bluuebunny/crossref_metadata_2025 huggingface dataset:
Occult small-bowel tumours: Their diagnostic features and management
Authors: Aubrey D A , Blumgart L H , Davies G T , Gravelle I H
Published: March 2007

The clinical and radiological features of 7 small-bowel tumours are described. The presentation of such tumours is usually insidious, with vague dyspepsia, occult intestinal bleeding, and episodes of subacute intestinal obstruction. However, when growth is predominantly extraluminal the lesions are more likely to present as perforations or abdominal masses. In jejunal lesions resection is dangerous because the tumours encroach on the middle colic and superior mesenteric vesels. Furthermore, the position makes anastomosis technically difficult.

Greater clinical awareness, improved radiological definition of the small intestine, and a willingness to undertake exploratory laparotomy are the features most likely to improve the prognosis of these tumours.
Leiomyosarcoma of the duodenum
Authors: McBrien M P , Jarrett P E M
Published: March 2007

Three cases of leiomyosarcoma of the duodenum are reported. The literature is reviewed, and the clinical, diagnostic, and pathological features of this tumour are described. Wide surgical excision has proved to be the most effective treatment.
Benign cartilaginous tumours of the spine. A report of one case together with a review of the literature
Authors: Bell M S
Published: March 2007

A case is described of a chondroma arising from the lamina and pedicle of the 2nd lumbar vertebra of a 25-year-old man presenting as a paraspinal swelling. It was excised but recurred 2 and 3 year later.
Spontaneous perforation of bladder diverticula
Authors: Mitchell R J , Hamilton S G I
Published: March 2007

A case of spontaeous perforation of a bladder diverticulum with recovery is reported. The world literature is reviewed, and the possible aetiology and management discussed.
Extracorporeal perfusion of pig liver in the treatment of acute liver failure
Authors: Parbhoo S P , Chalstrey L J , Ajdukiewicz A B , James I M , Hillenbrand P , Kennedy Jean
Published: March 2007

Five patients in deep hepatic coma due to acute liver failure were treated by perfusion of pig liver. All patients showed severe electro-encephalographic changes and 1 patient who recovered showed virtually no cerebral activity. An exchange of 48–94 litres from pig liver to patient was achieved during the procedure. All patients showed neurological improvement after perfusion. Three patients died 2 hours to 10 days after liver perfusion. The remaining 2 patients made a full recovery and are leading a normal life 9 and 14 months after perfusion.
Successful preservation of pig's liver for 5-8 hours by simple ice storage
Authors: Hadjiyannakis E J , Calne R Y , Marshall V C , Davis D R
Published: March 2007

Successful preservation of pig's liver using simple ice storage is described. The liver is apparently stored well by this method for 5-8 hours.
The effect of short-term exposure to carbon monoxide on platelet stickiness
Authors: Birnstingl M A , Brinson K , Chakrabarti B K
Published: March 2007

Prolonged exposure to carbon monoxide accelerates the development of atheroma in rabbits owing to intimal accretion of platelets and fibrin and intramural lipid accumulation (Wanstrup, Kjeldsen, and Astrup, 1967; Birnstingl, Hawkins, and McEwen, 1970).

A group of 7 rabbits was exposed in a closed chamber to an atmosphere containing 400 p.p.m. CO for 6-14 hours on several occasions. Platelet stickiness was estimated by a modified Hellem's glass-bead method immediately after exposure and on the following day, for comparison with values in the resting period prior to exposure. There was a highly significant increase in platelet stickiness immediately after exposure to CO, followed the next day by a significant fall below the pre-exposure value. The increase in platelet stickiness after CO exposure may provide a link between tobacco smoking and peripheral vascular disease.
Management of internal haemorrhoids by rubber-band ligation
Authors: Groves Anthony R , Evans John C W , Williams J Alexander
Published: March 2007

Rubber-band ligation has been used in the treatment of 156 patients with internal haemorrhoids. The treatment was performed without anaesthesia in an out-patient clinic. Only one pile was ligated at each visit and 77 per cent of the patients required either two or three ligations. Only 7 patients have been lost to follow-up. Twenty-six per cent of the patients experienced discomfort lasting for more than 3 days after one or other of the ligation treatments, but in only 9 per cent was the pain sufficiently severe for them not to wish to have the treatment again. After follow-up periods of 4 to 40 months, 66 per cent of the patients considered the results to be excellent and a further 25 per cent were improved.
Erosive gastritis: Its Diagnosis, Management, and surgical treatment
Authors: Desmond A M , Reynolds K W
Published: March 2007

Three hundred and thirty-one patients with severe haemorrhage resulting from erosive gastritis, representing 10 per cent of 3938 patients admitted with severe gastroduodenal bleeding during the past 30 years, are presented. The problems of diagnosis and management are discussed; particularly, the role of immediáte gastroscopy and the indications for surgical treatment and the surgical procedure best designed to control the haemorrhage.

