bluuebunny/crossref_metadata_2025 huggingface dataset:
Testicular torsion in the armed services: Twelve year review of 179 cases
Authors: Jones D J , Macreadie D , Morgans B T
Published: March 2007

All cases of testicular torsion occurring in the Armed Services between 1972 and 1983 have been reviewed. All cases were post-pubertal. The incidence in older age groups is higher than previously reported. No cases were seen in undescended testes. No seasonal variation in presentation was detected. Recurrent scrotal pain before acute presentation occurred in 29 per cent of cases. The testicular salvage rate was 75 per cent. The salvage rate in patients with pain for > 24 h was 46 per cent. Patients with a history of intermittent scrotal pain should be explored as a matter of urgency. Operation should still be considered in patients who have had pain for > 24 h.
Incidence of postoperative adhesion obstruction following neonatal laparotomy
Authors: Wilkins Barbara M , Spitz L
Published: March 2007

Of 649 neonates undergoing laparotomy in a 10 year period, 54 (8.3 per cent) developed adhesion related intestinal obstruction requiring surgical treatment. In 16 infants the obstruction followed a period of prolonged postoperative ileus, while the remaining 38 had completely recovered from the previous surgical procedure before the development of obstruction. The adhesion obstruction occurred after a single neonatal laparotomy in 35 cases but the remaining 19 had undergone subsequent laparotomies; 75 per cent of the obstructions developed within 6 months and 90 per cent within 1 year of surgery. The highest risk groups were infants undergoing correction of gastroschisis (15.4 per cent) and malrotation (15 per cent). There were nine deaths, two of which were a direct consequence of the adhesion obstruction.
Pre-Operative assessment of local invasion in rectal cancer: Digital examination, endoluminal sonography or computed tomography?
Authors: Beynon J , Mortensen N J McC , Foy D M A , Channer J L , Virjee J , Goddard P
Published: March 2007

Forty-four patients with primary rectal cancers and six patients with benign rectal lesions were examined pre-operatively digitally, with endorectal sonography (ELU) and also computed tomography (CT). Digital examination of the rectal cancers had an overall accuracy of 68 per cent and predicted invasion beyond the muscularis propria with a sensitivity of 68 per cent, specificity of 83 per cent, positive predictive value of 100 per cent and negative predictive value of 46 per cent. In comparison CT had an accuracy of 82 per cent, sensitivity of 86 per cent, specificity of 62 per cent, positive predictive value of 91 per cent and negative predictive value of 50 per cent. ELU was the most reliable indicator of local invasion in rectal cancer when compared with postoperative histopathology with an accuracy of 91 per cent, sensitivity of 94 per cent, specificity of 87 per cent, positive predictive value of 97 per cent and negative predictive value of 78 per cent.
Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum)
Authors: Bowdler D A , Stell P M
Published: March 2007

Carcinoma is a rare but recognized complication of posterior pharyngeal pulsion (Zenker's diverticulum). Such diverticula merit radiological and endoscopic examination before operation. Surgery is preferred to radiotherapy in the treatment of carcinoma, the choice of operation resting between one-stage diverticulectomy for cancer confined to the body of the sac and pharyngolaryngectomy for more extensive lesions.
Defective fibrinolysis: A risk factor in early femoropopliteal graft thrombosis
Authors: Earnshaw J J , Westby J C , Makin G S , Hopkinson B R
Published: March 2007

Resting plasma fibrinolytic activity and fibrinolytic activity after stimulation by 10 min of venous occlusion (fibrinolytic potential) were estimated in 51 patients before femoropopliteal reconstructive surgery. Twelve patients suffered a graft thrombosis in the first month. Resting plasma fibrinolytic activity was similar in patients with thrombosed grafts and those with functioning grafts. However reduced fibrinolytic potential was found to be a risk factor for graft thrombosis in the month after surgery (P = 0·01). Other risk factors were increasing age (P = 0·007) and the indication for surgery (P = 0·03). Thirty-four patients whose grafts were functioning after 1 month were followed up for a mean of 9 months. A further eight grafts thrombosed. Neither fibrinolytic activity nor fibrinolytic potential were found to be risk factors for late graft thrombosis. Fibrinolytic potential has been shown to be an independent risk factor for early graft thrombosis. Peri-operative fibrinolytic stimulation might be a method of improving femoropopliteal graft patency.
Left intrahepatic cholangio-enteric anastomosis (round ligament approach): An effective palliative treatment for hilar cancers
Authors: Traynor O , Castaing D , Bismuth H
Published: March 2007

Palliation of obstructive jaundice in patients with hilar cancer can be achieved either by surgical bypass or by intubation and drainage. A simple and effective technique is presented which gives excellent palliation without the need for tubes or stents: left intrahepatic cholangio-enteric anastomosis, using the duct of segment III (i.e. the inferolateral segment of the left liver). The procedure is performed by using the round ligament approach to the duct of segment III in the base of the umbilical fissure. A defunctioned loop of jejunum is then anastomosed to this duct. Over a period of 25 years, 48 patients with hilar cancer had this procedure in this unit. The operative mortality (death within 2 months) was 6 per cent and the complication rate was 17 per cent. Seventy-three per cent of patients had complete relief of jaundice and a further 23 per cent had partial relief. The mean survival was 9·2 months and the quality of life was excellent. These data suggest that this is a very satisfactory palliative technique for patients with hilar cancer who are not suited for radical tumour excision.
History of colorectal polypectomy and risk of subsequent colorectal cancer
Authors: Kune G A , Kune Susan , Watson Lyndsey F
Published: March 2007

