bluuebunny/crossref_metadata_2025 huggingface dataset:
Retroperitoneal tumour infiltration detected by bone scanning in patients with infiltrating lobular carcinoma of the breast
Authors: Wilkinson M J S , Howell A , Harris M , Adam N M , Lupton E , Johnson R J , Sellwood R A
Published: March 2007

Radionuclide bone scans performed in some patients with carcinoma of the breast showed abnormal retention of isotope in the renal pelvis which developed and progressed during the period of follow-up after mastectomy. This phenomenon was seen in 15 of 30 patients with infiltrating carcinoma of the breast (ILC) but in none of 29 with infiltrating duct carcinoma (IDC). Autopsies were performed in eight of the patients with ILC and three of those with IDC. Diffuse retroperitoneal and ureteric infiltration was seen in seven (88 per cent), with ILC and none with IDC. These data suggest that this scan abnormality is an indicator of retroperitoneal spread by ILC.
Risk factors and clinical data related to oestrogen receptor status in women presenting with breast cancer
Authors: Montgomery A C V , McClelland R A , Skilton R A , Easton D , Cancer Breast
Published: March 2007

Oestrogen receptor (ER) content was measured in 257 patients presenting with ‘operable’ breast cancer. Difference in age, menopausal status, parity, age at first pregnancy, breast feeding habit and details of past and family history were compared with oestrogen receptor status. The symptoms and their duration together with the extent of the disease both clinically and pathologically were also compared with receptor status. Association both for increasing age and postmenopausal status was found when oestrogen receptors were present in the primary tumours in significant quantities. No separation between the effect of age and menopausal status on oestrogen receptor status could be distinguished. No relationship was demonstrated between oestrogen receptor status and the other clinical and pathological factors examined.
Management of splenic trauma: The Durban experience
Authors: Chadwick S J D , Huizinga W K J , Baker L W
Published: March 2007

In a retrospective survey of splenic trauma managed at a teaching hospital, the data of 127 patients during a 2 year period have been analysed. Splenic conservation was achieved in 47 laparotomies (38·8 per cent). Six patients with blunt abdominal trauma (4·7 per cent of all patients) were managed non-operatively. Splenic conservation by suture with or without packing with omentum or oxidized cellulose was successful in 27 out of 37 attempts. Failure of this technique was easily recognized during laparotomy and no patient required re-operation for continued splenic bleeding after splenorrhaphy. There was no significant difference between successful conservation of the spleen at laparotomy of patients below the median age (28 years) and older patients. Wound sepsis was increased after splenectomy (P < 0·05). Splenic conservation is not appropriate for all types of splenic injury. Where conservation is not possible splenectomy and re-implantation is recommended.
Pilonidal sinus excision — healing by open granulation
Authors: Marks J , Harding K G , Hughes L E , Ribeiro C D
Published: March 2007

A prospective study is reported of 100 pilonidal sinus excisions healing by open granulation. Delays in healing appeared to be due to infection, particularly by anaerobic bacteria. Comparisons are made between three groups studied consecutively — 30 wounds not treated with antibiotics, 20 given a fixed two-week course of metronidazole and 50 managed flexibly. In this last group, wound management was determined by clinical appearance; 24 wounds were clinically healthy throughout and received no antibiotic while 26 looked unhealthy initially or after an interval and were treated with metronidazole, supplemented in some cases with erythromycin. The best results were obtained in the group managed flexibly. It is considered that the problems of delayed healing are due to excisions which leave a wound of a shape ill-designed to maintain good drainage. Unhealthy wounds should be re-shaped if possible and treated early with a combination of metronidazole and erythromycin.
Oxygen tension on the skin of the gaiter area of limbs with venous disease
Authors: Clyne C A C , Ramsden W H , Chant A D B , Webster J H H
Published: March 2007

We examined the levels of oxygen on the skin of the gaiter areas of limbs with venous disease using a Roche Transcutaneous pO2 Monitor to determine whether hypoxia contributes to the skin changes and ulceration associated with severe venous disease. We studied patients with superficial varicose veins and no skin changes (Group 1: n = 25), patients with skin changes and healed ulcers (Group 2: n = 15), and an age matched normal control group (controls: n = 25). TcpO2 measurements were taken 5 cm above the medial malleolus with the limb both horizontal and vertical using a Roche Transcutaneous pO2 Monitor. A standard heel-raising test using a Medisonics Photoplethysmograph indicated the degree of venous insufficiency present. Results show that Group 1 patients and controls have similar skin oxygen levels (Group 1: TcpO2 66·48 + 14·12 mmHg; controls: TcpO2 61·60 ± 11·02 mmHg) whereas those with skin changes and ulceration have significantly lower oxygen levels (Group 2: TcpO2 46·57 ± 9·70 mmHg, t = 4·29, P<0·001). Group 2 patients did not show a significant rise in TcpO2 levels in the standing position whereas Group 1 patients and controls did (t = 2·6, P < 0·02). PPG post-exercise recovery times confirmed differences between the three groups. These findings show that significant skin hypoxia occurs on the gaiter area of limbs with severe venous disease and support the concept of an oxygen diffusion block.
Effects of a selective β2-blocker (ICI 118,551) on hepatic haemodynamics in the cirrhotic and non-cirrhotic rat
Authors: Jenkins S A , Baxter J N , Johnston J N , Devitt P , Shields R
Published: March 2007

