bluuebunny/crossref_metadata_2025 huggingface dataset:
Relative effects of ileal resection and bypass on intestinal adaptation and carcinogenesis
Authors: Rainey J B , Davies P W , Williamson R C N
Published: March 2007

Since ileal resection and ileal bypass are commonly performed in man and might stimulate colonic hyperplasia, their co-carcinogenic potential was explored in male Sprague-Dawley rats (n = 135). One week after 33 per cent distal small-bowel resection, 33 per cent distal small-bowel bypass or distal ileal transection (control), animals started a 6-week course of azoxymethane injections (total dose 90 mg/kg ip). Findings in rats killed at 20 and 25 weeks were similar: bypass produced a higher yield of colorectal tumours (4.0 ± 0.6 per rat: mean ± s.e.) than controls (2.4 ± 0.4; P < 0.05), but resection caused maximal enhancement (5.2 ± 0.5: P < 0.01). In rats killed at 30 weeks, however, tumour yields were almost identical. Overall, resection increased colonic tumour yield by 55 per cent (P < 0.02) and bypass by 32 per cent. Stathmokinetic measurements of crypt cell production rate (CCPR) at 20 weeks showed similar increases after resection and bypass both in residual functioning small bowel (109–200 per cent: P < 0.01) and in colorectum (63–100 per cent: P < 0.05). At 30 weeks these adaptive effects persisted, despite an overall increase in CCPR with age. Loss of functioning ileum enhances experimental colorectal carcinogenesis principally by reducing the latent period for tumour development. Resection has a greater effect than bypass probably by producing earlier hyperplasia, though later adaptive effects are similar.
Painful anal ulceration in homosexual men
Authors: McMillan A , Smith Isabel W
Published: March 2007

Forty homosexual men with painful anal ulceration were studied. Two patients had primary syphilis; sixteen men had primary anal herpes and twenty-two men had traumatic ulceration of the anal canal. The clinical features of the men with primary herpes were compared with those of the group with traumatic anal fissures. Fever, paraesthesiae in the buttocks and lower limbs, and difficulty in initiating micturition were found significantly more frequently in the former group of patients.
Prediction of amputation wound healing: The role of transcutaneous pO2 assessment
Authors: Ratliff D A , Clyne C A C , Chant A D B , Webster J H H
Published: March 2007

With the recent trend towards more distal lower limb and below-knee amputation for peripheral vascular disease, failure of amputation healing remains a common clinical problem. There is an urgent need for more objective measures of selecting the most appropriate distal amputation level compatible with healing. Oxygen availability is the final arbiter of tissue viability and healing potential, and we have shown that the measurement of transcutaneous pO2 (TcpO2) accurately reflects the degree of ischaemia in the lower limb. In 59 patients having 62 amputations for peripheral vascular disease significantly lower TcpO2 levels were related to amputation failure. Below-knee amputations with a pre-operative below-knee TcpO2 of above 35 mmHg always healed, and failures had levels of 35 mmHg or less. Nine out of sixteen patients having above-knee amputations had pre-operative below-knee TcpO2 values well above 35 mmHg, suggesting that they may possibly have undergone successful below-knee amputation. No correlation between ankle systolic pressure and amputation healing was found. TcpO2 measurement is simple, non-invasive and reliable and offers an exciting research advance in the assessment of effective tissue perfusion.
Skin reactions related to surgical scrub-up: Results of a Scottish survey
Authors: Mitchell K G , Rawluk D J R
Published: March 2007

The prevalence of skin reactions associated with surgical scrub-up among a representative sample of theatre personnel in Scotland was 37.2 per cent. Only 5 per cent of the sample had severe symptoms as judged by the necessity to consult a dermatologist. A skin reaction following surgical scrub-up is most likely to be due to a drying effect from frequent scrubs, and moisturizing creams are effective in controlling symptoms in up to 25 per cent of those developing reactions. Individuals who have other allergic symptoms appear more likely to develop skin reactions than those with no other allergic symptoms. These individuals may benefit from regular use of hand creams or using a scrub routine which causes less trauma to their skin as a prophylactic measure.
The urgent diagnosis of gallstones in acute pancreatitis: A prospective study of three methods
Authors: Neoptolemos J P , Hall A W , Finlay D F , Berry J M , Carr-Locke D L , Fossard D P
Published: March 2007

Ultrasonography (US), radionuclide biliary scanning (RBS), and biochemical tests were performed within 72 h of admission in 83 patients with acute pancreatitis in an attempt to define those with gallstones as an aetiological factor. US was 92 per cent accurate in the 80 per cent of patients in whom the gallbladder was demonstrated. There were no false positives. Sixty-seven per cent of patients with gallstones were diagnosed although this improved to 78 per cent when US was repeated following the patients' clinical improvement. The pattern of RBS was completely normal in 46.5 per cent of patients with biliary pancreatitis and 64 per cent of patients with non-biliary pancreatitis. Biochemical tests completely separated 47 per cent of patients with gallstones from those without. Used in combination with US these two methods accurately identified 81 per cent of patients in the biliary group.

