bluuebunny/crossref_metadata_2025 huggingface dataset:
Choice of injection site for low dose heparin in inguinal herniorrhaphy
Authors: De Lange Samuel
Published: March 2007

A prospective controlled randomized clinical trial of 125 patients undergoing elective inguinal hernia repair demonstrates that the arm is preferable to the abdominal wall as injection site for low dose heparin with regard to wound haematoma formation. Two patients in the ‘arm’ group developed a wound haematoma compared with 18 patients in the ‘abdomen’ group (P < 0·005). 99Tcm-labelled heparin was used to study the pharmacokinetics of heparin in an attempt to explain the results.
Bromocriptine in severe cyclical breast pain
Authors: Durning Patricia , Sellwood R A
Published: March 2007

The use of bromocriptine has been evaluated in a double-blind crossover trial of placebo against 5 mg bromocriptine over six menstrual cycles in 38 women with severe cyclical breast pain. Assessment using both the linear analogue system and clinical examination showed a statistically significant reduction in pain, tenderness and nodularity.
Biliary and pancreatoduodenal diversion by means of an isolated jejunal loop
Authors: González E Moreno , Blanch G García , García I García , Kempin J Calleja , Pascual M Hidalgo
Published: March 2007

Seven patients suffering from chronic pancreatitis, with dilatation of the duct of Wirsung and obstruction of the intrapancreatic segment of the choledochus, underwent a pancreatic and biliary jejunoduodenal diversion. An isolated jejunal loop was used as a conduit between the bile and pancreatic ducts and duodenum in 3 patients, while in 4 patients separate isolated loops between the duct and duodenum were fashioned. The postoperative period passed without incident. All the patients were symptom free 3 months after operation.
Polya gastrectomy for recurrent ulceration following vagotomy
Authors: Clark C G , Ward M W N
Published: March 2007

Thirty-seven patients with recurrent ulceration after vagotomy were treated by Polya gastrectomy and have been followed up for a minimum of 3 years (median 5 years). The diagnosis of recurrent ulcer was made by endoscopy or at operation. Nine patients were initially treated with cimetidine and either failed to respond or relapsed on maintenance dosage. There were 2 operative deaths and 2 patients were lost to follow-up. The results of Polya gastrectomy were Visick grade I: 61 per cent, Visick grade II: 15 per cent, Visick grade III: 9 per cent and Visick grade IV: 15 per cent. Two patients had further recurrent ulceration.
The effects of subclinical malnutrition and refeeding on the healing of experimental colonic anastomoses
Authors: Ward M W N , Danzi M , Lewin M R , Rennie M J , Clark C G
Published: March 2007

The effects of dietary protein deprivation on the healing of colonic anastomosis in the rat have been investigated. Nutritional status was assessed both before and after operation using body weight, nitrogen balance studies and serum albumin estimations. Healing of colonic anastomosis was assessed by bursting pressure measurements. Rats fed a protein-depleted diet throughout the study were compared both with rats restored to a full diet after surgery and rats receiving a full diet throughout. Although protein depletion caused a 12·5 per cent weight loss and a negative nitrogen balance, serum albumin remained normal in all rats at the time of operation. After operation, all rats were in negative nitrogen balance, although this was greater in the protein-depleted group. Similarly, in comparison to control animals, the protein-depleted group had significantly lower colonic bursting pressures and significantly lower serum albumin concentrations. Rats returned to a full diet after operation had smaller losses of nitrogen and normal colonic bursting pressures. The results indicate that a commonly encountered degree of malnutrition, insufficient to affect nutritional indices used in clinical assessment, may interfere with colonic healing. Early re-introduction of nutrition in the postoperative period may be able to reverse this effect.
Splenectomy and vasoligation for patients with haematemesis secondary to bilharzial hepatic fibrosis
Authors: El Masri Shawgi H , Hassan Mohamed A
Published: March 2007

One hundred and thirteen patients with haematemesis secondary to bilharzial hepatic fibrosis had splenectomy and vasoligation. There were 6 deaths in the immediate and 28 in the late postoperative period. The commonest cause of death was recurrent haematemesis followed by hepatic failure. Transient jaundice, ascites and infection were common in the postoperative period. The operation improved the cellular elements of the blood but the 20 per cent incidence of recurrent bleeding is unacceptable.
Cimetidine and perforated peptic ulcer
Authors: McKay Alan J , McArdle C S
Published: March 2007

Cimetidine is thought to have accelerated the reduction in elective peptic ulcer surgery but its effect on the incidence of perforated peptic ulcer has not been reported. A 15-year (1966–1980) review of peptic ulcer surgery in a district general hospital is presented. Since cimetidine became available (November 1976), the mean annual number of elective operations has fallen from 91·4 to 50·5 (45 per cent reduction). The number of perforations has fallen from 40·6 to 36·5 (10 per cent reduction).

