bluuebunny/crossref_metadata_2025 huggingface dataset:
Secondary involvement of the penis by rectal cancer
Authors: Rees B I
Published: March 2007

Two cases of metastasis to the penis from a primary rectal carcinoma are described. The clinical features, treatment and prognosis together with the probable modes of metastasis are discussed. All previously reported cases of penile metastasis from the rectum are reviewed.

It is suggested that contrary to previous reports the prognosis is not uniformly poor and hence a more aggressive attitude to treatment should be adopted. Metastatic lesions in the penis should also be considered as a cause of urinary obstruction following abdominoperineal excision of the rectum.
Traumatic haemobilia
Authors: Vallidis E , Papalexandris N
Published: March 2007

A case of traumatic haemobilia which was diagnosed preoperatively, is reported. The site of bleeding was demonstrated by operative angiography through the right hepatic artery. The patient was treated by ligation of the common hepatic artery. Re-bleeding required a second operation and ligation of the right hepatic branch without adverse consequences on the hepatic function.
Gumma of the liver
Authors: Parnis Roger
Published: March 2007

A misdiagnosed case of gummatous disease of the liver is described.
Rupture of subcapsular haematoma of the liver in a case of eclampsia
Authors: Browne C H , Hanson Gillian C , De Jode L R , Roberts P A
Published: March 2007

A case of rupture of subcapsular haematoma of the liver in a patient suffering from eclampsia is reported in which the patient survived. Peritoneal tap provided important diagnostic information. Surgical intervention with control of the liver haemorrhage provides the only chance of survival.
A controlled trial of parenteral prophylactic gentamicin therapy in biliary surgery
Authors: Keighley M R B , Baddeley R M , Burdon D W , Edwards J A C , Quoraishi A H , Oates G D , Watts G T , Alexander-Williams J
Published: March 2007

This trial has investigated the value of gentamicin therapy in patients requiring biliary surgery. One hundred consecutive patients were randomly allocated to receive either gentamicin or no antibiotic. Postoperative infection was assessed by an independent observer. Cultures and gentamicin assays were performed on bile and blood sampled during and after operation. The minimum inhibitory concentrations of gentamicin were measured with isolated bacteria.

In 80 per cent of patients biliary organisms were inhibited by 2μ g/ml of gentamicin. Twice this concentration was found in the serum at operation in 88 per cent, but in the bile in only 18 per cent. Nevertheless, gentamicin lowered the incidence of bacteria in the bile from 42 to 25 per cent. There was a reduction in wound sepsis from 21 to 6 per cent (P<0·05). Bacteriaemia was demonstrated in only 1 patient receiving gentamicin compared with 5 controls and 1 death occurred from endotoxaemia in the control group.

These data suggest that gentamicin will reduce the morbidity of biliary surgery, particularly in patients in whom the bile is infected at operation.
Bacteria in flower vase water: Incidence and significance in general ward practice
Authors: Bartzokas C A , Holley Marguerite P , Sharp Christine A
Published: March 2007

Culture of flower vase water from wards in the David Lewis Northern Hospital, Liverpool, revealed large numbers of potentially pathogenic bacteria. The types of organisms isolated may reflect the particular ecology of this hospital as they differed in some ways from those reported from other centres. The incidence of wound infections during the period of study was low (5·2 per cent) despite the regular overgrowth of bacteria in flower vases, and there did not appear to be any definite correlation between the types of bacteria isolated from flower vase water and those responsible for wound infections.

The addition of hydrogen peroxide to flower vases proved a very effective antiseptic and is recommended for general use as a precautionary measure.
Analgesic abuse in urological practice
Authors: Parker R W , Shaw Richard E
Published: March 2007

Thirty-three patients seen in a urological department had taken large doses of analgesic for prolonged periods of time. In 9 cases a diagnosis of pyramidal necrosis was established, while 4 others had pyelographic evidence of pyelonephritis, and analgesic abuse was probably an important aetiological factor in their renal condition. Analgesic nephropathy is easily overlooked unless patients are questioned routinely regarding their intake of analgesic. It is important to identify the group of patients without evidence of serious renal disease who are taking excessive quantities of analgesic and to urge them to abandon the practice.
The Fowler—Weir approach to appendicectomy
Authors: Askew A R
Published: March 2007

The medial approach of Fowler-Weir enables rapid opening of the abdominal cavity and provides good access to the appendix. Although there is less muscle trauma the wound seems as painful postoperatively as with the classic muscle-splitting approach. However, morbidity is less as shown by a decrease in the wound and deep infection rate compared with that after appendicectomy by the McBurney approach.
The cause and treatment of postvagotomy diarrhoea
Authors: Condon John R , Robinson V , Suleman M I , Fan V S , McKeown M D
Published: March 2007

Six patients with watery postvagotomy diarrhoea and 4 patients with intractable diabetic diarrhoea were treated with cholestyramine. The diarrhoea responded completely to therapy, during which the stool content of water, sodium, potassium and magnesium fell. Two of the patients, while receiving cholestyramine, had a rise in faecal fat, but this was not accompanied by diarrhoea, the stools being well formed.