The effects of a selective β2-blocker (ICI 118,551) on hepatic haemodynamics were studied in cirrhotic and non-cirrhotic rats. Infusions of 10 and 20 μg (kg body wt)−1 min−1 β2-blocker (in cirrhotic and non-cirrhotic rats) significantly reduced portal pressure, portal venous flow and liver blood flow without altering heart rate. Splanchnic vascular resistance was significantly increased following infusions of 10 and 20 μg (kg body wt)−1 min−1 β2-blocker. An intraportal injection of β2-blocker (10 μg body wt)−1 or hepatic artery ligation lowered portal pressure by approximately the same magnitude. Intraportal injection of β2-blocker after hepatic artery ligation did not further reduce portal pressure. The results indicate that a selective β2-blocker reduces portal pressure by a combination of increased splanchnic vascular resistance and hepatic arterial resistance. It is concluded that a selective β2-blocker may be of clinical value in the long-term managements of portal hypertension.
Malignant masquerade at the hilum of the liver
Authors: Hadjis N S , Collier N A , Blumgart L H
Published: March 2007

Eight patients with biliary obstruction and a pre-operative diagnosis of a neoplastic lesion at the confluence of the hepatic ducts were found postoperatively to have benign disease. Cholangiography was highly suggestive of a malignant stricture in all patients. Angiography performed in six patients indicated that the lesions were potentially resectable. Seven patients underwent elective surgery; in six the ductal confluence including the lesion was removed, without mortality. Six patients are alive, five of them totally asymptomatic, in a median follow-up of 32 months. Many patients with hilar strictures are treated for what appears radiologically to be a neoplastic lesion. Since treatment often involves the placement of an endoprosthesis or palliative surgery, without histological diagnosis, some of these patients with benign disease are likely to be treated inappropriately, unless they are considered for a curative resection.
The role of surgical local excision in the treatment of rectal cancer
Authors: Whiteway Janet , Nicholls R J , Morson B C
Published: March 2007

Selection of patients with ulcerating rectal cancer for treatment by local excision has been governed by a policy based on clinical and histological criteria; if these criteria are not fulfilled, major resection is recommended. This policy was re-examined in three groups of patients treated by local excision: Group 1 for cure (27 patients), Group 2 due to unfitness for major surgery (13 patients), Group 3 for local tumour control in the presence of metastatic disease (6 patients). When the policy was fulfilled, there was a cancer-specific death rate of 8.3 per cent in Group 1 (two patients with poorly differentiated tumours) and 0 per cent in Group 2. Unavoidable policy breaches occurred when patients refused major surgery or were too unfit: in the latter elderly group, this did not have the adverse effect expected. It is concluded that pre-operative clinical digital assessment and histological grading are a satisfactory means of identifying a small group of tumours appropriate for local treatment and that the results justify local excision where the policy is observed.
A multivariate analysis of clinical and pathological variables in prognosis after resection of large bowel cancer
Authors: Chapuis P H , Dent O F , Fisher R , Newland R C , Pheils M T , Smyth E , Colquhoun Kim
Published: March 2007

Data on 709 patients who had a resection for colorectal carcinoma at Concord Hospital between 1971 and 1980 were studied to determine the independent effects on survival of several patient characteristics and pathological variables using the Cox regression model. Clinicopathological stage had the strongest association. Other variables ranked according to their relative importance independent of stage were: histological grade, level of direct spread, the presence of venous invasion, age and sex of the patient and the presence of obstruction.
Ultrasonographic detection of early and curable carcinoma of the gallbladder
Authors: Koga A , Yamauchi S , Izumi Y , Hamanaka N
Published: March 2007

Five patients with early carcinoma of the gallbladder detected by ultrasonography were studied. Three complained of non-specific upper abdominal symptoms or were asymptomatic and two had severe biliary colic. Gallstones were present in the two-patients without biliary symptoms. Early carcinoma of the gallbladder was demonstrated as a polypoid tumour by ultrasound in four patients and as thickening of the gallbladder wall in one. The tumour was over 2 cm in diameter in all but one patient in whom the tumour enlarged rapidly from 5 to 10 mm. Size of the tumour and extent of spread were closely related. All but one patient underwent curative resection. Ultrasonography enhances the detection of early carcinoma of the gallbladder especially in old patients with nonspecific abdominal symptoms and the operative cure rate is thereby improved.
Layered versus mass closure of abdominal wounds in infants and children
Authors: Kiely E M , Spitz L
Published: March 2007

A prospective trial of layered versus mass closure of laparotomy wounds was performed on 507 infants and children over a 33 month period. All wounds were sutured using polyglycolic acid sutures. There were four wound failures including one disruption in the layered closure group and one wound failure in the mass closure group. The incisional hernias healed spontaneously. Either method of closure yields good results and non-absorbable sutures are unnecessary.
Experimental wound healing: Increased breaking strength and collagen synthetic activity in abdominal fascial wounds healing with secondary closure of the skin
Authors: Scott P G , Chambers Margaret , Johnson B W , Williams H T
Published: March 2007