One hundred and five patients treated for perforation (97 duodenal, 8 gastric) from 1978 to 1980 were reviewed in detail. Of the 64 patients with a chronic ulcer, 8 were taking cimetidine when their ulcers perforated and a further 8 had been on the drug previously. Cimetidine has substantially reduced elective peptic ulcer surgery. There appears to have been no equivalent reduction in the incidence of perforation.
Do women do worse after proximal gastric vagotomy?
Authors: Linhardt G E , Stoddard C J , Johnson A G
Published: March 2007

The view that woman fare worse than men following gastric surgery led us to examine the results of proximal gastric vagotomy (PGV) performed in 25 women with chronic duodenal ulcer. Follow-up was from 6 months to 8 years, with an average of 45 months. These were compared with men undergoing PGV for the same condition over the same period. The age, duration of symptoms and complication and recurrence rates were similar. Modified Visick grading rated the result as good in more than 90 per cent of both men and women. Flatulence and postprandial fullness were the most common complaints but were usually mild. The results of PGV in women are just as good as those in men.
Skin closure of inguinal herniorrhaphy wounds in short-stay patients
Authors: Ralphs D N L , Cannon S R , Bolton J P
Published: March 2007

One hundred and twenty-two inguinal hernias were repaired in a consecutive series of 104 patients. The patients were randomly divided into two groups. In one, 66 wounds were closed by the traditional method of using interrupted non-absorbable skin sutures. In the second group, 56 wounds were closed with subcuticular Dexon sutures. The results of the two methods of skin closure were compared in the immediate postoperative period, at 2 weeks, 3 months and at more than 18 months after surgery. The final appearance of the wounds was similar in the two groups. Dexon has the advantage for short-stay patients of not requiring removal.
Abdominal wall resection and reconstruction with the aid of Marlex mesh
Authors: Blom W F , Koops H Schraffordt , Vermey A , Oldhoff J
Published: March 2007

Treatment of malignant tumours of the abdominal wall is primarily surgical and should consist of ample excision with a margin of 4–6 cm into the adjacent healthy tissue. When primary closure of the defect in the abdominal wall is not feasible, it can be repaired with the aid of Marlex mesh, combined if necessary with a pedicled omentum flap and free skin grafts. Major resections of the abdominal wall are thus made possible.
Twenty-six cases of liver trauma
Authors: Calne R Y , Wells F C , Forty J
Published: March 2007

Twenty-six cases of liver trauma admitted to Addenbrooke's Hospital between 1971 and 1981 are reported. They are assessed according to the grade of liver damage, and a policy of management of liver trauma is proposed. A case is made for the use of packing under certain defined conditions.
Bile diversion after total gastrectomy
Authors: Donovan I A , Fielding J W L , Bradby H , Sorgi M , Harding L K
Published: March 2007

A method for studying bile reflux into the oesophagus after total gastrectomy is described using 99Tcm-HIDA and an external imaging system. Two reconstructions were studied: oesophagojejunostomy with a diverting entero-anastomosis (omega reconstruction, 6 studies) and Roux-en-Y reconstruction (20 studies). The incidence of reflux on scanning correlated well with the incidence of oesophagitis, and the finding of reflux was almost always associated with severe symptoms. The omega procedure was unsuccessful in diverting bile in 5 patients despite an entero-anastomosis as wide as 12 cm. The Roux-en-Y reconstruction was unsuccessful in diverting bile in 5 patients all of whom had a diverting limb 35 cm in length; none of the 9 patients with a diverting limb longer than 35 cm refluxed (range 40–50 cm).
Anorectal sepsis: Microbiology in relation to fistula-in-ano
Authors: Grace R H , Harper I A , Thompson R G
Published: March 2007

One hundred and sixty-five patients presented in a 4-year period; 68 (41·2 per cent) had had previous anorectal sepsis and in 56 of these patients (82·3 per cent) the presenting sepsis was at the site of the previous abscess. The abscesses were drained and pus was sent for culture; any fistula, if found, was laid open. A second examination under anaesthesia was performed within 7–10 days if no fistula had been found. The pus from 114 patients grew bowel-derived organisms; 62 (54·4 per cent) fistulas were found. The pus from 34 patients grew skin-derived organisms but no fistula was demonstrated in this group. It is suggested that a second examination need only be performed if culture of the pus grows bowel-derived organisms; anorectal abscesses which grow skin-derived organisms are not associated with a fistula.
The clinical syndrome of mammary duct ectasia
Authors: Thomas W G , Williamson R C N , Davies J D , Webb A J
Published: March 2007

Over an 11-year period in one surgeon's practice, mammary duct ectasia constituted 5·5 per cent of all breast diseases treated by operation. A total of 78 patients undergoing major duct excision for mammary duct ectasia has been studied to determine the success of the standard operative treatment. Good results were obtained when the indications for operation were nipple retraction, nipple discharge or a sub-areolar mass. By contrast, generally poor results were obtained in 9 patients in whom the indication for operation was recurrent para-areolar sepsis; two of these ultimately came to simple mastectomy.
Treatment of well-differentiated carcinoma of the thyroid based on initial staging
Authors: Duffield R G M , Lowe D , Burnand K G
Published: March 2007

