bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage
Authors: Macleod I A , Mills P R
Published: March 2007

Ninety-five (24 per cent) of 389 admissions with acute upper gastrointestinal haemorrhage had further haemorrhage. An analysis of factors leading to further haemorrhage was undertaken by considering patients' clinical history, physical state on admission and endoscopic findings. The risk of further haemorrhage was significantly greater in patients bleeding from oesophageal varices or peptic ulcer and in those patients who were sober, shocked or anaemic on admission. Overall, those over 60 years of age were more likely to rebleed, but this difference was not apparent in relation to endoscopic source of blood loss.
Percutaneous transhepatic drainage in obstructive jaundice: Advantages and problems
Authors: McPherson G A D , Benjamin I S , Habib N A , Bowley N B , Blumgart L H
Published: March 2007

This study is a critical prospective assessment of 37 patients with obstructive jaundice, treated by percutaneous transhepatic biliary drainage. The median duration of drainage was 18 days (range 44–56), and during this period clearance of bilirubin and improvement in creatinine clearance were obtained. Only 10 patients gained weight. Three patients required early laparotomy. Thirty-three patients underwent definitive surgery. Of these, 8 died without leaving hospital. The incidence of infection rose during drainage, and infected bile was clinically significant. Two deaths were associated with infection, arising in the drainage system, producing intrahepatic abscesses around the drain track.

While the evidence for a staged approach in the severely ill patient with obstructive jaundice is substantial, the procedure of percutaneous transhepatic tubal drainage carries significant hazards, under-emphasized in previous reports. Further controlled assessment is required before this technique is accepted as the initial best option for decompression of the obstructed biliary tract.
The use of jejunal interposition for intractable symptoms complicating peptic ulcer surgery
Authors: Ramus N I , Williamson R C N , Johnston D
Published: March 2007

Ten patients severely disabled by post-gastrectomy syndromes were allocated to two treatment groups. Those with predominant dumping received a 10-cm antiperistaltic jejunal interposition; those with predominant bile vomiting received a 20-cm isoperistaltic interposition. After follow-up for a minimum of 3 years, 6 patients remained virtually asymptomatic (Visick grades 1 and 2). There were 2 deaths from myocardial infarction, 6 months and 2 years after remedial surgery. One patient developed a stomal ulcer after successful treatment of dumping. Jejunal interposition appears to be a safe and relatively successful procedure. A short antiperistaltic loop is recommended for early dumping; for bile vomiting a longer isoperistaltic segment is a satisfactory alternative to Roux-en-Y conversion.
Active trypsin and reflux oesophagitis: An experimental study in rats
Authors: Mud H J , Kranendonk S E , Obertop H , Van Houten H , Westbroek D L
Published: March 2007

In order to clarify the role of active trypsin, bile acids and pepsin in reflux oesophagitis, a comparable series of experiments was performed in rats before and after reflux-inducing operations. Three control procedures were used—laparotomy (n = 10), oesophageal transection and reanastamosis (n = 7) and a Roux-en-Y reconstruction (n = 9)—and seven experimental procedures in order to produce gastric, bile and pancreatic reflux (G + B + P) (n = 9), gastric and pancreatic reflux (G + B) (n = 8), bile and pancreatic reflux (B + P) (n = 10), pancreatic reflux alone (P) (n = 9), gastric reflux alone (G) (n = 8), bile reflux alone (B) (n = 9) and gastric with bile reflux (G + B) (n = 9). Macroscopic and histologically confirmed oesophagitis was produced in groups G + B + P, G + P, B + P and P. The trypsin levels were significantly elevated in these groups, compared to both the control and other experimental groups (P < 0·01). Bile acid levels were insignificantly different between the groups. Because these experiments involved vagal transection, no oesophagitis was found in the gastric juice reflux group.

This study has shown for the first time a correlation between the presence of active trypsin in the oesophagus and the occurrence of oesophagitis. It is possible that active components of duodenal juice may contribute to the development of reflux oesophagitis in man.
Resection and sutured colo-anal anastomosis for rectal carcinoma
Authors: Parks Alan G , Percy John P
Published: March 2007

Resection with preservation of the anal sphincters is now widely accepted as providing satisfactory treatment for carcinoma of the upper rectum. However, restorative resection is less widely performed for tumours of the lower rectum because anastomosis can be technically difficult when performed low in the pelvis. Between 1973 and 1980, 76 patients with rectal carcinoma underwent rectal resection and restoration of bowel continuity by means of a sutured anastomosis between colon and anal canal. The pathological characteristics of these tumours were similar to those of all cases of carcinoma of the rectum treated at St Mark's Hospital between 1948 and 1972. Two patients developed pelvic sepsis following colonic necrosis and anastomotic breakdown. Eight developed pelvic sepsis without major anastomotic breakdown. No patient died as a result of pelvic sepsis. Sixty-nine of the 70 patients who were able to be assessed were either completely normal functionally or had only minor deficiencies of bowel function.