Forty-seven patients required 51 emergency surgical procedures, and it was found that the Billroth-I gastrectomy was far superior to any other operation. Polya gastrectomy, vagotomy, and gastric vasoligation were used, with a high incidence of recurrent bleeding and often necessitating a further emergency surgical operation—usually total gastrectomy. It is suggested that a possible explanation of this is the prevention of biliary reflux into the stomach, which is what the Billroth-I gastrectomy seems to achieve. In 1 case presented, a patient with a Polya gastrectomy and erosions who had severe haemorrhage, bleeding was controlled by conversion to a Billroth-I anastomosis.
The lesion of the second cancer of the large bowel
Authors: Heald R J , Lockhart-Mummery H E
Published: March 2007

A survey is presented of the clinical experience at St. Mark's Hospital with 83 patients suffering from metachronous cancer of the large intestine. It was found that there was a much improved chance of cure in those who were attending the follow-up clinic at the time of the occurrence of their second growth. The reasons for this and the implications in cancer prophylaxis are discussed.
Vesico-ureteric reflux following renal transplantation
Authors: Yadav R V S , Johnson W , Morris P J , Sprague P , Yoffa D , Marshall V C
Published: March 2007

Twenty-eight patients who had received a renal transplant have been studied in order to determine the incidence and significance of vesico-ureteric reflux in association with urinary infection.

The ureters had been anastomosed either by uretero-ureteric or ureterovesical techniques without an anti-reflux procedure.

Ten of the 28 patients had reflux into the transplant and 4 had reflux into a non-functioning ureteric stump. Reflux was significantly more frequent in the ureterovesical group.

Marked reflux in patients with recurrent urinary infections was associated with renal damage. Marked reflux in uninfected patients or mild reflux in patients with recurrent urinary infections was not associated with renal damage.
Lymphangiography and surgery in lymphangioma of the skin
Authors: Edwards J M , Peachey R D G , Kinmonth J B
Published: March 2007

The results of surgery in a group of 7 patients with lymphangioma circumscriptum are presented. Lymphangiography was carried out in 5 of these patients and in 1 further patient who was not submitted to surgery.

Lymphangiography of the affected limb revealed normal subcutaneous lymphatic vessels and normal filling of nodes in the regional node areas. No direct connexion between the lymphangioma and the subcutaneous lymphatics or regional lymph-nodes was demonstrated.

Lymphography helps to show the extent of the underlying pathology before operation. It is also helpful in showing the relation of the lesion to the main lymph pathways of the area so that they may be preserved during operation.

Surgical treatment for patients with lymphangioma should only be undertaken if a definite cosmetic improvement can be assured. Even with discrete lesions regional excision has to be wide in extent owing to the marked tendency to subcutaneous extension of the abnormality. With these conditions satisfied the results of surgery should be good. With more extensive lesions partial excision of the most troublesome areas in one or more stages may give considerable benefit.
The boerhaave syndrome (spontaneous rupture of the oesophagus)
Authors: Callaghan Joseph
Published: March 2007

Two cases of spontaneous rupture of the oesophagus are presented. Thoracotomy and surgical closure of the perforations resulted in satisfactory outcome in both instances. It is believed that the second case is the only recorded case in which haematemesis from a bleeding duodenal ulcer was the precipitating factor, and also it is believed that he is the oldest survivor to be reported. The literature, aetiology, and treatment of this interesting disease are discussed.
The effects of calculi on ureteral function
Authors: Ross J A , Edmond P
Published: March 2007

The dynamic action of the renal pelvis and ureter has been studied in 50 patients with ureteral colic due to calculi.

Calculi in the renal tract, passing down and obstructing the ureter, profoundly disturb the normal intraluminar pressure and peristaltic activity. Initially, there is a rise in pressure above the obstruction with increased peristaltic activity, which is later followed by a marked depression of this activity.

Fatigue from prolonged stretching of the ureteral muscle and the lack of normal stimulus owing to diminished secretion of urine are considered to be the most likely explanation for this loss of activity.

Urgent relief of the obstruction is the logical treatment, and the policy of forcing fluids in the presence of an obstructed ureter may be questioned. The relief of pressure with retrograde catheterization at an earlier stage than is the current practice should be considered.
Some clinical aspects of idiopathic retroperitoneal fibrosis
Authors: Mitchinson M J
Published: March 2007

A series of 40 patients with idiopathic retroperitoneal fibrosis is discussed with reference to some of the clinical observations. Among other conclusions it appears that corticosteroids should be used more in the treatment of this disease.
Bilateral ureteric obstruction caused by benign pelvic lipomatosis
Authors: Golding P L , Singh M , Worthington B
Published: March 2007

A second case of bilateral ureteric obstruction owing to diffuse pelvic lipomatosis is reported. The clinical features and possible aetiological factors are discussed. The condition may be mistaken for a pelvic neoplasm due to high fixation of the bladder and colon, but it is felt that the diagnosis can be made on the basis of characteristic radiological findings. Surgical intervention is unsuccessful in replacing the bladder and colon to their normal positions but may be necessary for relief of obstruction.
Giant hydronephrosis in a solitary crossed ectopic kidney
Authors: Yates-Bell A J , Packham D A
Published: March 2007

A case of giant hydronephrosis occurring in a solitary crossed ectopic kidney is presented. This is the seventeenth instance of this renal anomaly, and the first reported in association with a giant hydronephrosis. The diagnosis is discussed, and attention is drawn to the high incidence of genital defects and pathological change associated with solitary ectopic kidneys.
Omental reinforcement of intestinal anastomoses an experimental study in the rabbit
Authors: Carter D C , Jenkins D H R , Whitfield H N
Published: March 2007