Sixty-six patients with well-differentiated thyroid carcinomas have been followed up for a minimum of 10 years. A conservative surgical approach was adopted for unsuspected intrathyroid tumours. Twenty-three out of 29 patients (80 per cent) with papillary carcinomas and 18 out of 37 (50 per cent) with follicular carcinomas were alive at the time of review. Although patients with follicular carcinoma have only a moderate overall prognosis, patients with node-negative intrathyroid tumours (unsuspected) treated by conservative resection have a 79 per cent 10-year survival. These survival figures compare favourably with other reported series where all the patients were treated by radical surgery. Early conversion of a conservative resection to a total thyroidectomy for an unexpected tumour does not appear to be warranted since an increased risk of complications is not balanced by an improved outcome. Two patients, with intrathyroid papillary carcinomas who developed tumours in the residual gland more than 5 years after initial lobectomy, successfully underwent further resections of the thyroid remnants, and are disease free more than 9 years later.
The use of a rigid choledochoscope in exploration of the common bile duct
Authors: Ernst D , Windsor C W O
Published: March 2007

In 62 consecutive explorations of the common bile duct during a 2-year period, a Storz rigid choledochoscope was used to visualize the lumen of the duct before its closure over a T tube. All patients had radiological abnormalities on cholangiography; 45 had stones and 17 apparent strictures. In those with stones, the instrument was introduced after apparent removal of the stones to confirm the completeness of the manoeuvre. This examination showed that 11 patients (25 per cent) still had stones present and needed further manipulation. When the duct was seen to be clear, a T tube was inserted and the validity of the choledochoscopic findings checked by postoperative T-tube cholangiography. This confirmed the visual accuracy in all but one patient, an accuracy of 98 per cent. Of the 17 patients explored for other radiological abnormalities, choledochoscopy correctly determined the aetiology or excluded abnormalities in all cases. No complications of the procedure were encountered.
The pelvic ileal reservoir: An experimental assessment of its function compared with that of normal rectum
Authors: Cranley B , McKelvey S T D
Published: March 2007

The function of the 3-loop pelvic ileal reservoir as an alternative to total proctocolectomy and ileostomy is assessed experimentally in dogs and compared with normal rectum under identical conditions. No difference was found between the pelvic ileal reservoir and normal rectum in their ability to maintain continence. The efficiency of evacuation, however, is significantly better in normal rectum (P < 0·01). Observations made over a prolonged period of time suggest that frequency of defecation, tenesmus and incomplete evacuation are persistent problems with an ileal reservoir. The results of the experiments concur with clinical findings that satisfactory continence may be achieved by using the ileal reservoir but that it does not possess the ability of normal rectum to evacuate completely. Hence the frequent need for self-catheterization.
Cerebrospinal fluid rhinorrhoea and its management
Authors: Westmore G A , Whittam D E
Published: March 2007

A series of 100 cases of cerebrospinal fluid rhinorrhoea has been analysed with reference to the incidence and pattern of meningitis in order to formulate a rationale for the future management of such cases. Most cases are best managed conservatively for the first 14 days during which the majority resolve spontaneously. Of those requiring surgery, the trans-ethmoid/sphenoidal route of repair is preferred except in certain specified circumstances. The high incidence of meningitis in cerebrospinal fluid rhinorrhoea following nasal or trans-sphenoidal surgery probably demands early operation by craniotomy.
Prospective study of dialysis fistulas: Problem patients and their treatment
Authors: Reilly D T , Wood R F M , Bell P R F
Published: March 2007

A 5½-year prospective study of the fate of arteriovenous fistulas for haemodialysis is reported with particular reference to the prevention and treatment of complications. A total of 157 consecutive patients was accepted for chronic haemodialysis: 148 patients had a first attempt at a wrist fistula construction, 2 patients had a failed exploration of the wrist, 1 patient had a primary brachial fistula due to absent forearm veins and 6 patients were excluded from analysis because vascular access operations had already been performed elsewhere. Including early failures, 80 per cent of the fistulas remained patent 1 year after construction and 65 per cent remained patent at 4 years. When early thrombosis and technical failures were excluded, the 1-year patency rate was 90 per cent.

Of the study group of 150 patients with attempts at wrist fistula construction, 94 had no problems with their fistulas. Five were lost to follow-up and complications developed in 51 patients, including poor flow, thrombosis, venous hypertension and false aneurysm. These patients constituted a problem group and 107 further procedures were required to re-establish satisfactory access. Analysis of variables including age, sex, smoking habit, pre-dialysis time and operative factors showed only vein size to exert a significant effect on fistula survival. Discriminant analysis failed to separate the two groups. There were 42 salvage operations and 65 new access procedures. The latter included 49 wrist or brachial fistulas, 9 ankle shunts and only 4 loop grafts.

It is suggested that with careful management of wrist fistulas and their complications, the place of autogenous or artificial grafts is strictly limited.
A study of the quality and duration of survival following resection, endoscopic intubation and surgical intubation in oesophageal carcinoma
Authors: Watson A
Published: March 2007

A series of 130 cases of oesophageal carcinoma managed by one surgeon in a unit with a major interest in oesophageal disorders is reviewed. The management policy has been an active one of resection in suitably selected cases, less favourable ones being treated by operative intubation before 1979 and by endoscopic intubation since 1979. Operative mortality and morbidity have been compared between the three groups, together with duration of survival and quality of swallowing as measured by a modified Visick grading. In the intubated groups, endoscopic intubation carried a hospital mortality of 15·6 per cent compared with 40·8 per cent in the operative group. It was associated with less morbidity and a better quality of survival, although survival times were comparable and did not exceed 18 months in either group. In the resection group, hospital mortality was 12·2 per cent, and both the mean survival and quality of swallowing were greater than in either endoscopic group.

