bluuebunny/crossref_metadata_2025 huggingface dataset:
A comparison of xenon-133 clearance with electromagnetic flowmeters and an indicator dilution method for the measurement of liver blood flow
Authors: Thorne Joanna , Bennett R , Shields R , Johnson J , Taylor I
Published: March 2007

Measurement of liver blood flow has been carried out by three different methods in 14 dogs to assess the accuracy of xenon-133 clearance following portal vein injection.

Electromagnetic flowmetry with flow probes on the hepatic artery and portal vein resulted in a mean value of 121.9 ± 39.3 ml min−1 100 g−1. An indicator dilution study utilizing chromium-51-labelled red cells gave a mean value of 119.4 ± 31.4 ml min−1 100 g−1 and the xenon-133 clearance following portal vein injection, 120.3 ± 33.8 ml min−1 100 g−1. One-way analysis of variance showed no statistically significant variation between these three groups. There was a close correlation between xenon-133 clearance and electromagnetic flowmetry and between xenon-133 clearance and the indicator dilution technique.

These data suggest that xenon-133 clearance following portal vein injection gives an accurate assessment of liver blood flow and this technique (as well as direct parenchymal injection) can be adapted for clinical use.
Exploration of the common bile duct: A comparative study
Authors: Vellacott K D , Powell P H
Published: March 2007

The results of a retrospective comparative study of 122 patients who underwent explorations of the common bile duct in a district general hospital over a 5-year period are presented. Seventy-eight patients had a supraduodenal choledochotomy, 32 had a transduodenal sphincterotomy and 12 had a combination of both procedures.

Particular attention was paid to postoperative complications in relation to the grade of the surgeon performing the operation and also to the age of the patient.

A total of 78 (64 per cent) patients had definite stones in the common bile duct. Of these patients, 7 (9 per cent) were subsequently shown to have retained stones, all having been operated on by registrars. Registrars also did more negative explorations than consultants.

Nine patients (7.4 per cent) died, all but 1 of them being over the age of 70 and 4 of them having had a combined procedure.

We conclude that transduodenal exploration should be avoided in patients over 70, particularly when added to a supraduodenal exploration.
Haemorrhagic cholecystitis
Authors: Shah V R , Clegg J F
Published: March 2007

Two cases of haemobilia due to haemorrhagic cholecystitis are presented; only 28 other cases have been described. As there are so many more dramatic causes and treatment for haemobilia it is important for the surgeon to recognize that a common operation will suffice for this rare condition. In both cases bacteria were grown from the bile and it is to be hoped that bile culture will be recorded more commonly in future in cases of this interesting condition.
Splenic cysts: A review of 6 cases
Authors: Humphreys W G , Johnston G W
Published: March 2007

Benign cysts of the spleen are rare. Six cases have been managed in this hospital in the past 25 years. The history, physical findings and investigations are reviewed. It is suggested that splenectomy is the treatment of choice as it carries a low morbidity and mortality.
The excretion of alkaline ribonuclease by children undergoing surgery
Authors: Barlow G B , Whitear Susan H , Wilkinson A W
Published: March 2007

The excretion of alkaline ribonuclease has been measured in the urine of two groups of children after major operations. The excretion was significantly increased in all patients after open operations on the heart and in many of those who were operated on soon after birth for anomalies in the intestine. It is suggested that these elevations may indicate a disturbance of pancreatic function.
Phaeochromocytomas in 72 patients: Clinical and diagnostic features, treatment and long term results
Authors: Modlin I M , Farndon J R , Shepherd A , Johnston I D A , Kennedy T L , Montgomery D A D , Welbourn R B
Published: March 2007

Phaeochromocytomas were diagnosed in 72 patients in Hammersmith, Belfast and Newcastle between 1955 and 1976. Fourteen were found unexpectedly at autopsy while 58 were diagnosed in life. Associated lesions included neurofibromatosis (7 patients), medullary carcinoma of the thyroid (3), renal artery stenosis (2) and cerebellar haemangioblastoma (1). The clinical features were similar to those reported by others. Hypertension was found in all but one of the patients and was sustained only in 17 per cent, paroxysmal only in 48 per cent and sustained with superadded paroxysms in 33 per cent. Hypertension was significantly greater in the women than in the men.

Diagnosis was confirmed chemically in all patients and urinary vanylmandelic acid (VMA) was elevated in all but one. Tumours were localized correctly by various radiographic techniques and by selective venous sampling in over 80 per cent of patients. The tumours were in adrenals in 59 patients (bilateral in 6) and at extra-adrenal, intra-abdominal sites in 13.

The tumours were removed surgically from those in whom they were diagnosed in life. Before 1967 3 of 17 patients died after operation (18 per cent). Since then patients have been prepared with alpha blockade and have received infusions of plasma, blood or dextran after removal of the tumours. One of 41 patients so treated has died after operation (2 per cent). Phaeochromocytomas were diagnosed and treated in pregnancy in 4 patients, all of whom survived. Two of the fetuses died.

Five tumours diagnosed in life were malignant and 2 recurred (40 per cent). Fifty-three were benign and 2 of these recurred locally (4 per cent).

All but 2 patients (who could not be traced) were followed completely from 1 to 20 years after operation and 3 died during this period. Two-thirds of the patients were alive after 10 years.

Paroxysmal hypertension was abolished by operation, but sustained hypertension often persisted and required drug therapy.

