bluuebunny/crossref_metadata_2025 huggingface dataset:
Methyl-tert-butyl-ether for treating bile duct stones: The British experience
Authors: Neoptolemos J P , Hall C , O'Connor H J , Murray W R , Carr-Locke D L
Published: March 2007

Methyl-tert-butyl-ether (MTBE), infused via a nasobiliary catheter, was used to treat 33 patients with bile duct stones in nine units around Britain. MTBE contributed to success in 12 (36 per cent) cases: seven passed stones spontaneously during MTBE infusion and five had partial stone dissolution allowing subsequent endoscopic extraction. MTBE was non-contributory in 21 (64per cent) cases: four passed stones after MTBE was stopped, six were treated by subsequent endoscopic techniques without evidence of dissolution, seven underwent surgery, and four were treated conservatively (with one death). In at least ten of the 21 cases in which MTBE was non-contributory, pigment stones were present. Forty-two complications occurred in 26 (79per cent) patients. The efficacy of MTBE for treating bile duct stones might be improved by better methods of instillation and, since success may be related to technique, the use of MTBE should be restricted to units familiar with this chemical.
Roles of bile and bacteria in biliary peritonitis
Authors: Andersson R , Tranberg K-G , Bengmark S
Published: March 2007

Bile is known to have an adverse effect in peritonitis but the mechanism(s) and site of action of bile are unknown, as are the relative roles of bile and bacteria. The present study was designed to answer some of these questions. Experiments in which rats were injected intraperitoneally and intravenously with bile, Escherichia coli or saline showed that bile had no systemic toxicity and that it increased the mortality rate only when introduced into the peritoneal cavity together with bacteria. Measurements of peritoneal fluid volumes and blood pressure did not confirm the theory that the increased mortality rate was a consequence of loss of plasma volume into the peritoneal cavity. The number of intraperitoneal bacteria decreased continuously in animals receiving intraperitoneal E. coli alone. When bile was added by intraperitoneal injection, the number of intraperitoneal bacteria started to rise at 2 h and then increased steadily with a consequent bacteraemia at 10 h. The number of bacteria per peritoneal phagocyte was significantly lower after intraperitoneal injection of E. coli and bile, when compared with injection of E. coli alone. It is concluded that bile exerts its detrimental effect within the peritoneal cavity in the presence of bacteria. Bile impairs local host defence in a way that remains unknown and may be related to the detergent–lytic effects of bile salts.
T tube intubation in the management of seriously ill patients with oesophagopleural fistulae
Authors: Naylor A R , Walker W S , Dark J , Cameron E W J
Published: March 2007

Ten patients referred late with oesophagopleural fistulae were managed by T tube intubation of the oesophageal defect. Seven survived and six had radiographic evidence of closure of the defect. One patient who removed his T tube early was discharged to convalesce with a small oesophagocutaneous fistula. Three patients died as a consequence of pre-existing renal failure, upper gastrointestinal haemorrhage and adult respiratory distress syndrome. Patients presenting late with multisystem complications and ongoing sepsis secondary to oesophagopleural fistulae pose a major management problem. Our preliminary results suggest that T tube intubation offers a potential alternative to major surgical intervention, when more conservative measures have failed.
Achalasia-like syndrome in systemic sclerosis
Authors: Park R H R , McKillop J H , Belch J J F , Faichney A , MacKenzie J F
Published: March 2007

Two methods of quantifying oesophageal emptying for liquids have been used to assess the dysphagia of patients with systemic sclerosis: the oesophageal infusion scintiscan and the timed Gastrografin® swallow. Upper gastrointestinal endoscopy and oesophageal manometry were also performed. Thirteen patients with oesophageal symptoms were studied. Eight had dysphagia, and all of these had endoscopies with no evidence of oesophagitis or stricture. Four of these eight subjects had gross delay of oesophageal emptying for fluids, and manometry showed absence of oesophageal peristalsis and incomplete relaxation of the lower oesophageal sphincter. This abnormality is similar to achalasia. Two of these four patients have benefited from pneumatic dilatation with improvement in their severe dysphagia. We believe that pneumatic dilatation should be considered in patients with systemic sclerosis and severe dysphagia where reflux oesophagitis is not apparent.
Surgery for melanoma metastatic to the gastrointestinal tract
Authors: Klaase J M , Kroon B B R
Published: March 2007

Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4per cent. During the period 1981–87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2–87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7·5 (range 0·7–32·0) months. Five patients are still alive 72, 72, 70, 7 and 2′ months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19per cent. These results support surgical intervention for patients with complaints andlor complications attributable to gastrointestinal metastatic melanoma.
Highly selective vagotomy 5–15 years on
Authors: MacIntyre I M C , Millar A , Smith A N , Small W P
Published: March 2007

