bluuebunny/crossref_metadata_2025 huggingface dataset:
Dissolution of retained bile duct stones using heparin
Authors: Chary Srinivasa
Published: March 2007

Five cases of retained bile duct stones treated with heparin in normal saline are reported. In 2 cases the stones were retained in the left hepatic duct, proximal to the T tube. Infusion of heparin in normal saline was found to be simple and effective in treating retained bile duct stones without obvious side-effects. If stones are inadvertently left in the common bile duct following surgery, attempts should be made to encourage them to pass by heparin infusion through the T tube before a second operation is contemplated. Sufficient time must be allowed before the treatment is considered to have failed.
The value of profundaplasty in the management of severe femoropopliteal occlusion
Authors: Modgill V K , Humphrey C S , Shoesmith J H , Kester R C
Published: March 2007

A series of 45 patients with advanced occlusive arterial disease of the femoropopliteal segment underwent profundaplasty as the sole operative procedure. The value of this technique as a salvage procedure for the severely ischaemic limb is discussed.
Doppler ultrasound in the functional assessment of extended deep femoral angioplasty
Authors: Thomas M H , Quick C R G , Cotton L T
Published: March 2007

Twelve patients who have had an extended deep femoral angioplasty (EFDA) for severe lower limb ischaemia have been assessed. The patients underwent a standard exercise ankle pressure test before operation and 6 months after operation. The test included the measurement of resting brachial and ankle pressures, walking distance on a treadmill and the post-exercise pressure response. A limb ischaemic score was derived from these measurements; 8 patients showed an improved score, 3 patients exhibited no change and 1 was worse. The mean improvement in walking distance of the successful cases was 182 per cent (s.d. 96 per cent). There were no amputations during the period of study.
The efficacy of graduated compression stockings in the prevention of deep vein thrombosis
Authors: Scurr J H , Ibrahim S Z , Faber R G , Le Quesne L P
Published: March 2007

The incidence of deep venous thrombosis (DVT) was studied by the 125I-fibrinogen technique in 70 patients who had had major abdominal operations and who were wearing graduated static compression stockings on one leg, the patient's other leg being used as a control. In the whole group 7 patients developed bilateral DVT, 19 patients developed unilateral DVT in the control leg and only one patient developed unilateral DVT in the stockinged leg. The difference between stockinged and control legs was highly significant (P = 0·0003). In the 19 patients with malignant disease the incidence of DVT in the stockinged leg remained significantly less (P = 0·037). It is concluded that graduated static compression stockings do reduce the incidence of postoperative deep venous thrombosis.
A prospective trial of prophylactic antibiotics in hand lacerations
Authors: Roberts A H N , Teddy P J
Published: March 2007

A series of 368 patients with hand lacerations which required suturing were randomly allocated to one of three treatment groups. The incidence of infected and of imperfectly healed wounds was noted 7 days after suturing. As well as the influence of antibiotics on healing, sixteen other factors which it was considered might affect healing were analysed.

The overall infection rate was 9·8 per cent, and there was no significant difference between the three groups. The imperfect healing rate (which includes the infected cases) was 24·6 per cent. There was a lower rate (P<0·05) of imperfect healing in the Triplopen group (15 per cent) than in either the flucloxacillin group (29·5 per cent) or the group who received no antibiotics (29·0 per cent).

Other factors associated with imperfect healing found to be significant at the 1 per cent level, were wound contamination, pain and the presence of a wet or changed dressing at the second examination.
Intermittent sigmoid volvulus in the younger age groups
Authors: Smith R B , Kettlewell M G , Gough M H
Published: March 2007

Sigmoid volvulus is a well-recognized clinical entity, occurring more commonly in the male in middle or old age. In younger age groups the diagnosis is therefore often delayed. We report here 11 patients of an average age of 31 years (range 12–57 years), with a preponderance of females (7 : 4), who have presented to us in the past 2 years with intermittent sigmoid volvulus. The average age at onset of initial symptoms was 26 years. All had the diagnosis confirmed radiologically by colonoscopy or at operation. The diagnostic features of the condition are described.
The significance of starch powder contamination in the aetiology of peritoneal adhesions
Authors: Cooke S A R , Hamilton D G
Published: March 2007

The presence or absence of starch granulomas on the peritoneal surface or within peritoneal adhesions is reported in 20 patients subjected to a second laparotomy. Evidence is presented to show that starch granuloma formation is common in the early months following operation and that adhesions associated with starch granulomas cause intestinal obstruction. It is suggested that although starch is usually absorbed within 2 years, associated band adhesions may persist. Glove powder contamination of the peritoneal cavity may thus be a common cause of band adhesion obstruction.
Results of colectomy for diverticular disease of the colon
Authors: Charnock F M L , Rennie J R , Wellwood J M , Todd I P
Published: March 2007

A retrospective study of 71 patients who had a colonic resection for diverticular disease at one hospital during a 7-year period was undertaken. Patients were divided into those undergoing surgery for complications of diverticular disease (49) and those in whom abdominal pain and an altered bowel habit were attributed to the presence of diverticular disease in the absence of any detectable complication (22). In both groups major complications occurred after operation. The incidence of complications was greater when surgery was undertaken in stages to effect colonic resection and restoration of intestinal continuity. Symptoms were more often cured or relieved in those patients undergoing surgery for complicated diverticular disease than in those with ‘uncomplicated’ disease. These poor results may be due to incorrectly attributing symptoms to diverticula which happened to be present.
Acute ischaemic enteritis in Goa
Authors: Gupta S D , D'Silva Vasco , Salelkar A V , Reys M
Published: March 2007

