bluuebunny/crossref_metadata_2025 huggingface dataset:
Controlled clinical trial comparing early with interval cholecystectomy for acute cholecystitis
Authors: McArthur P , Cuschieri A , Sells R A , Shields R
Published: March 2007

The traditional management of acute cholecystitis is initial conservative treatment with antibiotics followed by elective cholecystectomy. Although early cholecystectomy has often been advocated, there has been only one randomized controlled clinical trial comparing the two methods of treatment. This paper reports the preliminary results of such a trial in which 32 patients have been studied so far.

Of the 17 patients managed conservatively, there was a misdiagnosis in 2 (11.8 per cent). In the remaining 15 patients with acute cholecystitis 3 (20 per cent) required urgent operation because of failure of medical treatment. Elective cholecystectomy was not technically difficult.

Of the 15 patients treated by early cholecystectomy, there was a misdiagnosis in 1 (6.8 per cent). Surgery was technically difficult in 2 patients but cholecystectomy was possible in all. The former 2 patients required blood transfusion, but in the remainder the estimated blood loss was only slightly more than in the elective group.

There was no mortality in either group nor any complication directly attributable to the biliary surgery. The incidence of minor postoperative complications was only slightly greater in those treated by early operation. The length of postoperative stay was similar in both groups but those treated conservatively spent an average of 11 more days in hospital.

The preliminary results indicate that those treated by early cholecystectomy spend less time in hospital and avoid the complications of failed conservative treatment without the added risk of increased postoperative mortality and major complications.
The effect of the size of the gastric outlet on gastric emptying after vagotomy for duodenal ulcer
Authors: George W D , Cowley D J , Royston C M , Glass H I , Spencer J
Published: March 2007

Gastric emptying of isotopically labelled solid meals was studied in normal human subjects and in 30 patients who had had an operation for chronic duodenal ulcer. Each patient had a vagotomy of the whole stomach combined with either a Finney pyloroplasty to produce a large gastric outlet or a Heineke-Mikulicz pyloroplasty to produce a relatively small outlet.

At 10–22 days after operation gastric emptying was equally and significantly slowed in both groups when compared with the normal controls. This delay occurred regardless of whether the vagotomy was complete or incomplete.

At 4–6 months after operation emptying had returned to normal in the patients who had had a Finney pyloroplasty but remained significantly slowed after Heineke-Mikulicz pyloroplasty.

Mild symptoms of gastric stasis frequently occurred in both groups in the early postoperative period, but were rare 4–6 months after operation. There was no correlation between the incidence of these early symptoms of stasis and the size of the gastric outlet constructed.
Experience with 26 reservoir ileostomies
Authors: Goligher J C , Lintott D
Published: March 2007

A personal experience of 26 reservoir ileostomies is reviewed. There were no operative deaths, but 3 patients developed non-fatal faecal fistula and 6 patients eventually had their reservoir removed for a variety of reasons. No patient given a reservoir without an intussusception valve was fully continent, but of 15 patients with a reservoir incorporating such a valve who were followed up, 9 enjoyed complete continence, though 2 experienced periodic difficulty with stomal intubation. The indications for this operation are discussed.
An assessment of the value of the white cell count in the management of suspected acute appendicitis
Authors: Bolton J P , Craven E R , Croft R J , Menzies-Gow N
Published: March 2007

A prospective study of 100 consecutive patients was carried out to determine if a knowledge of the white cell count was a useful factor in determining the correct management of patients presenting with suspected acute appendicitis.

A retrospective study of the differential white cell count and neutrophil morphology was performed to see if these investigations would provide more specific aids to diagnosis.

These studies show that such haematological information is only of limited supportive value in the total assessment of these patients. Where the clinical findings are at variance with the white cell count, the clinical findings should take precedence.
Comparison of impedance and strain gauge plethysmography in the measurement of blood flow in the lower limb
Authors: Schraibman I G , Mott D , Naylor G P , Charlesworth D
Published: March 2007

Simultaneous measurement of the flow of blood in the calf in 24 normal volunteers by impedance and mercury strain gauge plethysmography has revealed a systematic difference in the results from the two methods. Possible reasons for this discrepancy are discussed.
Loose bodies in the elbow
Authors: Bell M S
Published: March 2007

This is a retrospective study of 52 patients with loose bodies in the elbow joint. The major cause was osteoarthrosis, accounting for 37 per cent of the cases, and the commonest site was the anterior compartment of the joint. Restriction of elbow extension by 10° or more was the most constant clinical finding. Thirty-three patients were subjected to arthrotomy, with a low complication rate.
Identification of talc on surgeons' gloves and in tissue from starch granulomas
Authors: Henderson W J , Melville-Jones C , Barr W T , Griffiths K
Published: March 2007

Particles of talc have been identified on the route surface of surgeons' rubber gloves and in sections of tissue classified as “starch” or “foreign body” granulomas. This analytical study indicates that under certain circumstances these granulomas could have been caused by talc contamination.
How tight should tension sutures be tied? A controlled clinical trial
Authors: Rosenberg I L , Brennan T G , Giles G R
Published: March 2007