It is concluded that at least one-third of phaeochromocytomas are not diagnosed in life and that a high index of suspicion is required to bring them to light. If they are diagnosed and treated by present methods, the prognosis is good.
Pancreatogram changes in patients with calculous biliary disease
Authors: Axon A T R , Ashton M G , Lintott D J
Published: March 2007

A successful pancreatogram was obtained at endoscopic retrograde cholangiopancreatography (ERCP) in 53 patients with calculous biliary disease. Twenty-eight patients presented with jaundice and 25 with pain. In both groups there was a high incidence of pancreatogram abnormalities (47 and 48 per cent respectively). These findings demonstrate that the pancreas is often abnormal in the presence of complicated calculous biliary disease even though there may be no recent clinical evidence of pancreatitis and suggest that asymptomatic chronic pancreatitis may be common. The clinical significance of the abnormalities is discussed.
Transcutaneous defunctioning colostomy
Authors: Sykes Fernando Reñaga
Published: March 2007

The technique is described for constructing an occlusive tube colostomy which requires no second operative procedure for closure. The advantages of this method are discussed and it is recommended as a superior alternative to loop colostomy or caecostomy for defunctioning the unobstructed distal bowel.
Cimetidine in the treatment of peptic ulceration following renal transplantation
Authors: Williams G , Castro J E
Published: March 2007

Seven patients who developed peptic ulceration following renal transplantation have been treated by cirnetidine. One died before its value could be assessed. The remaining 6 were symptom-free within 48 h. In 3 patients the ulcer appeared healed on gastroscopy, in one there was no change, another required operation for gastrointestinal bleeding 1 month afrer beginning cimetidine and the other patient has been lost to follow-up after 5 months' treatment. Two patients had a significant rise of serum creatinine whilst on the drug, but there is no evidence of increased immunological reactivity towards the graft and no agranulocytosis.
Does rectal examination affect serum acid phosphatase levels?
Authors: Bannerjee S K , Barker I F , Waterworth T A
Published: March 2007

Formol-stable serum acid phosphatase (SAP) was measured in 200 patients with symptoms of prostatism, before and at varying time intervals after digital rectal examination. In three separate groups of 50 patients SAP levels were measured before and at 5,15 and 30 min following rectal examination and in a fourth group of 50 patients it was measured before and at 6, 24 and 48 h after examination. No significant change occurred in SAP levels following this examination in any of the groups sfudied. We conclude that rectal examination does not raise the SAP and that, contrary to popular belief, blood levels recorded at any time within this 48-h period are reliable.
Sparks mandril, velour Dacron and autogenous saphenous vein grafts in femoropopliteal bypass
Authors: Christenson J T , Eklöf B
Published: March 2007

Ninety-nine consecutive vascular reconstructions with femoropopliteal bypass performed during 1973-6 have been reviewed. A Sparks mandril was used in 11 patients, reversed autogenous saphenous vein in 30 and velour Dacron prostheses in 58. The indication for operation was severe ischaemia in 79 per cent. The overall patency rate at 12 months was 70 per cent for autogenous vein, 46 per cent for velour Dacron prosthesis and 18 per cent for Sparks mandril. When the distal anastomosis was located above the knee the patency rate was 100 per cent and 87 per cent for autogenous vein and velour Dacron graft sespectively, while the corresponding figures for distal anastomosis below the knee were 58 per cent and 11 per cent. At follow-up 60 per cent of the patients showed improvement owing to the vascular reconstruction.
A study of basal cell carcinoma of the inner canthus, 1967–72
Authors: McGregor John C
Published: March 2007

Basal cell carcinoma was the commonest malignant lesion at the inner canthus. Reconstruction following excision was most commonly achieved with a post-auricular full thickness graft. Provided excision is adequate, a local flap is a good alternative. There is no evidence that the use of a graft increased recurrence, but it may have allowed earlier detection. The primary recurrence rate after primary surgical excision was 3.6 per cent. Recurrence occurred in several cases when histology indicated incomplete excision. Follow-up under these circumstances should be continued for up to 10 years. When adequate primary surgical excision was performed, there was no evidence that rodent ulcer of the inner canthus behaves diferently or has a worse prognosis than at other sites. There has probably been undue concern in the past about epiphora following resection of the lacrimal drainage system.
Muscle and serum adenosine triphosphatase in patients suffering from tetanus
Authors: Singh K M , Sawheny D , Kapoor N K
Published: March 2007

Serial estimation of muscle and serum adenosine triphosphatase (ATPase) activity was performed in 16 healthy control patients and 32 cases with tetanus. There was no significant difference due to age and sex in muscle and serum ATPase activity between the normal and tetanus cases. Tetanus patients showed a marked increase in muscle and serum ATPase activity as compared to normal. The ATPase activity increased with the severity of convulsion and disease. There was increased mortality in tetanus patients having higher values of muscle and serum ATPase.
Lingual thyroid: A review of 12 cases
Authors: Kamat M R , Kulkarni J N , Desai P B , Jussawalla D J
Published: March 2007

Twelve patients with lingual thyroid are reviewed. Two of these patients had a follicular carcinoma in the ectopic gland and both are well 5 and 16 years after treatment.

The diagnosis is essentially clinical but confirmation may be made with a thyroid scan.

