bluuebunny/crossref_metadata_2025 huggingface dataset:
Proliferation patterns and aneuploidy in adenomatous polyps of the colon
Authors: Matthews J , Sousha S , Parkins R A , Glynn M , Cooke T
Published: March 2007

The frequency of aneuploidy and the proliferative activity of 57 colorectal adenomatous polyps was investigated by static cytophotometry and compared with 43 adenocarcinomas and 60 samples of normal mucosa. Twenty per cent of the adenomas contained aneuploid cells compared with 63 per cent of the adenocarcinomas. Except in the case of villous adenomas, there was a general increase in the proliferative activity of the diploid adenomas with increasing degrees of dysplasia. All of the adenomas showed an increase in proliferation compared with normal mucosa. There was a positive correlation between the size of the diploid adenomas and proliferative activity (P < 0·001).
Renal transplantation in patients over 55 years old
Authors: Lauffer G , Murie J A , Gray D , Ting A , Morris P J
Published: March 2007

From 1975 to 1987, 507 patients, of whom 63 (12.4 per cent) were over 55 years old at the time of operation, received first cadaver renal transplants. The annual percentage of recipients given transplants after the age of 55 has risen from 0 per cent in 1975 to 44 per cent in 1987. Of the 63 older patients, 41 had at least one serious non-renal disease at the time of transplantation. Perioperative mortality rate was 3 per cent. After successful transplantation these patients remained subject to a significant number of serious complications, even in the cyclosporin era. Despite these adverse factors, actuarial graft survival for the population over 55 years of age was no worse than for those patients receiving first cadaver grafts who were under 55 years old, although patient survival was poorer in the former group (P = 0.027). Analysis of the subgroup of 56 patients treated with an immunosuppression protocol containing cyclosporin failed to show any adverse effect of age on either graft or patient survival. It is concluded that renal transplantation can be as successful in patients over 55 years of age as it is in younger patients and, given an adequate supply of kidneys, should be considered the treatment of choice for the elderly patient with end-stage renal failure.
Pre-operative or postoperative colonic examination for synchronous lesions in colorectal cancer
Authors: Tate J J T , Rawlinson J , Royle G T , Brunton F J , Taylor I
Published: March 2007

A review of 130 consecutive large bowel examinations at which a cancer of the colon or rectum was diagnosed has been undertaken. Of 50 patients examined by colonoscopy, the whole colon was seen in only 21 (42 per cent) and almost half of these had a tumour in the caecum or ascending colon. In most cases, an incomplete examination was a result of narrowing of the lumen by the tumour preventing passage of the endoscope. Of 80 patients examined by double contrast barium enema, the entire length of the colon was visualized in 83 per cent but the quality of the examination was sufficient to confidently exclude synchronous neoplastic lesions in only 51 per cent. The incidence of synchronous cancer in this series was within the expected range, although two such cancers were not detected until laparotomy, but the incidence of synchronous adenomas was two-thirds of the expected number in colonoscopy patients and one-third in those examined by barium enema. It is concluded that, in patients with known colorectal cancer, preoperative investigation is unreliable for the detection of all synchronous neoplasia and that patients should have postoperative colonoscopy.
Comparison of a low molecular weight heparin and unfractionated heparin for the prevention of deep vein thrombosis in patients undergoing abdominal surgery
Authors:   The European Fraxiparin Study (EFS) Group, Encke A , Breddin K
Published: March 2007

In a prospective, randomized multicentre trial the efficacy and safety of the low molecular weight heparin (LMWH) fraction Fraxiparin® and unfractionated calcium heparin (Calciparin®) were compared for the prevention of postoperative deep vein thrombosis. Of 1909 patients included in the trial 1896 underwent abdominal surgery and received either one daily subcutaneous injection of 7500 anti-X a units Fraxiparin or 5000 units calcium heparin three times a day subcutaneously. Elastic compression stockings were worn by both groups of patients in the postoperative period. Before randomization the patients were stratified in two subgroups with or without malignant disease. To assess the rate of deep vein thrombosis (DVT), 125I-labelled fibrinogen leg scanning was performed daily for 7 postoperative days. Positive results were confirmed by phlebography whenever possible. Venous thrombosis occurred in 27 of 960 patients (2.8 per cent) given Fraxiparin and in 42 of 936 patients (4.5 per cent) given calcium heparin (P = 0.034). The rates of proximal vein thrombosis were 0.4 per cent (4 patients) and 1.4 per cent (13 patients) respectively (P<0.05). Pulmonary embolism occurred in 2 of 960 patients (0.2 per cent) treated with Fraxiparin and in 5 of 936 patients (0.5 per cent) treated with calcium heparin. The two treatments were equally well tolerated. Intra- and postoperative blood loss, the number of wound haematomas as well as frequency and volume of transfusions were similar in both groups. The present trial demonstrates that a single daily subcutaneous injection of Fraxiparin is more effective than the established low dose subcutaneous heparin prophylaxis with 5000 units three times per day in preventing postoperative DVT after abdominal surgery in patients wearing compression stockings.
Obstructive pancreatitis: Unusual causes of chronic pancreatitis
Authors: Lowes J R , Rode J , Lees W R , Russell R C G , Cotton P B
Published: March 2007

