bluuebunny/crossref_metadata_2025 huggingface dataset:
Idiopathic megacolon: A review of 42 cases
Authors: Lane R H S , Todd I P
Published: March 2007

Forty-two patients with idiopathic megacolon who were seen at St Mark's Hospital over an 18-year period are reviewed with regard to presentation, investigation and management. The differential diagnosis is discussed with particular reference to Hirschsprung's disease. The important aspects of medical treatment are outlined and the possible reasons for failure in more than one-half of the patients are discussed. The indications for surgical intervention in 14 patients are reviewed. The results following subtotal colectomy were better than following a localized sigmoid resection.
Organic constipation in adults
Authors: Smith Barbara , Grace Roger H , Todd Ian P
Published: March 2007

Four cases of non-Hirschsprung megacolon in adults are presented. The histology of the myenteric plexus suggests that this may be an anomaly of development.
Preoperative diagnosis in carcinoma of the breast
Authors: Davies C J , Elston C W , Cotton R E , Blamey R W
Published: March 2007

Two methods of obtaining a preoperative diagnosis of breast lumps have been evaluated by simultaneous use on 131 patients. Tru-Cut needle biopsies gave a reliable diagnosis in 75 per cent of those suffering from primary carcinoma of the breast. No cases of benign disease were wrongly reported as carcinoma by this method. Fine-needle aspiration cytology gave no helpful information in one-half of the patients with malignant disease and in addition 5 cases of benign disease were falsely reported as carcinoma. Tru-Cut needle biopsy is a valuable preoperative investigation in patients with primary carcinoma of the breast.
The place of transthoracic vagotomy in the management of recurrent peptic ulceration
Authors: Hede J E , Temple J G , McFarland John
Published: March 2007

For the successful treatment of recurrent peptic ulceration confirmation of the presence of the ulcer by fibreoptic endoscopy is essential. Further investigation by barium meal and gastric acid secretion studies allows a rational surgical approach to be formulated. This process is illustrated by discussion of the investigative findings and the results of treatment in a series of 20 patients with recurrent peptic ulcer over a 5-year period. In onehalf of these patients a second abdominal operation was necessary, but in the other half a transthoracic vagotomy alone gave equally good results.
The long term results of profundaplasty in femoropopliteal arterial occlusion
Authors: Ward A S , Morris-Jones W
Published: March 2007

The long term results of profundaplasty in the treatment of femoropopliteal arterial occlusion have been reviewed. Fifty patients have been studied with a mean follow-up period of 4 years (range 6 months to 8 years).

Intermittent claudication was abolished or substantially improved in 5 of the 25 cases (20 per cent); rest pain was relieved in 10 of the 25 cases (40 per cent), the remainder requiring a major amputation. Lumbar sympathectomy produced little additional benefit in either group. The mortality rate in the rest pain group was high and only 5 patients survived for more than 3 years with both legs intact. The state of the distal ‘runoff’ and the degree of preoperative profunda stenosis appeared to have little influence on the clinical outcome. After operation pedal pulses were restored in 16 per cent of those presenting with claudication. Profundaplasty was without significant effect on the ankle systolic pressure index both in patients with claudication and those with rest pain.
Resection of the manubrium
Authors: Harrison D F N
Published: March 2007

Direct exposure of the superior mediastinum is essential when resecting subglottic tumours of the larynx, neoplasms of the cervical trachea or cervical oesophagus. This facilitates low resection of the trachea and clearance of the paratracheal nodes. This may best be carried out by removal of most of the manubrium sterni and both sternoclavicular joints and this operation has been performed in 22 patients with minimal morbidity or long term disability.
Crush syndrome: A report of 2 cases and a review of the literature
Authors: Brown A A , Nicholls R J
Published: March 2007

The crush syndrome was first defined as a clinical entity in 1941. This paper reports 2 patients suffering from the syndrome as a result of being trapped for several hours during the Moorgate tube train disaster. An account of the initial course, management and complications is presented and discussed with reference to the available literature on the subject.
Hiatus hernia repair combined with the construction of an anti-reflux valve in the stomach
Authors: Bingham J A W
Published: March 2007

An operation is described that combines hiatus hernia repair with the construction of an anti-reflux valve in the stomach immediately beyond the cardia.

One hundred and ten patients treated by this operation, including 28 with panmural oesophagitis, have been followed up by clinical and radiographic assessment at yearly intervals for periods from a little over 1 year to over 5 years. Three patients had return of reflux symptoms, 2 of these being the only patients in the series with X-ray reflux at follow-up. The return of reflux in these patients appeared to result from anatomical changes that were probably caused, at least in part, by over-tight application of the stapling instrument used in the operation.
Plasma gastrin concentration related to acid secretion during insulin hypoglycaemia
Authors: Russell R C G , Faber R G , Hobsley M
Published: March 2007

The release of gastrin by insulin hypoglycaemia was studied in man before and after vagotomy. Completeness of vagotomy was judged by the gastric acid response to the same hypoglycaemia, using several criteria including one that allows for pyloric losses and duodenogastric reflux. A total of 137 tests was performed on 10 subjects. The plasma gastrin concentration was found to rise in the preoperative studies and also in the postoperative studies no matter what type of vagotomy had been performed or what criteria of completeness of vagotomy were used. We concluded that gastrin can be released in response to hypoglycaemia in the absence of the vagus nerve.
Revagotomy for recurrent peptic ulceration
Authors: Taylor T V , Pearson K W , Torrance Bruce
Published: March 2007