In a case control study, which formed part of a large, population-based investigation of the incidence, aetiology and survival of colorectal cancer, 24 of 715 cases and 4 of 727 age/sex group matched controls gave a past history of bowel polypectomy (χ12 = 17, P < 0·001, relative risk = 6·37, 95 per cent confidence interval = 2·2-18·6). There was no significant sex or site difference associated with a history of previous polypectomy. These findings are consistent with the view that colorectal polyps are markers of risk (sixfold in the present study) for the subsequent development of colorectal cancer. The data also support the emerging practice that those with adenomatous polyps need regular surveillance of their large bowel as a screening measure.
Incisional hernia in re-opened abdominal incisions: An overlooked risk factor
Authors: Lamont P M , Ellis H
Published: March 2007

Many patients undergoing laparotomy will have had a previous incision in the abdominal wall which offers a convenient and logical route for re-exploration. This study aims to examine the risk of subsequent incisional herniation in incisions made through previous scar tissue compared with incisions made through fresh tissues. Out of a total of 1022 laparotomies performed in a 5-year period on one surgical unit, the incisional hernia rates were available for assessment in 699 freshly made incisions, 142 re-incisions and 36 incisional hernias. The incidence of incisional hernia was 6 per cent after freshly made incisions and this incidence was increased after both re-incision (12 per cent, P<0·05) and incisional hernia repair (44 per cent, P < 0·01). With the exception of jaundice, none of the other commonly accepted risk factors for incisional herniation were significantly increased in those patients with re-incised wounds who subsequently developed a hernia, when compared with patients who did not develop a hernia. An increased risk of incisional herniation is present when laparotomy is performed through a previous abdominal incision.
Anal sensation after restorative proctocolectomy for ulcerative colitis
Authors: Holdsworth P J , Johnston D
Published: March 2007

The hypothesis that anal sensation might be better after restorative proctocolectomy with end-to-end ileoanal anastomosis than after mucosal proctectomy with endo-anal anastomosis was tested in this study. Anal sensation was measured in 14 patients before operation, 16 patients after restorative proctocolectomy with end-to-end anastomosis (RP + EEA) and 13 patients after mucosal proctectomy with endo-anal anastomosis 1 cm above the dentate line (MP + EAA). Threshold electrosensitivity was measured in the upper, mid and lower anal canal by means of a bipolar constant current stimulator probe. The ‘recto’-anal inhibitory reflex was tested, and the patients' ability to discriminate between flatus and faeces and to release flatus ‘safely’ was assessed by interview. In the upper anal canal, threshold sensitivity was significantly greater in patients who had undergone MP + EAA than in patients who had undergone RP + EEA (P < 0.05). In the mid and lower anal canal, electrosensitivity in the three groups of patients did not differ significantly. Twelve patients (75 per cent) regained the ‘recto’-anal reflex after RP + EEA, but after MP + EAA only three patients (23 per cent) did so (P < 0.02). Thirteen patients after RP + EEA could release flatus safely without fear of faecal leakage, compared with only four after MP + EAA (P < 0.02). The proportions of patients in these two groups who said they were able to discriminate flatus from faeces did not differ significantly. Anal sensation and discriminatory function are significantly better after end-to-end ileoanal anastomosis than after mucosal proctectomy with endo-anal anastomosis.
Prospective randomized trial to compare the stapled double lumen pouch and the sutured quadruple pouch for restorative proctocolectomy
Authors: Keighley M R B , Yoshioka K , Kmiot W
Published: March 2007

Thirty-three consecutive patients having restorative proctocolectomy since April 1986 were randomly allocated to reconstruction using a stapled J pouch (n = 18) or a sutured W pouch (n = 15). There were no deaths, but one patient required pouch excision for isohaemia (J). One patient developed a leak from the pouch necessitating loop ileostomy (J) and one patient had a low pouch vaginal fistula successfully treated by a seton (W). There were no other major complications. Median (range) operative time was 200 min (165–290) for J pouch and 255 min (220–330) for the W pouch (P<0.05). In 24 patients followed up for more than 4 months after restoring intestinal continuity, median frequency of defaecation over 24 h was 4 (3–6) for the J pouch and 4 (3–6) for the W pouch. There was no incontinence, urgency or soiling. These results indicate that the quicker J pouch provides identical functional results to the larger W pouch in this series of patients.
Femorofemoral bypass in unilateral iliac artery occlusion
Authors: Fahal A H , McDonald A M , Marston A
Published: March 2007