Fifty-eight consecutive surgical pancreatic resections for chronic pancreatitis were examined. Eight cases were identified with obstructive pancreatopathy; all underwent pancreato-duodenectomy. Histological examination revealed that obstruction in three cases was due to duodenal wall cysts, and in two patients it was associated with pancreas divisum (the accessory papilla was obstructed by a neuroendocrine tumour in one case and by ectopic pancreatic tissue in the other). One case each was due to obstruction of an anomalous duct by vegetable matter, to segmental pancreatitis, and to an intraductal carcinoma. Obstructive pancreatitis has many causes and diligent pre-operative assessment is required as surgical resection may be beneficial. Special efforts should be made to identify ductal anomalies, duodenal cysts, ectopic pancreatic tissue, and small ampullary tumours of exocrine and endocrine origin in order to define the aetiology of pancreatitis.
Use of advisers in the diagnosis and management of abdominal pain in accident and emergency departments
Authors: Driscoll P A , Vincent C A , Servant C J , Audley R J
Published: March 2007

The performance of senior house officers (SHOs) and their advisers in accident and emergency departments was compared in the diagnosis of abdominal pain in 711 patients. Accuracy of diagnosis was 63 per cent for advisers and 54 per cent for SHOs. Overall, the adviser improves the diagnosis of the SHO in only 6 per cent of cases. The SHOs refer accurately in 94 per cent of cases, and the advisers improve the SHO referrals in only 1 per cent of patients. It is argued that the time-consuming process of calling a surgeon away from a ward or theatre to advise in the receiving room is of little value, and avoidance of this step would enable patients to be admitted more rapidly.
Pulmonary microembolization in experimental aortic surgery
Authors: Poskitt K R , Irwin J T C , Lane I F , Karacagil S , McCollum C N
Published: March 2007

Pulmonary dysfunction frequently follows major surgery and has many features identical to ‘shock lung’. A porcine model of aortic surgery is described in which 111In-labelled platelet kinetics were related to subsequent pulmonary function. In 14 pigs, standardized aortic surgery resulted in reproducible shock and a 50 per cent mortality at 3 days. Cardiac output fell from 22.3±0.2 to 1.0±0.1 litres min−1 following removal of the aortic clamp and mean platelet and leucocyte counts fell from 437±48 to 252±39×109 litres−1 and 21.7±1.5 to 12.9±1.2×109 litres−1 respectively (P<0.01). Aggregate levels in inferior vena caval blood were maximal at this time and radiolabelled platelets accumulated in the lung with a rise in pulmonary vascular resistance. Alveolar—arterial oxygen difference subsequently increased from initial values of 13.7±2.0 to 23.4±3.5 mmHg (P<0.01) following resuscitation and to 32.5±3.4 mmHg at 3 days following surgery (P<0.01). This clear sequence suggests that pulmonary platelet microembolization occurs during surgical shock and may be responsible for subsequent pulmonary dysfunction.
Sex, Enterobius vermicularis and the appendix
Authors: Williams D J , Dixon M F
Published: March 2007

Examination of 182 appendices containing Enterobius vermicularis demonstrated that male pinworms are seen more commonly than female. There was no association between the sex of pinworms and inflammation in the appendix but inflammation was frequently seen in association with luminal ova. Ova release from female pinworms may be a feature of appendiceal obstruction.
Risk factors in onychocryptosis
Authors: Langford D T , Burke C , Robertson K
Published: March 2007

A study is described in which the normal toes of 50 patients with unilateral ingrowing toenails were compared with those of 50 healthy subjects matched for age and sex. Twenty-one potential risk factors were compared between the groups. All measurements on patients were derived from unaffected toes in order to avoid anatomical distortion due to the disease process. Statistical analysis revealed significant differences between the groups for three anatomical measures, namely nail fold width (P < 0·001), medial rotation (eversion) of the great toe (P < 0·02) and nail thickness (P < 0·03). Possible discriminating variables were assessed using linear discriminant function analysis and a mathematical equation was derived based on these three factors. This equation was found to possess a potentially high predictive value in that it correctly classified 86 per cent of the patients and 77 per cent of the controls. A further group of 62 unselected patients presenting with unilateral onychocryptosis and 35 unaffected controls were assessed for these three parameters. Of these, 80 per cent of controls and 85 per cent of patients could be classified correctly by the equation. It is thus proposed that, in the majority of subjects with onychocryptosis, a discrete anatomical predisposition exists and that the other factors act only as triggers in the development of the condition. This study provides a rationale for less traumatic surgical approaches to ingrown nail than nail avulsion, with or without nail bed ablation and may also provide a means of identifying high-risk groups.
Computer-aided diagnosis: A review
Authors: Sutton G C
Published: March 2007

Fifteen years ago, computer-aided diagnosis of the acute abdomen promised much. Today it is little used. Studies have been flawed by poor trial design, bias, selective reporting of results, statistical naivety and spurious conclusions. The computer system lacks ‘common sense’ and is less accurate than clinicians. Yet its introduction has been associated with improved patient management and outcome. Much of the effect arisess from structured data collection methods and some from audit feedback to clinicians. It is on these innovations, not on the computer, that future work should focus.
A prospective randomized trial of Angelchik prosthesis versus Nissen fundoplication
Authors: Stuart R C , Dawson K , Keeling P , Byrne P J , Hennessy T P J
Published: March 2007