Highly selective vagotomy for duodenal ulcer was performed on 307 patients between 1973 and 1983 without operative mortality. Of these, 283 (92·2per cent) were followed up prospectively for a minimum of 5 years. Recurrent ulcer was diagnosed in 49 (17·3per cent). The recurrent ulcer rate increased from 13·2per cent at 5 years to 19·4per cent at 12 years. Age, length of history, previous haemorrhage or perforation and preoperative acid output were not associated with increased risk of recurrent ulceration. The risk in men and smokers was higher but not significantly so. The recurrence rate for individual surgeons varied from 5·3 to 25·6 per cent. Failure of healing with H2-receptor antagonists was not associated with a higher recurrent ulcer rate. Patients with a strong family history (more than one first degree relative affected) had a significantly higher recurrence rate (33·2per cent at 10 years) than those without (13·5per cent at 10 years). Of the 49 recurrent ulcer patients, 30 (61·2per cent) required either an operation or regular H2-receptor antagonists. Of the 250 patients (81·4per cent) available in 1988 for review of symptoms 5–15 years after operation, 5·4per cent had dumping, 8·9per cent epigastric pain, and 11·8per cent heartburn every day or most days. H2-receptor antagonists were required by 10·7 per cent of patients on a frequent or regular basis. Of 239 patients who answered the question, 218 (91·2per cent) felt that their symptoms had been cured or greatly improved and 203 (84·9) considered the operation a success. Despite the high recurrence rate, the operation was successful in controlling ulcer symptoms in around 90 per cent of patients and produced postvagotomy symptoms - none severe - in around 5 per cent of patients.
Triad of anorectal stenosis, sacral anomaly and presacral mass: A remediable cause of severe constipation
Authors: Heij H A , Moorman-Voestermans C G M , Vos A , Kneepkens C M F
Published: March 2007

Two neonates with intestinal obstruction and two children (aged 1 and 4 years) with severe constipation since birth are reported in whom stenosis of the distal rectum was found. In association with the rectal anomaly, three of them had a presacral tumour (teratoma in two, hamartoma in one) and all had a deformed sacrum. An embryological hypothesis to explain this association has been postulated by Currarino, after whom this triad has been named. Two patients were related (father and daughter). The role of hereditary factors in the occurrence of the syndrome has been reported before. Operative treatment of the rectal stenosis was necessary in all patients. Preoperative diverting colostomy was performed in three cases, followed by a posterior sagittal approach to excise the rectal stenosis and the presacral mass. In one case, persistent cerebrospinal fluid leakage required re-exploration for closure of a tear in a congenially abnormal dural sac. The fourth patient had undergone a low anterior resection in the past via the abdominal route and needed rectal dilatation afterwards for some time. The final result in all patients appears satisfactory, although follow-up is short. Most cases of this triad have been reported in children but a number of patients have been diagnosed only as adults. Recognition of this triad should imply a careful search for neural crest malformations. Operative treatment to correct all soft tissue anomalies leads to good results.
Selective postoperative radioactive iodine treatment of thyroid carcinoma
Authors: McHenry Christopher , Jarosz Harriet , Davis Melva , Barbate A L , Lawrence A M , Paloyan E
Published: March 2007

In a consecutive series of 234 patients with differentiated thyroid carcinoma of follicular cell origin (Hurthle cell tumors excluded), a radioactive iodine (131I) scan was obtained 3 to 6 months after thyroidectomy and 4 weeks after cessation of thyroid hormone treatments, only if extrathyroidal tumor extension or nodal or distant metastases were present. Twenty-one patients (9%) with 131I uptake of 3% or more (group 1) were treated with 150 to 200 mCi of 131I. Forty-four patients (19%) with less than 3% uptake (group 2) and 169 patients (72%) without evidence of metastases or extrathyroidal spread (group 3) were treated only with thyroid hormone. All patients initially underwent total thyroidectomy and modified neck dissection if cervical lymph node metastases were present. Three patients in group 1 and one patient in group 2 had recurrent tumor with a mean follow-up of 8.9 and 8.4 years. There were no recurrences in group 3 with a mean follow-up of 7.2 years. Death rate from thyroid carcinoma was 5% in group 1 (one patient) and 0% in groups 2 and 3. In conclusion, 1311 scanning and therapy may be omitted in patients with differentiated thyroid carcinoma in the absence of local tumor extension or regional or distant metastases. Therapy with 131I is not demonstrated to be of benefit in this population of patients. (Surgery 1989; 106:956-9.)
Pilonidal sinus: Finding the right track for treatment
Authors: Allen-Mersh T G
Published: March 2007

Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment - quick healing, no hospital admission, minimal patient inconvenience, and low recurrence -but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En bloc excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.
Endoscopic transanal resection of rectal tumours - a preliminary report of its use
Authors: Berry A R , Souter R G , Campbell W B , Mortensen N J Mcc , Kettlewell M G W
Published: March 2007