In conclusion US was found to be a rapid and accurate method of gallstone detection but used alone it has limited usefulness. RBS can be time consuming and was found to be of doubtful value. Biochemical tests were helpful in indicating a proportion of patients who had gallstones which were not detected by US, and therefore have a practical application. Current methods of gallstone detection in patients with acute pancreatitis are far from ideal and further studies are indicated.
Hepaticojejunostomy in benign and malignant high bile duct stricture: Approaches to the left hepatic ducts
Authors: Blumgart L H , Kelley C J
Published: March 2007

Biliary-enteric anastomosis for relief of biliary obstruction caused by benign or malignant disease at the confluence of the bile ducts can be difficult. An approach by dissection at the confluence has to be performed directly into an area of scarring or at the site of a neoplastic lesion; exposure of an adequate duct for anastomosis is often difficult and may appear impossible. This paper describes an alternative approach to the hepatic ducts by dissection of the left hepatic ductal system. The method has been used with success in thirty-six patients.
Carcinoma of the large bowel in the first four decades
Authors: Umpleby H C , Williamson R C N
Published: March 2007

Eighty-five patients aged 40 or less who presented with colorectal carcinoma over a 32-year period were reviewed. The incidence was 2.5 per cent of all patients with large bowel cancer (n = 3426). Predisposing causes included familial polyposis (eight patients), panproctocolitis (ulcerative, one; Crohn's, one) and irradiation (one); four patients were pregnant. One-third of the patients presented as emergencies, and 43 per cent of these had intestinal obstruction. Five-year survival rates were 41 per cent overall and 59 per cent after ‘curative’ resection. Survival was equivalent both for elective and emergency admission and for mucinous carcinomas (n = 16) and those non-mucinous carcinomas of moderate histological differentiation. Five-year survival rates were poorer when the history was less than three months in duration (20 per cent vs. 45 per cent: P = 0.02) and for rectal and rectosigmoid tumours than colonic tumours (31 per cent vs. 50 per cent: P = 0.05). Radical resection is indicated when feasible: four of five patients with involvement of adjacent viscera and four of six patients with resectable recurrence survived beyond 10 years. The outcome is similar to that at all ages, any unfavourable pathological features being balanced by improved survival following emergency operations.
Chemotherapy after palliative resection of colorectal cancer. Yorkshire gastrointestinal tumour group
Authors:   The members of the Group, Giles G R , Lawton J O , Malhotra Aruna , Hall R , Matheson T S , Craven J L , MacAdam W A F , Bird G G
Published: March 2007

Patients with residual disease after palliative resection of colorectal cancer were randomly allocated to receive methyl CCNU and 5-Fluorouracil or followed conventionally. There was a short term improvement in overall survival at 2 years significant at the 5 per cent level but ultimately all patients died. Chemotherapy did not significantly delay progression or prolong survival in patients with local residual disease. Although patients with more disseminated disease had a poorer prognosis than those with more limited disease, survival at 18 months was significantly prolonged (P < 0.02 > 0.01) by chemotherapy.
Management of enterocutaneous fistulas: A review of 132 cases
Authors: McIntyre P B , Ritchie Jean K , Hawley P R , Bartram C I , Lennard-Jones J E
Published: March 2007

The development of an enterocutaneous fistula has frequently been reported as being attended by a high morbidity and mortality, particularly in patients with inflammatory bowel disease who have high output, small bowel fistulas. We report a series of 114 patients who required treatment for 132 fistulas during the period 1976–1981. Fifty-one fistulas originated in the jejunum and ileum, and forty-eight patients had Crohn's disease. The majority of patients required surgical intervention and parenteral nutrition was required in forty-eight cases. Using an integrated programme of nursing, medical and surgical care, the overall healing rate was 90.9 per cent and the mortality 5.3 per cent. With the therapeutic methods currently available, an unacceptably high mortality rate in these patients can be avoided.
The clinician and the vascular laboratory in the diagnosis of aortoiliac stenosis
Authors: Campbell W B , Cole S E A , Skidmore R , Baird R N
Published: March 2007

Two hundred and twenty-one lower limbs in 116 arteriopaths were examined for evidence of aortoiliac stenosis, by analyses of common femoral artery Doppler waveforms for pulsatility index (PI) Laplace δ, and principal components, pulse volume recordings (PVR) and thigh pressure measurements. Clinical assessment of the aortoiliac segment was also recorded in 124 limbs. The accuracy of prediction of aortoiliac stenosis, measured on biprojectional arteriograms, was calculated for the different methods, using multiple regression analysis.

Considering all grades of stenosis together, clinical judgement was the best predictor of severity (R2 — the correlation coefficient squared = 0.66): addition of non-invasive tests increased the accuracy of prediction to R2 = 0.70. For stenoses > 50 per cent PVR amplitude- was the best non-invasive test (R2 = 0.39), but was no better than clinical assessment (R2 = 0.40). However, for stenoses < 50 per cent clinical judgement was poor (R2 = 0.13), and derived most benefit from addition of Laplace δ (R2 = 0.20) or PVR upstroke time (R2 = 0.26).

In addition, common femoral PI and Laplace δ were compared in the arteriopaths, and in 146 limbs of normal control subjects, by calculation of sensitivity and specificity. PI was superior to Laplace δ for detecting severe stenoses and occlusions, but Laplace δ was more accurate in the detection of lesser degrees of disease.