A review has been made of 59 patients with recurrent peptic ulceration after incomplete vagotomy. Eighteen transthoracic procedures were performed, the remainder having abdominal revagotomy. An antrectomy was also carried out in 10 of these patients. An intact posterior nerve trunk was the most common operative finding and when either an anterior trunk or nerve strands only were present there was less likely to be an early positive insulin response (P = 0·033). Following incomplete vagotomy a longer period of symptomatic relief is obtained when gastro-enterostomy rather than pyloroplasty is used as the drainage (P < 0·01). Completing the vagotomy by the abdominal route gave superior results to transthoracic revagotomy (P = 0·0015), the former procedure without antrectomy having no associated mortality in this series. Although the results of revagotomy and antrectomy are as good as those of transabdominal revagotomy alone, we recommend the latter more conservative treatment for recurrent ulceration after incomplete vagotomy.
Haemobilia: A report of 2 cases
Authors: Jansen W B J , Volder J G R
Published: March 2007

Although rare, haemobilia should be included in the differential diagnosis of obscure gastro-intestinal bleeding, particularly when accompanied by colic and jaundice. Case histories of 2 patients with haemobilia of different origin are presented. One had traumatic haemobilia after suture of a liver rupture; in the other patient an aneurysm of a branch of the right hepatic artery ruptured into the hepatic duct. The first patient recovered spontaneously; the second required ligation of the affected blood vessel. Diagnosis and treatment of the haemobilia syndrome are discussed, with reference to the liver blood supply.
Cryoprecipitated plasma perfusion preservation and cold storage preservation of duct-ligated pancreatic allografts
Authors: de Gruyl J , Westbroek D L , MacDicken I , Ridderhof E , Verschoor L , van Strik R
Published: March 2007

It has been shown previously that, at least in dogs, a vascularized pancreatic allograft with ligation of the pancreatic duct can maintain normal beta-cell function for at least 5 years. In this study common organ preservation techniques, as used in human cadaveric kidney transplantation, were applied to canine pancreatic allografts to determine the influence of 24-hour preservation on beta-cell function, graft survival and histological appearances.

Three groups of dogs were compared: group A consisted of 9 dogs with fresh grafts; group B consisted of 5 dogs who received grafts preserved for 24 hours by pulsatile hypothermic cryoprecipitated plasma perfusion; and group C was composed of 5 animals who received grafts that had been flushed with Collins' solution followed by hypothermic storage for 24 hours.

It appeared that both preservation methods were equally effective and that preservation did not alter either the graft's function or its histological appearance. No significant differences after transplantation were observed in the endocrine function tests of the three groups when compared with the preoperative values; neither was there a significant difference in the mean graft survival time between the groups.
The Erlangen magnetic colostomy control device: Technique of use and results in 22 patients
Authors: Goligher J C , Lee P W R , McMahon M J , Pollard Muriel
Published: March 2007

The evolution and general principle of the Erlangen magnetic ring colostomy device are described and its practical use illustrated by reference to a personal series of 22 patients treated with the device. Analysis of the functional results obtained in 13 of these cases, who were assessed after at least 3 months' trial, shows that only 3, or at most 4, could be considered to have achieved worth-while continence, but there are grounds for believing that these results might be improved a little by more stringent selection of patients for the procedure and by employing a more meticulous technique for implanting the rings.
Deep venous thrombosis in patients having aorto-iliac reconstruction
Authors: Angelides N S , Nicolaides A N , Fernandes J , Gordon-Smith I , Bowers Rosemary , Lewis J D
Published: March 2007

The 125I-labelled fibrinogen test has been used to assess the incidence of deep venous thrombosis in 88 patients who had undergone elective aorto-iliac reconstruction. Deep venous thrombosis was detected in 18 (20·5 per cent). The results suggest that these patients merit prophylaxis.
Computer-aided diagnosis of lower abdominal pain in women
Authors: Walmsley G L , Wilson D H , Gunn A A , Jenkins D , Horrocks Jane C , de Dombal F T
Published: March 2007

This paper describes the use of a system of computeraided diagnosis in an unselected, prospective survey of 393 women suffering from lower abdominal pain of less than 1 week's duration. An accurate diagnosis was made by clinicians at first patient contact in 68·5 per cent of the group of patients. The computer's diagnostic prediction (based on the same data) matched the final diagnosis in 81·6 per cent of the patients. During this survey a marked improvement in diagnostic accuracy was observed amongst the junior clinicians. It is suggested that this is because of the discipline of data collection imposed and the intermittent feedback received, and also that this educational aspect of computer usage may be of wider benefit.
Successful treatment of early cancer of the liver and portal hypertension in patients presenting with bleeding oesophageal varices
Authors: Kobayashi Michio , Inokuchi Kiyoshi , Nagasue Naofumi , Saku Motonori , Iwaki Atsushi
Published: March 2007

