bluuebunny/crossref_metadata_2025 huggingface dataset:
Emergency surgery for diverticular disease complicated by generalized and faecal peritonitis: A review
Authors: Krukowski Z H , Matheson N A
Published: March 2007

There is little uniformity in either the indications for operation, the classification of the pathology or the operative management of generalized or faecal peritonitis secondary to perforated diverticular disease. Nevertheless, this review has shown a clear advantage both in terms of immediate mortality and morbidity for primary resection over conservative operations in which the colon is retained in the abdomen. We propose that, when a clinical diagnosis of localized sepsis secondary to diverticular disease is made, the management should be nonoperative with systemic antibiotics and supportive therapy. Operation should be reserved for those patients with obvious generalized peritonitis or failure of conservative treatment. When operation is necessary the affected sigmoid loop should be resected and the operation completed as a Hartmann's procedure in all but the most favourable circumstances when a primary anastomosis may be considered after on-table irrigation of the colon.
An evaluation of pelvic lymphoscintigraphy in the staging of colorectal carcinoma
Authors: Reasbeck P G , Manktelow Anne , McArthur A M , Packer S G K , Berkeley B B
Published: March 2007

Lymphoscintigraphy was used to delineate the lymphatic drainage of the rectum and distal colon in 18 patients with carcinoma of the rectum or sigmoid colon, in four with inflammatory disease of the large bowel and in 20 controls without colorectal pathology. Abdominal imaging was performed after submucosal injection of either 4mCi 99mTc-antimony sulphide colloid or 0·5 mCi 99mTc-dextran into the rectum through a proctoscope. In nine patients with colorectal carcinoma, abdominal imaging was performed immediately pre-operatively and the excised specimen of large bowel was also imaged in vitro immediately postoperatively. The presence or absence of nodal uptake of radionuclide on abdominal scanning did not discriminate between normal and diseased large bowel, and the extent of nodal uptake demonstrated either by abdominal scans or by in vitro scans of excised specimens bore no relationship to the presence or absence of nodal metastases demonstrated histologically in the cancer patients. Pelvic lymphoscintigraphy as performed in this study has no demonstrable value in the diagnosis or staging of colorectal cancer.
Detection of liver metastases. A prospective study comparing liver enzymes, scintigraphy, ultrasonography and computed tomography
Authors: Schreve R H , Terpstra O T , Ausema L , Lameris J S , Van Seijen A J , Jeekel J
Published: March 2007

A prospective comparative study between liver enzymes, scintigraphy, ultrasonography and computed tomography for detection of liver metastases was performed in 113 patients who were eligible for operation for a carcinoma in the gastrointestinal tract. Twenty-three of the 113 patients (20 per cent) had liver metastases. The accuracy of scintigraphy was 79 per cent, of ultrasonography 85 per cent and of computed tomography 88 per cent. The results of these tests showed no statistical differences. Ultrasonography and computed tomography were significantly more accurate than alkaline phosphatase and γ-glutamyl transpeptidase (respectively P<0·01 and P<0·05). Taking into account cost effectiveness, simplicity and patient tolerance, ultrasonography is the test of choice for the detection of liver metastases.
The management of soft tissue sarcomas
Authors: Brennan M F
Published: March 2007

The management of soft tissue sarcomas presents one of the more exciting areas of the application of multimodal therapy for malignancy. Rapid developments have taken place in the understanding of the histogenesis, histopathology, prognostic indicators and treatment approaches. With the combination of local irradiation and adjuvant chemotherapy, limb sparing operations can now be widely advocated with amputation being reserved for proximal difficult lesions. Retroperitoneal sarcomas, however, remain a major challenge with little progress in results of therapy, other than improved operative morbidity in the last 10–15 years. Current prospective, randomized studies of the management policies designed to maximize survival while minimizing morbidity should provide further insights in the near future. Our current and past experience with more than 150 new cases each year allows a brief summary of the understanding and management of these difficult problems.
Benign breast disease in a West Indian population
Authors: Raju G C , Naraynsingh V
Published: March 2007

A review of 1726 breast lesions in West Indian women from Trinidad showed that the pattern of disease is significantly different from that reported in whites but similar to reports from India and Africa. This difference is mainly due to the high frequency of fibro-adenoma in our adolescent women. Fibro-adenoma was the commonest lesion (39.3 per cent), followed by mammary dysplasia (32 per cent) and carcinoma (21 per cent). Although carcinoma comprised only 21 per cent of all breast lesions, nearly 40 per cent of true neoplasms were malignant. We believe all suspicious breast lumps in black women need biopsy and further analysis of morphological components of benign breast lesions is necessary to evaluate precursors to cancer of the breast.
Pain and mobility after inguinal herniorrhaphy: Ineffectiveness of subcutaneous bupivacaine
Authors: Cameron A E P , Cross F W
Published: March 2007

We studied pain and mobility in 101 men undergoing elective unilateral inguinal herniorrhaphy. Subcutaneous infusion of 0.5 per cent bupivacaine via a fine catheter was used as an adjunct to conventional analgesia in half of the patients. This had no effect on the perception of pain measured at 8 and 24 h by visual linear analogue, nor on the analgesics requested by the patients. The walking ability of all patients was significantly impaired 24 h postoperatively, but again bupivacaine conferred no benefit. Organisms were cultured from 12.5 per cent of the catheters.
The diagnosis of aortic graft-enteric fistulae by computed tomography
Authors: Ackroyd Jenny , Williams T G , Thomas M Lea , Burnand K G
Published: March 2007