Evidence is presented which suggests that the mechanism of diarrhoea is similar in both disorders and is due to division or neuropathy of the hepatic fibres of the vagus nerve. This results in distension of the gallbladder, contraction of which expels increased quantities of bile salts, which swamp the reabsorptive capacity of the small intestine and induce diarrhoea by direct action on the colon. If this theory is valid, cholecystectomy, by preventing large quantities of concentrated bile salts from suddenly entering the gut, may result in improvement of postvagotomy and diabetic diarrhoea.
The cholecystokinin test: An assessment
Authors: Reid D R K , Rogers I M , Calder J F
Published: March 2007

A cholecystokinin (CCK) test was performed on 13 female patients who were thought to be having attacks of gallbladder pain and in whom at least one cholecystogram had been normal. In 10 of these patients the CCK test was performed during the course of a repeat cholecystogram in order to assess the effect of CCK on gallbladder contraction.

There was no constant relationship between a positive test and gallbladder contraction as measured radiographically.

Cholecystectomy was undertaken in 9 patients and of these, 4 had been CCK positive, 4 had been CCK negative and 1 had reacted equivocally. None of the CCK positive patients had stones at operation, whereas 2 of the CCK negative patients had one or two small stones. In this small series cholecystectomy relieved both the CCK negative and CCK positive patients of pain with equal frequency.

It is concluded that a negative CCK test by no means excludes the presence of symptomatic gallstones in patients with X-ray negative gallbladder pain.
Intra-arterial infusion of Solcoseryl: A clinical trial of a method of treatment for pre-gangrene of the lower limb
Authors: Charlesworth D , Harris P L , Palmer M K
Published: March 2007

A randomized double blind trial of the drug Solcoseryl given by intra-arterial infusion was carried out on 57 patients with pre-gangrene of the lower limb. A sequential analysis was carried out and the trial stopped when the results showed a statistically significant result in favour of the active drug.
Hydronephrosis complicating aortic reconstruction
Authors: Heard Gordon , Hinde Graham
Published: March 2007

Prompted by an encounter with a symptomatic case, a study has been made of hydronephrosis complicating operations for aortic reconstruction.

Twenty patients operated upon consecutively for occlusive vascular disease and undergoing reconstructions involving the use of synthetic material in the vicinity of the ureter have been investigated by intravenous pyelography.

The incidence of hydronephrosis in pyelograms after a year or more was 10 per cent of the patients and 5.7 per cent of the ureters at risk. Dilatation, when it arose, was always apparent in the immediate postoperative period, but half of the dilatations evident at that time resolved within a year.
Pancreatic pseudocysts in children: 4 Cases from Uganda
Authors: Carswell J Wilson , Cotter J , Master S P
Published: March 2007

Four cases of pancreatic pseudocyst in African children are described. There is some evidence that they followed pancreatitis of unknown aetiology. None had a history of trauma. Three were treated by cystogastrostomy, and the fourth by excision of the cyst.
Gas gangrene of the extremity: The presenting clinical picture in perforating carcinoma of the caecum
Authors: Mzabi R , Himal H S , MacLean L D
Published: March 2007

This paper reports 2 diabetic patients with perforating carcinoma of the caecum and gas gangrene of the pelvis and right lower extremity in whom the infective process was the main clinical feature.
Wound infections due to Bacteroides fragilis following intestinal surgery
Authors: Leigh D A
Published: March 2007

Ninety-six wound infections due to Bacteroides fragilis occurring after intestinal surgery are described. Most infections followed appendicectomy or colectomy for diverticulitis.

B. fragilis was isolated in pure growth from 47 per cent of infections, and in mixed culture the other common bacteria were Klebsiella spp., Escherichia coli and Enterobacter spp.

Fifty-three per cent of the infections responded rapidly to either non-specific measures or antibiotic therapy, but 47 per cent of patients developed complications, usually abscess formation.

The successful isolation of bacteroides from clinical material requires special precautions. The specimen for bacteriological examination must be sent to the laboratory in a transport medium which maintains an anaerobic environment and the culture techniques must include a selective agar for the isolation of anaerobic bacteria.

The role of antibiotic therapy in preventing postoperative wound infection after intestinal surgery is discussed. Bacteroides has an unusual pattern of antibiotic susceptibility and it is essential that an effective antibiotic such as lincomycin is included in the treatment of infection originating from the intestinal tract.
Chronic hydradenitis suppurativa: A report of 9 cases
Authors: Pigott Humphrey , Ellis Harold
Published: March 2007

This paper describes the treatment of 9 patients suffering from hydradenitis suppurativa all of whom were treated by surgical excision. The aetiology, diagnosis and treatment by surgical excision are discussed.
Early management of corrosive burns of the oesophagus
Authors: Balasegaram M
Published: March 2007

One hundred and sixteen patients with early corrosive burns of the oesophagus treated by the author are reviewed. It is emphasized that the all important aspect of management of these patients is prophylactic treatment to avoid stricture of the oesophagus. Early treatment consists of intravenous fluid therapy, broad spectrum antibiotics, sedation, parenteral hydrocortisone and more importantly maintaining the patency of the oesophagus followed by dilatation. The importance of early barium meal studies and oesophagoscopy is stressed.
Nitrogen mustard as adjunctive chemotherapy for breast carcinoma
Authors: Hines James R , Williams John S
Published: March 2007

