bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation of biliary tract disease by ultrasonic B-mode scanning
Authors: Addison N V , Follows O J , Weedon M R
Published: March 2007

To establish the value of diagnostic ultrasound (sonar) in the diagnosis of bilitary tract disease, 140 patients were scanned and also had a plain film of the biliary tract. of these, 105 had contrast radiography and 123 were subjected to laparotomy. The results obtained suggest that in the absence of jaundice, sonar compares well with oral cholecystography in demonstrating the gallbladder, but is not as good as intravenous cholangiography in showing the duct system. In the presence of jaundice, however, sonar is considered the imaging investigation of choice.
A prolonged course of cyclophosphamide as an adjunct to mastectomy in the primary treatment of breast carcinoma
Authors: Donovan I A , Powell Jean , Waterhouse J A H , Morrissey D M
Published: March 2007

Cyclophosphamide given after mastectomy for 4–6 months to a consecutive series of patients seen in one surgical practice in the years 1964 and 1965 significantly improved the 10-year survival rate of the treated patients as compared with the patients seen consecutively in the same surgical practice in the years 1957–63. Staging showed that the improvement was due to a significant increase in the survival rate in patients with histologically negative axillary nodes (P < 0·01). There was no significant difference in survival in the node positive or advanced disease groups.
Fibrinolytic activator in the endothelium of the veins of the lower limb
Authors: Nicolaides A N , Clark C T , Thomas R D , Lewis J D
Published: March 2007

The local fibrinolytic activity of the femoral, popliteal and soleal veins has been studied using a histochemical technique. The results suggest that the fibrinolytic activity in the soleal veins may be low when compared with that in the femoral and popliteal veins. This may be an aetiological factor responsible for the high incidence of thrombi occurring in the soleal veins.
Perforated jejunal ulcer and heterotopic gastric mucosa
Authors: Isbister William H , Weedon David
Published: March 2007

A case of perforated jejunal ulcer in a 16-year-old woman is detailed. The ulcer was associated with nearby polypoid heterotopic gastric mucosa. This is the first report of such an association.
Personal experience in the surgical management of carcinoma of the stomach
Authors: Costello C B , Taylor T V , Torrance Bruce
Published: March 2007

A consecutive series of 226 cases of carcinoma of the stomach has been studied. The policy of treatment has been consistent throughout and laparotomy was performed in 96.5 per cent of cases. The follow-up has been studied with regard to duration of symptoms, location and degree of spread of the tumour and different forms of operative treatment. Although Billroth I gastrectomy gave a 32 per cent 5-year survival rate for the less advanced tumours the overall survival remains, as in other series, depressingly low (8.5 per cent). Education of the public to present early would not appear to help the situation as survival was directly proportional to the duration of symptoms.
Protein turnover in patients before and after elective orthopaedic operations
Authors: Crane C W , Picou D , Smith R , Waterlow J C
Published: March 2007

Whole body protein turnover was measured in 11 patients before and after elective orthopaedic operations by giving 15N-glycine orally every 4 hours for 32 hours. The patients were maintained throughout on a constant protein intake. In 2 control subjects a comparison was made between intermittent dosage and continuous infusion of 15N-giycinefor the estimation of total protein turnover. With intermittent dosage the 15N abundance in urinary urea reached a constant level after about 24 hours. Rates of total protein synthesis and breakdown were calculated from the 15N abundance at the plateau level. After surgery there was a moderate increase in urinary N output. The apparent N balance (intake—urinary N) was −0·52 ± 1.31 g/d (mean ± s.d.) before operation and −7·51 ± 4.5 g/d after operation. The rate of protein synthesis fell from 3·83 ± 0·73g kg−1 d−1 before operation to 2·94 ± 0·83 g kg−1 d−1 after operation. This difference is statistically significant (0·05 > P > 0·01). There was no significant change in the rate of protein breakdown. The possibility remains that a block in protein synthesis, probably mainly in muscle, may be partly responsible for the so-called atabolicloss of nitrogen after injury, but this has not been proved.
Platelet function tests during major operation for gastro-intestinal carcinoma
Authors: Kokores J A , Economopoulos T C , Alexopoulos C , Pyrovolakis J , Papayannis A G
Published: March 2007

Platelet function tests were performed on 15 patients undergoing major operation preoperatively, during anaesthesia and 30 minutes and 3 hours after the beginning of operation. It was found that during anaesthesia platelet retention in a glass bead column and platelet aggregation were slightly reduced. During operation the bleeding time and the delay period of the collagen-induced aggregation were progressively prolonged, and the aggregation induced by ADP at a final concentration of 1 and 2 μm and by adrenaline was progressively reduced.
Single dose intra-incisional antibiotic prophylaxis of surgical wound sepsis: A controlled trial of cephaloridine and ampicillin
Authors: Pollock A V , Leaper D J , Evans Mary
Published: March 2007

In a series of 410 consecutive potentially contaminated operations, we have compared the relative efficacy of intra-incisional cephaloridine and ampieillin in single doses of 1 g in 2 ml of water. In high risk operations (ileocolorectal surgery, perforated appendicitis, or when the patient has 2·5 cm or more of subcutaneous fat at the site of the incision) cephaloridine prophylaxis resulted in a primary sepsis rate of 14 per cent compared with 36 per cent for ampicillin. In all other patients the two antibiotics were equally effective. Secondary sepsis, following discharge from the wound of a substance other than pus, was equally common in the two groups.
Intersphincteric excision of the rectum
Authors: Lyttle J A , Parks A G
Published: March 2007

Wide excision of the rectum in inflammatory bowel disease is both unnecessary and undesirable as the healthy pelvic floor is damaged and the pelvic nerves put at risk. An operative technique is described which includes dissection of the anal canal and rectum in the intersphincteric plane, i.e. the plane of fusion between the visceral rectum and anal canal and the somatic pelvic musculature, which minimizes these undesirable elements.

