bluuebunny/crossref_metadata_2025 huggingface dataset:
Balloon catheter control of a ruptured abdominal aortic aneurysm in a patient with Cullen's sign
Authors: Armour R H , Clifton M A , Marsh C H
Published: March 2007

A patient with Cullen's sign due to a ruptured abdominal aortic aneurysm is reported. At operation a ballon catheter was used to stop severe retroperitoneal bleeding and the aneurysm was replaced with a graft.
Diagnosis of malignant breast disease by axillary lymphoscintigraphy: A preliminary report
Authors: Agwunobi T C , Boak J L
Published: March 2007

The ability of regional lymph nodes to take up 99Tcm- labelled antimony sulphide colloid from the breast tissue was studied in 50 patients with mammary symptoms by gamma-camera scanning. Thirteen out of 14 patients with histologically confirmed carcinoma of the breast had a depressed uptake of labelled colloid in ipsilateral nodes, i. e. a positive scan. Twenty-nine out of 32 patients with benign breast disease had a negative scan. The method promises to aid both the precise diagnosis o breast disease and the definition of the extent of mammary cancer.
A prospective study of subclavian vein catheters used exclusively for the purpose of intravenous feeding
Authors: Blackett R L , Bakran A , Bradley J A , Halsall A , Hill G L , McMahon M J
Published: March 2007

One hundred and seventy-eight central venous catheters inserted via the subclavian vein for the purposes of intravenous feeding were studied in 77 patients.

Insertion of the catheter was complicated by puncture of the subclavian artery on three occasions and by a pneumothorax on two.

Catheters remained in situ for a mean period of 10 days. Ninety-two were removed because the requirement for nutrition no longer existed and 86 were removed because of suspected infection, venous thrombosis or mechanical problems. Infective organisms were grown from 17 catheters (9.5 per cent) but other unrelated causes of infection were frequently present in the population under study. Venous thrombosis of a major upper limb vein was seen in 8 patients.
Abdominal tuberculosis in the 1970s: A continuing problem
Authors: Shukla H S , Hughes L E
Published: March 2007

Eight cases of abdominal tuberculosis (5 indigenous and 3 immigrants) treated in Cardiff in the 5-year period 1972-6 were studied to determine clinical presentation, errors in diagnosis and usefulness of investigations. The heterogeneous presentation is reflected in the 7 types of lesion seen in the 8 cases. Anorexia and weight loss were present in all cases and abdominal colic and postprandial discomfort were common. No patient had diarrhoea, constipation or intestinal obstruction. The clinical diagnosis was wrong 7 out of 8 times. Investigations were unhelpful in the diagnosis and where a lesion was found on barium studies, a diagnosis of Crohn's disease or carcinoma was made. The same was true of the findings at laparotomy.

The examinations most useful in the diagnosis were histopathological examination for caseation and demonstration of acid-fast bacilli by alcohol and acid-fast tissue stains, or by a culture technique. The need for a greater awareness of abdominal tuberculosis, not only in immigrants but also in the indigenous population of Britain, is apparent.
A microsurgical technique for the creation of arteriovenous fistulas
Authors: Mansfield Averil , Cooke Timothy
Published: March 2007

A new method for creating arteriovenous fistulas employing microvascular techniques is described. It is proposed that this method should be used in problem cases where conventional means have failed or as a first procedure in cases in which technical problems are envisaged. A two-stage microvascular procedure has been used to create adequate fistulas in these difficult cases. Satisfactory fistulas have been formed in 15 out of 16 patients in whom these techniques have been used.
Strangulating adhesive small bowel obstruction with normal radiographs
Authors: Gough Ian R
Published: March 2007

A review of patients having laparotomy for adhesive small bowel obstruction has revealed that many patients have normal radiographs on admission and that this group of patients, who are predominantly women, have delayed laparotomies and are at a significantly increased risk of developing strangulating obstruction while in hospital. The clinical and laboratory data which may distinguish strangulating from non-strangulating obstruction were examined and found to be non-discriminatory in this series.
Day care after operations for hernia or varicose veins: A controlled trial
Authors: Ruckley C V , Cuthbertson Constance , Fenwick Norma , Prescott R J , Garraway W M
Published: March 2007

Alternative systems of care after operations for varicose veins or hernia were compared in a total of 360 selected patients, of whom 121 were allocated to be managed in an acute ward for 48 h, 122 in a convalescent hospital for 48 h and 117 to be discharged directly home to the care of the district nursing sister and general practitioner. There were no deaths or major complications. Anaesthetic or surgical problems caused 5 patients (3 convalescent and 2 day care) to be retained in hospital on the day of operation. Minor complications were recorded in approximately one-third of the patients. The majority of these were effectively dealt with by the district nursing sister and only one-third of the complications needed the attention of the general practitioner. Two of the ward patients and 1 of the convalescent patients required readmission to hospital (1 per cent in all). No significant difference was demonstrated in the medical outcome between the three groups after operation. Day care was the most economical of the three systems of care. Inquiry into the patients' opinions elicited the highest proportion of favourable responses in the day care group.
Results of Heller's operation for achalasia of the cardia
Authors: Menzies-Gow N , Gummer J W P , Edwards D A W
Published: March 2007

A survey of 102 patients with achalasia of the cardia treated by cardiomyotomy is reported. The technique of operation was unchanged throughout and the patients were followed up for a maximum of 22 years.