A total of 61 patients with gastro-oesophageal reflux, resistant to medical therapy, were entered into a prospective randomized trial comparing the Angelchik antireflux prosthesis with Nissen's fundoplication. Both groups had a similar age and sex distribution and their reflux profiles were comparable. An Angelchik prosthesis was inserted in 30 patients and 31 underwent fundoplication. The mean duration of postoperative follow-up was 38 months. At clinical assessment 23 (77 per cent) of the Angelchik group were graded Visick grade I or II, compared with 29 (94 per cent) of the Nissen group. Assessment by 24 h pH monitoring and manometry between 3 and 6 months after operation showed that both procedures were equally effective in reducing reflux and increasing lower oesophageal sphincter pressure. However, long-term endoscopic follow-up revealed grade III oesophagitis in seven patients in the Angelchik group. No patient in the fundoplication group had grade III oesophagitis. Three of eight patients with strictures in the Angelchik group reported persistent dysphagia. All seven patients with strictures in the Nissen group were relieved of their dysphagia. Migration or erosion of the prosthesis did not occur. Three prostheses (10 per cent) were removed, two for dysphagia and one because of sepsis.
Gastroplasty for morbid obesity: Technique, complications and results in 60 cases
Authors: Owen E R T C , Abraham R , Kark A E
Published: March 2007

A series of 60 gastroplasty operations based on Mason's vertical banded procedure are described. Details of technique, modifications, complications and results are discussed. Operative treatment results in a reduction to within 40 per cent of ideal weight in 80 per cent of patients between 12 and 18 months after surgery. The constricting band should not be greater than 5 cm; if it is most procedures will fail after 18 months. Pouch size should be measured and made no greater than 20 ml. The importance of nutritional counselling is emphasized. The surgical treatment should form part of a multidisciplinary approach with careful selection and long-term follow-up.
Effect of nutritional status on acute phase protein response to elective surgery
Authors: Cruickshank A M , Hansell D T , Burns H J G , Shenkin A
Published: March 2007

The aim of this study was to assess the effect of nutritional status on the acute phase protein response to elective surgery. Matched pairs of patients with gastric or colorectal cancer were studied. Undernourished patients (body-weight < 80 per cent of ideal and triceps skinfold thickness < 65 per cent of standard) were matched with controls (body-weight > 95 per cent of ideal and triceps skinfold thickness > 80 per cent of standard) for age, sex, type of pathology and surgery. Blood samples taken preoperatively and on days 1–5 after operation were analysed for C-reactive protein, α1-antitrypsin, α1-acid glycoprotein, albumin, prealbumin and transferrin. There was no significant difference in any of the preoperative protein concentrations between the two groups although undernourished patients tended to have lower transferrin concentrations (mean ± s.e.m., 2·2 ± 0·3 g/l) than the control group (2·9 ± 0·1 g/l). C-reactive protein response was significantly smaller in the undernourished group than in the control group (P = 0·05, Mann-Whitney U test). The responses of the other acute phase proteins did not differ between the two groups. There was no difference in the length of hospital stay after operation when undernourished patients (mean ± s.e.m., 17·7 ± 3·0 days) were compared with controls (14·3 ± 3·6 days). Undernourished patients therefore have an attenuated C-reactive protein response to elective surgery. The significance of this in relation to morbidity and mortality in severely ill patients requires further investigation.
Attitudes of operating theatre staff to inoculation-risk cases
Authors: Johnson C D , Evans R , Shanson D C , Wastell C
Published: March 2007

In a 12-month period, 177 patients at risk of infection with human immunodeficiency virus (HIV) or hepatitis B were operated on. Sixty-nine had HIV antibodies. The procedures used to identify these patients and minimize the risk of infection of hospital staff in the operating department are described. All staff working in the operating department were surveyed to determine their caseload, feelings of anxiety, and the incidence of high-risk exposure to infection. Anxiety was not related to workload, but was more common in those who had high-risk exposure. All members of staff who sustained a needlestick injury were tested for HIV antibodies at intervals after injury; 33 also volunteered to be tested in a screening session 3 months after the study period. None had HIV antibodies, suggesting that the risk of acquiring HIV infection in the operating department is low.
Liver transplantation for primary and secondary hepatic apudomas
Authors: Arnold J C , O'Grady J G , Bird G L , Calne R Y , Williams R
Published: March 2007

Four patients underwent liver transplantation in the Cambridge/King's College Hospital programme for malignant primary and secondary apudomas, secreting various peptide hormones and uncontrollable by standard treatment techniques. After transplantation all patients had excellent symptomatic relief and specific peptide hormone levels fell to normal ranges. Two patients remain alive and well after 38 and 22 months, the latter with recurrence of slight tumour-related symptoms and elevation of the specific secretory product. The other two patients died from chronic graft rejection 7 and 8 months after transplantation.
Changes in the hepatic perfusion index during the development of experimental hepatic tumours
Authors: Nott D M , Grime S J , Yates J , Day D W , Baxter J N , Jenkins S A , Cooke T G
Published: March 2007

