bluuebunny/crossref_metadata_2025 huggingface dataset:
Orthotopic liver transplantation: Postoperative complications and their management
Authors: Kirby R M , McMaster P , Clements D , Hubscher S G , Angrisani L , Sealey M , Gunson B K , Salt P J , Buckels J A C , Adams D H , Jurewicz W A J , Jain A B , Elias E
Published: March 2007

The Birmingham liver transplant programme started in 1982. Forty-six patients have been transplanted with a follow-up of 3 months or longer. Twenty-seven patients are still alive, of whom sixteen have lived for more than one year. The 30 day hospital mortality was 30·4 per cent and the actuarial predicted one year survival 55·5 per cent. Four patients have been regrafted for chronic rejection and graft failure. Thirteen patients have required surgery in the postoperative period for: bleeding (two), removal of abdominal packs (four), biliary leaks and obstruction (five), duodenal perforation (one) and small bowel obstruction (one). Acute rejection was common, occurring in 30 patients and progressing to chronic rejection in 4. Ten patients developed renal failure with an 80 per cent mortality and eleven patients developed grand mal fits. Severe bleeding (>70 units) was associated with previous abdominal surgery and a high mortality (88·9 per cent). Opportunistic fungal infection carried a 100 per cent mortality. Although more than half of all transplanted patients will survive for more than one year, the postoperative period is still one of high morbidity and mortality.
Dysplasia of the colon after jejuno-ileal bypass
Authors: McFarland R J , Talbot R W , Woolf N , Gazet J-C
Published: March 2007

Colonoscopic biopsies were performed on 38 patients, 10–13 years after jejuno-ileal bypass. No significant dysplasia or premalignant change was seen in 371 biopsies. In one patient two tubulovillous adenomata were found in an otherwise normal colon, which is likely to be a chance finding. Although it will take another 10–20 years to establish whether jejuno-ileal bypass is associated with an increased risk of large bowel cancer in humans, there is at present no indication for regular colonoscopic surveillance.
Intraduct enterokinase is lethal in rats with experimental bile-salt pancreatitis
Authors: Terry T R , Grant D A W , Hermon-Taylor J
Published: March 2007

Controlled intraduct infusion and peri-acinar dispersal of 100 µl buffer containing sodium glycodeoxycholate (GDOC) at concentrations of 8·5, 17 and 34 mmol/l in rats caused a progressively severe acute pancreatitis from which none of the animals died over the experimental period. Infusion of affinity-purified active human enterokinase in buffer did not cause pancreatitis, presumably because of the inability of the macromolecule to gain access to its specific intracellular substrate trypsinogens. The addition of enterokinase 200 ng to GDOC 34 mmol/l in the infusate resulted in a severe systemic disturbance and a form of acute necrotizing pancreatitis which was uniformly and rapidly lethal. This effect was not seen when equimolar trypsin was substituted for enterokinase. These findings show that enterokinase specifically increases the lethality of experimental bile salt pancreatitis and suggest that this bile-borne enzyme may in some cases pose a significant clinical threat.
Mechanism of the haemostatic effect of ethanolamine oleate in the injection sclerotherapy for oesophageal varices
Authors: Kang J H , Kambayashi J , Sakon M , Shiozaki H , Ogawa Y , Ohshiro T , Mori T
Published: March 2007

Changes in coagulation and fibrinolysis were investigated in 20 patients with oesophageal varices, who underwent endoscopic injection sclerotherapy (EIS) with 5 per cent ethanolamine oleate (EO), by means of serial determination of plasma fibrinopeptide A (FPA) and fibrinopeptide β15–42 (β15–42). One hour after the completion of EIS, the value of FPA was significantly increased to 38·1 ± 11·1 ng/ml (mean ± s.e.m.) from a pre-EIS value of 7·1 ± 1·4 ng/ml (P>0·01) and it gradually returned to normal range by 48 h after EIS. A very similar change was observed in the value of Bβ15–42 (P>0·01). These observations indicated that EIS provokes transient activation of coagulation and fibrinolysis. In vitro studies, however, revealed that EO inhibits fibrin clot formation because of the Ca2+-chelating ability of its constituent ethanolamine, although oleate or benzyl alcohol exhibited procoagulant activity in FPA formation in vitro. Nevertheless, an external application of EO or oleate over decapsulized kidney of rat resulted in a significant accumulation of 125I-labelled fibrin(ogen). From these results it was suggested that intravascular injection of EO, which exerts an inhibitory effect on coagulation in vitro, activates the local coagulation system. The activation may be accelerated by an acute inflammatory process provoked by oleate, which is supported by such clinical manifestations as mild fever, retrosternal pain leukocytosis and an increase in plasma fibrinogen level which was observed in all during the period.
Staphylococcal infection of open granulating wounds
Authors: Marks J , Harding K G , Hughes L E
Published: March 2007