It is concluded that in suitably selected cases, resection can be performed with a mortality considered acceptable for palliative intubation whilst conferring greater survival and restoration of normal swallowing. In less favourable cases, endoscopic intubation is superior to operative intubation in terms of reduced mortality and better restoration of swallowing.
Psoas abscess in Crohn's disease
Authors: Van Dongen L M , Lubbers E J C
Published: March 2007

In a series of 161 patients treated surgically for Crohn's disease, 7 patients were seen with a psoas abscess as a complication of the bowel disease. Drainage only was not sufficient to check the rapid downhill course in these patients. Resection of the underlying bowel disease was performed in all patients. There was one death from pulmonary embolism and 3 patients required drainage on more than one occasion.
Surgical treatment of pancreatic pseudocysts
Authors: Schattenkerk M Eeftinck , De Vries J E , Bruining H A , Eggink W F , Obertop H
Published: March 2007

Twenty-five patients with pancreatic pseudocysts were treated surgically. The operative mortality was 4 per cent. Morbidity after external drainage was higher (86 per cent) than after internal drainage (36 per cent), mainly due to the presence of chronic postoperative pancreatic fistulas. A standard procedure based on our own results and published data for management of pancreatic pseudocysts is proposed.
The control of human pancreatic adenocarcinoma xenografts in nude mice by hormone therapy
Authors: Greenway B , Duke D , Pym Barbara , Iqbal M J , Johnson P J , Williams R
Published: March 2007

The effect of hormone therapy on the growth of human non-endocrine pancreatic adenocarcinoma xenografts in nude mice was evaluated. The androgen testosterone stimulated tumour growth rate, whereas the anti-androgen cyproterone acetate significantly inhibited tumour growth rate compared with untreated controls. These findings provide further support for the suggestion that the growth and metabolism of pancreatic carcinoma may be dependent on the sex steroid hormones.
The value of routine peroperative cholangiography—a report of 4000 cholecystectomies
Authors: Doyle P J , Ward-McQuaid J N , Smith A Mcewen
Published: March 2007

A total of 4000 consecutive cholecystectomies performed over a period of 25 years has been analysed to determine whether routine peroperative cholangiography (PC) has influenced overall mortality. The patients have been divided into four cohorts of 1000, the first cohort before the introduction of PC, two covering the period of introduction of PC and the final cohort when PC was an established routine. A significant fall in overall mortality has been demonstrated, but when the patients are divided into simple cholecystectomy and the group undergoing additional choledochotomy there is no significant fall in the mortality rate. The mortality rate for the latter group is three or four times greater than that for the cholecystectomy alone group. The main contribution to the lower mortality is the reduced duct exploration rate following the introduction of PC. The stone recovery rate has improved from 34 to 71 per cent. The use of routine PC during cholecystectomy is recommended.
Combined antrectomy and Rouxen-Y anastomosis in the surgical treatment of recurrent peptic ulceration
Authors: Cooper G , Bell G
Published: March 2007

The results of antrectomy performed for recurrent peptic ulceration after vagotomy and drainage are frequently marred by bilious vomiting. Consequently, there has been interest in combining antrectomy with Roux-en-Y drainage to prevent this complication. The experience of one surgeon in revisional gastric surgery has been studied retrospectively. Thirty-six patients have been reviewed in detail, 24 of whom had a combined antrectomy and Roux-en-Y anastomosis: 16 for recurrent peptic ulceration, 2 for non-ulcer dyspepsia and 6 for bile reflux gastritis. None of these has required reoperation, and 12 of the 16 with recurrent ulcers have had a good result. Four of 12 who underwent antrectomy alone subsequently required biliary diversion. Combining antrectomy with a Roux-en-Y anastomosis prevents postoperative bile reflux gastritis and thereby the need for further revision on this account. The results of this approach compare well with those of other procedures used in the treatment of recurrent peptic ulceration.
Long term results of truncal vagotomy and pyloroplasty for gastric ulcer
Authors: Madsen P , Schousen P
Published: March 2007

The results of truncal vagotomy and pyloroplasty for gastric, prepyloric and combined ulcers in 215 patients were evaluated 9–15 years after operation. The operative mortality was 1·9 per cent, and the recurrence rates in gastric, prepyloric and combined ulcer patients were 8, 13 and 0 per cent respectively. Recurrent ulceration was significantly related to acid serretion. The functional results were not different in patients with gastric and prepyloric ulcers, but significantly better in the small group with combined ulcer than in the group with prepyloric ulcer. No long term weight changes were seen. Gastric cancer was the cause of death in 2 men and 1 woman treated for gastric ulcer.
Measurement of gastric emptying after gastric bypass surgery using radionuclides
Authors: Horowitz M , Cook D J , Collins P J , Harding P E , Hooper M J , Walsh J F , Shearman D J C
Published: March 2007