Fifty–three cases are presented. Perineal wound healing rates are comparable with those of other methods of resection and only 1 of 14 men reported partial sexual dysfunction following this operation.
An evaluation of viability tests of human cadaveric kidneys
Authors: Modgill V K , Wiggins P A , Rosenberg I L , Humphrey C S , Giles G R
Published: March 2007

Cadaveric kidneys are sometimes unsuitable for transplantation because of possible ischaemic damage. The advent of perfusion preservation machines has enabled evaluation of perfusion characteristics and perfusate changes of organs prior to transplantation. This study has evaluated the changes in perfusate pH, locate dehydrogenase, lactate and free fatty acid utilization in an attempt to identify those kidneys with ischaemic damage.

In this investigation no single factor was discriminatory and it was not possible to predict with any degree of certainty those kidneys liable to delayed function or to non-function.
Foam elastomer dressing in the management of open granulating wounds: Experience with 250 patients
Authors: Wood R A B , Williams R H P , Hughes L E
Published: March 2007

Our experience in the use of a silicone foam elastomer in the dressing of granulating wounds is described in a series of 250 patients. Among the types of wound treated were a pilonidal sinus, abdominal, perianal and perineal wounds, bed sores and diabetic gangrene of the foot. The technique has marked advantages over conventional packing of wounds in relation to patient comfort and saving of nursing time in hospital, and can eliminate the need for district nursing care in the domiciliary situation. Details of preparation, application and surgical management are given.
Surgical management of hyperhidrosis
Authors: Keaveny T V , Fitzgerald P A M , Donnelly C , Shanik G D
Published: March 2007

Sixty-five patients with severe disabling hyperhidrosis were subjected to operation. Eighty-nine sympathectomies and 42 axillary skin excisions were performed to abolish sweating. Almost 90 per cent of these patients were extremely satisfied with the outcome of surgery, which resulted in a change for the better in their social and working lives. When conservative therapy fails, we recommend these procedures, which often alleviate this most distressing symptom.
Angiographic control of traumatic haemobilia by selective arterial embolization
Authors: Eggink W F , Perlberger R R , van Urk H
Published: March 2007

Traumatic haemobilia was diagnosed and treated successfully by selective arterial catheterization and embolization with Gelfoam particles, thus avoiding the hazards of surgical intervention, in a 16-year-old boy with tuberculous peritonitis. No ill effects to the liver parenchyma were noticed as evidenced by liver function tests and liver scan.
A complete suction system for operative surgery
Authors: Tinckler Laurence F
Published: March 2007

A versatile suction system utilizing a hand-held suction head with on–off control is described. Interchangeable nozzles and guards adapt the sucker to work appropriately in most operative situations.
Choledochoscopy in exploration of the common bile duct
Authors: Finnis D , Rowntree T
Published: March 2007

The technique of operative fibreoptic choledochoscopy is described; the results are reported in 88 patients with gallstones requiring exploration of the common bile duct. There were no cases of retained calculi that were endoscopically undetected. Postoperative T-tube cholangiography was carried out in 81 cases and confirmed the findings of operative biliary endoscopy in all cases. Choledochoscopy is an accurate and safe operative procedure which can eliminate the problem of undetected residual calculi.
Local and surgical management of enterocutaneous fistulas
Authors: Irving Miles
Published: March 2007

Intensive nutritional treatment is now recognized as the single most important factor in achieving closure of enterocutaneous fistulas, replacing attempts at early surgical closure. Operation in the early stages of management should be confined to the drainage of abscesses, the defunctioning of diseased or disrupted bowel and the formation of feeding enterostomies. In those few cases where spontaneous closure of the fistula does not occur, definitive surgical operation can be carried out when malnutrition has been corrected. The combination of nutritional treatment, skin protection and judicious surgery can reduce the mortality to below 10 per cent.
The survival of patients with colorectal cancer treated in a regional hospital
Authors: Gill P G , Morris P J
Published: March 2007

The survival rate for 301 patients who had a resection for colorectal cancer in Oxford over a 6-year period between 1966 and 1971 has been reviewed. The crude and age-adjusted 5-year survival rates for those who had a resection for cure were 37·3 per cent and 53·8 per cent respectively. The corresponding survival rates for all patients after resection were 25·8 and 37·2 respectively.

The most important determinant of survival was the pathological stage of the primary tumour, the agecorrected 5-year survival being 100 per cent for stage A lesions, 58 per cent for stage B, 27·1 for stage C and 5·5 per cent for stage D. Patients who presented with either intestinal obstruction or perforation of their carcinoma had a significantly worse prognosis than those who did not. Patients under 35 years of age did not survive as long as older patients. Those patients who had an anterior resection survived longer than those who underwent colectomy or abdominoperineal resection, probably due to the selection of pathologically favourable cases in the former group. The occurrence of infection in the postoperative period did not influence survival.