The significance of staphylococcal infection has been studied prospectively in 250 wounds healing by open granulation. In a series of 50 axillary skin excisions, 17 became infected with Staphylococcus aureus with consequent pain and delay in healing. The infections responded well to Fucidin ointment. Nasal carriers of the organism may be especially liable to this complication. In contrast, although S. aureus was not infrequently found in deep granulating wounds, there was no clear evidence of harm resulting in the 50 laparotomy wounds and 150 pilonidal sinus excisions studied. The susceptibility of superficial wounds to the infection is ascribed to friction from dressings. Deep granulating wounds are occasionally affected similarly when the cavity has filled.
Surgical staging of gastric carcinoma: Sources and consequences of error
Authors: Madden M V , Price S K , Learmonth Genevieve M , Dent D M
Published: March 2007

Macroscopic ‘TNM’ staging was performed during 78 consecutive operations for gastric carcinoma and compared with subsequent pathological staging. Surgical assessment was correct for tumour (T) in 60 per cent when depth of invasion was assessed, for nodes (N) in 61 per cent, for liver metastases (M) in 92 per cent but for all aspects in only 21 per cent. Curability (conservatively defined as T1–3, N0–1, M0) was correct in 8 of 18 patients thus assessed at surgery and incurability was pathologically correct in 58 of 60 patients. Despite inaccurate surgical staging, no patient was denied a resection although 10 patients had unduly radical procedures for their stage and 2 had inappropriately conservative procedures for their stage (but without evidence of residual disease). Staging errors did not jeopardize conventional surgical management substantially and use of intra-operative microscopic sampling of nodes would have improved surgical treatment only minimally.
Bush thoracotomy in the Highlands of Papua New Guinea
Authors: Fingleton L J
Published: March 2007

Bush thoracotomy is a procedure performed by traditional medicine men to let out blood and pus from the chest. It has a significant complication rate and 60 cases presenting to the major hospital in Papua New Guinea are analysed over a 2-year period. The complications were empyema (40), osteomyelitis of the rib (2), wound infection (2), pneumothorax (1), neuralgia (1) and chest pain (4). All cases were further complicated by underlying pulmonary infection and often by delay in presentation. Fifteen cases were seen in the first year (1983–84) and forty-five in the second (1984–85). A more aggressive surgical approach was adopted in the second year (21 thoracotomies with 17 decortications compared with 1 thoracoplasty in the first year). However, this course of events was accompanied by an increase in mortality from 0 to 5. Although there were a number of contributory factors, lesser surgical procedures, such as open pleural drainage, are recommended for the sicker patients.
The intragastric balloon: A novel idea proved ineffective
Authors: McFarland R J , Grundy A , Gazet J-C , Pilkington T R E
Published: March 2007

Twelve grossly obese patients who weighed 121 ± 22 kg (mean ± s.d.) had a free-floating 600 ml spherical intragastric balloon inserted per -oesophagus and have been followed for 12–24 months. Nine patients lost up to 21 kg (11 ± 6·4 kg) over 3 months after which they reached a plateau and then regained weight so that by 1 year only one patient had maintained her weight loss. Three patients could not tolerate the balloon owing to complete reflex inhibition of gastric emptying. Such marginal and temporary weight loss is of no value in the treatment of gross obesity.
The lower oesophageal sphincter after floppy Nissen fundoplication
Authors: Bancewicz J , Mughal M , Marples Margaret
Published: March 2007