A retrospective study is reported of 38 patients with breast carcinoma treated by radical mastectomy and a short course of nitrogen mustard. They were followed up for an average of 10 years. There were no serious untoward reactions to the drug. The 5- and 10-year corrected survival rates were 74 and 71 per cent respectively. There would appear to be a renewal of interest in adjuvant chemotherapy for patients with breast carcinoma.
The changing pattern of hospital admissions for diverticular disease of the colon
Authors: Kyle James , Davidson Alan I
Published: March 2007

Hospital admissions for symptomatic diverticular disease of the colon were studied during two periods, 1958–61 and 1968–71, in a relatively closed community in north-east Scotland. There was a significant increase in the numbers admitted, from 206 to 366. In the earlier 4-year period among patients aged 70 years and over there was a preponderance of females, but in the later study period the risk of developing symptomatic disease was almost as great among elderly males. Most of the elderly female patients were widowed city dwellers. The proportion of patients requiring operation for or dying from diverticular disease declined, but perforation remained as a frequent complication carrying a high mortality.
The nature of haemorrhoids
Authors: Thomson W H F
Published: March 2007

An anatomical and clinical study aimed at uncovering factors likely to be helpful in understanding the true nature of haemorrhoids is described. The main finding was of specialized “cushions” of submucosal tissue lining the anal canal; it is argued that piles are merely the result of their displacement.
Gastric mucosal resection in the treatment of peptic ulcers: A 1–10 year clinical follow-up
Authors: Kirk R M
Published: March 2007

The clinical results of gastric mucosal resection are reported after a 1–10-year follow-up in which 76 per cent of patients were followed up for more than 5 years. There were 3 postoperative deaths in 152 patients. Mucosal antrectomy with vagotomy for duodenal ulcer in 96 patients, and for recurrent ulcer in 9 patients, has not been followed by a single recurrence. Gastric mucosal resection alone for the treatment of gastric ulcer in 21 patients resulted in 1 recurrence.

Although vagotomy combined with resection is currently out of fashion for the initial treatment of duodenal ulcer in Britain, mucosal gastric resection has technical advantages in combination with vagotomy for the cure of recurrent ulcers following duodenal ulcer surgery.
Abdominal tuberculosis: Demonstration of tubercle bacilli in tissues and experimental production of hyperplastic enteric lesions
Authors: Das Pritam , Shukla H S
Published: March 2007

Material obtained from 35 cases of abdominal tuberculosis was studied and an attempt was made to demonstrate tubercle bacilli by special staining of histological sections, culture and guinea-pig inoculation.

Acid fast bacilli could be demonstrated in 80 per cent of cases. The remaining cases were also possibly due to tuberculous infection because granulomas with Langhans's type of giant cells and caseation or calcification of lymph nodes were present. The bacilli were demonstrated in bowel tissue showing non-specific histology in 1 case. In 2 other cases with non-specific lesions in the bowel the bacilli were demonstrated in lymph nodes.

Guinea-pig inoculation studies showed that hypertrophic lesions of the bowel with a non-specific type of reaction could develop after intraperitoneal injection of tubercular material.

Although it cannot be said on the basis of this study that Crohn's disease is caused by tuberculous infection, it can be concluded that tuberculous infection can give rise to a Crohn's type of lesion.
Splenic-gonadal fusion
Authors: Pendse A K , Mathur P N , Sharma M M , Gupta O P
Published: March 2007

Various aspects of splenic-gonadal fusion are discussed and 1 case of the continuous type is reported. A plea is made to include this condition in the differential diagnosis of scrotal masses, particularly those on the left side.
A rabbit model of perforated appendicitis with peritonitis
Authors: King D W , Gurry J F , Ellis-Pegler R B , Brooke B N
Published: March 2007

No satisfactory animal model simulating acute perforating appendicitis followed by peritonitis in man has hitherto been achieved. A technique has been developed in New Zealand White rabbits to fulfil these desiderata. The bacterial flora associated with the ensuing peritonitis is similar to that found in man both as regards aerobes and anaerobes and their concentrations. The method effectively produces the required model in 70 per cent of rabbits subjected to the experiment. Satisfactory postoperative survival is achieved enabling therapeutic studies.
The non-surgical treatment of thyroid cancer
Authors: Halnan K E
Published: March 2007

The non-surgical treatment of thyroid cancer is outlined. The success of chemotherapy and of radiotherapy is dependent on the number of tumour cells present, and immediate postoperative treatment is therefore often valuable. The role of X-ray therapy, radio-iodine, hormones and chemotherapy is discussed for the different histological types.
The role of surgery in the management of Hodgkin's disease
Authors: Irving Miles
Published: March 2007

The marked improvement in the prognosis of patients with Hodgkin's disease has resulted from advances in radiotherapy and chemotherapy. Success with these treatments depends upon accurate knowledge of the extent of the disease. Clinical assessment of the presence of abdominal disease is unreliable. Exploratory laparotomy with splenectomy, multiple lymph node biopsy and liver biopsy will reveal that preoperative assessment of the extent of the disease is inaccurate in 30 per cent of cases. The information obtained prevents relapses from undiagnosed abdominal disease and ensures that inappropriate radiotherapeutic treatment is not given to patients with disseminated disease.
Experimental studies on the pathophysiological responses of the newborn to injury
Authors: Little R A
Published: March 2007