Six patients were treated conservatively with thyroxine with good results. Six patients were treated by surgical excision, 2 undergoing autotransplantation of the excised gland into the anterior abdominal wall.
Post-surgical hyponatraemia: The role of intravenous fluids and arginine vasopressin
Authors: Thomas T H , Morgan D B
Published: March 2007

In 14 patients having undergone abdominal surgery, plasma sodium, urine volume and osmolality and the urinary excretion of arginine vasopressin (AVP), the antidiuretic hormone in man, were measured daily for 7 days. Each patient was given 31 of intravenous fluids daily. In 8 patients the fluid was saline and in the other 6 it was dextrose-saline.

The plasma sodium did not change in the saline group whereas it fell in the dextrose-saline group during the day of operation and then remained low. On the day of operation the urinary AVP increased to very high levels in both groups of patients. On that day and during the postoperative period the AVP level and urine osmolality were much higher in the saline group than in the dextrose-saline group, which suggests that a loss or redistribution of extracellular fluid was not the cause of the high AVP. These results taken together suggest that it was the higher AVP level in the saline group that was required to keep the plasma sodium normal. On the other hand, the results suggest that in the dextrosesaline group, although the AVP was lower than in the saline group, it produced a urine osmolality greater than that necessary for balance so that the patients retained water and became hyponatraemic.

The fall in plasma sodium was small compared with that seen in patients with symptoms of water intoxication, but it may nevertheless have clinical effects and is best avoided. The results suggest that in these patients hyponatraemia can be avoided if saline rather than dextrose-saline is given on the day of operation.
Postprandial serum gastrin levels in patients with combined hypergastrinaemia and hyperchlorhydria
Authors: Lamers C B H , Van Tongeren J H M
Published: March 2007

We have determined the serum gastrin response to a standard test meal in 13 unoperated patients with combined fasting hypergastrinaemia (more than 150 ng/l) and basal hypersecretion of gastric acid (BAO more than 10 mmol/h). In 10 of 11 patients with proved or presumptive Zollinger–Ellison syndrome the peak postprandial rise in serum gastrin concentration was less than 50 per cent of basal value. The integrated gastrin response to feeding ranged from − 71.9 to 211.8 μg/l × 150 min. In 2 patients with proved hypergastrinaemia of antral origin, however, serum gastrin rose to 223 per cent and 225 per cent respectively of basal value after ingestion of the meal. The integrated postprandial serum gastrin responses in these patients were 66.8 and 22.0 μ/l × 150 min. Two patients with Zollinger–Ellison syndrome and total gastrectomy showed peak serum gastrin levels after feeding of 174 and 225 per cent of basal concentration. The integrated postprandial gastrin secretions were 365 and 366 μg/l × 150 min respectively.

It is concluded that the serum gastrin response to feeding, when expressed as percentage change, may be helpful in the differential diagnosis of unoperated patients with fasting hypergastrinaemia and basal gastric acid hypersecretion.
Autoparathyroidectomy: A case report
Authors: McLatchie G R , Morris E W , Forrester A , Fogelman I
Published: March 2007

This report describes a patient with primary hyperparathyroidism who became spontaneously normocalcaemic preoperatively. This was due to infarction in a parathyroid adenoma. Plasma parathormone (PTH) levels were monitored pre-and postoperatively.
Tracheal collapse after thyroidectomy
Authors: Green W E R , Shepperd H W H , Stevenson H M , Wilson W
Published: March 2007

Tracheal collapse after thyroidectomy is uncommon; when it occurs, complete airway obstruction is often sudden, unexpected and fatal.

In this paper a patient treated for tracheal collapse by tracheostomy and followed up for 1 year is described and, from a review of the literature, a further 9 cases are presented. The aetiology of the condition, the patient at risk and the technique of management are discussed.
Percutaneous transhepatic occlusion for bleeding oesophageal varices
Authors: Henderson J M , Buist T A S , MacPherson A I S
Published: March 2007

Using the technique described by Lunderquist et al. (1977), transhepatic injection of oesophageal varices has been performed under local anaesthesia in 9 patients with portal hypertension (11 procedures). On 2 occasions it was not possible to enter the left gastric vein. Bleeding resumed within 2 days of radiologically satisfactory occlusion in 2 patients and at 1, 3, 4 and 10 months after 4 procedures in 3 patients. Other complications included portal vein thrombosis, gross ascites and right pleural effusion. There were 2 hospital deaths, both in alcoholic patients with poor hepatic function. In spite of the apparently high morbidity we consider that there is a place for this technique in tiding over patients who are bleeding from oesophageal varices and are medically unsuitable for any surgical procedure.
Ingrowing toenails: The results of treatment
Authors: Palmer Bernard V , Jones Angela
Published: March 2007

Completed questionnaires were received from 208 patients on whom 245 operations for ingrowing toenails had been performed at King's College Hospital. Avulsion of a strip of nail had an 83 per cent recurrence rate, total nail avulsion 70 per cent, Zadik operations 28 per cent and wedge resections 29 per cent.

