bluuebunny/crossref_metadata_2025 huggingface dataset:
Survival of surgical patients with carcinoma, lymphoma and carcinoid tumours of the small bowel
Authors: Taggart D P , McLatchie G R , Imrie C W
Published: March 2007

We have analysed the effects of ‘curative’ and palliative surgery and adjuvant therapy on actuarial 5 and 10 year survival in 97 local patients with primary small bowel malignancies presenting to five Glasgow teaching hospitals over a 15 year period. The 5 year survival rates in 18 patients with lymphoma undergoing ‘curative’ surgery was 48 per cent while in patients whose surgery was considered palliative the figure was 12 per cent (P < 0·001). In the 29 patients with carcinoma, 17 had ‘curative’ surgery and 12 a palliative procedure with respective 5 year survival rates of 38 per cent and 0 per cent (P < 0·07). In 16 patients with carcinoid tumours the surgeons' assessment of curative or palliative surgery was of little consequence with 51 per cent of the palliative group alive at 10 years. Mean survivals were increased in lymphoma patients in both ‘curative’ and palliative groups receiving adjuvant therapy but not significantly so. We suggest that all detectable macroscopic tumour, where possible, should be removed and that adjuvant therapy may be of benefit in all patients with lymphoma, even when surgery is considered ‘curative’.
Clinical and radiographic features of simple and hydatid cysts of the liver
Authors: Harris K M , Morris D L , Tudor R , Toghill P , Hardcastle J D
Published: March 2007

The advances of hydatid chemotherapy and the non-operative management of simple (epithelial) hepatic cysts make a correct diagnosis of increasing importance. Twenty-six patients with hepatic hydatid cysts and eleven with simple cysts were reviewed. In both groups clinical presentation was most frequently due to pain. Sex, age and size of the cysts were similar. Hydatid serology was negative in six of the hydatid patients (23 per cent). None of the simple cyst patients had positive serology but one had a borderline titre. Ultrasound and computerized tomography identified daughter cysts within the main cyst in only 17 hydatid cysts (65 per cent) and considerable intra-cyst debris was also present in five of the simple cysts. Seven of the simple cysts were deroofed surgically and the remainder underwent percutaneous aspiration. Sixteen of the hydatid cysts were found to have a biliary communication whereas this was not found with any simple cyst. The difficulties in making a precise diagnosis in some patients with a liver cyst should deter the interventional radiologist and restrain the hydatid chemotherapist.
Immunorestorative effect of lipid emulsions during total parenteral nutrition
Authors: Monson J R T , Ramsden Carol W , MacFie J , Brennan T G , Guillou P J
Published: March 2007

This prospective in vivo cross-over study investigated the effect of Intralipid on immune responses. Twenty-three patients were randomly allocated to receive one of two alternative total parenteral nutrition (TPN) regimens for the first 7 days and the other regimen for the second 7 days. Only one of the regimens included a fat emulsion to provide 50 per cent of the calorific requirement. Immunological studies were performed on days 0, 7 and 14. These included peripheral blood T cell subsets, antibody dependent cellular cytotoxicity and basal and maximal Interleukin 2 production. All immunological parameters were significantly augmented during total parenteral nutrition using the lipid based regimen. No such change was seen during intravenous feeding with carbohydrate based TPN. It is concluded that, far from being immunosuppressive, the incorporation of a fat emulsion into a TPN regimen has immunostimulatory properties.
Direct arterial pressure measurements during operation to assess adequacy of arterial reconstruction in lower limb ischaemia
Authors: Tweedie J H , Ballantyne K C , Callum K G
Published: March 2007

Over a 3-year period 164 patients undergoing arterial reconstruction for lower limb ischaemia had direct arterial pressure measurements during the operation. The arterial pressure was measured by direct puncture of the vessel with a No. 23 gauge needle connected, via a cannula, to a pressure transducer. The pressure was measured proximal and distal to anastomoses or endarterectomies, and note was made both of the absolute pressure and waveform. At 3 months 95 per cent were patent. In nine patients (5 per cent), there was a significant fall of pressure across the reconstructed artery and in eight of these procedures were carried out to correct the fault. The technique of direct arterial pressure measurement is quick and easy to perform, with equipment that is used routinely for monitoring by the anaesthetist. There has been no evidence of damage due to the arterial puncture itself. It provides a simple, objective assessment of adequacy of an arterial reconstruction and may lead to the early correction of otherwise unrecognized faults, and thus prevent early graft occlusion.
Indications for thoracotomy in stab injuries of the chest: A prospective study of 543 patients
Authors: Demetriades D , Rabinowitz B , Markides N
Published: March 2007