The pattern of gastric emptying has been assessed after gastric bypass surgery using a double isotope technique for measuring solid and liquid emptying with a scintillation camera. Eleven control subjects and 12 patients, 12 months post-gastric bypass, were studied. Stomal and gastric pouch size were assessed at endoscopy. Solid emptying was slower and liquid emptying was more rapid after gastric bypass surgery. Initial rapid emptying of solid occurred in the 4 patients with the smallest pouch diameters. There was no correlation between stomal size and rates of solid or liquid emptying nor between the weight loss produced by the operation and the rates of solid or liquid emptying, stoma or pouch size.
Staples or sutures for colonic anastomoses—a controlled clinical trial
Authors: Brennan S S , Pickford I R , Evans Mary , Pollock A V
Published: March 2007

We randomly allocated 100 patients undergoing colonic or rectal resections to have their anastomoses made either by a single layer of braided polyester interrupted sutures, or by the SPTU circular stapling instrument. Twelve anastomoses leaked, 4 being detected only by contrast enema. There was no difference in leak rate between the two anastomotic methods, but patients in the stapled group had a significantly higher incidence of minor wound infection, and spent significantly more days in hospital after operation. The stapling instrument is no safer than sutures for colonic and rectal anastomoses, but considerably facilitates the performance of a low anterior resection.
Cough dynamics in oesophageal cancer: Prevention of postoperative pulmonary complications
Authors: Sugimachi K , Ueo H , Natsuda Y , Kai H , Inokuchi K , Zaitsu A
Published: March 2007

The value of the cough reflex and its pressure and flow in the immediate postoperative period was measured in patients who underwent subtotal oesophagectomy and reconstruction for oesophageal cancer and other thoracic surgery. Twenty-two patients with subtotal oesophagectomy and reconstruction were found to have an extensive reduction in cough reflex and force, compared with those who had undergone pulmonary lobectomy. Damage to the vagal nerve caused by dissection of the paratracheal lymph nodes, and injury to the diaphragm during operation for oesophageal cancer appeared to be responsible for the inability to cough. It was of interest that the patients who showed a high value of cough reflex and force in the immediate postoperative period had few pulmonary complications. The postoperative measurement of cough ability may be a useful indicator for safe extubation of the intratracheal tube, as a means of preventing pulmonary complications after thoracic surgery. Continuous mechanical ventilation and frequent suction to remove retained secretions are strongly recommended for the patients who are unable to cough properly.
A controlled trial of plasma lipid reduction in peripheral atherosclerosis—an interim report
Authors: Duffield R G M , Miller N E , Jamieson C W , Lewis B
Published: March 2007

The effects of plasma lipid reduction on the progression of femoral atherosclerosis have been studied in 24 hyperlipidaemic patients with stable intermittent claudication. The patients were randomized into treatment or ‘usual-care’ groups, the former receiving lipid-lowering therapy by diet and drugs, and the latter no such treatment. Biplanar femoral arteriography was performed before and after a mean period of 19 months. In the treatment group plasma total cholesterol was decreased by a mean of 25 per cent and plasma triglyceride by more than 40 per cent. Plasma lipids were unchanged in the usual-care group. Significantly fewer arterial segments showed detectable progression in the treatment group (P < 0·01). In addition, the mean increment in plaque area (mm2 per segment per year) in the treatment group was only 34 per cent of that in the usual-care group (P = 0.06).
Increased penile perfusion and reversal of vasculogenic impotence following femoro-femoral bypass
Authors: Schuler J J , Gray B , Flanigan D P , Williams L R
Published: March 2007

This study assessed the effect of femoro-femoral bypass on penile perfusion and impotence. Twelve patients with femoro-femoral grafts had Doppler pressure measurements and penile/brachial indices (PBI) recorded at both dorsal penile arteries, first with the graft open and then with the inflow portion of the graft temporarily occluded by manual external compression.

Doppler pressure measurements and PBI did not change significantly in the dorsal penile artery on the donor (inflow) side of the graft when the graft was temporarily occluded. Patients who were potent both pre- and postoperatively (n - 5) had no significant change in pressure or PBI on the recipient (outflow) side of the graft with graft occlusion. In those patients who experienced reversal of impotence following bypass (n = 4) the mean dorsal penile artery pressure on the recipient side decreased from 101 mmHg with the graft open to 30 mmHg with the graft occluded (P < 0·05).

Review of arteriograms revealed that patients most likely to experience increases in penile perfusion have either (a) recipient side common iliac artery occlusion and a patent internal iliac system which is perfused in a retrograde fashion or (b) recipient side proximal internal iliac occlusion with well-developed collateral circulation between the profunda femoris and the distal internal iliac arterial systems.

Femoro-femoral bypass can increase penile perfusion and alleviate vasculogenic impotence in selected patients.
Impotence in vascular disease: relationship to vascular surgery
Authors: Depalma R G
Published: March 2007

This review considers diagnosis and treatment of vasculogenic impotence. It describes current information related to normal mechanisms of penile erection and pathophysiology of organic impotence, methods of preoperative diagnosis, quantitative evaluation of penile blood flow and operative techniques to be employed in aneurysmal or occlusive aorto-iliac disease. The importance of preserving internal iliac flow and neural fibres enervating the genitalia is stressed. Large vessel reconstructions have proved practical in maintaining or restoring normal erectile function, but at present reconstructions of isolated pudendal or penile artery occlusions are experimental. Medical therapy can be effective in certain marginal cases of small vessel occlusion.
Prevention of fatal postoperative pulmonary embolism by heparin dihydroergotamine or Dextran 70
Authors: Gruber U F
Published: March 2007