A model of microscopic liver tumour has been developed in the Fisher rat by intraportal injection of 1·6 × 107 Walker 256 carcinosarcoma cells. Rats were studied at 2, 4 and 6 days after the inoculation of liver Walker cells. A control group received dead Walker cells. No tumour was visible in control groups at 2, 4 and 6 days after inoculation. Similarly in rats injected with live cells no tumour was visible at 2 days after inoculation but at 4 and 6 days the percentage hepatic replacement was (mean ± s.d.) 7·0 ± 2·3 and 27·9 ± 6·80 respectively. The hepatic perfusion index was significantly raised at 4 and 6 days after inoculation of live cells compared with control animals and those receiving viable cells after 2 days inoculation. Portal flow and portal venous inflow were significantly reduced when the hepatic perfusion index increased but hepatic arterial flow did not alter. Changes in the hepatic haemodynamics were accompanied by increases in the portal and splanchnic vascular resistance and an increase in the amount of arteriovenous shunting through the liver. These findings confirm studies that the hepatic perfusion index is useful in the detection of occult liver metastases but that the change is not a consequence of an increase in the hepatic arterial flow.
Adjuvant therapy of poor prognosis colon cancer with levamisole: Results of an EORTC double-blind randomized clinical trial
Authors: Arnaud J-P , Buyse M , Nordlinger B , Martin F , Pector J-C , Zeitoun P , Adloff A , Duez N
Published: March 2007

From 1978 to 1985, 297 patients were entered in a double-blind randomized trial comparing levamisole to placebo as adjuvant therapy of Dukes' C carcinoma of the colon. Therapy consisted of from two to five tablets of 50 mg levamisole (or placebo) twice a week, depending on bodyweight for 1 year. Levamisole was generally well tolerated, with only four reversible cases of agranulocytosis reported among 129 patients. The trial failed to show a benefit of levamisole on disease-free survival (P = 0·53) or on survival (P = 0·35). There was no difference between the two treatment groups in terms of number of disease relapses, sites of relapse, or time to relapse. The proportion of patients still alive at 5 years was 51 per cent (standard error, 5·5 per cent) in the levamisole group versus 39 per cent (standard error, 5·4 per cent) in the placebo group.
Major amputation in a defined population: Incidence, mortality and results of treatment
Authors: Kald A , Carlsson R , Nilsson E
Published: March 2007

Medical records of all patients, from a defined population of 88000 inhabitants, who underwent major lower limb amputation during 1980–82 were retrospectively scrutinized. The records showed 131 amputations were performed in 106 patients at the district hospital and 22 amputations on 17 patients at the local university hospital, referral centre, altogether 57 men and 66 women. This gave an amputation incidence of 46 per 105 inhabitants per year. Of the amputees 47 per cent were older than 80 years. Only two patients underwent reconstructive vascular surgery (at the university hospital) before surgery. Final amputation level was above-knee in 61 per cent of the patients treated at the district hospital. Mortality rates at 30 days and 2 years after the amputation were 23 and 56 per cent, respectively, and the age-corrected survival after 2 years was 55 per cent. For patients who came from and eventually returned to their own homes the mean hospital stay amounted to 184 days (postoperative deaths excluded). After amputation 26 patients were trained to wear a prosthesis and 16 of these used the prosthesis 2 years after amputation. The present study underlines the need for prospective and parallel studies of vascular surgery and amputation as well as analyses of the risk factors involved in lower limb ischaemia in defined populations.
Anastomotic suture materials and implantation metastasis: An experimental study
Authors: McGregor J R , Galloway D J , McCulloch P , George W D
Published: March 2007

Suture implantation of viable exfoliated malignant cells may be responsible for local recurrence (implantation metastasis) of colorectal cancer. In this study, four anastomotic materials (braided polyamide, braided polyglycolic acid, monofilament polypropylene and monofilament stainless steel) were compared with respect to their ability to entrap and transfer free Mtln3 carcinoma cells from the colonic lumen of a rat. The braided materials transferred greater numbers of cells than did the monofilament sutures (P<0·001), but significant differences were also observed between polyglycolic acid and polyamide (P<0·001) and between polypropylene and stainless steel (P<0·05). Secondly, the firm adherence of tumour cells to the suture materials was assessed by an in vitro technique. The Mtln3 cells were found to adhere in significantly greater quantities to the braided sutures than to the monofilaments (P<0·001) and this was supported by in vivo tumour growth studies. These findings may have implications for colorectal cancer surgery in man.
Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring
Authors: Cahill C J , Betzler M , Gruwez J A , Jeekel J , Patel J-C , Zederfeldt B
Published: March 2007

Sutureless colonic anastomosis using a biofragmentable anastomosis ring (BAR) has been evaluated in a prospective randomized comparison with sutures and staples for elective colorectal surgery. One hundred and one patients underwent BAR anastomosis, 85 a sutured anastomosis, and 16 a stapled anastomosis. There were two anastomotic leaks in the patients undergoing BAR anastomosis, seven in patients having a sutured anastomosis, and one in a patient who had a stapled anastomosis. Wound infection occurred in ten BAR patients, ten sutured patients and no stapled patient. There was no statistically significant difference in these or in other postoperative complications between the groups. The BAR was easy to use and is a safe alternative to sutures and staples for large bowel anastomosis.
Colonic complications of severe acute pancreatitis
Authors: Aldridge M C , Francis N D , Glazer G , Dudley H A F
Published: March 2007