A series of end-to-end everting colonic anastomoses were performed in 95 rabbits in order to assess the value of omental reinforcement. The animals were divided into three groups: (a) control animals, (b) animals with anastomoses reinforced by a free omental graft, and (c) animals with anastomoses reinforced by an omental pedicle. Reinforcement with a free omental graft carried a prohibitive increase in mortality. The use of an omental pedicle appeared to strengthen the anastomosis against forced disruption in the immediate postoperative period but it did not improve the survival rates and it may carry long-term dangers. The explanation for these findings is discussed. It is our view that there is no place for omental reinforcement in colonic surgery.
A case of diaphragmatic hernia, absent pericardium, and hamartoma of liver
Authors: Deutsch A A , Brown K N , Freeman N V , Stanley D A
Published: March 2007

A case is described of a diaphragmatic hernia associated with a left pericardial defect and hamartoma of the liver. The possible embryological origin of the first two defects from premature closure of the duct of Cuvier is discussed. The radiographic changes of the absent pericardium are mentioned and the histology of the liver hamartoma is described.
Peritonitis from amoebic liver abscess
Authors: Archampong E Q
Published: March 2007

Four consecutive cases of peritonitis from rupture of amoebic liver abscess presenting late with the condition have been described. After treatment involving intensive resuscitation with adequate fluid therapy, ampicillin and hydrocortisone, and early laparotomy all 4 cases survived. The likelihood of this result recurring by chance is calculated at 0·3 per cent (P≤0·05).

The conclusion is drawn that now that surgery is safer and metronidazole is available as a rapidly acting non-toxic amoebicide, perhaps amoebic abscesses should no longer be regarded differently from other hepatic abscesses, at least when they rupture into the peritoneal cavity.
New instruments for microvascular surgery
Authors: Acland Robert
Published: March 2007

Instruments are described which have been developed for use in work on blood-vessels of less than 1 mm. in diameter. They include hand-rests, pedal-operated instruments, vessel clamps, and a counter-pressor.
Kidney preservation for transportation experimental analysis of optimal perfusate composition
Authors: Collins Geoffrey M , Hartley Lionel C J , Clunie Gordon J A
Published: March 2007

Previous experiments have demonstrated that canine kidneys can be preserved for 24 hours or more following initial perfusion with a solution of intracellular composition (C3) and subsequent ice storage. In the present study the composition of C3 was varied to determine the role of each of the major constituents. The efficacy of the solution was found to depend more on magnesium sulphate than on the potassium content, although potassium assumed a greater importance in perfusates free of magnesium. No variation in composition produced a significant improvement in the results obtained with solution C3 itself.
The effect of oral supplementation of zinc sulphate on primary wound healing in rats
Authors: Lavy U I
Published: March 2007

The effect of oral supplementation of zinc sulphate on primary wound healing of abdominal wounds was studied in normal rats receiving a standard diet. Daily oral administration of 40 mg. of zinc sulphate (ZnSO4·7H2O) per rat for 13 days postoperatively resulted in a 35–36 per cent increase in the bursting strength of sutured incision wounds. This increase was statistically significant and corresponded to a gain of about 13 days in healing time. The same daily dose of zinc did not result in a significant increase of wound-bursting strength measured on the sixth day after operation.
Acute intramural abscess of the pyloric antrum–localized phlegmon
Authors: Gillespie Gordon , MacPherson Gordon H
Published: March 2007

A case of acute ‘localized’ phlegmonous gastritis is described. The predominant clinical features were persistent abdominal pain and a tender mass in the epigastrium. Complete recovery followed partial gastric resection.
The obliteration of perforating veins in the leg
Authors: Bentley R J
Published: March 2007

A technique is described for the localization and obliteration of perforating veins of the leg under direct vision without the need for multiple or extensive incisions.
Comparative evaluation of preoperative and operative radiology in biliary-tract disease
Authors: Grundy D J , King P A , Lloyd G
Published: March 2007

In 100 consecutive patients with an abnormal cholecystogram a study was carried out to compare the value of the 4-day Telepaque test, intravenous cholangiography, and operative cholangiography. Of the 100 patients, 87 were shown at operation to have stones in the gall-bladder and 22 to have stones in the common bile-duct. In 4 of the latter patients, stones were absent from the gall-bladder.

Operative cholangiography was the most accurate investigation in the diagnosis of a stone in the common duct; the operative cholangiogram gave definite evidence of stones in the duct in 20 of the patients, and was abnormal in some respect in all of the patients with a stone in the common duct. It is concluded that this investigation should be performed on all patients undergoing cholecystectomy.

The 4-day Telepaque test demonstrated stones in the gall-bladder in 30 per cent of the patients with a non-functioning gall-bladder on oral cholecystography, thus materially improving the diagnosis of gall-bladder stones preoperatively. Of duct stones, however, only 32 per cent were shown by the 4-day Telepaque test, and 59 per cent were demonstrated by intravenous cholangiography. In view of the risk associated with Biligrafin, and to a lesser extent with large doses of Telepaque, it is concluded that neither of these tests is desirable prior to cholecystectomy in the good-risk patient, provided that a satisfactory technique of operative cholangiography is used. They should be reserved for the poor-risk patient, when the presence or absence of duct stones may influence the decision to operate.
Argentaffin-cell tumour of Meckel's diverticulum a report of 2 cases and review of the literature
Authors: Jones E L , Thompson H , Williams J Alexander
Published: March 2007

Two patients with argentaffin carcinoma (carcinoid tumour) of Meckel's diverticulum are described and the literature is reviewed. Only 45 previous cases have been reported.

