bluuebunny/crossref_metadata_2025 huggingface dataset:
Observations on acute pancreatitis
Authors: Imrie C W
Published: March 2007

One hundred and forty cases of acute pancreatitis are reviewed of whisch 127 cases wee primary and 13 secondary acute pancreatitis. An association with biliary disease was found in 50 per cent of cases; 12·2 per cent of case were associated with heavy alcohol intake. In just over one-third of cases no aetiological factor was identified.

The overall mortality rate was 21·4 per cent; the mortality for primary acute pancreatitis was 18·9 per cent but only 5·5 per cent in patients under 50 year old. The mortality for secondary acute pancreatitis was 46 per cent. In primary acute pancreatitis operative intervention was associated with a 36·6 per cent mortality as compared with conservative management which had a 10·5 per cent mortality.

The most important complication of acute pancreatitis was acute renal failure which accurred in 20 patients, 15 of whom died. Pseudocysts formed in 15 patients and were best treated by internal drainage, via cstogastrostomy where possible.
Aorto-oesophageal fistula: A late complication of a resected coarctation
Authors: Bigge T , Rothnie N G
Published: March 2007

A case of aorto-oesophageal fistula is reported as a rare and late complication of surgery for aortic coarction. The clinical and aetiological aspects are discussed. Awareness of the condition is the key to early diagnosis and treatment.
The delayed hypersensitivity reaction in breast cancer
Authors: Roberts M Maureen , Jones-Williams W
Published: March 2007

Women with breast cancer confined to the breast (stage I) have a reduced dermal delayed hypersensitivity reaction to Varidase; the degree of anergy to this antigen increases as the disease progresses. The in vitro reaction to phytohaemagglutinin, however, remains normal throughout the course of the disease.
Protein-losing enteropathy in primary lymphoedema: Mesenteric lymphography and gut resection
Authors: Kinmonth J B , Cox S J
Published: March 2007

Patients with primary disease of the lymph system may present with hypoproteinaemia and peripheral oedema. The latter may be partly lymphatic and partly ‘famine’ oedema due to low serum protein.

The hypoproteinaemia may be shown to be due to protein loss into the gut. At laparotomy characteristic changes caused by mesenteric lymph obstruction are visible. They may be further elucidated by mesenteric lymphography.

Three patients have been treated by excision of the worst affected length of bowel and anastomosis. Their clinical and nutritional states have improved. There have been no complications.
Antral acidification and the gastric secretory response to pentagastrin and acetylcholine in dogs
Authors: Wheeler M H , Prescott R J , Forrest A P M
Published: March 2007

In 6 dogs with innervated antral pouches (3 with vagally innervated fundic pouches and 3 with vagally denervated fundic pouches) gastric secretion was stimulated by a range of submaximal doses of pentagastrin, each infused intravenously for a period of 6 hours.

During the three consecutive 2-hour collection periods of each test the antral pouch was perfused with isotonic saline of pH 7 0, 1.0 and 7.0 respectively at a rate of I ml/min. Neither acid nor pepsin secretion was inhibited by antral acidification. When the antral perfusion rate was increased to 3 ml/min there was still no inhibition of acid secretion from either type of fundic pouch.

In each dog the acid response of the fundic pouch to perfusion of the innervated antral pouch with 0–5 per cent acetylcholine was significantly reduced when the pH of the perfusate was lowered from 7.0 to 1.0.

The results provide no support for the existence of either an antral inhibitory hormone or inhibitory neural reflex active against pentagastrin-stimulated gastric secretion in the dog. It would seem that antral inhibition of gastric secretion is the result of a diminished release or formation of endogenous gastrin.
The pattern of bile salt reflux and acid secretion in sliding hiatal hernia
Authors: Crumplin M K H , Stol D W , Murphy G M , Collis J L
Published: March 2007

The role played by gastric fluid refluxed from the stomach into the oesophagus of patients with symutomatic sliding hiatal hernia has been evaluated in terms of gastric bile salt concentration and acid secretion rates. Patients with a peptic stricture had a higher basal acid output than control subjects. Approximately half of both hiatal hernia groups studied had periods of increased total bile salt concentrations either while fasting or following a test meal, This would indicate abnormal pyloric function in these patients. The quantitative examination of total and individual bile salts in solution in gastric juice suggests that a combination of gastric acid pepsin and bile may be a major, factor in the pathogenesis of the clinical responses to gastrooesophageal reflux. Neither total nor individual bile salt concentrations found in gastric juice helped to differentiate between the specific types of response seen in symptomatic sliding hiatal hernia.
Thyroid function following partial thyroidectomy
Authors: Griffiths N J , Murley R S , Gulin R , Simpson R D , Woods T F , Burnett David
Published: March 2007

The main objective of this investigation was to establish the incidence of hypothyroidism and recurrent goitre following partial thyroidectomy. Accurate measurements of the thyroid remnants and resected specimens have been made in all cases. The postoperative thyroid status has been assessed clinically and also biochemically by serum thyroxine as iodine, T3 resin uptake, free thyroxine index and thyroid-stimulating hormone estimations. Serum calcium and phosphorus have also been measured and the necessary histological material reviewed.