Only 6 patients (5.8 per cent) developed renewed symptoms of reflux and 7 patients (6.8 per cent) had peptic strictures. Over 80 per cent of the patients had no dysphagia or regurgitation postoperatively, but 61 per cent still complained of achalasic pain. The development of mucosal hernias after cardiomyotomy and the use of drinking times in the assessment of out-flow at the cardia are discussed.
Changes in metabolism of major food components in patients with intrathoracic replacement of the oesophagus with the stomach
Authors: Lam K H , Lim T K , Wong J , Ong G B
Published: March 2007

In 19 patients in whom the stomach had been used as an intrathoracic replacement after oesophagectomy the absorption of fat, carbohydrate and protein was studied. There is no single pattern of disturbance of such absorption. Protein digestion and absorption occur earlier and more rapidly than in normal subjects, probably as a result of accelerated gastric emptying.
Muscle chemistry of critically ill surgical patients and the effects of a course of intravenous nutrition
Authors: King R F J G , Collins J P , Morgan D B , Hill G L
Published: March 2007

The water, electrolyte and nitrogen contents of muscle were measured in 15 critically ill surgical patients before and after a course (approximately 2 weeks) of intravenous nutrition and in 8 normal individuals.

The muscle from the surgical patients contained a significantly increased ratio of water to fat-free dry weight (P < 0.01) due to an increase in the proportion of extracellular to intracellular water, and this was not corrected by intravenous nutrition. These changes could be due to an accumulation of extracellular fluid alone or to a loss of cell cytoplasm or a loss of whole muscle fibres. Intracellular chemistry was normal in the ill surgical patients and was not changed by intravenous nutrition.
Benign duodenocolic fistula
Authors: Howat John M T , Schofield Philip F
Published: March 2007

Benign duodenocolic fistula is a rare complication of a number of gastrointestinal diseases and it is seldom considered in diagnosis. Diarrhoea and weight loss are characteristic presenting features which may be masked by coexisting disease. Barium enema is the most useful diagnostic procedure. Prognosis is good if surgery is undertaken at an early stage after adequate correction of the metabolic consequences of the fistula, by administration of fluid, electrolytes and parenteral nutrition. This paper reports 4 cases of this condition and reviews the clinical features, investigation, aetiology and management.
Major arterial trauma: Review of experience with 267 injuries
Authors: Robbs J V , Baker L W
Published: March 2007

Experience with 267 arterial injuries treated over a 3-4 year period is reported. Vessels in the lower limb were involved most commonly (43 per cent), but there was also a relatively high incidence of carotid (13 per cent) and subclavian (9 per cent) injuries in this series. Penetrating wounds (stab and gunshot) were most comonly responsible. We found that serious distal ischaemia is uncommon in upper limb injuries, but expanding haematoma at the root of the limb is a cause of mortality and serious morbidity. Selective use of preperative angiography is recommended. Successful results follow liberal use of interpostion grafts after wide excision of doubtful vessel, rigorous wound excision, delayed primary closure and fixation of associated fractures. Repair of concomitant venous injuries should always be attempted but is more improtant in the lower than the upper limb. Late revascularization in the presence of critical ischaemia yields a 50 per cent limb salvage rate, but great care must be taken to avoid renal insufficiency and, if it occurs, energetic treatment is necessary for survival.
A method of grafting hand burns following early excision
Authors: Davies D M , Yiacoumettis A M
Published: March 2007

Early excision and delayed primary grafting of burns of the hand is presented as a method of achieving rapid healing, thus allowing early full mobilization. The results of 19 consecutively treated patients are reported.
Intrathoracic rupture of the spleen
Authors: Hocking Margaret A , Bolton Paul M
Published: March 2007

The case is reported of a 15-year-old girl who presented following trauma and was found to have a massive congenital diaphragmatic hernia through the foramen of Bochdalek. The spleen, which was intrathoracic, had ruptured. No other similar cases have been reported in the literature hitherto.
Prediction of wound sepsis following gastric operations
Authors: Gatehouse David , Dimock Frances , Burdon D W , Alexander-Williams J , Keighley M R B
Published: March 2007

Gastric aspirates were obtained from 12 healthy volunteers, 49 patients with duodenal ulcer, 14 with gastric ulcer and 35 with gastric carcinoma. The mean total viable bacterial counts in these groups were as follows: volunteers 0, duodenal ulcer 3.8 × 101, gastric ulcer 6.95 × 104, carcinoma 1.9 × 107 organisms/ml.

The incidence of wound sepsis in patients without antibiotic cover was: duodenal ulcer 17 per cent, gastric ulcer 38 per cent, carcinoma 56 per cent. Regardless of the underlying pathology, patients with counts greater than 5 × 106 organisms/ml in the gastric aspirate had a 93 per cent in incidence of wound sepsis, compared with 16 per cent in patients with counts of less than 5 × 106 organisms/ml (P <0.001). In the group with high counts all except one of the wound infections were caused by organisms present in the stomach at the time of operation.