A number of techniques have been used to diagnose aortic graft-enteric fistulae. These are reviewed and their value assessed. Three patients are described in whom the diagnosis was correctly made from characteristic appearances seen on a computed tomography (CT) scan. Further experience may show that CT scanning has an important role in the detection of this condition.
A 30-year survey of pulmonary embolism verified at autopsy: An analysis of 1274 surgical patients
Authors: Bergqvist D , Lindblad B
Published: March 2007

A retrospective study was undertaken of all surgical patients in Malmö, Sweden, during the period 1951-1980, in whom pulmonary emboli were found at autopsy. The autopsy rate was high throughout the period, ranging from 73 to 100 per cent. Of 5477 patients who died during the period, 1274 had pulmonary emboli (23.6 per cent), 349 of which were considered fatal, 353 contributory to death and 572 incidental. Fifty-one per cent of the patients were not operated upon. The number of contributory and incidental emboli increased over the period, to some extent probably reflecting greater thoroughness in postmortems. The frequency of fatal pulmonary emboli decreased in the last 5 year period. Pulmonary embolism was more rare in patients under 50 years of age. The proportion of females increased. In 24 cases major embolism emanated from thrombi around central venous catheters. This retrospective analysis of a large number of patients shows that pulmonary embolism continues to be a major cause of death in surgical patients, and in Malmö as common a cause of death in operated as in nonoperated patients.
Familial aortic aneurysms: Serum concentrations of triglyceride, cholesterol, HDL-cholesterol and (VLDL + LDL)-cholesterol
Authors: Norrgård Ö , Ängquist K-A , Johnson O
Published: March 2007

Patients with abdominal aortic aneurysms (AAAs) have been compared with healthy controls with respect to the serum concentrations of triglyceride, cholesterol, HDL-cholesterol and (VLDL + LDL)-cholesterol. The concentrations of triglyceride and (VLDL + LDL)-cholesterol in serum were higher in the patients than in the controls, while the concentration of HDL-cholesterol in serum was lower in the patients than in the controls. There was no statistically significant difference in the serum concentration of total cholesterol between the patients and the controls. Twelve patients had first degree relatives (brothers, sisters and/or parents) with AAAs and six patients had second degree relatives (cousins or brothers and sisters of the parents) with AAAs. There was no statistically significant difference between the patients who had first degree relatives with AAAs and the patients without AAAs in the family in the serum concentrations of triglyceride, cholesterol, HDL-cholesterol and (VLDL + LDL)-cholesterol.
Selective visceral angiography for unexplained acute gastrointestinal bleeding in a district general hospital
Authors: Athow Anna C , Sheppard Louise , Sibson D E
Published: March 2007

Eleven patients are reported with unexplained gastrointestinal haemorrhage (GIH) presenting over a 2 year period in whom selective visceral angiography (SVA) was carried out after a negative endoscopy. SVA revealed the anatomical source of bleeding in all eleven patients and the aetiology in six of them. The latter comprised two tumours of the small bowel, an A–V malformation of the jejunum, enlarged pancreaticoduodenal vessels, angiodysplasia of the caecum and carcinoma of the rectum. Of the remaining five patients, four were seen to have active bleeding into the large bowel and one into the duodenum. Local surgical resection was carried out in nine patients, only one of whom rebled. There was one pre-operative and one postoperative death. Experience with this technique has altered our management such that SVA is carried out sooner, saving the patient repeated admissions, investigations and transfusions. SVA is recommended as a pre-operative investigation for the surgeon managing acute unexplained GIH.
Truncal vagotomy and drainage: A comparison of elective and emergency operations
Authors: Clark C G , Fresini A , Araujo J G C , Moore F , Boulos P B
Published: March 2007

A comparison has been made between truncal vagotomy and drainage (TV+D) performed from 1968 to 1981 in 209 patients electively and in 68 patients as an emergency. The male:female distribution was 167:42 and 59:9 with a significant difference (P < 0.001) in the mean ages of 49 years and 55 years respectively. Major postoperative complications following emergency TV+D (22 per cent) were significantly more common (P < 0.001) than following elective TV+D (6.7 per cent) with seven (10.3 per cent) and one (0.5 per cent) deaths respectively. Of 163 patients in the elective and 54 in the emergency group followed up for an average of 5.7 and 5.9 years respectively, 132 patients (81 per cent) and 46 (82.5 per cent) had a good functional result graded as Visick I and II, but 31 (19 per cent) and 8 (14.8 per cent) patients respectively had a poor result due to recurrent ulceration in 23 (14.1 per cent) after elective TV+D and in all 8 (14.8 per cent) after emergency TV+D. These results are not statistically different. Thus emergency TV+D carries a higher mortality and morbidity than elective TV+D, but the long term results are similar. This conclusion substantiates the equivalent effectiveness of emergency and of elective TV+D.
The effect of a reversed ileal segment and artificial valve on intestinal transit and absorption following colectomy and low ileo-rectal anastomosis in the dog
Authors: Williams N S , King R F G J
Published: March 2007