Postoperative hypothyroidism occurred in approximately 11 per cent of previously toxic and 6.5 per cent of non-toxic patients, becoming evident in most cases within a year of operation. The T3 resin uptake measurement following operation in this and previous series suggests that in many patients there is a compensation process which is maintained by increased secretion of thyroid-stimulating hormone. No evidence has been adduced that patients who show this compensation mechanism are, as some have suggested, in a state of ‘subclinical hypothyroidism’ or that they become overtly hypothyroid later.

In this series hypothyroidism was more closely related to small remnant size than the presence of lymphadenoid change. A significantly higher proportion of patients with small thyroid remnants became hypothyroid in both toxic and non-toxic groups. Remnants of about 8–16 ml ‘cuboid’ volume (roughly 8–16 g by weight) have seemed reasonable for our patients.
Leiomyosarcoma of the foot presenting as an arteriovenous fistula
Authors: Thomas M H , Molland E A , Eadie D G A
Published: March 2007

A deeply situated leiomyosarcoma of the foot is a rare condition. The clinical presentation of such a case in a young man was confused with that of a postoperative arteriovenous fistula. The patient was treated initially by local excision of the tumour and later by amputation. The criteria for histological diagnosis and assessment of malignancy are discussed.
The ultrasonic detection of incompetent perforating veins
Authors: Miller Stanley Scott , Foote Andrew V
Published: March 2007

Of the methods of detecting incompetent perforators in current use, only two, clinical and ultrasouna, are easily performed and lend themselves to routine use in the ward or outpatients' department. The ultrasound method has a higher degree of accuracy than the clinical method, requires little in the way of additinal equipment or training and provides a very useful method of pre- and postoperative assessment of the varicose leg as well as a method for the study of the natural history of the disease.

In a pilot study of 100 limbs 28 incompetcnt perforators were discovered in 36 ‘normal’ limbs. A detection rate of 82 per cent in 165 marked sites was noted in limbs with varicose veins. Greater numbers of perforators were found in association with skin changes and previous operation than in uncomplicated varices. In 15 of 64 limbs with varicose veins no incompetent leg perforators were detected.
The value of gastrostomy in the surgery of aortic aneurysms
Authors: Morris Tom , Bouhoutsos John , Martin Peter
Published: March 2007

A retrospective study was made of the progress of 205 patients after operation for abdominal aortic aneurysm with special reference to the method of gastric decompression used. Forty-six patients had a gastrostomy, and their mean length of stay in hospital was 8 days less, a highly significant difference.
Recurrent head and neck cancer: The results of treatment
Authors: Williams R G
Published: March 2007

A study of 144 patients with cancer of the head and neck showed that 67 (46 per cent) developed recurrent cancer. Radical second treatment, almost exclusively by surgery, secured an 11 out of 67 or 16 per cent crude 5-year survival rate for recurrent head and neck cancer. Further analysis showed that the prospects of successful second treatment were negligible or nil with certain identifiable tumours or tumour sites. When these identifiable cases are excluded the survival rate for head and neck cancer became 11 out of 45 or 24 per cent. Age and general condition rendered some patients unfit for radical surgery. In this series 30 patients were treated by radical surgery with a patients cured: patients surgically treated ratio of 11 out of 30 or 36 per cent.
The effect of vagotomy on the inhibition of gastric secretion by intraduodenal acid
Authors: Ward A S
Published: March 2007

Acid in the duodenum is known to inhibit gastric secretion in man but whether this response is a humoral or a vagal phenomenon is unknown. If a vagal reflex is involved then selective and highly selective vagotomy, by preserving the duodenal nerve supply, could offer advantages over truncal division. This study was designed to investigate this claim.

The effect of intraduodenal hydrochloric acid on pentagnstrin-stimulated gastric secretion was stimulated in 17 control subjects, 32 preoperative duodenal ulcer patients and 28 vagotomized patients (16 truncal vagotomy and pyloroplasty; 6 selective vagotomy and pyloroplasty; 6 highly selective vagotomy). Inhibition of acid output occurred in 15 control subjects, and the mean inhibition for the group was 2.68 + 0.39 mEq/10 minutes (P < 0.001). Inhibition occurred in 22 duodenal ulcer patients, and the mean reduction in acid output for the entire group was 2.26 ± 0.46 mEq/l0 minutes (P < 0.001). Intraduodenal acid failed to produce a response in the vagotomized patients irrespective of the presence or absence of a duodenal nerve supply.

These results suggest that gastric secretory inhibition by intraduodenal acid is a vagal phenomenon in man; selective and highly selective vagotomy do not appear to carry any particular advantage over truncal section in terms of preserving this response.
Treatment of acute cholecystitis by routine urgent operation
Authors: Salleh Hussein Bin Mohamed , Balasegaram M
Published: March 2007

Two hundred and eighteen unselected cases of acute cholecystitis have been routinely treated by urgent cholcystectomy within 12 hours of admission to hospital. The mortality (0.5 per cent) and morbidity are within acceptable limits. The rate of diagnostic error has been low (1.4 per cent) so that negative laparotomy only occurred very occasionally.
Non-parasitic liver abscess
Authors: Schraibman I G
Published: March 2007