Delayed primary closure or secondary closure of skin and subcutaneous fat in contaminated laparotomy incisions virtually eliminates the risk of wound abscess in clinical practice. Incisional hernias rarely develop in these wounds. This experimental study offers a possible explanation. Longitudinal incisions in the linea alba of female Wistar rats healed under skin incisions which were either sutured (‘closed’ subgroup) or left to close by secondary intention (‘open’ subgroup). Postoperative breaking strengths and collagen contents (measured as hydroxyproline) were studied at intervals of 3-120 days. Measurable strength developed by 5 days, at which time ‘open’ subgroup wounds were found to be weaker and to have less collagen. At all other times, however, ‘open’ subgroup wounds were stronger, a property which could be ascribed at earlier, but not at later, periods (42 or 120 days), to a higher content and concentration of collagen. At 3 days the rate of collagen production was significantly (P<0·025) lower in ‘open’ than in ‘closed’ subgroup wounds but the converse was true at 6 and 9 days (P<0·025), thus accounting for the changes in biomechanical properties. It is suggested that initially the stimulus for collagen synthesis is greater in the ‘open’ wounds and this leads to the development of a collagenous structure which is better adapted to resist tensile forces.
The effect of antiseptics on the healing wound: A study using the rabbit ear chamber
Authors: Brennan S S , Leaper D J
Published: March 2007

The effects of several antiseptic agents on granulation tissue were studied using rabbit ear chambers as models of the healing wound. This enabled us to study dynamically the action of these agents on the microcirculation of the wound. All the agents tested caused some adverse effect, but in the cases of hypochlorite antiseptics Eusol and Chloramine T, blood flow in the capillary circulation of the granulation tissue ceased and the process of repair was subsequently delayed. A laser Doppler flowmeter was used to measure these changes in local perfusion which reflected the toxic effects seen on microscopy of the ear chamber.
Effects of bile, infection and pressure on pancreatic duct integrity
Authors: Armstrong C P , Taylor T V , Torrance H B
Published: March 2007

Ionic flux, potential difference and mucosal ultrastructure have been studied in the rat bile—pancreatic duct and the effects of pressure, bile and infection on the duct evaluated. The duct remained stable after perfusion with control solution under low pressure and high pressure produced widening of intercellular spaces only. Perfusion with a bacterial solution of Escherichia coli did not effect significant changes. Sterile human bile disturbed the integrity of the duct by increasing ionic flux, altering potential difference and producing reversible ultrastructural changes of cell oedema. High pressure increased these changes. Infected human bile under high or low pressure was by far the most toxic substance tested. Perfusion with infected bile led to irreversible duct damage and complete loss of duct integrity. Pressure and infected bile may have a role in damaging duct integrity and could thus play an integral part in the genesis of acute gallstone pancreatitis.
Malignant melanoma of the hand and foot: Diagnosis and management
Authors: Hughes L E , Horgan K , Taylor B A , Laidler P
Published: March 2007

Forty-six patients with melanoma of the hand (5) and foot (41) studied prospectively between 1972-84 have been reviewed to determine guidelines for diagnosis and management. The clinical appearance is varied and the lesions are often misdiagnosed as warts or fungal infections. Clinical assessment of tumour thickness on the sole is difficult because of the nature of the plantar skin. Incision rather than excision biopsy is indicated because of the functional consequences of large excisions on the hand and foot. Melanoma of the toe was treated by local metatarsophalangeal amputation. Plantar melanomas were excised with a 3 cm margin. Dorsum melanomas were treated by a selective policy of 1, 2 or 3 cm margins according to clinical assessment of tumour thickness. These policies have resulted in only one case of local recurrence. An in situ Silastic foam mould facilitates immediate application of split skin grafts to irregular areas. The functional results of split skin grafts on sole and heel have been satisfactory. Toe lesions were thickest, dorsum thinnest, sole and heel intermediate. The prognosis related to these groupings of tumour thickness. Simultaneous clinical nodal involvement carried a hopeless prognosis, and most patients developing nodes within 2 years die—unless treated by prophylactic dissection. The role of prophylactic dissection is still not defined, but it is likely that it will be used more frequently in the future. Early diagnosis offers most hope of improving the outlook. Many elderly patients with nodular lesions have had moles for many years. Younger patients are now being seen with thin lesions, even on the toe.
CAPD and renal transplantation
Authors: Donnelly P K , Shenton B K , Lennard T W J , Proud G , Taylor R M R
Published: March 2007

Continuous ambulatory peritoneal dialysis (CAPD) is believed to improve the immune competence of end-stage renal failure patients and to increase the risk of graft rejection following subsequent renal transplantation. At this centre, 220 consecutive renal transplants have been studied in patients treated by either CAPD or haemodialysis (HD). Patient and graft survival was not significantly different for the two treatment groups over a five year follow-up. When only first cadaver recipients were considered (152 grafts) one-year graft survival (non-immunological failures excluded) was 77 per cent for CAPD and 79 per cent for HD patients (P>0·05). Time on dialysis and number of pre-operative transfusions were significantly greater for the HD patients (P<0·05). A group of HD and CAPD patients were identified as being matched for age, sex, HLA, A, B, DR antigen matches, pre-operative transfusions and time-on dialysis. One-year graft survival of the CAPD patients was 82 per cent and for the HD patients 61 per cent. Studies of patient lymphocyte function and plasma suppressive activity in vitro revealed no differences between CAPD and HD treated patients. CAPD is not an immunological risk factor in renal transplantation and its continued use in the preparation of patients for transplantation is recommended.
The influence of tumour cell DNA abnormalities on survival in colorectal cancer
Authors: Armitage N C , Robins R A , Evans D F , Turner D R , Baldwin R W , Hardcastle J D
Published: March 2007