The main problem facing patients with ulcerative colitis after mucosal proctectomy and ileo-anal anastomosis (MP + IAA) is severe frequency of bowel action. Although the addition of a pelvic reservoir can improve matters, some patients still complain of this problem. In an attempt to slow transit, enhance absorption and improve function, we investigated the effects on these parameters of (1) a reversed ileal segment, (2) an artificial valve in an animal model. Studies were conducted before and after operation. The dogs randomly underwent either colectomy and low ileorectal anastomosis (IRA) alone (control, n = 12), IRA with a 10 cm reversed loop (IRA + RL, n = 10) or IRA with an artificial valve (IRA + valve, n = 10). Operative mortality rates were similar in the groups. Mean transit time (MTT) was significantly reduced after the control operation and after IRA + RL but not after IRA + valve. In addition MTT after IRA + valve (21±s.d., 3.4 h) was significantly greater than in the other two groups (control = 12.1 ± 4.3 h, IRA + RL, 12.8±5.5 h, P<0.04) and frequency of bowel actions seemed less. Measurements of absorption and nutritional state, however, did not differ significantly between the groups. Thus, although the artificial valve made no difference to absorption, it did prevent the reduction in MTT that occurred after the control operation whereas the reversed loop did not. This effect might thus benefit patients who undergo MP + IAA.
Proximal gastric vagotomy in patients resistant to cimetidine
Authors: Weaver R M , Temple J G
Published: March 2007

Fifty-seven patients, with chronic duodenal ulceration resistant to cimetidine therapy, underwent proximal gastric vagotomy during the period August 1979 to May 1984. Thirty-five failed to respond to cimetidine in a dose of 1 g/day, whilst 22 relapsed on reduction of dosage to 400 mg daily or on cessation of therapy. Forty have been followed up for a period of 12–53 months (median duration = 28.5 months), and assessed using the modified Visick system. Thirty-four patients (85 per cent) were graded Visick I or II. Four patients (10 per cent) had non-specific upper gastrointestinal symptoms (Visick III). In these patients endoscopy has shown no evidence of recurrent ulceration. Two patients (5 per cent) were graded Visick IV. One had recurrent ulceration on endoscopy. The other developed symptomatic gastro-oesophageal reflux, necessitating further surgery. These results support the view that cimetidine resistance is not a predictor of poor results following proximal gastric vagotomy.
Surgical pathology at early elective operation for suspected acute gallstone pancreatitis: Preliminary report of a prospective clinical trial
Authors: Mackie C R , Wood R A B , Preece P E , Cuschieri A
Published: March 2007

Fifty-five patients presenting with acute abdominal symptoms and found to be hyperamylasaemic underwent early biliary tract investigation, giving 31 patients in whom the presence of gallstones was suspected. In accordance with the protocol of a randomized controlled trial of early elective biliary tract surgery for patients suspected of having acute gallstone pancreatitis, 19 of these patients underwent laparotomy at a mean of 6.9 days after emergency admission. In this group operation showed that four patients had biliary tract stones and pancreatitis; ten patients had calculous cholecystitis (53 per cent) but no stigmata of pancreatitis; four patients had pancreatitis but no stones; one had a negative laparotomy. None of this group was found to have ampullary obstruction due to an impacted stone. Biliary tract investigations carried out during the first week following admission were unhelpful or misleading in 14 out of the whole group of 55 patients, and in all of those patients (11 per cent) who died or required surgical intervention during the same hospital admission. There appears to be a pathological heterogeneity among patients diagnosed as ‘gallstone pancreatitis’ on clinical and biochemical grounds alone.
Natural history of cystic disease: The importance of cyst type
Authors: Dixon J M , Scott W N , Miller W R
Published: March 2007

All breast cysts aspirated from a series of 100 patients followed for a minimum period of 2 years were classified on the basis of electrolyte composition as apocrine or flattened, this being the nature of the epithelium lining the two populations of breast cysts. Patients with single cyst were more than 3 times as likely to have a flattened rather than an apocrine cyst. Multiple cysts, whether simultaneous or sequential in any individual patient, were usually all of the same type, and were more commonly apocrine than flattened. A comparison of the frequency of subsequent cysts in patients whose initial cysts were of eithere apocrine than flattened. A comparison of the frequency of subsequent cysts in patients whose initial cysts were of either apocrine or flattened type showed further cysts were over 5 times more common in patients who presented with apocrine cysts. These observations suggest that the natural history of cystic disease is closely related to cyst type.
Bilateral gastric venous decompression by a modified Warren shunt
Authors: Nagasue N , Ogawa Y , Hirose S , Yukaya H
Published: March 2007

A new modification of the Warren shunt by which the coronary and short gastric venous systems can be simultaneously decompressed was carried out on two patients with oesophagogastric varices due to liver cirrhosis. One was an elective and the other an emergency operation. The left gastric vein entering the splenic vein was also drained through a Gore-Tex graft between the splenic and left renal veins. The proximal end of the splenic vein was ligated at its junction to the superior mesenteric vein. Porta-azygos disconnection was achieved by ligating the right gastric and gastro-epiploic veins. The shunt was patent and its effect on the varices was immediate with good decompression in both patients. The patients have had no recurrent variceal haemorrhage or postshunt encephalopathy. This modification may be indicated for selected patients with portal hypertension for both elective and emergency operations.
Determination of necrosis in necrotizing pancreatitis
Authors: Nordback I , Pessi T , Auvinen O , Autio V
Published: March 2007