Endoscopic transanal resection (ETAR) of rectal tumours is a simple and inexpensive procedure, well tolerated in elderly patients or those undergoing palliation. We have performed 137 ETARs in 81 patients with a 30-day mortality rate of 11·1 per cent and a postoperative complication rate of 15·3 per cent. Thirty-one patients (38 per cent) had ETAR for palliation: in this group rectal bleeding was abolished or improved in 66 per cent of patients, altered bowel habit (diarrhoea) corrected in 77 per cent of patients, faecal incontinence improved in 50 per cent of patients and rectal pain (including tenesmus) improved in 50 per cent of patients. Twenty-three patients (28 per cent) were treated for large benign rectal polyps: in this group symptoms were universally abolished. The technique is particularly suited to the management of these patients. Twenty-seven elderly patients with theoretically ‘curable’ rectal cancer underwent ETAR with a 78 per cent crude survival rate at 1 year. While long-term results remain to be assessed, ETAR appears a useful technique for treating selected patients with rectal tumours.
Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex® rectopexy for rectal prolapse
Authors: Sayfan J , Pinho M , Alexander-Williams J , Keighley M R B
Published: March 2007

Two treatment policies for rectal prolapse were prospectively assessed between April 1986 and January 1989. Sixteen patients had a Marlex® mesh posterior rectopexy alone and 13 underwent a sigmoidectomy combined with a sutured posterior rectopexy. Preoperative and post-operative assessment included manometry, a saline infusion test and video-proctography. Hospital stay, control of prolapse and complications were comparable in both groups. Restoration of continence occurred in nine of the 12 incontinent patients after Marlex rectopexy, compared with six of nine after sutured rectopexy and sigmoidectomy. Constipation persisted in three patients who were constipated before operation and in four of 13 who had previously normal bowel habits became constipated after Marlex rectopexy; constipation persisted in one of five previously constipated patients while none with previously normal bowel habits became constipated after sutured rectopexy and sigmoidectomy. Sigmoidectomy combined with sutured rectopexy was safe and as efficient as Marlex rectopexy in prolapse control and improvement of continence; significantly fewer patients were constipated (one of 13) after sigmoidectomy than following rectopexy alone (seven of 16). A randomized trial now seems justified.
Metabolism of body water and electrolytes after surgery for ulcerative colitis: Conventional ileostomy versus J pouch
Authors: Christie P M , Knight G S , Hill G L
Published: March 2007

Some authorities believe that patients with conventional ileostomies are chronically water and salt depleted but there are no data on the metabolism of body water and electrolytes after ileoanal J pouch. To clarify the situation we studied the body composition of 14 patients with well functioning ileostomies and 20 patients with well functioning J pouches. Both groups were compared with two closely matched control groups. Body weight, total body fat, fat-free mass, total body water and extracellular water were measured by neutron activation analysis, tritiated water and bromide dilution respectively; 24-h collections of urine and stool were analysed for volume and electrolyte content. The results show that the body content of water and extracellular fluid in ileostomy patients and J pouch patients is normal. The faecal volume and chemistry is similar in both groups resulting in a similar and significant degree of urinary sodium retention.
Effect of acute starvation on plasma fibronectin response to sepsis
Authors: Cheslyn-Curtis S , Aldridge M C , Dudley H A F
Published: March 2007

There is evidence that undernutrition may contribute to the reduction in plasma fibronectin concentration and the depression of the reticuloendothelial (RE) system associated with severe sepsis. We have investigated the effects of fasting, surgical trauma and sepsis on plasma fibronectin concentrations and RE function. In experiment 1, plasma fibronectin was measured in rabbits (n = 14) before and 48 h after fasting. In experiment 2, sepsis was induced by devascularization of the appendix in animals on a normal diet (sepsis group, n = 7) and in fas ted animals (fasting and sepsis group, n = 7). A third group of animals underwent only a laparotomy (laparotomy only group, n = 7). Plasma fibronectin concentrations and the blood clearance and organ distribution of 99mtechnetium tin colloid (TTC) were measured 24h after operation. Compared with pooled reference plasma, fasting in experiment 1 resulted in a reduction in mean(s.e.m.) plasma fibronectin concentration from 98(1·5) per cent to 86(3·7) per cent (T = 2, P < 0·005). Mean(s.e.m.) plasma fibronectin concentration was raised in the sepsis group to 117(4·6)per cent, compared with 97(2·5)per cent in the laparotomy only group (U = 5, P < 0·02), but there was no such increase in the fasting and sepsis group. There was a delay in the blood clearance and reduced hepatic uptake of TTC in both sepsis groups. The dissociation between fibronectin concentrations and RE function in animal models of sepsis casts doubt on the importance of fibronectin in RE function.
Effects of an amino acid solution enriched with either branched chain amino acids or ornithine-α-ketoglutarate on the postoperative intracellular amino acid concentration of skeletal muscle
Authors: Hammarqvist F , Wernerman J , Ali R , Vinnars E
Published: March 2007

Patients undergoing elective cholecystectomy provide a highly reproducible model of the effects of trauma on intermediary metabolism. Three parenteral nutrition regimens were given to groups of eight such patients. An isonitrogenous total parenteral nutrition, including a commercially available amino acid solution, an amino acid solution enriched with branched chain amino acids or one supplemented with ornithine-α-ketoglutarate, was given after operation. The intra cellular free amino acid concentrations of skeletal muscle were determined in tissue specimens obtained before operation and on the third postoperative day using a percutaneous needle biopsy technique. The mean(s.e.m.) decrease in the concentrations of free intracellular glutamine on the third postoperative day was less pronounced (P < 0·05) in the ornithine-α-ketoglutarate group (18·8(7·5) per cent) than in the control group (39·4(5·1)per cent) or the branched chain amino acid group (45·3(6·1) per cent). In conclusion, in the immediate postoperative period total parenteral nutrition supplemented with ornithine-α-ketoglutarate countered the decline in the muscle free glutamine. No difference in this parameter was seen between the control group and the branched chain amino acid group.
Strength of the colon wall in diverticular disease
Authors: Watters D A K , Smith A N
Published: March 2007