This is a prospective study of 543 patients with stab wounds of the chest treated in a 15 month period. Four hundred and sixty-seven patients (86 per cent) were selected for conservative treatment with no mortality. Of the 76 patients in the operatively treated group 68 were operated on in the operating theatre with a mortality of 17 per cent, while the remaining eight had a thoracotomy in the resuscitation room with a mortality of 87.5 per cent. Indications for early operation would appear to be the presence of signs of cardiac or major vascular injury (i.e. tamponade, profuse bleeding, an absent or diminished peripheral pulse, and shock not responding to aggressive resuscitation). A cautious digital exploration of the chest wound may help identify these injuries by obtaining information about the knife tract (towards or away from the heart or major vessels). The presence of shock on admission should not be an absolute indication for operation. Half the 156 patients with shock on admission were treated conservatively with no mortality. The presence of a wound over the precordium is not in itself an absolute indication for surgery. Seventy-two such patients, including 14 with shock, were successfully treated non-operatively. Massive air leaks are usually self-controlled and none of the 24 such cases required operation. The amount or rate of blood loss via the thoracotomy tube is not a reliable index of the severity of the injury and it should not be a sole criterion for the selection of the type of treatment.
Selective cefuroxime prophylaxis following colorectal surgery based on intra-operative dipslide culture
Authors: Claesson B E B , Filipsson S , Holmlund D E W , Mätzsch T W , Wählby L
Published: March 2007

The concept of a very limited effective period for prophylactic antibiotic action was challenged in a prospective, controlled and randomized study featuring a simplified method for assessing the degree of contamination in the operative field during colorectal surgery. The 226 patients were given 1 g metronidazole IV on induction of anaesthesia and 12 h postoperatively. Following standardized saline irrigation of the abdominal cavity, a uriculture dipslide was dipped in the residual fluid just before abdominal closure. The dipslide was incubated for 18 h, and colony counts of coliforms and Staphylococcus aureus were made. The number of colony-forming units (CFU) was classified as 0, 1–4 or ⩾ 5 (n = 123, 33 and 70). The patients with CFU ⩾ 5 were randomized to receive cefuroxime (1·5 g IV/8 h for 2 days) or no more antibiotics. In the patients given only metronidazole, the incidence of postoperative infections rose with the colony counts (5·7, 9·1 and 41·2 per cent with CFU 0, 1–4 and ⩾ 5). Addition of cefuroxime reduced the 41·2 per cent infection rate to 8·3 per cent (P = 0·003). The method thus identified a high-risk group in which a short postoperative course of cefuroxime significantly lowered the rate of sepsis.
In vitro binding and in vivo localization in colorectal cancer of a high affinity monoclonal antibody to carcinoembryonic antigen
Authors: Armitage N C , Perkins A C , Durrant L G , Ellis I O , Ballantyne K C , Harrison R C , Riley A M L , Robins R A , Wastie M L , Hardcastle J D
Published: March 2007

A monoclonal antibody to carcinoembryonic antigen (CEA) (C46) was tested for its binding properties to colorectal cancer cells in vitro and for its localization in patients with primary colorectal cancer. Strong binding was found to disaggregated primary colorectal cancer cells, with a median of 66 per cent of the cells in the tumour gate binding the antibody. There was a median binding ratio of 8·6:1 compared with normal immunoglobulin. The pattern of immunohistological staining was typical of that for an antibody to CEA. All seven patients with primary colorectal cancer imaged pre-operatively using 111In-labelled C46 gave positive images. The median tumour:non-tumour antibody uptake ratio from resected specimens (n = 8) was 5·8:1. (1·7–7·6:1). Eight of 11 sites of secondary colorectal cancer gave positive images. The high affinity and good tumour localization of C46 have improved clinical imaging and increase the possibilities for targetting of antitumour agents.
Effect of perioperative blood transfusion on recurrence of colorectal cancer
Authors: Parrott N R , Lennard T W J , Taylor R M R , Proud G , Shenton B K , Johnston I D A
Published: March 2007

The aim of the present study was to examine the outcome of 517 patients undergoing curative surgery for colonic and rectal cancer, and to compare the recurrence and mortality rates in transfused and non-transfused groups of patients. The two groups were evenly matched for age, sex, Dukes' stage and histological differentiation. There were significantly more rectal tumours in the transfused group (P < 0·01), but the distribution of colonic lesions did not differ. Life table analysis revealed that the transfused patients had a 20 per cent greater probability of recurrence at 5 years (P < 0·005) and there were 16 per cent more cancer related deaths (P < 0·01). Even when all rectal cancers were excluded, a similar trend was seen for the colonic lesions: a 24 per cent greater probability of recurrence at 5 years (P < 0·025) and 15 per cent more cancer related deaths (P < 0·02). We conclude that blood transfusion may be associated with increased mortality and recurrence in patients undergoing curative surgery for colorectal cancer.
Surgical treatment of perineal hidradenitis suppurativa with special reference to recognition of the perianal form
Authors: Brown S C W , Kazzazi N , Lord P H
Published: March 2007

Severe cases of hidradenitis suppurativa affecting the perineum and gluteal regions may be treated successfully by ‘deroofing’ the sinus and fistulae tracts. These lie in the dermis and are partly epithelialized by cells from involved hair follicles and disrupted sweat glands. Careful preservation of the floor of the tracts leads to re-epithelialization with disease-free skin. More radical surgery is unnecessary and the problems of covering widely excised areas in this heavily contaminated region are avoided. By spreading the treatment over several operating sessions and hospital admissions, postoperative discomfort and in-patient nursing requirements are minimized. The technique of deroofing is described and the treatment of three severe cases is discussed. One patient illustrated the recognized complication of malignant change occurring in long-standing untreated disease. A fourth case illustrates the difficulties in diagnosing perianal hidradenitis suppurativa and literature cited suggests it to be a more common condition than once thought and a diagnosis frequently missed.
Depression and social stress among patients with benign breast disease
Authors: Hughes Jennifer E , Royle G T , Buchanan R , Taylor I
Published: March 2007