Acute ischaemic enteritis is an uncommon condition which mainly affects young people. It is characterized by ischaemic changes in the small or large bowel which may be reversible in the early stages. The exact aetiology is not known. The condition may be due to toxins produced by either roundworms or Gram-negative bacilli or may be due to a localized allergic reaction. It is possible to make a preoperative diagnosis in most cases from the presence of abdominal pain, bloody diarrhoea and shock. Conservative treatment may be best in early cases but surgery is necessary in those cases where gangrene or perforation has occurred.
Changes in plasma lactate, phosphate and uric acid during postoperative carbohydrate infusion
Authors: Rowlands B J , Giddings A E B , Clark R G
Published: March 2007

Eighteen patients undergoing-elective abdominal surgery had pre- and postoperative carbohydrate infusion tests with glucose, fructose or sorbitol. All three substrates produced significant hyperlactataemia postoperatively, the elevations of plasma lactate with fructose and sorbitol infusion being significantly greater than with glucose. Plasma uric acid was unchanged but there were moderate falls in plasma phosphate postoperatively. Intravenous nutritional regimens containing fructose and sorbitol may potentiate the development of harmful metabolic acidosis in ‘at risk’ patients and should always be used cautiously. Glucose is the carbohydrate calorie source of choice.
Transabdominal suture of bleeding gastro-oesophageal varices in cryptogenic cirrhosis of the liver
Authors: Lam Shiu Kum , Lam Wah Kit , Cheng Frank C Y , Ong G B
Published: March 2007

Emergency transabdominal suture of gastro-oesophageal varices was performed when conventional conservative measures including oesophageal tamponade failed to control bleeding in 60 of 167 patients with cryptogenic cirrhosis and bleeding varices. The immediate mortality for the whole series was 29·9 per cent. Surgery performed in this selected manner carried an immediate mortality of 40 per cent. The transabdominal approach detected and treated 19 (31·7 per cent) patients who had concomitant bleeding from extra-oesophageal sources. Ageing and sex (male) affect the immediate prognosis adversely. Using a modification of Child's classification of hepatic dysfunction, a direct relationship between hepatic dysfunction and mortality was found, reaching 100 per cent in those with grade C (severe) dysfunction, irrespective of whether or not surgery had been performed. Bleeding was successfully arrested in 96·7 per cent of cases and recurrence of bleeding was acceptably low in the first 6 months of surgery but not after.
An unexpected complication of a liver biopsy
Authors: Terpstra O T , Van Vroonhoven Th J M V , Muller H
Published: March 2007

A case of anaphylactic shock after percutaneous liver biopsy is described. This was due to rupture of a large echinococcal cyst localized in the liver. Diagnosis and treatment with a review of the literature are discussed with emphasis on the complete removal of both the cyst and the surrouding capsule of fibrous liver tissue.
Cervical chordoma: Report of a case and the technique of transoral removal
Authors: Windle-Taylor Paul C
Published: March 2007

A case of cervical chordoma in a man of 27 years is described. The clinical features were of progressive spinal cord compression. Treatment was by transoral decompression of the second cervical vertebra and postoperative radiotherapy. The result was favourable and remained so at follow-up after 27 months. The relative merits and scope of the various approaches to the upper cervical vertebrae and the role of radiotherapy and chemotherapy are discussed.
Hypothyroidism following partial thyroidectomy for thyrotoxicosis and its relationship to thyroid remnant size
Authors: Tweedle David , Colling A , Schardt W , Green E M , Evered D C , Dickinson P H , Johnston I D A
Published: March 2007

One hundred and twenty-two patients were reviewed 1–7 years after partial thyroidectomy for thyrotoxicosis by two surgeons who had left thyroid remnants of different size. There was no significant difference in the prevalence of hypothyroidism or in the serum levels of thyroxine, tri-iodothyronine or thyroid-stimulating hormone between the two groups of patients. The overall prevalence of hypothyroidism was 16 per cent.
Pulse wave form transit ratios in the assessment of peripheral vascular disease
Authors: Craxford Alan D , Chamberlain John
Published: March 2007

This paper presents a ratio of the pulse wave form transit times in the proximal and distal arterial tree, produced by a simple, non-invasive, repeatable and reproducible technique. It has been shown to be highly significant in separating normal from disease states and the proximal from the distal lesion. It has been shown to be independent of the effects of age.