Eight thousand and one patients were admitted to a prospective, randomized multicentre trial comparing the prophylactic efficacy of heparin-dihydroergotamine (DHE) and Dextran 70 against fatal pulmonary embolism after emergency or elective orthopaedic surgery. Of the 7413 patients correctly admitted to the trial, 3698 were allocated to receive heparin-DHE and 3715 to receive Dextran 70. Twenty-eight patients in the heparin-DHE and 27 in the dextran group died within 40 days of operation. Necropsy was performed in 19 cases in each group. In 6 patients in the heparin-DHE and in 9 in the dextran group pulmonary embolism was the sole or a contributory cause of death (n.s.). In the dextran group there were more diffuse intraoperative bleeding complications (P < 0·01), more massive postoperative haemorrhages (P < 0·01), more small wound haematomas (P < 0·05) and more allergic reactions (P < 0·05). This is the first large multicentre trial dealing with elective and emergency procedures in orthopaedic patients.
Human umbilical vein and polytetrafluorethylene arterial grafts compared in an artificial circulation
Authors: Goldman M , Gunson B , Hawker R J , McCollum C N
Published: March 2007

The relative merits of gluteraldehyde tanned human umbilical vein (HUV) and polytetrafluorethylene (PTFE) as alternative arterial grafts have yet to be distinguished in clinical practice. A direct comparison between the thrombogenicity of these rival materials using human blood in an artificial circulation has therefore been made. Eight volunteers each donated 600ml of blood. The heparinized blood, now containing autologous 113Inm labelled platelets, was divided equally into paired artificial circulations incorporating 15 cm lengths of either 6 mm PTFE or HUV. The grafts were perfused for 45 min with a pulsatile flow mimicking the superficial femoral artery. Platelet deposition on the graft (graft activity) was expressed as the ratio of counts from the graft over those per millilitre of blood. The fall in platelet count over the 45-min period and change in threshold aggregation responses were also measured. Platelet deposition was consistently greater on HUV with a mean (±s.e.) graft activity of 5·59±0·9 markedly exceeding that in the PTFE group of 1·16±0·1 (P <0·01). This increased consumption of platelets by HUV was demonstrated by a mean fall in platelet count in the circulating blood of 46·7±8·4 × 109/l compared to a fall of 18·2 ± 6·2 × 109/l in the PTFE group (P <0·01). Furthermore, aggregation thresholds increased more after exposure to HUV compared to PTFE. The flow surface platelet deposition was confirmed by scanning electron microscopy and in addition patchy subintimal dissection was found in all the HUV grafts. HUV is markedly more thrombogenic than PTFE when examined in an artificial circulation under flow conditions similar to the human femoropopliteal segment.
Randomized controlled trial of injection sclerotherapy for bleeding oesophageal varices—an interim report
Authors: Yassin Y M , Sherif S M
Published: March 2007

Oesophageal varices are the commonest cause of acute upper gastrointestinal bleeding in Egypt, due to the prevalence not only of schistosomiasis but also chronic hepatitis. Poor results of conventional treatment and shunt surgery led us to evaluate injection sclerotherapy, using fibreoptic endoscopy. In a controlled trial, 108 patients were randomly allocated to injection sclerotherapy or to conventional treatment (medical measures, with modified splenectomy and oesophagogastric devascularization in selected cases). We report the results in the first 108 patients, with a follow-up of 1·35 months. Fifty-three patients received injection sclerotherapy; 5 died (2 of recurrent bleeding) and 5 others had recurrent bleeding but were controlled by further injections. Thirty-six of the 55 control patients underwent surgery; 5 died (2 of recurrent bleeding) and 2 others developed recurrent bleeding. Further bleeding occurred in 12 of the 19 patients who were managed by medical measures alone, with 7 dying. These early results indicate that injection sclerotherapy can be effective in urgent and elective situations and that it appears to have advantages over conventional medical and surgical treatments.
The diagnostic yield of ERCP in the investigation of unexplained abdominal pain
Authors: Ruddell W S J , Lintott D J , Axon A T R
Published: March 2007

One hundred and forty patients with undiagnosed severe chronic abdominal pain who had not undergone previous biliary surgery were investigated by ERCP. A diagnosis was achieved in 34 patients (24 per cent) including 8 with previously undiagnosed peptic ulceration and 5 with gallstones. Twenty-five patients (18 per cent) had an abnormal pancreatogram, including 1 with pancreatic cancer. The incidence of pancreatogram abnormalities suggestive or diagnostic of pancreatitis was particularly high (60 per cent) in patients with a history of alcohol abuse. ERCP has a valuable role in the investigation of patients with ‘obscure’ abdominal pain.
The fractured shaft—an unusual penile injury
Authors: Philp T , Collin J
Published: March 2007

Fracture of the shaft of the penis is a rare injury, only sporadically reported in the literature. We have recently treated 2 patients with this condition, and here give the clinical presentation and some points in their management.
Postanal repair for neuropathic faecal incontinence: Correlation of clinical result and anal canal pressures
Authors: Browning G G P , Parks A G
Published: March 2007