These results suggest that conventional clinical assessment is the best method for detecting aortoiliac stenoses > 50 per cent, but for less severe disease addition of vascular laboratory tests is helpful — especially PVR and Laplace waveform analysis.
Reconstructive renal vascular surgery for chronic renal failure
Authors: Jamieson G G , Clarkson A R , Woodroffe A J , Faris I
Published: March 2007

This paper reports the results of reconstructive renal arterial operations on 23 patients who underwent surgery because it was considered that renal artery disease was contributing to their chronic renal failure. The median pre-operative serum creatinine in this group of patients was 0·77 (range 0·15–1·14 mmol/l) and all patients had severe hypertension. In 10 cases there was evidence of other renal disease (analgesic nephropathy, 8; glomerulonephritis, 2). Operation performed was unilateral aortorenal reconstruction in 21 patients and bilateral reconstruction in 2 patients. There were four in-hospital deaths. In 15 patients operation was judged to have improved their renal function with a fall of median pre-operative creatinine from 0·34 mmol/l (0·15–0·84) to a median creatinine of 0·15 (0·05–0·52). There was one intra-operative death. There were 7 patients in whom operation led to no improvement in renal function. Their median pre-operative creatinine was 0·90 (0·32–1·14 mmol/l), and this pre-operative creatinine differs significantly from the group whose creatinine fell after surgery (P < 0·002). Renal artery reconstruction should be considered in patients with chronic renal failure who have correctable arterial lesions.
A comparison between two types of waveform analysis in patients with multisegmental arterial disease
Authors: Junger M , Chapman B L W , Underwood C J , Charlesworth D
Published: March 2007

The results of an experiment to compare two different methods of analysing ultrasound signals are presented. Normal volunteers, both young and old, and patients with arteriosclerosis were examined with Doppler shifted ultrasound and the results of two forms of waveform analysis retrospectively compared with angiograms. The angiograms were used to divide the patients into groups with similar patterns of disease. The ability of the two methods of analysis, ‘pulsatility Index’ (PI) and ‘Laplace transform damping factor’ (LTD), to identify patients with haemodynamically significant disease in the aorta or iliac arteries was tested statistically (Mann–Whitney U test) and compared in receiver operator curves. The results showed that both tests were equally good in the identification of aortoiliac disease, even when the superficial femoral artery was occluded, and that, contrary to theoretical arguments, LTD was influenced by distal impedance.
Acalculous biliary pain: Diagnosis and selection for cholecystectomy using the cholecystokinin test for pain reproduction
Authors: Lennard T W J , Farndon J R , Taylor R M R
Published: March 2007

A prospective double blind placebo controlled study was conducted on 41 patients with a clinical diagnosis ofacalculous biliary pain (ABP) and 10 healthy volunteers. Cholecystokinin (CCK) (Kabivitrum, Uxbridge) was given intravenously (1 Ivy Dog Unit/kg) over 5 min in a randomized crossover study using normal saline as a placebo infusion. All referred patients had undergone at least one normal oral cholecystogram, abdominal ultrasound and upper gastrointestinal endoscopy before infusions. Twenty-six patients developed pain in response to the CCK infusion and not the placebo, and the pain did not differ from their spontaneous pre-infusion pain as measured by the McGill Pain Questionnaire and a Visual Analogue Pain Scale. Fourteen patients developed no pain with either infusion, and one developed pain with both placebo and CCK. All patients whose pain was reproduced (CCK-positive) underwent cholecystectomy and peroperative cholangiography. Operative findings were normal in all of the CCK-positive group except one in whom a small common bile duct stone was found. Histopathology of resected gallbladders was abnormal in 24 out of 26 cases, but all patients operated on remained pain-free at follow-up (mean 11 months, range 2-24 months). Repeat CCK infusion postoperatively failed to bring on pain in any of the postoperative group.

The CCK infusion test is a simple, cheap, bedside or out-patient procedure which will identify true acalculous biliary pain which will respond well to cholecystectomy.
Pre-operative percutaneous transhepatic biliary drainage: The results of a controlled trial
Authors: McPherson G A D , Benjamin I S , Hodgson H J F , Bowley N B , Allison D J , Blumgart L H
Published: March 2007

The operative mortality for biliary tract obstruction due to malignancy is high. In 1981 a controlled clinical trial of pre-operative percutaneous drainage was started at the Royal Postgraduate Medical School. At the time of percutaneous transhepatic cholangiography patients were randomized either to laparotomy or to pre-operative percutaneous transhepatic biliary drainage (PTBD) followed by laparotomy. Only patients with malignant biliary tract obstruction and serum bilirubin greater than 100 μmol/l were included. Seventy patients entered the trial, and five were withdrawn. Of the 65 remaining, 31 underwent laparotomy and 34 had pre-operative PTBD followed by laparotomy. The median duration of drainage was 18 days and during this time the median bilirubin fell from 305 to 115 m̈mol/l. Five patients required early surgery for complications of PTBD and two died within 30 days of surgery. The mortality for laparotomy was 19 per cent (6/31) compared with 32 per cent (11/34) for drainage plus laparotomy. This trial highlights the hazards of PTBD in high risk patients and has failed to demonstrate a reduction in mortality with the use of pre-operative PTBD.
The localization of an anti-tumour monoclonal antibody (791T/36) in gastrointestinal tumours
Authors: Armitage N C , Perkins A C , Pimm M V , Farrands P A , Baldwin R W , Hardcastle J D
Published: March 2007