There was a good correlation in the bacteriology of apirates obtained during preoperative endoscopy compared with operative nasogastric samples (n = 31) both for viable counts (r = 0.93) and for the counts of individual organisms. Therefore, preoperative endoscopy can be used to identify patients who are at risk of developing wound sepsis after gastric surgery.
Adenocarcinoma arising in a duplication of the rectum
Authors: Downing R , Thompson H , Alexander-Williams J
Published: March 2007

A case of adenocarcinoma arising within a rectal duplication is reported.
Clinical experience with silicone rubber grafts as shunts in portal hypertension
Authors: Parr D C , Hopkinson B R
Published: March 2007

We report the use of a woven silicone rubber graft as an alternative prosthesis for a shunt in 8 patients with portal hypertension. Four patients were operated on as emergencies and 4 electively. In 4 cases the graft was used as a standard mesocaval H graft, in 2 as a portocaval H graft and in 2 cases it was used to simplify the Warren selective distal splenorenal shunt. The material has properties which make it a superior graft to existing prostheses and autogenous vein. Our results confirm the experience of others, that the poor risk patients do badly whatever form of shunt is performed, and of those who survive, the total portal shunt carries the risk of postoperative encephalopathy.
Aneurysms of the extracranial carotid arteries
Authors: Carrascal L , Mashiah A , Charlesworth D
Published: March 2007

Aneurysms of the extracranial carotid arteries are unusual; they present difficulties in diagnosis and may cause death or cerebrovascular accidents in a majority of patients. This report describes three different types of aneurysm of the carotid arteries and their presentation and discusses their management.
Popliteal artery entrapment syndrome: A case report
Authors: Inada K , Hirose M , Iwashima Y , Matsumoto K
Published: March 2007

A rare case of bilateral popliteal artery entrapment syndrome is reported. Pathological changes of the occluded lesion in this anomaly were investigated in 8 other cases. Abnormal longitudinal muscle in the media was noted in all. Development of these muscle bundles was considered to be due to chronic trauma inflicted by pressure on the arterial wall. Its significance is emphasized to assist in differentiation from other chronic arterial occlusive disease.
The fibrinogen uptake test after hip surgery
Authors: Loudon J R , McGarrity G , Vallance R , Baylis A C , Graham J
Published: March 2007

The fibrinogen uptake test has been used to detect deep vein thrombosis after total hip replacement in 90 patients. The upper third of the thigh in each leg was ignored and peripheral leg counting carried out distal to this. The results were directly compared with the findings of venography in the 170 legs of the 90 patients. There was a high false positive rate (30 per cent) with the fibrinogen uptake test which was associated with the presence of knee joint efusion or varicose veins, but not with the site of operation. There was a low false negative rate (less than 5 per cent), and the fibrinogen uptake test, used in this way, may fail to detect a percentage of small thrombi in the wound area that are probably produced by the local trauma of operation.

It is considered that the fibrinogen uptake test has a clinical use as a screening test for deep vein thrombosis after hip replacement, but venography is required in the interests of accuracy.
The management and prognosis of oesophageal perforation
Authors: Sandrasagra F A , English T A H , Milstein B B
Published: March 2007

Our experience with the management of 28 patients with oesophageal perforation is reviewed. The majority of perforations followed oesophageal instrumentation. The occurrence of pain, fever or cervical crepitus following endoscopy should raise the suspicion of oesophageal perforation. Plain radiographs of the neck, chest and abdomen provided confirmatory evidence of the presence of a perforation in 89 per cent of our cases. Contrast studies of the oesophagus demonstrated the site and extent of the leak in 21 of the 26 cases in which they were performed. The overall mortality for the series was 32 per cent. The mortality for thoracoabdominal perforations was nearly three times that for the cervical segment. Instrumental perforations were associated with a lower mortality than spontaneous perforations or those following paraoesophageal surgical procedures. The coexistence of an oesophageal obstruction with a perforation did not have an adverse effect on the outcome. The time lapse between the occurrence of the perforation and surgical intervention had a profound influence on the morbidity and mortality. Early closure of the perforation with drainage was associated with a 25 per cent mortality for thoracoabdominal perforations and no complications in the survivors. A delay of over 24 h, on the other hand, was associated with a high incidence of septic complications in both cervical and thoracoabdominal perforations, a longer period of drainage and a 50 per cent mortality in the latter group. A plea is therefore made for early surgical intervention in both cervical and thoracoabdominal perforations.
Diets and stoma function
Authors: Gazzard B G , Saunders B , Dawson A M
Published: March 2007

Fifty ileostomy and 50 colostomy patients were questioned as to which foods upset their stoma function. Most patients had no problem in finding a suitable diet and 70 per cent would eat any food on occasions, although half the patients found that side effects with particular foods were a nuisance. Only a small range of foodstuffs seemed to produce symptoms in a significant proportion of patients.

We feel that no particular foodstuff should be eliminated from a diet without an adequate trial as most patients are able to eat entirely normally.
Sigmoid motility and clinical results after transverse taeniamyotomy for diverticular disease
Authors: Pescatori M , Castiglioni G C
Published: March 2007

The purpose of our investigation was to evaluate the effect of multiple transverse taeniamyotomy on sigmoid motility and on the clinical picture of 8 patients affected by symptomatic, uncomplicated diverticular disease of the sigmoid, selected for the operation after the failure of medical therapy. We recorded rectosigmoid intraluminal pressures and the manometric tracings were correlated with the corresponding photofluorograms before and after the operation for 1 year.