Studies of the aetiology of diverticular disease of the colon have been focused on intraluminal pressure for almost three decades. It is only relatively recently that the mechanical properties of the wall of the colon have been examined. The tensile strength and elasticity of the colon decline with age and this is most marked in the left colon which is the narrowest and thickest part. This review discusses the case that the mechanical properties of the bowel wall are key factors in the development of diverticular disease. The potential role of high fibre diets in reducing the pressure changes which may stress the colon wall in this disease is also considered.
Current hypotheses on synergistic microbial gangrene
Authors: Kingston D , Seal D V
Published: March 2007

We have reviewed spreading infections of the dermis, with special reference to the importance of synergy in their causation. Evidence for this is accumulating from both clinical studies and from studies in laboratory animals. Necrotizing fasciitis (rapid spread over 24 h) can be caused by β-haemolytic streptococci, sometimes with Staphylococcus aureus, or by mixed infections of aerobes and anaerobes, often of gut origin. Animal studies provide good evidence that S. aureus can potentiate the β-haemolytic streptococcal infection in necrotizing fasciitis. There is also evidence that mixtures of aerobes and anaerobes can act synergistically, but animal models for necrotizing fasciitis have not been developed. Anaerobic cellulitis (variable rate of spread from hours to days) can be caused by mixed aerobes and anaerobes or by mixed clostridia. Animal studies provide good evidence for synergy in the former. Meleney's synergistic postoperative gangrene (slow spread over weeks) may be cutaneous amoebiasis: the animal model of Brewer and Meleney relates to the more rapid infections of anaerobic cellulitis.
Association of congenital hypertrophy of the retinal pigment epithelium with familial adenomatous polyposis
Authors: Iwama T , Mishima Y , Okamoto N , Inoue J
Published: March 2007

Ophthalmological examinations were performed in 49 people (43 patients) from 24 families affected by familial adenomatous polyposis (FAP). No features of congenital hypertrophy of the retinal pigmented epithelium (CHRPE) were noted in six first-degree relatives without colonic polyps. Patients with Gardner's syndrome exhibited CHRPE more frequently than those without exostosis or desmoid tumour (91 per cent versus 45 per cent). In addition the prevalence of CHRPE was slightly higher in the patients with gastric or duodenal polyps (68 per cent compared with 50 per cent) in those who had a normal gastroduodenal examination. There were 11 families in which two or more patients underwent ophthalmological examinations. In five of these 11 families, all 12 patients were negative for CHRPE. In four of the remaining six families, all 11 patients had CHRPE. CHRPE is one of the pleiotropy of FAP and ophthalmological examination is an important screening test for the family of patients with CHRPE associated with FAP.
Management of gastric variceal haemorrhage
Authors: Greig J D , Garden O J , Anderson J R , Carter D C
Published: March 2007

From March 1979 to April 1988 nine patients with hepatic cirrhosis have presented with acute variceal haemorrhage from gastric varices. Of six patients who underwent emergency laparotomy those with modified Child's grade C (n = 3) died within 30 days of surgery. Six patients have been followed for 2 years or longer. In the three patients who underwent under-running of gastric varices alone, two patients developed oeosophageal varices at 3 and 14 months, respectively, and in the third patient gastric varices recurred 3 years after surgery. In the remaining three patients, additional left gastric vein ligation was not associated with recurrence of gastric varices or the development of oesophageal varices.
Fine-wire localization and biopsy of non-palpable breast lesions
Authors: Tresadern J C , Asbury D , Hartley G , Sellwood R A , Borg-Grech A , Watson R J
Published: March 2007

We have undertaken fine-wire localization and biopsy of 130 impalpable breast lesions identified by mammography and considered suspicious of malignancy. Histologically 22 of these lesions were invasive carcinomas and 24 were in situ carcinomas (35 per cent malignant). Twenty-nine per cent of the lesions were identified during the screening of asymptomatic women. In the remainder, the presenting symptoms bore no relation to the eventual histological diagnosis. Clusters of micro-calcification were more often malignant than were abnormal soft-tissue masses. Malignancy in the absence of microcalcification was almost always invasive.
Measurement of serum thyroglobulin is of value in detecting tumour recurrence following treatment of differentiated thyroid carcinoma by lobectomy
Authors: Harvey R D , Matheson N A , Grabowski P S , Rodger A B
Published: March 2007