Fifteen proved cases of non-parasitic liver abscess from the Manchester region are presented with special reference to the diagnostic features, which with a high level of clinical suspicion will make the diagnosis possible. The value of the serum protein ratio and isotope scanning is particularly emphasized. A classification of the disease based on the pathology and the prognosis is advocated. Once the diagnosis is reached, surgical drainage is effective, but the consequences of delay or misdiagnosis may be fatal.
Pleural empyema due to ruptured amoebic liver abscess
Authors: Rasaretnam Rudra , Paul A T S , Yoganathan M
Published: March 2007

Thirty-one cases of empyema due to ruptured amoebic liver abscess treated by either intercostal tube drainage or decortication are presented. On account of the rapid development of a thick membrane, intercostal drainage was successful only in the cases which were seen early. The poor general condition of the patient was the cause of death in 4 of the 5 fatal cases.
The importance of adequate nutrition in closure of small intestinal fistulas
Authors: Himal Harry S , Allard Jean R , Nadeau Jacques E , Freeman Joel B , Maclean Lloyd D
Published: March 2007

Ninety-one patients with small intestinal fistula, exclusive of the peforated duodenal stump and fistula in patients with carcinomatosis, were treated over the period 1960–73.

Four regimens were used which permit comparison of early surgery, late surgery and nutritional support without surgery (1500–5000 kcal daily by the intravenous route). A lower mortality (8 per cent) resulted when patients were supported nutritionally combined with late definitive surgery if required after the peritonitis had subsided. The other groups in which no special effort at nutritional support was made resulted in a 33 per cent mortality rate.

Spontaneous closure of the fistula occurred in 21 per cent of the group without nutrition and in 56 per cent of the nutrition group. Definitive late surgery was required for distal obstruction, Crohn's disease and undrained abscess.

Total intravenous feeding is especially important in patients with fistula associated with peritonitis and sepsis.
Carriage of potentially pathogenic bacteria in the hair
Authors: Black W A , Bannerman Christina M , Black D A
Published: March 2007

Using an improved technique for sampling, the carriage rate of Gram-negative bacilli and Staphylococcus aureus in the hair was studied in two groups of surgical inpatients and two control groups drawn from the hospital stag and a hospital outpatients' clinic. No significant differences in the hair carriage rate of Gram-negative bacilli were observed between the patients and the control groups, or between patients with and without Gram-negative wound infection. The hair carriage rate of Staph. aureus was highest in the hospital staff group, and was significantly higher also in the outpatient control group than in the inpatient groups. The potential implications of these findings on hospital infection are discussed.
Short term routine antibiotic prophylaxis in surgery
Authors: Stokes E J , Waterworth P M , Franks V , Watson B , Clark C G
Published: March 2007

The effect of two doses only of tobramycin (or gentamicin) plus lincomycin timed to cover the operative and immediate postoperative period was tested in a double blind trial. Evidence is presented that wound infection was reduced. No acquired bacterial resistance was encountered nor is this likely after such short term therapy.

Routine use of this régime is recommended for all operations in which colonized viscera or infected body cavities have to be handled or opened.
Breast cancer and the immune response
Authors: Tee D E H , Pettingale K W
Published: March 2007

Patients with malignant disease including that of the breast may show specific immune reactions against their own tumours, and as the disease progresses other immune reactions may be depressed. The current controversy surrounding regional lymph node therapy in early breast cancer is discussed. Ideas about the further immunological investigation of patients with breast cancer are outlined.
The effects of carotid endarterectomy on the mechanical properties of the carotid sinus and carotid sinus nerve activity in atherosclerotic patients
Authors: Angell-James Jennifer E , Lumley J S P
Published: March 2007

The hypothesis that instability of blood pressure occurring after carotid endarterectomy is related to interference with mechanical properties of the arterial wall in the region of the carotid sinus was investigated in 11 patients undergoing carotid surgery for transient ischaemic neurological disturbances. The operative procedure was found to change the mechanical properties of the arterial wall, there being an overall increase in diameter and reduction in distensibility, and these changes were reflected in the recorded change of spontaneous sinus nerve activity and the systemic blood pressure. It is suggested that the sinus nerve and carotid baroreceptor region should be carefully preserved during carotid endarterectomy to prevent reflex postoperative hypertension. Should hypotension occur in the postoperative phase it can be treated by local anaesthesia of the sinus region, anaesthetic blockade being maintained until secondary adaptation of the receptors takes place.
The treatment of advanced bladder cancer with sensitized pig lymphocytes
Authors: Feneley R C L , Eckert H , Riddell A G , Symes M O , Tribe C R
Published: March 2007

Twenty-five patients with transitional cell carcinoma of the urinary bladder have been treated by infusion of sensitized pig lymph node cells into the arterial blood supply of the tumour. In 7 cases pig cell infusion was the only treatment, in a further 7 patients pig cells were given in the treatment of a major tumour recurrence following radiotherapy and in 11 patients pig cell infusion was followed after 4-8 weeks by an attenuated course of radiotherapy. In these three treatment groups 2, 3 and 9 patients respectively obtained clinical benefit and biopsy showed histological change.
The physical and bacteriological properties of disposable and non-disposable suction drainage units in the laboratory
Authors: Lumley J S P , Britton B J , Chattopadhyay B
Published: March 2007

The physical and bacteriological properties of disposable and non-disposable suction units have been studied in the laboratory. The disposable units which operate at a lower suction pressure were found to be subject to spontaneous loss of vacuum, while positional change of the containers of the magnitude encountered in clinical practice could easily produce reversal of flow from the container. The incidence of contamination in the systems in a laboratory model designed to simulate the ward situation was higher in the disposable units.
The results of reoperation for bile vomiting following surgery for peptic ulcer
Authors: Griffiths J M T , Smith A N , Small W P , Falconer C W A
Published: March 2007

A retrospective study is presented of 91 patients (72 male and 19 female) who underwent remedial surgery in the Gastro–intestinal Unit, Western General Hospital, between 1958 and 1972 for bile vomiting following surgery for peptic ulcer. The mean follow–up period was 5.2 years.