Thus, in general, patients with colorectal cancer have a poor 5-year survival (with the exception of stage A lesions), and this indicates the need for development of effective adjuvant therapy after surgery for this disease.
Traumatic diaphragmatic hernia
Authors: Bryer J V , Hegarty M M , Howe C , Rubin D , Angorn I B
Published: March 2007

A series of 58 cases of traumatic diaphragmatic hernia following blunt and penetrating injury is reviewed. The problems of radiodiagnosis are outlined and the need for barium contrast studies of the entire gastrointestinal tract to ensure recognition of isolated small bowel herniation is emphasized. Surgical access via laparotomy is recommended in the immediate post-traumatic presentation, whereas thoracotomy is preferable in cases diagnosed after a latent interval. Penetrating injury resulted in smaller diaphragmatic defects, greater morbidity and higher mortality due mainly to infective complications.
Parietal wound drainage in abdominal surgery
Authors: Higson R H , Kettlewell M G W
Published: March 2007

A Prospective randomized study of wound drainage in 250 surgical abdominal wounds was undertaken to determine (a) what effect wound drains had on clean surgical wounds; (b) whether wound drains reduced infection in potentially contaminated wounds; (c) whether wound drainge was an acceptable alternative to the use of topical antibiotics in frankly contaminated wounds.

Ten per cent of clean wounds which had been drained became infected, compared with 2 per cent of control wounds in the same group (p <0.002). Infection was also more common in potentially and frankly contaminated wounds in the presence on a drain. Skin organisms were grown from 8 drained and 2 nondrained wounds in this group (P <0.005), suggesting contamination by the drains. Drains were, however, associated with a lowere infection rate 23 obese patients with frankly contaminated wounds.
Surgical treatment of the severely ischaemic leg: I. Survival rates
Authors: Myers K A , King R B , Scott D F , Johnson N , Morris P J
Published: March 2007

Over a 10-year period, 411 patients with atherosclerotic major artery disease causing severe ischaemia of the legs were treated by surgery. Their survival rate, assessed by the life table method, was 80 per cent at 1 year and 50 per cent at 5 years. Early and late survival rates were significantly worse in elderly patients, and in patients with extensive gangrene. Late survival rates were significantly worse in diabetics, and in patients with clinical myocardial ischaemia.

Patients treated by arterial reconstruction showed a better survival rate than those treated by sympathectomy or amputation, though the latter groups contained more poor risk patients. Survival rates were not influenced by the technique of reconstruction.
A comparison of noxythiolin and povidone-iodine in experimentally induced peritoneal infection in mice
Authors: Browne M K , Leslie G B , Pfirrman R W
Published: March 2007

Noxythiolin (Noxyflex, Geistlich), given intraperitoneally as a 2.5 per cent solution, protected mice from the lethal effects of an intraperitoneal injection of Escherichia coli. Povidone-iodine (Pevidine, Berk), containing 0.075 per cent iodine, gave no protection.
Intravenous isotope calf scanning in the assessment of intermittent claudication
Authors: Hurlow R A , Chandler S T , Hardman J , Strachan C J L
Published: March 2007

A method of hyperaemic calf scanning using a bolus injection of 99Tcm pertechnetate into an arm vein is described and evaluated in 26 patients with intermittent claudication.

From the calf image displayed on a visual display unit after 2.5 minutes' scanning with a gamma camera, an assessment of the patency of the lower popliteal artery and run-off vessels can be made and of the distribution of blood flow to the calf muscles.

The technique enables the measurement of a calf ‘perfusion index’, which was found to be reproducible and to correlate well with the severity of disease in the proximal arteries leading to the calf, as assessed by the resting ankle/brachial pressure index (r = 0.65, P <0.001) and the ankle pressure response to exercise (r = 0.71, P ± 0.001).

The perfusion index correlated with maximum walking time (r = 0.57, P <0.01) but not with claudication time measured on a treadmill (r = 0.30).

Calf scanning is useful in the initial assessment of patients with claudication, and when combined with ankle pressure measurements it can provide objective flow and pressure data for evaluation of the progression of disease in conservatively managed patients with claudication, and for the assessment of the results of operation.
The combination of proximal gastric vagotomy with a rotational posterior gastropexy for duodenal ulcer
Authors: Hancock D M , Sankar M Y , Old J M , Bose A A K , Punnen P C , Mishra S M , Lobo F X , Trinder P
Published: March 2007

Preoperative oesophageal reflux symptoms have been controlled and the emergence of such symptoms de novo prevented in duodenal ulcer patients by combining proximal gastric vagotomy with a rotational posterior gastropexy. Fifty-two patients having such operations are compared with 46 patients treated by proximal gastric vagotomy (PGV) alone. The two groups match for age, sex and weight but there were more grade 3 refluxers in the group having rotational posterior gastropexy (28) than among those having proximal gastric vagotomy alone (5).

Six out of 28 patients in the PGV group who did not have preoperative regurgitation symptoms developed acid brash postoperatively on a 1–6½-year follow-up as against none of 17 patients in the other group. One year follow-up was complete in 94 cases and 57 had a 3·–6½-year follow-up. The 95 per cent confidence limits for cure of grade 3 reflux symptoms by the combined PGV and gastropexy operation were 44·7–88·7 for heartburn and 57·8–97·5 for regurgitation. Postoperative dysphagia can be minimized by attention to a few details during performance of the simple gastropexy procedure.