Between January 1973 and January 1988, 188 patients with unilateral iliac artery occlusion were treated at The Middlesex and University College Hospitals, 185 for primary disease and three for blockage of a previous aortobifemoral graft. In the early part of the series, a variety of operations, including aortofemoral and iliofemoral bypass, and endarteriectomy, was used. Femorofemoral bypass was at first reserved for patients who were considered unfit for major surgery, but the results seemed so good that it was adopted as the procedure of choice. Latterly, percutaneous transluminal angioplasty became available, and the role of this is discussed. Over the 15-year period, 150 patients underwent femorofemoral bypass (all but two receiving a prosthetic graft). Of these, 90 per cent had disabling claudication and 8 per cent had critical ischaemia. There were six early deaths (within 30 days of operation) and five late deaths, and two surviving amputees; nine patients could not be traced. The remaining 128 patients have been assessed at intervals of from 3 to 92 months, both clinically and with Doppler studies. The cumulative patency was 86 per cent at 13 years, and all of these patients experienced subjective and haemodynamic improvement in the recipient limb. Eight grafts occluded in the early postoperative phase. In five patients there was deterioration in the donor limb; it is postulated that the effect was due to causes other than the operation. There were two serious postoperative complications due to technical error, one of which led to early above-knee amputation. These are presented in detail. In the light of this experience, the advantages and indications for femorofemoral bypass and the results to be expected from it have become clarified, and the technique standardized so that errors can be avoided. We suggest that femorofemoral bypass is now the operation of choice for unilateral iliac artery occlusion.
Results of external sphincter repair in Crohn's disease
Authors: Scott A , Hawley P R , Phillips R K S
Published: March 2007

The results of anal sphincter repair in a group of six patients with anorectal Crohn's disease are reported. All patients had previously undergone anal surgery which was followed by faecal incontinence in five. The sixth patient became incontinent following obstetric injury. Of the six patients, five are completely continent and one has a permanent stoma (follow-up from 18 months to 16 years, mean 7·8 years). Anal sphincter repair in this highly selected group of patients with Crohn's disease has not been complicated by wound breakdown or fistula formation, and has given good results.
Non-condylomatous perianal disease in homosexual men
Authors: Carr N D , Mercey D , Slack W W
Published: March 2007

This retrospective study details the findings and outcome in 34 homosexual men, out of a total of 177 patients, who underwent surgery for non-condylomatous perianal disease over a 2-year period. Of 34 homosexuals 20 presented with anorectal sepsis compared with 11 of 79 heterosexual male patients (χ2 = 24.47, P<0.001). Lesions included chronic intersphincteric abscess (eight patients), anal fistula (seven patients) and chronic intersphincteric abscess and fistula (five patients). Anal fissure occurred in 15 patients, anal ulcer in three, skin tags in six, haemorrhoids in two and Kaposi's sarcoma in one. Eight patients were human immunodeficiency virus (HIV) antibody negative, four were asymptomatic HIV antibody positive, 12 had symptomatic HIV infection using the Centers for Disease Control classification and in ten patients HIV status was unknown. Irrespective of the type of surgery performed, healing occurred within 6 weeks of operation in all HIV antibody negative patients, all asymptomatic HIV antibody positive and in only one of nine patients with symptomatic HIV infection. Eight of nine patients with symptomatic HIV infection failed to heal by this time (χ2 = 8.98, P<0.05). These findings suggest that the prevalence of anorectal sepsis in homosexual men is high and that symptomatic HIV infection is an important determinant of progress after surgery.
Common femoral artery volume flow in peripheral vascular disease
Authors: Lewis P , Psaila J V , Morgan R H , Davies W T , Woodcock J P
Published: March 2007

Common femoral artery volume flow was measured at rest and during postocclusive reactive hyperaemia in 80 normal subjects and 67 patients with radiological evidence of occlusive peripheral vascular disease. At rest, mean(s.d.) common femoral artery volume flow in normal subjects (344 (135) ml/min) and all patients with peripheral vascular disease (401(168) ml/min) was not significantly different. During postocclusive reactive hyperaemia, mean(s.d.) peak flow was significantly higher in normal subjects (1951 (438) ml/min) than in patients with peripheral vascular disease (996(457)ml/min) (P < 0·01). Common femoral artery volume flow in patients with critical ischaemia and intermittent claudication did not differ at rest but mean(s.d.) peak flow in patients with critical ischaemia (697(276) ml/min) was significantly lower than in claudicants (1131 (447)ml/min) (P < 0·01). Mean(s.d.) resting common femoral artery volume flow in limbs with femoropopliteal disease (457(185) ml/min) was significantly greater than that in limbs with occlusion of the aortoiliac segment (308(130) ml/min) (P < 0·01). However, this difference did not persist during postocclusive reactive hyperaemia. A hyperaemic index, calculated from the hyperaemic responses to below knee and whole limb ischaemia, was used to quantify segmented perfusion during postocclusive reactive hyperaemia. The mean(s.d.) value in normal subjects, 46(9) per cent, and in those with aortoiliac disease, 52(12) per cent, indicated approximately equal perfusion of the above and below knee limb segments. In those with femoropopliteal disease the mean(s.d.) hyperaemic index was 17(13) per cent, revealing relative hypoperfusion of the below knee segment.
Spontaneous rupture of renal allografts: The importance of renal vein thrombosis in the cyclosporin era
Authors: Richardson A J , Higgins R M , Jaskowski A J , Murie J A , Dunnill M S , Ting A , Morris P J
Published: March 2007

Spontaneous renal allograft rupture occurring within 14 days of transplantation occurred in 15 patients from 791 consecutive transplants. In each of eight patients treated with azathioprine and prednisolone there was pathological evidence of rejection and only two patients had thrombosis of the renal vein. Of the seven cases occurring in patients treated with triple therapy regimen (low dose cyclosporin, prednisolone and azathioprine), histological evidence of rejection was present in only three cases, but renal vein thrombosis was found in all seven. Spontaneous rupture of a transplanted kidney, a relatively uncommon complication, is more likely to be due to renal vein thrombosis than to rejection in the cyclosporin era.
Carcinoma of the rectum: A 10-year experience
Authors: Dixon A R , Maxwell W A , Holmes J Thornton
Published: March 2007