Fifty-eight (63.8 per cent) patients had undergone a previous gastric resection, 26 (28.5 per cent)a vagotomy and drainage operation and 7 (77 per cent)a gastrojejunostomy alone.

At reoperation no abnormality could be found to account for the vomiting in 29 (30.9 per cent)patients, 52 (57.1 per cent) had an obstructed afferent loop, efferent loop or stoma and 6 (6.6 per cent) had acute gastritis only. Twelve (13.2 per cent)patients had a recurrent ulcer. Preoperative barium meal examination and gastroscopy together correcrly indicated the operative findings in 846 per cent of cases.

For bile vomiting following Polya gastrectomy 64–68 per cent of those who had a Roux-en- Y conversion or an isoperistaltic jejunal interposition obtained lasting relief of symptoms, as against 55 per cent of patients who had their Polya anastomosis converted to a Billroth Z type. Where the original operation had been a vagotomy and drainage procedure 71 per cent of those converted to a Polya gastrectomy did well, but conversion to a different type of drainage or refashioning of the existing anastomosis was successful in only 40 per cent.

The results in 28 patients with a concomitant psychoneurosis were not significantly different from those in the rest of the group.
The place of pylorus-preserving gastrectomy in the treatment of duodenal ulcer
Authors: Hennessy T P J , Whelton M J , Brady M P
Published: March 2007

Forty-seven patients with chronic duodenal ulceration have had a pylorus-preserving gastrectomy carried out.

The mean reduction in maximal acid output after the procedure was 65 per cent. Pyloric sphincter function appeared normal postoperatively and gastric emptying time was slow without stasis. Postoperative dumping was absent and there has been no evidence of recurrence. In spite of retention of a cuff of antrum circulating gastrin levels are greatly reduced.

The results appear to justify the use of the procedure for uncomplicated duodenal ulcer.
Epidural analgesia following cholecystectomy
Authors: Addison N V , Brear F A , Budd K , Whittaker M
Published: March 2007

In a prospective study of 50 patients undergoing cholecystectomy epidural analgesia was found to be more effective than pethidine in achieving adequate postoperative analgesia. Pain was assessed using the visual linear analogue. In patients receiving epidural analgesia there was a 16 per cent reduction in the incidence of postoperative pulmonary infection compared with the control group. The small but significant number of complications arising and the time involved during anaesthesia may preclude the method from wider adoption, but it is suggested that epidural analgesia should be considered in high risk patients.
Gastrin response to food in duodenal ulcer patients before and after selective or highly selective vagotomy
Authors: Stadil F , Rehfeld J F , Christiansen P M , Kronborg O
Published: March 2007

The role of the vagus in the gastrin response to a steak meal was investigated in patients with duodenal ulcer. Thirty patients were studied before and after vagal denervation of the entire stomach (selective vagotomy and s pyloroplasty). Basal and stimulated gastrin concentrations in serum, as determined by radio-immunoassay, were higher postoperatively (87 pre-/III postopera-tively (basal)and 2431341 (peak) pglml). Thirty other patients were studied before and after denervation of the gastric body (highly selective vagotomy). Bnsnl and stimulated gastrin concentrations were also higher postoperatively in these patients (94/133 and 277/343 pg/ml respectively). The differences between the two groups were insignificant. Between individuals, gastrin responses varied markedly, but pre- and postoperative responses were positively related within the same subject. No differences were observed between patients with ‘positive’ or ‘negative’ Hollander responses to insulin. In 6 subjects studied 2 and 14 weeks postoperatively no difference was apparent between the two studies.

It is concluded that antral branches of the vagi play only a minor role, if any, in the gastrin response to food.
Recurrent pneumococcal peritonitis associated with an intra-uterine contraceptive device
Authors: Herbert Timothy J , Mortimer P P
Published: March 2007

A case of recurrent pneumococcal peritonitis is reported in which it appears that an intra-uterine contraceptive device (IUCD) was implicafed in the infection. The pathogenesis and management of the condition are discussed.
Fibrous histiocytoma of the thumb
Authors: Helal B , Currey H L F , Vernon-Roberts B
Published: March 2007

A young man with a 20-year history of agonizing pain arising from a lump which was overlying the metacarpo-phalangeal joint of his left thumb. This was unrelieved by surgery carried out 3 years after the onset of symptoms. Further operation was performed and the lesion proved to be a fibrous histiocytoma. The differential diagnosis is discussed.
Partial thyroidectomy for thyrotoxicosis
Authors: Gough A L , Neill R W
Published: March 2007

In a study of 235 consecutive patients who had undergone partial thyroidectomy for thyrotoxicosis 86 per cent of the patients who were traced were euthyroid. Only 9 per cent had developed hypothyroidism and 4per cent had become toxic again. It is concluded that the partial operation will render the great majority of patients euthyroid and that the subtotal operation should be abandoned.
The single thyroid nodule and carcinoma
Authors: Messaris G , Kyriakou K , Vasilopoulos P , Tountas C
Published: March 2007

A review of 568 cases of single thyroid nodule operated upon during the period 1960–72 is presented.