One hundred and forty women referred to the Southampton breast clinic had a psychiatric interview at home, before their first clinic attendance. The 107 subsequently diagnosed as having benign breast disease had a high rate of depressive symptomatology in comparison with women in published surveys of the general population. In the year before referral, 25 (23 per cent) had had definite depression and 19 (18 per cent) had had borderline depression: at the time of interview 9 (8 per cent) had major depression and 22 (21 per cent) had minor depression. Depression in these patients was associated with recent life events and social difficulties. Mood disturbance and psychosocial stress may lead to medical consultation about benign breast disease, or even contribute to its development. Severe depression was less common in the 33 patients who turned out to have breast cancer, though more of them had minor depression, and they reported fewer recent life events.
Increased dietary calcium and small bowel resection have opposite effects on colonic cell turnover
Authors: Appleton G V N , Bristol J B , Williamson R C N
Published: March 2007

Oral supplements of calcium reduce the mitogenic effects of fatty acids and bile acids on large bowel mucosa. The cytokinetic effects of intraluminal calcium were tested in normal and adapting colonic epithelium. Male Sprague–Dawley rats (n = 60) weighing 356·7 ± 24·9 g were submitted to either an 80 per cent jejuno-ileal resection or simple transection and resuture of the jejunum. Within each group, half the animals had 24 g/l calcium lactate added to the drinking water. Seven weeks postoperatively crypt cell production rate (CCPR) was determined in the lower descending colon. Among controls with transection CCPR was 4·49 cells crypt−1 h−1; calcium supplements reduced this figure by 26 per cent (P < 0·05). As expected jejuno-ileal resection increased CCPR (by 51–61 per cent), but again calcium reduced this response by 31 per cent (P < 0·02). Increased dietary levels of calcium thus inhibit colonic cell turnover and blunt the adaptive response to massive enterectomy, conceivably by binding tropic factors such as bile acids.
Rising detection rate of symptomatic Dukes' A colorectal cancers
Authors: Vellacott K D , Smith J H F , Mortensen N J McC
Published: March 2007

All 197 patients admitted to the Bristol Royal Infirmary during the 16 year period 1970--1985, and diagnosed as having Dukes' A colorectal cancers, were studied. The numbers diagnosed per year by 1985 were 20, compared with 9·4 per year for the period 1970–1979. This represented an increase in the percentage of Dukes' A cancers of all the colorectal cancers diagnosed from 8·3 to 15 per cent. The increase was largely due to better quality double contrast barium enemas and increased use of flexible sigmoidoscopy and colonoscopy. The operative mortality dropped from 17 to 3 per cent in the last 6 year period. The recurrence rate was 9·6 per cent of which 1 per cent were locally resected and crude 5 year survival was 90·4 per cent up to 1981.
Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury
Authors: Browning G G P , Varma J S , Smith A N , Small W P , Duncan W
Published: March 2007

Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n = 7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum.
Nipple preservation during mastectomy
Authors: Kissin M W , Kark A E
Published: March 2007

In a retrospective study of 100 patients with operable breast cancer, microscopic involvement of the nipple-–areola complex was found in 16 cases. Each of these 16 cases occurred in patients with centrally situated tumours. In contrast, nipple involvement did not occur with peripherally situated tumours lying >2 cm outside the areolar margin (P>10−6, Fisher's exact test). Nipple involvement was more likely in patients with ≥ 4 positive axillary nodes (P >0·01, χ2 test). From this study it appears that nipple preservation may be undertaken during mastectomy for small peripheral tumours, provided the nipple is clinically normal, and frozen section analysis of the sub-nipple area is shown to be free from tumour invasion. These criteria for nipple preservation were satisfied in 20 patients out of a prospective series of 60. In this group, nipple preservation on the skin flap improved the cosmetic result of breast reconstruction in 35 per cent, and facilitated skin closure in 20 per cent. After a mean follow-up period of 50·4 months, nipple preservation was not associated with any significant excess of local recurrences.
Peritoneal closure after lateral paramedian incision
Authors: Gilbert J M , Ellis H , Foweraker Sharon
Published: March 2007

The lateral paramedian incision has been advocated as the strongest incision for abdominal surgery. We have evaluated this incision and tested the necessity for closing the deep peritoneal layer by a prospective randomized trial. All 206 patients undergoing laparotomy in the Surgical Unit in 1984, both elective and emergency cases, were included. In patients undergoing laparotomy through unscarred tissue, a lateral paramedian incision was performed and they were randomized to have either the peritoneum closed (n = 77) or left open (n = 75). Patients in whom the laparotomy was performed through a previous incision (n = 51) and those in whom the abdomen had to be opened urgently (n = 3) were excluded from the trial but studied separately (n = 54). The rectus sheath was closed with monofilament nylon in all cases. Patients were assessed for wound integrity during the immediate postoperative period and at 1, 3, 6 and 12 months after operation. So far the patients have been followed up for between 1 and 2 years and follow-up is continuing as in some cases incisional hernia may not be detected until several years after operation. There have been no cases of burst abdomen. No incisional hernias have developed in patients in whom a lateral paramedian incision was performed and the peritoneum was closed, and one incisional hernia has occurred in the patients in whom the peritoneum was left open. Seven incisional hernias have occurred in patients excluded from the trial of the lateral paramedian incision (13 per cent). We conclude that the lateral paramedian incision successfully abolishes the burst abdomen and that incisional hernia is rare. It is not necessary to close the peritoneum with this incision.
Indium-111-labelled leucocytes in the diagnosis of abdominal abscess
Authors: Goldman M , Ambrose N S , Drolc Z , Hawker R J , McCollum Charles
Published: March 2007