In both patients the primary tumour had metastasized by the time the diagnosis was made. The first patient developed the carcinoid syndrome 3 months after removal of the tumour but he is alive and well over 5 years later.

The findings in these 2 patients add further support to the view that a carcinoid in a Meckel's diverticulum behaves like that in the small bowel rather than that in the appendix, with an appreciable (21 per cent) incidence of metastasis. The recommended treatment, therefore, should be similar to that of small intestinal carcinoid, namely, wide excision of intestine with a wedge of mesentery. Furthermore, prophylactic resection of Meckel's diverticulum is recommended whenever possible to eliminate the possibility of subsequent development of this tumour.
Aortic aneurysm following external cardiac massage
Authors: Mayers C P
Published: March 2007

Various hazards of external cardiac massage, such as rib fracture and bone-marrow emboli, are well known. This paper describes an unusual hazard, aortic aneurysm. The mechanism of production of this lesion differs in several respects from that of most closed-chest aortic lesions.
The non-absorbable cystic duct ligature
Authors: Gunn A
Published: March 2007

A case is reported of a common bile-duct calculus which had formed around a non-absorbable cystic duct ligature used during cholecystectomy 6 years previously. Although there are advantages in the use of the non-absorbable cystic duct ligature, the risk of migration to the common duct and consequent stone formation is probably greater than is recognized.
Ulceration of the mouth, pharynx, and larynx in Crohn's disease of the intestine
Authors: Croft C B , Wilkinson A R
Published: March 2007

Three hundred and thirty-two cases of Crohn's enteritis were reviewed retrospectively and 20 or 6.1 per cent were found to have suffered from oral ulceration at some stage during their illness. One of these patients with histological evidence of Crohn's disease in the mouth, pharynx, and larynx is described in detail.
Through-knee amputation
Authors: Newcombe J F , Marcuson R W
Published: March 2007

Forty-three through-knee disarticulation amputations in 41 patients are reviewed. In 11 patients the procedure was entirely palliative, and 8 of these died within 1 month of operation. Of the 30 patients for whom a prosthesis was planned, only 2 died within this period. Ten patients were measured for a walking pylon preoperatively. The value of premeasurement is demonstrated by the speed of rehabilitation which was achieved by this group. The time scale of rehabilitation was much longer in those patients who were measured for their prostheses postoperatively. However, other adverse factors were present in this group, and their importance is discussed. Despite these factors, a very high rate of ultimate rehabilitation was obtained. Healing was obtained in 83 per cent of the entire series. The results indicate that the through-knee amputation is excellent for the elderly patient with atherosclerotic gangrene of the foot. The importance of an active programme of walking training in this advanced age-group is particularly stressed.
Biliary-pressure studies during cholecystectomy
Authors: Cushieri A , Hughes J Howell , Cohen M
Published: March 2007

A method of manometric choledochography is described by which three types of choledochal pressure/filling curves could be obtained in patients undergoing cholecystectomy. This work provides evidence that biliary pressures are mainly a function of the choledochal sphincter in man and are largely independent of duodenal muscular activity. Reflux of contrast medium into the pancreatic duct is not associated with either obstructive pathology of the lower choledochus or biliary hypertension.
The results of fundoplication for the relief of oesophageal reflux due to hiatus hernia
Authors: Shah I K , Daniel O
Published: March 2007

Fundoplication has been performed in 25 patients suffering from symptoms or complications due to oesophageal reflux associated with hiatus hernia. There was no peri-operative mortality and only 1 failure to relieve symptoms of reflux. The procedure is benign and is well tolerated if it is performed without splenectomy.
Perforated duodenal ulcer in childhood
Authors: Johnstone J M S , Rintoul R F
Published: March 2007

Perforation of an acute duodenal ulcer in an infant and a child, both with other illness, is reported. Surgical management in both cases was successful. The importance of awareness of this complication is stressed and the cause, presentation, and management are discussed.
Drainage following cholecystectomy
Authors: Williams C B , Halpin D S , Knox A J S
Published: March 2007

The effect of intraperitoneal drainage and incidental appendicectomy has been studied in 309 patients who had undergone routine cholecystectomy.

Patients who did not have drainage fared better than those in which drains were used. There was an increase in postoperative morbidity when the drain was left in position for more than 48 hours. But when the drain was removed during the first 48 hours the results obtained were the same as for cases in whom no drain was used. Incidental appendicectomy while carrying out cholecystectomy did not affect the morbidity or mortality of the operation.