A small hepatoma was diagnosed by selective arteriography in 2 patients admitted for treatment of bleeding oesophageal varices. In both cases, hepatoma and variceal lesions were successfully treated. In the first case, left gastric vena caval shunt and local excision of the hepatoma were performed. In the second case, distal splenorenal shunt and local excision of the tumour were carried out. Although a combination of hepatoma and oesophageal varices may be an embarrassing problem, both lesions can be remedied provided that hepatoma is diagnosed at an early stage. It is stressed that arteriography is of value in assessment.
A case of multiple trauma following a motor cycle accident
Authors: Ferguson D G
Published: March 2007

This paper reports a fractured femur, jejunal laceration and a torn aorta in a young man who appeared reasonably well on admission to hospital. The diagnostic problems and treatment of this case are discussed.
In vitro studies of gallstone dissolution using bile salt solutions and heparinized saline
Authors: Hardie I R , Green M K , Burnett W , Walland D R , Hall-Brown A
Published: March 2007

A controlled in vitro study of gallstone dissolution has been carried out using a model designed to simulate the in vivo situation in the bile ducts. Sodium taurocholate, sodium cholate, heparinized saline and physiological saline were infused for 10 days over 81 stones from 32 patients and changes in weight and structure were recorded. The bile salt solutions caused weight loss in 81·5 and 85·7 per cent respectively of the stones treated, but the two saline solutions caused weight gains in 74·5 and 88 per cent respectively. Fragmentation occurred in 18·5 per cent of stones treated with sodium taurocholate, in 25 per cent of those treated with sodium cholate and in 11·8 per cent of those treated with heparinized saline. Small stones lost a lower absolute amount of weight than large stones but this represented a greater proportion of their initial weight.

These investigations confirm the advantages of a dynamic in vitro model to study gallstone dissolution. Bile salt solutions infused into the bile ducts may clear retained stones by causing reduction in stone weight or fragmentation or both, but heparinized saline appears to be unsuitable for gallstone dissolution. Larger stones may require longer periods of infusion.
Nipple retraction in duct ectasia
Authors: Rees B I , Gravelle I H , Hughes L E
Published: March 2007

Thirty patients with nipple retraction associated with duct ectasia have been studied to determine the clinical features of this condition. This association is a common one and the similarity of these nipple changes to those produced by cancer is emphasized. While clinical evaluation of the nipple changes may give an indication of the diagnosis, it is by no means absolute and mammography is advocated in all cases. Combined clinical and mammographic assessment will allow confident differentiation of the two causes in many cases, and a policy for management of nipple retraction is presented.
Congenital oesophagobronchial fistula in the adult
Authors: Salepcioglu A , Cebeci H , Saner H , Akcal T
Published: March 2007

A case of congenital oesophagobronchial fistula presenting in adult life without the more usual accompanying pulmonary infection is presented. The clinical, radiographic, morbid anatomical and histological features of this lesion are discussed.
Where is your vagotomy incomplete? Observations on operative technique
Authors: Johnson A G , Baxter H K
Published: March 2007

There is a trend in gastric surgery towards more selective types of vagotomy but the techniques are more difficult and incomplete nerve section may be more likely. Using the Grassi intra-operative test of mucosal pH, we have studied 50 consecutive patients, 13 having truncal vagotomy, 9 having bilateral selective vagotomy and 28 having proximal gastric vagotomy. We have identified four distinct areas of the stomach where nerve fibres are likely to be left. Three of these can usually be eliminated by careful attention to technique, but the fourth—the distal extent of the parietal cell mass—can only be identified by a precise intra-operative test; this is relevant to proximal gastric vagotomy but not to truncal vagotomy. Unexpected anatomical variations of the vagus nerve branches were found in 8 patients. A precise intra-operative test of residual innervation is particularly helpful in establishing the technique of proximal gastric vagotomy.
The clinical significance of pneumatosis cystoides intestinalis: A report of 5 cases
Authors: Thomson W O , Gillespie G , Blumgart L H
Published: March 2007

Pneumatosis cystoides intestinalis is an uncommon condition characterized by the presence of gas within the wall of the bowel. In most cases the clinical course is benign and may well be self-limiting, while in others the appearance of pneumatosis may indicate the presence of bowel ischaemia and necessitate emergency laparotomy. This paper describes 5 cases which demonstrate some of the difficulties in diagnosis and management and the improvement which can result from clinical awareness of the condition.
The effect of the surgical approach on respiratory function after oesophageal resection
Authors: Black J , Kalloor G J , Collis J Leigh
Published: March 2007

Respiratory function has been studied in 32 consecutive patients having oesophageal resection to determine the overall pattern and to compare the effect on it of two standard surgical approaches. Eighteen patients had a left thoraco-laparotomy and 14 a laparotomy and separate right thoracotomy.

The two groups were similar in age, sex, chest symptoms and smoking habits. The average operative time and amount of blood transfused were almost identical.

Arterial PO2 and PCO2 were determined before surgery and on the first and third postoperative days. Spirometry was done preoperatively and on the thirteenth day after operation.