Experimental studies are reviewed which show that there are significant differences with age in both the local and general responses to injury. The results seem to confirm the belief in the striking ability of the newborn to withstand injury and suggest that one important aspect of this resistance is an increased ability to compensate circulatory hypovolaemia.
Recurrence of gastric ulcer after selective vagotomy and pyloroplasty for chronic uncomplicated gastric ulcer: A 5–10 year follow-up
Authors: De Miguel Jacinto
Published: March 2007

Selective vagotomy and pyloroplasty were used in the surgical treatment of 73 patients with benign gastric ulcer between July 1964 and February 1970. Over the long period of observation recurrence of the gastric ulcer was found in 13 patients (19.1 per cent). This complication occurred equally commonly after treatment of primary and secondary gastric ulcers and was twice as frequent in women as in men. Possible reasons for these recurrences are discussed.

It is concluded that vagotomy and pyloroplasty cure benign gastric ulcer in about 80 per cent of patients, and this should be taken into account in the choice of surgical treatment, especially in patients in whom a gastrectomy might put the patient's life at risk. However, because of the high recurrence rate, it is doubtful whether this operation should be considered the treatment of choice for all cases of gastric ulcer.
A rare complication of hydrocele
Authors: Chatterjee A C
Published: March 2007

A case of multiple stones complicating a hydrocele is presented. Review of the relevant literature has failed to show a similar case. The aetiology of stone formation appears to be obscure.
The effect of metal clips on the tensile properties of healing skin wounds
Authors: Harrison I D , Williams D F , Cuschieri A
Published: March 2007

The effects of nylon sutures and metal skin clips on the tensile properties of healing skin wounds have been studied in the pig. Wounds closed with clips have significantly poorer mechanical properties at 5,7 and 14 days after wounding than similar wounds in the same animal closed with interrupted nylon sutures. This difference increased progressively with the period of retention of the clips. It is also shown that in equivalent groups of 14-day wounds, those in which clips were retained after the seventh day had a lower tensile strength, poorer ability to absorb energy and a lower elastic modulus than similar wounds where clips had been removed early. No such adverse effect was noted with nylon sutures.
Carcinoma of the duodenum: Its preoperative diagnosis
Authors: Satake K , Sowa M , Yamashita K , Kamino K , Kinoshita H , Kato M , Umeyama K
Published: March 2007

Carcinoma of the duodenum, although uncommon, can be diagnosed by direct visualization, photography of the tumour and biopsy by the fibre-duodenoscope. The duodenoscopic examination may not only distinguish carcinoma of the duodenum from pancreatic carcinoma, ampullary carcinoma and secondary tumour from an adjacent organ but will also enable a correct diagnosis to be made early in the course of the disease.

It is therefore suggested that duodenoscopy and biopsy will increase the resectability and 5-year survival rate.
Clinical features of the degenerate meniscus with the results of meniscectomy
Authors: Noble Jonathan
Published: March 2007

A series of 172 patients with an unambiguous diagnosis of horizontal cleavage lesion is reviewed, the average duration of which was 4 1/2 years. Although all the patients complained of pain, night pain and mechanical instability were not invariable. Joint line tenderness was the commonest physical sign. Whereas all but 7 per cent were either “cured” or “improved”, nearly half the patients had persistent complaints, usually pain. The objective physical findings at review frequently failed to correspond with patients' opinions of their knees. Recovery after meniscectomy may be slow.
Familial cancer of the gastro-intestinal tract
Authors: Lovett Eileen
Published: March 2007

A family with a high incidence of early onset gastrointestinal carcinoma is described. Individuals from four generations have been proved to have had the disease. The management of individuals as yet unaffected is discussed and a régime for follow-up suggested.
Enzyme inhibition in colorectal surgery
Authors: Delaney Peter , Lalor Denis
Published: March 2007

Anastomotic dehiscence is particularly common after low anterior resection of the rectum. The enzyme collagenase is largely responsible for this high complication rate. Inhibition of this enzyme in an experimental model produced significantly stronger colonic anastomoses. There may be a place for such an inhibitor in clinical surgery.
Operative cholangiography: Criteria which make exploration of the common bile duct desirable
Authors: Marks C G , Kelvin F M
Published: March 2007

The purpose of this study was to evaluate the individual criteria and combination of criteria examined by operative cholangiography which make exploration of the common bile duct desirable. The overall accuracy of exploration of the common bile duct (89 per cent) was similar to that of previous series. In the normal group the accuracy of the criteria established by Le Quesne (1960) is confirmed.

The most reliable criteria in the abnormal cholangiograms were the presence of single or multiple filling defects in the common bile duct, the absence of free flow of contrast medium into the duodenum and an abnormality of the terminal narrow segment. Measurements to aid assessment of free flow into the duodenum are suggested. In 34 of 40 positive explorations the common bile duct diameter was 14 mm or less; 10 common bile ducts which contained stones were less than 10 mm in diameter. Excess filling of the intra-hepatic ducts was often impossible to judge in the abnormal group and was the least valuable criterion.