A consecutive series of 303 patients with carcinoma of the rectum and distal sigmoid colon treated by a single surgeon over a 10-year period are reported. Of these, 202 underwent an anterior resection, 85 an abdominoperineal excision of the rectum and 16 a coloanal anastomosis. Surgery was considered palliative in 52 patients undergoing anterior resection and 24 undergoing abdominoperineal resection. The 30-day hospital mortality rate was six patients (3 per cent) for anterior resection and two patients (2 per cent) for abdominoperineal resection. Peroperative anastomotic testing demonstrated leakage in five stapled anastomoses; these were rectified and no clinical sequelae occurred. Two patients (1 per cent) developed a clinical anastomotic leak, one of which proved fatal; in each case the intraoperative test was negative. The overall 5-year survival rate was 64 per cent after anterior resection and 52 per cent after abdominoperineal resection; the median follow-up was 64 months. The incidence of local pelvic recurrence was 6·4 per cent after anterior resection and 14 per cent after abdominoperineal (not significant). These results confirm the success of sphincter-saving anterior resection combined with total mesorectal excision, routine full mobilization of the splenic flexure and cancercidal lavage of the distal rectum in the treatment of low rectal carcinomas; morbidity, local recurrence and survival are not compromised.
Topical application of honey in treatment of burns
Authors: Subrahmanyam M
Published: March 2007

A total of 104 cases of superficial burn injury were studied to assess the efficiency of honey as a dressing in comparison with silver sulfadiazine gauze dressing. In the 52 patients treated with honey, 91 per cent of wounds were rendered sterile within 7 days. In the 52 patients treated with silver sulfadiazine, 7 per cent showed control of infection within 7 days. Healthy granulation tissue was observed earlier in patients treated with honey (mean 7·4 versus 13·4 days). Of the wounds treated with honey 87 per cent healed within 15 days as against 10 per cent in the control group. Relief of pain, a lower incidence of hypertrophic scar and postburn contracture, low cost and easy availability make honey an ideal dressing in the treatment of burns.
Statistical guidelines for the British Journal of Surgery
Authors: Murray G D
Published: March 2007

A set of statistical guidelines is presented which should be followed by authors preparing manuscripts for submission to The British Journal of Surgery. Simple points relating to presentation are explained in full, and more complex issues are highlighted and discussed in an accompanying review article.
Realistic expectations for the patient with intermittent claudication
Authors: O'Riordain D S , O'Donnell J A
Published: March 2007

To determine the natural history of intermittent claudication 112 patients were followed for a minimum of 5 years and a median period of 82 months. Thirty-seven patients (33 per cent) died during the study period. Myocardial infarction (44 per cent) and cerebrovascular disease (28 per cent) were the most common causes of death. Overall mortality rate was 8, 23 and 40 per cent, at 2, 5 and 8 years respectively. Initial ankle-brachial pressure index (ABPI) correlated with subsequent death. With an initial ABPI <0·5 death occurred in 20, 50 and 69 per cent at 2, 5 and 7 years respectively, compared with 5, 16 and 24 per cent respectively for those with an initial ABPI ≤ 0·5 (P<0·0001). Of the survivors only 21 per cent had worsening claudication and 13 per cent progressed to critical ischaemia. Arterial bypass for limb salvage was required in eight patients and four limbs were lost during the study period. ABPI identifies a subgroup of claudicants with an extremely high risk of death from coronary and/or cerebral pathology. In this subgroup an aggressive approach to the correction of atherosclerotic risk factors, rather than emphasis on the peripheral vascular problem alone, may improve survival.
Role of sequential leucocyte counts and C-reactive protein measurements in acute appendicitis
Authors: Thompson M M , Underwood M J , Dookeran K A , Lloyd D M , Bell P R F
Published: March 2007

The accurate clinical diagnosis of acute appendicitis is dificult, and many techniques have been suggested to improve diagnostic accuracy such as laparoscopy, ultrasonography and barium enema examination. In this study serial total leucocyte counts and serial C-reactive protein (CRP) concentrations in acute appendicitis were measured. The sensitivity and specificity of serial leucocyte counts in acute appendicitis were 92 and 100 per cent, and for CRP concentrations 69 and 75 per cent, respectively. The sensitivity and specificity of serial total leucocyte counts fulfilled the criteria for a diagnostic test. It is suggested that in patients with equivocal clinical findings, clinical observation combined with serial leucocyte counts may improve decision making.
Fat-wrapping in Crohn's disease: Pathological basis and relevance to surgical practice
Authors: Sheehan A L , Warren B F , Gear M W L , Shepherd N A
Published: March 2007