Motility indices were computed and a significant decrease after meals and Prostigmin was found in patients who underwent transverse taeniamyotomy. These functional changes were accompanied by a marked clinical recovery, expressed in terms of relief from lower abdominal pain and improvement in bowel movements.

Considering the functional and clinical disadvantages reported after colectomy and longitudinal myotomy, and observing our results after transverse taeniamyotomy, even though they are short term results, we conclude that the latter operation is an effective procedure for the treatment of diverticular disease with muscular hypertrophy and high intracolonic pressure which has not responded to a medical and dietetic regimen.
The long term sequelae of deep vein thrombosis
Authors: Mudge Marjorie , Hughes L E
Published: March 2007

Five hundred and sixty-four patients undergoing abdominal surgery, who were carefully assessed at the time of operation for evidence of venous thrombosis, have been followed up to determine the incidence of legsymptoms, varicose veins and post-thrombotic syndrome.

Patients are frequently troubled by pain, swelling and phlebitis, which can persist for up to a year after operation. New varicose veins developed by 1 year in 20 per cent of patients. These occurred with increased frequency in patients who also developed a deep vein thrombosis, but they were also seen in patients who showed no clinical or isotopic evidence of thrombosis. The post thrombotic syndrome was present in 26 patients by 3 years after the operation; half of these patients had suffered the syndrome before the definitive operation.

Assessment of the long term effects of venous thrombosis must be carried out against the background of similar effects seen in patients without thrombi, and the development of the post-thrombotic syndrome may best be considered as the summation of a number of incidents, overt or occult, occurring throughout a lifetime.
The clinical and economic effects of early return to work after elective inguinal hernia repair
Authors: Bourke J B , Taylor M
Published: March 2007

Since 1 January 1976 male patients of four consultant surgeons undergoing elective repair of a unilateral inguinal hernia have been included in a trial to see if ‘early’ return to work or normal activity is associated with an increased recurrence rate and also to investigate any economic consequences. To date 295 patients have been entered into the trial and the first 150 have been reviewed at 1 year. There was a complete follow-up at 1 year. There was 1 recurrence (0·7 per cent) at 1 year, and this had occurred by the time the patient came to the clinic to be included in the trial. Patients supervised by their general practitioner were off work for 78·5 days, while those advised to return to work early were off work for 52·1 days. This difference of 25·4 days is significant at the 0·1 per cent level. Loss of earnings while off work was reported by 36·7 per cent of patients, and the average sum lost was £19·86 per week. Thus, patients lost £72·06 on average. If patients went back to work at 52 days instead of at 78 days, the benefit to the economy would be of the order of £7 m., and this ‘early’ return to work is not associated with an increase in the recurrence rate at 1 year.
Assessment of the nutritional state of patients with an intestinal fistula
Authors: Gross E , Holbrook L B , Thornton Margaret
Published: March 2007

The arm muscle area, derived fat-free mass, urinary excretion of 3-methylhistidine and creatinine were measured serially in a group of patients with an intestinal fistula receiving prolonged nutritional support. While the two anthropometric tests appeared reasonable indicators of changes in muscle mass in these patients, the marked intra-individual variability in excretion of 3-methylhistidine and creatinine created problems in interetation.

It is suggested that more use be made of serial anthropometry in district general hospitals as an alteranative, simple, measure of nutritional status.
Early breast cancer: Part I: Surgical pathology and preoperative assessment
Authors: Hughes L E , Forbes J F
Published: March 2007

The management of early breast cancer is showing a growing tendency to move away from radical surgery back towards conservative surgery and systemic adjuvant therapy. This paper and the one that follows review the data that underly this trend and consider the clinical and biological principles that are presently used to make a decision regarding the optimal primary treatment for breast cancer. The conclusion is reached that conservatism is based on a false understanding of the disease and on false conclusions drawn from premature analysis of data from clinical trials.

Optimal management can be determined by appropriate preparative investigation. Breast cancer patients can be divided into three groups: early cases, with a good prognosis, late, incurable cases and an intermediate group. Radical therapy by surgery or surgery combined with radiotherapy gives better results than a conservative approach in the early and intermediate groups. The intermediate group should be seen as having a poor, but not necessarily hopeless prognosis. These cases may benefit particularly from adjuvant chemotherapy, but this should not be used as an excuse to deny the patient adequate local measures, which alone (at present) offer hope of cure. The problem posed by the third group should be seen as one of optimal palliation.