In a prospective randomized trial there was no advantage in tying tension sutures flush with the wound; by tying them loosely (over three fingers of the assistant's hand) there was less wound pain and less cutting in of the tension suture into the ridge of the wound and along the suture tracks.
The survival rate of men with carcinoma of the breast
Authors: Slack Robert W T
Published: March 2007

The Cancer Register for the South-West Region of England has been used to examine the survival rate of men with carcinoma of the breast, and a comparison has been made with carcinoma of the breast in women. For all men with carcinoma of the breast the prognosis is worse than for all women, but comparing the prognosis by clinical stage, the difference between men and women is small. However, the survival rate in men under 65 years of age is appreciably better than for men over 65, and for older men the survival rate is considerably less than for women over 65.
Pressure measurements beneath below-knee amputation stump bandages: Elastic bandaging, the Puddifoot dressing and a pneumatic bandaging technique compared
Authors: Isherwood P A , Robertson J C , Rossi D A
Published: March 2007

Elastic wrap bandaging is unreliable and dangerous in terms of pressure and pressure distribution (tourniquet effect). The Puddifoot dressing is safe and is less likely to produce a tourniquet effect. The range of pressures it produces is low-possibly too low to achieve ideal moulding or oedema control. A pneumatic bandage achieved a relatively narrow range of pressures between capillary and arteriolar blood pressures. It minimized tourniquet effects and differences between skilled and unskilled bandagers. It is sufficiently promising to merit development.
Severe pseudomembranous colitis after lincomycin and clindamycin
Authors: Smart R F , Ramsden D A , Gear M W L , Nicol A , Lennox W M
Published: March 2007

Four cases of severe pseudomembranous colitis following the use of lincomycin and clindamycin are described; 2 required emergency total colectomy and 2 died. Cases of such gravity after the use of these drugs have not been previously reported.

One hundred and fifty-six orthopaedic cases where clindamycin and lincomycin were used postoperatively are reviewed; 34 had diarrhoea (22 per cent), and 3 of the severe cases occurred in this group.

The diagnosis of pseudomembranous colitis may be difficult as the latent period from initiation of drug therapy to commencement of diarrhoea may be as much as 18 days, and that from cessation of drug therapy may be as much as 11 days. The value of early sigmoidoscopy in cases of diarrhoea of obscure aetiology is emphasized, and the characteristic sigmoidoscopic and histological appearances of pseudomembranous colitis are described.

As these drugs may produce a lethal condition it is suggested that they should be used with appropriate discretion, especially in the elderly female who appears to be most at risk.
Some observations on gallstones and bile composition
Authors: Sutor D June , Cowie A G A , Clark C G
Published: March 2007

A series of 31 consecutive patients undergoing surgery for gallstone disease has been studied and the composition of the gallstones and bile from the gallbladder und common duct determined. As a result of the stone analysis by the X-ray powder diffraction method, the patients were classified according to whether their stones consisted of cholesterol, calcium salts or a mixture of the two. The mean composition of the common duct bile for the groups with cholesterol and mixed stones was just outside the micellar region of cholesterol solubility. The gallbladder bile from the cholesterol group of stone-formers was also supersaturated, but the gallblader bile from the group of mixed stone-formers was undersaturated with respect to cholesterol. None of the patients forming gallstones of calcium salts showed any abnormality in the cholesterol content of their bile.
Pancreatic pseudocysts
Authors: Karatzas G M
Published: March 2007

Twenty-seven patients with 32 pancreatic pseudocysts have been seen during the past 10 years at St George's Hospital, London. Two of the pseudocysts were found in unusual positions-one in the right inguinal canal and the other one in the porta hepatis. Approximately half of the pseudocysts in this series followed biliaryinduced pancreatitis. The various clinical presentations are reported and the surgical treatment is discussed. Internal drainage is the most effective treatment and in the majority of cases transgastric cystogastrostomy via a tube is the procedure of choice. One death occurred, an overall mortality rate of 3.1 per cent.
Curling's ulcer: A rare condition
Authors: Muir Ian F K , Jones Peter F
Published: March 2007

A case of Curling's ulceration of the duodenum in a child with 50 per cent burns, requiring operative arrest of the bleeding, is reported, and this condition is reviewed. Inquiry among the surgical units treating burns in Great Britain showed that only 18 cases of alimentary bleeding had been seen in the course of treating some 32 500 patients. The incidence in Europe and Australia appears to be of the same order, bur there is a much higher incidence in some burns units in North America. Possible reasons for these differences are examined. The occurrence and treatment of Curling's ulcer in childhood are considered.
A comparison between suction and corrugated drainage after simple mastectomy: A report of a controlled trial
Authors: Bourke J B , Balfour T W , Hardcastle J D , Wilkins J L
Published: March 2007

A randomized prospective trial of closed suction wound drainage compared with corrugated wound drainage after simple mastectomy for early breast cancer (lesion confined to the breast and without skin ulceration)is reported. Fifty-one patients were admitted to the study anti there was no difference between the two groups with respect to local complications such as infection, skin necrosis and collection under flaps and wound healing. Dressings require to be performed significantly less frequently with suction as opposed to corrugated drainage and suction drains were removed significantly sooner than corrugated drains. It is concluded that closed suction wound drainage should be used after simple mastectomy.
Pleural empyema in association with renal sepsis
Authors: Irving A D , Turner M A
Published: March 2007

Five cases of pleural empyema in association with perinephric abscess or renal infection are presented. This represents 4 per cent of a series of 122 pleural empyemas, or 30 per cent of' empyemas with subdiaphragmatic aetiology.