It is recommended that immediate avulsion of ingrown toenails should not be a routine practice.
Wound sepsis following gastrointestinal surgery: A comparison of topical and two-dose systemic cephradine
Authors: Finch D R A , Taylor Lorraine , Morris P J
Published: March 2007

A prospective study of the effect of the route of administration of prophylactic antibiotic on the wound infection rate following gastrointestinal surgery was performed. Patients were randomly allocated to one of three groups: group 1 received no form of antibiotic prophylaxis; group 2 received 1 g of cephradine applied topically to the wound at closure; group 3 received 1 g of cephradine intravenously at induction of anaesthesia and a further intravenous dose of 500 mg 4 h later. Wound infections occurred in 12 of 83 patients in the control group (14.5 per cent), in 6 of the 83 patients in the group who received topical antibiotic (7.2 per cent) and in 3 of the 82 patients who received systemic antibiotics (3.6 per cent). Only the group who received systemic antibiotic showed a statistically significant reduction in the incidence of wound infections compared with the control group (P = 0.03).
A case of craniocleidal dysostosis presenting with vascular complications
Authors: Short D W
Published: March 2007

A case of craniocleidal dysostosis was presented. In spite of the skeletal abnormalities present, the disease was not diagnosed until the patient, a married woman of 63, developed ischaemia of her right upper limb, followed by cerebral symptoms. An arch aortogram demonstrated an occlusion of the first part of the right subclavian artery involving the origin of the vertebral artery and a post-stenotic dilatation of the left subclavian artery due to costoclavicular compression. Such vascular abnormalities have not been previously described in this condition.
A 10-year survey of large bowel carcinoma at Groote Schuur Hospital with particular reference to patients under 30 years of age
Authors: Elloit M S , Louw J H
Published: March 2007

In a 10-years survey of large bowel carcinoma at Groote Schuur Hospital 926 cases were studied retrospectively. A marked difference was seen in both the age of presentation and histological differentiation in two different racial groups. All patients who were 29 years of age or less at the time of presentation have been studied in detail. Predisposing factors, symptomatology, treatment, pathology and prgnosis are discussed. It is apparent that large bowel carcinoma in the young has a very poor prognosis.
Total excision or restorative resection for carcinoma of the middle third of the rectum
Authors: Nicholls R J , Ritchie Jean K , Wadsworth Jane , Parks A G
Published: March 2007

Restorative resection is being used increasingly for carcinoma of the mid rectum but it is not yet certain whether this operation is as curative as total excision. Between 1963 and 1972, 209 patients left St Mark's Hospital after a radical operation for a single rectal carcinoma situated between 8 and 12 cm from the anal verge. A total of 199 patients was followed up for 5 years. Of these, 112 had been treated by total excision of the rectum and 87 by restorative operation. Survival was correlated with the Dukes' stage, histological grade and extent of local spread in the two groups.

There was no significant difference in 5-year survival after either total excision or restorative resection for Dukes' B (74 per cent, 71 per cent respectively) or average grade (61 per cent, 73 per cent respectively) tumours. Patients with Dukes' C tumours fared better when treated by restorative resection (36 per cent, 63 per cent), probably due to fewer high grade tumours in the restorative group (38 per cent, 18 per cent). Combining two variables, survival was not significantly different for patients with Dukes' B tumours of average grade (69 per cent, 62 per cent) or for Dukes' C tumours of average grade (48 per cent, 76 per cent). When the three pathological variables were combined, there was an improved survival after restorative resection for some pathological combinations.

It is concluded that restorative resection for carcinoma of the mid rectum is as curative as total excision in terms of 5-year survival.
The fibrinolytic activity of the vein following venous stasis
Authors: Wu Andrew V O , Mansfield Averil
Published: March 2007

This animal study investigated the fibrinolytic activity in the vein wall of the pig following venous stasis, which was induced artificially using an intermittently inflated pneumatic cuff. The method used to measure the fibrinolytic activity was modified from Todd's original technique. The area of lysis and the area of the vein wall were measured and expressed as a ratio, called the fibrinolytic index. After 3 h of intermittent venous stasis the fibrinolytic index was reduced by 68 per cent, significantly lower than the control group.

The reduction of the fibrinolytic index by venous stasis could play an important part in the development of deep vein thrombosis.
The incidence of deep vein thrombosis in Hong Kong Chinese after hip surgery for fracture of the proximal femur
Authors: Mok C K , Hoaglund F T , Rogoff S M , Chow S P , Ma A , Yau A C M C
Published: March 2007

Fifty-three Hong Kong Chinese patients with fractures of the proximal femur have been studied after hip surgery using functional ascending phlebrograms for evaluating deep vein thrombosis. There was an incidence of deep vein thrombosis of 53·1 per cent in the fractured limbs and 14·3 per cent in the uninjured limbs. The majority of thrombi (84·6 per cent) were located in the calf. No clinical of fatal pulmonary embolism was observed.
Noxythiolin (Noxyflex), aprotinin (Trasylol) and peritoneal adhesion formation: An experimental study in the rat
Authors: Raftery A T
Published: March 2007

Clinical and experimental studies have suggested that noxythiolin and aprotinin may prevent intraperitoneal adhesion formation. A comparison was therefore made of their efficacy in preventing the reformation of adhesions following surgical lysis in a controlled trial using rats. Neither noxythiolon nor aprotinin had any significant benefit over surgical lysis alone. The mortality rate was high in the noxythiolin-treated group.
A safe and effective disposable low pressure suction drain
Authors: Seely M F , Hyde W A , Irving Miles
Published: March 2007