Six patients have been observed to develop recurrent pelvic tumour, localized to the pelvis in 4 patients and concurrent with the development of widespread metastases in 2. Twenty-one of 32 patients are alive 3 years and 12 of 19 patients are alive 5 years after a curative operation for rectal carcinoma. These results are comparable with those seen following total excision of the rectum and pelvic floor for similarly sited tumours.
Results of extended surgery for cancer of the rectum and sigmoid
Authors: Bonfanti Giuliano , Bozzetti Federico , Doci Roberto , Baticci Fabio , Marolda Raffaele , Bignami Paola , Gennari Leandro
Published: March 2007

The clinical records of 61 patients who underwent extended surgery, including resection of parietes or other viscera, from 1965 to 1977 for cancer of the rectum and sigmoid were reviewed. Abdominoperineal resection was performed in 41 patients, anterior resection in 18 and Hartmann's resection in 2. The postoperative mortality rate was 8·2 per cent, the non-lethal morbidity rate 30·3 per cent, but 4 patients presented multiple complications. The 5-year survival rate was evaluated separately for patients with and without microscopic evidence of neoplastic involvement of the simultaneously excised structures; in the first group it was 32 per cent, in the second 75 per cent. Local or distant recurrence occurred in 66 per cent of patients with microscopic infiltration and in 24 per cent of patients without microscopic infiltration. These results compare favourably with those reported after ordinary resections of Dukes' C cancers of the rectum and sigmoid, and seem to justify the use of extended surgery when cancer of the rectum and sigmoid has invaded contiguous structures.
The management of post-traumatic intrahepatic cutaneous biliary fistulas
Authors: Smith E E J , Bowley N , Allison D J , Blumgart L H
Published: March 2007

Three cases of post-traumatic intrahepatic cutaneous biliary fistulas are presented, and some of the techniques available for the surgical management of persistent fistulas are described: simple suture, fistulo-jejunostomy and fistulo-cholecystostomy. All 3 patients achieved good clinical and biochemical results from their operations.
Stapling instruments in upper gastrointestinal surgery: A retrospective study of 362 cases
Authors: Lowdon Ian M R , Gear Michael W L , Kilby John O
Published: March 2007

A retrospective review of 362 upper gastrointestinal operations performed over a 6-year period was undertaken. The incidences of complications following the use of stapling instruments (Autosuture) or the use of conventional anastomotic techniques were compared. Complications considered to be related to anastomotic techniques were: leak or bleeding from the suture line or the development of intra-abdominal or wound sepsis. The complication rates were 21 per cent for operations using conventional suturing techniques and 16 per cent for operations in which the stapling instruments were employed.
Malignant phaeochromocytoma: Report of a case and a critical review
Authors: Dow C Jean , Palmer M K , O'Sullivan J P , Kirkham J S
Published: March 2007

A right adrenal phaeochromocytoma is described in a 64-year-old man. Metastases to bone and subsequent death following cord compression occurred within 2 years of diagnosis. Twenty-seven cases in the English literature have been reviewed since 1968. In three of these, the pathological proof was unsatisfactory for the diagnosis of malignancy, and one further case was inadequately documented. The variation in incidence of malignancy found in large retrospective series may relate to inconsistency in pathological criteria, as well as to selective reporting of cases.
Endoscopic retrograde cholangiograms of the normal and post-cholecystectomy biliary tree
Authors: Hamilton I , Ruddell W S J , Mitchell C J , Lintott D J , Axon A T R
Published: March 2007

The diameter of extrahepatic and intrahepatic bile ducts was measured on 50 normal retrograde cholangiograms and on the cholangiograms of 109 post-cholecystectomy patients undergoing endoscopic retrograde cholangiopancreatography: 70 of the post-cholecystectomy patients had a normal cholangiogram and 39 had retained stone or biliary stricture, of whom 17 were jaundiced. Biliary diameter at all points measured was greater in the post-cholecystectomy patients with no biliary lesion than in normals, and further increased in the presence of pathology (e.g. retained stone). The extent of overlap in biliary diameter between all these three groups is so great that measurement of bile duct calibre cannot separate patients with retained stone from post-cholecystectomy patients without retained stone, or from patients with an entirely normal biliary tree, even in the presence of obstructive jaundice. Methods of evaluating the biliary tract which rely on the measurement of bile duct diameter (e.g. ultrasound) are therefore of limited value in the investigation of post-cholecystectomy patients.
Delayed hypersensitivity testing for the prediction of postoperative complications
Authors: Ausobsky J R , Bean P , Proctor J , Pollock A V
Published: March 2007

One hundred and sixty-six patients undergoing elective major laparotomy were skin tested preoperatively with four common recall antigens in an attempt to correlate preoperative cell-mediated immune status with postoperative septic complications. Nineteen patients were anergic, 22 relatively anergic and the remaining 125 reacted to two or more of the antigens and were regarded as normally reactive. No significant differences in morbidity or mortality were found between patients who had depressed delayed cutaneous hypersensitivity reactions and those who reacted normally. We conclude that identification of those patients with depressed cell-mediated immunity preoperatively does not help in predicting postoperative problems.
The long term effects of proctectomy on bladder function in patients with inflammatory bowel disease
Authors: Neal David E , Parker Andrew J , Williams Norman S , Johnston David
Published: March 2007