It is suggested that the renal tract should be investigated in all cases of recurrent or non-resolving pleural empyema of uncertain aetiology.
Testicular involvement in the retroperitoneal fibrosis syndrome
Authors: Fraser Ian
Published: March 2007

A case of retroperitoneal fibrosis involving the testicle is presented. The widespread extent of the retroperitoneal fibrosis syndrome is reviewed briefly. The literature contains little information concerning the aetiology of testicular involvement in the disease process, which generally affects the para-aortic tissues. The physical signs mimic testicular neoplasm. A common embryological derivation of the tissues affected is postulated.
The value of the leucocyte count in the diagnosis of acute appendicitis
Authors: Raftery A T
Published: March 2007

Total and differential leucocyte counts were performed on 175 patients with a provisional diagnosis of acute appendicitis. Ninety-six per cent of patients with acute appendicitis had either an abnormal total or differential leucocyte count. Four of 24 patients operated on with a normal leucocyte count had acute appendicitis. It is concluded that leucocytosis of above 10 000/mm3 or a differential in excess of 75 per cent neutrophils supports the clinical diagnosis of acute appendicitis and that routine estimation of the leucocyte count is a useful investigation. While a normal leucocyte count does not exclude even a perforated appendicitis, such a count should prompt further review of the diagnosis, especially in the presence of an atypical history or minimal physical signs.
Lobar dearterialization in liver trauma
Authors: Tanphiphat Chanvit
Published: March 2007

Two cases of blunt liver trauma managed by hepatic artery ligation are reported. Lobar dearterialization is a simple and effective method of achieving haemostasis in exsanguinating wounds of the liver. The postoperative management and scope of this procedure are discussed.
Syndromes in amoebic liver abscess
Authors: Ramachandran S , Goonatillake H D , Induruwa P A C
Published: March 2007

A series of 137 patients with amoebic liver abscess has been studied. Recognition of clearly defined but diverse clinical syndromes was found to be necessary not only in diagnosis but also in planned surgical management. The majority of patients had the classic syndrome of fever, sight abdominal or chest pain, hepatomegaly, hepatic tenderness and radiological abnormalities. Other syndromes of presentation included the silent abscess, acute amoebic colitis, the acute abdomen, the intra-abdominal lump, the external sinus, pyrexia of obscure origin, obstructice, jaundice and renal, pleuro-pulmonary and cardiac symptoms. The syndromes due to an abscess in different parts of the right lobe and in the left lobe of the liver are to some extent distinct. In spite of the varied modes of presentation of amoebic liver abscess, the key to diagnosis is an understanding of the chronological sequence of the disease and its progression from one syndrome to another. Diagnostic methods of value and the mortality are discussed.
Carcinoids of the first part of the duodenum
Authors: Orttz Hector , Ortega José S , Bernat Ramón , Sitges Antonio
Published: March 2007

Three cases of duodenal carcinoid tumour are described and the histology of this type of tumour is discussed. Two of the patients have been followed up for 8 years. No further complications related to the tumours have been observed.
Primary suture of the perineal wound following rectal excision for adenocarcinoma
Authors: Marks C G , Leighton Monica , Ritchie Jean K , Hawley P R
Published: March 2007

A statistical analysis of the correlations between a number of factors, including age, tumour pathology and surgical management, and the results of primary suture of the perineum after excision of the rectum for adenocarcinoma in 63 males is presented.

An unsuccessful outcome was related to the extent of the dissection either necessitated by advanced tumour or resulting from excision of the coccyx. A successful result was associated with small tumours and preoperative antibacterial treatment.

Topical antibacterial treatments, topical mercuric perchloride and the drainage route did not appear to affect the outcome.
Surgical research in the United Kingdom: Past, present and future
Authors: Dudley H A F
Published: March 2007

The history of Surgical research in the United Kingdom leading to the foundation of the Surgical Research Society (SRS) is briefly reviewed. The tendency of the SRS has been to become increasingly rigorous, reductionist and a forum for work which is not only of a high standard but also largely completed. This has had both good and potentially bad effects. Susgeons should realize that their major involvements in research will lie in the relatively untidy field of clinical science, and it is hoped that this view will continue to influence the activities of the SRS.
Salvage of the lower limb
Authors: Yogasundram Y N
Published: March 2007

This is a retrospective study of 80 patients with 94 severely ischaemic lower limbs treated over a period of' 6 years. Arterial reconstruction was possible in 47 patients (54 limbs) and 76 per cent of' these limbs were salvaged. There was no operative mortality. An attempt has been made to analyse the reasons for the failure. The fate of the patients who underwent major amputation is described. The selection of patients for direct arterial surgery is discussed, together with some of the technical problems involved.
Rectal sphincter reconstruction in perineal colostomies after abdominoperineal resection for cancer
Authors: Simonsen Oscar S , Stolf Noedir A G , Aun Frederico , Raia Arrigo , Habr-Gama Angelita
Published: March 2007