Serum thyroglobulin was measured in 243 samples from 84 patients (20 men and 64 women, with a mean age of 48·9(14) years) with differentiated thyroid carcinoma treated by lobectomy, and in 58 patients treated by total thyroidectomy. Both groups were given thyroxine to suppress thyroid stimulating hormone (TSH). Three patients in the lobectomy group and eight in the thyroidectomy group had evidence of tumour recurrence. Serum thyroglobulin concentration was elevated in the presence of known recurrent tumour (P < 0·001) irrespective of the type of operation, and in its absence tended to be higher in the lobectomy than in the thyroidectomy group (median 4 μg/l versus 2 μg/l, P < 0·05). Serum thyroglobulin levels of less than 10 μg/l could confirm the absence of otherwise known tumour recurrence in both groups with a specificity of 100 per cent, and sensitivities of 80 per cent and 86 per cent in the lobectomy and thyroidectomy groups respectively. Exclusion of samples liable to spurious elevation of thyroglobulin improved the sensitivity in the lobectomy group to 92 per cent. Despite the presence of residual thyroid tissue, measurement of serum thyroglobulin can exclude the presence of significant metastases in most patients following lobectomy for thyroid carcinoma.
Infected false aneurysms in the groin of intravenous drug abusers
Authors: Welch G H , Reid D B , Pollock J G
Published: March 2007

The hazards of dealing with infected false femoral aneurysms resulting from intra-arterial narcotic injection are highlighted in six patients. Two patients were human immunodeficiency virus positive and three patients were hepatitis B surface antigen positive. Because of these infections exploration of groin swellings as presumed soft tissue abscesses is potentially hazardous without proper proximal vascular control. All patients underwent reconstruction following arterial ligation and five grafts became infected, with life threatening haemorrhage occurring in four patients. Five grafts have subsequently occluded or have been removed without loss of limb viability, although two patients have been regrafted. A high index of suspicion and assessment by a vascular surgeon, with angiography if indicated, is required in any intravenous drug abuser presenting with a groin swelling following injection. Because of the great risk of graft infection, it is suggested that ligation and debridement alone be carried out, with immediate arterial reconstruction only for non-viability.
Hepatic haemodynamic changes after portacaval anastomosis in normal, cirrhotic and chronic prehepatic portally hypertensive rats
Authors: Romeo J M , Lopez-Farre A , Martin-Paredero V , Lopez-Novoa J M
Published: March 2007

Radioactive microspheres were used to determine the hepatic haemodynamic response to portacaval anastomosis in normal, cirrhotic and chronic prehepatic portally hypertensive rats 20 days after operation, and in normal rats 2 months after operation. After 20 days portacaval anastomosis caused a decrease in liver mass only in normal and cirrhotic animals, whereas hepatic arterial blood flow per unit of mass increased in normal (+ 488 per cent), cirrhotic (+ 191 per cent) and prehepatic portally hypertensive rats (+ 133 percent). Despite these facts, animals with portacaval anastomosis showed a reduced hepatic total perfusion (arterial plus portal inflow) per unit of mass with respect to controls in normal (−53 per cent) and cirrhotic rats (−68 per cent), but not in those with prehepatic portal hypertension. Comparing studies carried out at 2 months with those performed 20 days after portacaval anastomosis in normal rats, some recovery of liver mass and total liver blood flow was observed. In conclusion, portacaval anastomosis produced a limited increase in hepatic arterial blood flow which was unable to preserve liver mass and its total perfusion in normal and cirrhotic animals. In contrast, portacaval anastomosis did not significantly alter liver mass or its perfusion in animals with chronic prehepatic portal hypertension, as both values were previously diminished in controls. Thus, the risk of liver failure after portacaval anastomosis is higher in normal and cirrhotic rats than in those with chronic prehepatic portal hypertension.
Percutaneous arterial recanalization
Authors: Michaels J A
Published: March 2007

The current status of new techniques for percutaneous arterial recanalization, including laser, thermal and mechanical angioplasty techniques, is described. The reported results, potential advantages and possible future developments are discussed.
Graduated compression stockings in the prevention of postoperative deep vein thrombosis
Authors: Jeffery P C , Nicolaides A N
Published: March 2007

This review examines the role of graduated elastic compression stockings in the prevention of postoperative deep vein thrombosis. Used alone compression stockings reduce the incidence of postoperative deep vein thrombosis by approximately 60 per cent and when used in combination with other preventive methods, such as low dose heparin or intermittent calf compression, they further reduce the incidence by up to 85 per cent.
Femoropopliteal arterial fibrodysplasia
Authors: van den Dungen J J A M , Boontje A H , Oosterhuis J W
Published: March 2007

Fibrodysplasia is a rare and unusual cause of obstruction of the superficial femoral or popliteal artery. Three young patients with intermittent claudication due to occlusion of the femoropopliteal artery are described. Histological examination showed destruction of the elastic and muscle fibres of the media. In one patient secondary fibrosis of the intima was seen. The adventitia showed an increase in elastin fibres in all cases. The lesions described can be respectively classified as perimedial fibroplasia, as medial dissection and as intimal fibroplasia. This is the first description of a patient with histopathologically proven perimedial fibroplasia and medial dissection of the femoropoliteal artery and the second case of intimal fibroplasia.
Intermittent hepatic dearterialization induces glucose intolerance: An experimental study in the rat
Authors: Sjövall S , Ahrén B , Bengmark S
Published: March 2007