The effect on bladder function of protectomy for colitis or Crohn's disease was studied by means of a questionnaire and by pressure/flow cystometry. Thirty-seven patients who had undergone protectomy for inflammatory bowel disease were compared with 34 control patients who had undergone bowel resection without protectomy. Symptoms of urinary dysfunction were found to be significantly more common in patients after protectomy than in controls (P < 0·05). Straining at micturition (P < 0·05) and a sensation of incomplete emptying of the bladder (P < 0·02), in particular, were significantly more common after protectomy. Evidence of denervation of the bladder, as shown by the finding of capacious bladders with poor detrusor function, was found in 6 patients after protectomy but in none of the controls (P < 0·05). The residual volume of urine in the bladder after micturition was significantly greater in patients after proctectomy than in controls (P < 0·02). Thus, the bladder is at risk of denervation in the course of proctectomy for inflammatory bowel disease even when dissection is kept close to the rectum.
Delayed hepatic resection for major liver injury
Authors: Smadja C , Traynor O , Blumgart L H
Published: March 2007

Seven patients with major liver injury initially assessed and managed elsewhere, and then referred to the Hepatobiliary Unit at Hammersmith Hospital, London, are reported. Six of the 7 patients had been operated upon and 4 had undergone two laparotomies before referral. All were seriously ill as a result of bleeding or liver necrosis and infection. Further laparotomy was carried out for the control of bleeding, débridement of dead tissue and drainage of infected material. Hepatic resection was performed in all patients and 3 of the 7 died in the postoperative period.

Liver resection is necessary for the control of bleeding and removal of dead tissue in severe shattering injuries. Should temporary packing be instituted in order to obtain control, then early referral for definitive treatment is necessary. Delay is dangerous and extension of necrosis with secondary infection is inevitable.
The P3 iso-enzyme of serum amylase in the management of patients with acute pancreatitis
Authors: Collins R E C , Frost S J , Spittlehouse K E
Published: March 2007

The concept of the P3 index and its use in separating acute pancreatitis from other causes of hyperamylasaemia is described. The mean P3 index of 12 healthy volunteers was 94·8 per cent. All 69 patients with acute pancreatitis had a P3 index below 80 per cent with a mean value of 67·9 per cent. The P3 index is abnormal longer than the raised serum amylase, which increases diagnostic accuracy. Causes of hyperamylasaemia other than acute pancreatitis have been studied and most patients have a P3 index above 80 per cent, although certain false positive values have been obtained. No patient with acute pancreatitis has had a P3 index above 80 per cent on admission. Five cases of acute pancreatitis have been studied in whom the P3 index remained abnormal; all had continuing pancreatic disease, usually with pseudocyst formation. The test has proved most valuable in identifying those patients at risk of developing subsequent problems. To date, the test cannot be relied upon to help in deciding upon the severity of an attack of acute pancreatitis.
A new posterior exposure of the splenic vein for an H-graft splenorenal shunt
Authors: Barsoum M S , Rizk-Allah M A , Khedr M El-Said , Khattar N Y
Published: March 2007

A preliminary report is presented of a posterior exposure of the splenic vein allowing H-graft splenorenal shunt to be carried out without removing the spleen. The operation was successfully performed in 14 patients with portal hypertension due to schistosomal hepatic fibrosis, and this was associated with post-hepatitic cirrhosis in 5 of them. Dacron grafts were inserted in 8 patients and autologous internal jugular vein grafts in 6 patients. The long term follow-up of the patients (maximum 45 months) showed that recurrence of bleeding developed in 2 patients due to shunt thrombosis and one died. Complications occurred in 3 patients, including one patient who developed first grade encephalopathy. Shunt patency was demonstrated in 12 patients, including all the vein grafts.
Femoropopliteal bypass grafts—an isotope technique allowing in vivo comparison of thrombogenicity
Authors: Goldman M , Norcott H C , Hawker R J , Hail C , Drolc Z , McCollum C N
Published: March 2007

Prosthetic femoropopliteal grafts attract platelet thrombus and often occlude in the months following implantation. Hence a technique to measure the in vivo thrombogenicity of different vascular substitutes in patients has been developed. In 28 patients the rate of accumulation of 111-indium-labelled platelets in saphenous vein, polytetrafluoroethylene (PTFE) and double velour Dacron femoropopliteal grafts was studied. One week postoperatively autologous 111In-labelled platelets were injected and the isotope emissions over the graft and contralateral leg counted. Graft thrombogenicity was calculated as the daily rise over 7 days in the ratio of counts over the graft to those over the contralateral leg. Mean thrombogenicity index (± s.e.mean) was greatest in the Dacron grafts at 0·24 ± 0·03 which compared with 0·13 ± 0·02 in PTFE (P<0·05). Saphenous vein was markedly less thrombogenic than either prosthetic graft with a mean index of only 0·025 ± 0·01 (P < 0·01). Platelet survival failed to differentiate the three graft materials, demonstrating that the direct measurement of 111 In platelet deposition was a more sensitive technique.
Long term evaluation of a reservoir jejunal interposition with an isoperistaltic conduit in the management of patients with the small stomach syndrome
Authors: Cuschieri A
Published: March 2007

The results of reservoir jejunal interposition in 9 patients with severe symptoms of the small stomach syndrome have been reviewed after a median follow-up period of 4·2 years (range 6 months to 10 years). Objective assessment of improvement in terms of weight gain, haemoglobin and serum albumin levels was obtained in all the patients but only 3 have reached and maintained their ideal weight. No patient has been rendered symptom free, but significant improvement of the post-cibal symptoms was observed in 7 patients. The most common residual symptoms have been heartburn and postprandial epigastric fullness. These have improved with metoclopramide therapy.
Comparison of rigid and flexible fibreoptic sigmoidoscopy with double contrast barium enemas
Authors: Vellacott K D , Amar S S , Hardcastle J D
Published: March 2007