It is concluded that in the absence of bile leakage, drains from the hepatorenal space should be removed within 48 hours, and incidental appendicectomy should be carried out when it can be performed with ease and without undue manipulation.
Anterior dislocation of the hip and diastasis of the contralateral sacro-iliac joint—the rear-seat passenger's injury?
Authors: Markham D E
Published: March 2007

A mechanism of injury is described to account for the combination of anterior dislocation of the hip and diastasis of the contralateral sacro-iliac joint occurring in rear-seat car passengers. Two cases are described and discussed in relation to precipitating factors and how the injury may be prevented.
A case of xanthogranulomatous pyelonephritis
Authors: Bartram Clive , Jagelman David
Published: March 2007

A patient with a non-functioning kidney was investigated. Although the arteriographic findings suggested an inflammatory process, a malignant lesion could not be excluded. The appearance of the kidney at operation suggested malignancy but histological examination following nephro-ureterectomy showed xanthogranulomatous pyelonephritis. This is an uncommon reaction to severe renal infection and is often associated with upper renal tract obstruction. The clinical and radiological findings of this condition are reviewed.
A case of carcinoma of the colon in association with neurofibromatosis
Authors: Jenkins D H R , Gill W
Published: March 2007

A case is presented of neurofibromatosis of the large bowel associated with a primary adenocarcinoma of the colon. This is believed to be the first report of such an association.
A clinical trial to determine whether a Lytle's repair of a primary indirect inguinal hernia needs the addition of a rectus flap an exercise in scientific method
Authors: Doran F S A
Published: March 2007

It is a paradoxical fact that although surgeons have discovered how to carry out organ transplants they have not disovered what is the best way to treat such very common conditions as early carcinoma of the breast and primary indrect inguinal hernia.

The reason for this failue is that when surgeons talk of their dedication to scientific methods they refer to an archaic, fallacious, and discredited method; a method discarded by the physical sciences a very long time ago, It is called “Baconian empiricism”.

The time is long overdue for this archaic method to be rejected and replaced in all surgical work by properly constructed clinical trials leading to an approved mathematical scrutiny of the observed results. The trial must be conducted in a way which eliminates bias for or against the rival methods being tested, otherwise the important mathematical tests of validity cannot be applied to the observed results.

Evidence is submitted to show that more valid information can be obtained from a series of 155 cases of herniorrhaphy arranged in a scientific clinical trial than can be obtained from 2000 cases mechanically collected and tabulated in accordance with the rules of Baconian empiricism.

This clinical trial is used as an example of the new scientific approach to the problem of the primary indirect inguinal hernia, but it applies equally well to the treatment of early carcinoma of the breast.

The question asked was whether, having repaired the deep abdominal ring, a recutus flap ought to be added. The mathematical scrutiny of the observed results of the trial prove that this additional step would not improve the results obtained by a simple suture of the deep ring on its own.
Development of Right Inguinal Hernia Follwing Appendicectomy a 10-Year Review of Cases
Authors: Gue S
Published: March 2007

The incidence of right inguinal hernia in patients who have undergone appendicectomy is significantly greater than that in the general population. It is suggested that the most likely cause is injury to the segmental nerve-supply to the inguinal musculature.

It is suggested that the sequela of right inguinal hernia follwing appendicectomy may be decreased, if not prevented, by proper understanding of the anatomy of the region and care during surgery, but “in spite of the tempting sumplicity of aetiologic reasoning, a cause-and-effect relationship cannot yet be confirmed”.
Pneumoperitoneum as an Aid in the Surgical Treatment of Giant Herniae
Authors: Barst Henry H
Published: March 2007

The management of giant hernia and eventration can be greatly facilitated and made safe by the use of preoperative pneumoperitoneum. Daily insufflation of air into the peritoneal cavity, starting with 500 ml. and increasing gradually to 2–3 litres a day for approximately 2 weeks, stretches the abdominal cavity and avoids respiratory and circulatory distress at the time of operation. This preoperative treatment converts a potentially dangerous operation into a fairly simple procedure.
Subcutaneous Nodular Lymphohistiocytic Hyperplasia
Authors: Hale J E , Mackenzie D H
Published: March 2007

Five cases of a subcutaneous lymphohistiocytic lesion arising in relation to the deltoid muscles are described. The histological appearances are described and the differential diagnosis is discussed.
Squamous Carcinoma of the Stomach Following Corrosive Acid Burns
Authors: Eaton Henry , Tennekoon G E
Published: March 2007

Two cases of primary squamous-cell carcinoma arising in a stomach damaged by corrosive acid burns are reported. Thirty-three previously reported cases of pure squamous carcinoma of the stomach are tabulated and their pathogenesis is discussed. A plea is made for treating corrosive acid burns of the stomach by some form of resection of the entire area involved rather than by more conservative methods, such as gastrojejunostomy, which have been used in the past.
Rectal Stones
Authors: Jagelman D G
Published: March 2007

A case is reported of a rare complication of total cystectomy and ureterocolic anastomosis for carcinoma of the bladder. The patient suffered not only from some of the more common complications of this procedure but also developed bleeding per rectum, the cause of which was impaction of two calculi in the rectum. Analysis of these stones showed an inner core of mixed gall-stone and an outer shell of urinary struvite.
Muscle Blood-Flow Following Insertion of a By-pass Vein-Graft in Femoropopliteal Occlusive Disease
Authors: Bell Graham , Short Douglas W
Published: March 2007

Muscle blood-flow has been measured by the local clearance of 133Xe in 32 patients (34 limbs) following arterial replacement with a by-pass vein-graft for atherosclerotic occlusive disease affecting the femoropopliteal segment.