Fifty-six patients with gastrointestinal cancers and four patients with benign colorectal tumours have been injected with radiolabelled anti-tumour monoclonal antibody (791T/36) to assess the degree of localization of the antibody by external scintiscanning and measurements on resected specimens. Twenty-nine patients with primary colorectal cancer showed increased uptake of the radiolabelled antibody in the resected tumours, with a tumour to normal tissue (T:NT) ratio of 2·5:1. All but two of fifteen patients with recurrent or metastatic tumour showed positive images of the deposits on external scintiscanning. Twelve patients with noncolonic gastrointestinal malignancy were studied and in only two patients were tumours demonstrated by external scanning. There were no positive images in four patients with benign colonic disease nor could increased uptake of radiolabelled antibody be demonstrated in the resected specimens. Immunohistology and autoradiography have shown that the antibody can be demonstrated in the pseudoacini and stroma of colon cancer. There are indications that this may represent localization to a cell surface antigen which becomes detached in the processing of the histological sections. It seems that in the gastrointestinal tract the monoclonal antibody 791T/36 is consistently taken up by colorectal cancer. Only a few noncolonic cancers and no benign colonic tumours take up the antibody. This antibody uptake may prove of value in the detection of occult metastases and in the targeting of antitumour agents.
A frequency-duration index (FDI) for the evaluation of ambulatory recordings of gastro-oesophageal reflux
Authors: Branicki F J , Evans D F , Jones J A , Ogilvie A L , Atkinson M , Hardcastle J D
Published: March 2007

Oesophageal pH monitoring has been undertaken in 20 symptomatic patients and 20 normal subjects for periods of 24 hours at work and in the home using a pH sensitive radiotelemetry capsule and a portable receiving system.

There was no correlation between symptoms and endoscopic findings in symptomatic patients. The number and duration of reflux episodes was greater in symptomatic patients than normal subjects during 24 hour ambulatory study (P < 0·002). A frequency-duration index for the evaluation of recordings is described which was significantly greater in symptomatic patients than in normal subjects during both day (P < 0·002) and night (P < 0·008) periods of recording. Discrimination between the two groups was more clearly seen using the frequency-duration index compared to either the frequency of reflux episodes or the cumulative duration of acid reflux.
The thoracic stomach: A study of gastric emptying, bile reflux and mucosal change
Authors: Mannell Aylwyn , Hinder R A , San-Garde B A
Published: March 2007

The clinical progress, histological state of the gastric mucosa, gastric emptying of a liquid meal and duodenogastric reflux were studied postoperatively in 15 patients with a vagotomized intrathoracic stomach without a drainage procedure. The intact though denervated pylorus did not impede the emptying of liquids. Bile reflux into the thoracic stomach in both the erect and supine positions was significantly greater than that measured in control subjects. While posture did not affect duodenogastric reflux in the normal adult, bile reflux across the denervated pylorus was significantly increased in the supine position. Chronic active gastritis was noted in 12 patients but could not be correlated with the degree of bile reflux. Nine patients had evidence of pulmonary aspiration and gastric food residue was a common finding at endoscopy. The vagotomized intrathoracic stomach may need a drainage procedure to facilitate solid emptying.
A high macrophage content in human breast cancer is not associated with favourable prognostic factors
Authors: Steele R J C , Eremin O , Brown M , Hawkins R A
Published: March 2007

The macrophage contents of 40 human primary breast cancers were ascertained using three separate macrophage membrane markers. Four prognostic factors (lymph node status, tumour size, histological grade and oestrogen receptor status) were determined concurrently in these mammary carcinomas. No significant relationship was found between the macrophage content of the mammary carcinomas and any individual prognostic factor. When the patients were grouped according to whether they had 0–2 or 3–4 high risk factors, however, the macrophage content was significantly greater in those tumours with the poorer prognosis, regardless of the marker used to enumerate the cells. A high macrophage content, therefore, is not associated with favourable prognostic factors in breast cancer. Indeed, the present study has revealed the reverse to be the case.
Prognostic evaluation in node-positive breast carcinoma: Stage versus growth rate
Authors: Hartveit F , Thoresen S , Mæhle B O
Published: March 2007

The range in survival time in operable node-positive breast carcinoma is considerable. Postoperative management is thus dependent on accurate prognostic assessment. This involves the choice of relevant prognostic factors. Theoretically these should include measurements of both stage and growth rate. In a series of 96 cases it is demonstrated that the diameter of the primary (3 cm and under/over 3 cm) can be used as a measure of tumour stage; the histological grade of the primary as one of tumour growth rate; and the presence/absence of tumour cells in the efferent nodal vessels (EVI status) as a measure of nodal stage. The latter is proposed as an alternative to the number of tumour-bearing nodes recovered from the axilla. Division of the cases on this basis was sufficient to assess high or low risk using routine histological methods.
Ruptured aortic aneurysms: Postoperative complications and their aetiology
Authors: Fielding J W L , Black J , Ashton F , Slaney G
Published: March 2007