The connective tissue changes that accompany intestinal Crohn's disease have received little attention from pathologists. This is particularly so with fat hypertrophy, and yet surgeons have long recognized the phenomenon of fat-wrapping in the intestines and used it to delineate the extent of active disease. A consecutive, unselected series of 27 intestinal resections performed on 25 patients for histologically confirmed Crohn's disease was studied to correlate fat-wrapping with other clinicopathological features. Fat-wrapping was identified in 12 of 16 ieal resections and in seven of 11 large bowel resections. It correlated closely with transmural inflammation and there was a relationship between fat-wrapping and other connective tissue changes including fibrosis, muscularization and stricture formation. Morphometry demonstrated that there was true hypertrophy and that fat-wrapping does not relate solely to bowel wall shrinkage. There was correlation with ulceration but in 11 cases macroscopic ulceration extended beyond the fat-wrapping and in six to surgical resection margins. The pathological features of 225 small intestinal resections were reviewed and fat-wrapping was seen only in Crohn's disease. Fat-wrapping correlates best with transmural inflammation and represents part of the connective tissue changes that accompany intestinal Crohn's disease. Findings also suggest that fat-wrapping alone should not be used as an accurate marker of disease extent at the time of surgery.
Prospective randomized comparison of in situ and reversed infrapopliteal vein grafts
Authors: Harris P L , Veith F J , Shanik G P , Nott D , Wengerter K R , Moore D J
Published: March 2007

A three-centre prospective randomized trial was undertaken to compare the efficacy of in situ and reversed saphenous vein grafts for long bypasses to tibial and peroneal arteries. Of 162 patients entered into the study, 82 received an in situgraft and 80 a reversed vein graft. All operations were for limb salvage and the two groups of patients were well matched for age, sex, incidence of diabetes, smoking habits and coronary artery disease. At a maximum follow-up of 3 years there were 48 primary graft failures: 19 in the in situ group and 29 in the reversed vein group. Of these, three in situ grafts and seven reversed grafts were salvaged by secondary intervention. Secondary cumulative patency rates calculated at 3 years after operation were 68 and 66 per cent respectively for in situ and reversed grafts (P not significant). Cumulative limb salvage rates were 78 per cent for in situ grafts and 87 per cent for reversed grafts (P not significant). Separate analysis of a subgroup with small veins (≦ 3·5 mm minimum diameter) showed cumulative patency rates at 2 years of 74 per cent for in situ grafts and 60 per cent for reversed grafts (P not significant). These results indicate that for veins >3·5 mm in diameter the in situ and reversed techniques for operation are equally effective. Some doubt remains about the best way of using smaller veins; a large number of such veins need to be studied to resolve this question.
Function of ileal J pouch-anal anastomosis in patients with familial adenomatous polyposis
Authors: Penna C , Tiret E , Kartheuser A , Hannoun L , Nordlinger B , Parc R
Published: March 2007

Pouch function after proctocolectomy and ileal J pouch-anal anastomosis was assessed at 1 and 5 years in 41 patients with familial adenomatous polyposis. The mean(s.d.) stool frequency per 24 h decreased from 4·4(1·7) to 3·9(1·8) (P < 0·05), the mean(s.d.) nocturnal stool frequency fell from 0·6(1·0) to 0·3(0·6) (P < 0·05), and the number of patients having nocturnal bowel movements decreased from 16 to seven (P < 0·05). At 5 years, only one patient still followed a strict diet (versus ten at 1 year, P < 0·05) and only two needed antidiarrhoeal medication (versus ten at 1 year, P < 0·05). There were no episodes of pouchitis or late reservoir-related complications. The function of ileal pouch-anal anastomosis improves over time in patients with familial adenomatous polyposis.
Intraoperative measurement of vascular graft resistance as a predictor of early outcome
Authors: Davies A H , Magee T R , Baird R N , Horrocks M
Published: March 2007

The quality of distal run-off is one of the most important factors influencing the early outcome of femorodistal vein grafting. During femoropopliteal and infrapopliteal bypass, assessment of graft resistance and flow were made using a combination of Doppler flowmeter recordings and measurements of arterial pressure. In a series of 100 reconstructions there were 12 early failures. The mean (95 per cent confidence interval (c.i.)) maximal flow measurement in the group of grafts that failed when anastomosed to the popliteal artery or tibioperoneal trunk was 125 (74–176) ml/min compared with 256 (223–289) ml/min in successful grafts (P = 0.006). The corresponding figures for grafts inserted into a single crural vessel were 99 (72–126) and 165 (137–193) ml/min (P < 0.02). In the group that failed the mean (95 per cent c.i.) resistance after papaverine injection was 1.02 (0.82–1.22) peripheral resistance units (p.r.u.) compared with 0.47 (0.44–0.51) p.r.u. in the successful group (P < 0.001). Using a combination of resistance > 0.9 p.r.u. and capacity loss ratio after papaverine injection < 10 per cent to identify grafts that subsequently failed, the sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 92, 97, 85, 99 and 97 per cent respectively. These results confirm that haemodynamic measurements can be used at operation to identify a group of patients in whom bypass is likely to fail.
Faecal occult blood screening for colorectal neoplasia in a targeted high-risk population
Authors: Caffarey S M , Broughton C I M , Marks C G
Published: March 2007

A general practice-based programme was initiated in 1987 to identify individuals at high risk of developing large bowel cancer and offer them screening of faecal occult blood. In all, 5298 people from 21 general practices in the Guildford area were offered 7510 screening tests. In total, 5934 tests were completed (compliance rate 79.0 per cent) with 287 positive results (4.8 per cent). Of the patients with positive results, 44 had cancer and 38 polyps. The sensitivity of the test for cancer was 63 per cent, the specificity 96 per cent and the positive predictive value for all neoplasia 29 per cent. The detection rate of 44 cancers per 5934 people screened compares favourably with data from the Nottinghambased screening of an unselected population (0.74 versus 0.23 per cent).
Conservative treatment for low rectal carcinoma by local excision with or without radiotherapy
Authors: Rouanet P , Aubert B Saint , Fabre J M , Astre C , Liu J Z , Dubois J B , Joyeux H , Solassol C , Pujol H
Published: March 2007