The extensive morbidity and mortality of intra-abdominal abscess is mainly due to the delay in a diagnosis. The diagnostic accuracy of 111In-labelled mixed leucocytes with gamma imaging has been investigated in 100 consecutive patients including 34 following surgery and 36 with inflammatory bowel disease. White cell scans were performed 24 h following infection of autologous 111In-labelled leucocytes and were compared with clinical outcome where abscess was only diagnosed when pus either discharged or was drained at operation. Gamma images detected 28 of the 30 abscesses with no false positives giving 93 per cent sensitivity and 100 per cent specificity. Loculi of pus were identified in 11 of the 36 patients with inflammatory bowel disease with no errors in interpretation. Inflammation was reported in 15 of the remaining 25 patients with known but not necessarily active inflammatory bowel disease. 111In-labelled leucocyte imaging provides a rapid, safe and precise method for detecting intra-abdominal abscess even in the presence of inflammatory bowel disease.
Primary lymphoma of the breast
Authors: Dixon J M , Lumsden A B , Krajewski A , Elton R A , Anderson T J
Published: March 2007

Fifteen patients with primary lymphoma of breast are reported from a 30-year review. Eight of the patients were diagnosed in the last 5 years of this review, suggesting either an increase in the incidence or an increasing awareness of this condition. The age range was from 17 to 77 years. All patients presented with a breast mass and nine had histologically proven axillary node involvement. One patient had Hodgkin's disease and the remainder were non-Hodgkin's lymphoma. Treatment was by a combination of surgery, radiotherapy and chemotherapy. During follow-up which varied from 4 to 20 years (median 8 years) three patients developed metachronous involvement of the opposite breast and three died from their disease. Prognosis was related to tumour histology and stage of disease. The three who died all had high grade centroblastic lymphoma, the three largest tumours and nodal involvement. Five and ten-year survivals were 85 per cent and 73 per cent respectively, better than the survival of patients for either other non-disseminated extranodal lymphomas or breast cancer.
Predictive power of progesterone receptor status in early breast carcinoma
Authors: Sutton R , Campbell M , Cooke T , Nicholson R , Griffiths K , Taylor I
Published: March 2007

Progesterone receptor status (PgR) and oestrogen receptor status (ER) were examined in 332 women with stage 1–11 breast carcinoma treated at a single centre either by simple mastectomy with (n=283) or without (n=6) axillary clearance, or by segmental mastectomy with (n=18) or without (n=25) axillary clearance and radiotherapy; median follow-up time was 40 (range 10–60) months. Neither the concentration nor the presence of PgR related to either disease-free interval or survival. However both the presence and the concentration of ER were found to be associated with a longer disease-free interval amongst patients with stage II tumours (P <0·01). From this study it appears that progesterone receptor status does not predict outcome in early breast carcinoma.
Choledochoduodenostomy for intrabiliary rupture of hydatid cysts of liver
Authors: Alper A , Ariogul O , Emre A , Uras A , Ökten A
Published: March 2007

Frank intrabiliary rupture is an important complication of liver hydatid cysts and its incidence is between 5 and 25 per cent. The main principles of management are the surgical treatment of the cyst with removal of all cystic elements and drainage of the biliary tree. Accurate pre- and intra-operative diagnosis and permanent drainage of the biliary tree by a wide choledochoduodenostomy are important to reduce morbidity and mortality. In this report 28 cases of frank intrabiliary rupture of hydatid cysts treated by choledochoduodenostomy are presented.
Early diagnosis of femorodistal graft stenoses
Authors: Wolfe J H N , Lea Thomas M , Jamieson C W , Browse N L , Burnand K G , Rutt D L
Published: March 2007

Detection and early correction of stenoses following femorodistal bypass grafting may prevent graft occlusion. We studied 43 grafts (36 saphenous vein and 7 human umbilical vein) prospectively by peroperative angiography and then by clinical assessment, post-exercise Doppler ankle pressures and digital subtraction angiography at 1 week, 3 months, 6 months and 1 year. There were 11 grafts inserted for critical ischaemia, 16 for rest pain and 16 for disabling claudication. Four patients died within the year with five patent grafts and these were excluded from the final results. Eight grafts failed during the first year; four within 1 month and a further four subsequently, with no warning alteration of symptoms, ankle Doppler pressure or digital subtraction angiography. Four additional grafts were jeopardized by symptomatic stenoses. Six grafts developed an asymptomatic stenosis of > 50 per cent without a change in exercising ankle Doppler pressure. Three symptomatic stenoses were successfully revised but the fourth occluded on conservative management. Three asymptomatic stenoses have also been successfully revised and three have been treated conservatively. Close surveillance of femorodistal grafts is justified by this study but a deterioration in ankle brachial Doppler index was only useful in the patients with recurrent symptoms and was unable to detect half the stenoses of > 50 per cent. The detection of these by intravenous digital subtraction angiography might help to avoid graft failure.
Indicators of depressed fibrinolytic activity in pre-operative prediction of deep venous thrombosis
Authors: Sue-Ling H M , Johnston D , Verheijen J H , Kluft C , Philips P R , Davies J A
Published: March 2007