The diagnosis of necrosis and its extent in acute necrotizing pancreatitis is one main problem in establishing criteria for possible pancreatectomy. With this in mind a clinicopathological analysis was carried out on 54 patients who had undergone pancreatic resection for acute necrotizing pancreatitis. The macroscopic appearance of the gland correlated poorly with its histology. Parenchymal necrosis varied from 0 to 100 per cent of the resected specimen though all the glands were considered totally or subtotally necrotic. In the clinicobiochemical status no criteria were found determining the extent of necrosis. Obesity, hypotension, hypocalcaemia and elevated serum creatinine in severely ill patients (as determined by Ranson criteria) strongly supported extensive peripancreatic and septal necrosis; however, 38 per cent of patients developed necrosis without those stigmata. While waiting for new methods to determine necrosis we prefer conservative treatment. In contrast to our previous tactics we think that resection should be limited to extreme cases in order to avoid resection of glands with limited necrosis and thus mainly reversible parenchymal damage.
Acute appendicitis in the over-sixty age group
Authors: Sherlock D J
Published: March 2007

58 (37 per cent) of the 155 patients over the age of 60 years presenting with appendicitis at East Birmingham Hospital from 1970 to 1982 were found to have perforated appendices; the corresponding proportion under the age of 60 was 346 out of 3608 patients (10 per cent), the difference being statistically significant (P<0·001). The delay before surgery and the length of in-patient treatment were significantly longer in the group who perforated, and the mortality was greater, although not achieving significance. Examination of the yearly incidence reveals neither an increasing trend of appendicitis in elderly patients, nor an increase in the perforation rate over the period studied. Delay, at all stages, appears to be the major factor responsible for the higher rate of perforation in this age group; only by an increased awareness of appendicitis in the elderly can this risk be minimized.
A score system for evaluating random control clinical trials of prophylaxis of abdominal surgical wound infection
Authors: Evans Mary , Pollock A V
Published: March 2007

We devised 33 rules for the evaluation of random control trials (RCT) and used them to assess 56 RCTs listed in Index Medicus during 1980–82 on antibiotic prophylaxis of surgical wound infection. We asked 15 questions about design and conduct, 10 about analysis and 8 about presentation. Out of a maximum score of 100 only 16 papers scored over 70, the highest being 89 and the lowest 34. Defects in presentation were not common, and 17 papers scored over 90 per cent. Defects in analysis included the incorrect use of statistical tests and ignoring the Type II error in ‘negative’ trials; only 13 papers scored over 70 per cent. Defects in design and conduct included transgressions of ethical principles, inappropriate regimens, ill-defined end points and biased randomization or assessment; only 20 papers scored over 70 per cent. We conclude that there is room for improvement in the performance of RCT and that the application of the 33 rules would be helpful not only to researchers but also to editors and referees of scientific journals, and to their readers.
Antibiotic treatment during surgery for diffuse peritonitis: A prospective randomized study comparing the effects of cefuroxime and of a cefuroxime and metronidazole combination
Authors: Törnqvist A , Forsgrent A , Leandoer L , Ursing J
Published: March 2007

In a prospective randomized open study of patients operated upon for diffuse peritonitis, the effects of two different antibiotic regimens were evaluated. Cefuroxime given as a single drug (Group I; n = 59) was compared with a combination of cefuroxime and metronidazole (Group II; n = 63). Bacteriological cultures, both aerobic and anaerobic, were obtained peroperatively and in the event of any complication. The antibiotic sensitivities of isolated bacteria, and the serum and tissue concentrations of cefuroxime were determined. Postoperative infectious complications occurred in 22 per cent of Group I patients (cefuroxime), and in 17±5 per cent of Group II (cefuroxime plus metronidazole). The mortality rates were 5 per cent for Group I and 8 per cent for Group II. Tissue concentrations of cefuroxime were well above the MIC (minimal inhibiting concentration) values for most of the bacteria isolated. From a few patients in Group I, however, cultures were obtained with isolates sensitive to metronidazole but resistant to cefuroxime. Our findings suggest that, in the antibiotic treatment of patients operated for diffuse peritonitis, an agent which is primarily effective against aerobic bacteria (but not entirely without effect on anaerobes) is as effective as combination therapy covering both aerobic and anaerobic bacteria.
Fracture of the penis
Authors: Naraynsingh V , Raju G C
Published: March 2007

An experience with six cases of fractured penis is described. A ‘rolling sign’ accurately identifies clot at the fracture site and facilitates a direct and rapid approach to the torn corpus cavernosum. Early operation hastens recovery and limits deformity.
Atypical claudication
Authors: Tait W F , Charlesworth D , Lemon J G
Published: March 2007

In a prospective study the incidence, causes and management of atypical claudication have been investigated. All patients had a clinical assessment, Doppler ultrasound studies and X-rays of the lumbosacral spine, some had epidural injections, myelography with computerized axial tomography and arteriography. The incidence of atypical claudication was low, 13 per cent of all claudicants referred to our department, and although difficulties in diagnosis were encountered an approximately equal incidence of spinal and arterial causes was found. Only one patient had a definite central spinal stenosis. The need for invasive investigations was low (18 per cent) and even lower for surgery (7 per cent); the majority of patients' symptoms responded to conservative management.
Achalasia of the cardia in children
Authors: Buick R G , Spitz L
Published: March 2007