Attention is drawn to the advantage of an immediate radiological report.
Delayed arterial embolectomy: A plea for a more active surgical approach
Authors: Ammann J , Seiler H , Vogt B
Published: March 2007

In a series of 18 patients delayed embolectomy of the limb was performed 8-63 days after embolism had occurred. Three patients died (2 of them after amputation), and 7 limbs were amputated after surgery. In 10 instances blood flow was fully restored by the operation. Analysis of the 18 cases leads to the conclusion that the success of delayed embolectomy where neuromuscular function is intact depends primarily on surgical technique. Direct embolectomy by local or regional exposure of the obstructed arterial level is shown to produce better results than conventional (distant) balloon catheter embolectomy by proximal incision. This is thought to be due to increased mural adherence of the embolus, with secondary thrombus formation after a delay of 8 days or more. A plea is therefore made for a more aggressive surgical attitude to delayed arterial embolization. Provided that preoperative arteriography has localized the obstructive level and that the patient's general condition allows major vascular surgery, direct removal of the embolus and secondary thrombi by open exposure of the obstructed artery is recommended.
Bypass grafting to the anterior tibial artery
Authors: Armour Roger H
Published: March 2007

Four patients with severe ischaemia of a leg due to atherosclerotic occlusion of the tibial and peroneal arteries had reversed long saphenous vein grafts to the patent lower part of the anterior tibial artery. Two of these grafts continue to function 19 and 24 months after operation respectively. One graft, failed on the fifth postoperative day and another occluded 4 months after operation. The literature on femorotibial grafting has been reviewed. The early failure rate of distal grafting is higher than in the case of femoropopliteal bypass, but a number of' otherwise doomed limbs can be salvaged. Contrary to widely held views, grafting to the anterior tibial artery appears to give results comparable to those obtained when the lower anastomosis is made to the posterior tibial artery.
Leiomyosarcoma of the right common iliac artery: A case report
Authors: Birkenstock W E , Lipper S
Published: March 2007

A case initially diagnosed at laparotomy as having a phaeochromocytoma was re-explored after negative biochemical tests and found to have a leiomyosarcoma of the right iliac artery.
Ascites and hydrothorax in association with struma ovarii
Authors: Hurlow R A , Greening W P , Krantz E
Published: March 2007

A case is presented of ascites and hydrothorax in association with struma ovarii. Nine previously reported cases are reviewed and the possible causes of the ascites and hydrothorax discussed.
Unoperated ruptured abdominal aortic aneurysms: A retrospective clinicopathological study over a 10-year period
Authors: McGregor John C
Published: March 2007

A series is described of 41 cases of unoperated ruptured abdominal aortic aneurysm in 9894 consecutive autopsies performed in two large general hospitals in Glasgow between 1964 and 1974. The preceding clinical presentations are discussed. These show the difficulties in diagnosing the condition correctly and quickly and the liability to confusion with other intra-abdominal conditions. The correct diagnosis was established before death in only 11 cases, it was suspected in 6 cases and was completely missed in 24 cases.

Pathologically, all the cases were atheromatous and measured more than 5 cm in diameter, and the most common site of rupture was through the lateral wall, Resection would appear to have been technically possible without undue difficulties in the majority of the cases.

An analysis of all the findings indicates the necessity for greater clinical awareness of this condition and its variable mode of presentation. Only in this way will early diagnosis and safer surgical intervention be possible.
Early experience with the Boerema button for bleeding oesophageal varices
Authors: Johnston G W , Kelly J M
Published: March 2007

Early experience with the use of the Boerema button for bleeding oesophageal varices is reported. A simplified technique for its insertion is described, and of the 6 patients so treated, only 1 died. No patient has re-bled in the short follow-up period available, and oesophageal appearances suggest that prolonged relief from bleeding can be anticipated. Further exploration of the button ligation transection technique is suggested not only for control of acute bleeding, but also for patients unsuitable for shunt surgery.
A combined synchronous technique for the McKeown three-phase oesophagectomy
Authors: Royston C M S , Dowling B L
Published: March 2007

A combined synchronous technique is described for the McKeown three-phase oesophagectomy; it reduces operative time and allows a safer mobilization of the stomach into the neck.
Repair of epigastric incisional hernia
Authors: Maguire James , Young Donald
Published: March 2007

A 4–18-year follow-up of a series of epigastric incisional hernia repairs by o method using lateral relieving incisions of the anterior sheath of the rectus is presented. The practicality of operating through the repaired abdomen is shown. The possibility of performing this method of repair at the end of an operation through an existing incisional hernia is mentioned. The recurrence rate was less than 20 per cent.
The relationship between alcohol and head injury and its effect on the conscious level
Authors: Galbraith S , Murray W R , Patel A R , Knill-Jones R
Published: March 2007