The pressure and intra-abdominal length of the lower oesophageal sphincter (LOS) were measured by oesophageal manometry before and after floppy Nissen fundoplication (FNP) for intractable gastro-oesophageal reflux. Control of reflux was assessed by 24 h pH recording and endoscopy. It was complete in 67 cases (84·8 per cent) in this non-consecutive series. In the group as a whole LOS pressure increased significantly after FNP, but the intra-abdominal length did not. LOS pressure decreased in 21 cases of whom 16 (76·2 per cent) still had perfect reflux control. Likewise, intra-abdominal length decreased in 41 cases of whom 36 (87·8 per cent) had good reflux control. There was no evidence of a compensatory increase in length to account for reflux control when LOS pressure decreased. When a length—pressure diagram was plotted for the postoperative measurements no clear separation of those with persistent reflux could be seen. These results suggest that the measured changes in LOS pressure and length following FNP are an artefact of surgery rather than the means by which the operation controls gastro-oesophageal reflux.
Dietary habits of patients with regurgitation after colon interposition
Authors: Harju E , Isolauri J
Published: March 2007

The dietary habits after colon interposition following oesophagectomy in patients without symptoms (n = 8), with regurgitation (n = 22) and in sex-and age-matched healthy controls (n = 20) were studied by a 7-day diary method. The patients ate smaller meals (1080 ± 90 kJ versus 1810 ± 151 for the controls, P <0·01), more frequently during the day (eight versus five in the controls). Solid and sour foods were preferred, especially by those with regurgitation, compared with controls. The asymptomatic patients consumed more milk and coffee and less cheese, sour milk, meat, fish, eggs, tea and orange juice than the patients with regurgitation. Vegetable fats and medium chain triglycerides were consumed in negligible amounts. The patients with regurgitation had more fluids separately from meals than the asymptomatic patients. The results suggest that intake of vitamin supplements and replacement of animal fats by vegetable fats may be useful in these patients. Much of the dietary difficulties after colon interposition might be the result of the intra-abdominal colon graft loop anastomosed to the antrum; a short graft with a more proximal anastomosis to the lesser curvature merits study in this context.
Accuracy of suture placement
Authors: Seki S
Published: March 2007

Three groups of seven surgeons were each randomly selected from three larger groups with surgical experience of <1, 6–10 and 16–20 years. Each surgeon was asked to aim a needle at an exit point using two methods: ‘jiggling’ (readjustment of the needle in aiming at the target) allowed and jiggling not allowed. The results were not as precise as expected. An improvement from group 1 to group 2 was noticed in both methods (P <0·01), but from group 2 to 3 there was improvement only in the method where jiggling was allowed (P <0·01). All groups showed a tendency to overshoot the target (P <0·01): a shift towards the surgeon in group 1(P <0·05) and towards the opposite side in groups 2(P <0·01) and 3 (P <0·05). Jiggling significantly reduced the inaccuracy, and it was concluded that pinpoint accuracy improved with surgical experience. However, the experienced surgeons improve their accuracy by jiggling, with the potential danger of tissue damage by needle adjustment.
Favourable response to conservative surgery for extra-pancreatic gastrinoma with lymph node metastases
Authors: Bornman P C , Marks I N , Mee A S , Price S
Published: March 2007

Five patients with the Zollinger—Ellison syndrome who had extra-pancreatic (duodenal or paraduodenal) gastrinoma with lymph node metastases responded favourably to simple excision or mere shelling out of macroscopic tumour. Acid studies, serum gastrin and the secretin test became normal in all cases in the immediate postoperative period and remained so in three of the five patients when tested at 57, 33 and 8 months. The tests became abnormal in two patients when tested 8 and 53 months after surgery, but both patients are currently well-controlled on ranitidine 150 mg b.d. 22 and 65 months respectively after surgery. These results suggest that in patients with extra-pancreatic gastrinoma who have lymph node metastases simple excision of all macroscopic tumours may offer the prospect of long-term control. The place of total gastrectomy in such patients is questioned.
Cyclical mastalgia: Clinical and mammographic observations in a screened population
Authors: Leinster S J , Whitehouse G H , Walsh P V
Published: March 2007

The incidence of cyclical mastalgia in well women presenting for breast screening was 69 per cent. The incidence of cyclical mastalgia increases with age up to the menopause. There was a higher incidence of ‘high risk’ mammographic patterns and a lower incidence of ‘low risk’ patterns, according to the Wolfe classification, in women with cyclical mastalgia compared with the rest of the screened population. This finding correlated with the severity, duration and need for treatment. The differences in breast pattern did not persist after the menopause. The question of whether or not cyclical mastalgia can be regarded as a risk factor for breast cancer is uncertain and needs further evaluation.
Prospectively randomized clinical trial to compare in situ and reversed saphenous vein grafts for femoropopliteal bypass
Authors: Harris P L , How T V , Jones D R
Published: March 2007