Females were more frequently affected than males, the ratio being 8.6:1. The right lobe was more frequently involved (57.6 per rent) than the left. The nodules in our series were classified according to the scintiscan findings as follows: cold 466 cases (82 per cent), warm 32 cases (5.6 per cent) and hot or toxic 70 cases (12.4 per cent). The incidence of carcinoma was 12 per cent and 6.2 per cent in cold and warm nodules respectively. No malignancy was found in either hot nodules or toxic adenomas. The incidence of carcinoma was higher in male patients and significantly higher in patients of over 60 years.
The effect of posture on the gastric emptying of solid meals in normal subjects and patients after vagotomy
Authors: Hancock B D , Bowen-Jones E , Dixon R , Testa T , Dymock I W , Cowley D J
Published: March 2007

The effect of posture on gastric emptying of solid meals has been studied in normal subjects and compared with the effect in patients who had recently had either a truncal vagotomy and pyloroplasty or a highly selective vagotomy. The meal was labelled with 51Cr and emptying monitored with a gamma camera.

The stomach of the normal subjects emptied at the same rate whether they were standing up or lying down. Patients tested less than 3 months aflev truncal vagotomy and pyloroplasty and also after highly selective vagotomy had significantly faster (P < 0.01) gastric emptying when standing than when lying down. Afrer trunral vagotomy and pyloroplasty emptying was significantly slower than normal when lying down but normal when standing. After highly selective vagotomy emptying was normal when lying down but significantly faster than normal when standing.
A trial of 1-(2-chlorethyl)-3-(4-methyl-cyclohexyl)-1-nitrosourea in the treatment of patients with advanced gastro-intestinal cancer
Authors: Giles G R , Hall R , Brennan T G , Worthy T S
Published: March 2007

This paper describes an uncontrolled preliminary study of a nitrosourea drug 1-(2-chlorethyl)-3-(4-methyl-cyclohexyl)-1-nitrosourea, testing its activity against advanced gastro-intestinal cancer. Used as a single agent in a single oral dose, the objective remission rate was only II per cent. Palliation of symptoms was achieved in one-third of the cases. Side-effects were commonly seen, with immediate nausea and vomiting in two-thirds of the patients and evidence of bone marrow suppression in 55 per cent. This particular nitrosourea derivative does not appear to have a significant advantage over other forms of cytotoxic therapy when used as a single agent.
Pseudo-obstruction of the large bowel
Authors: Bardsley David
Published: March 2007

Twelve episodes of large bowel pseudo-obstruction occurring in 11 patients are described. The clinical and radiological features are discussed from a diagnostic aspect. The aetiology and treatment of the condition are considered.
Tuberculosis in the wall of a branchial cyst
Authors: Bourke J B , Smith P G , Obrahi M
Published: March 2007

The occurrence of tuberculosis in the wall of a branchial cyst is reported. This appears to be only the second recorded case.
The effect of elastic stockings on superficial venous pressures in patients with venous insufficiency
Authors: Somerville J J F , Brow G O , Byrne P J , Quill R D , Fegan W G
Published: March 2007

Relief of symptoms and alterations of superficial venous pressures as a result of wearing elastic stockings were assessed in 12 patients with varicose veins. The effect of wearing elastic stockings on superficial venous pressures was measured in 10 normal volunteers.

In the group of patients continuous elastic stocking compression produced relief of symptoms and a lowering of the venous ambulatory pressure.
The influence of haemoglobin and platelet levels on the results of arterial surgery
Authors: Bouhoutsos John , Morris Tom , Chavatzas Demetrios , Martin Peter
Published: March 2007

The early complications of 445 arterial operations were analysed with reference to the preoperative haemoglobin concentration and platelet count. The haemoglobin levels were compared with those of 200 non-arteriosclerotic control subjects, and the influence of cigarette smoking on the haemoglobin levels of both groups was assessed. It was concluded that smoking did not affect the haemoglobin levels and that arterio-sclerotic patients tended to have higher haemoglobin levels than normal controls. It seems that the higher the haemoglobin or platelet level the greater is the risk of complications at or soon after operation.
The response of the lower oesophageal sphincter to maximal doses of pentagastrin
Authors: Trindade L M , Rosenberg I L , Rozycki Z J , Giles G R
Published: March 2007

Measurements of the lower oesophageal sphincter pressure and gastric secretion were made in patients with dyspepsia but no reflux and in patients with a hiatus hernia and reflux in response to a near maximal dose of pentagastrin. Patients with hiatus hernia had lower resting sphincter pressures than those with dyspepsia. The magnitude of the pressure rise following pentagastrin was related to the resting tone of the sphincter. However, in terms of percentage increase over resting sphincteric pressure, patients with dyspepsia and patients with a hiatus hernia had similar responses.
The occult osteomatous changes in the mandible in patients with familial polyposis coli
Authors: Utsunomiya Joji , Nakamura Tadashi
Published: March 2007

Characteristic radio-opaque lesions were detected in the mandibular bone, most clearly on the panoramic X-ray, in 27 or 93·2 per cent out of 29 cases in 15 families with familial polyposis coli, including 21 cases without Gardner's stigmata, 7 cases with the incomplete syndrome and 1 with the complete syndrome.