Thirty-seven patients with low rectal carcinoma were treated by transanal resection between January 1979 and December 1988. Adjuvant radiotherapy was used in eight patients before operation, in 13 after operation and six patients had both preoperative and postoperative radiotherapy. The selection criteria for transanal resection were low, superficial tumours treated conservatively with curative intent (group 1, 18 patients) or patients medically unfit for (12) or refusing (seven) abdominoperineal resection (APR) (group 2, 19 patients). In group 1, the local recurrence rate was 11 per cent with an overall 5-year survival rate of 100 per cent. In group 2, the local recurrence rate was 53 per cent with an overall 5-year survival rate of 35 per cent. There was no postoperative mortality and minimal morbidity. Salvage of local failure was by APR in six patients. The survival rate after local recurrence was 70 per cent at 1 year and 30 per cent at 5 years. Transanal resection can be proposed as a curative procedure for selected low, small, minimally infiltrating and well differentiated adenocarcinomas. Local control might be improved by postoperative radiotherapy for Astler—Coller stage B1 tumours or those above 3 cm in diameter. Further trials should examine the results of high-dose (60 Gy) preoperative radiotherapy so that transanal resection might be employed for favourable postirradiation stage (0 or A) lesions. This new strategy will benefit from a better evaluation of tumour response after primary radiotherapy and an improved assessment of histological excision margins.
Intersphincteric resection for low rectal tumours
Authors: Schiessel R , Karner-Hanusch J , Herbst F , Teleky B , Wunderlich M
Published: March 2007

An abdominoperineal operation is described that extends rectal resection for low tumours into the intersphincteric plane with removal of the internal sphincter. Bowel continuity is restored by coloanal anastomosis. Of 38 patients who underwent surgery since 1984, 34 had low rectal cancer and four carcinoid or large villous adenoma. There was no mortality. Four patients developed local recurrence during a median observation period of 3 years. Continence was satisfactory in all patients. The median daily number of bowel movements during the first months after colostomy closure was 9 but decreased to 3 after 1 year and 1 after 2 years. Anal manometry demonstrated a significant reduction of mean resting pressure from 91·8 to 35·1 cmH2O with no recovery after 2 years (P<0·0001). Squeeze pressure showed only a transient decrease.
Segment III cholangiojejunostomy for palliation of malignant hilar obstruction
Authors: Guthrie C M , Banting S W , Garden O J , Carter D C
Published: March 2007

Between 1984 and 1992, 26 patients with obstructive jaundice due to malignancy at the liver hilum were treated by segment III Roux-en-Y cholangiojejunostomy. Twenty-two patients had hilar cholangiocarcinoma, one carcinoma of the gallbladder, one pancreatic carcinoma, one recurrent gastric carcinoma and one lymphoma. Seventeen patients had no complications in the postoperative period and six had complications; there were three postoperative deaths. Eighteen of the 23 surviving patients experienced complete resolution of jaundice for at least 3 months. Four developed recurrent jaundice and three had episodes of cholangitis before death. Segment III cholangiojejunostomy offers effective palliation for most patients with irresectable hilar malignancy.
Influence of screening on the incidence of ruptured abdominal aortic aneurysm: 5-year results of a randomized controlled study
Authors: Scott R A P , Wilson N M , Ashton H A , Kay D N
Published: March 2007

From family medical practices 15775 men and women aged 65-80 years were identified and randomized into two groups: one group was invited for ultrasonographic screening for abdominal aortic aneurysm (AAA), and the other acted as age- and sex-matched controls. Of the 7887 invited for screening 5394 (68·4 per cent) accepted. AAA was detected in 218 (4·0 per cent overall and 7·6 per cent of men). Aortic surgery was offered to the screened group if certain criteria were met and no patient died from rupture who was fit for operation and accepted elective treatment. The incidence of rupture was reduced by 55 per cent in men in the group invited for screening, compared with controls. The incidence of rupture in women was low in both groups.
Percutaneous cholecystostomy: A valuable technique in high-risk patients with presumed acute cholecystitis
Authors: Melin M M , Sarr M G , Bender C E , van Heerden J A
Published: March 2007

Percutaneous cholecystostomy offers a potentially important therapeutic modality for critically ill patients with acute cholecystitis who represent a high risk for general anaesthesia. The aim of the study was to assess experience with percutaneous cholecystostomy in resolving the acute episode of cholecystitis without operative intervention. Twenty-two consecutive patients with a clinical diagnosis of acute cholecystitis underwent the procedure. All were at high risk for general anaesthesia, and all but one developed cholecystitis while hospitalized for another co-morbid condition; 14 were in an intensive care unit. Twenty-one of the 22 patients proved to have acute cholecystitis (11 acalculous, ten cholelithiasis). There were no acute technical complications. Toxaemia resolved in 17 of the 21 patients with acute cholecystitis. Acute cholecystitis failed to resolve in three patients; all died within 48 h from overwhelming generalized sepsis. One patient required emergency cholecystectomy for bile peritonitis when the cholecystostomy catheter became dislodged 24 h after placement. The 60-day mortality rate for the acalculous and calculous patient groups was 55 and 20 per cent, respectively. Only three interval cholecystectomies have been performed at a mean follow-up of 19 months. In conclusion, percutaneous cholecystostomy may be the procedure of choice for the management of acute cholecystitis in the very high-risk critically ill patient. If symptoms fail to resolve quickly, ongoing sepsis, cholangitis or gallbladder necrosis should be suspected.
Effect of transcutaneous electrical muscle stimulation on postoperative muscle mass and protein synthesis
Authors: Vinge O , Edvardsen L , Jensen F , Jensen F G , Wernerman J , Kehlet H
Published: March 2007