A review of 198 ruptured aortic aneurysms has been undertaken, this being 36–3 per cent of all the aneurysms treated during the period 1960–81. The overall mortality rate was 42·9 per cent. The peroperative mortality was 6·6 per cent and the mortality of the patients who survived the operation was 38·9 per cent. Factors which influenced postoperative mortality were the age of the patient, the distance travelled to hospital, the presence of an intraperitoneal bleed, the duration of the operative procedure and the volume of blood transfused, but only the amount of blood transfused had a statistically significant influence on mortality. However, as the highest mortality associated with any of these risk factors was 54·9 per cent, no single factor alone can be considered a contra-indication to operation. As there are no reliable predictive factors, we believe that all cases with clinically ruptured aortic aneurysms should have a laparotomy and resection. The most common postoperative complications were varying degrees of renal and respiratory insufficiency and the occurrence of these was significantly associated with the volume of blood transfused.
Primary adenocarcinoma of the vermiform appendix: Report of a series of ten cases, and review of the literature
Authors: Gilhome R W , Johnston D H , Clark J , Kyle J
Published: March 2007

Ten cases of primary adenocarcinoma of the vermiform appendix are presented. The condition is rare and usually presents after middle age as acute appendicitis. It is seldom recognized during appendicectomy. The tumours resemble colonic adenocarcinomas but, because of peculiarities in the anatomy of the appendix, there is a tendency to early local spread. Right hemicolectomy performed as soon as the true nature of the lesion is recognized is the treatment of choice and has been shown to improve survival. Even after hemicolectomy the prognosis must be guarded, as local spread of disease may not be controlled in many cases.
Obstructing/perforated carcinoma of the left colon treated by resection and the formation of a double colostomy
Authors: Day T K , Bates T
Published: March 2007

Forty patients presenting with obstructing left colon tumours between 1975 and 1980 were treated by a modified Paul-Mikulicz resection. The hospital mortality was 5 per cent. Subsequent mortality was largely related to the stage of the tumour at presentation and was not higher than that to be expected after an elective resection. In 21 patients the procedure was palliative and 16 of these patients later died. The quality of palliation was reasonable in 80 per cent and poor in 20 per cent. Despite the need for a second hospital stay to close the colostomy, time in hospital accounted, on average, for less than one-tenth of the remaining lifespan in those having a palliative resection.
Partial closure and other techniques in pilonidal surgery: An assessment of 157 cases
Authors: McLaren C A
Published: March 2007

The report is a retrospective study of 157 patients with pilonidal disease. The period in hospital, the healing time, and the rates of wound breakdown and sinus recurrence were documented following four different methods of management. After incision and drainage of the pilonidal abscess, later excision was necessary in less than 40 per cent of patients. Elective excision of the granulation tissue and skin, with partial closure of the defect, gave better results than excision and primary suture.
Hypocalcaemia after subtotal thyroidectomy for thyrotoxicosis
Authors: Ramus N I
Published: March 2007

Eighty-one patients who underwent subtotal thyroidectomy for thyrotoxicosis had a 10 per cent incidence of symptomatic hypocalcaemia (corrected calcium <2.0mmol/l) but only a 1.2 per cent incidence of prolonged hypocalcaemia. In the same patients only one had a transient right sided recurrent laryngeal nerve palsy. These results would seem to confirm the wisdom of lateral ligation of the inferior thyroid arteries to protect the recurrent laryngeal nerve. They lend no support to the suggestion that in order to protect parathyroid function this teaching be abandoned in favour of a policy of ligation of the arteries on the surface of the gland. Nevertheless, injury, devascularization or inadvertent removal of parathyroid tissue must still be the first practical consideration.
Smooth muscle neoplasms of the rectum and anal canal
Authors: Walsh T H , Mann C V
Published: March 2007

Forty-eight patients who presented to St. Mark's Hospital, London between 1948 and 1979 with smooth muscle neoplasms of the rectum or anal canal have been reviewed. Twenty-six tumours arose from the muscularis mucosae of the rectum. These lesions were small, asymptomatic and did not recur after local removal. Eighteen tumours arose from the muscularis externa of the rectum. Local excision of these resulted in a high local recurrence rate regardless of the degree of differentiation of the tumour but long-term survival figures were similar whether the tumours were treated by local or radical techniques. However, the prognosis did relate to the degree of tumour differentiation, being worst in the poorly differentiated group. In four cases the smooth muscle tumour arose from the internal sphincter of the anal canal.
Anorectal myectomy in adult Hirschsprung's disease: A report of six cases
Authors: Hamdy M H , Scobie W G
Published: March 2007

The presentation and management of six adult patients with proven aganglionosis of the rectum are reported. Rectal mucosal biopsy combined with enzyme histochemistry was used to establish the diagnosis and it is recommended as the first investigative procedure. Conservative surgery either with anterior resection and anorectal myectomy or myectomy alone was found to be simple and relatively complication-free and to give very satisfactory results.
Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence
Authors: Kiff E S , Swash M
Published: March 2007

We have studied 30 patients with idiopathic (neurogenic) faecal incontinence using anorectal manometry and concentric needle and single fibre electromyographic methods. We have measured the terminal motor latency in the pudendal nerves of these patients using a new digitally directed transrectal stimulation and recording technique (right mean (±s.d.) 3.2±0.9 ms, left mean (±s.d.) 3.0±0.9 ms) and compared the results with those obtained from 28 normal subjects (right mean (±s.d.) 2.0±0.5 ms, left mean (±s.d.) 1.9±0.3 ms). These differences between normal and incontinent patients were significant (P = 0.01) using the Wilcoxon Rank Sum Test. The findings support the hypothesis that idiopathic (neurogenic) faecal incontinence is due to damage to the nerve supply of the pelvic floor musculature.
The aetiology and significance of distal choledochoduodenal fistula
Authors: Martin D F , Tweedle D E F
Published: March 2007