The incidence of head injury has risen in recent years and now accounts for almost one-third of acute male surgical admissions to the Western Infirmary, Glasgow. A prospective study has established that in Glasgow alcohol is a major associated factor, 62 per cent of males and 27 per cent of females having detectable levels in the blood (> 5 mg/100 ml); in these patients the mean level was 193 mg/100 ml in men and 165 mg/100ml in women. The alcohol level was significantly higher in patients who had had ‘a fall under the influence’, or had been the victims of assault, than in those involved in traffic or other accidents. This suggests that alcohol may be an important contributory cause of head injuries in this city. Depression of the conscious level occurred at blood alcohol levels around 200 mg/ 100 ml, but a significant number of patients in coma had a serious head injury.
Self-retaining chest drainage tubes
Authors: Tinckler Laurence F
Published: March 2007

A self-retaining chest drainage tube together with a special introducing trocar and cannula is described. The tube has been designed to overcome the disadvantages of existing conventional chest drainage tubes.
Primary malignant tumours of the thyroid: The relationship between histological classification and clinical behaviour
Authors: Beaugié J M , Brown C L , Doniach I , Richardson J E
Published: March 2007

One hundred and seventy-nine primary malignant tumours of the thyroid seen at The London Hospital between 1945 and 1972 were classified by the system of Woolner et al. (1961) and Hazard (1964). The distinct pathological and clinical features of the differentiated primary carcinomas and the similarities and differences between malignant lymphoma and anaplastic carcinoma were confirmed. This study showed the ‘benign’ behaviour of more than half the ‘differentiated’ papillary and follicular carcinomas when treated by thyroid lobectomy and the very malignant nature of anaplastic carcinomas and lymphomas whatever their treatment. The behaviour of medullary carcinoma was closer to that of the other differentiated tumours than to the undifferentiated varieties. Our patients were not thought to have been exposed to known goitrogens or previous thyroid irradiation.
Experimental carotid-basilar bypass
Authors: Feely Michael
Published: March 2007

A procedure for anastomosing the carotid to the vertebrobasilar circulation in the dog is described. A total of 20 experiments (10 acute and 10 chronic) were performed on dogs. The grafted vessel was found to be patent in 2 out of 4 dogs at 3 months after operation. The flow through the grafts, recorded by electromagnetic flowmeter, was 5–9 ml/min.
Peripheral aneurysms in Behçet's disease
Authors: Jenkins A McL , Macpherson A I S , Nolan B , Housley E
Published: March 2007

Two patients with Behçet's disease are reported, both of whom had aneurysms of peripheral arteries. In one the aneurysms were multiple. The aneurysm was replaced with a Terylene prosthesis in one patient, and in the other an autogenous vein bypass was used. In each case a further aneurysm developed adjacent to the vascular anastomosis. Severe ischaemia of the affected limbs subsequently developed in both patients.
Parietal pleurectomy for recurrent pneumothorax
Authors: Askew A R
Published: March 2007

One hundred patients with persistent or recurrent pneumothorax treated by parietal pleurectomy are described. There was one known recurrence and no postoperative deaths. Six patients required further surgery for complications. In the uncomplicated cases the average stay in hospital following operation was 11.5 days. Parietal pleurectomy should he regarded as the treatment of choice for patients with recurrent pneumothorax who are fit to undergo surgery.
Resection and reconstruction for carcinoma of the thoracic oesophagus
Authors: Akiyama Hiroshi , Hiyama Mamoru , Hashimoto Chiaki
Published: March 2007

The technique and results of oesophageal resection through a right thoracotomy and laparotomy with reconstruction utilizing the stomach via a retrosternal route are reported.

Forty patients underwent this procedure, with no mortality. The average blood loss during operation was 424 ml, and 72 per cent of this series underwent the operation without blood transfusion.

It is belied that this type of one-stage operation for carcinoma of the oesophagus is reasonable from the viewpoint of adequate resection of malignancies, and it can be performed with minimal surgical risk. With experience, perhaps it will become a standard method such as the Billroth I method in gastric surgery.
The clinical presentation of pyogenic liver abscess
Authors: Young A E
Published: March 2007

The high mortality rate from pyogenic liver abscess is contributed to by delay in diagnosis. The widespread availability of radio-isotope liver scanning facilitates diagnosis once A hepatic abscess is suspected. This retrospective study identifies diagnostic features present at the time of admission to hospital in 28 patients who were subsequently found to have a hepatic abscess.
The effect of methionine on colonic wound healing in malnourished rats
Authors: Irvin Thomas T
Published: March 2007

Recent studies have suggested that the healing of colonic anastomoses is impaired in malnourished subjects.

It has been claimed that the healing of skin and abdominal wounds in experimental animals is improved by the administration of the essential amino acid methionine, and in the present study the effects of methionine on colonic wound healing were studied in malnourished rats.

Test animals were fed a protein-free diet for 7 weeks before surgery. Methionine-treated animals received the amino acid by subcutaneous injection during the seventh week of protein deprivation and throughout the postoperative period. Anastomoses were made in the left colon, and colonic wound healing was assessed by measurements of the bursting wall tension and collagen content of anastomoses. The results were compared with those of control animals fed a normal rat diet.

Protein deprivation for 7 weeks resulted in a 34 per cent reduction in body weight, and a significant reduction in the tensile strength and collagen content of colonic anastomoses was observed. Methionine supplements had no apparent effect on these parameters of wound healing.