Two hundred and fifteen femoropopliteal bypass procedures using autologous saphenous vein grafts were randomly allocated to either the reversed or in situ technique. Eleven veins (5 per cent) were rejected at operation on the basis of their small size, nine in the reversed group and two in the in situ group, and there were two (2 per cent) perioperative deaths in each group, leaving 102 reversed and 98 in situ grafts for further study. The cumulative patency at 3 years of the reversed grafts was 77 per cent and that of the in situ grafts was 68 per cent (n.s.). The patency of all grafts was affected adversely by small veins (P <0·005), long grafts (P <0·05), low volume of blood flow in the grafts (P <0·001) and poor run-off (P <0·05). These factors influenced the outcome of the in situ and reversed operations to a similar degree and there was no statistically significant difference between them within any subgroup. The mean compliance of the in situ grafts measured 3 months or more after operation with an ultrasonic echo-tracking system was 0·024 ± 0·01 per cent/mmHg (± s.d.) compared with 0·017 ± 0·01 per cent/mmHg for the reversed grafts (t = 2·43, P <0·02). The incidence of fibrous stricture formation as shown by intravenous digital subtraction angiography was 29 per cent in both the reversed and the in situ grafts. The results of the study to date indicate that reversed and in situ vein grafts are equally effective for femoropopliteal bypass.
Transcranial Doppler assessment of cerebral collateral during carotid endarterectomy
Authors: Padayachee T S , Gosling R G , Lewis R R , Bishop C C , Browse N L
Published: March 2007

Sixteen patients (mean age 59 ± 9 years) who were to undergo carotid endarterectomy were examined pre- and peroperatively using pulsed Doppler-shifted ultrasound; blood velocities in the middle cerebral artery were measured before and during common carotid compression in the conscious patient, and before and during measurement of carotid stump pressures at surgery in the anaesthetized patient. Measurements at endarterectomy showed a significant difference in middle cerebral artery blood velocities from patients with stump pressures of greater and less than 50 mmHg (t = 4·0, P <0·005). A threshold of 10 cm s−1 distinguished between stump pressures of greater and less than 50 mmHg in 15 of the 16 patients. Pre-operative blood velocity measurements during carotid compression did not correlate with those taken peroperatively at carotid clamping.
Acute superior mesenteric ischaemia
Authors: Wilson C , Gupta R , Gilmour D G , Imrie C W
Published: March 2007

A review of case records and post-mortem reports from Glasgow Royal Infirmary over the past 12 years identified 102 patients with acute superior mesenteric ischaemia, 53 (52 per cent) of whom were first diagnosed at post mortem. Overall mortality was 92 per cent and mortality in the 49 patients diagnosed in life was 84 per cent. Fourteen patients (14 per cent) underwent exploratory laparotomy only with no survivors, 26 (25 per cent) had bowel resection alone with 7 surviving, and 9 (9 per cent) had a revascularization procedure, 5 requiring additional bowel resection, with only one surviving. Survivors were usually younger, had a shorter history and less extensive bowel infarction. Improvements in intensive care and nutritional support with the greater use of revascularization procedures in the past 6 years have barely influenced mortality. Delays in diagnosis and treatment contribute to the poor results. Earlier diagnosis might be aided by measuring serum inorganic phosphate and, coupled with the more widespread use of emergency angiography and revascularization procedures, holds out the best hope for future improvement.
Prevention of gastric mucosal lesions following aortic cross-clamping
Authors: Svensson L G , Von Ritter C , Oosthuizen M M J , Fimmel C J , Rickards Elizabeth , Hunter Shelagh J S , Robinson Marion F , Hinder R A
Published: March 2007