Thirteen patients undergoing investigation for biliary or pancreatic disease were found at endoscopic retrograde cholangiopancreatography to have unsuspected choledochoduodenal fistula. In only one patient could the presenting symptoms be directly attributed to the fistula. Ten of the thirteen patients had previously undergone exploration of the common bile duct and instrumentation at surgery is postulated as being the most likely cause of these fistulae. Treatment of the uncomplicated fistula appears unnecessary.
Clinicopathological staging of gastric cancer
Authors: Fielding J W L , Roginski C , Ellis D J , Jones B G , Powell J , Waterhouse J A , Brookes V S
Published: March 2007

13175 patients with gastric carcinomas have been staged with reference to the TNM staging system. This has confirmed the poor overall prognosis (5·5 per cent and 3·8 per cent age-adjusted survival rates at 5 and 10 years respectively). However, it has demonstrated the significant survival associated with the treatment of Stage I disease (70·0 per cent at 5 years and 63·2 per cent at 10 years). This study demonstrates that 72·9 per cent of cases are unresected and that interpretation of resectability rates must be related to the population base of the study.
Blunt thorax oesophageal stripping: An emergency procedure for caustic ingestion
Authors: Brun J G , Celerier M , Koskas F , Dubost C
Published: March 2007

We report our experience with an original procedure which we have applied to the management of acute necrotic caustic burns of the upper gastro-intestinal tract. Blunt thorax oesophageal stripping is performed through a cervicotomy and a laparotomy, thus avoiding a wide pleural exposure and the frequent and often fatal respiratory complications of a thoracotomy. The stripping method permitted survival of 13 of 17 patients and is thus considered to be a safer and more successful technique than open thoracic oesophagectomy.
Early aneurysmal degeneration of human umbilical vein bypass grafts
Authors: Layer G T , King R B , Jamieson C W
Published: March 2007

Three cases of early aneurysmal degeneration of modified human umbilical vein (HUV) grafts in the femorodistal segment are described. One such graft is the first reported with multiple true aneurysms. The pathology and management of this complication is discussed.
Hydatid thrill: An explanation of the phenomenon
Authors: Sukumar A
Published: March 2007

The hydatid thrill is a rare but pathognomic sign of hydatid disease. The physical basis of the thrill was studied in two patients with the disease. The thrill occurs when a mother cyst packed with unruptured daughter cysts is gently percussed. The consistency of the wall of the daughter cyst and the tension of the fluid inside it are responsible for making the cysts vibrate and produce the sensation of a thrill. Free fluid from ruptured daughter cysts dampens the vibrations. It is extremely rare for a mother cyst to have all the daughter cysts in an intact condition.
The venous anatomy of the lower oesophagus in normal subjects and in patients with varices: An image analysis study
Authors: Spence R A J
Published: March 2007

The microvasculature of the lower oesophagus has been studied quantitatively using a computer assisted image analysis system. Twenty normal specimens of oesophagus and stomach were studied and seven further specimens from patients with varices were also assessed. Each specimen could be clearly subdivided into three zones. Zone 1 was the stomach where the mean relative area occupied by veins in the lamina propria was 2.6 per cent (s.e.m. ±0.2) in the normal subjects and 3.7 per cent (s.e.m. ±0.8) in the variceal specimens. Zone 2 began at the oesophagogastric junction and extended 2–5 cm into the lower oesophagus. The mean area occupied by veins in the lamina propria increased to 19.8 per cent (s.e.m. ±1.2) in the normal and 32.8 per cent (s.e.m. ±3.9) in the varices specimens. Zone 3 was the remainder of the proximal oesophagus and the mean area occupied by veins in the lamina propria was 4.9 per cent (s.e.m. ±0.3) in the normal and 6.1 per cent (s.e.m. ±0.5) in the varices specimens. Further analysis revealed that this increase in area occupied by veins in the distal oesophagus was due to an increase in both the number and size of vessels in the lamina propria of Zone 2. These findings may explain the propensity for oesophageal varices to bleed mainly from the distal oesophagus.
Surgical treatment of squamous cell carcinoma of the oesophagus
Authors: Hennessy T P J , O'Connell R
Published: March 2007

During the period 1976–1983, a total of 72 patients with squamous cell carcinoma of the oesophagus were seen. Exploration was undertaken in 62 patients and all those explored had their tumours resected. The overall operative mortality rate was 12.9 per cent. Overall survival rates were 49 per cent at 1 year, 31 per cent at 2 years and 11.5 per cent at 5 years.
Dilatation of benign oesophageal strictures in the outpatient department
Authors: Stoddard C J , Simms J M
Published: March 2007

Maloney's mercury weighted dilators have been used to dilate benign oesophageal strictures in 109 patients in the outpatient department. A total of 524 dilatations have been performed. Following dilatation two patients had a small haematemesis but there have been no oesophageal perforations. Maloney's dilators can be used in the outpatient department effectively to dilate benign oesophageal strictures and the risk of complications is low.
Drainage operations in chronic pancreatitis
Authors: Cooper M J , Williamson R C N
Published: March 2007