In an experimental study, 13 patients undergoing major elective abdominal surgery were given postoperative transcutaneous electrical muscle stimulation (TEMS) to the quadriceps femoris muscle on one leg; the opposite leg served as control. Changes in cross-sectional area (CSA) and muscle protein synthesis were assessed by computed tomography and ribosome analysis of percutaneous muscle biopsies before surgery and on the sixth postoperative day. The percentage of polyribosomes in the ribosome suspension decreased significantly (P < 0·03) after operation in control legs, but not in stimulated legs (P > 0·16). The total concentration of ribosomes decreased significantly in legs treated with TEMS (P < 0·03) but not in control legs (P > 0·16). CSA decreased significantly in both legs. The decrease in polyribosomes and CSA after operation was significantly less in stimulated legs than in controls (P < 0·05). TEMS may be a simple and effective method for improving muscle protein synthesis and muscle mass after abdominal surgery and should be evaluated in other catabolic states with muscle wasting.
Augusta Déjerine‐Klumpke: The first female neuroanatomist
Authors: Shoja Mohammadali M. , Tubbs R. Shane
Published: March 2007

Augusta Déjerine‐Klumpke, the wife of Joseph Jules Dejerine, an eminent French neurologist, was an American and the first woman to intern in a Parisian hospital. She is known for Klumpke's radicular palsy, which is a neuropathy involving the lower nerve roots of the brachial plexus. The neuroanatomical treatise that she wrote together with her husband is considered a masterpiece. Klumpke won several awards in medical science, the first of which was in the field of anatomy when she was a student. She was a pioneer of rehabilitation therapy after spinal cord injuries and contributed much to our current knowledge of spinal cord diseases. We review the current English and French literature regarding this neuroanatomist who was the first woman to directly contribute to the writing of a neuroanatomy textbook. Clin. Anat. 20:585–587, 2007. © 2007 Wiley‐Liss, Inc.
Coronary and left ventricular pacing as standby in invasive cardiology
Authors: De La Serna Fernando , Meier Bernhard , Pande Abhay K. , Urban Philip , Adatte Jean‐Jacques , Moles Victor P. , Killisch Jean‐Pierre , Bodenmann Jean‐Jacques , Barcellona Gaetano , Dorsaz Pierre‐André , Favre Josiane
Published: March 2007

Coronary pacing using as unipolar negative electrode a guidewire placed in a coronary branch was tested in 349 sites of 300 consecutive patients undergoing coronary angio‐plasty. It was possible for 339 sites (97%). The threshold currents ranged from 1 to 15 (mean ± standard deviation 3.4 ± 2.4) mA. Side effects were seen in 13 patients (4%): 6 (2%) had transient coronary spasm, 4 (1%) had diaphragmatic stimulation, and 3 (1%) had stinging pain at the skin electrode. Of the 10 cases with pacing failure, left ventricular pacing was successfully tested in 5 by introducing the coronary wire or another wire into the left ventricle. It yielded a threshold of 2–8 (3.2 ± 2.7) mA. Therapeutic pacing for significant bradycardia was required in 7 patients (2%). It was successful in all. Coronary or left ventricular pacing appears to be a simple and reliable temporary measure. When there is no wire in the coronary artery or for diagnostic catheterization, left ventricular pacing can be done using the same setup and any type of guidewire.
Percutaneous closure of a secundum atrial septal defect and double balloon valvotomies of a severe mitral and aortic valve stenosis in a patient with lutembacher's syndrome and severe pulmonary hypertension
Authors: Ruiz Carlos E. , Gamra Habib , Mahrer Peter , Allen John W. , O'Laughlin Martin P. , Lau Francis Y. K.
Published: March 2007

This is a 43‐yr‐old female presenting with recurrent atrial septal defect, closed surgically, 10 years prior, severe aortic and mitral stenosis, and severe tricuspid regurgitation. She was considered inoperable because of the severe pulmonary hypertension and the complexity of the disease. A percutaneous umbrella closure of the atrial septal defect in conjunction with mitral and aortic balloon valvotomies could be safely and successfully performed. After significant clinical and hemodynamic improvement, surgery was judged feasible, but was refused by the patient who suddenly expired 8 weeks later.