Intermittent hepatic dearterialization is used in the palliative treatment of liver malignancy. However, its metabolic consequences are not established. Therefore the influences of the procedure on the plasma insulin, glucagon and glucose responses were studied in healthy rats and in rats with a tumour inoculated subcapsularly into the liver. To study the influence on stimulated islet hormone secretion we infused arginine intravenously (7 mg/min) for 30mm, because arginine is known to stimulate the secretion of both insulin and glucagon. During hepatic dearterialization, hyperglycaemia developed; mean(s.e.m.) blood glucose levels after 60min of dearterialization were 20·2(1·3)mM versus 14·7(1·5) mM in controls (P < 0·001). Concomitantly, compensatory hyperinsulinaemia and hypoglucagonaemia occurred. Furthermore, during both dearterialization and in the immediate reperfusion phase, the arginine-induced increase in plasma insulin levels was impaired (P < 0·001), whereas the arginine-induced increase in plasma glucagon levels was not significantly affected. These changes were qualitatively the same in tumour-free and tumour-bearing rats. We conclude that glucose intolerance develops during selective hepatic dearterialization, which is evident both from basal hyperglycaemia and impaired insulin secretion.
Nitrogen requirements in severely injured patients
Authors: Larsson J , Lennmarken C , Mårtensson J , Sandstedt S , Vinnars E
Published: March 2007

The study was designed to evaluate nitrogen needs in severely injured patients during the first week after trauma. Thirty-nine patients aged from 18 to 65 years with a burn or fractures of more than two long bones were studied. Energy requirements were given par enter ally as fat and glucose in isocaloric amounts. The patients were randomized into five groups receiving different amounts of nitrogen from zero to 0·3 g kg body-weight−1 24 h−1. Daily and cumulative nitrogen balance, urinary 3-methylhistidine excretion and nitrogen retention were calculated on days 2–8 after trauma. With no nitrogen, the mean(s.e.m.) daily nitrogen balance after the trauma was −13·8(0·5) gN. The balance improved markedly in groups with a nitrogen intake of up to 0·2 g kg body-weight−1 (P < 0·001) compared with the no-nitrogen group. The 3-methylhistidine excretion increased because of the trauma in all groups with no statistically significant difference between the groups. Nitrogen retention decreased with increase in nitrogen supply and with time after injury. It is suggested that a nitrogen supply of 0·20 kg body-weight−1 24 h−1 is optimal for severely injured patients during the first week after trauma.
Splenectomy for hypersplenism in chronic lymphocytic leukaemia and malignant non-Hodgkin's lymphoma
Authors: Delpero J R , Houvenaeghel G , Gastaut J A , Orsoni P , Blache J L , Guerinel G , Carcassonne Y
Published: March 2007

Between 1 January 1980 and 31 July 1988, 62 patients with chronic lymphocytic leukaemia (CLL) or malignant non-Hodgkin's lymphoma (NHL) were splenectomized for splenomegaly and presumed hypersplenism. All patients except one had splenomegaly (mean(s.d.) weight 1585 (872) g, range 150–4300 g) and 34 had massive splenomegaly (> 1500 g). Forty-nine patients had platelet counts < 100 × 109/l and 16 patients had anaemia with haemoglobin levels < 10 g/dl. White cell counts were < 3×109/l in six NHL patients. Fifteen patients had bicytopenia, and three NHL patients had tricytopenia. The selected group of 62 patients underwent splenectomy largely because of failure to respond to medical therapy (39 patients) or inability to tolerate or start adequate chemotherapy because of very low blood counts (11 patients). There was one postoperative death, and a 29 per cent morbidity rate. The response rate was 89 per cent in the first month after splenectomy and 39 patients (63 per cent) had a continuing complete response with a median follow-up of 26 months (range 3–96 months). Twelve patients (10 with CLL) received no further therapy after splenectomy. Seven patients failed to respond and 15 relapsed after splenectomy. These 22 patients could be distinguished on the basis of: (1) lower average preoperative platelet counts (P < 0·007), postoperative platelet counts (P < 0·001), and postoperative rise in platelets (P < 0·004); (2) lower average spleen weight (P < 0·052); (3) preoperative chemotherapy (P < 0·044). However preoperative and postoperative platelet counts were the only two variables selected by stepwise regression analysis (P < 0·05 and P < 0·01, respectively). Bone marrow failure did not preclude complete response after splenectomy. Long-term survivors emerged from the group of patients with continuing complete response. Of the seven patients who failed to respond, five died with a median survival of 4 months, and of the 15 patients who relapsed after splenectomy, 13 died, with a median survival of 6 months after relapse and 18 months after splenectomy. Thus, splenectomy may be an effective palliation for both CLL and NHL patients with splenomegaly and hypersplenism.
Hypertensive anal cushions as a cause of the high anal canal pressures in patients with haemorrhoids
Authors: Sun Wei Ming , Read N W , Shorthouse A J
Published: March 2007