A surgical technique is proposed for the reconstruction of the anal sphincter in perineal colostomies after abdominoperineal resection for cancer. The procedure, which employs the gracilis muscle for the sphincteric reconstruction, is described and the operative results and complications are analysed in 24 patients submitted to this type of surgery. Of the 22 patients who were followed up, 17 had excellent or good results with retention of solid or soft stools. Three patients had poor results with no voluntary retention, while 2 others were partly incontinent of solid faeces. In this group of 5 patients, 3 had stenosis of the colostomy and I had no sensibility of impending defaecation.
Cancer prognosis predicted by preoperative lymphocyte responsiveness in vitro
Authors: Watkins Sylvia M
Published: March 2007

The prognosis in cancer patients was studied in relation to their preoperative cell-mediated immune status. Thirty patients with various types of operable cancer were studied. Transformation of the lymphocytes in response to phytohaemagglutinin (PHA) in vitro was measured preoperatively. All the patients were followed up for 3 years. Those with normal preoperative lymphocyte responsiveness had a far better prognosis than those in whom this test was subnormal.
Spontaneous perforation of the common hepatic duct
Authors: Gough A L , Edwards A N , Keddie N C
Published: March 2007

A case of spontaneous calculous perforation of the common hepatic duct is presented. The late result of duct repair, that of stricture formation, is illustrated.
Gastric lesions in generalized neurofibromatosis
Authors: Hoare A M , Elkington S G
Published: March 2007

A patient with dyspepsia and multiple gastric polyps associated with generalized neurofibromatosis is described, and the English literature on generalized neurofibromatosis with gastric involvement is reviewed. Nine patients with gastric neurofibromas have been reported and 2 with one and two gastric polyps respectively, but none with multiple gastric polyps. The commonest presentation has been dyspepsia suggestive of a peptic ulcer.
The bleeding caecal angioma: A diagnostic problem
Authors: Bentley P G
Published: March 2007

Three cases are reported of bleeding angioma of the caecum. The wider use and improved technique of selective arteriography have led to an increase in frequency of diagnosis of this condition, and facilitate the management.
Fournier's gangrene: A report of 5 cases
Authors: Pande S K , Mewara P C
Published: March 2007

A report of 5 cases of infective gangrene of the genitalia and adjacent tissues occurring within a If-1/4year period is presented. Of these, 4 cases occurred within 5 months. All the patients were adult males. During the same period no similar pathology was observed in any female or child. Such a large number of cases occurring in so short a time is intriguing but we are unable to explain it. The treatment in all cases was with general supportive drugs, blood transfusion when needed and specific antibiotics. Local excision of the dead tissues and dressing with hydrogen peroxide and eusol gave satisfactory results.
Sternoclavicular joint enlargement following block dissection
Authors: Lamb C E M
Published: March 2007

The sternoclavicular joint may become enlarged subsequent to block dissection of' the neck. It should be managed conservatively and does not require removal, although both clinical and X-ray appearances may give rise to suspicion of' metastasis in the head of the clavicle. A hypothesis of the pathology of' this unfamiliar condition is proposed.
Surgical treatment of bronchiectasis in Kartagener's syndrome
Authors: Michel L , Lantin F , Vandeperre J
Published: March 2007

A case of Kartngener's syndrome in which bilateral partial pulmonary resection was performed is reported. The literature concerning the surgical treatment of severe bronchiectasis is reviewed.
The treatment of acute abscesses by incision, curettage and primary suture under antibiotic cover
Authors: Jones N A G , Wilson D H
Published: March 2007

One hundred and fifty consecutive acute abscesses have been treated by incision, curettage and primary suture under antibiotic cover. The antibiotic used in this series was lincomycin 600 mg i.m. with premedication and clindamycin 150 mg 4-hourlyfor 4 days postoperatively (children and infants received smaller doses). Similar results for the rate of healing were achieved in all groups of abscesses. A case is made for the use of the technique of incision, curettage and primary suture with antibiotic cover for acute abscesses as an alternative to conventional methods of treatment.
Bronchopleural fistula: A review of 86 cases
Authors: Williams N S , Lewis C T
Published: March 2007

A review of all the bronchopleural fistulas which developed following pulmonary resection in the Department of Cardio-Vascular and Thoracic Surgery of The London Hospital between 1953 and 1973 is presented. During this period 3150 pulmonary resections were performed for various conditions and 86 fistulas occurred, an incidence of 2·7per cent.

The aetiology, diagnosis and treatment of thesefistulas are discussed.
Exomphalos and gastroschisis: A 10-year review
Authors: Venugopal S , Zachary R B , Spitz L
Published: March 2007

Ninety-six cases of exomphalos or gastroschisis managed at The Children's Hospital, Shefield, during the period 1964–74 are analysed. There were 36 cases with minor lesions, 30 with major lesions, 27 with a ruptured exomphalos and only 3 with gastroschisis. The overall mortality rate was 46·9 per cent. Survival could be closely correlated with the birth weight, the nature of the primary lesion, the presence or absence of liver within the sac and the presence and severity of associated congenital anomalies. A ‘scoring system’ based on these criteria is proposed to predict the prognosis of an infant with an exomphalos.
Prophylaxis against anaerobic sepsis in bowel surgery
Authors: Keighley M R B , Crapp A R , Burdon D W , Cooke W T , Alexander-Williams J
Published: March 2007