Colonic complications are rare in acute pancreatitis. Over the last 9 years at St. Mary's Hospital, London, UK, we have managed severe acute pancreatitis by intensive supportive therapy followed by sub-total pancreatic resection and/or debridement in those who fail to improve. Of the 22 patients who have undergone this form of surgery, nine were found to have colonic involvement in the form of either necrosis or perforation. In addition, one patient presenting at West Middlesex University Hospital, Isleworth, UK, had severe acute pancreatitis and almost total colonic necrosis as an unexpected finding at emergency laparotomy. These ten patients comprised seven men and three women of median age 59 years and with a median of four Ranson criteria. In seven patients, colonic involvement was discovered at the time of pancreatic surgery or laparotomy for pancreatitis and in the remainder it presented between 1 and 3 weeks later as either a faecal fistula (n = 2) or persistent abdominal sepsis (n = 1). The ascending colon was involved in one patient, the splenic flexure and descending colon in one, the transverse colon in three, the splenic flexure alone in four, and one patient had almost total colonic involvement. All patients underwent resection of the involved colon and exteriorization with either a proximal colostomy (n = 7) or ileostomy (n = 3) and a distal mucous fistula. Pathological examination of the resected colons revealed a spectrum of changes from pericolitis through to ischaemic necrosis suggesting at least two possible mechanisms. Six patients died from overwhelming sepsis between 1 day and 4 weeks (median 11 days) after colonic resection. Severe acute pancreatitis must be recognized as a cause of colonic ischaemia and necrosis; this complication is associated with a very poor prognosis despite surgical intervention.
Appendicitis and appendicectomy in a Melanesian population
Authors: Foster H Mca , Webb S J
Published: March 2007

A prospective study of patients with appendicitis has been conducted over a 3-year period in the Melanesian population of the North Solomons. Patients presented with suspected appendicitis at an annual rate of 39 per 100 000 population. Appendicitis was confirmed at operation at an annual rate of 22 per 100000 population. The disease was considerably more frequent in male than in female patients. The annual appendicectomy rate was 29 per 100 000 population. Thirty per cent of patients presented with signs of late or complicated appendicitis, while 37 per cent of patients submitted to operation were found to have advanced appendicitis. The incidence and pattern of appendicitis in the North Solomons are quite different from those seen in the urbanized populations of developed countries.
Low power interstitial Nd YAG laser photocoagulation: Studies in a transplantable fibrosarcoma
Authors: Matthewson K , Barr H , Tralau C , Bown S G
Published: March 2007

The effects of interstitial delivery of low power (1·2-2 W), long exposure (600–1200 s) Nd YAG laser light on a transplantable fibrosarcoma in rats have been studied. Three cohorts of ten animals were treated either by 1·2 W for 600 s, 1·2 W for 1200 s or 2 W for 600 s to each tumour nodule. An additional untreated cohort served as controls and a further cohort was treated by radical surgical resection. A partial response as evidenced by ulceration was seen in all laser-treated tumours. In the cohort treated by 2 W for 600 s there was complete loss of palpable tumour, and in five out of the ten animals there was no evidence of local recurrence following a prolonged period of observation. Three of these eventually died from metastatic disease and two were cured. There was a significant prolongation of survival in this cohort compared with the controls (median 70 days versus 30 days, P < 0·05), but not in any of the other cohorts. Histological assessment of tumours 2 days after laser treatment showed a central area of degeneration with shrunken and densely staining nuclei and disorganized cytoplasm, the boundary between the degenerate zone and surrounding viable tumour being well defined. The technique might be used to induce necrosis of intrahepatic and other solid organ tumours.
Reduced human peritoneal plasminogen activating activity: Possible mechanism of adhesion formation
Authors: Thompson J N , Paterson-Brown S , Harbourne T , Whawell S A , Kalodiki E , Dudley H A F
Published: March 2007

A unifying pathophysiological hypothesis states that the plasminogen activating activity (PAA) of the peritoneal mesothelium determines whether the fibrin which forms after peritoneal injury is either lysed or organized into permanent fibrous adhesions. The PAA of human peritoneal biopsies was measured using a fibrin plate lysis technique to assess the changes that occur in inflammation and ischaemia, conditions which both produce fibrous adhesions. Activity was found in all biopsies from normal parietal and visceral (appendix, bowel and omentum) peritoneum with no significant site-to-site variation. Inflamed peritoneum (parietal, appendicular and mesenteric) had significantly less PAA compared with normal peritoneum; visceral ischaemia also resulted in a significant decrease of PAA. These reductions in human peritoneal PAA observed in inflammation and ischaemia support the view that mesothelial PAA plays a key part in the prevention of events leading to the production of fibrous adhesions.
Fibroadenoma of the breast: A follow-up of conservative management
Authors: Wilkinson S , Anderson T J , Rifkind E , Chetty U , Forrest A P M
Published: March 2007

This report details the outcome after clinical diagnosis of mammary fibroadenoma in 110 women aged under 35 years. After fine needle aspiration cytology, and subsequent exclusions and failures of follow-up, 92 lesions were observed for a mean of 47 weeks (range 13–90 weeks), with regular measurements until removal of persisting lesions at 12 months. Fifteen lesions disappeared and 56 had the classical histology of fibroadenoma, mean size 2·5 cm; 30 of the latter continued to grow throughout the study. Cytology is essential to exclude malignancy if conservative treatment is considered, and is helpful in identifying a benign lesion. A period longer than 12 months may be required for resolution of a fibroadenoma and removal under local anaesthesia as a day case offers a simple alternative.
Surgical significance of non-toxic iodine-avid goitre
Authors: Kalra M , Khanna S K
Published: March 2007