Stress ulceration is frequently encountered after cardiovascular surgery. In this study of 32 male baboons, severe gastric ischaemia was used to produce gastric stress lesions. The occurrence of these lesions was reduced by allopurinol (P = 0·03) and completely prevented by the combination of allopurinol with superoxide dismutase (P = 0·004). A shorter ischaemic period also reduced the number of lesions (P = 0·02). Concurrent with the stress lesion formation, there was a fall in mucosal glutathione and oxidized glutathione levels (P <0·05).
Effect of duodenogastric reflux on gastric mucosal proliferation after gastric surgery
Authors: Houghton P W J , McC. Mortensen N J , Williamson R C N
Published: March 2007

The effect of duodenogastric reflux on cell proliferation and mucosal mass in the stomach was studied. Male Wistar rats (n=118) were submitted to Polya partial gastrectomy, partial gastrectomy with Rouxen-Y diversion of bile, total duodenogastric reflux or handling of the stomach alone (sham operation). Following oral administration of the carcinogen N-methyl-N′-nitro-N-nitrosoguanidine for 6 months, animals were killed 6, 9 or 12 months postoperatively and their stomachs were examined for crypt cell production rate and mucosal DNA content. Compared with shams, crypt cell production rate was more than twice as high in the gastric remnant 12 months after Polya partial gastrectomy (P <0·001) and median DNA content was 31 per cent greater (P = 0·05). After total duodenogastric reflux, DNA content was 62 per cent greater than in shams (P = 0·02), while Roux-en-Y diversion reduced crypt cell production rate by 65 per cent (P <0·001). Only Polya gastrectomy increased the number of rats developing gastric carcinomas (9 versus 2 shams; P <0·05). Increased mucosal cell proliferation in rats with duodenogastric reflux may help to explain the development of gastric stump cancer.
Plunging ranula: A report of three cases and review of the literature
Authors: Parekh D , Stewart M , Joseph C , Lawson H H
Published: March 2007

Three cases of plunging ranula are reported and the literature reviewed. Extravasation of saliva from the sublingual gland due to trauma or obstruction of its ducts appears to he the most likely cause of plunging ranula. Available data suggest that the submandibular gland is usually not involved, although at the time of surgery it may be extremely difficult to exclude a submandibular origin of the cyst in the neck. Communication between the oral and cervical components of the plunging ranula probably occur via a hiatus in the mylohyoid muscle. Such communication passing directly into the submandibular compartment may simulate submandibular gland involvement. Since 1910, 139 procedures in 89 patients with plunging ranula have been reported in the English literature. The recurrence rate was 70 per cent after incision and drainage of the cyst, 53 per cent after marsupialization, 85 per cent after excision of the cyst in the neck and 2 per cent after excision of the sublingual gland via the cervical or intra-oral route. This review suggests that excision of the sublingual gland with intra-oral drainage of the cervical swelling appears to be the treatment of choice for the plunging ranula.
Effects of haemorrhage on wound strength and fibroblast function
Authors: Taylor D E M , Whamond J S , Penhallow J E
Published: March 2007

The impairment of healing in laparotomy wounds in rats with compensated oligaemia has been studied in two parallel investigations. Animals-bled 1 ml/100 g body weight (bled) were compared with unbled animals undergoing the same operation (control). Firstly, wounds were assessed after 22 days for strength of skin and muscle layers (11 control: 9 bled). Both layers were significantly weaker in bled animals; by 36 per cent for skin (P <0·02) and by 22 per cent for muscle (P = 0·02). Secondly, wound fibroblast function was assessed after 10 days by quantitative histology and autoradiography (30 control: 31 bled). There were no significant differences between the two groups for fibroblast density, replication ([3H]thymidine), or general protein synthesis ([3H]leucine). Bled animals had less dense collagen packing by 21 per cent (P <0·01), but 33 per cent more incorporation of ([3H]proline by fibroblasts (P <0·01) compared with control animals. The effect of compensated oligaemia on wound healing is more marked in skin than in muscle; it appears to be a specific increase in collagen turnover with the increase in reabsorption exceeding that in synthesis.
Splenectomy in the management of haematological disease
Authors: Dawson Audrey A , Jones P F , King D J
Published: March 2007