Neuropathic faecal incontinence is associated with low anal pressures and shortening of the anal canal. The operation of postanal repair has been shown to result in the return of acceptable continence in over 80 per cent of such patients. This paper examines the effect of the operation on anal canal pressures. Forty-two patients with primary faecal incontinence and electrophysiological evidence of neuropathy affecting the external anal sphincter and pelvic floor musculature were studied. Anal pressures were measured before operation and not less than 1 month afterwards. Two groups were chosen according to the clinical result. Group 1 consisted of 34 patients who regained continence and group 2 comprised 8 patients judged as having had an unsatisfactory result. In group 1 there was an increase in anal canal length (1.4 ± 0.2 cm, mean ± s.e.m., paired t test, P < 0.001), resting pressure (19 ± 3 cm H2O, P < 0.001) and voluntary contraction pressure (13 ± 3 cm H2O, P < 0.001). In group 2 there was some increase in anal canal length (1.0 ± 0.2 cm P < 0.01) but no increase in mean resting pressure or mean voluntary contraction pressure. The results show that postanal repair effectively lengthens the anal canal and increases anal pressures in patients with a successful clinical outcome.
Attenuation of adrenocortical response to upper abdominal surgery with epidural blockade
Authors: Tsuji H , Asoh T , Takeuchi Y , Shirasaka C
Published: March 2007

Plasma cortisol concentrations and urinary 17-OHCS excretion were measured in two groups of 15 patients receiving elective gastrectomy under either general anaesthesia or epidural blockade. In another 15 patients receiving epidural blockade, the vagus nerve was blocked by injection of local anaesthetics or by truncal vagotomy, and their cortisol response to gastrectomy was compared with the other two groups. Gastrectomy under general anaesthesia caused a marked increase in plasma cortisol concentrations and in urinary excretion of 17-OHCS. These adrenocortical responses to gastrectomy were significantly inhibited in patients operated upon under epidural blockade extending from T3–4 to L1–2 and continuing for 48 h postoperatively. In patients receiving both epidural and vagus nerve blockade, the plasma cortisol response was the same as in those receiving epidural blockade alone. The results indicated that the adrenocortical response to upper abdominal surgery was safely attenuated, though not abolished, with high spinal epidural blockade continuing for 48 h postoperatively. The vagus nerve was not likely to be playing an important role in the adrenocortical response to gastrectomy.
Bile acids and post-vagotomy diarrhoea
Authors: Blake G , Kennedy T L , McKelvey S T D
Published: March 2007

Cholecystectomy increases the risk of post-vagotomy diarrhoea and bile acid binding agents may relieve it, suggesting a role for bile acids in its pathogenesis. The faecal bile acid loss in 15 patients with episodic diarrhoea after vagotomy and drainage was not raised when compared with 12 normal subjects, except on days when diarrhoea occurred. This elevation was caused by an increase in stool weight rather than bile acid concentration, suggesting that the increased bile acid loss during attacks was not causally related. Asymptomatic vagotomy patients excreted normal amounts of bile acids. Seven patients with episodic diarrhoea after vagotomy and drainage with cholecystectomy continuously excreted excessive amounts of bile acids when compared with normal subjects and asymptomatic patients. The concentration of bile acid in their stools was higher than that observed in symptomatic patients after vagotomy and drainage alone. The continuous presence of excess bile acid may prime the colon to react more readily to stimuli caused by disturbed gastric emptying and rapid small bowel transit, without being the main factor in causing the condition. These findings may explain the increased risk of diarrhoea when cholecystectomy is combined with vagotomy.
The reasons for persistent hypercalcaemia after cervical exploration for presumed primary hyperparathyroidism
Authors: Russell C F , Edis A J , Purnell D C
Published: March 2007

Of 500 consecutive patients who underwent cervical exploration for presumed primary hyperparathyroidism, 461 (92·2 per cent) were cured, as judged by an immediate return of serum calcium levels to normal. Thirty-nine patients (7·8 per cent) had persistent hypercalcaemia after the initial operation. The clinical profiles, operative and pathologic findings, surgical procedures performed and subsequent management of these 39 patients were reviewed. At re-evaluation, 4 patients were noted to have been cured of their hyperparathyroidism: Twenty-one patients had persistent hyperparathyroidism: in 6, all 4 parathyroid glands had not been identified at the initial operation and in 15, hypercalcaemia persisted after the identification of 4 glands. One patient had recurrent hyperparathyroidism after the removal of a 720 mg adenoma and the identification of 3 normal parathyroid glands. Nine patients had non-parathyroid causes for the hypercalcaemia: 2 had occult malignant neoplasms, 6 had benign familial hypocalciuric hypercalcaemia and 1 had immobilization hypercalcaemia. In 4 patients the reason for the persistent hypercalcaemia remained unclear. We suggest a schema that may be used as a guideline in the investigation and management of patients with persistent hypercalcaemia after primary neck exploration for presumed hyperparathyroidism.
Calcium excretion (CaE) in metastatic breast cancer
Authors: Campbell F C , Blamey R W , Woolfson A M J , Elston C W , Hosking D J
Published: March 2007