Only 3 out of 19 members of these families who were free from polyposis had radio-opaque jaw lesions. The cases with polyposis of other types also showed a negative result.

The radiological diagnosis suggested that the lesions were of the character of endosteoma. Our observation is considered to be significant evidence in the understanding of the pathogenesis of Gardner's syndrome as well as a useful method for the early detection of carriers in the polyposis family.
The relationship between ultrasound assessment and angiography in occlusive arterial disease of the lower limb
Authors: Chamberlain J , Housley E , Macpherson A I S
Published: March 2007

The Doppler ultrasound technique has been used to assess the haemodynamics of the peripheral circulation in patients with arterial disease. Using this method the resting pressure index and the response after exercise of the systolic pressure at the ankle was determined in 62 limbs.

Following exercise, four patterns of abnormal response to exercise were found and graded in severity from 1 to 4. A single aorto-iliac lesion was associated with a normal or slightly reduced resting pressure index but with a severe reduction of pressure (grade 3–4) after exercise. A single femoropopliteal lesion was usually associated with a low resting pressure index but only a slight (grade 1–2) fall after exercise.

A low resting pressure index and a severe postexercise grade were found in patients with multiple occlusions. Disease of the profunda femoris artery was associated usually with both a low resting pressure index and a grade 3–4 post-exercise curve.
Phenol sympathectomy in the treatment of intermittent claudication: A controlled clinical trial
Authors: Fyfe T , Quin R O
Published: March 2007

Twenty-five patients with intermittent claudication were randomly allocated to treatment either by injection of phenol into the lumbar sympathetic chain or by injection of local anaesthetic subcutaneously. On the day after the injection, sympathectomy, assessed by skin temperature change, was achieved in 85 per cent of the phenol group.

At 1 month subjective improvement was claimed by 45 per cent of the patients in the sympathectomized group and by 64 per cent in the control group; at 3 months the figures were 25 and 45 per cent respectively.

Treadmill testing at two exercise loads showed no significant difference in claudication distance or stopping time between the two groups. Calf blood pressure response following exercise was not affected by sympathectomy.

There is no subjective or objective evidence that phenol sympathectomy improves intermittent claudication.
Nutritional support in the management of external fistulas of the alimentary tract
Authors: Kaminsky Victor M , Deitel Mervyn
Published: March 2007

A total of 56 patients with 65 fistulas was treated using one or a combination of three modern nutritional aids. Fifty-two of the fistulas (80 per cent) closed spontaneously and only 7 fistulas (10.8 per cent) required attempts at operative closure. The overall mortality was 7 patients (12.5 per cent), which compared favourably with a 40 per cent mortality in an earlier comparable group which had not received such nutrition.
The treatment of resistant malignant ascites by insertion of a peritoneo-atrial Holter valve
Authors: Pollock A V
Published: March 2007

Holter valves have been used in 9 cases to drain ascites, and in 1 case a pleural effusion, into the superior vena cava. All these effusions were due to malignant disease. Three patients died before the results of the operation could be assessed and in 1 case ascites rapidly recurred. Five patients were relieved until death from their primary disease. One patient died 3 1/4 years after insertion of the valve, but ascites had returned—probably as a result of recurrent blockage of the valve by particulate matter.
Decreased incidence of indomethacin-induced gastric ulceration in rats by bile duct diversion
Authors: Abtahi Foroogh S , Djahanguiri Bijan
Published: March 2007

Gastric mucosal ulceration was produced in rats following intraperitoneal injection of indomethacin (40 mg/kg). The incidence of ulcerations was progressively reduced as the bile flow was diverted progressively distal to the ampulla of Vater. It is suggested that bile reflux into the stomach may play a part in the pathogenesis of indomethacin-induced gastric ulceration in rats.
An appraisal of peritoneal lavage in the diagnosis of the acute abdomen
Authors: Evans Christine , Rashid A , Rosenberg I L , Pollock A V
Published: March 2007

Forty-seven selected patients presenting with acute abdominal symptoms were investigated by examination of the fluid obtained by peritoneal lavage. In 34 patients this confirmed the clinical diagnosis, in 11 it was a more positive help in that it corrected an erroneous clinical diagnosis and in 2 the results of the investigation were misleading.
Complete disappearance of popliteal arterial thromboses in 2 patients
Authors: Bloor Kenneth , Cope Victor
Published: March 2007

Two young male patients with complete spontaneous resolution of popliteal thrombosis are described. The thromboses had been present for roughly 3½ and 4 months. Such resolution has not been previously reported. The cause of the lesions is unexplained. It is suggested, should such a lesion be encountered, that the correct treatment is exploration to exclude adventitial cysts and popliteal entrapment, and simple evacuation of clot and anticoagulation.
Motility changes in the antrum after proximal gastric vagotomy
Authors: Kelly Malcolm , Kennedy Terence
Published: March 2007

The normal pattern of resting and post-prandial motor activity in the gastric antrum has been established by observations in 6 dogs. There was a gradual increase in the amplitude of contraction during the first 2 hours after eating; this was maintained for 3 hours and then declined. For the first 45 minutes terminal antral contraction occurred, partially retaining and triturating the gastric contents. After 45 minutes the waves became sequential, symmetrical, increased in vigour and actively pumped food into the duodenum.