In 27 cases (29 limbs) in which the graft was functioning satisfactorily there was a marked improvement in muscle blood-flow with a return to within normal range in most instances. In 5 patients the graft occluded within 3 months of operation and in these cases there was no significant alteration in the muscle blood-flow following operation. The measurement of muscle blood-flow therefore provided objective corroborative evidence of the success or failure of the procedure.

Seventeen of the group had muscle blood-flow measurements carried out at 3-monthly intervals for a year or more after operation. The postoperative flow tended to remain stable throughout this period, and did not show any tendency to return to the preoperative levels as has previously been reported for thrombo-endarterectomy. This lends further support for the view that in reconstructive surgery for femoropopliteal occlusive disease the long-term results are better with by-pass vein-grafts than with thrombo-endarterectomy.
The Movements of the Adult Ascaris Lumbricoides
Authors: Paul Milroy
Published: March 2007

Deductions made from Makidono's (1956) observations of the movements of ascarids in the small intestine of man and from findings at surgical operations and post-mortem examinations of the positions of ascarids causing clinical disturbances have been used to build a concept of the behaviour of ascarids under normal and abnormal conditions.
Pyloric Function and Gall-Stone Dyspepsia
Authors: Johnson A G
Published: March 2007

Pyloric function was studied by means of a modified pyloric regurgitation test in which regurgitation was assessed both radiologically and biochemically. Forty-two tests were performed in 40 patients from six clinical grups: those with gall-stones with and without dyspepsia; those after cholecystectomy with and without persistent dyspepsia; and those with normal radiographs with and without dyspepsia. A close correlation was found between a history of flatulent dyspepsia and the detection of pyloric regurgitation in each matched pair of grups and in the series as a whole (P < 0·001). The time at which regurgitation occurred appeared to be significant. Regurgitation was not observed in symptomless subjects.
Prostatectomy and Deep-Vein Thrombosis
Authors: Nicolaides A N , Field E S , Kakkar V V , Yates-Bell A J , Taylor S , Clarke M B
Published: March 2007

In a study of 50 patients who had undergone prostatectomy the incidence of deep-vein thrombosis was measured, using the 125I-fibrinogen test. Of these, 12 (24 per cent) developed deep-vein thrombosis. This preliminary study showed that in patients who had had a transurethral resection the incidence of deep-vein thrombosis was 6·8 per cent, while in patients who had had a retropubic prostatectomy it was 47·6 per cent.
The delayed hypersensitivity response in primary breast carcinoma as an index of host resistance
Authors: Mitchell Roger J
Published: March 2007

An attempt has been made to correlate the Varidase test with possible immunological phenomena as assessed histologically. It would appear statistically that the test is more likely to be negative in the presence of poor differentiation, suggesting that there may be some form of immunological suppression in these cases. In the majority of these poorly differentiated cases there was an absence of lymphocytic involvement of the tumour. However, no obvious connexion between Varidase and lymphocytic infiltration of the tumour or sinus histiocytosis has been found.

The Varidase test cannot therefore be assumed to be a reliable guide of the accepted histological criteria of host-defence reactions. Any information as to why this test should be so consistently depressed in the presence of malignant disease has not been forthcoming. This work is a preliminary report and is an attempt to assess the total immune competence of a group of adult patients in the presence of mammary carcinoma. It is freely acknowledged that further work into the long-term survival of these patients is necessary before further conclusions can be drawn.
The role of radiotherapy in the management of malignant thymoma
Authors: Penn C R H , Hope-Stone H F
Published: March 2007

A series of 18 cases of malignant thymoma referred for radiotherapy during a 21-year period is reviewed. The presentation, treatment policy, and results are examined. Of the 7 cases treated with a full radical dose all were alive at 3 years, all 4 cases followed for 5 years survived that period, and 3 of the 4 cases followed for 10 years were alive at that time. Of these, only 3 cases had had macroscopically complete excision of the tumour at thoracotomy. These findings suggest that postoperative radiotherapy should be of benefit in all cases of invasive thymoma whether operable or otherwise.
Peripheral tuberculous lymphadenitis in the elderly
Authors: Peel A L G
Published: March 2007

Retrospective and current studies of peripheral tuberculous lymphadenitis in the elderly (over the age of 60 years) are described. The efficacy and side-effects of standard antituberculous chemotherapy in this group of patients are analysed. Simple excisional surgery with the local instillation of streptomycin is suggested as a rational and effective method of treatment of localized tuberculous lymphadenitis in the elderly.
Haemoperitoneum complicating secondary carcinoma in the liver
Authors: Ahmed Ali , Metcalfe-Gibson C
Published: March 2007

Haemoperitoneum complicating primary hepatic carcinoma is well documented but secondary hepatic carcinoma rarely causes intra-abdominal haemorrhage. A case of haemoperitoneum from secondary pancreatic carcinoma of the liver is reported.
Lumbosacral agenesis in a 60-year-old man
Authors: Nicol W J
Published: March 2007

A case of lumbosacral agenesis below the third lumbar vertebra in a 60-year-old man is described. The patient is thought to be the oldest survivor with such an extensive defect.
Fractures of the floor of the anterior cranial fossa. The selection of patients for dural repair
Authors: Jefferson Antony , Reilly Gerald
Published: March 2007