If pancreatic ductal hypertension explained the pain of chronic pancreatitis, adequate decompression of ectatic ducts should provide lasting relief. We have analysed a personal series of 20 patients (14 men and 6 women) with chronic pancreatitis undergoing one or more drainage procedures. Alcohol was the main aetiological factor, and symptoms had been present for a median of 2.5 years. Pancreatic ductal decompression was achieved by pancreatic sphincteroplasty (n = 4) or longitudinal pancreaticojejunostomy (11). Thirteen patients underwent incidental or additional procedures to decompress the biliary tree: sphincteroplasty (5), choledochal bypass (7) and T-tube drainage (1). Cysts were either drained (7) or resected (3). Two patients required re-operation for subphrenic abscess. Some pancreatic insufficiency was detected pre-operatively in 11 patients (exocrine 10, endocrine 4) and was essentially unchanged in all but one patient who came to total pancreatectomy. Two other patients required a coeliac plexus block, but the remaining 17 patients had good pain relief at a median follow-up of 30 months. Ductal drainage procedures effectively relieve the pain of chronic pancreatitis without further compromising pancreatic function.
Surgery for acute Crohn's colitis: Results and long term follow-up
Authors: Mortensen N J McC , Ritchie Jean K , Hawley P R , Todd I P , Lennard-Jones J E
Published: March 2007

Acute Crohn's disease of the colon requiring emergency surgery is uncommon, but may be increasing in frequency. Between 1954 and 1981, 215 patients had surgery for acute inflammatory bowel disease at St. Mark's Hospital, and of these 18 had acute Crohn's colitis. There was one postoperative death, and the remaining patients were followed up for an average of 8 years. Ten patients had toxic dilatation, two a toxic dilatation with free perforation, three had perforation without dilatation and in three surgery was required for an acute deterioration. Surgical treatment included proctocolectomy (one), colectomy and ileostomy (fourteen), colectomy and ileorectal anastomosis (two) and defunctioning ileostomy alone (one). Subsequent rectal excision was necessary in ten of sixteen patients. Acute colonic Crohn's disease requiring surgery is less likely than ulcerative colitis to be amenable to restorative surgery despite a policy of rectal conservation.
Femoropopliteal bypass with a Goretex prosthesis: A long-term follow-up
Authors: Klimach O , Underwood C J , Charlesworth D
Published: March 2007

This report describes a series of 101 femoropopliteal bypasses performed on 85 patients (16 bilateral procedures), in whom a 6 mm diameter polytetrafluoroethylene prosthesis (Goretex) was used. The indication for operation was severe claudication in 58 cases and pregangrene in 43 cases. After one year there was a statistically significant difference between the cumulative patency rates for these two subgroups at 66 and 29 per cent respectively (P<0·001). In patients with good ‘run-off’, i.e. three patent vessels in the lower leg, there was a tendency for the bypasses to remain patent for longer than in patients in whom there were only one or two vessels present (e.g. 58 and 33 per cent respectively at 2 years), although this trend was not statistically significant. At 3 years the cumulative patency rate for the whole group was 36 per cent and for claudicants alone was 48 per cent.
Acute gastrointestinal complications of infrarenal aortic aneurysm repair
Authors: Crowson M , Fielding J W L , Black J , Ashton F , Slaney G
Published: March 2007

Acute gastrointestinal complications developed in 31 of 472 patients following aortic aneurysmectomy (6·6 per cent). In order of frequency these were: ischaemic intestine in nine patients, mechanical or paralytic ileus in eight patients, peptic ulceration in seven patients, undiagnosed gastrointestinal bleeding in five patients and paraprosthetic fistula in two patients. The risk of developing peptic ulcer complications was not significantly increased in patients with a previous history of peptic ulcer disease. The risk of developing an ischaemic intestine was increased if the distal limb of a prosthesis was anastomosed directly to the external iliac artery. The associated mortality was high and 21 (67·7 per cent) patients died. 33·3 per cent of the mortality occurring with elective aneurysm resection was associated with gastrointestinal complications.
Vascular injury following cardiac catheterization
Authors: McMillan I , Murie J A
Published: March 2007

Fifteen out of 3500 patients undergoing cardiac catheterization sustained arterial injury requiring surgical repair. Seven injuries to the common femoral or profunda femoris arteries presented late as false aneurysms, requiring simple suture repair. Three superficial femoral and four brachial artery injuries presented immediately after catheterization and surgical repair generally required the insertion of a vascular graft. The outcome of surgery was uniformly excellent. Small vessel cannulation is associated with increased likelihood of arterial injury. The common femoral route, with a high puncture site avoiding the superficial femoral or profunda vessels, is to be preferred to the brachial approach.
Benign bile duct stricture following cholecystectomy: Critical factors in management
Authors: Blumgart L H , Kelley C J , Benjamin I S
Published: March 2007

Seventy-eight patients with benign bile duct stricture following cholecystectomy were referred for further management over an 8-year period. The majority (58 per cent) had multiple operations before referral. On presentation 90 per cent of patients had abnormal liver function tests, 19·5 per cent a depressed serum albumin, 49 per cent a history of previous major infection, and 14 per cent associated liver disease and portal hypertension. Seventy-two patients (92 per cent) were operated upon: 63 by stricture repair alone, 4 by stricture repair and portal systemic anastomosis, and one by splenorenal anastomosis alone. Of the patients treated by stricture repair alone and no other procedure 90 per cent have a good result with a mean follow-up of 3.3 years, and an operative (30-day) mortality of 3·2 per cent. There were no postoperative deaths in 61 patients in whom stricture repair alone was performed by direct suture techniques, but in the presence of portal hypertension and liver disease the mortality was 27 per cent. Factors influencing a satisfactory stricture repair were the number of previous operations, site of stricture and type of repair. Factors influencing mortality were the number of previous operations, a history of major infection, the site of stricture, pre-operative serum albumin concentration, and the presence of liver disease and portal hypertension.
Pre-operative localization of parathyroid tumours using static B scan ultrasonography
Authors: Parrott N R , Rose P G , Farndon J R , Johnston I D A
Published: March 2007