The cellular DNA content was measured from paraffin-embedded material in 134 colorectal cancers from patients in whom the outcome was known. Seventy-two (55 per cent) were found to contain cells with abnormal DNA (DNA aneuploid). The presence of such a population of cells was not related to pathological stage or histological grade. However, only 14 (19 per cent) patients with DNA aneuploid tumours survived 5 years compared with 27 (43 per cent) of patients with diploid tumours (χ2 = 8·0, P = 0·005). Stepwise logistic analysis showed cellular DNA content to be an important prognostic factor in colorectal cancer, independent of pathological stage and histological grade.
An assessment of occult blood testing to determine which patients with large bowel symptoms require urgent investigation
Authors: Farrands P A , O'Regan D , Taylor I
Published: March 2007

One hundred and fifty-two consecutive patients with symptoms suggestive of colorectal disease were offered occult blood testing before undergoing barium enema examination or colonoscopy; one hundred and thirty-nine successfully completed the test. Thirty-four had positive results of whom thirteen had a cancer and eight an adenomatous polyp (diagnostic yield for neoplasia of 59 per cent). No false negative results occurred, a sensitivity of 100 per cent, and only 21 false positives occurred, a specificity for malignancy of 84 per cent. Subjects attending outpatients should be offered occult blood testing; those with a positive test should undergo colonoscopy. The cost-benefit of such a scheme is emphasized.
Fibro-adenoma of the breast
Authors: Wilkinson S , Forrest A P M
Published: March 2007

A retrospective study of 134 patients with a clinical diagnosis of fibro-adenoma of the breast indicated that histological confirmation of this diagnosis is made in only 50 per cent. The majority of the others have a diagnosis of benign mammary dysplasia. Eight patients had an unsuspected carcinoma, all but one being above the mean age for the fibro-adenoma group. The natural history of fibro-adenoma is not known precisely. In view of the high sensitivity of fine needle aspiration cytology in the diagnosis of malignant disease, we believe that there is justification to carry out a prospective study to determine this. In this study women with a clinical diagnosis of fibro-adenoma will be carefully observed provided they are less than 35 years of age and fine-needle aspiration cytology reveals no malignant cells.
The role of greater omentum in reconstructing skin and soft tissue defects of the groin and axilla
Authors: Watkins R M , Meirion Thomas J
Published: March 2007

In three patients undergoing extended inguinal (2) or axillary (1) block dissection for recurrent malignant disease use of conventional reconstructive methods was not possible. Transposed greater omentum was used to provide a vascularized base for split-thickness skin grafts in two patients and to protect a vascular prosthesis placed in heavily irradiated tissues in the third. In each case whole limb ablation was avoided and the salvaged limb showed good function. No local recurrence of malignant disease was seen.
Reticulo-endothelial function in rats with obstructive jaundice
Authors: Tanaka N , Ryden S , Bergqvist L , Christensen P , Bengmark S
Published: March 2007

Reticulo-endothelial function was evaluated by measuring the biokinetics of a standardized 99mTc-sulphur colloid using scintillation camera technique in rats with biliary obstruction. There was no difference in the uptake of the colloid in the liver (K1) between sham operation and biliary obstruction at 1 week and 3 weeks. However, when corrected for changes in liver volume, the corrected colloidal uptake rate (cK1) of the liver was significantly decreased in 1 week's biliary obstruction (P<0.005 compared with sham operation) and 3 weeks' biliary obstruction (P<0.025 compared with 1 week obstruction). Colloidal uptake rate of the extrahepatic reticulo-endothelial system (K2) was significantly increased (P<0.005) in rats with 3 weeks' biliary obstruction. Activity distribution of 99mTc-sulphur colloid in 3 weeks' biliary obstruction was significantly decreased in both total organ basis and per gram basis (P<0.005). The results demonstrated a depression of RE activity of the liver in biliary obstruction.
The effect of gastric partitioning on gastric emptying in morbidly obese patients
Authors: Gannon M X , Pears D J , Chandler S T , Fielding J W L , Baddeley R M
Published: March 2007

Gastric partitioning is undertaken for morbid obesity but the mechanism by which weight loss is achieved is unclear. The effect of partitioning on gastric emptying has therefore been studied. In thirty patients with a mean weight of 124.6 ± 7.3 kg (± s.e.m.), a stapling technique was used to create a 50 cm3 upper gastric reservoir which communicated via a 10 mm stoma with the distal stomach. Twenty-four pre-operative and nineteen postoperative gastric emptying studies were performed using separate 50cm3 solid and liquid 113mIn-labelled meals. The time taken to achieve 50 per cent gastric emptying and the delay in isotope reaching the duodenum were measured from gamma camera images. There was no correlation between the pre-operative weight of the patients and their gastric emptying rates. The median 50 per cent gastric emptying time for solids was increased from 21 min (range 8–34) to 37.5 min (range 8–60) (P<0.001), unpaired Wilcoxon), but was little changed from 17 min (1.5–30) to 16 (1.5–30) min using liquids. Delay in arrival at the duodenum was increased for solids from 0.5 min (.5–13) to 2.5 min (0.5–42.5) (P<0.05) but again there was no significant effect on liquid emptying. Postoperative 50 per cent emptying time for solids correlated with mean weight loss at 3, 6, 9 and 12 months (P<0.05). Following gastric partitioning there is delayed emptying of solids with related weight loss but liquid emptying is unaffected.
Pre- versus postoperative radiotherapy in rectal carcinoma: an interim report from a randomized multicentre trial
Authors: Påhlman L , Glimelius B , Graffman S
Published: March 2007