A pentagastrin-glucose pH monitoring test has been devised for this study. When the mean duration of reflux episodes during the 1 h after pentagastrin and the 1 h after 200 ml of 20 per cent glucose is plotted against the number of such episodes, the differences indicate that PGV impairs whilst PGV and gastropexy improves function at the gastro-oesophageal junction. Faber's peak acid output (PAO1) discriminant (Faber et al., 1975) was first used to define positive insulin tests in males. Such positive cases have been reported as having a 50 per cent chance of developing recurrent ulceration. We found that 9 out of 31 patients in the PGV group were positive at 1 year as against 2 out of 28 patients having the combined operation (P<0·05). We have now applied Maybury's criterion (Maybury et al., 1977) of PAO1 adjusted for height to our results. Significant differences between the two operations were only evident after a curve derived from Maybury's data was increased by 50 per cent and then applied to our results. Nine out of 36 of the PGV group as against 1 out of 36 of the PGV and gastropexy group were positive by this test (P<0·01). Addition of such a procedure to PGV may reduce the ulcer recurrence rate after PGV alone.
Surgical treatment of the severely ischaemic leg: II. Salvage rates
Authors: Myers K A , King R B , Scott D F , Johnson N , Morris P J
Published: March 2007

The salvage rates in 437 severely ischaemic legs (384 patients) treated by arterial reconstuction or by lumbar sympathectomy were studied by the life table method. The results were analysed in the surviving patients.

Following arterial reconstruction, the salvage rate was 70 per cent at 2 years and 60 per cent at 5 years. The results were similar for aortofemoral reconstruction and for femoropopliteal bypass grafting. Following aortofemoral reconstruction the outcome was better for endarterectomy procedures than for Dacron grafts. The salvage rate for femoropopliteal bypass grafts with patent tibial vessels was higher than for grafts to an isolated popliteal segment or for femorotibial grafts. Late occlusion of a reconstruction frequently did not necessitate major amputation, whereas several amputations were required in spite of a functioning reconstruction.

Following sympathectomy the salvage rate was 60 per cent from 1 year onwards. The results were better for tibial artery disease than for femoropopliteal or aortoiliac disease. Failed sympathectomy frequently led to major amputation of the leg or death of the patient.

The salvage rates after either reconstruction or sympathectomy were not influenced by age, sex or a prior history of clinical myocardial ischaemia, but the rates were worse in diabetics. The outcome of either operation was best when the procedure was performed for rest pain or ischaemic ulceration, satisfactory for limited gangrene but very poor for extensive gangrene.
Lumbar radiculopathy contralateral to upper lumbar disc herniation: Report of 3 cases
Authors: Choudhury A R , Taylor J C , Worthington B S , Whitaker R
Published: March 2007

Three cases of lumbar radiculopathy contraluleral to an upper lumbar disc herniation are reported. This clinical syndrome is explained on the basis of prominent spondylotic changes and stenosis contralateral to the side of disc herniation associated with anatomical anomalies of lumber nerve roots. The disc herniation causes displacement and impaction of the dural sac with the emerging nerve roots in a narrowed lateral recess.
Cholecystectomy and a simple technique of operative cholangiography
Authors: Devlin H Brendan , Sahay A K , Tiwari P N , Galvin P B , Peel A L G
Published: March 2007

A simple, easily reproducible technique of operative cholangiography is described. The technique has three advantages: (a) there is no need to divide or ligate the cystic duct; (b) it demonstrates the cystic duct anatomy clearly and is particularly useful in demonstrating stones in that duct thus eliminating the hazard of the retained stone in the cystic duct stump; (c) it is possible to eliminate the problem of false positives due to air bubbles.

A consecutive series of 442 cholecystectomy patients is reviewed. The overall operative mortality was 1·6 per cent; no death could be attributed to operative cholangiography. Thirty-five of 324 patients (10·8 per cent) with gallstones and no history of jaundice were shown to have unexpected abnormalities in the common bile duct.
A fundoplication clamp
Authors: Tinckler L F
Published: March 2007

An instrument is described which has been specially designed to facilitate the performance of the operation of fundoplication for the surgical treatment of oesophageal reflux.
Deep vein thrombosis after total hip replacement: A clinical and phlebographic study
Authors: Nillius Anders S , Nylander Göran
Published: March 2007

Two hundred and forty-seven phlebograms (113 bilateral and 21 unilateral) were performed in 134 patients 10–14 days after total hip replacement. Fifty-eight per cent of the patients were found to have deep vein thrombosis. The patients with DVT were significantly older than patients without DVT, but there was no difference regarding sex, type of hip prosthesis, side of operation or day of mobilization. No difference was found in the duration of operation and anaesthesia, the operative haemorrhage and the amount of bank blood transfused in patients with and without DVT.

Fifty per cent of the thrombi were confined to the calf veins. Ninety-seven per cent of these thrombi were asymptomatic and were as frequent on the operated as on the non-operated side. The remaining 50 per cent of the thrombi engaged the thigh with or without simultaneous calf vein involvement. These thrombi produced symptoms in 23 per cent of the cases and were significantly more common on the operated than on the non-operated side.