During the period 1970–87, of 1580 patients operated on for non-toxic nodular goitre, 17 satisfied the laboratory criteria for iodine avidity. All of these goitres were non-endemic, with no evidence of enzymatic deficiency. Preoperative thyroxine markedly reduced the surgical morbidity by decreasing the size and vascularity of the gland.
Out-patient operation of inguinal hernia in children
Authors: Mejdahl S , Gyrtrup H J , Kvist E
Published: March 2007

A retrospective review is presented of 496 children with a median age of 4 years (range 0–13 years) on whom a total of 527 hernia repairs were performed as out-patients. No wound infections were observed, and the rate of early surgical complications was 1·5 per cent. There were 15 (3·7 per cent) known recurrences. No complications from the anaesthetic were recorded. Owing to the negligible infection rate and the low surgical complication and recurrence rates it is concluded that children with inguinal hernia would benefit from operation as out-patients, and that they should be operated on immediately after diagnosis, irrespective of age. Besides probably minimizing the children's psychological trauma, out-patient surgery provided considerable savings to the health service in the present study.
Ischaemic strictures in patients treated with a low anterior resection and perioperative radiotherapy for rectal carcinoma
Authors: Påhlman L , Glimelius B , Frykholm G
Published: March 2007

In five (6 per cent) of 78 consecutive patients treated with an anterior resection for rectal carcinoma, a stenosis of the sigmoid colon just above the anastomosis was observed. Four patients had received preoperative radiotherapy over a period of 1 week to a total dose of 25·5 Gy and one patient had received postoperative radiotherapy (60 Gy) over a total of 8 weeks. The length of the stenosis varied from 4 to 120 cm. Two patients subsequently underwent reoperation with an abdominoperineal resection and three patients with a Hartmann procedure. In all patients the inferior mesenteric artery had been ligated close to the aorta. It is proposed that the stenosis may have been due to insufficient circulation in the marginal artery. This insufficiency may have been aggravated by the irradiation, as the retained part of the sigmoid colon was partly included in the irradiation target.
Anorectal physiology validated: A repeatability study of the motor and sensory tests of anorectal function
Authors: Rogers J , Laurberg S , Misiewicz J J , Henry M M , Swash M
Published: March 2007

Sixteen subjects (mean (s.d.) age 50·7 (12·8) years, three men) were studied on two separatè occasions by two experienced investigators in random order. A standard protocol of anatomical, manometric and electrophysiological assessments of anorectal motor and sensory function was followed. No significant differences were found between the results obtained by the two investigators in the measurements of perineal descent, anal canal length, anal canal resting pressure and squeeze pressure, pudendal nerve terminal motor latency, single-fibre electromyography fibre density of the external anal sphincter, and thresholds of mucosal electrosensitivity. This study shows that the standard tests of anorectal sensorimotor function are repeatable by different investigators. In addition, it suggests that comparison of data obtained in different centres using these techniques is valid.
Intraoperative immunostaining for detection of invasive cells at the resection margin of Borrmann type 4 gastric carcinoma using monoclonal antibody S202
Authors: Yokota T , Yamaguchi T , Sawai K , Takahashi T
Published: March 2007

Borrmann type 4 gastric cancer is clinically characterized by diffuse infiltration with carcinoma cells. An antiscirrhous carcinoma monoclonal antibody (MAb) S202 was used in a rapid immunostaining procedure to identify the limit of tumour invasion during surgery in samples obtained from the resection margins in 37 cases of Borrmann type 4 gastric cancer. In two instances, conventional cytological diagnosis using haematoxylin and eosin staining was negative, and in another it was inconclusive; whereas by the rapid immunostaining method single cells stained darkly, indicating malignancy. In two specimens, a positive diagnosis could be made by both methods, but immunostaining of these sections served to highlight the adenocarcinoma cells against the inflammatory background: further resection was performed. This technique enables clear recognition of the infiltrating tumour cells in the frozen sections of resected specimens. The rapid immunostaining method using MAb S202 allowed accurate and rapid determination of the limit of tumour extension at the surgical margin during surgery.
Changes in vascularity of liver tumours after hepatic arterial embolization with degradable starch microspheres
Authors: Civalleri D , Scopinaro G , Balletto N , Claudiani F , Decian F , Camerini G , Depaoli M , Bonalumi U
Published: March 2007

The role of vascularity as a prognostic factor was investigated in 35 patients undergoing arterial chemotherapy for liver tumours. Compared with parenchyma, tumour vascularity was classified as hot (18 cases), cold (12 cases), and mixed (12 cases) using 99mTc-macroaggregated albumin (MAA) hepatic arterial scans. The proportion of patients showing complete and partial responses to treatment was higher in the hot group (56 per cent) than in the combined cold and mixed group (12 per cent). In 15 cases (six hot, six cold and three mixed lesions), additional MAA scans were performed immediately after arterial embolization with degradable starch microspheres (DSMs). Either complete or partial reversal of tumour vascularity was observed after DSM-embolization in five and seven cases respectively, two and two of them respectively showing native cold lesions. As tumour vascularity appears to be a prominent prognostic factor, DSM-embolization should improve the efficacy of treatment by improving liver extraction of drugs and causing flow redistribution towards hypovascular areas.
Human fasting and postprandial sphincter of Oddi motility
Authors: Worthley C S , Baker R A , Lannos J , Saccone G T P , Toouli J
Published: March 2007