Fifteen children with achalasia treated surgically over a period of 21 years are reported. All had a modified Heller's myotomy as a primary treatment. The thoracic approach was used in five and the abdominal route in ten. In three patients the myotomy was confined to the oesophagus. Six patients had antireflux procedures at the time of initial myotomy. The mean follow-up period was 6.2 years. Nine patients had excellent results, three had good results, two had fair results and one had a poor result. Of the nine children who did not have an antireflux procedure, three developed symptomatic and radiologically proven gastro-oesophageal reflux. The results of myotomy in children with achalasia are satisfactory but a significant number may develop gastro-oesophageal reflux. We believe that a modified Heller's myotomy combined with a short loose Nissen fundoplication should be the primary treatment of achalasia in children.
Surgical treatment of perforated duodenal ulcer: A prospective trial between simple closure and definitive surgery
Authors: Tanphiphat C , Tanprayoon T , Na Thalang A
Published: March 2007

Seventy-eight patients with perforated duodenal ulcer were prospectively studied between 1977 and 1982. Patients were alternately allocated to receive simple closure (Group I, 33 patients) and definitive surgery (Group II, 32 patients). High-risk patients and those whose conditions dictated a definitive operation were excluded. All patients in Group II had a truncal vagotomy and drainage except one who had a proximal gastric vagotomy. There was no death in Group I or Group II; the complication rate and postoperative course were similar. Twenty-seven patients in Group I and 26 patients in Group II were available for follow-up 12 to 80 months after operation, mean 39 months. Good/excellent results were achieved in 30 per cent of Group I compared with 81 per cent of Group II (P<0.01). Eighty-five per cent of Group I patients developed recurrent ulcer symptoms and 33 per cent had already had a second definitive operation. Two patients (8 per cent) in Group II were reoperated upon for recurrent ulcer due to an incomplete vagotomy. In a population of patients where long-term follow-up and medical treatment for duodenal ulcer is unsatisfactory, truncal vagotomy with drainage should be the treatment of choice for perforation. Simple closure should be reserved for high-risk patients or when the surgeon is inexperienced.
Transcutaneous Doppler ultrasound measurement of coeliac axis blood flow in man
Authors: Qamar M I , Read A E , Skidmore R , Evans J M , Williamson R C N
Published: March 2007

Transcutaneous Doppler ultrasound was used to measure coeliac axis blood flow in 42 normal subjects in the fasting state and in 10 subjects following a liquid meal. A Duplex scanner was used and coeliac axis blood flow was estimated by calculating the instantaneous average velocity of blood flow over the cardiac cycle. Both the diameter of the vessel and the angle between the vessel and the beam were measured from real time imaging. The mean (±s.e.m.) of coeliac axis blood flow was 703± 24 ml/min. There was no difference in the results between the sexes nor any correlation between flow and age. The mean coefficient of variability was 7.8 per cent in a 1 day test and 9.2 per cent in a 2 day test. Coeliac axis blood flow increased by 38 per cent immediately after the end of ingestion of the meal and declined to 29 per cent 5 min and 24 per cent 10 min later.
Sump syndrome following choledochoduodenostomy and its endoscopic treatment
Authors: Baker A R , Neoptolemos J P , Carr-Locke D L , Fossard D P
Published: March 2007

The clinical features of eight patients with sump syndrome following side-to-side choledochoduodenostomy are reported. The syndrome is defined and its aetiology discussed with special reference to debris in the common bile duct, bacterial overgrowth and the clinical picture of acute cholangitis, which does not appear to be necessary for the diagnosis to be made. Five patients were successfully treated by endoscopic sphincterotomy and a sixth by endoscopic removal of food debris from the sump. The other two patients had further surgery.
Significance of positive bacterial cultures from aortic aneurysm contents
Authors: Buckels J A C , Fielding J W L , Black J , Ashton F , Slaney G
Published: March 2007

Aneurysm contents were cultured in 275 patients out of a series of 546 cases undergoing infrarenal aortic aneurysm repair between 1961 and 1981. The incidence of positive cultures was 8 per cent. Cultures were more likely to be positive if taken from ruptured (16.7 per cent) and acute (9.1 per cent) aneurysms than from elective (4.2 per cent) cases (χ2 = 6.69, P < 0.01). Gram-positive organisms predominated with Micrococcus being the commonest isolate. Positive cultures were seen at an annual rate of 1–3 cases up to 1976 since which time all have been negative and we believe this may be due to prophylactic antibiotics being given preoperatively rather than postoperatively. The incidence of subsequent graft sepsis was greater in patients with positive aneurysm contents cultures (7 out of 22) than in those with negative cultures (6 out of 253) (χ2 = 32.7, P <0.001). We recommend the routine culture of aneurysm contents to identify patients who are at high risk of developing graft sepsis and suggest that those cases with positive cultures receive prolonged organism-specific antibiotic therapy. In addition, there is evidence that pre-operative antibiotics may eliminate organisms from aneurysms, thus reducing the subsequent risk of graft sepsis.
Fine bore jejunostomy feeding following major abdominal surgery: A controlled randomized clinical trial
Authors: Smith R C , Hartemink R J , Hollinshead J W , Gillett D J
Published: March 2007