It is concluded that DVT after hip replacement can be of two different types: thrombosis caused by stasis and the general effects of trauma and thrombosis caused by local factors involving the thigh veins of the operated leg.
A new look at the arterial supply of the bile duct in man and its surgical implications
Authors: Northover J M A , Terblanche John
Published: March 2007

The blood supply of the human bile duct has been re-evaluated using high resolution resin casts prepared from 24 fresh human cadavers. The refined technique used yielded casts of all vessels, including capillaries, and produced a clear picture of the blood supply of the human bile duct for the first time. The arterial supply of the supraduodenal duct was shown to be axial, with the main vessels, which have been named the 3 o'clock and 9 o'clock arteries, running along the lateral borders. The retroportal artery, which has not been described by previous workers, was present in all complete casts and was a major source of the axial blood supply to the supraduodenal duct in 32 per cent of them.

The major importance of this new knowledge of bile duct blood supply may well lie in the understanding of the aetiology of postoperative bile duct strictures and in their prevention. An explanation is proposed for the long strictures sometimes seen after minimal surgical trauma to the bile duct, based on damage to the small vessels supplying the duct; guidelines to prevent such damage are presented. Ischaemia of the bile duct may also explain some of the biliary problems that have followed human liver transplantation and other procedures involving biliary anastomosis, such as Whipple's operation.
The effect of histamine and histamine antagonists on gastric acid secretion and mucosal blood flow in man
Authors: Knight S E , McIsaac R L , Rennie C D
Published: March 2007

Histamine has been investigated for its effect on gastric acid secretion and mucosal blood flow in man. Dose–response curves were constructed and analysed in the presence of H1- and H2-antagonists. Mepyramine had no effect on acid secretion or mucosal blood flow. Cimetidine reduced acid secretion but had no effect on blood flow. This suggests that the vasculature is less sensitive to cimetidine than the parietal cell.
Low dose heparin and compression stockings in the prevention of postoperative deep venous thrombosis
Authors: Törngren Staffan
Published: March 2007

The frequency of deep venous thrombosis (DVT) was studied in 98 patients undergoing major abdominal surgery. All the patients received low dose heparin prophylaxis 5000 i.u. every 12 h for 5–7 days. In each patient, a graduated compression stocking was also worn and randomly allocated to one of the legs and the other leg served as a control. DVT was diagnosed by the 125I-fibrinogen method. Four patients developed bilateral DVT and 8 patients unilateral DVT, all of whom developed it in the control leg. The difference in unilateral DVT between stockinged and control legs was significant (P < 0·004). It is concluded that a combination of low dose heparin and graduated compression stockings is more effective than low dose heparin alone in reducing the frequency of postoperative DVT. It is suggested that this combination of prophylaxis might be of value in high risk patients.
Catecholamines and experimental stress ulcer: Morphological and biochemical changes in the gastric mucosa
Authors: Beraha N , Silveira M , Man W , Silcocks P B S , Spencer J
Published: March 2007

A model for the production of gastric mucosal haemorrhages and ulcers, similar in morphology and distribution to those seen in stress states in man, has been produced by the intraperitoneal injection of adrenaline in single, double or treble doses of 0·6 mg/kg. Lesions were produced in 2 or 3 h, without ligation of the pylorus. Severe mucosal changes were associated with a fall in gastric mucosal histamine concentration. Mucosal serotonin did not change. Rises in mucosal adrenaline were accompanied by a fall in noradrenaline, total catecholamine levels being unchanged.
Fracture of the penis
Authors: Goh H S , Trapnell J E
Published: March 2007

Two cases of fracture of the penis are reported and the literature is reviewed. Of the two alternative treatments—conservative and immediate exploration with suture closure of the defect—the authors recommend the surgical approach. This would appear to eliminate any possibility of late surgical deformity of the Peyronie type.
Changing survival prospects in carcinoma of the rectum
Authors: McDermott F T , Hughes E S R , Pihl E A , Milne B J
Published: March 2007

The survival prospects for carcinoma of the rectum in a series of 1320 patients managed between 1950 and 1978 by one surgeon have been analysed by computer. Survival curve analysis showed a worsened survival after curative resection during 1970–8 in comparison with previous decades (P = 0·001). The 5-year cancer-specific survival after curative resection (832 patients) decreased from 73 per cent (1950–9) to 50 per cent (1970–3) (P = 0·001). An increase in the incidence of Dukes' stage C tumours from 22 per cent (1960–9) to 32 per cent (1970–8) (P = 0·003) explains, at least in part, the worsened survival prospects. Paradoxically the deterioration was paralleled by earlier presentation (P = 0·001).

The worsened survival prospects were not explained by alterations in sex or age distribution, tumour site, or increase in the percentage of sphincter-saving resections. The alternative hypotheses that earlier presentation has resulted in a larger proportion of aggressive tumours coming to curative resection or that worsened survival prospects represent a real change in the behaviour of carcinoma of the rectum in the Australian community are discussed.
A technique for the measurement of the amount and distribution of chronic gastritis
Authors: Lawson H H
Published: March 2007

A technique has been described to measure the amount and distribution of gastritis in whole stomachs or resected partial gastrectomy specimens. At a magnification of × 360, mucosal normality or the predominant form of chronic gastritis was recorded at 0·4-mm intervals. Bar diagrams were prepared of the mucosa at 6-mm intervals. Examples are given of the appearance along the lesser curvature where a large ulcer was present, and after the healing of an ulcer. The technique can also be used for the display of information when only multiple biopsy specimens are available.
Segmental splenectomy in schistosomiasis
Authors: Kamel R , Dunn M A
Published: March 2007