Since October 1980 a randomized multicentre trial has been in progress among patients with rectal carcinoma, in whom high-dose fractionated pre-operative irradiation (total dose 25.5 Gy in 5–7 days) is being tested against postoperative irradiation to a high dose level using a conventional fractionation scheme (totally 60 Gy in 8 weeks) delivered only to a high-risk group of patients (Dukes' stages B and C). The primary aim of the trial is to investigate whether local recurrence rate differs between the two groups, and a secondary aim is to see whether 5-year survival will differ between the two groups of patients. Up to October 1984, 360 patients have been randomly allocated to these two groups. Locally curative surgery has been performed in 161 patients in the pre-operative irradiation group and in 152 patients in the postoperative irradiation group. Pre-operative irradiation was extremely well tolerated and there were no irradiation-related complications; 95 per cent of these patients received their treatment according to the intended schedule. However, 48 of the 161 patients had a tumour in Dukes' stage A. Pre-operative radiotherapy had no impact on postoperative mortality or the occurrence of anastomosis dehiscence, but significantly more patients with perineal wound sepsis after an abdominoperineal resection were found in the group of patients receiving pre-operative radiotherapy. This prolonged the stay in hospital after surgery. Postoperative radiotherapy was not so well tolerated as pre-operative treatment, and in a substantial number of patients the treatment could not be commenced until a relatively long time after surgery. To date, the local recurrence rate is acceptably low (≈ 10 per cent) in both treatment groups.
The effects of different suture techniques on collagen metabolism in experimental distal colonic anastomoses
Authors: Yesilkaya Y , Soyhan N , Bengisu N , Sen M , Aritas Y
Published: March 2007

Two types of suture techniques have been compared in anastomoses of the distal colon in 20 mongrel dogs. They were divided into four groups, each consisting of five dogs. In A and C groups a single layer suture technique, and in B and D groups a two layer suture technique was used. In order to determine tissue hydroxyproline activities at the suture lines, the anastomosed segments were resected on the fifth day in A and B, and on the tenth day in C and D groups. It was observed that the hydroxyproline activities in single layer anastomoses were higher than those of two layer anastomoses with the implication that there was more rapid wound healing.
New method for the dynamic assessment of anorectal function in constipation
Authors: Womack N R , Williams N S , Holmfield J H M , Morrison J F B , Simpkins K C
Published: March 2007

A new dynamic technique for the investigation of anorectal function has been developed. This involves radiological visualization of the rectum during voiding of a semisolid radio-opaque contrast medium, and simultaneous measurement of the intrarectal pressure and electrical activity of the external anal sphincter. The method has been used to study patients (n = 16) with profound difficulty passing formed stool. It has demonstrated an abnormal increase in the activity of the puborectalis and superficial anal sphincter muscles during voiding in these patients, compared with normal subjects (n = 6). The inability to void was associated with failure to widen the anorectal angle on straining.
What is the best way of measuring perineal descent? A comparison of radiographic and clinical methods
Authors: Oettle G J , Roe A M , Bartolo D C C , McC. Mortensen N J
Published: March 2007

The ‘perineometer’ underestimated movement of the pelvic floor by nearly 60 per cent in 21 patients tested; mean descent was 1.2 cm, compared with a radiographic mean descent of 2.9 cm (P < 0.001). Since the instrument measures movement of the anal verge, not the pelvic floor, no account is taken of anal canal shortening. Radiographic methods are still necessary for the reliable identification of abnormal descent.
Effect of adjuvant chemo- or immunotherapy on the prognosis of colorectal cancer operated for cure
Authors: Wunderlich M , Schiessel R , Rainer H , Rauhs R , Kovats E , Schemper M , Dittrich Ch , Micksche M , Sedlacek H H
Published: March 2007

After radical surgery for colorectal cancer, 178 patients with a Dukes' B or C tumour were randomly assigned to one of three groups: A, controls (n=62); B, chemotherapy (n=59); C, immunotherapy (n=57). Randomization criteria (age, sex, Dukes' stage, localization of tumour, operative procedure) were evenly distributed throughout the groups. After a median observation time of 30 months, statistical analyses were performed: survival and probability to be free of recurrence was described by Kaplan—Meier estimates of the survival function; for comparison of these survival functions, Breslow's test was used. Overall analyses show no benefit in the treatment group compared to controls. Separate analyses by Dukes' stages showed that in patients with Dukes' C tumours the probability of survival 40 months after surgery was 72 per cent in group C, 51 per cent in group B, and 33 per cent in group A. The differences between groups C and A, and B and A were statistically significant (P<0.02 and P<0.03 respectively). For a Dukes' C tumour the probability to be free of distant metastases at 30 months after surgery was 80 per cent in group B, 68 per cent in group C and 52 per cent in group A. Also for a Dukes' C tumour the probability to be free of liver metastases at 21 months after surgery was 83 per cent in group B, 81 per cent in group C, and 54 per cent in group A (significant differences: B—A and C—A P<0.04 for both). There was no influence on the estimated incidence of local recurrences for stage Dukes' C. Patients with a Dukes' B tumour did not benefit from either of the adjuvant therapy schemes.
Extended indications for polypropylene mesh closure of the abdominal wall
Authors: Chan S T F , Esufali S T
Published: March 2007