Before operation respiratory function was similar in the two groups. On the first postoperative day both groups showed a pronounced fall in arterial PO2, with partial recovery on the third day. This recovery was significantly greater in the double incision group (t = 2·64, P < 0·02). Mean PCO2 levels altered less markedly, there being a small rise on the first day, with a fall to below normal on the third. There was no difference between the groups in PCO2. Vital capacity and I-second expiratory volume were reduced on the thirteenth day in both groups, but without a significant difference between the groups.

Two patients died of pulmonary embolism, but the others recovered satisfactorily. It is concluded that: There is pronounced hypoxaemia in the first few days after oesophageal resection in the majority of patients. This is consistent with a satisfactory clinical state.The double incision laparotomy and right thoracotomy approach affects respiratory function less than left thoraco-laparotomy. When technically feasible it may be preferable in patients with respiratory impairment.
The ultrasound diagnosis of rectus sheath haematoma
Authors: Lee P W R , Bark M , Macfie J , Pratt D
Published: March 2007

Three cases of rectus sheath haematoma are presented in which the diagnosis was confirmed by the use of ultrasound. The aetiology and diagnosis of the disease are discussed and the use of ultrasonography in a disease with a previously low preoperative diagnostic rate is emphasized.
The pacemaker-twiddler's syndrome: Another disadvantage of abdominal implantation of pulse generators
Authors: Guharay B N , Ghose J C , Majumdar H , Basu A K
Published: March 2007

Breakage of a pacer lead due to the pacemaker-twiddler's syndrome (PTS) occurred in 4 of 62 survivors following epicardial–intramural pacer lead implantation with the pulse generator placed in each case in a subcostal left upper quadrant subcutaneous pocket. The abdominal pulse generator pocket appears to invite spontaneously occurring PTS, more so in a pregnant woman. The important predisposing factor to the development of PTS is an excessively spacious pulse generator pocket containing a pool of fluid. Addition of a few simple modifications to the technique of cardiac pacing would prevent the complication; these include implantation of the pulse generator in a plane deeper to the pectoral muscles, suspending the pulse generator from the clavicle and application of vacuum-suction drainage to the generator pocket in the initial phase of wound healing. In the presence of an optimally fitting pulse generator pocket, PTS should be rare with subclavicular subpectoral pulse generator implantation without active patient participation. The syndrome may not be as rare a cause of pacer lead malfunction as may appear from the relative paucity of reports in the literature.
A new interpretation of the insulin test validated and then compared with the Burge test
Authors: Maybury N K , Russell R C G , Faber R G , Hobsley M
Published: March 2007

A prospective study of 40 patients undergoing proximal gastric vagotomy confirmed the validity of a new interpretation of the insulin test in the early post-operative period (Maybury et al., 1977). Of the 30 patients falling into the group expected to be free from recurrent ulceration (low risk group), none had developed symptoms suggestive of this condition, whilst of the 10 in the contrasting high risk group, 6 have already developed proved recurrences (mean follow-up period 26 months).

A further group of 24 patients was studied by performing a peroperative Burge test for completeness of vagotomy and comparing these results with a postoperative insulin test. This study showed that the Burge test, properly performed, is a reliable test of the adequacy of vagotomy. The use of this test has led to a better understanding of the operative technique required to achieve the objective of an adequate vagotomy.
The role of plastic wound drapes in the prevention of wound infection following abdominal surgery
Authors: Psaila J V , Wheeler M H , Crosby D L
Published: March 2007

A randomized controlled trial has been performed to assess the value of plastic wound drapes in the prevention of surgical wound infection. One hundred and forty-four patients undergoing abdominal surgery were allocated to one of three groups; a control group (A) in which standard cloth towels were applied to the abdominal wound, group B in which an adhesive plastic drape was added and group C in which a plastic ring protector was inserted into the wound.

There were 26 cases (18 per cent) of wound infection. The wound infection rate in the plastic drape groups did not differ significantly from that in the control group.

Bacteriological culture from a wound swab taken at operation was positive in 32 per cent of the cases. The presence of a plastic wound drape did not influence the positive culture rate.

In 68 per cent of wounds which became infected the operative swab was positive as compared with 24 per cent in those not developing a wound infection. Thirteen of the 33 patients (39 per cent) with a positive wound swab subsequently developed a wound infection. In 10 of these 13 cases of infection the operative swab permitted an accurate prediction of the organism responsible for the subsequent infection.
Distal lower limb arterial reconstruction with modified allograft saphenous veins
Authors: Sheil A G R , Stephen M S , Brooks A J , Johnson D S , Loewenthal J
Published: March 2007

Cadaveric donor saphenous veins subjected to proteolytic enzymatic digestion, crossbonding and heparin bonding were used for arterial reconstruction in the legs of 13 patients threatened with amputation and without suitable autogenous saphenous veins. Distal anastomoses were to the tibial and peroneal vessels. Twelve patients (92 per cent) were discharged from hospital with functioning grafts; 9 grafts (69 per cent) continue to function 2–16 (average 8) months after operation. Amputation was avoided in 11 patients (85 per cent). Although early results are encouraging, late results are yet to be determined.
Plasma catecholamine concentrations during operation
Authors: Butler M J , Britton B J , Wood W G , Mainwaring-Burton R , Irving M H
Published: March 2007