In the clinical situation the ratio is of value in the initial assessment of the patient (by separating ischaemic from non-ischaemic limb pain); in elucidation of significant occult proximal lesions in the presence of distal disease; in indicating the type of angiography required (femoral arteriography rather than translumbar aortography in suitable subjects); in following the progress of patients in operative and conservative management régimes; and in the long term follow-up of the natural history of obliterative vascular disease.
Reappraisal of the left lateral decubitus X-ray in splenic rupture
Authors: Myers R A M , Andrew W , Wilkinson A E
Published: March 2007

The lateral decubitus view of the barium-filled stomach has been reassessed in a series of 42 patients with possible splenic rupture and compared with a group of 17 patients with splenomegaly. Displacement of the gastric fundus of more than 4 cm from the inner rib margin is highly suggestive of splenic rupture. Where doubt exists, the test should be repeated within a short while. Peritoneal lavage and a full blood count investigation both add to the diagnostic accuracy.
The finding of thrombus at carotid endarterectomy and its relationship to the timing of surgery
Authors: Harrison M J G , Marshall John
Published: March 2007

The clinical, angiographical, operative and histological records of 52 patients undergoing carotid endarterectomy for transient cerebral ischaemic attacks were reviewed. Thrombus or other friable material was present in 66 per cent of the 24 patients operated upon within 4 weeks of a clinical attack, but in only 21 per cent of the 28 patients in whom the time interval was longer. The data favour an embolic explanation for the clinical episodes and further suggest that thrombus formation on atheromatous stenosis and ulceration is intermittent.
Small bowel ischaemia and infarction in young women taking oral contraceptives and progestational agents
Authors: Hoyle M , Kennedy A , Prior A L , Thomas G E
Published: March 2007

Case histories of three young women who suffered small bowel infarction associated with oral contraceptives and progestational agents are presented. Two infarctions were due to superior mesenteric artery thrombosis and one to superior mesenteric vein thrombosis. All of these patients were of blood group A and smokers, factors which are known to predispose to vascular thrombosis. A study was made of 18 additional cases reported in the literature. It was found that many of these cases presented with a history of symptoms of 2 weeks or more and at operation some of the cases appeared to be reversible. One case was reported where apparent reversion of the process of vascular thrombosis occurred after cessation of the oral contraceptive.
Renal autotransplantation in the treatment of hypertension and uraemia due to renal artery stenosis
Authors: Worth R C , Wilkinson R , Taylor R M R , Farr M J
Published: March 2007

Four cases of renovascular hypertension cured or improved by renal autotransplantation are described. In one case correction of renal ischaemia resulted in an improvement of renal function. Previous reports of this technique are reviewed and the limitations of the more standard operation of saphenous vein bypass graft are discussed.
Effects of structural configuration of prosthetic aortic valves upon coronary blood flow
Authors: Sabbah Hani N , Blick Edward F , Stein Paul D
Published: March 2007

This study was performed in order to determine the effects of the structural configuration of prosthetic aortic valves upon coronary blood flow. A pulse-duplicating system was utilized to which a rigid model of the root of the aorta and the left artery were attached. A stented normal human valve, stented porcine valve, pivoting disc valve, tilting disc valve and a caged ball valve were tested at simulated resting conditions. The results showed that the pulse configuration and proportions of coronary flow that were systolic and diastolic changed with various valves. There was no significant reduction of the mean simulated coronary flow with the porcine valve or disc valves. Coronary flow was augmented with the caged ball valve. These differences were interpreted as being due to several fluid dynamic phenomena. These were piston effects, inertia of reversed blood flow, torque and the effects resulting from the unique pressure distribution on each valve.
Villous adenoma causing acute appendicitis
Authors: Munk John F
Published: March 2007

Acute appendicitis is the most common of surgical emergencies. However, it is very unusual to find a benign neoplastic lesion causing appendicitis. Adenomas of the caecum or the appendix are rare and very few cases of these associated with appendicular inflammation have been described. This report presents a case of acute appendicitis with perforation resulting from obstruction by an adenoma. The management of the condition is discussed.
The use of a silicone gel prosthesis in the treatment of post-prostatectomy incontinence
Authors: Das S , Kaufman J J
Published: March 2007

Eighty-three patients with post-prostatectomy urinary incontinence were treated by silicone gel prostheses implanted over the bulbous urethra. The prosthesis provides continence by passively increasing the urethra resistance. Successful results were achieved in 72 per cent of patients. The mechanism of post-prostatectomy incontinence and the development of anti-incontinence surgery is briefly reviewed.
Abdominal wound closure: A trial of nylon, polyglycolic acid and steel sutures
Authors: Leaper D J , Pollock A V , Evans Mary
Published: March 2007

Failures after abdominal wound closure (early dehiscences and late incisional hernias) are due to breakage of sutures, slippage of knots or tearing out of sutures from the tissues. The suture-holding capacity of the entire thickness of muscle and aponeurosis is nearly twice that of the anterior rectus sheath, and deep bites (1·0 cm from the cut edges) are nearly twice as secure as bites of 0·5 cm.

In a random controlled clinical trial of 357 major laparotomies, closure with either layered monofilament nylon or mass polyglycolic acid or steel resulted in 2 burst abdomens (0·56 per cent), 10 incisional hernias due to suture failure (3·4 per cent) and 8 incisional hernias caused by deep sepsis (2·7 per cent). There were no statistically significant differences among the treatment groups, but 1 patient in the nylon and 3 in the steel groups had persistent sinuses until their sutures were removed.
A controlled comparison of one- and two-layer techniques of suture for high and low colorectal anastomoses
Authors: Goligher J C , Lee P W G , Simpkins K C , Lintott D J
Published: March 2007

A controlled trial of one- and two-layer inverting techniques of suture for the construction of high and low colorectal anastomoses was conducted on 137 patients, the integrity of the suture lines being assessed clinically and by routine radiological examination after a small Gastrografin enema.