One hundred consecutive new patients attending a general surgical and gastrointestinal outpatient clinic had a flexible fibreoptic sigmoidoscopic examination before a double contrast barium enema. Colonic lesions were found in 45 patients and flexible sigmoidoscopy was superior to barium enemas in diagnosing lesions in the sigmoid colon. Two cancers, 1 histologically a Dukes' A lesion, and 6 adenomatous polyps greater than 0·5 cm in diameter, in the sigmoid colon, were not detected by barium enemas. In 6 of these patients extensive diverticular disease was present. In patients with rectal bleeding found to have diverticular disease demonstrated radiographically, an endoscopic examination must be performed to exclude polyps or cancer. Flexible fibreoptic sigmoidoscopy may reduce the numbers needing barium enemas.
The staple closure of loop colostomy
Authors: Quill D , Conway W , Peel A L G
Published: March 2007

A technique of colostomy closure using the TA55 stapling instrument is described. No serious complications were encountered using this technique in a series of 20 consecutive loop colostomy closures.
Reduced catheter sepsis and prolonged catheter life using a tunnelled silicone rubber catheter for total parenteral nutrition
Authors: Mitchell A , Atkins Susan , Royle G T , Kettlewell M G W
Published: March 2007

One hundred and five patients were given total parenteral nutrition (TPN) for an average of 15 days via centrally placed venous catheters. Thirty-seven polyvinyl chloride (PVC) and 80 silicone rubber catheters were used. All the silicone rubber and 8 of the PVC catheters were buried in a subcutaneous tunnel. When silicone rubber catheters were used, there was significantly less catheter sepsis (P<<0·01), catheter life was prolonged by 50 per cent and fewer catheter insertions per patient were necessary.
Levamisole and postoperative complications: A controlled clinical trial
Authors: Ausobsky J R , Evans Mary , Pollock A V
Published: March 2007

We studied the relationship between cell-mediated immunity (assessed by preoperative skin reactions to four recall antigens) and postoperative infective complications in 166 patients undergoing major laparotomies. They were randomly allocated to receive ·150 mg of levamisole or placebo on the day of operation and for the following 2 days; their course was followed for at least 1 month. Neither the degree of preoperative anergy nor the administration of levamisole resulted in any significant differences in numbers of postoperative deaths or infective complications, but the levamisole group had significantly less postoperative pyrexia than the control group.
Adverse effects of exploratory laparotomy in patients with unsuspected liver disease
Authors: Powell-Jackson P , Greenway B , Williams R
Published: March 2007

Thirty-six patients were referred to the Liver Unit between 1971 and 1980 after unsuspected liver disease had been found at laparotomy. The preoperative diagnosis had been extrahepatic biliary obstruction in 16 patients and intra-abdominal malignancy in 15. Misdiagnosis resulted from insufficient attention to the history and physical signs in 31 patients and omission or misinterpretation of liver function tests and of other hepatobiliary investigations in the remaining 5 patients. The morbidity and mortality of the 36 patients within 1 month of operation was 61 per cent and 31 per cent respectively. All patients with viral or alcoholic hepatitis died, and severe complications, which included bacterial peritonitis, wound dehiscence and hepatic failure, developed in 13 of 15 in whom ascites due to cirrhosis or the Budd–Chiari syndrome was present before operation.
Pre-incisional intraparietal injection of cephamandole: A new approach to wound infection prophylaxis
Authors: Armstrong C P , Taylor T V , Reeves D S
Published: March 2007

Pre-incisional injection of cephamandole has been studied. Wound tissue levels of cephamandole have been found to be extremely high throughout the operation. Serum levels were comparable to those obtained with parenterally administered antibiotic. The use of a pre-incisional injection of antibiotic therefore offers major theoretical advantages over the use of either conventional parenteral or topical antibiotics in the prevention of postoperative sepsis.
Preoperative intraparietal (intra-incisional) cefoxitin in abdominal surgery
Authors: Taylor T V , Walker W S , Mason R C , Richmond J , Lee D
Published: March 2007

The effect of preoperative intraparietal (intra-incisional) injection of cefoxitin along the site of the intended incision on the incidence of wound infection has been investigated by a randomized prospective study of 181 consecutive patients undergoing abdominal surgery. A significant reduction in wound infection was evident in the cefoxitin-treated group (4·4 per cent) when compared with controls (16·7 per cent) (χ2 = 6; P = 0·02). Administration of antibiotic by this route did not delay wound healing or produce any undesirable sequelae.
Intraoperative microscopy of bile—is it useful?
Authors: Gallagher P , Ostick G , Jones D , Schofield P F , Tweedle D E F
Published: March 2007

Direct microscopy of the bile was performed during cholecystectomy in 111 patients in an attempt to identify those with a high risk of wound infection. Bacteria were identified in 23 patients, 11 of 83 undergoing cholecystectomy alone and 12 of 28 undergoing exploration of the common bile duct (P < 0·01). These 23 patients were randomly allocated to an antibiotic group or a control group; there was one wound infection in the antibiotic group and two in the control group. A total of 14 patients developed wound sepsis. Infection was more likely if the common bile duct was explored (6 of 28) rather than cholecystectomy alone (8 of 83). There was a poor correlation between microscopy and culture of the bile for bacteria and there was no increase in sepsis when bacteria were observed on microscopy. We were not able to identify a high risk group of patients by intraoperative microscopy of bile.
Acute acalculous cholecystitis following trauma
Authors: Herlin P , Ericsson M , Holmin T , Jönsson P-E
Published: March 2007