Plasma catecholamines have been measured before, during and after operation in 40 patients undergoing elective major abdominal surgery and in 12 patients during open heart surgery. Plasma concentrations did not increase during abdominal surgery and showed only small increase during cardiopulmonary bypass. It appears that it is not possible to assess individual intra-operative sympatho-adrenal responses to surgical trauma by measurement of plasma catecholamine concentrations because of the efficiency of catecholamine uptake mechanisms.
Partial hepatectomies with a hand-held laser knife: An experimental study
Authors: Orda R , Wiznitzer T , Goldwasser B , Bubis J J , Levene S , Kaye R M
Published: March 2007

Fifteen mongrel dogs underwent a left lateral non-anatomical partial hepatectomy using a carbon dioxide laser, diathermy or a surgical scalpel. An original prototype of a compact hand-held laser was used and its effects were compared with those of the other two instruments. An improved dry cut surface was achieved by placing a rubber snare proximal to the planned incision. While no significant differences in the blood loss or in the operating time were found among the experimental groups, the laser beam sealed vessels of up to about 6 mm in diameter without any complementary suture ligatures, which were needed in the other groups. Histological studies revealed less tissue trauma in the sections performed by the laser and only slight secondary inflammatory reaction.
Pilonidal sinus: A 5-year appraisal of the Millar–Lord treatment
Authors: Edwards M H
Published: March 2007

One hundred and two patients with a pilonidal sinus treated by minor excision had a life-table of 5-year freedom from recurrence of 89 per cent provided that they attended a dressing clinic until the wound healed. With failure to attend the clinic, the recurrence freedom fell to 57 per cent (P < 0·004). Age, sex, acute abscess, previous excision, presence of hairs and the number of midline pits and lateral abscesses did not significantly influence the result. The method supersedes more extensive procedures, but should be tested against even less traumatic techniques.
A successful repair of a recto-urethral fistula: A case report
Authors: Miller William
Published: March 2007

A case report of a method of repair of a recto-urethral fistula is described. A combined synchronous abdominoperineal approach was used with the patient in the lithotomy–Trendelenburg position. The greater omentum was mobilized and interposed between the repaired rectum and the prostatic urethra. A review of the literature is presented.
A gravimetric plethysmograph and its evaluation in clinical use
Authors: Jackson J R , Matthews Jennifer A
Published: March 2007

A gravimetric plethysmograph, the technique of its use and its evaluation in vascular surgical practice are described. The instrument measures flow by the increase in leg weight (rather than volume) produced by an increase in blood content resulting from venous occlusion. The instrument was found to be convenient to use and satisfactory records were obtained in 88 per cent of patients. Values for flow at rest and during reactive hyperaemia were clearly related to the presence of indications for surgical treatment and were similar to those reported by other workers. It is suggested that a peak hyperaemic flow of greater than 15 g 100 ml−1 min−1 may indicate that there are no indications for surgical treatment. The changes in hyperaemic flow values after treatment were clearly related to the symptomatic improvement resulting from it. It is concluded that the gravimetric plethysmograph is suitable for use in the assessment of patients with obliterative arterial disease of the legs.
The effect of small bowel bypass on diabetes mellitus
Authors: Fielding J W L , Baddeley R M
Published: March 2007

The effect of jejunoileostomy on fasting blood sugar, glucose tolerance, hypoglycaemic therapy and weight reduction has been studied in 13 massively obese diabetic patients.

The average weight reduction was 36'7 per cent of the preoperative body weight. As a result, 12 patients resumed normal fasting blood sugars and 8 showed normal glucose tolerance tests. A significant improvement in the glucose tolerance tests of the remaining 5 patients was seen. None of the patients required long term hypoglycaemic therapy after the small bowel bypass.
Penetrating gunshot wounds of the chest in civilian practice: Experience with 250 consecutive cases
Authors: Oparah Sonny S , Mandal Ashis K
Published: March 2007

Our experience indicates a continued rising incidence of gunshot wounds of the chest in the United States. During the past 4½ years, 250 consecutive cases were treated at the King-Drew Medical Center in Los Angeles. Ninety per cent presented with a haemothorax or haemopneumothorax. Pneumothorax alone was present in only 3 per cent of cases. Twenty per cent had associated intra-abdominal injuries, involving mostly the diaphragm, liver, spleen and the gustrointestinal tract. Eighty per cent were treated with tube thoracostomy and among these there were 2 deaths, neither being related to the chest injury. About 16 per cent underwent thoracotomy with a mortality of 12·8 per cent, all the deaths being caused by severe cardiac wounds. The overall mortality was 2·8 per cent. The complication rate was 5·3 per cent, most complications occurring in patients with associated intra-abdominal and spinal cord injuries. The average period of hospitalization was 6·5 days. The management plan and the indications for the two courses of therapy are discussed.
Pneumatosis coli: A familial association
Authors: Underwood John Weston , Finnis Derek , Scott William
Published: March 2007

A woman and her son who both developed pneumatosis coli within a period of 6 months are described. No familial or cluster association has previously been reported. The aetiology of this uncommon disease is reviewed.
The bacteriology of primary wound sepsis in potentially contaminated abdominal operations: The effect of irrigation, povidone-iodine and cephaloridine on the sepsis rate assessed in a clinical trial
Authors: Pollock A V , Froome K , Evans Mary
Published: March 2007

Two hundred and nine potentially contaminated abdominal operations were randomly allocated to prophylaxis with a single dose of 1 g cephaloridine intraincisionally, irrigation of the wound at the end of the operation with saline or spraying of the wound with povidone-iodine. In high risk operations (ileocolorectal or those in obese patients) the rate of major wound sepsis in those protected by cephaloridine was 3·8 per cent compared with 13·2 per cent in the irrigation and 16.7 per cent in the povidone-iodine groups. In low risk operations no significant differences in sepsis rates were found.