Euglobulin lysis time (ELT), tissue plasminogen activator (tPA), and the fast-acting inhibitor of tPA, were measured pre-operatively in 128 patients who underwent elective major abdominal surgery. Deep venous thrombosis (DVT) was detected by 125I-labelled fibrinogen scan in 37 patients (29 per cent) after operation. Pre-operatively, there was diminished euglobulin lysis activity (332 ± 197 versus 255 ± 156 min, mean ± s.d.; P <0·025), and tissue plasminogen activator activity (4·2 ± 9·9 versus 7·7 ± 14·3 milliunits/ml, mean ± s.d.; P = 0·094) in patients who subsequently developed postoperative DVT compared with those who did not. There was no significant difference between the two groups in the level of inhibition of tissue plasminogen activator (160·6 ± 75·4 per cent versus 152·5 ± 77·5 per cent, mean ± s.d.; n = 47). Stepwise logistic discriminant analysis of the data obtained pre-operatively showed that tissue plasminogen activator, a more specific measure of fibrinolytic activity, was a weaker predictor of DVT than euglobulin lysis time. The results confirm other observations which indicate that lowered fibrinolytic activity is a risk factor for postoperative DVT. In addition, they suggest that this is not due entirely to low levels of activity of tissue plasminogen activator in plasma.
Major causes of intestinal obstruction in Libya
Authors: Kuruvilla M J , Chhallani C R , Rajagopal A K , Salem Rakas F
Published: March 2007

The object of this study is to focus attention on the causes of intestinal obstruction in Libya. In this study, spread over 30 months and involving 114 patients, the most common cause was the entrapment of bowel in an external hernia. Postoperative adhesions accounted for obstruction in a third of our patients, and 59 per cent of them followed appendicectomy. Biliary lithiasis is the most common surgical disease in Libya, yet there was only one instance of gallstone ileus in this series. Sigmoid volvulus and intestinal lymphoma were also rare, and tubercular stricture and Crohn's disease were remarkable by their absence. There were no cases of idiopathic intussusception during or immediately following Ramadan.
Splenic trauma and overwhelming postsplenectomy infection
Authors: Di Cataldo A , Puleo S , Li Destri G , Racalbuto A , Trombatore G , Latteri F , Rodolico G
Published: March 2007

This review examines the incidence and implications of overwhelming infection in patients who have undergone splenectomy following trauma.
Splenectomy for massive splenomegaly
Authors: Bickerstaff K I , Morris P J
Published: March 2007

Splenectomy was performed on 47 patients with massive splenomegaly (spleen weight > 1·5 kg). With one exception, all patients had a haematological malignancy. The indications for splenectomy were for the diagnosis of unknown cause (n = 5), for the relief of pain (n = 8). as the initial treatment of hairy cell or prolymphocytic leukaemia (n = 8), and for the correction of a haematological cytopenia (n = 26). Splenectomy was completely successful in relieving pain and in establishing a diagnosis, and provided effective palliation in patients with hairy cell and prolymphocytic leukaemia. An immediate correction of a haematological cytopenia was achieved in 24 patients, and the correction was maintained for over 1 year in 11 patients. There were no postoperative deaths and morbidity was acceptably low. We conclude that patients with massive splenomegaly can derive considerable benefit from splenectomy and that massive splenomegaly should not be regarded as a contra-indication to splenectomy.
Management of colovesical fistula
Authors: Rao P N , Knox R , Barnard R J , Schofield P F
Published: March 2007

The clinical presentation and management of 24 patients treated for colovesical fistula were reviewed. It is concluded that an aggressive investigative approach in the management of patients with suspected colovesical fistula is rewarding. Cystoscopy and barium enema appear to be the most useful investigative tools. Once found the fistulae should be managed surgically. Radical excision of the sigmoid colon with primary anastomosis is the treatment of choice and is accompanied by no mortality and a very low complication rate.
New technique for pancreaticojejunostomy using a biological adhesive
Authors: Tashiro S , Murata E , Hiraoka T , Nakakuma K , Watanabe E , Miyauchi Y
Published: March 2007

A new technique of pancreaticojejunostomy using a fibrin glue biological adhesive system (BAS) after pancreaticoduodenectomy is reported. Pancreaticojejunostomy was performed on 112 patients between 1971 and 1985. Forty-two of the patients received BAS application (Group I), but the remaining seventy did not (Group II). To evaluate more precisely the effectiveness of BAS, 22 patients in Group I (Group I–ST) and 26 patients in Group II (Group II–ST) who were operated upon by the same surgeon during the same period were reviewed retrospectively. The selection of patients for the use of BAS was randomized. In Group I–ST, one patient had a minor leak; no major leaks or operative deaths occurred. Two of the twenty-six patients in Group II–ST had minor leaks and one patient had a major leak causing death. This new technique for pancreaticojejunostomy using a biological adhesive system may be useful for preventing anastomotic leaks, especially in a patient with a normal pancreas.
Prediction of postoperative pulmonary complications in oesophagogastric cancer surgery
Authors: Fan S T , Lau W Y , Yip W C , Poon G P , Yeung C , Lam W K , Wong K K
Published: March 2007