A consecutive series of 11 patients with post-traumatic acute acalculous cholecystitis is reviewed. Three patients had sustained multiple trauma, whereas 6 patients had recently undergone alimentary tract surgery and 2 patients orthopaedic or gynaecological surgery. All patients were treated by cholecystectomy. Four cases required reoperation because of an abdominal abscess and 2 cases because of a subcutaneous abscess. One patient was re-explored due to haemorrhage from the gallbladder bed, and another patient due to occlusion of the coeliac axis. The mortality rate was 18 per cent. The importance of early diagnosis and surgical intervention with cholecystectomy are emphasized in this rare condition with high morbidity and mortality.
Partial excision and drainage of post-traumatic splenic cysts
Authors: Millar J S
Published: March 2007

In areas of the world where malaria is endemic it is now advisable to conserve the spleen whenever possible following trauma. Post-traumatic cysts of the spleen may therefore be more commonly encountered. The experience in the four cases presented here shows that such cysts can be successfully managed without splenectomy. Evacuation of the cyst contents at laparotomy, followed by excision of the capsular component of the cyst and external drainage, gives good results.
Safe removal of failed transplanted kidneys
Authors: Voesten H G J , Slooff M J H , Hooykaas J A P , Tegzess A M , Kootstra G
Published: March 2007

The surgical removal of a transplanted kidney following rejection or failure can be hazardous. A total of 110 grafts were removed consecutively in 84 patients (in 21 cases a second graft and in 5 cases a third graft was removed). Two surgical techniques were applied: extracapsular and intracapsular removal. The extracapsular technique was associated with complications in 11 out of 69 cases (16 per cent) and the intracapsular technique, in 3 out of 36 cases (8 per cent). In 5 cases the operative technique could not be determined from the records.

In the 14 cases developing complications, wound infection was observed in 7 cases, wound haematoma in 4 and mycotic aneurysm, pulmonary embolism and clotting in the bladder each in 1 case. One patient (1·2 per cent) died due to late complications after allograft nephrectomy following rupture of a mycotic aortic aneurysm. The technique of kidney transplant removal by either the intra- or extracapsular route and the exact timing of the operation are important features for safe treatment of patients with end-stage graft failure.
Nine years' experience with end-to-end arteriovenous fistula at the ‘anatomical snuffbox’ for maintenance haemodialysis
Authors: Bonalumi U , Civalleri D , Rovida S , Adami G F , Gianetta E , Griffanti-Bartoli F
Published: March 2007

One hundred and seventy-seven end-to-end arteriovenous fistulas were created at the ‘anatomical snuffbox’ between 1 January 1972 and 31 December 1980. The survival rate of the fistulas was 83·1 per cent at 1 year and 46·3 per cent at 6·5 years; 10·2 per cent failed immediately. Local and general complications were virtually absent. Forty fistulas stopped functioning after a period varying from 10 days to 6·5 years following the operation. The main cause of late failure (50 per cent) was aneurysm formation due to repeated needle venepuncture at the same site and subsequent obliteration of the upper venous segment.

The end-to-end anastomosis seems to be preferable to other techniques because of the absence of local vascular complications and a lower risk of cardiac embarassment. The ‘anatomical snuffbox’ site is convenient and spares the proximal vessels for reoperation if necessary.
Endoscopic retrograde cholangiopancreatography in the investigation and management of patients after acute pancreatitis
Authors: Hamilton I , Bradley P , Lintott D J , McMahon M J , Axon A T R
Published: March 2007

Thirty-one patients who had been admitted with acute pancreatitis underwent endoscopic retrograde cholangiopancreatography (ERCP) following initial investigation by cholecystogram or intravenous cholangiogram and by biochemical screening. Previously undiagnosed gallstones were demonstrated at ERCP in 4 patients, and in 2 others known gallstones were effectively treated by endoscopic sphincterotomy. Changes of chronic pancreatitis were found in 8 pancreatograms and no patient in whom a normal pancreatic duct was demonstrated has suffered a further recurrence of acute pancreatitis. ERCP was valuable in the management of patients with acute pancreatitis, both in the diagnosis and management of biliary disease and in the recognition of underlying chronic pancreatitis.
Sensitivity of endoscopic retrograde pancreatography in chronic pancreatitis
Authors: Caletti G , Brocchi E , Agostini D , Balduzzi A , Bolondi L , Labo G
Published: March 2007

This study examines the value of endoscopic pancreatography in chronic pancreatitis. With the cooperation of nine departments in Italy, the authors examined the pancreatograms of 1179 patients with chronic pancreatitis. The pancreatograms were abnormal in 80·6 per cent. There were difficulties in distinguishing between cancer and pancreatitis in 11·3 per cent, and difficulty in deciding whether the radiographs were normal or slightly abnormal in 6·8 per cent. The ability of pancreatography to diagnose chronic pancreatitis increased with the duration of the disease, reaching 92·3 per cent in those patients who had had chronic pancreatitis for 5 or more years. However, the failure to obtain a pancreatogram increased as calcification increased. A good correlation between abnormalities of the pancreatogram and of the pancreatic function tests was demonstrated.
Peptic ulceration in adolescence
Authors: Mohammed R , MacKay C
Published: March 2007