Over a two-year period (1982–1984) polypropylene (Marlex) mesh was used without closing the abdominal wound in 21 patients judged clinically likely to require further abdominal exploration. A total of 43 meshes were implanted. All 21 patients had more than one major laparotomy, median 3 laparotomies (range 2–7) for drainage of pus (76 per cent) and/or intestinal leakage (67 per cent). Definitive abdominal wound closure after removal of polypropylene mesh was either by delayed primary suturing (33 per cent) or consisted of split skin grafting on the granulating wound (24 per cent). Three wounds were left to granulate without skin grafting (14 per cent). Mortality in this group of patients was 29 per cent and no complications resulted directly from implantation of polypropylene mesh. Polypropylene mesh closure of the abdominal wall not only provides simple and rapid access to the abdomen but also allows free drainage and daily inspection for the development of fistulae or the seepage of pus which are indications for further exploration. In that the clinical outcome is relatively favourable in this group of critically ill surgical patients who required multiple laparotomies within a short interval, it is suggested that mesh closure of the abdominal wound is indicated whenever abdominal reentry is judged probable or rational.
Large abdominal incisional hernias: Repair by fascial approximation reinforced with a stainless steel mesh
Authors: Validire J , Imbaud P , Dutet D , Duron J J
Published: March 2007

One hundred and fifty large abdominal incisional hernias were treated following a standardized operating technique using metallic mesh (Toilinox®) and approximation of the anterior sheath of the rectus abdominis. The average follow-up was four years. Good clinical results without pain were found in more than 95 per cent of the patients. Recurrence occurred in 9.5 per cent of the patients. The complications, wound infection or parietal necrosis, never necessitated removal of the prosthesis. These results justify the use of this technique even when intra-abdominal septic procedure is associated.
Controlled environment unit in the care of the below-knee amputation stump
Authors: Ruckley C V , Rae A , Prescott R J
Published: March 2007

A controlled environment unit has been compared with plaster dressings in the management of the below knee stump in 60 patients undergoing amputation for advanced vascular disease. The main criteria were stump healing and the speed of rehabilitation. There were 30 patients in each group. Three patients died within 10 days of operation. Primary healing was obtained in 65 per cent, secondary healing in 22 per cent and revision to above knee was required in 13 per cent. There were no statistically significant differences between the two groups. Neither did they differ in the times taken to reach the various stages of rehabilitation from bed excercises to independent walking with final prosthesis. While the controlled environment unit was as effective as the plaster dressing it tended to impede the patients' early mobility and to hinder nursing care. In particular it is not recommended for patients who may be confused or restless in the early postoperative period.
Deep vein reflux: An assessment by descending phlebography
Authors: Ackroyd J S , Thomas M Lea , Browse N L
Published: March 2007

This study of 51 patients aims to define the ‘normal’ range of reflux in the deep veins and the incidence of pathological reflux in patients with the post-thrombotic syndrome (PTS). ‘Normal’ limbs, limbs with simple varicose veins and limbs with post-thrombotic syndrome have been studied using a standardized technique for descending phlebography, supine and with a controlled Valsalva. The ‘normal’ range of reflux has been found to be grade 0–2. The incidence of pathological reflux in patients with proven post-thrombotic damage to the deep veins is 31 per cent.
Increased glomerular filtration rate in patients after reconstructive surgery on the abdominal aorta
Authors: Nielsen O M , Engell H C
Published: March 2007

Fifty-three patients undergoing elective reconstructive surgery on the abdominal aorta were included in a prospective study to obtain information on postoperative glomerular filtration rate (GFR) in relation to increased fluid and sodium intake and decreased plasma colloid osmotic pressure (COP). GFR, extracellular fluid volume (ECV) and COP were measured before operation and on the first and fourth day after surgery. GFR and ECV were measured by means of the single injection residue detection method using the inulin analogue polyfructosan-S as marker. The compiled GFR values increased from 92.3 to 103.7 ml min−1 1.73m−2 (P < 0.002) on the first day, and to 105.3 ml min−1 1.73m−2 (P < 0.001) on the fourth day after surgery. Concomitantly, ECV increased from 8.9 litres 1.73m−2 before operation to 9.5 litres 1.73m−2 (P < 0.05) and 9.6 litres 1.73m−2 (P < 0.025) respectively. Positive linear correlation was found on the first postoperative day between GFR per 1.73m2 and ECV per 1.73m2 (r = 0.33, P < 0.05) and between GFR per 1.73m2 and extracellular sodium content per 1.73m2 (r = 0.38, P < 0.01). COP was not correlated to GFR per 1.73m2. The postoperative increase in GFR found in this study is most likely to be the result of increased ECV and renal plasma flow. Whether other factors are also involved remains unknown.
Radioimmunolocalization and selection for surgery in recurrent colorectal cancer
Authors: Begent R H J , Keep Patricia A , Searle Frances , Green A J , Mitchell H D C , Jones Barbara E , Dent Joan , Pendower J E H , Parkins R A , Reynolds K W , Cooke T G , Mersh T Allen , Bagshawe K D
Published: March 2007