Sixty-two patients were admitted to a prospective randomized controlled trial 10 investigate the influence of a prophylactic antibiotic, lincomycin, on anaerobic sepsis following bowel surgery. The incidence of postoperative sepsis was reduced from 45 to 18 per cent (P < 0·025). Wound infections were reduced from 38 to 12 per cent (P < 0·05). Intra-abdominal or pelvic abscess occurred in 1 of the treated group compared with 3 controls. Septicaemia occurred after operation in 1 patient receiving lincomycin and in 3 of the controls; in 2 of the latter, pure growths of bacteroides were isolated from the blood cultures and 1 of these patients died. Although Iincomycin had no influence on the number of patients who developed aerobic postoperative infections, there was a significant reduction in the incidence of sepsis due to bacteroides, which occurred in 10 of the control group compared with 1 in the lincomycin group (P < 0·005). No patients developed complications attributable to lincomycin, such as pseudomembranous colitis.

These data indicate that the genus Bacteroides are important pathogenic organisms and are responsible for postoperative morbidity. Furthermore, anaerobic sepsis can be reduced by appropriate prophylactic antibiotics.
Colonic lymphoma complicating ulcerative colitis
Authors: Renton P , Blackshaw A J
Published: March 2007

Colonic lymphoma is a rare complication of ulcerative colitis. Two cases are described in patients who had had ulcerative colitis for 12 and 22 years respectively. Both patients presented with a recent change in their symptoms, which had become increasingly severe and which had not remitted with customary treatment for ulcerative colitis. Physical and haematological examinations revealed no evidence of generalized lymphoma, though barium enema studies indicated the sites of the lymphomatous lesions superimposed on chronic ulcerative colitis which were confirmed at operation and biopsy.
A study of perineal wound healing after abdominoperineal resection
Authors: Saha S K , Robinson A F
Published: March 2007

A comparative study of 53 cases has revealed that a technique of complete primary closure of the perineal wound after abdominoperineal resection of the rectum and anal canal appears to be a superior, more rational approach than other orthodox techniques, (It is unsuitable for any case contaminated with pus or faeces during operation.) Redivac apparatus used through a separate route for continuous drainage from the sacral cavity has made the postoperative care easier for nurses and surgeons and this period more comfortable for the patient. It provides a simple method compared with other suction apparatus used for the same purpose.

Of the 53 cases, 12 were operated on using a traditional technique involving the closure of the perineal wound around a tube drain connected to an underwater seal, while in the remaining 41 the approach described here was used. Primary healing of the perineal wound with the latter approach was obtained in about 88 percent, With the other technique the figures were 34 and 66 per cent respectively for early healing within 3 weeks and delayed healing between 3–8 weeks. Primary healing of the perineal wound reduces the total stay in hospital and the morbidity.
The distribution and early morphology of the chronic gastric mucosal reaction
Authors: Lawson H H
Published: March 2007

The distribution of the chronic gastric mucosal reaction (CGMR) that resulted from the exposure of the mucosa to refluxing duodenal contents did not suggest that one area of the stomach was more susceptible than another. The earliest histological appearances of established CGMR as seen 3 months after surgery were epithelial proliferation and pseudo-pyloric metaplasia.
The role of the pyloric antrum and Hofmeister valve in the development of the chronic gastric mucosal reaction
Authors: Lawson H H
Published: March 2007

A limited chronic gastric mucosal reuction (CGMR) develops when duodenal contents enter the stomach with an intact pyloric antrum. However, after antrectomy the same stimulus leads to a widespread CGMR. The pyloric antrum, therefore, seems to influence the development of the CGMR. A Hofmeister valve included in a Polya gastrectomy does not prevent the development of the CGMR, presumably because reflux is not prevented.
The relationship of plasma glucagon to the hyperglycaemia and hyperinsulinaemia of surgical operation
Authors: Giddings A E B , O'Connor K J , Rowlands B J , Mangnall D , Clark R G
Published: March 2007

In a controlled metabolic study of 42patients undergoing abdominal surgery a significant increase in basal values of immunoreactive glucagon (IRG) was found 24 hours postoperatively. No correlation between the onset and duration of hyperglycaemia and the increase of IRG was observed. No increase in immunoreactive insulin (IRZ) was seen during operation, but there was a rise 24 hours postoperatively.

The infusion of arginine was accompanied by a rise in IRG both pre- and postoperatively, but despite the high values obtained there was no accompanying further increase in basal plasma glucose in the postoperative situation. The pre- and postoperative IRI responses were similar. Our evidence suggests that glucagon is not a primary mediator of the stress response, or of the hyperglycaemia of surgical operation in these patients.
Amputation for vascular disease
Authors: Jamieson C W , Hill D
Published: March 2007

Amputation for peripheral ischaemia still has a depressingly high early and late mortality, and morbidity and the end result are usually less than satisfactory. Individual surgeons probably see too few amputees to treat them with maximal efficiency, and these patients create a large burden on beds and resources.