A clinical diagnosis of anastomotic leakage was made in 9 patients (or perhaps more accurately in 5 only), but subclinical dehiscence was demonstrated radiologically in a further 39 patients (or perhaps 43). There was a slightly greater incidence of dehiscence after the one-layer technique of suture for both high and low anterior resection.
Colectomy and ileorectal anastomosis for colitis: Report on a personal series, with a critical review
Authors: Jones Peter F , Munro Alexander , Ewen Stanley W B
Published: March 2007

In a consecutive series of 86 patients who required total colectomy for inflammatory bowel disease, 36 (43 per cent) had an ileorectal anastomosis. On review between 1 and 18 years after the operation, there were 25 patients who retained the anastomosis, all of whom were in good general health. Details of their clinical and sigmoidoscopic assessment and the histological grading of rectal biopsies are given. The results are compared with other published reports in a critical review of the present standing of ileorectal anastomosis.
Penetrating thoracoabdominal injuries
Authors: Sandrasagra F A
Published: March 2007

Twenty-three cases of penetrating thoracoabdominal injury are reviewed. Abdominal pain, tenderness and rigidity were found to be the most constant indicators of diaphragmatic penetration in these injuries (65 per cent). These features may occur as referred phenomena of purely thoracic injuries and persist as a result of the presence of an intercostal drainage tube used in the treatment of such injuries. There may be no abdominal signs in injuries of the diaphragm unaccompanied by any visceral damage or in injuries confined to the lesser sac. A high index of suspicion in the presence of a wound over the lower half of the chest is necessary to detect these lesions. Negative radiological findings do not exclude a diaphragmatic injury.

The thoracic component of a penetrating thoracoabdominal injury can usually be treated conservatively by aspiration or drainage of the pleural space, but laparotomy is advised for the repair of the abdominal viscera. The need for thoracotomy should be determined by the merits of the thoracic injury or the desirability of pleural toilet. The intra-abdominal injury may then be dealt with through the diaphragm. There is a greater tendency to pleural infection in thoracoabdominal injuries than in simple penetrating thoracic injuries, which is attributable to contamination by intestinal contents through the diaphragmatic tear. The mortality in this series was due to the abdominal injuries, the early recognition and treatment of which would have improved results.
Occult rupture of the spleen
Authors: McMahon M J , Lintott J D , Mair W S J , Lee P W R , Duthie J S
Published: March 2007

Five cases of occult or ‘spontaneous’ rupture of the spleen are described. Pathological examination of the spleen showed changes of infectious mononucleosis in 2 cases, Hodgkin's disease in 1, amyloidosis in 1 and in the remaining spleen no underlying disease process was seen. All 5 cases survived, and evidence from the literature suggests that this may have been in some measure due to the fact that prompt surgical treatment followed a correct preoperative diagnosis. The importance of awareness of the condition, radiological investigation and peritoneal lavage in reaching the correct diagnostic conclusion is discussed.
Vascular injuries in the extremities in battle casualties
Authors: Schramek A , Hashmonai M
Published: March 2007

A series of 51 wounded soldiers with 54 arterial and 28 venous injuries is presented. Interposition of autogenous vein grafts was performed in 30 arterial injuries. Lateral suture or patch arterioplasty was performed in 7 arteries. End-to-end anastomosis was possible in 8 cases. Primary vein repair was performed in 14 vein injuries. Lateral suture, patch plasty, end-to-end anastomosis and interposition composite vein grafts were used. A distal temporary arteriovenous fistula to increase the flow through venous interposition grafts was performed in 4 cases.

Hyperbaric oxygen treatment was used in 7 cases in which successful arterial repair did not reverse ischaemia, and it prevented major amputations.

Neurovascular injuries are not always an indication for primary amputation. Six such cases are discussed.
Abdominal aortic aneurysm: Perianeurysmal fibrosis and ureteric obstruction and deviation
Authors: Darke S G , Glass R E , Eadie D G A
Published: March 2007

Seven cases of ureteric obstruction and one case with bilateral medial ureteric deviation complicating inflammatory aneurysm of the aorta are reported. The value of routine preoperative pyelography in all patients with abdominal aortic aneurysm is emphasized. Diagnostic difficulties that may arise when these conditions coexist are discussed.

Our experience suggests that these patients are best treated by both aneurysmectomy and ureterolysis and that long term follow-up is advisable.
Knotted drainage tube: An unusual postoperative complication
Authors: Downing R , Wilkinson A , Alexander-Williams J
Published: March 2007

Spontaneous knotting of a postoperative drainage tube is reported.
Serum ionized calcium in acute pancreatitis
Authors: Allam B F , Imrie C W
Published: March 2007