A series of 87 patients operated on because of subfrontal fractures is reported. In 73 of these a fistulous lesion (connecting the brain with the nose or the accessory air sinuses) was displayed and was repaired. Almost always a bifrontal exploration has been made, because the lesions were bifrontal in 43 per cent of cases. The mean follow-up period was 4 years; to date no instances of postoperative meningitis or rhinorrhoea have occurred. Our experience suggests that cerebrospinal rhinorrhoea accompanying fractures of the facial bones (without fractures of the skull vault) can safely be treated conservatively. Damaged brain adheres to the lips of the torn dura and permanently prevents natural healing, thereby creating a continuing threat to life. Consequently it is recommended that all frontal fractures lying below the hairline and all comminuted anterior temporal fractures should be referred for expert neurosurgical/neuroradiological assessment. This is because 42 per cent of the patients requiring operative repair were selected after tomographic studies of the anterior fossa; they had not presented with the classic criteria of cerebrospinal rhinorrhoea, intracranial air, or meningitis.
Acid-fundic selective vagotomy of the stomach without drainage in the treatment of duodenal ulcer: Technique and results
Authors: Imperati Luigi , Natale Costanzo , Marinaccio Francesco
Published: March 2007

Out of 415 patients with duodenal ulcer under-going vagotomy in the past 6 years, 198 truncal vagotomies (T.V.) and 217 selective vagotomies (S.V.) were performed. Of the 217 S. V. s, 134 cases had a total selective vagotomy of the stomach (preserving the pyloroduodenal nervous peduncle), and in 83 cases a proximal selective vagotomy was performed (preserving also the antral branches of the two principal nerves of the gastric lesser curve or Latarjet nerves). The authors prefer the name ‘acid-fundic selective vagotomy (A.F.S.V.) of the stomach’ for the latter procedure.

In 89 of the patients having S.V. no gastric drainage procedure was performed; in 27 of these a total S.V. had been performed and in 62 cases an A.F.S.V.

In patients undergoing S.V. without gastric drainage the clinical results and gastric emptying were fairly good in the cases with a total S.V. (follow-up time, 12 months), and very good in the cases with an A.F.S.V. (follow-up time, 6 months). Basal acid output (B.A.O.) and maximal (pentagastrin-stimulated) acid output (M.A.O.) were evaluated in those patients undergoing A.F.S.V. before and 10 days after operation. B.A.O. was reduced by 80.5 per cent and M.A.O. by 68.5 per cent. An insulin test performed 3 months after operation was negative in 80 per cent of cases (complete vagotomy); in the other cases the vagotomy was adequate.

Clinical results, although after only a short follow-up, suggest that the procedure can be considered as the treatment of choice in most patients with an uncomplicated duodenal ulcer (76 per cent in our series). Gastric drainage is required only in cases of stenosing duodenal ulcer with delayed gastric emptying. Pyloroplasty is also mandatory in the treatment of bleeding ulcer and of perforated ulcer (if the suture is stenosing).
Inflammatory aneurysms of the abdominal aorta
Authors: Walker D I , Bloor K , Williams G , Gillie I
Published: March 2007

Two hundred and seventeen patients presenting with abdominal aneurysms in the Department of Surgery at the Manchester Royal Infirmary between the years 1958–69 were surveyed retrospectively.

One hundred and eighty-seven of the patients underwent operation for resection of their aneurysms; of these, 19 (10 per cent) showed excessive thickening of the aneurysm walls and perianeurysmal adhesions at operation.

Subsequent histological examination of the walls of these unusual aaneurysms showed extensive active chronic inflammatory changes, including plasma-cell infiltration.

This group of patients whose aneurysms we describe as ‘inflammatory’ presented with different clinical features in comparison with the atherosclerotic group.

Retrospective investigation has not yet revealed any aetiological factors. We feel that ‘inflammatory’ aneurysms are a discrete entity with significant differences from atherosclerotic aneurysms and previously described arteritis.
The histopathology of small vessels following microvascular repair
Authors: Baxter Thelma J , O'brien B McC , Henderson P N , Bennett R C
Published: March 2007

The histopathological findings following microvascular repair of 105 arteries and 89 veins in Englishstrain rabbits are reported. The importance of (a) the accurate apposition of the vessel walls and (b) the avoidance of excesive medial necrosis is stressed. The process of subintimal hyperplasia is described and the importance of its role in the repair of small vessels is discussed. Previously, the new formation of elastin tissue has been considered pathognomonic of vascular disease. The appreciably slower rate of repair in veins is also reported. From these observations suggestions have been made with regard to improved technique of surgical repair.
Ventilation in an artifically produced gas cavity under basal conditions
Authors: Wosornu Lade
Published: March 2007

The left hemithoraxes of 150 SPF rats were transformed into stable skin-lined gas cavities which were opened to the exterior. Fifty-nine of 75 rats so exposed survived with the natural, unilateral lung receiving air from the trachea, and the skin-lined hemithorax (an artificially produced gas cavity) receiving air independently from a thoracostomy.

In the test rats the mean arterial pH, Po2, and Pco2, were 7.355 ± 0.17, 77.03 ± 2.56 mm. Hg, and 38.41 ± 2.41 mm. Hg respectively. The values were similar to those obtained for unoperated rats (7.349 ± 0.015, 80.18 ± 2.77 mm. Hg, and 38.24 ± 0.94 mm. Hg). Although the skin-lined hemithorax was functionally an open-ventilated gas cavity, its mean tidal volume (0.93 ± 0.07 ml.) and its mean minute-ventilation (271.6 ± 24.4 ml. per kg. per minute) were about half of normal.