Segmental splenectomy was performed in 5 patients with hepatosplenic schistosomiasis mansoni and symptomatic splenomegaly. The aim was to preserve a functional remnant comprising 20–30 per cent of the bulk of a greatly enlarged spleen. The operative technique involved devascularization of anatomic segments and suture of an omental patch to the residual spleen. This procedure was simple, well tolerated and effective in relieving abdominal discomfort and cytopenias. The residual spleens showed normal uptake of 99Tc-sulphur colloid. If long term observation confirms the value of segmental splenectomy in hepatosplenic schistosomiasis, it may become appropriate therapy for those patients with symptomatic splenomegaly who do not require portal decompression.
Gastric emptying and postprandial duodenogastric reflux in dogs with Heineke–Mikulicz pyloroplasty
Authors: Müller-Lissner Stefan A , Sonnenberg Amnon , Hollinger Albert , Schattenmann Gotthard , Siewert J Rüdiger , Blum André L
Published: March 2007

A two-marker technique avoiding transpyloric intubation was used to measure the volume of gastric secretion, the rate of gastric emptying and the degree of postprandial duodenogastric reflux in 8 dogs, 5 without and 3 with Heineke–Mikulicz pyloroplasties. The stomach emptied after a liquid fatty meal at an overall rate of 4·9 ml/min ± 0·2 s.e.m. in animals with a normal pylorus and 5·7 ± 0·2 ml/min in those with pyloroplasties (P < 0·05). Though mean fractional emptying rates were similar, the fractional emptying rate was greater in animals with pyloroplasties than in those without in the first 10 and in the last 20 minutes. The rate of duodenogastric reflux was likewise greater in animals with pyloroplasties than in those without (1·8 ± 0·2 ml/min and 0·7 ± 0·2 ml/min respectively, P < 0·05). The rates of gastric secretion did not differ materially (2·2 ± 0·3 ml/min and 2·1 ± 0·2 ml/min), but a greater proportion of the gastric contents was emptied more than once in animals with pyloroplasties than in those without (7·7 ± 1·5 per cent and 2·3 ± 1·0 per cent, P < 0·05).
Fatal infection in mice after injection of immunosuppressive serum fractions from surgical patients
Authors: McIrvine A J , Wolfe J H N , Collins Katherine , Mannick J A
Published: March 2007

Following surgical or accidental trauma many patients show suppression of cellular immunity. In this investigation sera from severely burned patients and patients undergoing aortic aneurysm repair were studied. Sera shown to suppress phytohaemagglutinin-induced blastogenesis of normal human lymphocytes were fractionated using ion exchange and G25 Sephadex chromatography. Suppressive activity was largely confined to a low molecular weight (LMW) fraction and was dose dependent. LMW fractions of normal sera had no significant suppressive activity. The purpose of this study was to test the causal relationship between immunosuppressive serum and decreased resistance to bacterial infection. Listeria monocytogenes infected mice were used as an in vivo model to test suppression of cellular immunity. Injection of LMW fractions of suppressive sera significantly increased mortality in these mice, but had no effect on non-infected mice. There was good correlation between the in vitro and in vivo effects of the suppressive fractions. These results suggest that a circulating factor in the serum of injured patients suppresses cellular immunity and may be responsible for impaired resistance to infection.
Viability of exfoliated colorectal carcinoma cells
Authors: Umpleby H C , Fermor B , Symes M O , Williamson R C N
Published: March 2007

The viability of tumour cells shed into the intestinal lumen was determined in 49 patients with carcinoma of the large bowel. Preoperative colorectal lavage was performed in 19 patients and irrigation of the cut ends of the operative specimen in 30 patients. The resulting cell suspensions were centrifuged on a Nycodenz® linear density gradient column so that tumour cells, being larger, were concentrated in a band at the top. In 14 of 19 colorectal lavage cases viable tumour cells were recovered, as assessed by their characteristic morphology and ability to exclude trypan blue. A median of 0·78 × 106 viable tumour cells was recovered. The median percentage cell viability in the suspension was 92, i.e. 8 per cent of the tumour cells were dead (stained with trypan blue). In eight specimens viability was confirmed by the ability of tumour cells to hydrolyse fluorescein diacetate. In 17 of 30 proximal resection margin irrigations a median of 0·55 × 105 viable tumour cells was recovered, with a median percentage viability of 92·5. In 15 specimens the neoplastic cells showed fluorescence. In 21 of 25 distal resection margin irrigations a median of 1·92 × 105 viable tumour cells was recovered with a median percentage cell viability of 79·3, and fluorescence was observed in all specimens. The number of viable tumour cells did not correlate with the stage, differentiation, diameter or fixity of the tumour. However, the number of tumour cells recovered from the distal resection margin was inversely related to the distance of the tumour from that margin (Rank Difference Coefficient R = −0·6). Thus viable exfoliated tumour cells were demonstrated in 52 of 74 specimens (70 per cent). Their presence in large numbers at the site of intestinal anastomoses supports a potential role in the aetiology of suture-line recurrence.
Criteria from intra-arterial femoral artery pressure measurements combined with reactive hyperaemia to assess the aorto-iliac segment; A prospective study
Authors: Verhagen P F , van Vroonhoven Th J M V
Published: March 2007