Measurement of serum ionized calcium was performed daily for 7 days after admission in 8 consecutive patients with acute pancreatitis. The results support the findings of our previous study that the most common cause of the low serum calcium often found in patients with this disease is a low serum albumin; when correction of serum calcium is made for hypo-albuminaemia, most patients are found to be normocalcaemic. The occasional hypocalcaemia as shown by the ‘corrected’ serum calcium or by serum ionized calcium measurement is usually mild and transient, indicating that the normal homoeostatic mechanisms of the body can efficiently maintain the physiologically active fraction of the serum calcium within, or close to, the normal range. These findings explain the rarity of overt and subclinical tetany in acute pancreatitis. This study has shown that correction of serum calcium for albumin provides similar information to the direct measurement of serum ionized calcium. The value of ‘apparent’ hypocalcaemia in assessing severity of acute pancreatitis requires reappraisal, while greater attention should be directed towards the investigation and management of hypoalbuminaemia in this disease.
The effect of experimental haemorrhagic shock on the bacterial content of thoracic duct lymph
Authors: Barsoum M S , Badran I G , Boulos F I , Said M I , Ekladios E M
Published: March 2007

The effect of haemorrhagic shock on the simultaneous appearance of enteric micro-organisms in the central lymph and the portal blood was studied in 30 dogs. Irreversible haemorrhagic shock results in portal bacteraemia but the lymph remains sterile. Thoracic duct drainage is harmful and hastens the onset of irreversibility.
Adult intussusception in Glasgow 1968–74
Authors: Murdoch R W G , Wallace J R
Published: March 2007

A further review of adult intussusceptions in Glasgow between 1968 and 1974 is presented. A higher than expected incidence of idiopathic intussusception has been found both in this and in the earlier Glasgow series of Smith and Gillespie (1968)—44 per cent and 50 per cent respectively.
Treatment of intestinal fistulas
Authors: Monod-Broca P
Published: March 2007

There have been three major advances in the treatment of small bowel fistulas since 1960: irrigation with lactic acid; total or parenteral nutrition; and continuous low flow enteric nutrition. The causation and clinical features of these fistulas are reviewed. The different unfavourable prognostic features are evaluated with reference to a series of 384 cases published by Edelmann et al. (1975). The different methods of treatment, both medical and surgical, are analysed.

In spite of the great progress in medical management, surgery retains an important place. The guidelines for this medicosurgical policy are laid down.

The mortality of intestinal fistulas was around 60 per cent before 1960 and has now diminished by half. It should be possible to lower it still further to around 10 per cent in future years, by careful application of the methods described.
Delayed (degenerate) interfascicular nerve grafting: A new concept in peripheral nerve repair
Authors: Dickson Robert A , Dinley John , Rushworth Geoffrey , Colwin Ann
Published: March 2007

Interfascicular nerve grafts allowed to undergo endoneurial tube emptying in situ before transfer have been compared with grafts transferred fresh in terms of structure and function. The sciatic nerve of the rat was the model and its structure and ultrastructure were superior following degenerate grafting. More importantly, electrophysiological studies showed that function in nerves repaired with degenerate grafts was significantly better than in those repaired with fresh grafts.
Surgery, venous thrombosis and anti-Xa
Authors: Stamatakis J D , Lawrence D , Kakkar V V
Published: March 2007

Deep venous thrombosis is a common and unpredictable complication of surgery. In this study it is proposed that patients who develop this complication may be predicted by a low preoperative level of a naturally occurring inhibitor of coagulation, anti-Xa.

Two groups of patients were investigated. Women taking the oral contraceptive pill had lower preoperative anti-Xa levels than their non-pill controls (P < 0·01) and in addition had a significantly higher incidence of deep venous thrombosis (DVT) following emergency surgery (P < 0·05). In 90 patients undergoing total hip replacement, the mean preoperative anti-Xa level of those patients who developed DVT was significantly lower than those who did not (P < 0·001). Ninety-four per cent of patients with a preoperative anti-Xa level of less than 80 per cent developed DVT. The effect of low dose heparin on anti-Xa was studied.

The results suggest a mechanism for the cause of postoperative thrombosis which also permits selection of individual patients who will develop this complication.
The prospective evaluation of tumour-associated antigens for the early diagnosis of pancreatic cancer
Authors: Wood R A B , Moossa A R
Published: March 2007

An unselected series of 136 patients suspected of having a major intra-abdominal pathological condition had blood drawn and stored as serum. A definitive histo-logical diagnosis was made in all cases, usually by laparotomy. The serum was analysed with coded samples for carcino-embryonic antigen, alpha-fetoprotein and pancreatic oncofetal antigen and all recorded levels above the upper limit of normal for that test were taken as a positive result. Results were analysed to give the predictive value of a positive test and a negative test for each antigen. A negative pancreatic oncofetal antigen test was found to be useful in excluding a diagnosis of pancreatic cancer.
Effects of Corynebacterium parvum on tumour metastases in mice
Authors: Castro J E
Published: March 2007

The effects of Corynebacterium parvum on the Lewis lung tumour and its metastases have been studied. Intravenous but not intraperitoneal or subcutaneous C. parvum reduced the growth of the primary tumour. Both intravenous and intraperitoneal C. parvum significantly reduced pulmonary metastases. When combined with excision of the primary tumour, C. parvum given not more than 2 days before excision caused only slight reduction of metastases, but when given intravenously or intraperitoneally 3–4 days before excision, metastases were significantly reduced and some mice were cured of tumour. Subcutaneous C. parvum had no effects on metastases.

Non-specific operation (amputation) increased tumour metastases, but C. parvum counteracted this.