A randomized controlled prospective clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy. Fifty patients undergoing surgery for gastrointestinal malignancy were randomly allocated into treatment and control groups. A low residue liquidized diet (IsocalR) was administered to the patients in the treatment group. Control patients received routine intravenous therapy. Nutritional parameters (serum albumin, serum transferrin, serum prealbumin, weight, body fat and fat free mass) were measured pre-operatively and on the tenth postoperative day. Postoperative surgical complications were similar in both groups. There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding. Postoperative stay was significantly longer (P <0.01) in the treatment group patients. Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication-free, successful treatment, subgroup. It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications, its routine use cannot be recommended.
Serum dependent variability in the adherence of tumour cells to surgical sutures
Authors: Dwyer P O' , Ravikumar T S , Steele G
Published: March 2007

Five commonly used surgical sutures were tested for their abilities to adhere tumour cells by an in vitro adherence assay. Adherence was quantified in vitro using radiolabelled tumour cells after standard incubation with a set length of the differing sutures. Tumour cells consistently adhered least to Prolene. All suture materials tested adhered significantly more tumour cells than Prolene (P <0.002 for chromic and <0.0001 for nylon, silk and Vicryl when compared with Prolene, with increasing cell numbers adhering to the sutures tested in that order). These differences in adherence were dependent upon an as yet unidentified macromolecule(s) in serum. All of the suture materials supported tumour growth in vivo after pre-incubation with tumour cells. Rapidity of in vivo tumour growth, however, correlated well with the in vitro tumour adherence characteristics of the different suture materials. The clinical significance of these findings is discussed.
Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: A comparison of three reservoir designs
Authors: Nicholls R J , Pezim M E
Published: March 2007

One hundred and four patients were treated by restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial polyposis. Three different designs of reservoir were used (triple loop 68, double loop 13, quadruple loop 23). There were no postoperative deaths but six (5.8 per cent) had the reservoir removed. Rates for pelvic sepsis were 25, 15 and 13 per cent, and for intestinal obstruction requiring laparotomy 14.7,0 and 8.6 per cent. Function was assessed in 88 patients (58, 12 and 18) after mean intervals from closure of the ileostomy of 23.7, 12.7 and 4.5 months. Frequency of defaecation per 24 h was 3.7 ± 1.6, 5.5 ± 1.6 and 4.1 ± 1.3, being significantly greater for double loop reservoirs; night evacuation was more prevalent in the same group (26, 58 and 22 per cent). Significantly fewer patients with triple than with double loop reservoirs required antidiarrhoeal medication (19 and 58 per cent). Normal continence occurred in 67, 75 and 89 per cent of patients in the three groups. All patients with double or quadruple loop reservoirs defaecated spontaneously while only 41 per cent with triple loop reservoirs did so. Mean intra-operative reservoir volumes were 177 ± 64, 172 ± 58 and 325 ± 37 ml and volumes after closure of the ileostomy were 416 ± 176, 197 ± 69 and 322 ± 33 ml respectively. Double loop reservoirs were significantly smaller than the other two designs after ileostomy closure. There was an inverse relationship between reservoir volumes and frequency. A quadruple loop reservoir directly connected to the anal sphincter preserved spontaneous evacuation and resulted in function similar to that obtained with the triple loop reservoir.
Experience of posterior division of the puborectalis muscle in the management of chronic constipation
Authors: Barnes P R H , Hawley P R , Preston D M , Lennard-Jones J E
Published: March 2007

Nine women with severe chronic constipation who were unable to expel a water-filled rectal balloon underwent posterior division of the puborectalis muscle. Pre-operative concentric needle electromyography and measurement of the anorectal angle at rest and during straining suggested that the puborectalis muscle failed to relax during attempted defaecation in these patients. Two patients reported improvement after surgery and had normal balloon expulsion after operation. However seven patients reported no benefit from surgery and tests of defaecatory function and anorectal angle did not change. Incontinence for solid stool was not reported following puborectalis muscle division although five patients reported incontinence of flatus, liquid stool and mucus.
Meckel's diverticulum in the adult
Authors: Diamond T , Russell C F J
Published: March 2007

Meckel's diverticula were removed from 49 adult patients during a 15 year period. In 24 (49 per cent) of the patients the diverticulum was the cause of symptoms while in the remaining 25 it was an incidental finding at laparotomy. Of the symptomatic patients, 10 had acute inflammation of their diverticula, 8 presented with small bowel obstruction (in 4 cases due to fibrous bands) and 4 attended because of gross rectal bleeding; of the 2 remaining patients one was found to have intusssusception of Meckel's diverticulum into the terminal ileum whilst the other had a nodule of calcified material lying within a partly gangrenous vitellointestinal duct. There was no operative mortality in the series. Heterotopic tissue was noted histologically in six Meckel's diverticula, all of which produced symptoms. The importance of considering a diagnosis of Meckel's diverticulum in the young adult presenting with acute small bowel obstruction or rectal bleeding is emphasized.
Prolonged bandaging is not required following sclerotherapy of varicose veins
Authors: Fraser I A , Perry E P , Hatton Marion , Watkin D F L
Published: March 2007