Adjuvant systemic therapy raises hope of improving results, but no patient with breast cancer has yet been cured by chemotherapy or the application of immunological principles. Future improvements are most likely to derive from optimal use of each modality, and not at the expense of the most effective method at present available–radical surgery. The many remaining questions regarding management can best be answered by careful, controlled clinical studies, and every effort should be made to include patients with a poor prognosis in appropriate clinical trials.
99Tcm-polyphosphate uptake by breast tumours
Authors: Clyne Charles A C , Perry P M , Gibson A , MacLeod M A
Published: March 2007

Technetium polyphosphate uptake by breast tumours has been investigated in 69 patients. Although 70 per cent (38 out of 54) of malignant tumours took up the isotope in comparison with 45 per cent (5 out of 11) of benign lesions, this technique would be unreliable for diagnostic purposes.
Relief of lymph obstruction by use of a bridge of mesentery and ileum
Authors: Kinmonth J B , Hurst P A , Edwards J M , Rutt D L
Published: March 2007

The background to the use of a bridge of ileum with its associted mesentery in the relief of lymphatic obstruction is described. A case report of the successful use of this method in a 22-year-old patient with lymphedema praecox is presented. Following experience with further cases. It is suggested that. Provided changes in lymph channels and in the tissues of the affective drainage through small gut lymphatics may be achieved.
Common bile duct perfusion combined with operative cholangiography
Authors: Hopton David
Published: March 2007

A series of 223 patients undergoing cholecystectomy has been studied. In 204 patients the common bile duct was perfused with saline at a pressure of 30 cm. The rate of flow has been analysed as a means of determinaing the presence of common bile duct stones, this being confirmed on the evidence of operative cholangiography or exploration of the duct. The results suggest that flow studies can be more consistently obtained than cholangiograms, which were not available for technical reasons in 8·0 per cent of patients in this series. The results of flow studies are comparable with those of cholangiography in confirming the normality of the common bile duct but are less reliable in detecting stones. The reliability is such that if radiological facilities are not available, flow studies are an acceptable alternative.

In none of these patients was stenosis of the sphincter of Oddi detected. If this clinical entity does exist, it is rare and of little significance.
Cryosurgery in the management of rectal tumours
Authors: Osborne D R , Higgins A F , Hobbs K E F
Published: March 2007

Ten patients with rectal tumours were treated by cryosurgery. Good palliation without local complications was achieved in the cases of rectal carcinoma and a complete cure followed treatment of benign rectal tumours. Low rectal carcinomas with clinical evidence of dissemination are ideally suited for cryosurgery and complications are minimal. Cryosurgery is a simple, safe procedure which can be performed without a general anaesthetic, and this study indicates that it has a place in the management of rectal tumours.
Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis
Authors: Baker W N W , Glass R E , Ritchie Jean K , Aylett S O
Published: March 2007

The case notes of all patients treated for ulcerative colitis by colectomy and ileorectal anastomosis at the Gordon Hospital under the care of Mr S. O. Aylett from 1952 to 1976 have been reviewed. Three hundred and seventy-four patients left hospital with an ileorectal anastomosis and have been followed for periods up to 23 years. Twenty-two patients are known to have developed a carcinoma of the rectum. Within 10 years of the onset of the disease, no rectal carcinoma was found in 3534 patient-years. The risk was 1 in 185 patient-years between the tenth and twentieth years and 1 in 115 patient-years between the twentieth and thirtieth years. The cumulative risk was 6 per cent (± 2 per cent) at 20 years and 15 per cent (± 4 per cent) at 30 years.

The need for meticulous follow-up is emphasized. The finding of dysplasia in rectal mucosal biopsies will, it is hoped. identify the patient at particularly high risk and enable rectal excision to be undertaken before carcinoma develops.
The medical management of renal artery stenosis in transplant recipients
Authors: Jachuck S J , Wilkinson R , Uldall P R , Elliott R W , Taylor R M R , Hacking P M
Published: March 2007

The investigation, management and clinical course of 12 patients developing stenosis of the renal artery following transplantation are described. The possible aetiology of the three arteriographic patterns of stenosis is discussed. Surgical correction of graft arterial stenosis is difficult and may lead to graft loss, whereas the outcome with antihypertensive drug treatment with or without anticoagulants is good. Surgery should only be contemplated if medical treatment is failing or if renal function is deteriorating.
Arteriovenous grafts for vascular access in haemodialysis
Authors: Kester R C
Published: March 2007

The outcome of 68 arteriovenous grafts placed in 46 patients requiring haemodialysis was studied over a period of 3.5 years. The biological grafts included autogenous saphenous vein, modified bovine carotid artery and human umbilical cord vein allograft, whereas the synthetic grafts comprised Sparks Dacron mandril, expanded reinforced polytetrafluoroethylene and knitted Dacron velour. These subcutaneous grafts were arranged as looped or straight configurations in the forearm or thigh. Of 59 grafts evaluated in patients with end-stage renal failure, only 48 per cent of the forearm grafts performed well, compared with 85 per cent of the thigh grafts. Although only 38 per cent of the looped grafts were successful, 78 per cent of the straight grafts functioned satisfactorily. Synthetic grafts suffered less serious complications than the commercial biological grafts.
Pyeloduodenal fistula: A case report and review of the literature
Authors: Batch A J G , Amery A H , Reddy E R
Published: March 2007

A case of the rare condition of pyeloduodenal fistula is presented—the thirty-second case so far recorded in the literature. The authors consider that this instance shows some of the features typical of the cases so far reported.

The literature is reviewed and the aetiology, presentation, diagnostic methods and treatment are briefly discussed.
Results of proximal gastric vagotomy over 1–5 years in a district general hospital
Authors: Makey D A , Tovey F I , Heald R J , Clark C G
Published: March 2007

One hundred and seventy-three patients underwent proximal gastric vagotomy for duodenal ulceration over a 6-year period. One hundred and fifteen of these have been followed up for 1–5 years. The operative mortality was nil and the result was satisfactory in 91 per cent. The incidence of side effects was small, notably that of dumping being 2.4 per cent and of diarrhoea, 3.6 per cent. Incidence of postoperative heartburn was reduced from 13 per cent to 4 per cent by the introduction of hepatic interposition.