Direct femoral artery blood pressure measurements combined with reactive hyperaemia (FAP study) were performed on 50 extremities (45 patients) with multilevel arterial occlusive disease of the lower extremities. In a previous retrospective study we established criteria for detection of significant aorto-iliac occlusive disease. These criteria were used in a prospective way in this study. Twenty-seven extremities were subjected to a proximal and 23 extremities to a distal reconstruction. The half-year postoperative results were evaluated. The criteria used were 86 per cent sensitive, 100 per cent specific and 93 per cent accurate in relation to predicting the postoperative haemodynamic result. The positive predictive value was 100 per cent and the negative predictive value 89 per cent. The criteria are presented and compared with data from the literature. It is concluded that FAP studies are a simple and excellent way to assess the aorto-iliac segment and to predict the outcome of a reconstruction in multilevel arterial occlusive disease.
Long saphenous incompetence as a cause of venous ulceration
Authors: Sethia K K , Darke S G
Published: March 2007

Four hundred and seventeen consecutive patients referred with significant chronic venous disorders of the lower limb have been studied. Two hundred and ninety-nine were considered to have uncomplicated primary varicose veins, with saphenous incompetence. The remaining 118 presented with past or current skin ulceration, prominent pain and swelling, or both. Ascending and descending venography and further Doppler studies revealed only 18 patients (17 with ulceration) with an incompetent long saphenous system and ankle perforators as the only identifiable abnormalities. In 12 of these, patients' dorsal foot vein pressures were measured at rest and the maximum fall demonstrable after exercise expressed as a percentage of this (12.9 per cent ± 6.0). This test was repeated with a narrow tourniquet inflated to 160 mmHg, applied to the mid-thigh (35.6 per cent ± 7.4) (P < 0.05), and again after accurate groin ligation and stripping of the long saphenous vein to the knee (31.9 per cent ± 10.7) (P < 0.05). These results seem to validate the use of the foot pressure/tourniquet test in assessing the relevance of saphenofemoral incompetence, and suggest in a proportion of venous ulcers this is a princical factor.
Vascular spasm and gangrene during heparin–dihydro-ergotamine prophylaxis
Authors: Cunningham M , De Torrenté A , Ekoé J-M , Ackermann J-P , Humair L
Published: March 2007

A case is reported of a multiple trauma victim who developed severe vascular spasm whilst receiving heparin-dihydro-ergotamine thrombo-embolic prophylaxis which ultimately led to amputation of the right foot. Identification of high risk groups for this complication is attempted from a review of the literature. Treatment should be with intra-arterial or intravenous nitroprusside or nitrates. Little information is as yet available on the use of prostacyclin in this condition.
Abnormalities of colonic function in patients with rectal prolapse and faecal incontinence
Authors: Keighley M R B , Shouler P J
Published: March 2007

We have investigated changes in colonic motility and anorectal function in 6 continent patients with a rectal prolapse; in 10 incontinent patients with rectal prolapse and in 16 patients with idiopathic faecal incontinence compared with 26 age and sex match controls. A history of incontinence, irrespective of a prolapse, was associated with significantly lower anal squeeze pressures (P < 0·05), a deficient anorectal angle (P < 0·05), failure to retain a balloon containing more than 250 cm3 of air in the rectum (P < 0·01) and increased sigmoid motility (P < 0·02) compared with controls. By contrast patients with rectal prolapse and no incontinence had normal anal pressures, a normal anorectal angle and normal sigmoid motility, but transit was delayed. These results indicate that abnormal sigmoid motility is commonly associated with faecal incontinence and that slow transit constipation is frequent in patients with rectal prolapse who are continent.
Changing patterns in colostomy closure: The Bristol experience 1975-1982
Authors: Foster M E , Leaper D J , Williamson R C N
Published: March 2007

The results of colostomy closure in 113 patients (1975–1982) were examined to determine whether the identification of risk factors or improvements in surgical management had made this procedure safer. Overall mortality was low (0.9 per cent), but faecal fistulas occurred in 16.5 per cent and the incidence of wound infection was high (34 per cent). Comparison of the first and second 4 year periods shows recent improvements in the rates of wound infection (24 versus 51 per cent: P < 0.01) and anastomotic leakage (10 versus 30 per cent: P < 0.05). A long delay (> 6 months) between creation and closure of the colostomy was associated with an increased incidence of postoperative diarrhoea compared with shorter periods of defunction (38 versus 14 per cent: P< 0.01). The morbidity of colostomy closure is decreasing but remains an important clinical problem.
Chronic pilonidal disease: A randomized trial with a complete 3-year follow-up
Authors: Kronborg O , Christensen K , Zimmermann-Nielsen C
Published: March 2007

Three treatments for chronic pilonidal disease were compared in a randomized trial. Healing without formation of new sinuses occurred equally frequent after excision (E), excision with suture (E + S) and excision with suture under cover with clindamycin (E + S + C). The times of healing were significantly shorter after E + S (median 14 days, n = 29) than after E (64 days, n = 29) and tended to be even shorter after E + S + C (11 days, n = 30). Recurrence rates within 3 years amounted to 13 per cent after E, 25 per cent after E + S and 19 per cent after E + S + C, but the total time of healing after initial surgery as well as excision of recurrences was significantly shorter after E + S than after E and tended to be even shorter after E + S + C.
Effects of propranolol on hepatic haemodynamics in the cirrhotic and non-cirrhotic rat
Authors: Jenkins S A , Baxter J N , Johnson J N , Devitt P , Shields R
Published: March 2007