The concept of single amino acid supplementation in cachetic patients undergoing surgery is an attractive one, but it has yet to be established that methionine supplements alone can alter the course of wound healing in such cases.
Open pedicle grafts of ileum for the repair of large duodenal defects: An experimental study
Authors: Gupta A K , Garg B K , Kansal Y K , Sharma B D
Published: March 2007

An experimental study of open pedicle grafts of ileum for the repair of large duodenal defects is presented. All the grafts survived and functioned well. No shrinkage occurred. The results are extremely encouraging for the clinical application of this technique.
Tension pneumothorax from a perforated gastric ulcer
Authors: Nayak I N , Lawrence D
Published: March 2007

A case of tension pneumothorax from a perforated gastric ulcer is reported and the pathogenesis and management of this rare complication are discussed.
Malignant acanthosis nigricans and its unusual association with carcinoma of the colon and carcinoma of the cervix
Authors: Liddell K , Jensen N E
Published: March 2007

Malignant acanthosis nigricans is rarely associated with carcinoma of the bowel or cervix. However, this dermatosis is described in a case of adenocarcinoma of the ascending colon, and in another with carcinoma of the cervix.
An unusual presentation of carcinoma of the rectum
Authors: Nagulesparan M , Williams R A
Published: March 2007

The case is described of a middle-aged man whose rectal carcinoma presented with meningitis, due to a fistula into the spinal theca.
Total three-stage oesophagectomy for cancer of the oesophagus
Authors: McKeown K C
Published: March 2007

The technique of total three-stage oesophagectomy is described fully. Points of detail in the procedure of the abdominal, thoracic and cervical phases are emphasized. A brief note is made regarding the management of the respiratory situation at the end of the operation.
Emergency portasystemic shunt for bleeding varices
Authors: Balasegaram M
Published: March 2007

Sixty-eight patients with bleeding oesophageal varices due to cirrhosis of the liver who have had an emergency portasystemic shunt are reviewed.

The reasons for the emergency shunt surgery and the results are described and discussed. The low postoperative mortality is attributed to careful case selection. Apart from clinical and serological factors, the importance of the bromsulphthalein excretion test is stressed.

Emergency shunts are now undertaken by the author in patients whose serum bilirubin is less than 2.5/100 ml and bromsulphthalein retention less than 10 per cent in 30 minutes. This is in marked contrast to the author's previous series in which there was a 30 per cent mortality.

The poor results in patients treated conservatively and the disparity between the author's results and those of other reported series are reviewed and discussed.
Liver abnormalities and gallstones: A prospective combined clinical, histological and surgical study
Authors: Triger D R , Maciver A G , Gamlen T R , Wilken B J
Published: March 2007

In a prospective study of 57 patients coming to elective cholecystectomy for gallstone disease, clinical, biochemical and immunological features have been correlated with the histological changes in core biopsies of the liver obtained at surgery. Only 13 liver biopsies were normal. Ten biopsies showed changes of acute duct obstruction, 16 showed minimal portal tract abnormalities and 10 showed moderate portal tract inflammation and scarring. Histological changes were more marked in male patients. Clinical and biochemical investigations were not useful in predicting histological appearance, apart from cases with jaundice at the time of operation where changes of acute duct obstruction were usually, but not invariably, seen. Auto-antibodies were present in 50 per cent of cases tested and all persisted for at least 6 months after operation. They were commoner in patients with more marked histological changes. Operative cholangiography was of little use in predicting histological change. These findings suggest that the possibility of gallstones should be considered in the interpretation of any abnormal liver biopsy irrespective of clinical symptoms or biochemical investigations.
A controlled trial of drainage after cholecystectomy
Authors: Gordon A B , Bates T , Fiddian R V
Published: March 2007

A prospective controlled trial of drainage after cholecystectomy has been carried out. In a consecutive series of 143 patients undergoing cholecystectomy, 50 patients were randomly allocated to a drainage group and a further 50 patients to a non-drainage group. The remaining 43 patients were drained electively because the common bile duct was explored or because of infection or incomplete haemostasis.

There was no significant difference in the incidence of wound infection or other complications between the drainage and the non-drainage groups. The duration of postoperative pyrexia, the number of analgesic injections and the length of postoperative hospital stay were the same in both the randomized groups.

One patient in the randomized drainage group had a reactionary haemorrhage from the drain site requiring transfusion. There was no mortality but one patient in the elective drainage group had to be re-explored for a subhepatic abscess. Three patients in this group drained bile from the drain for 3–9 days but all had a T tube in place.

This trial fails to demonstrate any advantage or disadvantage in draining the gallbladder bed after cholecystectomy.
Brucellosis of the spine
Authors: Glasgow M M S
Published: March 2007

Three cases of spinal brucellosis are presented, demonstrating involvement of the cervical, thoracic and lumbar regions respectively, and the management is discussed.