The incidence of recurrent ulceration was 5.1 per cent after an average interval of 2 years and that of new gastric ulceration 2.6 per cent after an average of 4 years. There were no recurrent ulcers in those who had peroperative Burge tests, although secretory studies showed no difference between those tested and those not tested. Most recurrences occurred in the earliest cases operated on before Burge testing was introduced and when only 2 cm of the lower oesophagus were exposed.
Long term follow-up of patients with gastric ulcers treated by vagotomy, pyloroplasty and ulcerectomy
Authors: Cade David , Allan David
Published: March 2007

Vagotomy and pyloroplasty with excision of the ulcer has been performed in a series of 90 patients with benign gastric ulcers. Long term follow-up has shown only 2 patients with recurrent ulceration. Fifty-eight patients with more than 2 years' follow-up attended for personal interview, of whom 96 per cent had a satisfactory result.
Volume infusion in experimental refractory shock
Authors: Smith J A R , Norman J N
Published: March 2007

The postulated contribution of primary myocardial failure to the pathogenesis of refractoriness of shock to conventional therapy is in direct contradiction to the widely advocated clinical practice of infusion of large volumes of fluid in shock resuscitation. A standard canine haemorrhagic shock model, in which refractory shock is induced by maintaining an arterial blood pressure of 40 mmHg for 2 h, has been used to assess the effects of volume infusion to maintain a central venous pressure of 0–2 mmHg for a further 2 h and the tolerance of such an infusion by the heart in refractory shock.

Fluid infusion ensured significantly better figures for oxygen balance than in those animals where additiotial fluid was not given, and the volumes required appeared to be well tolerated by the shocked myocardium.

Primary myocardial failure does not appear to be a major aetiological factor in refractory shock, and provided that the usual monitoring parameters are recorded, volume infusion remains a major part of shock resuscitation.
Sequential patterns of haemodynamic and metabolic changes in experimental hypovolaemic shock. II. Responses to reinfusion of shed blood
Authors: Pardy B J , Dudley H A F
Published: March 2007

The haemodynamic and metabolic effects which follow the infusion of blood in experimental hypovolaemia have not been studied in detail. The 10 dogs that survived 90 min of hypovolaemia in a study of bleeding (Pardy and Dudley, 1979) were investigated during and shortly after the reinfusion of shed blood using the same techniques.

Data from 9 animals were suitable for analysis. As with bleeding, 6 sequential phases were identifed; reinfusion of blood was completed in the fifth phase. Initial reinfusion was associated with a rapid improvement in haemodynamic and metabolic status, although mean arterial pH fell because carbon dioxide production increased. Maximum metabolically effective tissue perfusion was probably attained in phase II, but haemodynamic improvement continued until phase IV. Arterial pH did not rise above the pre-infusion value until phase V, and this rise was the result of a fall in PaCO2 secondary to a reduction in physiological dead space and an increase in buffering capacity.

Pulmonary artery pressure was superior to systemic artery pressure as a predictor of cardiac output during blood volume restoration. A number of conclusions pertaining to clinical practice are drawn.
The reproducibility of the station pullthrough technique for measuring lower oesophageal sphincter pressure
Authors: Hay D J , Goodall R J R , Temple J G
Published: March 2007

The results are presented of two studies of the station pullthrough technique for lower oesophageal manometry. The first part of the work is an assessment of the reproducibility of this technique using both an infused tube system and a system of subminiature, intraluminal strain gauge transducers. The second part of this report describes a study into the effect that the position of the recording hole on the probe may have in relation to the measured pressure for the lower oesophageal sphincter.
Chylothorax following resection of the oesophagus
Authors: Lam K H , Lim S T K , Wong John , Ong G B
Published: March 2007

Chylothorax complicating operations on the oesophagus has been reported infrequently; it carries a mortality rate of about 50 per cent. A search of the literature has yielded only 10 cases. This paper reports 4 further cases which occurred among 685 resections of the oesophagus, giving an incidence of 0.6 per cent. The diagnosis should be confirmed with lymphangiography. Treatment should be early exploration and ligation in patients in whom the thoracic duct has been divided at operation. If the duct has been injured during blind dissection a period of conservative treatment is advisable. Parenteral nutrition is a useful adjunctive treatment.
Complications associated with the use of the Celestin tube for benign oesophageal obstruction
Authors: Ranson M B , John H T
Published: March 2007

Two cases are described in which disruption of a Celestin tube took place after being lodged in a benign oesophageal stricture for 14 months. One patient presented with apparent acute pancreatitis and the other with a minor gastrointestinal bleed.
Translocating the aberrant right subclavian artery in dysphagia lusoria
Authors: Mok C K , Cheung K L , Kong S M , Ong G B
Published: March 2007

A case of dysphagia lusoria with unusual associated symptoms in an adult is presented. The condition was treated by division of the aberrant right subclavian artery at its origin through a median sternotomy and translocating the distal subclavian artery to the aortic arch with an interposition Dacron graft. All the reported techniques of dividing and transposing the aberrant right subclavian artery in dysphagia lusoria are reviewed and discussed.
Gastric carcinoma and previous peptic ulceration
Authors: Ellis D J , Kingston R D , Brookes V S , Waterhouse J A H
Published: March 2007

The incidence of patients with gastric carcinoma having had a previously diagnosed or suspected peptic ulcer was noted in two studies. These studies were the West Midlands Gastric Chemotherapy Trial (1974–6) and a retrospective study of patients presenting to the United Birmingham Hospitals with gastric carcinoma during the years 1958–62 and 1968–72.