There is room for improvement in all aspects of our management of amputees. Primary healing rates might be better with less heroic attempts to obtain a distal amputation. Sepsis is lessened by the use of prophylactic antibiotics. Tight bandaging and the intra-operative fitting of prostheses are undesirable. Simple tests of skin blood pressure may aid prediction of the degree of ischaemia at the proposed level of limb section and the chances of healing. The late mortality is high and merits study of methods designed to reduce it such as long term anticoagulation.
Perforated peptic ulcer: A comparison of long term results following partial gastric resection or simple closure
Authors: Skarstein A , Høisæter P Å
Published: March 2007

The results of simple closure were compared with those of partial resection in the treatment of perforated peptic ulcer. The investigation was carried out 7–13 years after the primary operation on 126 patients who had been allotted to one of the two treatment methods on the basis of an almost randomized schedule.

Better late results were obtained with partial resection than with simple closure in patients in the age range 50–59 years at operation, with short duration of perforation and with a long history of symptoms before perforation.

None of the patients treated with partial resection later underwent surgical treatment for recurrence of symptoms. In the simple closure group 27·3 per cent needed further surgery at 3 months to 10 years after perforation.
Spontaneous rupture of liver tumours
Authors: Mokka R , Seppälä A , Huttunen R , Kairaluoma M , Sutinen S , Larmi T K I
Published: March 2007

Five geriatric patients with spontaneous rupture of the liver caused by hepatic malignancies were operated upon without mortality. Liver resection seems to be the treatment of choice, but in selected cases with unresectable tumours ligation of the hepatic artery alone is preferable to an attempt to control haemorrhage by packing and suture.
Effects of haemorrhage upon surgical operations
Authors: McGinn F P
Published: March 2007

The complications of emergency surgery for acute upper gastro-intestinal haemorrhage in 95 patients were compared with those of surgery for non-bleeding benign peptic ulceration in 380 patients. There was a significantly higher number of senior surgeons performing emergency surgery for haemorrhage. There was a significantly higher mortality (10·5 per cent), wound dehiscence rate (12·6 per cent) and wound complication rate with re-bleeding (33·7 per cent) in the post-haemorrhage patients compared with the non-bleeding group (1·3, 1·8 and 11·6 per cent respectively). There was no Significant difference in the incidence of chest infection in the two groups. Mortality and morbidity after haemorrhage were correlated directly with the amount of blood transfused before surgery.

Rats were used to study the effect of the removal of 13 per cent of the blood volume, and its restoration after varying time intervals, upon subsequent wound healing. Abdominal wounds were tested at 7 days for breaking and bursting strength. There was no difference between the wound strength of the control animals and animals which had been bled for 4 minutes before wounding. A significant reduction of wound strength occurred in animals which had been bled for 30–60 minutes before wounding.

Prolonged blood loss was associated with deficient wound healing even if blood loss was restored before the wounds were made. Stored blood may be deficient in a factor which is necessary for normal wound healing.
The value of preliminary bone scanning in staging and assessing the prognosis of breast cancer
Authors: Campbell D J , Banks A J , Oates G D
Published: March 2007

Preliminary bone scans have been performed on all patients with early breast cancer. The incidence of positive scans has been recorded and several factors determining scan status have been enumerated. Particular attention has been focused on the natural history of scan positive and scan negative patients. Eighteen per cent of stage I and 41 per cent of stage II cancers had positive bone scans. Scan results were correlated with age, menopausal status, tumour position, tumour size and histological node status. Postmenopausal patients were found to have a significantly increased risk of being scan positive (P < 0·01). Follow-up studies have confirmed that the lesions demonstrated by scanning actually represent metastatic foci. At 18 months 85·7 per cent of scan positive patients had evidence of disseminated disease compared with only 11·4 per cent of scan negative patients (P < 0·01). Clinically overt advanced disease evolves from positive scan lesions.

It is clear that a significant percentage of patients felt to have early breast cancer already have widely disseminated disease at the initial presentation. The biological significance of bone scan lesions makes a sensitive screening test for dissemination an essential part of the preliminary assessment of patients with breast cancer. Bone scans provide an excellent prognostic index at a patient's initial assessment.
Preclinical warning of recrudescent mammary cancers by pregnancy-associated alpha-macroglobulin
Authors: Anderson J Maxwell , Stimson W H , Kelly F
Published: March 2007

Nine of 30 mammary cancer patients developed metastases during 13–94 months after mastectomy. All 9 patients had elevated blood levels of pregnancy-associated α-macroglobulin (PAM) 1–21 months before conventional detection of metastases. Seven of the clinically well patients had PAM rises exceeding 90 per cent above the baseline and in 4 of these the PAM later fell to lower levels. PAM appears to have potential as an indicator of the growth of micrometastases.
Bilharzial granuloma of the gastro-intestinal tract
Authors: Elmasri S H , Boulos P B
Published: March 2007

Thirty-four patients with bilharzial granuloma of the gastro-intestinal tract were analysed. The commonest site was the rectosigmoid. Bilharzial ‘appendicitis’ was also common but the exact relation between bilharzial granuloma and acute inflammation remains unclear. Preoperative diagnosis of bilharzial granuloma is occasionally dificult and histological proof is necessary. Surgical treatment with polypectomy in the case of a solitary polyp and excision of the affected segment of bowel when there are multiple polyps are recommended, There is no evidence that the conditon is premalignant.
Bilharziasis and prolapse of the rectum
Authors: Abul-Khair Mahmoud Helmy
Published: March 2007