The physical and microbiological properties of a new disposable suction drainage system have been investigated under clinical and laboratory conditions. The system appears to have overcome the disadvantages associated with previous disposable and reusable low pressure suction drainage systems for use after surgical operation in that this system effectively prevents reflux and retrograde contamination.
Total small bowel strangulation: A case report
Authors: Pettersson Gösta , Svensson Jan-Olov , Darle Nils
Published: March 2007

A case of strangulation of the entire small intestine caused by an internal incarcerated hernia is presented. At laparotomy the small intestine was severely discoloured, paralytic and the viability of the bowel was questionable. No resection was performed. At a second laparotomy 10 h later the intestine was hyperaemic and exhibited lively motor activity. Recovery was complete. The importance of prolonged conservative management in avoiding extensive resection is stressed.
Blood transfusion and renal transplantation
Authors: Proud G , Shenton B K , Smith B M
Published: March 2007

Blood transfusions given to potential renal transplant recipients are beneficial to subsequent graft survival. This study has shown an association between the inhibitory activity of patients' plasma on their own non-specific lymphocyte responses to antigen and the administration of blood transfusions. Most of the inhibitory activity was related to alpha-2 macroglobulin. Alpha-2 macroglobulin was able to prolong the survival of rat cardiac allografts. Immunoregulatory activity related to the alpha globulins of plasma has been described in a wide variety of conditions (i.e. cancer, pregnancy, diabetes) and this study has shown similar activity following blood transfusions.
Radionuclide venography for the demonstration of the proximal deep venous system
Authors: Bentley P G , Kakkar V V
Published: March 2007

The majority of pulmonary emboli originate in the deep veins of the lower limb. Fatal emboli usually arise from thrombi that have extended into the femoral or iliac veins or lower inferior vena cava. It is often impossible to demonstrate this area, the proximal venous segment, using conventional ascending venography when there is deep venous occlusion.

The alternative methods available—retrograde, pertrochanteric and transfemoral venography—are invasive. Radionuclide venography (RNV) has been developed as a less invasive alternative. It has been found to be accurate in the proximal deep venous system when compared with conventional ascending venography, and in the presence of proximal occlusion it gives images unobtainable by other means. The radiation dose is extremely low and a perfusion lung scan is obtained without further injection of isotope. RNV appears to be the best method for monitoring the progress of thrombolytic therapy for major venous occlusion.
Nature of the disturbance in the body fluid compartments during and after surgical operations
Authors: Robarts W M
Published: March 2007

Haematocrit and plasma protein concentrations have been measured in patients undergoing surgical operations in order to estimate relative changes in the volumes of the extracellular and plasma compartments. That these provide valid estimates of volume changes has been shown by applying them to patients known to have lost extracellular fluid. Further confirmation that changes in haematocrit, as indices of falls in plasma volume, are valid even after surgery is provided by measurements of red cell mass, using red cells labelled with 99Tcm.

When these methods were applied to patients undergoing abdominal and non-abdominal operations, only the abdominal group showed a significant fall in plasma volume. This fall was caused not by a loss of crystalloid from the extracellular space as a whole, but by a loss of plasma; the magnitude of this loss correlated significantly with the duration of operation. These changes were also demonstrated using the radioisotope dilution indicators 125I (RISA) and 131I (RISA).
The value of measuring intravascular platelet aggregates in the prediction of postoperative pulmonary dysfunction
Authors: McCollum C N , Campbell I T
Published: March 2007

A modified Swank screen filter technique was used to investigate, first, whether intravascular platelet aggregates (IPA) could be detected in patients immediately after surgery and then, the relationship between IPA levels and postoperative pulmonary function. The test, as modified, achieved an excellent reproducibility (r = 0·95) and a close correlation with the number of aggregates identified in samples of femoral vein blood by subsequent scanning electron microscopy (r = 0·93).

In 20 patients IPA levels were measured 30 min and 3 h after surgery and pulmonary function (arterial Po2, physiological dead space and alveolar/arterial Po2 gradient) was evaluated preoperatively and on days 1 and 7 postoperatively. Patients with elevated IPA levels suffered a greater mean fall in arterial Po2 at 7 days (1·8 kPa) than did patients with normal IPA levels (0·6 kPa) (P < 0·05). This was explained by a marked increase in the pulmonary arteriovenous shunt as indicated by the alveolar/arterial Po2 gradient (2·3 kPa v. 0·4 kPa, P < 0·01). Those patients with increased pulmonary shunting and arterial hypoxia 1 week after surgery also had a greater fall in the platelet count on the first postoperative day.

The screen filtration technique is a reproducible test which measures IPA accurately and may be used to predict pulmonary function 1 week later. This suggests that treatment to inhibit IPA may reduce postoperative pulmonary dysfunction.
Regulation of enterokinase synthesis in animal and human small intestine by luminal signals: Its implication in upper gastrointestinal surgery
Authors: Bett N J
Published: March 2007

Enterokinase is an enzyme produced by the mucosa of the small intestine. Its sole function is to activate trypsinogen to trypsin. In animals and man the duodenum and proximal jejunum have high levels of activity whereas the remaining small bowel has minimal levels.

A reproducible assay was developed for measuring mucosal enterokinase activity applicable to operative and endoscopic biopsies. Anaesthetic and operative techniques were developed for small intestinal resections in guinea-pigs to ensure their long term survival.