Following sclerotherapy of varicose veins, 158 limbs of 154 patients were randomized to be bandaged with either crepe or Coban for 6 weeks each, or with Coban for 3 days only. Objective assessment of vein eradication and subjective evaluation of symptoms 3 months after completion of treatment showed no clear differences between these regimens. Significantly more discomfort was experienced with Coban than crepe when used for 6 weeks. It is suggested that, following sclerotherapy, 3 days is an adequate period of bandaging when using Coban. Such a policy would considerably reduce the inconvenience to patients during treatment.
Prospective study of the Angelchik anti-reflux prosthesis
Authors: Wale R J , Royston C M S , Bennett J R , Buckton G K
Published: March 2007

Fifty patients with medically refractory gastro-oesophageal reflux were treated by the insertion of an Angelchik anti-reflux prosthesis. All patients had a pre-operative upper gastrointestinal endoscopy, 32 were investigated with 15 h overnight oesophageal pH studies combined with oesophageal bile sampling and 20 underwent oesophageal manometric studies. At pre-operative endoscopy 45 patients had evidence of oesophagitis and the 5 who did not had pathological reflux demonstrated on overnight pH testing. Postoperatively the main clinical problem was dysphagia which appeared to settle with time but left one-third of patients with mild dysphagia at the end of 12 months. A further 12 per cent had residual moderate to severe dysphagia which required the removal of the prosthesis in five patients (10 per cent). In only one patient was the dysphagia due to prosthetic migration and this was the first patient in the series. Subsequently, we have had no problems with prosthetic migration, disruption, or erosion into the oesophagus. The overnight pH studies confirmed the efficacy of the prosthesis in preventing reflux which correlated with symptomatic improvement. We conclude that, while the Angelchik anti-reflux prosthesis is an effective device, it has a disturbingly high incidence of postoperative dysphagia though this appears to settle with time, leaving around 10 per cent of patients with severe dysphagia which will necessitate removal of the prosthesis and one-third with mild dysphagia which may settle with the further passage of time.
Complications and hospital stay after surgery for breast cancer: A prospective study of 385 patients
Authors: Tejler G , Aspegren K
Published: March 2007

General complications, wound complications and hospital stay after surgery for operable mammary carcinoma were studied prospectively in 385 patients treated by either modified radical mastectomy (324 operations) or segmental resection with axillary dissection (71 operations). The overall infection rate was 3·6 per cent. Postoperative seromas were noted in 34·8 per cent of the wounds. Other complications were few. The average hospital stay was 7·2 days. Seventeen per cent of the total number of days in hospital for these patients were due to factors other than the mammary cancer.
The biliary tract in patients with acute gallstone pancreatitis
Authors: Armstrong C P , Taylor T V , Jeacock Julie , Lucas S
Published: March 2007

The biliary tract has been prospectively studied in a consecutive series of 769 patients undergoing surgery for gallstones to determine whether differences exist between subjects with and without a history of acute pancreatitis. The incidence of acute gallstone pancreatitis (AGP) was 7·7 per cent and men with gallstones were significantly more likely to develop pancreatic inflammation. Operations on patients with AGP were accompanied by a higher mortality rate which was almost entirely due to the severity of the disease at the time of surgery. The earlier operations were performed after the onset of pancreatitis the more often stones were found in the common bile duct and at the ampulla. Patients with AGP had smaller and more numerous gallbladder stones in association with a wider cystic duct than controls. The common bile duct diameter in patients with AGP was independent of the presence of choledochal calculi implying either previous temporary obstruction to the biliary tree or a dilated duct ab initio. Pancreatic duct reflux was far more commonly observed on the cholangiograms of patients with AGP and in these patients reflux occurred into a wider pancreatic duct, at a greater angle and was associated with a longer functioning common channel. No patient developed recurrent pancreatitis following biliary surgery. These features strongly support the concept of gallstone migration and suggest that patients with gallstones who develop acute pancreatitis have essential differences in their biliary tree which mechanically facilitate migration of calculi.
Metronidazole and Augmentin in the prevention of sepsis after appendicectomy
Authors: Drumm J , Donovan I A , Wise R , Lowe P
Published: March 2007

Two hundred and fifty patients were admitted to a prospective randomized trial to compare the efficacy of Augmentin with metronidazole in the prevention of sepsis after appendicectomy. Pre-operatively they received either 500 mg metronidazole or 1·2 g Augmentin intravenously. Those patients with gangrenous or perforated appendices received eight additional doses of the trial drug at 8 hourly intervals. Overall there were 13 wound infections in the Augmentin group (11 per cent) and 21 in the metronidazole group (18 per cent). The 90 per cent confidence limits for the overall 7 per cent difference in infection rates were ±8·5 per cent. There were high rates of wound infection in the gangrenous group (Augmentin 8 per cent versus metronidazole 19 per cent) and especially in the perforated group (Augmentin 33 per cent versus metronidazole 63 per cent). There was no statistically significant difference between the infection rates with the two antibiotics but our study suggests that Augmentin, which is active against both aerobes and anaerobes, may be more effective than metronidazole in reducing wound sepsis after appendicectomy.
Demonstration of a reduction in postoperative body protein breakdown using the Clinitron fluidized bed with an ambient temperature of 32°C
Authors: Jones Gwyneth A , Clague M B , Ryan D W , Johnston I D A
Published: March 2007