The incidence of patients found to have had a previous operation for duodenal ulcer or to have post-mortem evidence of one was 6.5 per cent and 5.7 per cent respectively. A radiologically proved duodenal ulcer had been identified in 5.5 per cent and 2.1 per cent respectively and the incidence of previous symptoms suggestive of a duodenal ulcer was 4.0 per cent and 5.2 per cent. These figures indicate the total incidence could be 12.97 – 16.0 per cent, which is much higher than previously reported.

The mean time interval between operation for duodenal ulcer and the development of gastric carcinoma was much longer in patients having had a partial gastrectomy than in patients having had a vagotomy and drainage procedure.

The incidence of previous benign gastric ulcers was 2.5 per cent and 0.9 per cent. Fifty-three per cent of patients having had a previous operation for duodenal ulceration were found to have an unresectable carcinoma, compared with the overall unresectable rate of 35 per cent.
Late revascularization of the lower limb following acute arterial occlusion
Authors: Robbs J V , Baker L W
Published: March 2007

Thirty-four patients presenting with signs of grave ischaemia of the lower limb following acute arterial occlusion had revascularization procedures performed. Fifteen of the incidents followed embolism or thrombosis and 19 were due to a traumatic cause.

Limb salvage was achieved in 67 per cent of the non-traumatic group und in 56 per cent of the traumatic group. Severe complications such as crush syndrome and disseminated intravascular coagulation occurred but there were no deaths.

No significant adverse factors with regard to limb prognosis could be defined.

We feel that late revascularization in the absence of major gangrene is worth while provided that facilities for critical postoperative care exist.
Ascaris lumbricoides and perforation of the ileum: A critical review
Authors: Ihekwaba Frank N
Published: March 2007

Ileal perforation due to typhoid bacilli is the commonest cause of peritonitis in the Tropics. Perforation due to Ascaris lumbricoides is rare. Three cases of ileal perforation believed to be due to A. lumbricoides are presented and the evidence critically reviewed. It is suggested that signs of heavy infestation with A. lumbricoides make a diagnosis of intestinal perforation more likely in a patient with an acute abdomen.
Thyroid cancer in Kuwait: Review of 117 cases
Authors: El-Ghamrawi K A , Khalifa M S
Published: March 2007

One hundred and seventeen patients with thyroid cancer were seen at the Radiotherapy and Isotope Centre, Al-Sabah Hospital, Kuwait, between 1963 and 1974. Thyroid cancer constituted 4.7 per cent of all cancer cases among females and 2.4 per cent among males. Of these carcinomas, 58 per cent were papillary, 25 per cent follicular, 11 per cent anaplastic and 1.7 per cent medullary. Four cases (3.4 per cent) were of malignant lymphoma. The 10-year survival was 74, 96 and 21 per cent for papillary, follicular and anaplastic tumours respectively. The present series confirms the prognostic value of age, sex and histology and shows that node metastasis does not prejudice survival. The study does not show any correlation between the type of operation and survival.
Non-occlusive acute intestinal vascular failure
Authors: Haglund Ulf , Lundgren Ove
Published: March 2007

The records of 87 patients with vascular intestinal insufficiency leading to gangrene were analysed in retrospect. In 77 patients the cause of the vascular insufficiency could be determined. In 25 per cent no organic obstruction to blood flow was found in the macroscopic intestinal vessels. The patients with non-occlusive intestinal gangrene showed a tendency to be younger and to have associated cardiac infarction more frequently than those with vessel obstructions. Moreover, non-occlusive intestinal gangrene was found more frequently following a period of systemic arterial hypotension. A history of atrial fibrillation and digitalis therapy was present with equal frequency in both groups of patients.

Based on these cases and on current animal experimental data, it is suggested that the bowel gangrene seen in non-occlusive ischaemia is due to short-circuiting of oxygen at the base of the villi in the villous counter-current exchanger. This mechanism becomes much more effective in hypotension owing to reduced velocity of the villous blood flow. The possibility is emphasized that, with a coexisting atherosclerotic narrowing in the mesenteric vascular tree, cardiovascular disturbances which are themselves not enough to alter central arterial pressure, may none the less induce regional hypotension. Such regional hypotension could lead to villous destruction and initiate a vicious circle which ends in generalized gangrene of the bowel.
Grey-scale ultrasonography and endoscopic pancreatography after pancreatic trauma
Authors: Vallon A G , Lees W R , Cotton P B
Published: March 2007