Patients, both adults and children, with various haematological disorders who had splenectomy electively in the diagnosis, staging or treatment of their condition during a 15-year period in the Aberdeen hospitals were reviewed. The outcome regarding the disease and the immediate and long-term complications of splenectomy in this group of 185 patients are presented. Splenectomy has an acceptably low morbidity, even in patients with serious haematological disease, in the hands of an experienced surgical team, where there is close co-operation between surgeon and haematologist. Occasionally, late overwhelming infections may occur, despite prophylaxis with penicillin and pneumococcal vaccination. It seems likely that, in their zeal to report such hazards, authors may allow the pendulum against splenectomy to swing too far, in the direction of leaving patients, especially adults, with considerable symptoms and poor health, rather than risk the occasional consequences of the asplenic state.
Assessment of ornithine decarboxylase activity in rectal mucosa as a marker for colorectal adenomas and carcinomas
Authors: Moorehead R J , Hoper Margaret , McKelvey S T D
Published: March 2007

We have investigated the role of ornithine decarboxylase activity in rectal mucosa as a marker for colorectal neoplasia. Biopsies of normal rectal mucosa were taken from 18 patients with adenomas > 1 cm diameter, 11 with carcinomas and 16 controls. The mean ornithine decarboxylase activity in normal rectal mucosa of adenoma patients, 6·52 nmol CO2 released h−1 (mg cell protein)−1, was significantly lower than that in controls, 16·8, P = 0·006. The difference in rectal ornithine decarboxylase activities between cancer patients, 3·58, and controls was also significant, P = 0·001. These preliminary results suggest that ornithine decarboxylase may be a useful marker in screening for colorectal neoplasia.
Influence of sialomucin at the resection margin on local tumour recurrence and survival of patients with colorectal cancer: A multivariate analysis
Authors: Dawson P M , Habib N A , Rees H C , Williamson R C N , Wood C B
Published: March 2007

In a multicentre prospective trial 358 patients undergoing curative surgery for colorectal cancer were followed for a median 18·0 months (± 7·2 months). The presence or absence of sialomucin in either resection margin was studied using the high iron diamine-alcian blue stain. There was evidence of excess sialomucin at one or other resection margin in 106 patients (29·6 per cent). Apart from sigmoid carcinomas occurring more often in the sialomucin positive group, there were no significant differences in any histological or clinical parameters between groups. Survival analysis for the events ‘death’, ‘local recurrence’, and ‘all recurrence’ was undertaken using the Cox regression model. The best prognostic variables selected in a stepwise fashion for death and all recurrence were ‘Dukes' classification’, ‘sialomucin present’ and ‘histological differentiation’. The best prognostic variables selected for local recurrence were ‘sialomucin present’, ‘Dukes' classification’ and ‘histological differentiation’. Sialomucin in a resection margin is an important independent prognostic variable for the development of local tumour recurrence and of subsequent survival for patients with colorectal carcinoma.
Outcome of colorectal cancer
Authors: Pescatori M , Mattana C , Maria G , Ferrara A , Lucibello L
Published: March 2007

The outcome of 454 patients who presented with colorectal carcinoma during a 16 year period is reviewed: 54 per cent were males, 58 per cent were aged more than 60 and 10 per cent had an emergency admission, 42 per cent of tumours occurred in the rectum. A curative resection was possible in 68 per cent. Postoperative mortality was 7 per cent. The overall crude 5-year survival was 41 per cent. The mortality from local recurrence was significantly higher in rectal (11·7 per cent) than in colonic cancer (8·8 per cent; P<0·01). The rate of recurrence and metastases was higher in patients with low rectal cancer than in patients with cancer of the middle and the upper rectum (P<0·01). Distant metastases were the cause of death in 94 per cent of the patients who had a Miles' operation for cancer of the middle rectum, whereas local recurrence was responsible for late mortality in 80 per cent of patients who underwent an anterior resection. No difference in 5-year survival was found in the restorative and in the excisional group.
Adenomatous polyposis: An association with carcinoma of the thyroid
Authors: Plail R O , Bussey H J R , Glazer G , Thomson J P S
Published: March 2007

A review of the St Mark's Hospital Polyposis Registry has revealed an association between adenomatous polyposis (familial polyposis coli) and thyroid carcinoma. Even though full clinical information was unavailable on all patients in the registry, it is evident that young women (below 35 years of age) are at particular risk of developing thyroid cancer, mainly of a papillary type, their chances of being affected being approximately 160 times that of normal individuals. All patients with adenomatous polyposis should thus have regular thyroid examination.
Sliding flap advancement for the treatment of high level fistulae
Authors: Wedell J , Meier Zu Eissen P , Banzhaf G , Kleine L
Published: March 2007