Transposition of high-enterokinase-secreting segments of guinea-pig small intestine to low-enterokinase regions and vice versa showed no alteration of entero-Kinase activity in the transposed segments. Similarly, resection of the enterokinase region in five proximal pancreaticoduodenectomy operations in man revealed no induction of enterokinase in the remaining jejunum at endoscopy 6 months later.

Isolation of high-enterokinase-secreting segments of small bowel from their luminal continuity by fashioning of Thiry—Vella fistulas led to a decay of enterokinase activity to minimal levels within 12–16 h. Perfusion of these fistulas with trypsin and sodium, or chymotrypsin and sodium, prevented this decay. If the enterokinase was allowed to decay over 24 h its activity could be restored to 80 per cent of its normal level by perfusion for 24 h with trypsin and sodium.

Trypsin and sodium act in combination on an enterocyte membrane receptor to stimulate enterokinase synthesis.
Simple enucleation and radiotherapy in the treatment of the pleomorphic salivary adenoma of the parotid gland
Authors: Armitstead P R , Smiddy F G , Frank H G
Published: March 2007

A series of 76 patients with a primary pleomorphic salivary adenoma treated by simple extracapsular enucleation and high energy radiation between 1963 and 1976 is presented. Analysis of the results has shown a very low incidence of complications with only minimal cosmetic deformity. Of the 76 patients, only 5 have been lost to follow-up, 3 patients have died of causes unrelated to the tumour and only 1 patient has developed a recurrence. Further local excision in this patient showed the histological appearances of adenocarcinoma.
Segmental air plethysmography during arterial reconstruction
Authors: Baird R N , Davies P W , Bird D R
Published: March 2007

Sixty-one patients undergoing 83 lower limb reconstructions for chronic arterial ischaemia or aortic aneurysm from April 1977 to March 1979 were monitored intraoperatively using the pulse volume recorder (PVR), Doppler auscultation and palpation of pedal pulses. Nine technical defects (11 per cent) were recognized 5 min after declamping and corrected before the operative wound was closed. In 31 grafts to the popliteal artery median ankle PVR amplitude increased from 4·5 mm (95 per cent confidence limits, 2–6 mm) at the start of the operation to 18 mm (14–21 mm, P < 0·0001 Wilcoxon). Four poor PVR wave forms were successfully improved by operative revision. Initial median calf PVR amplitude with isolated aortic or iliac artery occlusions in 30 limbs was 41 mm (29–56 mm), similar to that in 22 control limbs (38 mm, 28–53 mm), and did not alter following successful reconstruction. In this group there were 2 operative revisions and all grafts were patent postoperatively.

In successful proximal reconstructions of 22 severely ischaemic limbs with combined proximal and distal disease, median PVR amplitude fell from 10·5 mm (6·5–14 mm) to 8 mm (6·5–15 mm, not significant). There were 3 operative revisions and all grafts remained patent postoperatively. In this group with combined proximal and distal disease pulse wave transit time (R wave of ECG to peak calf PVR wave form) became shortened from 577 ms (542–633 ms) to 481 ms (467–495 ms, P < 0·05). Where operative correction was required, transit time on initial declamping became prolonged but fell to less than the pre-reconstruction transit time following successful revision. These results suggest that the information provided by intraoperative monitoring with the PVR will contribute towards a reduction in early graft occlusions and re-explorations in the postoperative period.
Anorectal Crohn's disease
Authors: Williams N S , Macfie J , Celestin L R
Published: March 2007

Four hundred and twenty-three patients with Crohn's disease have been reviewed, 48 of whom had isolated anorectal involvement—an incidence of 11·4 per cent. These patients were compared with 48 randomly selected and sex-matched cases who presented with isolated ileocolic disease.

The age of the anorectal patients (53·6 ± 18 years) was greater than that of the controls (34·2 ± 12 years). The duration of follow-up was 6·0 ± 4 years and 12·6 ± 8 years respectively. Rectal bleeding, diarrhoea and perianal disease were more common in the anorectal group. Twenty-two patients (46 per cent) with anorectal disease and 40 (83 per cent) in the ileocolic group underwent definitive surgery. There were 4 (18 per cent) postoperative deaths in the anorectal group and none among the controls.

The incidence of recurrence was lower among the anorectal patients (21 per cent) compared with the ileocolic group (40 per cent). However, the estimated probability of recurrence, based on the duration of follow-up, the number of deaths during follow-up and the actual incidence of recurrence, is similar in both groups.
In vitro dissolution of human gallstones: The efficacy of heparinized solutions
Authors: Toouli J , Williamson B W A , Gooszen H , Blumgart L H
Published: March 2007

The use of heparinized solutions to dissolve or fragment stones retained in the biliary tree after surgery is still controversial. In this in vitro study heparin in concentrations of up to 100 000 u/l did not dissolve or fragment the stones examined, nor did it enhance the dissolution properties of the bile salt, sodium cholate.
Intestinal bacterial metabolism of protein and bile acids: Role in pathogenesis of hepatic disease after jejuno-ileal bypass surgery
Authors: Powell-Jackson P R , Maudgal D P , Sharp Dorothy , Goldie Alison , Maxwell J D
Published: March 2007

Jejunal bacterial colonization and intestinal metabolism of bile acids and protein by bacteria have been investigated in 12 patients with abnormal liver histology following jeujno-ileal bypass surgery for obesity.