Vagotomy modified the mechanism of the antrum in various ways. Truncal and selective vagotomy reduced the work capability to 20 per cent of its normal value when recorded 1 month after operation. In both groups the waves were disorganized.

Proximal gastric vagotomy abolished the braking mechanism and removed the initial inhibitory stimuli to antral motility. Within 1 month of operation the antrum had regained 58 per cent of its normal work capability and the contractions were well organized.
A case of haemorrhage from volvulus of the gastric fundus
Authors: Metcalfe-Gibson C
Published: March 2007

Volvulus of the stomach is a rare condition and complications are even more uncommon. A case of haemorrhage complicating volvulus of the gastric fundus is presented.
Single layer anastomosis after rectosigmoid resection
Authors: Matheson N A , Irving A D
Published: March 2007

Anastomosis after resection of the rectosigmoid colon is often followed by leakage at the suture line. When occult leakage discovered on routine contrast study is included incidence rates of over 50 per cent have recently been reported.

A single layer interrupted seromuscular inverting technique was used for the anastomosis after elective rectosigmoid resection in 52 consecutive patients. The total incidence of suture line leakage was 6 per cent. Therefore a high incidence of anastomotic dehiscence in the rectum can be avoided and it is concluded that a single layer technique is sound.
A colostomy/ileostomy construction clamp
Authors: Tinckler Laurence
Published: March 2007

An atraumatic handleless clamp is described with which it has been found simpler to construct a terminal ileostomy or colostomy than with other forms of clamp in general use.
Ureteric obstruction due to sigmoid diverticulitis
Authors: Rees B I , Bolton P M
Published: March 2007

Two cases in which the ureter was obstructed by an inflammatory diverticular mass are presented. The difficulties of distinguishing such a mass from a carcinoma both clinically and at operation are emphasized. In order to minimize the risk of ureteric injury and to facilitate planning of the operative procedure, it is recommended that intravenous pyelography should be performed before resection of a suspected diverticular mass.
The importance of environmental conditions, especially temperature, in the operating room and intensive care ward
Authors: Brock Lord
Published: March 2007

Although most patients are essentially well enough to be able to resist or to adapt to unfavourable ambient conditions, this may not be so with an ill patient or one who is having or has had a serious operation. The climatic conditions necessary in the operating room to give an optimal environment are discussed. These are second in importance only to control of infectivity. Airconditioning in operating suites should be obligatory; there is even official acceptance of this. Earlier recommendations that the operating room should be heated to up to 80 °F(27·9 °C) are obsolete. The temperature most favoured by surgeons is 18·5–21 °C; some prefer a range of 21–22 °C. The critical ambient temperature desirable is 21 °C. For infants and children this may be increased up to 24 °C. It is difficult or impossible to achieve climatic conditions in the operating room that are acceptable to all. The needs of the patient are of special importance and are largely neglected; he alone is unable to speak for himself. The disposition of air inlets in the operating room is fully discussed.

Climatic conditions in the intensive care unit are of great importance and are discussed. The need for full air-conditioning is absolute although this is often ignored. The delivery of conditioned air within the intensive care unit is also fully presented, especially the need to avoid direct chilling of the patient. The advantages of horizontal laminar air flow are presented.
Some observations on peripheral venous pressure using a non-invasive technique: A preliminary report
Authors: Gaylis H
Published: March 2007

Observations are presented which suggest that peripheral venous pressure can be measured indirectly by a noninvasive technique at the bedside, using a portable Doppler ultrasound flowmeter.

The pressure at which the audio signals are heard over veins on release of the occluding cuff seems to be a measure of peripheral venous pressure. This is supported by showing a correlation between the method and conditions in which raised venous pressure in the lower limb are known to exist. The results of a few direct venous pressure measurements are reported which appear to give added support.

It is suggested that this simple non-invasive technique may be of value in detecting certain cases of deep vein thrombosis of the lower extremities.
Neoplastic change in duplications of the alimentary tract
Authors: Orr M M , Edwards A J
Published: March 2007

Two cases of adenocarcinoma arising in sequestrated duplications of the bowel in adults are reported. The literature is reviewed and a tendency for duplications to present in early childhood is noted. Although relatively few of these anomalies persist into adult life 8 cases of neoplastic change have now been reported. The histological features of many of the duplications undergoing malignant degeneration suggest the presence of underlying epithelial instability in this condition. It is postulated that duplications of the large bowel have malignant potential.
A controlled clinical trial of three different methods of perineal wound management following excision of the rectum
Authors: Irvin T T , Goligher J C
Published: March 2007

Three methods of perineal wound closure were studied in a randomized prospective clinical trial in 106 patients undergoing excision of the rectum for inflammatory or malignant disease. In method 1 the perineal wound was managed by open drainage. In both methods 2 and 3 the perineal wound was closed by primary suture, suprapubic suction drains being left down to the presacral space, but in method 2 the pelvic peritoneal floor was reconstituted, whilst in method 3 it was left unsutured. Topical and systemic antibiotics were administered to all patients submitted to primary closure of the perineal wound but not routinely to those whose perineal wound was left open.