Bacteriological studies of incised organs, subcutaneous fat and pus showed that the majority of wound infections arose from endogenous sources. The outstanding problem remains that of prevention of contamination of the abdominal wall during surgery.
Cytotoxic perfusion for colorectal liver metastases
Authors: Taylor I
Published: March 2007

A clinical trial to assess the value of different perfusion techniques in the management of colorectal liver metastases is presented. The perfusion with 5-fluorouracil was commenced at the time of resection of the primary tumour when palpable liver metastases were found. In terms of survival, no benefit was found with hepatic artery ligation and perfusion and with portal vein perfusion alone compared with the control group. However, the combination of the two improved the survival rate and a possible explanation for this is discussed.
Interposition left gastric–caval shunt using internal jugular vein autograft in the treatment of portal hypertension
Authors: Gonzalez E Moreno , Martin J Hebrero San , Abella P Carda , Aguyo J L Rodriguez , Jelavik Dusko
Published: March 2007

The selective left gastric-caval shunt is, in theory, one of the better procedures in the surgical treatment of portal hypertension. We have performed a modification of the previously described technique utilizing an internal jugular vein autograft in 4 patients who had had more than one major haemorrhage from oesophageal varices 3–12 months before operation. There were no postoperative deaths. All 4 patients are still alive 3 months to 4 years after shunting, with no episodes of bleeding. On radiological and endoscopic follow-up, the oesophagogastric varices were noted to be markedly smaller in size than before shunting.
Operative intubation in the treatment of complicated small bowel obstruction
Authors: Munro Alexander , Jones Peter F
Published: March 2007

Intestinal intubation carried out at laparotomy for complicated small bowel obstruction is not yet a generally accepted technique. Experience in 32 patients has shown that it is safe and effective. The procedure was initially described in North America for use in recurrent adhesive small intestinal obstruction but the indications have been extended and it has proved of value in other difficult situations.

A technique for intubation is described and the results obtained in various clinical situations are given.
Evaporative water loss in adult surgical patients in the Sudan
Authors: Kambal A
Published: March 2007

Evaporative water loss and urine volume were investigated in 65 healthy adult Sudanese male surgical patients in Khartoum. The mean evaporative water loss per day was found to be 3063 g in the hot dry season and 667 g in the cold dry season. The mean 24-h urine volume was found to be 594 and 1515 ml respectively.

There was a significant correlation between evaporative water loss and the air temperature and the effective temperature.

These findings support the results reported from other parts of the tropics that the values for evaporative water loss and urine volume quoted for temperate climates are not representative of those encountered in the tropics.
The Gritti–Stokes amputation in ischaemia: A review of 134 cases
Authors: Doran J , Hopkinson B R , Makin G S
Published: March 2007

The results of 134 Gritti–Stokes amputations for ischaemia are presented. The mortality rate was 11 per cent and healing occurred in 88 per cent, reaffirming the good results already reported for this operation. The long term results are reviewed in an attempt to decide whether the most frequently cited criticisms of this procedure are justified. Stump pain and mobility of the patella were not major problems. The difficulties in fitting a suitable prosthesis are discussed and attention is drawn to the advantages of a new prosthesis that has been developed for this amputation.
Closure of gastrojejunostomy for the relief of post-vagotomy symptoms
Authors: Green Roger , Spencer Anne , Kennedy Terence
Published: March 2007

When dumping, diarrhoea or bile vomiting follows vagotomy and gastrojejunostomy, simple closure of the stoma, without alternative drainage, has been performed in 19 patients. Thirteen patients, 5 with truncal, 7 with selective and I with proximal gastric vagotomy, have been followed up for 1–6 years. Five were completely relieved of symptoms, 7 improved and there was only I complete failure. Bile vomiting was more often relieved than dumping or diarrhoea. The procedure is safe and significant gastric retention does not occur provided that at least one year is allowed to elapse after the primary operation.
Small bowel melaena: 2 cases diagnosed by angiography
Authors: Forbes W St C , Nolan D J , Fletcher E W L , Lee E
Published: March 2007

Two cases of small bowel tumour presenting with melaena are reported. Selective visceral arteriography was found to be invaluable in the management of these cases. The first case presented with intermittent bleeding causing anaemia. Conventional barium studies of the small and large bowel revealed no abnormality. Superior mesenteric angiography revealed a mass lesion in the jejunum, with features characteristic of a leiomyoma. The second case presented with massive gastrointestinal bleeding. Selective visceral angiography was performed initially and revealed a large, mainly avascular, mass lesion in the ileum. Pathological examination showed a leiomyoma which had undergone cystic degeneration. The value of selective angiography in patients with suspected small bowel bleeding is discussed.
Vascular malformations of the parotid region
Authors: Faber R G , Ibrahim S Z , Brew D St J , Hobsley M
Published: March 2007