The usefulness of percutaneous therapy as a rescue procedure and the management of patients with Eisenmenger's physiology are discussed.
Coronary arteriovenous fistula presenting as congestive heart failure
Authors: Kugelmass Aaron D. , Manning Warren J. , Piana Robert N. , Weintraub Ronald M. , Baim Donald S. , Grossman William
Published: March 2007

Coronary arteriovenous fistulae are rare, but can be of hemodynamic significance. We report a circumflex‐coronary sinus fistula in an elderly man which was associated with a loud continuous murmur and congestive heart failure. Noninvasive evaluation, including transesophageal echocardiography and magnetic resonance imaging, suggested the diagnosis. Angiographic diagnosis of concomitant atherosclerotic coronary disease may be difficult, and can require postoperative study. © 1992 Wiley‐Liss, Inc.
Origin of all three coronary arteries from separate ostia in the right sinus of valsalva: A rarely reported coronary artery anomaly
Authors: Pollack Brian D. , Belkin Robert N. , Lazar Steven , Pucillo Anthony , Cohen Martin B. , Weiss Melvin B. , Herman Michael V.
Published: March 2007

Anomalous origin of the circumflex and left anterior descending coronary arteries from separate ostia in the right sinus of Valsalva is a rarely reported phenomenon. Few clinical details concerning patients with this anomaly are available in the literature. Angiographic and clinical data in an adult patient with this finding are reported here. © 1992 Wiley‐Liss, Inc.
Coronary rotational ablation for unsuccessful angioplasty due to failure to cross the stenosis with a dilation catheter
Authors: Brown Robert I.G. , Penn Ian M.
Published: March 2007

Attempted coronary angioplasty of a right coronary artery sub‐total occlusion was unsuccessful due to failure to cross the lesion with the dilatation catheter. Both fixed‐wire and over‐the‐wire systems were tried. Coronary rotational ablation was successful in reducing the stenosis and allowing successful angioplasty. © 1992 Wiley‐Liss, Inc.
Prolapsing large aneurysm of the atrial septum simulating a right atrial mass
Authors: Angelini Paolo , Wilansky Susan , Gaos Carlos , Montazavi Ali , Boncompagni Enzo , Cooley Denton A.
Published: March 2007

An unusual case of a large, prolapsing atrial septal aneurysm in a patient with an otherwise normal heart is described. The aneurysm caused right atrial obstruction and resuited in a “tumor effect.” The patient experienced debilitating symptoms for years before receiving an appropriate diagnosis and curative surgical treatment. © 1992 Wiley‐Liss, Inc.
Right atrial myxoma associated with vascular malformation and atypical chest pain
Authors: Fox James J. , Bonavita Gregory J. , Sethi Virender
Published: March 2007

A 58‐yr‐old woman with a right atrial myxoma associated with a vascular malformation supplied by the right coronary artery is described. She presented with atypical chest pain that was reproduced during angiography of the malformation. Findings were confirmed during surgery. © 1992 Wiley‐Liss, Inc.
Instantaneous recruitment of reversed coronary collaterals that had been dormant for six years
Authors: Moles Victor P. , Meier Bernhard , Urban Philip , Pande Abhay K.
Published: March 2007

We report a case of instantaneous recruitment of reversed coronary collaterals 6 years after their disappearance with recanalization of the recipient vessel. Coronary collaterals can provide flow in both directions and remain immediately recruitable for years in case of occlusion of either vessel involved. © 1992 Wiley‐Liss, Inc.
Intracoronary thrombus: Chronic urokinase infusion and evaluation with intravascular ultrasound
Authors: Jain Ashit , Ramee Stephen R. , Mesa Juan , Collins Tyrone J. , White Christopher J.
Published: March 2007

Percutaneous revascularization of coronary arteries with intraluminal thrombi is a clinical problem. We report a patient in whom we administered prolonged infusion of intracoronary urokinase and then assessed the stenosis with intravascular ultrasound before and after atherectomy. We found both angiography and intravascular ultrasound to be misleading in determining the presence of residual thrombus after thrombolysis. © 1992 Wiley‐Liss, Inc.
Percutaneous transfemoral spring coil embolization of a pseudoaneurysm of the femoral artery
Authors: Saito Shigeru , Arai Hidekazu , Kim Kunikane , Aoki Naoto , Tsurugida Masanobu
Published: March 2007

Pseudoaneurysm of the femoral artery is a possible complication of percutaneous trans‐femoral catheterization. Its typical treatment has been open surgical repair. This article describes a new technique for the treatment of femoral artery pseudoaneurysm by spring coil embolization. © 1992 Wiley‐Liss, Inc.
ACS RX™ flow support catheter as a temporary stent for dissection or occlusion during balloon angioplasty: Initial experience
Authors: Heuser Richard R. , Mehta Steven , Strumpf Robert K.
Published: March 2007

The ACS RX™ flow support catheter, which functions as a temporary stent, was placed successfully during four procedures in three patients who had suboptimal results following angio‐plasty. This investigational device allowed prolonged perfusion and supported the vessel wall when coronary blood flow was compromised, avoiding emergent coronary artery bypass graft surgery during two procedures. In the remaining procedures the device was used as a bridge to surgery. These early applications of the flow support catheter following failed balloon angioplasty suggest a rapid, effective alternative to the auto‐perfusion balloon when it fails or is contraindicated because of the lesion location.
Failure of endocardial biopsy from the internal jugular vein due to endocardial scar: A new indication for the femoral venous approach
Authors: Matthai William H. , Herrmann Howard C. , Kussmaul William G.
Published: March 2007

Following cardiac transplantation, patients undergo serial endomyocardial biopsies to evaluate rejection, usually by the internal jugular approach. A case report and data are presented that demonstrate that this approach becomes less efficient and occasionally impossible in the third year after transplant (53% success rate per biopsy attempt) as compared to the first year after transplant (80%) probably due to the development of endocardial scar in the area sampled by the bioptome. Alternatively, one can change to the femoral venous approach which continues to have a high success rate in the third year after transplant (83%) because a different area of the interventricular septum is sampled when this approach is used.