The fate of 22 adolescents (mean age 14 years) with proved peptic ulceration is reported. Five presened as an emergency with performation of haemorrhage, whilst the remining 17 had typical ulcer dyspepsia. Despite intensive medical measures 17 patients required difinitive surgery. Ten patients were under 18 years of age at the time of operation and all were opearted on at under 25 years of age. the results were excellent in 14 out of 17 patients at 5-year followup, suggesting that surgery should not be withheld on the grounds of age alone. The role of histamine H2 receptor antagonists needs to be assessed in this type of patient.
Implantation of autologous splenic tissue after splenectomy for trauma
Authors: Lanng Nielsen J , Sørensen F Hanberg , Saksø P , Hansen H Hvid
Published: March 2007

Implantation of autologous splenic tissue was performed in 2 patients after splenectomy for trauma. In order to demonstrate some function of the implanted splenic tissue, spleen scintigraphy, using 99Tcm-labelled heat-damaged autologous erythrocytes, and measurement of the percentage of circulating vacuolated erythrocytes were carried out 1 and 3 months after splenectomy. The spleen scans were positive after 1 month and the isotope uptake increased after 3 months, demonstrating splenic phagocytic function. The number of vacuolated erythrocytes also indicated some restoration of the pitting function of the implanted splenic tissue. No alterations in serum immunoglobulins were seen, but a moderate thrombocytosis and monocytosis persisted for 3 months. Future improvements in the implantation procedure are discussed.
Rubber band ligation versus haemorrhoidectomy for prolapsing haemorrhoids: A long term prospective clinical trial
Authors: Murie J A , Sim A J W , Mackenzie I
Published: March 2007

Eighty patients with prolapsing haemorrhoids, randomly treated by either rubber band ligation (n = 39) or haemorrhoidectomy (n = 41), were assessed 12 and 42 months after treatment. Thirty-eight patients in each group presented with rectal bleeding. Twelve months later, 36 in the rubber band ligation group and 37 in the haemorrhoidectomy group had benefited from treatment. After 42 months, all patients in the rubber band ligation group reported improvement in this symptom; one in the haemorrhoidectomy group did not. At 12 months all but one patient in the rubber band ligation group and all in the haemorrhoidectomy group had improved with respect to haemorrhoidal prolapse. At 42 months all except one in each group reported improvement in this symptom. Anal pain, pruritus ani and soiling are symptoms commonly associated with haemorrhoids. All were improved by both rubber band ligation and haemorrhoidectomy. Neither technique was superior in this respect and there was no change in results between 12 and 42 months.

Relief from symptoms of haemorrhoids at 12 months, obtained by rubber band ligation or by haemorrhoidectomy, is maintained 42 months after treatment. Thus, rubber band ligation has a good long term outcome and, as a convenient outpatient procedure, should continue to be advocated as the first-line management for prolapsing haemorrhoids.
Spectral analysis of Doppler ultrasound: Its clinical application in lower limb ischaemia
Authors: Aukland A , Hurlow R A
Published: March 2007

Twenty-nine patients with symptomatic lower limb ischaemia were studied using a continuous wave Doppler ultrasound spectrum analyser. Frequency spectra were recorded from the peripheral arteries to determine the pulsatility index, damping factor and pulse wave transit time, and the results were related to arteriography.

In the aortofemoral segment, the pulsatility index at the common femoral artery decreased significantly with increasing stenosis, but the transit time was only prolonged with total occlusion. In the femoropopliteal segment there were significant differences in all parameters between each grade of stenosis. Accurate Doppler and radiological assessments of the calf vessels were possible in only 31 limbs; ultrasound did not enable differentiation between patent and occluded vessels.

The pulsatility index at the common femoral artery may be helpful in detecting aortofemoral disease, and accurate assessment of the femoropopliteal segment is possible, but spectral analysis is of no value in assessing the calf vessels.
A trial of glucagon in the treatment of painful biliary tract disease
Authors: Stower M J , Foster G E , Hardcastle J D
Published: March 2007

Seventy-one patients with a clinical diagnosis of painful biliary tract disease have been entered into a double-blind trial of glucagon. Twenty-eight were excluded as gallstones were not proved: of the remainder, 21 patients received glucagon and 22 placebo. Glucagon-treated patients were pain free 14·26 h(± 2·77 s.e.m.) after commencing treatment compared to 29·14 h(± 6·01 s.e.m.) for the placebo group (P < 0·05). Tenderness in the right hypochondrium showed a significant improvement when assessed at 12 h (P < 0·02) and 24 h (P < 0·1) for those given glucagon. A significant difference in blood glucose levels was seen between the two groups (P < 0·05). No serious side effects were observed. Glucagon relieves the pain and tenderness associated with painful biliary tract disease more effectively than conventional therapy.
The ‘acute’ abdomen in heroin addiction
Authors: Leguit P , Slot H , Roos C
Published: March 2007