Twenty-six cases with complete prolapse of the rectum were investigated. In 8 of these, bilharziasis of the rectum and colon was found to be the cause of the prolapse. The role of bilharziasis in the pathogenesis of this condition is discussed. The age and sex incidence of bilharzial prolapse differs from that of cases without bilharziasis.
The effect of anti-thrombotic drugs on prosthetic grafts in the canine inferior vena cava
Authors: Calvert M H , Gough M H
Published: March 2007

The effect of phenylbutazone, an anti-thrombotic agent, on the occlusion rate of knitted Dacron grafts placed in the infrarenal inferior vena cava of dogs was studied. Grafts placed in dogs treated with phenylbutazone remained patent significantly longer than those in untreated animals. All the grafts in the untreated group occluded, but 2 remained patent in the treated animals.
Prophylactic lincomycin in the prevention of wound infection following appendicectomy: A double blind study
Authors: Leigh D A , Pease R , Henderson H , Simmons K , Russ R
Published: March 2007

The prophylactic use of a single dose of lincomycin in 100 patients undergoing appendicectomy reduced the incidence of postoperative wound injection from 17 to 6 per cent compared with a similar group of control patients. There was no correlation with the histological findings in the appendix, but patients with perforated appendicitis were excluded from the study. Bacteriological examination of the appendix area before surgery showed that Bacteroides fragilis and Escherichia coli were the organisms most frequently isolated. The majority of wound infections were due to B. fragilis, either alone or in association with aerobic organisms, but infection due to E. coli and Staphylococcus aureus also occurred.

Systemic antibiotic therapy can successfully reduce the complications following appendicectomy but it is necessary to use a compound with activity against anaerobic organisms.
Segmental dearterialization in penetrating renal trauma
Authors: Angorn I B
Published: March 2007

Refractory renal haemorrhage following low velocity penetrating trauma has conventionally been treated by nephrectomy or partial nephrectomy. Anatomical studies have demonstrated that the renal artery branches are end-arteries, each branch supplying a renal segment, with no collateral artery supply between segments. Lifethreatening haemorrhage is arterial, and usually issues from a single segmental artery easily demonstrable by renal angiography.

Fourteen patients had various segmental arteries ligated to control haemorrhage. Associated visceral injuries were present in 4 patients. Preoperative selective renal arteriography was possible in 13 patients and demonstrated the bleeding site in all cases. Segmental dearterialization produced haemostasis in 12 of the 14 patients. One patient required nephrectomy and one patient ligation of a second segmental artery to control bleeding. All the patients survived the operative procedure. Supine renin levels were normal on the fourteenth postoperative day and no patient developed hypertension during the follow-up period of 9–24 months.

Segmental renal dearterialization by open operation is a simple and effective technique of controlling refractory renal haemorrhage with maximum preservation of renal parenchyma.
The effects of prolonged hepatic ischaemia before 70 per cent partial hepatectomy in the dog
Authors: Mackenzie R J , Furnival C M , Wood C B , O'Keane Maureen A , Blumgart L H
Published: March 2007

The effect of prolonged normothermic ischaemia before partial hepatectomy was assessed in 10 dogs. During the period of ischaemia, portal decompression was maintained.

The survival rate for animals undergoing 75 minutes of total liver ischaemia was 60 per cent, and 2 of the dogs died as a result of hypoglycaemia. High levels of alkaline phosphatase and transaminases in the survivors indicated a severe degree of hepatocyte damage. However, complete restoration of liver mass was noted 6 weeks after partial hepatectomy and was not impaired by the prolonged ischaemia.

This study confirms the resistance of the dog liver to ischaemia before partial hepatectomy. The critical period beyond which ischaemia is followed by an increasing number of deaths and severe metabolic upset is in the region of 1 hour.
Parathyroidectomy: Extent of resection and late results
Authors: Cooke T J C , Boey J H , Sweeney E C , Gilbert J M , Taylor Selwyn
Published: March 2007

Opinion is divided as to the necessary extent of parathyroid resection in primary hyperparathyroidism. Some surgeons urge that subtotal parathyroidectomy be performed routinely, while others reserve subtotal resections for patients with parathyroid hyperplasia.

In a review of 102 patients treated by parathyroidectomy for primary hyperparathyroidism and subsequently followed up for an average of 6 years, there were 73 patients with parathyroid adenoma, 26 with hyperplasia and 3 with carcinoma. The adenoma was not found at the first operation in only 3 cases; in the other 70 after removal of the adenoma no further hypercalcaemia was observed during the follow-up period. Persistent or recurrent hypercalcaemia was a problem in 9 out of the 26 patients with primary hyperplasia who had inadequate resection at the first operation, and also in the 3 patients with carcinoma.