Metastases were significantly increased by the administration of silica and cortisone acetate but were unaffected by trypan blue. The antimetastatic action of C. parvum was not significantly altered by these treatments. Thymectomy and irradiation did not affect tumour metastases or the antimetastatic action of C. parvum, whereas antilymphocyte serum depressed metastasis and abrogated the protective effects of C. parvum.

It appears that the inhibitory effects of C. parvum on tumour metastases are mediated through macrophages in concert with a subpopulation of T2 lymphocytes.
Does the peritoneum need to be closed at laparotomy?
Authors: Ellis Harold , Heddle Robert
Published: March 2007

Closure of vertical laparotomy wounds was randomized between a two-layer technique of continuous catgut to peritoneum and continuous nylon to sheath and a one-layer technique in which the peritoneal suture line was omitted. In 162 two-layer closures there were 4 burst abdomens and 7 wound hernias (6·8 per cent wound failures); in 164 one-layer closures there were 5 burst abdomens and 7 hernias (7·3 per cent failures). Of 21 patients in this series with jaundice, the abdominal wounds dehisced in 3, and 4 patients developed incisional hernias (33·3 per cent failures) compared with a 5·2 per cent failure rate in the 305 non-jaundiced patients (P < 0·01).

Closure of the peritoneum as a separate layer, as widely advised and practised, appears to play no significant role in the healing of the laparotomy wound.
Rubber band ligation or lateral subcutaneous sphincterotomy for treatment of haemorrhoids
Authors: Arabi Y , Gatehouse D , Alexander-Williams J , Keighley M R B
Published: March 2007

A randomized trial has been conducted to compare treatment for first- and second-degree haemorrhoids by rubber band ligation and lateral subcutaneous sphincterotomy. The symptomatic results of both procedures were similar at one year, though the initial results of sphincterotomy were poor. Eleven patients later required haemorrhoidectomy—5 after lateral subcutaneous sphincterotomy and 6 after rubber band ligation. Rebanding was necessary in 11 patients treated by rubber band ligation (22 per cent). Immediate complications of pain and bleeding were reported in 27 per cent of patients treated by rubber band ligation compared with 14 per cent after lateral subcutaneous sphincterotomy, whereas 2 patients developed a fistula after lateral subcutaneous sphincterotomy.

Lateral subcutaneous sphincterotomy was associated with a 30 per cent reduction in anal sphincter pressure at 4–6 months and the anal pressure was also reduced (by 24 per cent) at 1 year. Rubber band ligation had no influence on anal pressure.

The poor results of lateral subcutaneous sphincterotomy occurred in patients with prolapse and with anal pressures of less than 100 cm H2O. Although lateral subcutaneous sphincterotomy is a satisfactory means of treating patients with first- and second-degree haemorrhoids, it requires admission to a day case unit. For this reason lateral subcutaneous sphincterotomy is unlikely to be preferred to rubber band ligation in the outpatient management of piles.
The treatment of colonic cancer presenting with intestinal obstruction
Authors: Irvin T T , Greaney M G
Published: March 2007

The factors affecting the prognosis of patients presenting with colonic obstruction caused by carcinoma were examined in a retrospective study of 66 patients undergoing emergency surgery for obstruction. The findings in these cases were compared with 176 patients with colonic cancer undergoing elective surgical treatment.

Obstructed patients had a significantly higher surgical mortality (37·9 per cent) than elective cases (11·9 per cent). There was a significantly higher incidence of lymph node metastases in obstructed patients and those who survived surgery had a significantly lower 5-year survival rate (22·9 per cent) than elective cases (41·5 per cent). Primary resection of obstructing tumours was followed by a higher 5-year survival rate (31·8 per cent) than staged resections (7·7 per cent), but these operations were used selectively and the 5-year survivors following primary resection all had tumours of the proximal colon. Primary resection and anastomosis of the distal colon was associated with a surgical mortality of 50 per cent.

Further progress in the cure of patients with obstructing cancer of the colon may be limited by the aggressive nature of the disease, but the use of primary resection in these cases should be examined in a prospective clinical trial.
Familial abdominal aortic aneurysms
Authors: Clifton Martin A
Published: March 2007

The case histories of three brothers, the only siblings of one family, all of whom underwent surgery for the treatment of a previously asymptomatic ruptured abdominal aortic aneurysm, are recorded.

The possibility of underlying constitutional and hereditary factors is discussed and the suggestion of a primary familial incidence of atheromatous, non-dissecting aortic aneurysm is raised.
Abdominal aortic aneurysms: Should they all be resected?
Authors: Christenson Jan , Eklöf Bo , Gustafson Ingvar
Published: March 2007

A retrospective study has been carried out on 124 consecutive patients with abdominal aortic aneurysms admitted during the period 1960–74. The mortality rate after emergency operation was 56 per cent and after elective operation 15 per cent. As in other vascular centres during these years the mortality rate has decreased among electively operated patients. We have tried to answer two questions: which patients without signs of rupture should undergo operation and which patients with a ruptured aneurysm should not be operated upon?
Seasonal variation in the incidence of deep vein thrombosis
Authors: Lawrence J C , Xabregas A , Gray L , Ham J M
Published: March 2007

Two double-blind controlled clinical trials of the effectiveness of prophylactic low dose subcutaneous calcium heparin (dose based on body weight) in the prevention of deep vein thrombosis (DVT) have been completed. The first was concerned with upper abdominal operations in 242 patients over 21 years of age, and the second with 50 patients presenting with a fracture of the neck of the femur. There was no increase in the incidence of bleeding or wound complications in the patients given heparin. In each trial, the incidence of DVT as diagnosed by 125I-labelled fibrinogen was significantly reduced in the treated group.