Aerobic and/or anaerobic coionic flora was present in jejunal aspirates from 8 of 12 bypass patients, but in none of the controls. Intestinal protein metabolism and bile acid deconjugation (measured by urinary indican excretion and 14C-glycocholic acid breath test) was significantly enhanced in bypass patients.

Intestinal bacterial overgrowth, with abnormal intestinal metabolism by bacteria of ingested nutrients and bile acids, could contribute to hepatic disease after bypass surgery via the production of endogenous hepatotoxins.
Chylous ascites and obstructive lymphoedema of the small bowel following abdominal radiotherapy
Authors: Hurst P A , Edwards J M
Published: March 2007

The case history of a patient who developed chylous ascites following abdominal irradiation for recurrent carcinoma of the colon is presented. Laparotomy revealed generalized radiation damage of the small bowel with a particularly severely affected segment of jejunum, from the serosal surface of which chyle was seen to be leaking. Mesenteric. lymphangiography revealed an obstruction to lymphatic drainage in the mesentery. Resection of the worst affected segment of bowel prevented further development of chylous ascites.
Leucocyte counts in the diagnosis and prognosis of acute appendicitis in children
Authors: Doraiswamy N V
Published: March 2007

Preoperative total and differential leucocyte counts were made in 225 children with acute appendicitis, 50 children with a normal appendix and 100 children with acute abdominal pain which resolved without any therapy. When adjusted to age, neutrophilia in 96 per cent, 30 per cent and 32 per cent and leucocytosis in 41·8 per cent, 4 per cent and 3 per cent was noted in the respective groups, the levels being significantly higher in the acute appendicitis group than in the other two groups. Among children with appendicitis, infections were observed in 62·8 per cent of the group with leucocytosis and in 13·7 per cent of the group with a normal leucocyte count; the difference is statistically significant. It is suggested that in acute appendicitis neutrophilia supports the diagnosis and leucocytosis indicates the prognosis. The rate of infection increases as the total leucocyte count rises above the upper normal limit. The difference of opinions on the significance of leucocyte counts in acute appendicitis is discussed.
Controlled environment therapy in the management of lymphoedema: A case report
Authors: Morris Arthur Mcg , Morrison Gordon W
Published: March 2007

A case of surgically-treated elephantiasis of a lower limb is reported in which preoperative controlled environment therapy (CET) proved to be an effective, rapid method of reducin the oedema.
The presentation of gastrointestinal lymphoma: Study of a population
Authors: Green John A , Dawson Audrey A , Jones Peter F , Brunt Peter W
Published: March 2007

The clinical presentation and findings in 45 patients with lymphoma of the gastrointestinal tract occurring in an unselected population are described. Nineteen patients presented as emergencies with haemorrhage, perforation, pyloric stenosis or intestinal obstruction. Systemic symptoms, peripheral lymph node enlargement and hepatosplenomegaly were rare, and a preoperative diagnosis of lymphoma was seldom made. Endoscopy was superior to radiology in defining lesions in the stomach and duodenum. Lesions which were multicentric, or of unusual macroscopic appearance, were common in the small bowel, and these should raise the suspicion of lymphoma.

Local and systemic recurrence was common, but was not always fatal. Patients with gastric lymphomas survived longer than those with intestinal disease.
Pneumatosis coli and sigmoid volvulus: A report of 4 cases
Authors: Gillon J , Holt S , Sircus W
Published: March 2007

Pneumatosis coli is an uncommon disease which is frequently misdiagnosed and inapproapriately treated. The condition can usually be managed conservatively but complications requiring surgical treatment are occasionally encountered. We describe 4 patients with pneumatosis coli and associated volvulus of the sigmoid colon. Some of the factors that may have contributed to pneumocyst formation in these 4 patients are discussed with reference to recent advances in our understanding of the pathogenesis of pneumatosis coli.
Colonic carcinoma at the site of ureterosigmoidostomy: What is the risk?
Authors: Thompson P M , Hill J T , Packham D A
Published: March 2007

A case of colonic carcinoma arising 27 years after urinary diversion by ureterosigmoidostomy is reported. This late complication is now well recognized and increasing numbers of cases are being reported. The implications of this aptient and the 31 previously reported cases are considered.
Postoperative hypoxaemia: Oesophagectomy with gastric replacement
Authors: Bishop D G M , McKeown K C
Published: March 2007

Pre- and postoperative arterial blood samples were analysed for oxygen partial pressure (Pao2) and carbon dioxide partial pressure (Paco2) in a consecutive series of 21 patients subjected to two- or three-stage oesophagectomy for carcinoma of the oesophagus. The forced vital capacity (FVC) was measured at the same time.

On the second postoperative day the Pao2 showed a fall to 65 per cent of the preoperative value followed by a gradual recovery to 78 per cent on the tenth postoperative day. After 13 weeks the Pao2 had recovered to 95 per cent of the preoperative value.

The Paco2 decreased in the early postoperative period but had returned to the preoperative level by the tenth day. The FVC showed a trend similar to the Pao2 with a reduction to 33 per cent of the preoperative value on the second postoperative day, 52 per cent on the tenth day and 85 per cent after 13 weeks.
The preoperative detection of internal mammary lymph node metastases in breast cancer
Authors: Osborne M P , Jeyasingh K , Jewkes R F , Burn Ian
Published: March 2007

The internal mammary lymph node chain has been studied in patients with breast cancer by radioiosotope imaging. The technique enabled the study of lymph node function in an area inaccessible to clinical examination or lymphography.