In a series of 102 patients with cancer of the oesophagus or gastric cardia in whom surgery had been performed, postoperative respiratory infection, respiratory failure and mortality secondary to respiratory complication occurred in 55·8, 34·3 and 21·6 per cent respectively. The incidence of complications correlated well with the pre-operative peak expiratory flow rate when it was <65 per cent of the predicted normal value. However, the predictive ability of peak expiratory flow rate was much less than the patient's age, pre-operative serum albumin level, pre-operative Pa,O2 and number of surgical wounds when all risk factors were considered. Significantly more complications occurred when the patient was >65 years old, Pa,O2 was <10 kPa, serum albumin was <39 g/l and when the operation required three incisions. These findings may serve as guidelines for identification of high-risk patients in the future.
Role of urokinase in colorectal neoplasia
Authors: Gelister J S K , Jass J R , Mahmoud M , Gaffney P J , Boulos P B
Published: March 2007

The biofunctional activity of the plasminogen activators urokinase and tissue plasminogen activator has been measured in extracts from 50 colorectal carcinomas and 21 adenomas using a bioimmunoassay. Compared with control mucosa urokinase activity was significantly-elevated in adenomas (P<0.001) and carcinomas, levels being significantly higher in carcinomas (P<0.05). In contrast tissue plasminogen activator activity was reduced in adenomas (P<0.01) and carcinomas, levels being significantly lower in carcinomas (P<0.01). Although enzyme activity did not relate to Dukes' stage or histological grade urokinase activity was higher in carcinomas with venous invasion (n = 17, P<0.05), in those with moderate or extensive local spread (n = 27, P<0.05) and in cases where a palliative resection only was feasible because of advanced disease (n = 8, P<0.05). Urokinase has been implicated in tissue degradation as well as fibrinolysis and may play a role in tumour invasion and metastasis in human colorectal neoplasia.
Primary gastric lymphoma
Authors: Hockey M S , Powell Jean , Crocker J , Fielding J W L
Published: March 2007

This is a population-based review of 153 cases of primary gastric lymphoma. Sixty-seven (43 per cent) were histologically reviewed using the Kiel classification. There were no significant differences between reviewed and unreviewed cases. Ninety-seven per cent of all cases were of the non-Hodgkin's type. The annual incidence was constant at 1.2 per cent of gastric malignancies. The mean age was 60 years and the male to female ratio 1:8. Presenting symptoms were similar to those of gastric cancer. Twenty-one per cent had a palpable mass but one-third of these were amenable to a potentially curative resection. Some 66 per cent were resectable and 58 per cent had a macroscopic clearance of tumour. TNM stage and absolute tumour size were significant prognostic factors (P<0.005 and P<0.05 respectively) but the Kiel classification was not. The overall 5 year survival was 24 per cent. Apart from 10 patients whose only anti-tumour treatment was radiotherapy (5 year survival 36.9 per cent) no patient who did not have curative surgery survived 5 years. The 5 year survival for curative resection was 34 per cent and for curative resection plus radiotherapy was 43.5 per cent (45 and 73.4 per cent for the node negative cases respectively). A laparotomy is essential; ‘curative’ surgery possibly with adjuvant radiotherapy offers the best hope for cure.
Early results of low dose intra-arterial streptokinase therapy in acute and subacute lower limb arterial ischaemia
Authors: Earnshaw J J , Gregson R H S , Makin G S , Hopkinson B R
Published: March 2007

Thirty-two patients with acute and subacute limb-threatening peripheral arterial ischaemia were treated with low dose intra-arterial streptol ase infusions. The mean duration of infusion was 38 h. Six patients developed pericatheter thrombosis and two had distal embolization of fragments of thrombus but in all cases these responded to repositioning the catheter and continuing the infusion. Five patients developed groin haematomata and in three of these there was evidence of a systemic fibrinolytic effect from the streptokinase with plasma fibrinogen reduced below 1 g/l. The most serious complication was perforation of the popliteal and tibial arteries which occurred on two occasions and required cessation of the infusion. Twenty-two patients (69 per cent) achieved limb salvage, eight (25 per cent) suffered a major amputation and two (6 per cent) died. The outcome was not related to the site, nature or duration of the arterial occlusion but patients with loss of sensation or paralysis of the affected limb were significantly less likely to obtain limb salvage (P = 0.001). For occlusions greater than 30 cm in length a new technique was used where the thrombus was lysed from distal to proximal in short lengths by gradual catheter withdrawal. This was successful in five out of six cases. Low dose intra-arterial streptokinase has been confirmed as an effective, relatively safe method of treatment in recent arterial ischaemia and can be recommended in situations where the results of surgery may not be favourable. In particular, patients with arterial thromboses and no distal run-off, distal and late arterial emboli, thrombosed popliteal aneurysms and patients after a failed embolectomy, have all been shown to respond to thrombolytic therapy with intra-arterial streptokinase.
Effect of defibrinogenation on the early patency rate of experimental small calibre arterial grafts
Authors: Mahir M S , Hynd J W , Flute P T , Dormandy J A
Published: March 2007