We have recently used grey-scale ultrasonography and endoscopic pancreatography to investigate II patients with symptoms attributed to pancreatic trauma weeks, months or even years earlier. The pancreas was normal in one patient, and another, who presented with pain and jaundice after a car accident, was shown to have cancer of the pancreatic head. The remaining patients all had local lesions due to trauma; ultrasound showed a mass or cyst close to the point of duct obstruction or stenosis shown on pancreatography. Ultrasonography and pancreatography can together provide a precise map with which to plan effective management in patients having suffered pancreatic trauma.
Modified surgical procedures in intestinal tuberculosis
Authors: Pujari B D
Published: March 2007

The results of modified surgical procedures in intestinal tuberculosis in 79 patients are presented. Special emphasis is laid on the role of limited ileocaecal resection and ileoplasty. These procedures are safe, quick and easy with preservation of functional portions of the bowel. They are of immense value in emergencies in chronically ill and emaciated patients.
Randomized controlled trial of cefuroxime for established postoperative respiratory infection
Authors: Litchfield J C , Keighley M R B , Myatt I W , Edwards M C
Published: March 2007

A randomized controlled trial has investigated the value of cefuroxime (a new antibiotic resistant to β-lactamase) in 80 patients with established postoperative respiratory infection. Although the majority of respiratory isolates were sensitive to cefuroxime, there was no significant advantage in the antibiotic group compared with the controls with respect to duration of fever, radiological abnormality or infected sputum. We conclude that antibiotics me rarely necessary for the majority of patients who develop postoperative respiratory injections.
The use of metronidazole in the preparation of the bowel for surgery
Authors: Taylor S A , Cawdery H M , Smith J
Published: March 2007

A randomized trial was carried out in 120 patients undergoing colonic surgery mainly for carcinoma. Sixty-one patients received metronidazole and Thalazole and 59 received Thalazole alone. Sepsis occurred in 8 (13.1 per cent) of the 61 patients who received metronidazole, compared with 29 (49.2 per cent) of 59 patients who received only Thalazole. Of the 8 patients with sepsis who received metronidazole, none had infection due to anaerobic organisms.
Treatment of chronic oesophageal perforations with special reference to an endoscopic method
Authors: Gunning A J , Kingsnorth A
Published: March 2007

The endoscopic treatment of chronic oesophageal perforations (more than 18–24 h old) by the application of sodium hydroxide 20 per cent to the edges of the perforation is described. The importance of pleural and mediastinal toilet and the accurate siting of drainage tubes and full expansion of the lung, together with measures for diminishing oral, gastric and bilary secretions from the perforation, are stressed.

Five patients who have been treated by this conservative method are presented and the method compared with the more radical surgery advocated by the majority of other surgeons.
The anatomical basis for gastric mobilization in total oesophagectomy
Authors: Thomas D M , Langford R M , Russell R C G , Le Quesne L P
Published: March 2007

Following the injection of suitable media, the arterial tree of 22 post-mortem human stomachs was studied by angiography, or corrosion and micro-dissection. In stomachs infused exclusively by the right gastroepiploic artery, i.e. following ligation of all other gastric vessels on the stomach wall, both methods produced good fundal filling, while demonstrating consistently poor filling of a strip of stomach wall along the lesser curve.

These findings do not support the assertion that in operations involving mobilization and transposition of the stomach the viability of the fundus is critically dependent upon an anastomotic circulation involving the extragastric portion of the left gastric vessels, but rather indicate that these vessels can, if required, be excised with impunity in most patients, provided that there is no extensive atherosclerosis. However, these findings indicate that such a procedure may impair the blood supply of the lesser curve, and they provide an anatomical explanation of the occasional occurrence of necrosis of the lesser curve following proximal gastric vagotomy.
The temporary effect of proximal gastric vagotomy on experimental duodenal ulcers and gastric secretion
Authors: Joffe S N , Bapat R D
Published: March 2007

A proximal gastric vagotomy (PGV) prevented experimental duodenal ulcers in rats for only 5 days and thereafter all rats developed duodenal ulceration. In sham-operated rats the mean stimulated gastric acid output was 186 μmol/60 min. Immediately following a PGV there was a significant decrease in gastric juice volume and aridity (P < 0.001) with a fall in the mean stimulated acid output to 12 μmo1/60 min. On the seventh day after vagotomy the stimulated acid output (volume and concentration) significantly increased to 88 μmo1/60 min (P < 0.001). When the dose of gastric secretagogues was reduced by 50 per cent, a PGV on day 0 prevented any changes occurring in the duodenal mucosa, but when repeated at 4 weeks after a PGV the severity of duodenal ulcers in vagotomized rats was greater than in those having had a sham operation (P < 0.05). This transient effect of a PGV on duodenal ulcerogenesis and gastric secretion may be due to recovery of the parietal cell mass.
Vagotomy and pyloroplasty for gastric ulcers
Authors: Eastman M C , Gear M W L
Published: March 2007

Eighty patients with benign gastric ulcer treated by vagotomy and pyloroplasty in a district general hospital are reviewed. There were no postoperative deaths in the patients undergoing elective surgery but 8 deaths in those undergoing emergency surgery for massive bleeding (38 per cent). Eighty-three per cent of patients had a result that was classed as good or satisfactory. Recurrent gastric ulceration was found in 8 per cent and a tendency to late asymptomatic ulcer recurrence is identified. Careful long term follow-up, including endoscopic re-examination, is advocated for patients undergoing conservative operations for benign gastric ulcer.