Twenty-two heroin addicts admitted with an acute abdomen to the surgical department in the years 1971–1981 were reviewed. Fifteen patients had symptoms suggesting intestinal obstruction, 7 proved to have pseudo-obstruction, 4 had withdrawal symptoms, 2 had faecal impaction and only 2 had adhesions which necessitated operation. A haematocrit level of more than 0·46 was found to be indicative of true obstruction. Frequently, elevation of the white blood cell count or erythrocyte sedimentation rate merely reflected a state of accompanying soft tissue infections which were very common in these patients. The remaining 7 patients were admitted with intra-abdominal inflammation, 2 patients had an appendix mass, I had gonococcal peritonitis, 3 had appendicitis and I had a normal appendix removed. In these 7 patients the history and physical findings were characteristic of the suspected pathology.
Rectal, bladder and sexual function after mucosal proctectomy with and without a pelvic reservoir for colitis and polyposis
Authors: Neal D E , Williams N S , Johnston D
Published: March 2007

Sexual, bladder and rectal function have been assessed prospectively in a group of patients undergoing mucosal proctectomy, primarily for ulcerative colitis. The function of the rectum and ‘neo-rectum’ was studied before and 3 months (on average) after operation in 18 patients. Intestinal continuity was restored by means of ileo-anal anastomosis; in addition to ileo-anal anastomosis, a pelvic reservoir (MP + RES) was constructed in 10 patients, while ileo-anal anastomosis alone (MP + IAA) was used in the remaining 8 patients. Thirteen of these patients have been studied for a minimum of 4 months after closure of the defunctioning ileostomy.

No evidence of impotence or of bladder dysfunction due to trauma to pelvic autonomic nerves was noted. Evidence of impairment of function of the internal anal sphincter was observed soon after operation in 16 of the 18 patients (P < 0·05). However, reflex function of the external anal sphincter could still be elicited in over 70 per cent of patients who were tested 3 months after operation. The functional results of patients after MP + RES were significantly better than those of patients who had undergone MP + IAA. Thirteen months (on average) after closure of the ileostomy, the maximum capacity and compliance of the ‘neo-rectum’ in patients after MP + RES (423 ± 87 ml and 14 ± 7 ml/cm H2O respectively) were significantly greater than in patients after MP + IAA (181 ± 103 ml and 4 ± 3 ml/cm H2O respectively; P < 0·05). A significant correlation between the capacity of the ‘neo-rectum’ and the frequency of defecation was noted. The results of the present study support the suggestion that a pelvic reservoir should be fashioned in adults undergoing mucosal proctectomy and ileo-anal anastomosis for inflammatory bowel disease.
The effect of split ileostomy on perianal Crohn's disease
Authors: Harper P H , Kettlewell M G W , Lee E C G
Published: March 2007

The effect of 32 split ileostomies on 29 patients with severe symptomatic perianal Crohn's disease is reported. The perianal disease improved or healed after 23 (72 per cent) split ileostomies, although it relapsed in 2 patients while diverted and in 6 after closure of the split ileostomy. Seven of 12 rectovaginal fistulas healed initially but only remained healed in those patients without rectal involvement with disease. At the time of review 6 patients have normal bowel continuity, 8 have had proctocolectomies and 15 are still defunctioned. Split ileostomy should be considered as an initial step in the management of intractable perianal disease.
Prediction and prophylaxis of postoperative thromboembolis—a comparison between peroperative calf muscle stimulation with groups of impulses and dextran 40
Authors: Lindström B , Holmdahl C , Jonsson O , Korsan-Bengtsen K , Lindberg S , Petrusson B , Pettersson S , Wikstrand J , Wojciechowski J
Published: March 2007

The effects of peroperative electrical calf muscle stimulation with groups of impulses giving a short lasting tetanus of the calf muscles on postoperative deep venous thrombosis (DVT) and pulmonary embolism (PE) were compared with that of dextran 40 given perand postoperatively. The incidence of DVT and PE during the first 4–6 postoperative days was recorded. The diagnosis of DVT was based on the 125I-fibrinogen uptake test and phlebography and of PE on pre- and postoperative perfusion pulmonary scintigram and chest X-ray examination. Both methods reduced the incidence of PE. Calf muscle stimulation reduced the DVT incidence in patients with malignant disease while the reduction in DVT incidence for the whole group only was significant in the stimulation as well as the dextran 40 group.

Mean values for preoperatively determined levels of antithrombin III, beta-thromboglobulin, fibrinopeptide A, plasminogen and ability to release fibrinolytic activity during venous stasis did not differ between those patients who developed or those who did not develop postoperative DVT or PE. However, antithrombin III levels below 80 per cent appeared to predispose to postoperative thromboembolism. The two prophylactic methods have similar effects on the incidence of postoperative thromboembolism. The stimulation method has certain advantages due to its safety and simplicity.
The clinical significance of gastric acid secretion in bilharzial hepatic fibrosis
Authors: El Masri S H , Okosdonossian E T , Boulos P B
Published: March 2007

Gastric acid secretion was studied in 19 patients with bilharzial hepatic fibrosis and in 19 healthy controls. The patients had significantly lower volumes and acid output than the control group. After splenectomy and vasoligation, the patients' gastric secretion did not increase significantly. Gastric secretion was similar in 19 patients with bilharzial hepatic fibrosis who had never experienced any episode of bleeding and in 19 who bled.
Non-specific stimulation of host defenses against a bacterial challenge in malnourished hosts
Authors: Galland R B , Polk H C
Published: March 2007