The value of radioimmunolocalization (RIL) of cancer depends on its performance in situations where the result determines the choice of management. A rise in serum carcinoembryonic antigen (CEA) values after apparently curative resection of colorectal cancer implies localized, resectable recurrence in some patients and widespread unresectable tumour in others. This study investigated the ability of RIL with radiolabelled antibody to CEA and a novel numerical method for analysis of results to determine the extent of disease in 31 patients with raised serum CEA but no physical signs of recurrence. Surgical exploration or conventional radiology later confirmed the presence of tumour in 94 per cent of sites which were positive by RIL. Negative RIL predicted the absence of disease in 53 per cent of patients. The investigation could discriminate between localized and disseminated disease and often performed better than conventional radiology. RIL appears useful in selection of patients for second look laparotomy.
The incidence of Filaria as an aetiological factor for testicular hydrocele
Authors: Dandapat M C , Mohapatro S K , Mohanty S S
Published: March 2007

Five hundred cases of hydrocele of the tunica vaginalis testis (TVT) have been studied in detail in order to ascertain their aetiology. In 43 per cent of cases hydrocele was found to be definitely due to filariasis, in 14 per cent it was highly likely that filariasis was responsible and in 16 per cent filariasis was suspected to be the aetiological factor. The remaining 27 per cent of cases were found to be non-filarial.
Ruptured abdominal aortic aneurysms: A study of incidence and mortality
Authors: Johansson G , Swedenborg J
Published: March 2007

The incidence of ruptured abdominal aortic aneurysms (AAA) during 1980 in the Stockholm county and the clinical fate of the patients were evaluated. Eighty-eight patients with ruptured AAA were found, an incidence of 0.06 per thousand. The overall mortality was 94 per cent. Sixty-four patients reached hospital, twenty-three received a correct diagnosis; thirteen were operated upon and five survived. Autopsy or operation revealed that most ruptures were retroperitoneal (88 per cent) and that only two aneurysms (2 per cent) extended above the renal arteries. It is concluded that the high mortality rate following rupture is more dependent upon failure to operate than on operative mortality.
Randomized study of Corynebacterium parvum adjuvant therapy following surgery for (Stage II) malignant melanoma
Authors: Thatcher N , Mene Aruna , Banerjee S S , Craig P , Gleave N , Orton C
Published: March 2007

One hundred and fifteen patients with histologically proven primary cutaneous melanoma were entered into a randomized prospective study following surgical removal of clinically obvious regional metastases. The study started in 1977 and was completed in June 1982. Fifty-eight patients (10 with regional skin metastases and 48 with regional node metastases) were in the control group and 57 (15 regional skin, and 42 regional node metastases) received adjuvant C. parvum. Other clinical features were well balanced for each group. C. parvum, 2 mg/m2 IV was repeated eight times at three weekly intervals. The schedule was based on previous work which indicated significant increase in killer cell activity. There was no serious toxicity and 22 patients exhibited tachyphylaxis. Seventeen patients in the control group (11 tumour free) are alive at 24–80 months, and 20 patients in the C. parvum group (12 tumour free) are alive 24–76 months from randomization. No statistically significant difference (P > 0.05) was observed between the two patient groups for overall survival (median 26 months) or relapse free survival (median 8 months) from the date of randomization. Nor was the overall survival from the date of primary surgery (median 52 months, range 4–237) or the relapse free survival, median 28 months, range 2–225, significantly different between the two groups of patients. The relapse pattern in the two groups, and survival after relapse were no different though the response rate to actinomycin D and DTIC chemotherapy was significantly higher in the control (48 per cent) than in the C. parvum (23 per cent) group. Toxicity to chemotherapy was not significantly affected by previous C. parvum treatment. Although there were trends for better survival, in the C. parvum patient group, statistically significant activity has not been noted in this study.
Hepatic hydatid disease in Libya
Authors: Elhamel A , Murthy B S
Published: March 2007

A series of 50 patients with hepatic hydatid disease all treated at the Central Hospital, Tripoli, Libya is presented to show the advantage of ultrasonography in pre-operative diagnosis and the advantages of complete resection or omentoplasty compared with removal of the endocyst and drainage.
Monoclonal immunoscintigraphy for the detection of primary colorectal cancers: A prospective study
Authors: Finan P J , Ritson Anne , Ware Fiona , Parkin A , Robinson P J , Sikora K , Giles G R
Published: March 2007

A prospective study to investigate the value of monoclonal antibody (McAb) immunoscintigraphy for the detection of primary tumours of the colon and rectum has been undertaken. Twelve patients received 1 mg 131I-labelled McAb YPC 2/12·1, an antibody raised to a human colonic carcinoma membrane preparation. Imaging of the blood pool was achieved using 99mTc-labelled red cells. After surgery specimens were scanned and samples of normal and malignant tissue excised to obtain antibody binding ratios. In only one patient was the primary tumour visualized pre-operatively. Images of the resected specimens revealed the primary tumour in ten cases but this appeared to be a function of increased blood pool within the tumour rather than specific antibody localization. The mean tumour/normal tissue count ratio was 1·27:1 (range 0·63:1–1·93:1). It is concluded that the McAb YPC 2/12·1 is unlikely to be of use clinically. Furthermore when selecting McAbs for the purposes of immunoscintigraphy the results of in vitro binding to malignant cell lines, immunohistological studies and xenograft experiments may be misleading and careful clinical evaluation is necessary.
Strategy for lymph node biopsy in homosexual men suspected of having LAV/HTLV-III related disease
Authors: Scott H J , Glynn M J , Lane I F , Anderson M G , Theodorou N A , Murray-Lyon I M , Reynolds K W
Published: March 2007