In 51 women with metastatic breast cancer calcium excretion per litre of glomerular filtrate (CaE) values were persistently higher in those with bone secondaries than in those with only soft tissue involvement despite a normal range of serum calcium in both groups. Measurement of CaE in 8 further patients who were severely hypercalcaemic as a result of their advanced breast cancer revealed the degree to which calcium resorption from bone secondaries and renal dysfunction contributed to the hypercalcaemia. Thus, in patients with breast cancer, CaE provides a reliable indicator of early changes of calcium homeostasis. It may provide an objective indication of progression of bone secondaries and also has important therapeutic implications in established hypercalcaemia.
The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital
Authors: Anand C S , Tandon B N , Nundy S
Published: March 2007

Four hundred and eight consecutive patients with upper gastrointestinal haemorrhage, admitted to a large hospital in India over the 5-year period 1976–81, were studied prospectively. The mean age was 41 years, the male: female ratio was 3:1, causes of bleeding were oesophageal varices in 45·5 per cent, duodenal ulcer in 25 per cent, gastric ulcer in 5 per cent and gastritis in 8·5 per cent. One hundred and twelve patients had operations with an overall mortality of 20 (18 per cent). Thirty-three (11 per cent) of the unoperated patients died. Eighty-seven per cent of patients left hospital alive and 76 per cent returned to their former way of life. Patients with upper gastrointestinal bleeding in North India are mainly young males, nearly half bleeding from oesophageal varices, and have a moderately good prognosis.
Results of transurethral resection of the benign prostate
Authors: Habib N A , Luck R J
Published: March 2007

This retrospective study reviews the results of 200 consecutive transurethral resections of prostate (TURP) for benign disease performed in two small district general hospitals. There was 1 postoperative death (0·5 per cent). Ninety-five per cent of the patients were discharged from follow-up with satisfactory results. Nine patients (4·5 per cent) are still under review either for postoperative complications or persistent symptoms.
Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients
Authors: Keighley M R B , Fielding J W L , Alexander-Williams J
Published: March 2007

One hundred and six consecutive patients were seen between January 1973 and January 1982 with a circumferential full thickness rectal prolapse. One hundred were treated by abdominal rectopexy using a rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum and to the lateral ligaments of the mobilized rectum. There were only 9 men in the series and 23 per cent of the patients were over the age of 80 years. Sixty-seven of the patients gave a history of faecal incontinence. Previous unsuccessful treatment for rectal prolapse included a Thiersch wire or a Silastic perianal sling in 19, electrical therapy in 12, rectopexy with polyvinyl alcohol sponge (Ivalon) in 5 and pelvic floor repair in 2. There were no operative deaths following Marlex mesh rectopexy. Twelve patients had their operation performed under spinal anaesthesia because they were considered unfit for general anaesthesia. No patient developed a recurrent rectal prolapse, but 24 of the 67 patients who had incontinence experienced persistent incontinence after rectopexy (36 per cent); 10 of these patients subsequently had a postanal repair with good results. Rectopexy had no influence on anal canal pressures. Marlex mesh rectopexy is a safe and effective operation for rectal prolapse. It appears to be superior to other operations in that, so far, there has been no recurrence.
E-rosette inhibition and tumour recurrence in early breast cancer
Authors: Haffejee A A , Webster D J T , Paterson A G , Whitehead R H , Thatcher J , Hughes L E , Angorn I B
Published: March 2007

The relationship of serum blocking activity and susceptibility to tumour recurrence using E-rosette inhibition by normal allogenic lymphocytes was evaluated before and after operation in 20 patients with early breast cancer. Preoperative serum inhibition levels did not predict recurrent tumour. The mean postoperative inhibition in patients with recurrence was significantly greater than in those without recurrence. Postoperative testing only in a group of 124 patients showed that the development of local tumour recurrence was preceded by significantly greater inhibition of E-rosetting than occurred in patients without recurrence. The application of a threshold level of serum inhibition of 15 per cent distinguishes patients who are unlikely to develop tumour recurrence over a 4-year follow-up period. Serial measurements of serum inhibition at 6-monthly intervals over 2 years did not add to the predictive value of this test.
The diagnosis and treatment of peri-aortic fibrosis (‘inflammatory’ aneurysms)
Authors: Baskerville P A , Blakeney C G , Young A E , Browse N L
Published: March 2007

A proportion of abdominal aortic aneurysms are found at laparotomy to have thick white walls and extensive peri-aneurysmal adhesions. Graft replacement in these patients is often difficult and associated with an increase in morbidity and mortality. In this study 103 patients with a clinical diagnosis of aortic aneurysm were scanned with computerized tomography to determine whether this condition could be diagnosed preoperatively. Of these, 15 showed diagnostic radiological criteria of peri-aortic fibrosis. Laparotomy revealed no false negatives and only one false positive. Clinical, serological and pathological findings have been compared to those with ‘normal’ aneurysms.

In view of the similarities between this condition and retroperitoneal fibrosis, 5 patients were treated with Prednisone 5 mg twice daily for up to 18 months and a CAT scan technique developed to monitor the degree of thickening quantitatively. Abdominal pain disappeared rapidly, and sequential scanning showed a decrease in peri-aortic fibrosis. Measurements showed the fibrosis only to disappear, with no increase in the diameter of the aortic lumen. In some cases, the lumen was only minimally dilated, although clinical examination suggested an aneurysm. Consequently we suggest that the term peri-aortic fibrosis is a better description of this condition whose aetiology is still obscure, and in which aneurysm formation, when present, may simply be consequent upon the fibrotic reaction in the wall.