Experience shows that peroperative biopsy with frozen section of all the parathyroids is useful in confirming their identity and can be a guide to the type of disease present and the appropriate extent of resection.
Aneurysms of the femoral artery
Authors: Adiseshiah Mohan , Bailey David A
Published: March 2007

Eight aneurysms of the femoral artery out of a total of 27 in 16 patients developed symptoms requiring surgery. The operation of choice was Dacron prosthetic replacement of the aneurysm with preservation of profunda femoris perfusion. The incidence of complications of aneurysms was 30 per cent. The asymptomatic aneurysms were untreated and did not cause the patients any inconvenience as observed at their follow-up. Hence, surgery is advocated only for patients who develop symptoms provided that adequate follow-up and community medicine facilities exist.
Retrograde jejunogastric intussusception: Report of 2 cases
Authors: Edwards J L , Aubrey D A
Published: March 2007

Two clinical variants of jejunogastric intussusception are described. In one, self-reduction is the rule, whilst in the other strangulation occurs and emergency surgery is mandatory. A case illustrating each variant is presented and its diagnosis and treatment are discussed.
Prosthetic replacement of a long segment of vein in the treatment of a lower limb injury
Authors: Tachakra S S , Smith J E M
Published: March 2007

A patient who sustained exceptionally severe damage to the main blood vessels and to the collateral circulation of his left lower limb is reported. The femoropopliteal vein was replaced by a Dacron prosthesis which remained patent for 6 weeks until an adequate collateral circulation was established.
Sclerosing peritonitis due to practolol: A report on 9 cases and their surgical management
Authors: Eltringham W K , Espiner H J , Windsor C W O , Griffiths D A , Davies J D , Baddeley H , Read A E A , Blunt R J
Published: March 2007

Nine patients with an unusual and serious intraabdominal complication of the beta-adrenergic blocking agent practolol seen since 1973 are reported. The striking and bizarre peritoneal changes induced by the drug have distinctive features that are not shown by other forms of peritoneal disease.

The cases presented with small bowel obstruction, usually chronic in type and often associated with profound weight loss and an abdominal mass. Characteristic radiological features were present. The abnormalities at laparotomy were impressive, with a gross proliferation of the visceral peritoneum which formed a dense white cocoon which encased, constricted and markedly shortened the small bowel, usually from the duodenojejunal flexure to the ileocaecal valve. The obstruction was relieved by mobilizing the small bowel from the ensheathing tissue. Restoration of alimentary function after surgery was delayed but the long term result was satisfactory with full relief of symptoms and the absence of recurrent obstruction during the follow-up period.

This complication may arise after treatment with the drug has been stopped, and although long term oral therapy has been discontinued, further cases will almost certainly present for some time to come.
Aortocaval fistula as a complication of leaking aortic aneurysm
Authors: Magee H R , Mellick S A
Published: March 2007

The successful management of 2 patients is reported, each involving the closure of a fistula into the inferior vena cava as a sequel to the rupture of an atherosclerotic aortic aneurysm. It is an uncommon complication which should be suspected in the presence of an aortic aneurysm with a loud machinery bruit. Associated peripheral cyanosis and venous pulsation in the accessible proximal veins of the lower extremity and priapism afford strong supporting evidence.
Drug consumption before perforation of peptic ulcer
Authors: Jørgensen T Glarborg
Published: March 2007

In a retrospective study of 195 patients with a perforated peptic ulcer 18 per cent of the patients had taken aspirn, phenylbutzone or corticosteroids during the period before the perforation. In a controlled prospective trial, 18 of 22 patients (82 per cent) had taken drugs known to be potentially harmful to the stomach. Aspirin was the drug mainly used. Thirteen of 22 patients had taken the drugs within 12 hours of the perforation, usually because of symptoms not related to the gastro-intestinal tract. Drug consumption and perforation of pre-pyloric ulcers were most closely associated; the latter applies particularly to female patients, who either had only a short history of upper gastro-intenstinal dyspepsia or were asymptomatic.
Protection of the skin around intestinal fistulas
Authors: Gross Errol , Irving Miles
Published: March 2007

The use of two recently introduced skin protective preparations in the treatment of perifistular skin inflammation is described. Karaya gum in paste form (karaya paste) and a compressed wafer of gelatin, pectin and methyl cellulose (Stomahesive) were used, alone or in combination, with drainable collecting appliances. The method protects the inflamed skin from fistula discharge and allows healing to proceed beneath the dressing. A technique to improve the adhesion of the appliance, in spite of large fluid losses, is outlined.

Healing of skin excoriation was obtained in nearly all cases. Complete control of leakage was achieved in a group of patients with a high output fistula.
The early mobilization of the elderly amputee
Authors: Hutton I M , Rothnie N G
Published: March 2007

A policy of early mobilization of elderly leg amputees using a simple temporary prosthesis has been assessed in the context of a district general hospital.

Close cooperation between members of the hospital management team, adequate rehabilitation facilities and close liaison with the limb-fitting centre and domiciliary services were found to be essential to support this policy.

Of 42 elderly amputees, 34 were supplied as early as possible with temporary prostheses. Nearly 80 per cent of them were able to walk without assistance on discharge from hospital care. Delays in discharge were mainly for socio-domestic reasons.

Early prosthetic mobilization in this aged and often frail group of patients led to a reduced morbidity and mortality. There was improved morale in patients and staff, rapid clearance of acute surgical beds and the all-important early achievement of domestic mobility and independence for the amputee.