In the test the mean rate of respiration and the mean tidal volume were 98.5 ± 4.3 per minute and 1.68 ± 0.04 ml. as compared with 76.1 ± 5.3 per minute and 1.94 ± 0.12 ml. in the unoperated rats. The differences were significant. However, the difference between the mean minute-ventilation (tidal volume × rate of respiration) in the two groups was not significant. The values obtained were 506.1 ± 36.2 ml. per kg. per minute (test rats) and 407.0 ± 50.4 ml. per kg. per minute (unoperated rats). This suggested further that under basal conditions the test rats achieved adequate ventilation by means of a compensatory rise in the rate of respiration.
A case of primary liver tumour associated with porphyria
Authors: Waddington R T
Published: March 2007

A case is described of primary liver carcinoma in a patient with a 10-year history of porphyria. Death resulted from occlusion of the pulmonary artery by tumour embolus.
Malakoplakia of the colon
Authors: Birkenstock W , Louw J H
Published: March 2007

A case of malakoplakia of the colon in a young man who presented with symptoms and signs suggestive of ulcerative colitis is reported. It is suggested that a careful search for Michaelis-Guttmann bodies in all chronic inflammatory lesions may reveal a much higher incidence of malakoplakia.
Anatomy of the external anal sphincter
Authors: Oh Changyul , Kark Allan E
Published: March 2007

The anatomy fo the external anal sphincter has been studied in 48 adult cadaveric and surgical specimens by anatomical dissection and histological sections in three-dimensional planes. The bilaminar and trilaminar concepts of external anal sphincteric anatomy are reviewed. The significant anatomical differences in the anterior portion of the external sphincter compared with the lateral and posterior portion are emphasized. The different configuration of the anterior part of the external sphincter in men and women is described. A new terminology is proposed, ‘superficial compartment’ (subcutaneous and superficial) and ‘deep compartment’ (deep and puborectalis), on the basis of the close anatomical relationship between each of these two pairs of muscles.
Long-term review of function following pull-through operations of the rectum
Authors: Bennett R C , Hughes E S R , Cuthbertson A M
Published: March 2007

Twenty patients previously reviewed from a functional standpoint following pull-through resection of the rectum have been reassessed 2 years or more following the initial review. Fourteen of the 20 patients showed further improvement at the second examination, and half of these patients could be reclassified to indicate a significantly improved overall functional result. It is clear that functional improvement may occur to a varying extent either gradually or at times rapidly even years after pull-through resection of the rectum.
Evaluation of breast tumour sex chromatin (barr body) as an index of survival and response to pituitary ablation
Authors: Perry Michael
Published: March 2007

In a retrospective study of 36 patients with advanced oreast cancer relationships were found between the cumour Barr body count and the response to pituitary ablation and the length of survival. High tumour Barr body counts were associated with long survival after treatment, and low counts with short survival. (P < 0.001). High counts were also associated with a good response to pituitary ablation, and low counts with a poor response (P < 0.01). The tumour Barr body count gave possibly better prediction than urinary steroid measurement.
Amputation neuroma of the great auricular nerve after parotidectomy
Authors: Hobsley Michael
Published: March 2007

Division of the great auricular nerve during the operation of parotidectomy sometimes results in an amputation neuroma. The condition can be diagnosed on clinical grounds, thus obviating the need for further surgical exploration.
Anteroposition of the portal vein and spontaneous passage of gall-stones. Case report and embryological hypothesis
Authors: Brook Wilfrid , Gardner Michael
Published: March 2007

A case of a woman who passed seven gall-stones ‘per vias naturales’ is presented. At subsequent operation for painful jaundice the portal vein was found to lie in front of the common bile-duct, although in its lower part it was retroduodenal.

A new embryological hypothesis to explain the preductal portral vein is presented.
Alteration in Fibrinolysis Associated With Surgery and Venous Thrombosis
Authors: Mansfield Averil O
Published: March 2007

A marked increase in fibrinolytic activity occurs during surgical operations, especially major surgery. This increase sometimes begins prior to the induction of anaesthesia. There is reduced fibrinolytic activity during the postoperative period and this occurs earlier and to a greater degree in those patients who develop a venous thrombosis as shown by the 125I-fibrinogen test.
Pyloroplasty alone in the management of patients with a negative exploration for duodenal ulcer
Authors: Douglas M , Duthie H L
Published: March 2007

If a preoperative diagnosis of duodenal ulcer in not confirmed at laparotomy an exploratory pyloroduodenotomy may be closed as a pyloroplasty without adding a vagal section. This study concerns 32 patients in whom this was done. As a group these patients tended to have somewhat atypical ulcer symptoms and indefinite radiological sings. Within a mean follow-up period of 3 1/2 years more than one-third of these patients developed recurrent ulcer symptoms, which in 4 patients ot date have been successfully treated by vagotomy. The functional result could not be predicted by the preoperative symptoms or radiological changes. The incidence of diarrhoea and post-cibal fullness, vomiting, dumping, colic, and hypoglycaemia was almos identical with that seen after vagotomy and pyloroplasty. The wisdom of using pyloroplasty without vagotomy in patients with ulcer symptoms is therefore questioned.