Sphincter of Oddi motility was evaluated in post-cholecystectomy patients with indwelling T tubes during fasting and after feeding. A triplelumen catheter was positioned to record from the sphincter of Oddi and duodenum. The sphincter of Oddi was characterized by phasic contractions independent of duodenal contractions. During fasting duodenal wave frequency exhibited four phases, whereas only two phases could be identified from the sphincter of Oddi. A prolonged phase A in the sphincter of Oddi corresponded to duodenal phases I, II and IV. A short phase B in the sphincter of Oddi just preceded the onset of duodenal phase III and was temporally related to it. Sphincter of Oddi basal pressure increased during duodenal phases III and IV. After ingestion of food, sphincter of Oddi basal pressure, wave amplitude and duration decreased, but the frequency remained unchanged. Conversely, duodenal frequency increased but there was no change in amplitude. Thus, the human sphincter of Oddi and duodenum exhibited independent motility demonstrating distinct phases during the interdigestive period. After food, sphincter of Oddi motility altered in a manner which would facilitate the passive flow of fluid into the duodenum.
Effect of mechanical bowel preparation on anastomotic integrity following low anterior resection in dogs
Authors: O'Dwyer P J , Conway W , McDermott E W M , O'Higgins N J
Published: March 2007

To assess the effect of mechanical bowel preparation on anastomotic integrity after low anterior resection, 36 mongrel dogs were randomized to have low anterior resection with or without mechanical bowel preparation. All dogs received prophylactic antibiotics and anastomotic integrity was assessed on the ninth postoperative day by barium enema, inspection of anastomoses for defects after careful excision at laparotomy, and anastomotic bursting pressures. Bursting pressures were significantly higher (P <0·005) in the group with bowel preparation. Anastomotic defects were present in 13 per cent of animals with bowel preparation and 47 per cent without bowel preparation (P = 0·057). Pelvic abscess and death from peritonitis occurred in 6 per cent of the group with bowel preparation and 29 per cent of the unprepared group. Mechanical bowel preparation significantly enhanced anastomotic integrity and reduced complications in this model.
Postoperative gastric ischaemia
Authors: Schein M , Saadia R
Published: March 2007

This review discusses postoperative gastric ischaemia after detailed consideration of the gastric blood supply and the effects of devascularization. Special consideration is given to gastric remnant necrosis, lesser curve ischaemia after highly selective vagotomy, and gastric ischaemia after other operations.
Three-dimensional morphological study of the pancreatic microvasculature in caerulein-induced experimental pancreatitis
Authors: McEntee G , Leahy A , Cottell D , Dervan P , McGeeney K , Fitzpatrick J M
Published: March 2007

A morphological study of the pancreatic microvasculature in experimental pancreatitis was performed in dogs, using three-dimensional scanning electron microscopy vascular casting and transmission electron microscopy. Animals with pancreatitis were characterized by a marked reduction in the number of capillaries outlined by the cast and by distortion of those that were outlined, with irregularity of the capillary lumen, abruptly terminating capillary buds and leakage of the cast material through the capillary membrane. The study provides convincing morphological evidence that one of the earliest changes in acute pancreatitis is distortion of the capillary circulation.
Endoscopic management of inoperable cholangiocarcinoma using iridium-192
Authors: Ede R J , Williams S J , Hatfield A R W , McIntyre S , Mair G
Published: March 2007

We report a well tolerated endoscopic technique of administering intraluminal radiotherapy to 14 patients with inoperable cholangiocarcinoma, in which the iridium-192 wire source was inserted down a nasobiliary catheter placed within a previously inserted endoscopic biliary prosthesis, thus allowing bile flow to continue during treatment. Radiotherapy was commenced 2 weeks after biliary decompression, when the median serum bilirubin level had fallen from 213 to 34 μmol/l. A total radiation dose of 6000 cGy at 0·5 cm from the source was administered over a median of 85 h (range 77·116 h). In four patients there was a transient increase in serum bilirubin during iridium treatment and, in two cases (14 per cent), this was associated with mild cholangitis. Both cases resolved rapidly once the iridium wire and nasobiliary catheter were removed. The median hospital stay after treatment was 2·5 days (range 0·28 days). The late complications associated with stent blockage were minimized by routinely changing stents at 4–6-monthly intervals; ten of the patients have so far undergone from one to five (median three) stent changes. Five patients have died at 3·6–8·2 months (median 4·8 months) following iridium treatment; four had extensive type III hilar lesions at diagnosis. Nine patients are still alive at 5·4–31·0 months (median 16·4 months). The overall median survival after iridium therapy is 10·5 months. This technique of endoscopic biliary decompression before internal iridium administration minimizes complications by allowing biliary drainage during treatment. The role of this treatment in patients with inoperable cholangiocarcinoma awaits the results of randomized, controlled trials.
Thyroid lymphoma
Authors: Shaw J H F , Holden A , Sage M
Published: March 2007