Five adult patients with vascular malformations in the parotid region are described. Three of these patients had lumps in the parotid gland clinically indistinguishable from parotid tumours: one had a diffuse swelling of the cheek, and the fifth had a pulsatile tumour in the deep lobe of the gland. Two patients had a characteristic sign–the lump in the cheek became more obvious, both visually and on palpation, when the masseter muscle was tensed. In 3 of the patients calcified opacities, resembling phleboliths, were demonstrated on plain X-ray examination. This is only parotid region in the British literature; no other report of a pulsating tumour within the parotid gland has been found in a search of the world literature.
Non-recurrent laryngeal nerve
Authors: Wijetilaka Shelton E
Published: March 2007

Two cases of a right non-recurrent nerve were encountered in 203 thyroidectomies. In its abnormal, non-recurrent course the nerve passes transversely from under the carotid sheath and takes a position which is at right-angles to the normal recurrent laryngeal nerve.
Cyclic AMP, adrenaline and noradrenaline in plasma during surgery
Authors: Madsen S Nistrup , Fog-Møller F , Christiansen C , Vester-Andersen T , Engquist A
Published: March 2007

Plasma concentrations of cyclic AMP, adrenaline and noradrenaline were measured in 6 patients undergoing hysterectomy from before induction of anaesthesia to 6 h after skin incision. Noradrenaline did not vary significantly during the observation period, whereas cyclic AMP and adrenaline increased after skin incision. A significant correlation was found between plasma concentrations of cyclic AMP and adrenaline (r = 0.84, P < 0.01), suggesting that the latter is responsible for the increase in plasma cyclic AMP which is observed in relation to surgical procedures.

Peak concentrations of cyclic AMP and adrenaline were seen in the early postoperative phase. This indicates that the most pronounced acute endocrine stress response to surgery of moderate severity occurs after termination of anaesthesia.
The patient's opinion of day care vein surgery
Authors: Clyne Charles A C , Jamieson C W
Published: March 2007

A questionnaire was sent to 181 patients whose varicose veins had been operated on as day cases. A good response was obtained that showed that day care was generally acceptable except in those cases requiring multiple incisions or stripping.
Intermittent claudication in the foot and buerger's disease
Authors: Hirai Masafumi , Shionoya Shigehiko
Published: March 2007

The objective of this investigation was to study the pathogenesis of intermittent claudication in the foot and to determine whether it could be used as a diagnostic manifestation of Buerger's disease. In 30 limbs with foot claudication and 20 limbs without foot claudication, systolic pressures at various levels of the leg were measured by a photoelectric technique, and the significance of collateral circulation in the foot on the development of claudication was studied. Although there was a significant difference between blood pressures at the foot and toe, considerable overlapping was seen between the two groups. This finding might indicate that muscle circulatory insufficiency in limbs with foot claudication results from occlusion of the nutrient arteries supplying the plantar muscles as well as poor collateral circulation in the foot.

Hospital records of 48 patients with foot claudication were reviewed and the question of whether these patients could be diagnosed as having Buerger's disease was discussed. On the basis of clinical findings and arteriographic appearances, the diagnosis of Buerger's disease was made in all patients except one with hypercholesteraemia.

From the results obtained here, foot claudication could be considered to be almost specific to Buerger's disease and a useful guide in the clinical diagnosis of this disease.
Oesophageal resection with cervical oesophagogastrostomy for corrosive oesophageal stricture
Authors: Ti T K , Sivaloganathan V
Published: March 2007

An 8-year experience of the surgical treatment of 28 patients with corrosive oesophageal stricture is reviewed. Eight patients underwent oesophageal bypass using colonic or jejunal graft with one death (12.5 percent mortality). The single death (5 per cent mortality) among 20 patients undergoing oesophageal resection was not related to the technical difficulty of the opration. In 17 of these patients reconstruction was by cervical oesophagogastrostomy and in 2 by pharyngogastrostomy. One case of oesophageal carcinoma occurred among 5 cases of corrosive stricture exceeding 20 years in duration. Oesophageal resection for sevevere corrosive stricture is not a hazardous procedure as generally believed and is desirable in view of the premalignant nature of corrosive stricture. Reconstruction by cervical oesophagogastrostomy after oesophageal resection is advantageous because of its relative simplicity and safety.
The assessment of aorto-iliac disease by static isotope angiology
Authors: Hurlow R A , Chandler S T , Strachan C J L
Published: March 2007

In 48 patients with severe claudication isotope images of the aortofemoral arteries have been assessed for the severity of disease in 417 anatomical segments and compared with arteriography. An overall correlation of 80 per cent was found; 87 per cent of patent and 76 per cent of occluded segments were correctly identified, but only 68 and 54 per cent of segments with minor and major disease respectively. Underestimation of disease occurred in only 6 per cent.
Assessment of suture materials for intestinal use by an extramucosal implant technique and a quantitative histological evaluation
Authors: Fontaine C J , Dudley H A F
Published: March 2007