Since January 1985 we have changed our policy regarding lymph node biopsy in male homosexuals presenting with lymphadenopathy. Before that date-all such patients underwent biopsy if there was no apparent cause. We no longer perform biopsy in male homosexuals presenting with uncomplicated persistent generalized lymphadenopathy (enlargement to more than 1 cm of lymph nodes in more than one extra-inguinal site for more than 3 months with no apparent cause) provided that the patient is positive for the antibody to lymphadenopathy associated virus/human T-lymphotropic virus type III. Such a policy should reduce the need for open biopsy procedures in this group of patients.
Low molecular weight heparin once daily compared with conventional low-dose heparin twice daily. A prospective double-blind multicentre trial on prevention of postoperative thrombosis
Authors: Bergqvist D , Burmark Ulla Stina , Frisell J , Hallböök T , Lindblad B , Risberg B , Törngren S , Wallin G
Published: March 2007

In a randomized, prospective, double-blind multicentre trial, the effect of conventional low-dose heparin 5000 units twice daily, was compared with that of a low molecular weight heparin fragment (4000–5000) 5000 anti-factor Xa units once daily. Four hundred and thirty-two patients fulfilled the inclusion criteria and were analysed for development of deep vein thrombosis (125I-labelled fibrinogen test) and haemorrhagic complications. Thrombosis occurred in a 4·3 per cent of patients in the low-dose heparin group and in 6·4 per cent of patients in the heparin fragment group, a difference which is not significant. There was a significant delay in the onset of thrombosis in the heparin fragment group. Mortality did not differ between the groups, nor did peroperative blood loss or transfusion requirements or infectious complications. Haemorrhagic complications occurred significantly more often in the fragment group (11·6 per cent) than in the conventional heparin group (4·6 per cent). Patients in the heparin fragment group experienced local pain following the subcutaneous injection significantly less often.
Anteroposterior rectopexy in the treatment of solitary rectal ulcer syndrome without overt rectal prolapse
Authors: Nicholls R J , Simson J N L
Published: March 2007

There is evidence that the solitary rectal ulcer syndrome is associated with rectal prolapse either overt or internal. The anterior rectal wall is affected in most cases and a modified abdominal rectopexy has been used with the aim of supporting both the anterior and posterior aspects of the rectum. Fourteen patients aged 19–70 years (mean 34·2 years) in whom conservative treatment has failed, have been treated by anteroposterior rectopexy. Tenesmus, bleeding and the passage of mucus have been abolished or greatly improved in 12, 14 and 13 patients respectively. The number of attempts to defaecate per 24 h has fallen from 8·7 ± 1·4(s.e.m.) pre-operatively to 3·4 ± 1·0(s.e.m.) postoperatively (P < 0·05) and the time spent in the lavatory has been reduced from 146 ± 18(s.e.m.) min to 15 ± 3(s.e.m.) min. Two patients have developed severe constipation postoperatively and two others have had persistent or recurrent tenesmus. Combined anteroposterior rectopexy has improved 12 out of 14 patients with the solitary ulcer syndrome without external rectal prolapse when assessed at 2–48 months postoperatively.
‘Laparostomy’: A technique for the management of intractable intra-abdominal sepsis
Authors: Mughal M M , Bancewicz J , Irving M H
Published: March 2007

Following laparotomy for severe intra-abdominal sepsis, the abdominal cavity was left open to heal by granulation in 18 patients. In 14 patients, operation was required because of recurrent gastrointestinal perforation or anastomotic dehiscence. In three, the indication for this procedure was recurrent pancreatic abscess. Of the 17, 13 had previously undergone multiple operations which had failed to control sepsis. Laparostomy was performed as a primary procedure in only one case, a patient with fulminating pancreatitis requiring pancreatic necrosectomy. All patients received parenteral nutrition. The overall mortality was 28 per cent. However, there was only one death among the last 9 patients treated compared with 4 in the previous 9. The median sepsis score in the first 9 (19, range 10–26) was not significantly different (P > 0·05)from that in the subsequent 9 patients (17, range 8–21). Three of the four who had initially presented with severe acute pancreatitis died. No patient eviscerated and only 9 (50 per cent) required mechanical ventilation for a median duration of 5 days. The median time for wound healing was 10 weeks and 6 patients have subsequently undergone definitive surgery with satisfactory results. Laparostomy is a valuable technique in the management of severe, intractable intra-abdominal sepsis.
Adjuvant radiotherapy and chemotherapy in breast cancer
Authors: McArdle C S , Crawford D , Dykes E H , Calman K C , Hole D , Russell A R , Smith D C
Published: March 2007

Three hundred and twenty-two women with involvement of axillary lymph nodes following surgery for operable breast cancer were randomized to receive either postoperative radiotherapy, chemotherapy (CMF) or radiotherapy followed by chemotherapy. There was an increase in disease free interval in pre- and postmenopausal patients receiving radiotherapy and chemotherapy regardless of the number of nodes involved. However, there was a trend towards an improvement in disease related survival only in those patients with more than three nodes involved.