The effect of defibrinogenation with Arvin1 was studied in a new animal model of early thrombosis of a 3 mm diameter polytetrafluoroethylene (PTFE) graft with a poor run-off. Fifteen control animals were compared with fourteen animals treated with subcutaneous Arvin 20 units kg−1 body weight day−1, starting 2 days before surgery and continuing for 2 days postoperatively. The peroperative fibrinogen level in the controls was 2·8 ± 0·9 g l−1 compared with 0·4 ± 0·3 g l−1 in the treated group. There was no significant difference in the peroperative or postoperative platelet count or haematocrit value between the two groups. Plasma viscosity and whole blood viscosity (at a low shear rate of 0·7 s−1) were significantly less during and after surgery in the defibrinogenated group. The degree of defibrinogenation in these animals produced no problems with haemostasis during surgery or in the postoperative period. The cumulative patency rates of the controls at 24 h, 48 h, and 4 days were 43 per cent, 28 per cent and 28 per cent compared with 86 per cent (P<0·05), 73 per cent (P<0·05) and 73 per cent (P<0·05) respectively in the defibrinogenated group. In this model of a narrow PTFE graft with a poor run-off, defibrinogenation was a safe and effective method of improving early patency of small calibre arterial grafts.
Anorectal temperature sensation: A comparison of normal and incontinent patients
Authors: Miller R , Bartolo D C C , Cervero F , McC Mortensen N J
Published: March 2007

In the skin, temperature sensation plays an important role in discriminating between gas, liquid and solid. To elucidate the role of temperature sensation in idiopathic faecal incontinence we studied the minimum detectable temperature change in the lower, middle and upper zones of the anal canal anal rectum in 33 normal subjects, and 20 patients with idiopathic faecal incontinence. A water perfused thermode was used to vary anorectal temperature from 37°C down to 32.5°C and up to 41.5°C. The temperature change was reported by the patient as the thermode temperature varied from 37°C to each extreme and on return to base line. The anal canal in the control group was highly sensitive to temperature change, the lower rectum was significantly less sensitive (P<0.0001). At each level in the anal canal and lower rectum the incontinent group were significantly less sensitive than their controls (P<0.005). The mid-rectum had no appreciable sensation in either group. We consider that this sensory deficit may be an important factor in idiopathic faecal incontinence.
Five year results of a randomized trial of adjuvant 5-fluorouracil and levamisole in colorectal cancer
Authors: Windle R , Bell P R F , Shaw D
Published: March 2007

Following curative surgery for colorectal cancer 141 patients were randomized to receive a 6 month course of 5-fluorouracil (5FU) with or without postoperative levamisole or supportive treatment only. The patients have been followed up for a minimum of 5 years and 52 per cent of patients in the control group, 44 per cent of the 5FU group and 32 per cent of the 5FU/levamisole group have died of tumour recurrence. This represents a significant survival advantage in the patients receiving levamisole, even when other patient and tumour factors are allowed for.
Physiological study of pruritus ani
Authors: Allan A , Ambrose N S , Silverman S , Keighley M R B
Published: March 2007

Physiological abnormalities in the anorectum of 34 patients with pruritus ani, and 20 age and sex matched controls were assessed. A saline infusion (1500 ml) test showed that leakage started after infusion of 600 ml in patients with pruritus ani compared with 1300 ml in controls (median values: P<0·001). There was an inverse relationship between the severity of the symptoms of pruritus ani and the volume of first leakage on the saline infusion test P<0·02. Studies to assess anal sphincter function, rectal sensation to balloon distension, rectal compliance, and perineal descent did not show any significant differences between pruritic patients and controls. However, pruritic patients without co-existing anal pathology had a significantly greater fall of anal pressure when a rectal balloon was inflated (57 per cent) when compared with controls (40 per cent) P<0·05.
Mechanical bowel preparation for colonic resection and anastomosis
Authors: Irving A D , Scrimgeour D
Published: March 2007

In a series of 72 consecutive elective and emergency colectomies with primary anastomosis, all pre- and perioperative mechanical preparation of the bowel was omitted and the patient covered only by a single peroperative intravenous dose of cefuroxime and metronidazole. No anastomotic dehiscence was clinically apparent and wound infection was noted in only 8.3 per cent of patients.
Diseases of the breast in Nigeria
Authors: Oluwole S F , Fadiran O A , Odesanmi W O
Published: March 2007

For the purpose of defining the distribution of breast diseases in Nigeria, a review of 671 cases seen in Ife over a 10 year period was undertaken. Twenty-six (3·9 per cent) of the patients were males. The frequency of breast diseases in this population was fibro-adenoma, 48 per cent; carcinoma, 21 per cent; breast abscess, 8·6 per cent; fibrocystic disease, 5·5 per cent; sclerosing adenosis. 5·4 per cent and gynaecomastia, 2·7 per cent. The other breast lesions were the same type of disease as documented in white patients. The most striking difference was the relatively high incidence of fibro-adenoma, especially in nulliparous adolescent females, while carcinoma and fibrocystic disease were fewer than expected. Breast carcinoma presented a decade earlier in Nigerian women and was usually advanced at presentation and of aggressive histological type. Of the breast carcinomas, 4·3 per cent were associated with pregnancy.
Carcinoma of the breast in women aged 35 or less
Authors: Backhouse C M , Lloyd-Davies E R V , Shousha S , Burn J I
Published: March 2007