Six suture materials, 5 of which are in common use for intestinal suture, were implanted in the small and large bowel of the rabbit, and thereafter the durability of their tensile strength and the histological reaction produced were assessed at standard times over 64 days. Absorbable sutures (catgut and polyglycolic acid) lose strength too rapidly to provide reliable sole support, though the synthetic absorbable produces only a slight reaction. Non-absorbables maintain their strength. Only minor differences exist between the reactions produced by different non-absorbables. Other considerations such as handling characteristics or the results of clinical work should be borne in mind in the selection of the optimum suture material.
The use of bulk evacuant in patients with haemorrhoids
Authors: Webster D J T , Gough D C S , Craven J L
Published: March 2007

Fifty-three patients with symptomatic haemorrhoids have been studied in a double-blind cross-over trial of a bulk forming agent (ispaghula husk) against a placebo. Although only 11 per cent of patients complained of constipation, a significant benefit in symptoms and improved bowel habit was demonstrated.
Pile suture: A new technique for the treatment of haemorrhoids
Authors: El-Meguid Farag A
Published: March 2007

A new technique for the treatment of haemorrhoids, termed pile suture, is described. It appears to have significant advantages over conventional haemorrhoidectomy both in terms of incidence of complications and patient comfort.
Intestinal ischaemia associated with ileal carcinoid tumours
Authors: Sworn M J , Reasbeck P , Buchanan Rose
Published: March 2007

A case of intestinal infarction due to multiple ileal carcinoid tumours is presented in which abdominal pain due to intestinal ischaemia was the first manifestation of the underlying tumour. It is postulated that intestinal ischaemia may be of more importance in the production of abdominal pain by carcinoid tumours than has been generally accepted, and that it is the result of functional and structural changes in and around the mesenteric blood vessels, caused by substances secreted by the carcinoid tumour.
Abdominal apoplexy
Authors: Stevenson I M , Mansfield A O , Temple J G
Published: March 2007

Two cases of the rare condition of abdominal apoplexy are described. The two main clinical presentations of this condition are discussed as is the aetiology. It is suggested that selective visceral angiography might prove helpful in preoperative diagnosis.
Roux diversion for bile reflux following gastric surgery
Authors: Kennedy Terence , Green Roger
Published: March 2007

Regurgitation of bile into the stomach after gastric surgery often causes severe and distressing symptoms, though the onset may be delayed for some years. We have used a Roux loop diversion as a secondary procedure for bile reflux in 36 patients, making the ananstomosis from 18 to 40 cm below the stomach. There were no deaths and the clinical results were good in 20 of 27 patients followed up from 1 to 10 years. Vagotomy was omitted in 13 patients, 2 of whom subseqently developed jejunal ulceration, One patient developed an unexplained gastric ulceration. One patient developed an unexplained gastric ulcer and 2 operations failed because the loop was too short. The optimum length may well be 40 cm and vagotomy should be added in all cases. In 3 patients with associated dumping the upper 10 cm of the Roux loop was reversed.
A single-centre double-blind trial of Trasylol therapy in primary acute pancreatitis
Authors: Imrie C W , Benjamin I S , Ferguson J C , McKay A J , Mackenzie I , O'Neill J , Blumgart L H
Published: March 2007

One hundred and sixty-one consecutive patients with primary acute pancreatitis were admitted to a double-blind trial of intravenous Trasylol therapy as a supplement to a standard regimen of conservative management. The patients were subdivided into younger (less than 60 years) and older patients (aged 60 years and over), and subjects in each group were randomly allocated on a double-blind basis either to Trasylol therapy (starter 500 000 KIU and thereafter 200 000 q. i. d. for 5 days) or to placebo. There were 14 deaths (8.7 per cent), 7 in the Trasylol and 7 in the placebo group, and no significant difference was found in either the mortality or the major complications rate, either overall or within either age group.

All 14 patients who died met the objective criteria for severe acute pancreatitis determined by the presence of at least three of a possible nine factors during the first 48 h of admission. Severe acute pancreatitis was present in 37 per cent of patients, who were evenly distributed between the Trasylol and placebo groups. Neither in those patients with severe nor those with less severe acute pancreatitis was there any significant difference between the two therapeutic regimens. Supplementary intravenous Trasylol therapy at this dosage confers no advantage over standard conservative treatment in the management of patients with primary acute pancreatitis.
Drug therapy in intermittent claudication: An objective assessment of the effects of three drugs on patients with intermittent claudication
Authors: Mashiah A , Patel P , Schraibman I G , Charlesworth D
Published: March 2007

It has been suggested that, by reducing the viscosity of blood, flow through capillaries is increased with consequent improvement in the symptoms of patients with peripheral vascular disease. We examined the effects of treatment with drugs purported to reduce blood viscosity to test the validity of this claim.

Measurements of viscosity and the rate of blood flow to the leg were made in a group of patients before and after treatment with three different drugs–tetranicotinoyfructose (Bradilan), oxypentifylline (Trental) and cinnarizine (Stugeron).) All patients had intermittent claudication in one leg and the distribution of arteriosclerosis was similar in each patient. After treatment there was little or no change in blood viscosity and no change in the rate of flow recorded in the symptomatic legs. We did not find any objective evidence to support the use of these drugs in patients with intermittent claudication.