We have studied the effects of non-specific enhancement of host defenses in malnourished mice using muramyl dipeptide (MDP). The challenge, consisting of a bacteria laden suture, simulates a surgical wound infection. Adult mice were subjected either to a 48-h period of acute starvation or to a 2 week period of protein deprivation. In each type of malnutrition, mice treated with MDP 24 h before the bacterial challenge had statistically lower local and systemic bacterial recovery, with a corresponding improvement in short term survival, than did untreated controls. MDP enhances local bacterial containment, thereby substantially reversing the detrimental effects of malnutrition on host defenses.
Manchester regional breast study—5 and 10 year results
Authors: Lythgoe J P , Palmer M K
Published: March 2007

Patients with early breast cancer (n - 1022) were treated between March 1970 and October 1975 in a prospective clinical trial. The results are presented after follow-up of 5–10 years. Clinical stage I cancer cases (n = 714) were randomly allocated to treatment by simple mastectomy and postoperative radiotherapy, or simple mastectomy alone. There was no statistically significant difference in overall survival between the two groups. There was a significant reduction in the frequency of local recurrence in those who received early postoperative radiotherapy compared with those who did not. Clinical stage II cancer cases (n = 308) were randomly allocated to treatment by simple mastectomy and postoperative radiotherapy or radical mastectomy alone. There was no statistically significant difference in survival or in the frequency of local recurrence between the two groups.
Urinary pseudouridine/creatinine ratio as an indicator of gastrointestinal cancer
Authors: Higley B , De Mello J , Oakes D Jane , Giles G R
Published: March 2007

Urinary pseudouridine/creatinine ratio was determined in 74 patients with gastrointestinal tumours and 34 patients with no known malignant disease. The reproducibility of a single random urine sample was demonstrated. The mean ratio for control patients was 26·9 ± 7·7 nmol/μmol and no control patient exceeded the mean by 2 standard deviations. There was no difference in the ratio between the sexes. Sixty-five per cent of colon cancer patients and 37·5 per cent of gastric and rectal cancer patients exceeded this upper limit of normality. There was no correlation between pseudouridine/creatinine ratio and histological differentiation, liver involvement or stage in either colorectal or gastric cancer patients. Urinary pseudouridine/creatinine ratio is one of the better non-specific cancer markers and may be particularly useful for detecting colonic cancer.
The fluid of choice for resuscitation of severe shock
Authors: Smith J A R , Norman J N
Published: March 2007

The choice of fluid for resuscitation in severe shock remains controversial. The various solutions commercially available have been compared in a standardized canine refractory shock model. The use of colloidal solutions proved preferable to the use of crystalloid solutions alone, as judged by oxygen debt, the volume required and the evidence of pulmonary overload. The three colloidal solutions studied, namely dextran 70, hydroxyethyl starch and Haemaccel (polygeline), produced very similar results. The clinical absence of reported serious side effects would suggest that Haemaccel is likely to be the colloidal fluid of choice. However, in the model studied, the use of a mixture of crystalloid and colloid produced results that were significantly better than either crystalloid or colloid alone. It is concluded that much of the controversy between crystalloid and colloid is artificial and that a mixture of these substances will be required in the resuscitation of the severely shocked patient.
Acute gallstone pancreatitis: Best timing for biliary surgery
Authors: Tondelli P , Stutz K , Harder F , Schuppisser J-P , Allgöwer M
Published: March 2007

The timing of biliary surgery in patients who have pancreatitis secondary to cholelithiasis is debatable. Of 523 patients admitted for acute pancreatitis between 1969 and 1978, 114 had gallstones for which an operation was performed. Immediate surgery was undertaken in 16 patients, early and late operation respectively in 98 patients. Complications occurred in 12 of the 114 patients and 7 patients died. Significantly more deaths occurred in the group who had an immediate operation (n = 5). In the group who had an operation more than 7 days after the amylase returned to normal, recurrent pancreatitis developed in 5 patients, 1 of whom died. It is concluded that immediate operation does increase mortality, and so may delay longer than 7 days after the amylase returns to normal.
The value of intensive follow-up after curative resection for colorectal carcinoma
Authors: Törnqvist A , Ekelund G , Leandoer L
Published: March 2007

A previous study undertaken by this department showed follow-up to be of little value in tracing curable recurrences in patients with colorectal cancer who had curative operations. The aim of the present investigation was to determine if more intensified follow-up would result in earlier diagnosis of recurrences and thus lead to earlier and more effective treatment. Altogether 599 patients with colorectal cancer were treated between 1973 and 1977. The 363 (61 per cent) patients who were operated upon for cure entered the study and were followed up until December 1979.

The same incidence of recurrence was seen in both series, but, with the more detailed protocol, they were more frequently detected before symptoms developed. However, the rate of curative reoperation for recurrence was not changed and only few patients survived after such reoperations. The conclusion is that the previous protocol is as efficient as the detailed one while no effective treatment of disseminated disease exists.
The aetiology of scrotal sepsis
Authors: Whitehead S M , Leach R D , Eykyn S J , Phillips I
Published: March 2007

The clinical findings and bacteriology of 30 abscesses of the scrotum are described. Anaerobic organisms were found in 27 abscesses (90 per cent), and in 3 cases in which they were not, the patients were receiving metronidazole at the time of drainage. Multiple anaerobic species were isolated, predominantly those found as commensals in the oropharynx and genital tract. ‘Gut specific’ Bacteroides spp. were very uncommon and were found only in patients with necrotizing fasciitis. It is suggested that the severity of some infections, particularly after scrotal surgery, is associated with thrombosis of the scrotal vessels.