The overall operative mortality was 8·5 per cent but no deaths could be definitely attributed to perineal wound complications. The incidence of primary wound healing after methods 2 and 3 was 45·2 and 4·9 per cent respectively. Operative contamination of the perineal wound had an adverse effect on perineal wound healing. The incidence of persistent wound sinuses and unhealed wounds at 3 and 6 months after primary wound closure was rather less than that encountered after open drainage.

It was concluded that primary closure of the perineal wound is the treatment of choice following excision of the rectum, except in cases in which contamination of the perineal wound has occurred during operation or the final state of haemostasis in the pelvis with diathermy and suture at the conclusion of the dissection was deemed to be unsatisfactory.
Povidone-iodine for the control of surgical wound infection: A controlled clinical trial against topical cephaloridine
Authors: Pollock A V , Evans Mary
Published: March 2007

One hundred and ninety-two operation wounds in a general surgical practice were randomly allocated to receive either topical cephaloridine or a povidoneiodine spray, and the rate of wound sepsis was studied. In all types of operation cephaloridine proved superior to povidone-iodine as a prophylactic, the difference reaching a significant level in potentially contaminated wounds.
Subphrenic abscess in children
Authors: Mackenzie M , Fordyce J , Young D G
Published: March 2007

Nineteen consecutive cases of subphrenic abscess which were treated in the Royal Hospital for Sick Children, Glasgow, from 1962 to 1972 are analysed. This complication of intra-abdominal suppuration of surgery still carries a grave prognosis. Four of the patients died (21 per cent); 2 deaths were related to the subphrenic abscess while the remaining 2 were not directly related to the abscess. The mean hospital stay of the survivors was 59 days (range 30–122 days). The changing patterns of aetiology and presentation which have recently been emphasized in general surgical practice are not reflected in this paediatric series.
Possible parathyroid origin of gastrin in a patient with multiple endocrine adenopathy type I
Authors: Cassar J , Polak J M , Cooke W M
Published: March 2007

After removal of two large pancreatic insulinomas, although the presenting spontaneous hypoglycaemia was eliminated, severe and persisting haematemesis and melaena supervened with a rise in serum gastrin. The patient had multiple endocrine adenopathy (pituitary, parathyroids and islet cells), but no evidence of a pancreatic gastrin-producing tumour. After emergency gastric operation for the bleeding, the serum gastrin remained high until the hypercalcaemia and hyperparathyroidism had been corrected by subtotal parathyroidectomy. Immunofluorescence studies showed gastrin in the parathyroid tissue.
Cavernous haemangioma of the frontal bone: Case report
Authors: Gupta S D , Tiwari I N , Pasupathy N K
Published: March 2007

A rare case of haemangioma of the frontal bone is presented together with a review of the literature. Carotid angiography was found to be a useful diagnostic aid to differentiate it from other lesions of the frontal bone. The best treatment is to excise both tables containing the haemangioma together with a rim of healthy bone in one block.
Postvagotomy dysphagia
Authors: Spencer J D
Published: March 2007

Following truncal vagotomy some patients develop dysphagia, which rarely can progress to complete obstruction. It has been postulated that haematoma formation in the tissues surrounding the lower oesophagus may lead to peri-oesophageal fibrosis and compression of the lumen of the oesophagus. This has been confirmed by open operation in only a few patients. A case is described in which oesophageal obstruction occurred 3 weeks after a vagotomy and pyloroplasty had been performed.
The relationship of anaemia to gastric secretion more than 15 years after vagotomy and gastro-enterostomy
Authors: Wheldon E J , Venables C W , Johnston Ivan D A
Published: March 2007

Iron deficiency anaemia is common following vagotomy and gastro-enterostomy, and this study has shown that all the anaemic patients had low gastric secretion.

After correction of their anaemia, gastric secretion was increased, but was still very low, and when these levels were compared with secretion in fit non-anaemic patients it was found that the latter group had a significantly higher secretion, and that a high proportion of them showed evidence of incomplete vagotomy.

These results suggest that there is a relationship between the levels of gastric secretion in patients after vagotomy and gastro-enterostomy and the development of anaemia. It may be that inadequate gastric secretion impairs the release of elemental iron from the diet and its subsequent absorption.
Diagnosis, clinical course and treatment of acute dermal gangrene
Authors: Ledingham I McA , Tehrani M A
Published: March 2007

Twenty patients with acute dermal gangrene following surgery, trauma or sepsis are described. In 12 the skin became gangrenous secondary to a necrotizing process affecting the subdermal fascia, and in 8 the condition arose primarily in the skin. In the first group mortality was high unless radical excision of the necrotic fascia was performed at an early stage; in 3 of the recent patients the overlying skin was removed, defatted and stored for later grafting. In the second group, incision and adequate drainage combined with antibiotics seemed to suffice. Hyperbaric oxygen was of dubious value in the first group but appeared to contribute to arrest of the lesion in the second group.