Time consuming, inaccurate and often invasive localization procedures before initial surgery in primary hyperparathyroidism are probably not justified. The clinical value of pulsed ultrasound has been appreciated since 1975 and the application of dedicated, high resolution, real time systems is now advocated. This paper examines the efficacy of conventional static B scan equipment in pre-operative localization of parathyroid tumours in 34 patients. When considering all glands, a true positive value (sensitivity) of 55·5 per cent was achieved, with a true negative rate (specificity) of 96·0 per cent. The accuracy for all glands (the true positive plus true negative results as a percentage of all glands scanned) was 85·3 per cent. An accuracy of 93 per cent was achieved when considering glands greater than 5 mm diameter, with false positive and negative rates of 3·6 and 20·0 per cent respectively. The limitations of the technique are discussed in the context of the current literature.
Anorectal profilometry with the microtransducer
Authors: Varma J S , Smith A N
Published: March 2007

The reproducibility of anal sphincter manometry has been evaluated in 17 patients with a continuous pull-through technique using a miniature transducer mounted on a 2mm diameter Dacron catheter. Comparison was made with a conventional station pull-through technique using a 4mm diameter waterfilled microballoon connected to an external transducer. Parameters measured with the microtransducer (maximum resting pressure, squeeze pressure, functional sphincter length, area under high pressure zone, amplitude of rectosphincteric reflex) showed mean coefficients of variation from 3·2 to 5·7 per cent. Pressures measured with the microballoon were uniformly higher than those obtained with the microtransducer. The functional sphincter length was significantly shorter when measured with the microballoon (P < 0·001). The microtransducer provides a highly accurate and reproducible method of anorectal profilometry that avoids many of the drawbacks associated with fluid-filled systems.
Natural killer cells in renal allograft rejection
Authors: Cooksey G , Robins R A , Blamey R W
Published: March 2007

Monoclonal antibody Anti Leu 7 has been used to enumerate peripheral blood NK cells in 20 renal allograft recipients. Blood was taken preoperatively and three times per week for the first month after transplantation; separated mononuclear cells were stained with Anti Leu 7 then analysed on a fluorescence activated cell sorter. Results were related to acute rejection episodes diagnosed clinically and confirmed by Trucut biopsy of grafts. A reduction in the number of Leu 7 positive cells occurred postoperatively. Nineteen out of 20 patients showed a rise in number of circulating NK cells during acute rejection episodes.
Serum carcinoembryonic antigen and acute phase reactant proteins in the pre-operative detection of fixation of colorectal tumours
Authors: Durdey P , Williams N S , Brown D A
Published: March 2007

Fixity of colorectal tumours carries a poor prognosis, but only if it is the consequence of malignant spread. Pre-operative radiotherapy may be beneficial but selection depends on clinical examination which is often inaccurate or impossible. We therefore investigated if serum concentrations of carcinoembryonic antigen and acute phase reactant proteins (APRPS) which may be elevated in patients with colorectal cancer could determine the degree and nature of local spread prior to operation. Carcinoembryonic antigen (CEA), α1 acid glycoprotein (AGP) and C-reactive protein (CRP) were measured pre-operatively in 100 patients with colorectal tumours, 89 of whom had a carcinoma. Thirty-two (36 per cent) were fixed, 18 (56 per cent) by malignancy (FM) and 14 (44 per cent) by inflammation (F1). Levels of CEA, AGP and CRP were all significantly higher in the serum of patients with fixed tumours (P < 0·05). Concentrations of AGP > 1·4 g/l or CRP > 15 mg/l were accurate predictors of tumour fixation (specificity 87 and 90 per cent; sensitivity 78 and 78 per cent. CEA appeared more accurate in determining the nature of fixation. A value of > 50ng/ml predicted 82 per cent of FM tumours (specificity 100 per cent; sensitivity 87 per cent). Thus, pre-operative measurement of serum CEA and APRP appear able to predict fixation of colorectal tumours.
Evidence for sphincter dysfunction in patients with gallstone associated pancreatitis: Effect of ceruletide in patients undergoing cholecystectomy for gallbladder disease and gallstone associated pancreatitis
Authors: Cuschieri A , Cumming J G R , Wood R A B , Baker P R
Published: March 2007

The functional activity of the sphincter of Oddi complex has been examined by ceruletide manometry in patients undergoing cholecystectomy with a normal peroperative cholangiogram. In Group I (n = 14), which included patients with previous acute cholecystitis/biliary colic, the sphincter activity appeared to be normal and responded to intravenous ceruletide by a marked relaxation with a significant fall in both the infusion and postinfusion pressures. In patients undergoing cholecystectomy for gallstone-associated pancreatitis (n = 8), the sphincter exhibited manometric features of hypotonia with low infusion and postinfusion pressures which were not significantly altered by intravenous ceruletide.