The incidence of DVT in the control groups varied significantly during the period of the trials. The incidence was much higher in the cold half of the year than in the hot months.

In the first trial, this variation in incidence was directly correlated with the average temperature and the diurnal variation in temperature in the perioperative period. These results may help to explain the considerable variation in the incidence of postoperative DVT reported from various parts of the world, and also from within Australia.
Cosmetic excision of an isolated extracranial arteriovenous malformation using Gelfoam embolization
Authors: Stillman Richard M , Powers John C , Fitzgerald Joseph F
Published: March 2007

Surgical excision of extracranial arteriovenous malformations may be indicated for cosmetic or urgent medical reasons, such as haemorrhage or high output cardiac failure. However, serious haemorrhage, incomplete removal and poor cosmetic results are well-known complications encountered after this operation. Preoperative embolization under angiographic control is recommended to reduce the incidence of these problems.
Perforated duodenal ulcer in the Black population of Central Johannesburg
Authors: Cooke S A R
Published: March 2007

The increasing incidence of perforated duodenal ulcer among Black patients admitted to the Johannesburg General Hospital between 1966 and 1976 is described against a background of the different forms of peptic ulcer disease seen in this hospital population. Admission for perforation during the years 1973–6 was as common among Black as among White patients. Perforation occurred principally in young (20–40 years) Black males (sex ratio 14 : 1), with a short history of preceding symptoms, and treatment was usually by simple closure. In the White group the age range was broader (20–70 years) and the male : female ratio only 2·7 : 1. Duodenal ulcer occurred predominantly in males (ratio 6 : 1), and the spectrum of the disease among the Black population in this urban environment resembled that among the White population in Johannesburg and in Western countries in the relative frequency of perforation and haemorrhage, rarity of stenosis and ratio of duodenal to gastric ulceration.
Intrinsic factor secretion after vagotomy
Authors: Meikle D D , Bull J , Callender S T , Truelove S C
Published: March 2007

The intrinsic factor (IF) output during basal and Histalog-stimulated gastric secretion has been estimated in two series of patients with chronic duodenal ulcer before and 3 months or more after treatment by either highly selective vagotomy or truncal vagotomy and pyloroplasty. The effects of the two different vagotomy operations appear to be virtually identical and each produced significant reductions in intrinsic factor secretion after Histalog stimulation. This confirms the view expressed by previous workers that it is the vagotomy as such which is responsible, excluding the drainage procedure from any possible role. Furthermore, as these results were demonstrated 3 months after operation, it is likely that the depressed IF secretion is a permanent feature and one which, it is postulated, may become progressively more severe.

In both series there is a marked reduction in IF output during the second hour of stimulated gastric secretion, indicating an early wash-out of preformed IF. This persists after vagotomy.
Intrathyroid cystic parathyroid adenoma: A rare case of hyperparathyroidism
Authors: Grimley R P , Davies Hugh
Published: March 2007

A case is presented of a 52-year-old man with a swelling in the neck and dysphagia resulting from an intrathyroid cystic parathyroid adenoma. Hypercalcaemia and unusually high parathyroid hormone levels were detected preoperatively. The adenoma was removed by partial hemithyroidectomy. The literature is reviewed.
Epidermal repair in chronic venous ulcers
Authors: Adair H M
Published: March 2007

Certain features of epidermal repair, namely increased mitotic activity, cell migration and cell differentiation, have been investigated in fresh biopsies from 17 patients with chronic venous ulcers, using light and electron microscopy. Increased mitotic activity was present at the edges of most of these lesions whether they were in a grossly recognizable healing or nonhealing phase, and some cells with ultrastructural features of migratory cells were invariably seen. The results are discussed in relation to other chronic epithelial lesions and suggest that failure of epithelialization is not due to any lack of epithelial cell production and that some other fundamental defect must be sought.
Occult primary malignant melanoma: Factors influencing survival
Authors: Milton G W , Shaw H M , McCarthy W H
Published: March 2007

Seventy-six patients with occult primary malignant melanoma were studied in order to detect features which would help to determine prognosis. It was found that the 5-year survival rate of these patients was: (a) no worse than in patients first presenting with one known primary lesion and metastases; (b) just as poor for women as for men; (c) more favourable if only a single lymph node was involved with secondary deposits; (d) similar whether the manner of spread of the disease was lymphatic or haematogenous; (e) similar whether there was or was not a history of a pre-existing lesion.

The prognosis for occult primary malignant melanoma, although bad, is not hopeless.
Diagnosis and management of post-cholecystectomy symptoms: The place of endoscopy and retrograde choledochopancreatography
Authors: Blumgart L H , Carachi R , Imrie C W , Benjamin I S , Duncan J G
Published: March 2007

Endoscopic retrograde choledochopancreatography (ERCP) was employed in 52 patients symptomatic after cholecystectomy in whom barium meal studies and intravenous cholangiography had failed to yield a diagnosis. Cannulation of the papilla of Vater was carried out in 50 of the patients in a mean time of 10 min. Diagnostic information demonstrating a pathological lesion or a normal biliary and pancreatic ductal system was obtained by means of endoscopy and ERCP in 48 cases. There were no serious complications.