Anorectal manometry and electrophysiology studies were conducted in 25 men with non-prolapsing haemorrhoids, ten men with prolapsing haemorrhoids, and 20 age-matched normal men. Mean(s.e.m.) minimum basal pressures were significantly higher in patients with non-prolapsing haemorrhoids than in normals (61(5) versus 43(7) cmH2O; P < 0·05) or patients with prolapsing haemorrhoids (55(4) cmH2O; P < 0·05). There were no significant differences in maximum basal pressures and maximum squeeze pressures. During rectal distension, all normal subjects showed relaxation in all anal channels. However, 92 per cent of patients with non-prolapsing haemorrhoids and 40 per cent of patients with prolapsing haemorrhoids showed no relaxation in the outer anal channels, even when relaxation occurred in the inner anal channels; internal sphincter electrical slow waves were suppressed and the integrated electrical activity of the external sphincter had returned to predistension values. Maximum residual anal pressures during balloon distension were significantly higher in patients with non-prolapsing haemorrhoids than normals (75(7) versus 45(7) cmH2O; P < 0·01), or patients with prolapsing haemorrhoids (53(3) cmH2O; P < 0·05). When subjects increased intra-abdominal pressure rectal pressure was significantly higher in patients with non-prolapsing haemorrhoids than in normal subjects (157(10) versus 105(15) cmH2O; P < 0·05), but not in patients with prolapsing haemorrhoids (126(14) cmH2O). Resting anal cushion pressures in patients with non-prolapsing or prolapsing haemorrhoids were much higher than normal capillary or venous pressure and significantly higher than those recorded in normals (median 35, 35 versus 10 cmH2O; P < 0·0001). Pressures recorded during coughing (60, 60 versus 30 cmH2O) and straining (78, 80 versus 55 cmH2O) were also significantly higher (P < 0·0001) in patients than in normals. Pressures after straining were higher than those recorded before (38 versus 29 cmH2O; P < 0·05) in 60 per cent of patients but no normal subjects and took 18–36 s to return to baseline. This study suggests that the abnormally high pressures in the anal canal in patients with haemorrhoids may be related to an increased vascular pressure in the anal cushions.
Satisfying patients' needs for surgical information
Authors: Edwards M H
Published: March 2007

Patients facing operation need good information. This is implicit in informed consent but it is often lacking. A solution is a comprehensive set of leaflets covering 65 different general surgical operations. The leaflets describe the illness, operation, exact management regimen, some complications and outlook, in a deliberately simple style. Master copies are stored on a wordprocessor to allow unlimited expansion and updating. A retrospective survey of 200 patients showed that those receiving leaflets were significantly more satisfied with information (72 per cent overall) than those not receiving leaflets (42 per cent overall) (P < 0·01). This was especially apparent for information about postoperative progress, both in hospital (92 per cent versus 52 per cent) and after discharge from hospital (88 per cent versus 39 per cent). The system is effective, cheap and popular with patients and medical and nursing staff. The wordprocessor allows extensive modifications of the information to suit other surgeons' requirements.
Bullet emboli to the systemic and venous circulation
Authors: Michelassi F , Pietrabissa A , Ferrari M , Mosca F , Vargish T , Moosa H H
Published: March 2007

The rarity of bullet emboli leads to frequent delays in diagnosis and inadequate early management. Our recent experience with this entity is described, and 153 cases reported in the English-language literature are reviewed and summarized. The majority of cases occurs as a consequence of civilian violence among men in their 20s and 30s. Most bullet emboli follow the direction of blood flow, although 15% of venous bullets cause embolization in a retrograde manner. One in 10 arterial emboli follow a right-heart or venous injury. Arterial bullets are symptomatic in 80% of cases, venous bullets in only one third. The choice of surgical management must be individualized according to the symptoms caused by the bullet and its location in the vascular system. In general, arterial bullet emboli are removed because of symptoms or findings of acute peripheral ischemia. Arterial and venous emboli not causing symptoms should be removed according to the risk of possible displacement and further embolization. Selective intraoperative angiograms and phlebograms can precisely localize the migrating bullet and permit appropriate placement of incisions before removal. (SURGERY 1990;107:239–45.)
Male homosexuality, HIV infection and colorectal surgery
Authors: Scholefield J H , Northover J M A , Carr N D
Published: March 2007

The sexual practices of male homosexuals may lead to the development of a wide variety of colorectal and perianal diseases. This review describes the pathogenesis of these conditions, their management, and the influence of HIV infection on these conditions.
Effect of postanal repair on progress of neurogenic damage to the pelvic floor
Authors: Laurberg S , Swash M , Henry M M
Published: March 2007

Physiological evaluation of the anorectum and pelvic floor muscles was carried out in 18 patients before and 9–35 months after postanal repair for anorectal incontinence. Thirteen patients (72 per cent) were improved, but in these patients the fibre density in the external anal sphincter muscle and the pudendal nerve terminal motor latency were both increased after surgery. In the five patients not improved after surgery only a few unstable motor unit potentials could be recorded in the external anal sphincter muscle. In two of these patients the pudendal nerve terminal motor latency could not be recorded after surgery. We suggest that this progression in the neurogenic damage to the pelvic floor muscles after postanal repair may be caused by the operation, and that it may be responsible for the poor functional outcome noted in some patients.
Bile duct size after cholecystectomy: An endoscopic retrograde cholangiopancreatographic study
Authors: Chung S C S , Leung J W C , Li A K C
Published: March 2007