Thirty-four patients with breast cancer have been studied by injecting the posterior sheath of the rectus abdominis muscle, in the subcostal region, with technetium-99m-labelled stannous phytate and subsequently imaging the anterior thorax. Lymph node metastases were diagnosed in 13 patients (38 per cent) in whom a suppressed uptake of the isotope by the internal mammary lymph nodes was observed. Eighteen patients (53 per cent) had normal scans and in 3 patients (9 per cent) the examination was technically unsatisfactory. Histopathological correlation of internal mammary node biopsy with the preoperative scan confirmed the scan findings in all but one case in which this was carried out. Radioassay of internal mammary lymph nodes confirmed that the agent was localized in them and that uptake was suppressed in the presence of metastases.

Twenty-three patients in this study underwent sequential scanning using first 99Tcm-labelled stannous phytate and subsequently 99Tcm-labelled antimony sulphide colloid. The latter agent was able to demostrate the anatomical presence of nodes when a suppressed uptake had initially been observed using 99Tcm-labelled stannous phytate.

Internal mammary lymphoscintigraphy may be of value in the preoperative of breast cancer.
Anticoagulant activity and operative blood loss after intrapulmonary heparin
Authors: Wright Charles J , Mahadoo Jaysen , Jaques Louis B
Published: March 2007

The safety and efficacy of heparin given by the intrapulmonary route are further assesed in this study. A single dose of heparin (2000 units/kg) was given by intratracheal instillation in dogs and measurements of plasma heparin concentration, whole blood clotting time and partial thromboplastin time made at intervals for 48 h. These values rose progressively and in parallel for 7 h and remained elevated for 48 h.

A series of operations was performed on dogs within 3 h of a single dose of intrapulmonary heparin (1500 units/kg). Operations involving minimal dissection (small bowel resection) and extensive dissection (resection of muscle) were performed in two separate groups. Within each group the animals were randomly given heparin or saline. In the limited dissection group there were no differences in operative blood loss, wound healing, or sequential haemoglobin and haematocrit measurements. In the group subjected to muscle resection there was increased postoperative wound drainage and a slightly greater fall in haemoglobin and haematocrit in those given heparin.

It is concluded that heparin is absorbed from the lung causing significant changes in coagulation parameters. Even with the relatively high dose of 1500 units/kg, operations were performed with minimal hazard. Intrapulmonary heparin may have important clinical applications after further investigation.
Non-operative removal of bile duct stones by duodenoscopic sphincterotomy
Authors: Cotton Peter B
Published: March 2007

Surgical exploration of the common bile duct carries considerable risks in elderly and frail patients. Peroral, fibreoptic duodenoscopy allows access to the papilla of Vater in sedated patients and the opportunity to perform a diathermy sphincterotomy for removal of bile duct stones. We have attempted sphincterotomy in 134 patients, most of whom had previously undergone cholecystectomy and had some contraindication to a further operation. Sphincterotomy was technically successful in 129 patients (96 per cent), and all duct stones were removed in 119 patients (92·5 per cent of successful sphincterotomies). The technique failed only once in 95 patients with stones less than 14 mm diameter. Immediate complications occurred in 10 patients, 3 of whom required emergency surgery; 1 patient died.

Endoscopic diathermy sphincterotomy is a major therapeutic advance in the management of elderly and high risk patients with bile duct stones. No significant adverse effects have yet been revealed in follow-up studies. However, the possibility of long term complications dictates the need for caution in offering this procedure to young patients who are fit for reoperation.
Physical characteristics of gallstones and the calibre of the cystic duct in patients with acute pancreatitis
Authors: McMahon Michael J , Shefta Jahan R
Published: March 2007

Forty-six gallbladders were examined for the number, weight, size and shape of their gallstones, and for the volume of flow, under conditions of constant pressure, that was transmitted by the cystic duct. Eighteen gallbladders were from patients who had previously suffered an attack of acute pancreatitis, and the other 28 were from control patients who had not had a known attack of pancreatitis.

Cystic duct flow rates, which we assumed were related to cystic duct calibre, were greater in the pancreatitis group (mean = 282 ml/min) than in the controls (mean = 134 ml/min) (P < 0·01). There were more stones in the gallbladders of the pancreatitis patients, and the mean stone weight was lower in this group (0·31 g compared with 0·74 g; P < 0·02). Large stones were more frequently seen in the control gallbladders. Small, irregular or mulberry-shaped stones were the dominant stone type in 78 per cent of the pancreatitis group but in only 43 per cent of the controls (P<0·05).

Thus a large-calibre cystic duct and numerous small stones with an irregular shape appeared to be more common in patients who had suffered acute pancreatitis, and may be factors in the pathogenesis of the attack.
Iatrogenic choledochoduodenal fistula: An unsuspected cause of post-cholecystectomy symptoms
Authors: Hunt D R , Blumgart L H
Published: March 2007

In the investigation of 90 patients referred with severe post-cholecystecomy problems, 8 patients were found at ERCP to have choledochoduodenal fistula. The clinical feature associated with the fistula included pain with fever, jaundice or hyperamylasaemia. Reviewing the details of the original surgery and the endoscopic findings, it is suggested that most, if not all, of these fistulas are iatrogenic. Treatment by biliary bypass is recommended.