A pathological lesion was demonstrated in all but one of the patients presenting with jaundice, cholangitis or pancreatitis but the diagnostic yield was not as high in patients with vague upper abdominal symptoms.

Endoscopy and ERCP are the investigative procedures of first choice in complex post-cholecystectomy cases in whom intravenous cholangiography fails, gives incomplete information or suggests normality in the face of continuing symptoms or clinical evidence of residual biliary disease.
A case of myasthenia gravis with thyrotoxicosis treated by combined subtotal thyroidectomy and total thymectomy
Authors: Naganathan N , Nambiar R , Tan N C , Chiang S C
Published: March 2007

Thyrotoxicosis occurring in conjunction with myasthenia gravis is rare. The usual treatment consists of medical control of the thyrotoxicosis, then thymectomy and later subtotal thyroidectomy. The case reported here concerns a 19-year-old girl who had surgical treatment for both lesions on the same occasion. With proper medical preparation, modern anaesthesia and respiratory care, the surgical treatment of both lesions can be accomplished in one stage.
Total hepatic ischaemia in the Rhesus monkey
Authors: McMaster Paul , Medd Richard
Published: March 2007

During operations for major hepatic trauma it may be necessary temporarily to deprive the liver of its blood supply by occlusion of the hepatic artery and portal vein. The maximum ‘safe period’ of total hepatic ischaemia in man is unknown.

In the monkey the ischaemic liver ‘leaks’ potassium, and levels of this element in the hepatic veins rise during ischaemia reaching a peak immediately after blood supply to the liver is restored. However, critical systemic levels of potassium are never reached and severe biochemical disturbance does not occur until 2 h following revascularization in animals having experienced ischaemic periods of longer than 20 min.
Ultrasonic scanning of the thyroid gland as a guide to the treatment of the clinically solitary nodule
Authors: Spencer Ralph , Brown Malcolm C , Annis David
Published: March 2007

This study examines the diagnostic accuracy of ultrasonic scanning in the recognition of multinodular goitre in 87 patients referred for examination who were thought by the referring clinician to have a single nodule in the thyroid gland. Twenty-five were found to have multinodular glands, 23 of which were correctly identified by ultrasound. Of those who had truly solitary nodules, ultrasonic scanning enabled us to identify all 23 who had cystic lesions and 35 out of the 39 who had predominantly solid lesions. The clinical significance of these observations in the management of patients with so-called ‘single nodules’ is discussed.
Abnormalities of gastric emptying and pyloric reflux in uncomplicated hiatus hernia
Authors: Donovan I A , Harding L K , Keighley M R B , Griffin D W , Collis J Leigh
Published: March 2007

We have measured the rate of gastric emptying of solid and liquid meals by an external scanning technique and have studied pyloric reflux by a radiological technique. Investigations were performed in patients with uncomplicated hiatal hernia, patients with uncomplicated duodenal ulcer and normal controls. There was a significant delay in the emptying of both solid and liquid meals in the patients with hiatal hernia compared with both the duodenal ulcer patients (solid meals P < 0·01, liquid meals P < 0·025) and with normal controls (solid meals P < 0·05, liquid meals P < 0·001). Duodenogastric reflux was observed in 35 per cent of hiatal hernia patients compared with 24 per cent of duodenal ulcer patients and no incidence in the controls.
Hydrotalcite in the treatment of bile vomiting
Authors: Hoare A M , McLeish A , Thompson H , Alexander-Williams J
Published: March 2007

Seventeen patients have completed a double-blind crossover study of hydrotalcite against placebo in the treatment of bile vomiting after surgery for peptic ulcer. Overall there was no significant difference between the two treatments, with 9 patients improving on hydrotalcite and 5 on placebo. The original operation had been performed less than 3 years before the study in 9 patients; in this subgroup there was an improvement on hydrotalcite treatment in 8 patients but in only 1 on placebo. These differences are statistically significant (P < 0·005). Nausea, vomiting, heartburn and epigastric tenderness were improved although gastritis and endoscopic changes were not affected. It appears that hydrotalcite can help palliate symptoms of bile vomiting occurring soon after surgery for peptic ulcer.
Leakage from T tube tracts as determined by contrast radiology
Authors: Domellöf L , Rydh A , Truedson H
Published: March 2007

The continuity of the T tube tract on removal of the drain was studied by fluoroscopic examination in 51 patients. Leakage was found in 25 cases (abdominal cavity 7, wound drain 6, local cavity 11, combined abdominal and wound drain leakage 1). No correlation was found between the incidence of pyrexia or pain and the presence of leakage. These complications, noted in 10 patients, are probably explained by bacterial contamination of the bile in combination with the trauma caused by extraction of the tube.
Wound implantation—a surgical hazard
Authors: Alagaratnam T T , Ong G B
Published: March 2007

A review of the literature on wound implantation together with a report on an unusual case of implantation of squamous carcinoma at the site of a gastrostomy is presented.