Endoscopic retrograde cholangiopancreatography (ERCP) was performed in 43 patients before and 4–14 months after cholecystectomy. All patients had a normal common bile duct and were asymptomatic after the operation. Preoperative and postoperative films of adequate quality were available for scrutiny in 35 patients. The largest mean(s.d.) diameter of the common duct, after correcting for magnification, was 0·96(0·27) cm before cholecystectomy and 1·16(0·29) cm after surgery (P < 0·0001). Thirty-one of the 35 patients showed increased duct size after cholecystectomy, and the difference was 1 mm or more in 26 patients. There was a positive correlation between the increase in bile duct size and the time interval after cholecystectomy. After cholecystectomy a small but significant increase in bile duct diameter is demonstrable on ERCP.
Pathogenesis of acute cholecystitis after gastrectomy
Authors: Takahashi T , Yamamura T , Utsunomiya J
Published: March 2007

The increased incidence of gallbladder diseases after gastrectomy is discussed with regard to contractile motility of the gallbladder. Ultrasonographic findings and contraction of the gallbladder in response to egg yolk or caerulein were studied before and after gastrectomy at intervals ranging from 2 weeks to 6 months. Enlargement of the gallbladder with accumulation of biliary sludge and hypomotility were frequently observed within a month of operation for gastric cancer, suggesting that biliary stasis is an important contributing factor in postoperative acute cholecystitis. Within 3 months of operation, contraction had recovered to close to preoperative levels and the incidence of biliary sludge formation gradually decreased. Daily administration of an opiate antagonist, naloxone (0·8 mg), significantly improved gallbladder dyskinesia and decreased the incidence of biliary sludge formation within 1 month of gastrectomy.
Recurrent reflux and wrap disruption after Nissen fundoplication: Detection, incidence and timing
Authors: O'Hanrahan T , Marples M , Bancewicz J
Published: March 2007

One hundred and twenty-five patients with refractory gastro-oesophageal reflux disease underwent floppy Nissen fundoplication. Median follow-up was 52 months, and included endoscopy, manometry and prolonged pH recordings in all cases in addition to clinical assessment. Using objective criteria, 12patients (9·6per cent) developed recurrent reflux. In nine of these patients, endoscopy had suggested that the Nissen fundoplication had disrupted; wrap disruption was confirmed in seven patients who underwent reoperation. The median time to endoscopic recognition of wrap disruption was 7 months (range 3–10 months). In contrast, of 115 patients with endoscopic evidence of an intact fundoplication, only 3 (2·6 per cent) had recurrent reflux. Endoscopy allowed reliable differentiation between those with and without reflux control after operation (P< 0·007). These results suggest that recurrent reflux after Nissen fundoplication is due to wrap disruption. This phenomenon occurs within the first postoperative year and can be recognized by informed endoscopic assessment.
Vomiting after Roux-en-Y biliary diversion: Relationship to surgical technique
Authors: Ferguson G H , Rose M , Maclennan I , Taylor T V , Torrance H B
Published: March 2007

Vomiting is a frequent complaint after revisional gastric surgery using a Roux-en- Y biliary diversion. This is believed to be due to gastric stasis or stasis in the jejunal component of the Roux-en-Y. Thirty-three patients, ten with a satisfactory outcome following Roux-en- Y diversion and 23 with an unsatisfactory outcome, were studied using a semisolid, radiolabelled meal and compared with 12 normal subjects. Outcome was assessed by modified Visick grading. Seven patients with an unsatisfactory outcome because of frequent vomiting had gastric stasis and two had delay in emptying of the jejunal component of the Roux-en-Y. Vomiting was more likely in patients with a dependent sump (P<0·0006) and emptying was significantly prolonged where a sump was present (P = 0·0009). Surgical technique contributed to the dependent sump.
Clinical trial of calcium alginate haemostatic swabs
Authors: Blair S D , Jarvis P , Salmon M , McCollum C
Published: March 2007

The influence of a new haemostatic material on surgical bleeding was evaluated in 100 patients who were prospectively randomized to either normal surgical gauze or calcium alginate swabs used throughout cholecystectomy (n = 40), simple mastectomy (n = 18) or inguinal hernia repair (n = 42). Overall, median (range) blood loss was 91(3–329) ml for gauze and was significantly reduced by calcium alginate swabs to 72(2–181)ml (P<0·05). Unexpectedly, operation times were also shortened from 45(17–95) min for gauze to 35(13–70) min with calcium alginate swabs (P < 0.02). This reduction in blood loss and operating time was greatest for mastectomy, was still statistically significant for cholecystectomy, but was unimportant in inguinal hernia repair. Calcium alginate haemostatic swabs may become routine in major surgery, particularly where blood loss leads to the need for transfusion.