Breast cancer in young women is an unusual problem which has acquired a poor prognostic reputation in the eyes of many clinicians. We have reviewed all 59 patients with malignant disease of the breast aged 35 years or less managed in the Breast Unit at Charing Cross Hospital between 1974 and 1984. After exclusion of 5 patients (2 with lymphomas, I with fibrosarcoma, and 2 with inadequate available data), 54 patients were available for analysis. More than 3 months delay from first symptoms to presentation was seen in 45 per cent and 36 per cent were considered ‘late’ at initial clinical staging (T3–4, N2–3 or M1). Nevertheless, a 5-year survival of 66 per cent was seen among the 29 patients with sufficient length of follow-up. Distribution among the main histological types was very similar to that found in a consecutive series of 264 breast cancers of all age groups in our unit. We conclude that breast carcinomas in young patients do not significantly differ in type or behaviour from other age groups and that with treatment similar to other premenopausal patients, a prognosis comparable to older patients can be expected.
Prospective randomized trial comparing two injection techniques for sclerosing oesophageal varices: Over-tube and free-hand
Authors: Kitano S , Koyanagi N , Iso Y , Iwanaga T , Higashi H , Sugimachi K
Published: March 2007

The safety, efficacy and complications of two techniques of endoscopic injection sclerotherapy were examined in 102 consecutive patients, using either a totally transparent over-tube or the free-hand technique. The choice of treatment was at random. There was a significantly higher control of variceal bleeding when the over-tube technique was used (100 per cent versus 77 per cent, P<0·05). The frequency of re-bleeding before the eradication of oesophageal varices was significantly less in the over-tube group than in the free-hand group (P<0·01), although all re-bleedings were well controlled with additional injections of 5 per cent ethanolamine oleate. There was no significant difference between the two techniques with regard to the frequency of endoscopic injection sclerotherapy for eradication of oesophageal varices. The over-tube technique is safer than the free-hand technique and takes less time to accomplish; at the initial session of treatment, time and bleeding during these techniques were 11·5 ± 2·3 mm (mean ± s.d.) and 7·3 ± 5·9 ml in the over-tube technique, and 20·4 ± 4·1 min and 45·1 ± 30·0 ml in the freehand technique (P<0·001, in both time and bleeding).
Acute idiopathic scrotal oedema: Incidence, manifestations and aetiology
Authors: Najmaldin A , Burge D M
Published: March 2007

Twenty-four children with a total of 31 episodes of acute idiopathic scrotal oedema (AISO) were assessed during a 5 year period. AISO accounted for 30 per cent of all admissions with acute scrotal pathology in this period and was the final diagnosis in 69 per cent of cases in those presenting under the age of 10 years. Although presentation was with unilateral (48 per cent) or bilateral (52 per cent) AISO, considerable overlap between these two groups occurred. Five patients (21 per cent) had recurrent attacks. Fourteen boys (60 per cent) had a history of aliergy or had allergic manifestations at presentation compared with an incidence of allergy of 28 per cent in 42 controls (P < 0.05). AISO is the commonest cause of the ‘acute scrotum’ in boys under the age of 10 years and is probably allergic in origin.
Model of TPN-associated hepatobiliary dysfunction in the young pig
Authors: Truskett P G , Shi E C P , Rose Margaret , Sharp P A , Ham J M
Published: March 2007

Gallbladder ‘sludge’ and cholestasis are two common complications associated with total parenteral nutrition (TPN), but the aetiology of each is uncertain. An animal model has been developed in the young pig which demonstrates these two complications. Five female piglets, of Landrace Large White Cross variety weighing 4.5–5.9 kg, received nutritional support for 2 weeks with a continuous infusion of TPN solution at a dose of 150 kcal kg−1 day−1. The solution was 35 per cent dextrose, 5 per cent L-amino acids with conventional electrolyte, mineral and vitamin additives. No lipid was used in the solution. Five weight-matched animals were used as controls. All animals in the TPN group developed ‘sludge’ in their gallbladders, decreased basal bile flow, decreased bile salt excretion and a diminished response to bile salt stimulated bile flow, as compared with controls. There was no abnormality in routine liver function tests or liver histology. It is concluded that TPN therapy in this animal model is associated with the appearance of gallbladder ‘sludge’, and cholestasis as demonstrated by direct bile flow studies. It is suggested that this bile flow abnormality is due to a decrease in bile salt dependent and bile salt independent fractions of canalicular bile flow. The model provides the opportunity to investigate TPN related hepatobiliary dysfunction in an animal that has similar liver function to man and comparable mutritional requirements.
Results of proctocolectomy for Crohn's disease
Authors: Scammell B E , Andrews H , Allan R N , Alexander-Williams J , Keighley M R B
Published: March 2007

Seventy-four patients have had a one-stage proctocolectomy for the management of Crohn's disease. Indications for operation were: acute colitis 28 percent, chronic colitis 39 per cent, perianal disease 13 per cent, proctitis and perianal disease 8 per cent, bleeding 5 per cent, coexisting colonic malignancy 7 per cent. There were two hospital deaths (2·7 per cent), both associated with sepsis. Late deaths (n = 13) were most commonly associated with reoperations for recurrent disease (n = 3), cardiovascular disease (n = 4) and colorectal carcinoma (n = 1). Postoperative complications were principally associated with sepsis. Cumulative reoperation rates at 5 and 10 years were 19 and 24 per cent respectively. Recurrence was unrelated to the age of the patients, the duration of disease, or the presence of ileal disease at the time of colectomy.