We have reviewed the local experience of 15 cases of thyroid lymphoma with a view to documenting the epidemiology, presentation, management and prognostic factors governing outcome for this rare condition. All the patients were European despite the fact that 15 per cent of the local population is either Maori or Polynesian. The average age at presentation was 62 years and 13 of the 15 patients were women. The duration of symptoms was short: on average 9 months. Where feasible a definitive resection of the lesion was performed but this could only be performed in six of the 15 cases. The commonest histological type was non-Hodgkin's lymphoma which accounted for 14 of the 15 cases with the large cell variant being the most common (five cases). The mean period of follow-up was 3·3 years: only eight patients were alive and well at that time. The prognostic factors that influenced outcome were: (1) the histology of the lesion — large cell lymphoma carried a bad outlook; (2) whether the lesion could be totally resected or not — five out of six patients undergoing total resection remain alive and well; (3) the presence of pre-existing Hashimoto's thyroiditis was a favourable prognostic factor as only one patient without underlying Hashimoto's disease or positive antithyroid antibodies was alive at the end of the study; (4) male sex may also be an unfavourable prognostic factor as both men in the study died of disease 0·3 and 5 years after diagnosis.
Randomized study of adjusted versus fixed low dose heparin prophylaxis of deep vein thrombosis in hip surgery
Authors: Taberner D A , Poller L , Thomson J M , Lemon G , Weighill F J
Published: March 2007

A randomized study of adjusted versus fixed low dose heparin prophylaxis has been conducted in 100 patients undergoing surgery for hip replacement or fractured neck of femur. The two types of patients were randomized independently into the adjusted and fixed dose regimens. Patients in the adjusted group were controlled by an activated partial thromboplastin time method particularly responsive to the anticoagulant effect of heparin. The aim was to maintain the peak value just above the upper limit of the normal range. Adjustment of dosage began 24 h after surgery in the replacement group and 24 h after admission in the fracture group. Significant improvement in protection against postoperative deep vein thrombosis, assessed by venography, was observed in the adjusted group undergoing hip replacement (P = 0·013) and overall in both groups (P = 0·017) compared with a conventional fixed dose subcutaneous regimen (calcium heparin 5000 units, 8-hourly). In most instances, adjustment resulted in increased heparin dosage but this was not associated with any evidence of excessive bleeding.
Conservative treatment of ingrowing toenails
Authors: Reijnen J A M , Goris R J A
Published: March 2007

A combination of conservative measures was used to treat 105 patients with 119 ingrowing toenails. The method proved to be simple and cheap, but time consuming. Post-treatment discomfort and the time taken to return to normal activities were acceptable; the cosmetic result was good. Two-year follow-up revealed that the success rate of the method in less advanced cases (stages I and II) was high (96 per cent), although in the long term there was a tendency to recurrence in stage II cases. The failure rate in advanced cases (stage III) was high (up to 62 per cent). Conservative treatment can be used successfully in mild cases of ingrowing toenails.
The development and evaluation of a clinical test of surgical resident proficiency
Authors: Anderson Benjamin O , Sun John H , Moore Ernest E , Thompson Laetitia L , Harkin Alden H , Bartle Edward J
Published: March 2007

The two purposes of this study were to develop a clinical test of surgical resident proficiency and to compare this clinical test with currently applied methods of resident evaluation. Appendicitis is a common surgical disease, and its accurate diagnosis depends largely on clinical acumen. Ten third-year surgical residents prospectively evaluated 107 patients admitted because of suspected appendicitis. After taking a history, performing a physical examination, and reviewing laboratory data, these residents were asked to state, as a percentage, the likelihood that each patient had appendicitis. Sixty-three patients had appendicitis documented by pathologic inspection after appendectomy. Forty-four patients did not have appendicitis, as was determined by operation (17) or by in-house observation and resolution of abdominal pain (27). These outcomes were used to calculate a diagnostic ability score (DAS) for each resident. Residents were evaluated by standard methods including in-service examinations and monthly evaluations by the attending staff. Residents were also evaluated by nonstandard, but potentially useful, neuropsychologic and psychologic tests, including the trail making test, the Ravens progressive matrices test, the paced auditory serial addition test (PASAT), the grooved pegboard test of manual dexterity, and the profile of mood states (POMS) psychologic questionnaire. Cumulative scores were calculated and compared by multiple regression with coefficient variance analysis. The correlation (R2) of DAS with standard evaluation techniques was as follows: In-service (0.055), faculty (0.508), trails (-0.293), Ravens (0.028), PASAT (0.251), dexterity (0.432), POMS (0.381). We found that (1) the DAS is a discriminating clinical test; (2) the DAS correlates with subjective faculty evaluation; and (3) the DAS does not correlate with in-service examination scores. We conclude that faculty evaluation remains the best currently applied test of surgical resident clinical proficiency as measured by the DAS. (SURGERY 1989;106:347–53.)
Primary disorders of oesophageal motility
Authors: Stuart R C , Hennessy T P J
Published: March 2007

Primary motor disorders of the oesophagus have distinct manometric patterns but require full oesophageal investigation to exclude a secondary cause. Myotomy and forceful dilatation give good results in achalasia, though myotomy is superior in the long term. Indications for surgery are rare in diffuse spasm and nutcracker oesophagus. Non-cardiac chest pain may be related to reflux, diffuse spasm or nutcracker oesophagus, but correlation between motor abnormalities and symptoms is poor and psychological disturbances are frequent.