Patients managed at an elevated ambient temperature after major surgery have a less pronounced rise in postoperative urinary nitrogen excretion. To investigate the mechanism involved, body protein breakdown was assessed, using a tracer dose of labelled amino acid, in patients following aorto-bifemoral bypass surgery nursed on either a Clinitron fluidized bed at 32°C or a hospital bed at 22°C and correlated with urinary total nitrogen excretion. Results showed a small reduction in measured body protein breakdown on the second postoperative day in patients managed on the Clinitron fluidized bed at 32°C (2·92 ± 0·91 versus 3·23 ± 0·84 g protein kg−1 day−1; mean ± s.d.), which was equivalent to the mean protein sparing (0·29 g protein kg−1 day−1) demonstrated by the significant improvement in urinary total nitrogen excretion (9·20 ± 2·0 versus 12·48 ± 3·9 g N day−1; mean ± s.d.: P < 0·05). Urinary total nitrogen excretion (N) and body protein breakdown (B) showed a weak though significant positive correlation (B = 1·25 + 13·13N; r = + 0·55 : P = 0·05), whereas no correlation existed between urinary total nitrogen excretion and the derived rate of body protein synthesis. There was also a significant decrease in postoperative stress, measured during the isotope infusion, in patients managed on the Clinitron fluidized bed at 32°C (12·3 ± 2·2 versus 16·1 ± 3·2 per cent activity incorporated into plasma proteins; mean ± s.d.: P < 0·05). These results show the beneficial effect of managing postoperative patients on a Clinitron fluidized bed at 32°C in conserving body nitrogen through a reduction in body protein breakdown, probably as a consequence of decreased postoperative stress.
Heparin with and without graded compression stockings in the prevention of thromboembolic complications of major abdominal surgery: A randomized trial
Authors: Wille-Jørgensen P , Thorup J , Fischer A , Holst-Christensen J , Flamsholt R
Published: March 2007

One hundred and seventy-six patients scheduled for elective major abdominal surgery were randomized to two prophylactic regimens to prevent postoperative thromboembolism. All patients were screened with the 125I-labelled fibrinogen uptake test, and thromboembolism was verified by ascending phlebography and/or perfusion/ventilation lung scintigraphy. In the group of patients receiving low-dose heparin treatment (5000 units twice daily subcutaneously) 12 per cent developed thromboembolic complications. In the other group, where low-dose heparin treatment was supplemented with graded compression stockings only 2 per cent developed thromboembolism. It is concluded that the combination of low-dose heparin and the use of graded compression stockings is superior to heparin alone in preventing thromboembolism following major abdominal surgery.
Zinc deficiency and the prolonged accumulation of zinc in wounds
Authors: Senapati Asha , Thompson R P H
Published: March 2007

Zinc is required for protein synthesis and therefore for wound healing. Zinc levels were 50 per cent higher in muscle and skin from abdominal wounds of rats during the maturation phase of wound healing, but mild deficiency greatly reduced this accumulation. The results suggest that zinc takes part in the late stages of wound healing when protein is laid down, and that such extra local demands expose otherwise marginal zinc deficiency.
The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy
Authors: Glass R E , Ritchie Jean K , Thompson H R , Mann C V
Published: March 2007

At St Mark's Hospital survival after radical surgery for cancer of the rectum has not changed significantly over the past 30 years. The technique of extended abdomino-iliac lymphadenectomy was developed in an attempt to improve prognosis in patients considered to have particularly unfavourable tumours. Between 1960 and 1981 the technique was used in 75 patients with a single adenocarcinoma of the rectum. Two patients died postoperatively and 52 patients developed complications; a mortality and morbidity similar to those seen after conventional surgery at this hospital. Five-year survival rate showed no improvement over that achieved by conventional techniques; disappointingly this was also the case for patients with Dukes' C1 tumours. The results of this study suggest that an improvement in survival in patients with cancer of the rectum is unlikely to be achieved by any extension of conventional radical surgery.
Colonic anastomotic healing and oxygen tension
Authors: Shandall A , Lowndes R , Young H L
Published: March 2007

Using a Clark oxygen electrode and a 133Xe clearance technique, tissue oxygen tension (To2) and blood flow have been determined in the small and large bowel of a rabbit experimental model. The predictive value of perianastomotic To2 in colonic anastomoses was determined, healing being assessed by leakage rate, tensile strength and hydroxyproline content. The effect of suture technique on colonic perianastomotic To2 has also been studied. Colonic and small intestinal To2 correlated with blood flow (r = 0·93). Basal colonic blood flow and oxygen tension were significantly lower than in the small intestine (P<0·01). Interrupted and continuous suture techniques decreased colonic perianastomotic To2, although mean To2 in the continuous group was significantly lower than in the interrupted group (P<0·01). The leakage rate was 10 per cent (1/10) for anastomoses constructed with a perianastomotic To2 above 55 mmHg compared with 100 per cent (10/10) if less than 25 mmHg (P<0·001). Perianastomotic To2 correlated with breaking energy (P<0·001), breaking strength (P<0·01) and hydroxyproline content (P<0·05).