm muscle circumference (AMC), anthropometric index (body weight × TSF × AMC) or serum-transferrin, but did slightly with pre-operative body weight related to ideal body weight (r = -0.3, P<0.05). Thus, the magnitude of the trauma and not the duration of anaesthesia may be important for occurrence of postoperative fatigue. Furthermore, fatigue after elective abdominal surgery seems to be unpredictable from the pre-operative status of the patient.