Particular reference is made to the problems of establishing the diagnosis, and also to the differentiation of this condition from tuberculosis of the spine.
Fluid-filled intestinal obstruction
Authors: Kingsnorth A N
Published: March 2007

Three cases of intestinal obstruction are described in which the diagnosis was delayed because of the absence of gas in the bowel. The obstructed bowel was entirely fluid-filled and so abdominal distension was not marked, peristaltic sounds were not accentuated and the abdominal X-rays did not show air-fluid levels.
The effects of Corynebacterium parvum and surgery on the Lewis lung carcinoma and its metastases
Authors: Sadler Tessa E , Castro J E
Published: March 2007

The effects of Corynebacterium parvum on the mouse primary Lewis lung carcinoma and its metastases were studied. C. parvum was given at the same time as subcutaneous inoculation of tumour or in combination with surgical excision of the primary after 10 days' growth.

When intravenous C. parvum was given at the same time as tumour there was a reduction in the primary tumour growth rate. There was a similar reduction in growth if the drug was given intravenously 7 days after tumour inoculation. Intraperitoneal and subcutaneous administration of C. parvum had no effect on the primary tumour.

The number of pulmonary metastases were significantly reduced after intravenous or intraperitoneal C. parvum given at the same time as tumour. When C. parvum and surgery were combined and C. parvum was given not more than 2 days before operation there was only a slight reduction in metastases, but when the injection was given intravenously or intraperitoneally 3–4 days before operation the number of metastases was significantly reduced. Subcutaneous administration of C. parvum had little effect on metastases.

There was no difference in the number of metastases if C. parvum-treated mice were killed after 21 or 28 days. C. parvum given on the same day as surgery was more effective if tumour excision was performed before day 10 when the metastases were less well established.

It was concluded that in well-defined conditions C. parvum is effective against metastases of the Lewis lung carcinoma.
Splenogonadal fusion
Authors: Tsingoglou S , Wilkinson A W
Published: March 2007

The fusion between splenic tissue and the left gonad or the derivatives of the left mesonephros is a rare congenital anomaly first described in detail by Pommer in 1887/9 and divided into two forms by Putschar and Manion in 1956.

In the first or continuous type a cord of splenic or fibrous tissue connects the spleen and the gonadal-mesonephric structures. In the second type the fused splenomesonephric structures have lost continuity with the main spleen.

An example of the continuous form is presented and the previous reports are briefly reviewed.
Fatal pseudomembranous enterocolitis following clindamycin therapy
Authors: Dane T E B , King E G
Published: March 2007

A fatal case of pseudomembranous enterocolitis following oral and parenteral clindamycin therapy is presented, interesting features in this case are involvement of the small bowel and complete sparing of the large bowel distal to a defunctioning transverse colostomy. The significance of the absence of disease in the defunctioned bowel is discussed in terms of aetiology and diagnosis of pseudomembranous enterocolitis.
Distal colomyotomy: Follow-up of 37 cases
Authors: McGinn F P
Published: March 2007

The 3–7-year follow-up results of 37 patients undergoing the operation of distal colomyotomy are reported. Twenty-five underwenr surgery for uncomplicated diverticular disease; there was no mortality but 40 per cent of patients had recurrent symptoms. Twelve patients underwent surgery for complicated diverticulas disease, with an operative mortality of 16.6 per cent and a recurrent symptom rate of 37.5 per cent.
Rectal biopsy in the diagnosis of neurological disease in childhood
Authors: Smith Paul , Dickson J A S , Lake Brian D
Published: March 2007

A surgical technique for taking a full thickness rectal biopsy for neurological diagnosis is described. The indications for, and results of 93 biopsies are reviewed. A definite neurological diagnosis was made in 38 (41 per cent). The usefulness of rectal biopsy is now largely confined to Batten's disease, which was found in 32 (34 per cent of the total). Alternatives and objections to rectal biopsy for neurological diagnosis are discussed. It is concluded that rectal biopsy is a safe and reliable procedure.
A retrospective analysis of the accuracy of immediate frozen section diagnosis in surgical pathology
Authors: Lessells A M , Simpson J G
Published: March 2007

An evaluation OJ the accuracy of' 3556 frozen section diagnoses over a 10-year period has been carried out. The overall accuracy rate was 97.4 per cent, with unimportant discrepancies present in a further 1.8 per cent. In only 28 cases (0.8 per cent) was a false negative or positive diagnosis of malignancy made. Of these, 4 patients underwent an unnecessary radical operation, while in 9 patients further surgery had to be carried out at a later date. The essential accuracy of the frozen section technique is confirmed.
Biopsy of the impalpable breast lesion detected by mammography
Authors: Millis R R , McKinna J A , Hamlin I M E , Greening W P
Published: March 2007

Specimen radiology plays an essential part in the surgical management of the impalpable breast lesion detected by mammography. It also plays a necessary part in the complete pathological examination of the specimen. A method for preoperative localization of the mammographically detected impalpable breast lesion is described.
The association of duodenogastric reflux with dumping and gastric retention
Authors: Donovan I A , Keighley M R B , Griffin D W , Harding L K , Alexander-Williams J
Published: March 2007

Gastric emptying of solid and liquid meals together with duodenogastric reflux has been measured in a prospective trial of proximal gastric vagotomy and truncal vagotomy and antrectomy. Three abnormalities of motility associated with postoperative symptoms have been defined. If more than one abnormality was present in an individual there was an 80 per cent incidence of associated symptoms. Proximal gastric vagotomy produced significantly fewer abnormalities of gastro-duodenal motility than did truncal vagotomy and antrectomy.