The effects of systemic and intraportal administration of propranolol on hepatic haemodynamics were studied in cirrhotic and non-cirrhotic rats. In the non-cirrhotic rat systemic infusion of 4 μg (kg body wt)−1 min−1 propranolol significantly decreased portal pressure, wedged hepatic venous pressure, portal venous flow and liver blood flow without affecting heart rate. Similar changes were observed in the cirrhotic rat following an infusion of 2 μg (kg body wt)−1 min−1 propranolol. Higher rates of propranolol infusion produced greater reductions in portal pressure, wedged hepatic venous pressure, portal venous flow and liver blood flow in cirrhotic and non-cirrhotic rats but these changes were accompanied by a bradycardia. The reduction in portal pressure effected by propranolol was accompanied by an increased splanchnic vascular resistance. Intraportal injection of propranolol resulted in a rapid but transient fall in portal pressure. The decrease in portal pressure was sustained if propranolol was infused intraportally. The results indicate that propranolol effects a reduction in portal pressure via a combination of increased splanchnic vascular resistance, increased hepatic arterial resistance and reduced cardiac output. The observation that propranolol can significantly reduce portal pressure without affecting heart rate may be clinically important in the long-term management of portal hypertension. Furthermore, the rapid reduction in portal pressure following intravenous administration suggests that propranolol may be of value in the acute control of variceal haemorrhage.
Radial forearm flap for floor of mouth reconstruction
Authors: Matthews R N , Hodge R A , Eyre J , Davies D M , Walsh-Waring G P
Published: March 2007

Approaches to reconstructing floor of mouth defects are reviewed including methods of bony reconstruction following mandibular resection. The place of the free radial forearm flap, incorporating vascularized hemiradius if necessary, is described together with the anatomy, operative technique and a review of seven cases. It is concluded that this flap is an important addition to current methods of reconstructing substantial intraoral soft tissue defects alone or associated mandibular defects as well, owing to the high quality of results and to its low morbidity.
The surgical treatment of anorectal malignant melanoma
Authors: Ward M W N , Romano G , Nicholls R J
Published: March 2007

The clinical presentation and surgical treatment of 21 patients with anorectal melanoma over a 44 year period have been analysed. During the first 24 years of this period total rectal excision was regarded as the treatment of choice and since then wide local excision. Two groups of patients emerge for comparison of the results of surgical treatment. There were no long-term survivors in either group and little difference between survival rates after either procedure. It was concluded that the change from radical to conservative surgery for anorectal melanoma has made no difference in terms of survival and the possible advantages of this change have been discussed.
New method for assessment of anal sensation in various anorectal disorders
Authors: Roe A M , Bartolo D C C , McC. Mortensen N J
Published: March 2007

A new technique for quantifying anal sensation utilizing mucosal electrosensitivity is described and has been tested in 97 patients. Normal subjects (n = 20) have a sensory threshold varying from 2 to 7·3 mA being most acute in the region of the anal valves. Sensory awareness also extends into the upper anal canal. Patients with neuropathic incontinence (n = 17) have a sensory deficit (P <0·002) whilst patients with haemorrhoids (n = 28) have less sensitive mucosa displaced into the upper anal canal (P < 0·0001). Patients with acute fissure-in-ano (n = 10) have lower thresholds of sensation at the site of the fissure and slow transit constipation patients (n = 22) have normal anal sensation. The technique is reproducible and should prove useful in the investigation of anorectal disorders.
Mammillary fistula
Authors: Lambert M E , Betts C D , Sellwood R A
Published: March 2007

During a 6-year period 38 patients with 52 mammillary fistulae were seen. On average, 5 abscesses had preceded recognition of a fistula in the areolar region (range 1–18). In 11 cases the fistulae were immediately apparent as discharging openings but they more commonly presented as subareolar abscesses. Fistulae were treated either by laying open or by excision of the track and at mean follow-up of 25 months (range 1–75) there has been recurrent fistula formation in only one case. Mammillary fistulae should be suspected and sought in all patients presenting with abscesses adjacent to the nipple.
Routine or selective peroperative cholangiography
Authors: Mofti A B , Ahmed I , Tandon R C , Al-Tameem M M , Al-Khudairy N N
Published: March 2007

The routine use of peroperative (pre-exploration) cholangiography was prospectively studied in 433 consecutive patients undergoing elective cholecystectomy. Satisfactory peroperative cholangiography was achieved in 396 patients using a C-arm image intensifier with image retention facility. Clinical indications for exploration of the common bile duct were noted for each patient but the decision for choledochotomy was determined by the cholangiographic results. Two hundred and forty-nine (63 per cent) patients had no clinical indications for duct exploration and cholangiographic findings were all normal. Of the 147 patients with positive clinical criteria, 39 (9.8%) had abnormal cholangiograms and required exploration of the common bile duct. In three patients duct exploration was negative giving a false positive rate of 0.73 per cent. The use of the image intensifier allowed dynamic study during cholangiography and optimum evaluation of the duct system. The results support the view that peroperative cholangiography could be restricted to patients with clinical indications for exploration of the common bile duct.