The technique of sliding flap advancement for the treatment of high anal fistulae is described. The technique is not suitable for cases with an acute abscess and is reserved for patients with a well-established chronic fistula track. Thirty patients with anal fistulae were treated by sliding flap advancement from 1980 to 1984. Twenty-nine patients had satisfactory results. With a follow-up ranging from 18 months to 4 years no recurrence of fistulae or abscess were observed. The advantages of the advancement flap technique over the staging division technique with application of a seton and over the rerouting technique are discussed.
New physiological method of evaluating oesophageal transit
Authors: Cranford C A , Sutton D , Sadek S A , Kennedy N , Cuschieri A
Published: March 2007

A method of measurement of oesophageal transit time in the upright posture of a chewed solid bolus has been developed and assessed in normal volunteers (n = 16) and in 32 patients with oesophageal disease: organic stricture (n = 5), oesophageal motility disorders (n = 19) and reflux oesophagitis without stricture formation (n = 8). The test involves swallowing a 10 ml poached egg white bolus labelled with 99mTc sodium pertechnetate and external scanning by a gamma camera. An on-line computer program allows detailed analysis by the condensed image technique (which demonstrates the pattern of oesophageal transit) and activity-time curves for the whole, the upper, middle and lower thirds of the oesophagus. The reproducibility of the test is good (coefficient of variation of the total transit of 14 per cent). The results on the normal volunteers have shown that oesophageal transit slows in an aboral direction with transit being faster in the upper, when compared with the middle and lower thirds. The test clearly differentiates patients with oesophageal disease from the normal. The condensed image analysis appears to be useful in outlining the pattern of transit in patients with motility disorders. Patients with reflux oesophagitis have delayed oesophageal transit.
Review of a hospital experience of breast abscesses
Authors: Scholefield J H , Duncan J L , Rogers K
Published: March 2007

A retrospective review of breast abscesses during a 10-year period was performed. Only 8.5 per cent (6/72) of patients were in the puerperium. Peripherally sited abscesses were predominantly staphylococcal in origin, incision and drainage was effective treatment in all. By contrast, a subareolar abscess yielded a higher proportion of anaerobic bacteria and 46 per cent (13/28) of these patients had duct ectasia. We conclude that in present day practice a breast abscess is more likely to be related to duct ectasia than to the puerperium, and that patients with anaerobic infection or subareolar abscesses should be assumed to have duct ectasia and may require excision of the major duct system (Hadfield's procedure).
Digital ischaemia and palpable pedal pulses
Authors: Comerford J A , Broe P J , Wilson I A , Bouchier-Hayes D J
Published: March 2007

Digital ischaemia in the presence of an otherwise well-perfused foot in the non-diabetic patient presents diagnostic problems especially as the manifestations are frequently evanescent. Eighty such patients (sixty men and twenty women aged 55–84 years) who presented to St. Laurence's Hospital from 1982 to 1985 inclusive were evaluated. Micro-embolization was inferred from the demonstration of a cardiac (20) or an arterial source (42) in 62 of 80 patients. In 14 of the remaining 18 patients a malignancy was diagnosed, which was found to be visceral cancer in 11 cases. Indium platelet scanning revealed platelet aggregation in 14 of 26 patients examined. Laboratory evidence of abnormalities of platelet aggregation or blood coagulation was found in only 6 patients. There have been no further symptoms in 37 patients who have been treated surgically or in 17 of 21 patients who have been treated with either anticoagulation or antiplatelet therapy.
Asymptomatic carotid murmur: Ultrasonic factors influencing outcome
Authors: Aldoori M I , Benveniste G L , Baird R N , Horrocks M , Fairgrieve J
Published: March 2007

Sixty consecutive patients with an asymptomatic mid-cervical murmur on auscultation were identified amongst 1000 patients who underwent duplex scanning of the extracranial carotid arteries during 1981-83. They were classified according to the scan results into 12 high risk subjects with > 75 per cent stenosis of an internal carotid artery, 37 low risk subjects with a < 75 per cent stenosis and 6 with no detectable stenosis. The mean duration of follow-up was 3 years (minimum 2 years) or until stroke or death. One was lost to follow-up and four were excluded having undergone carotid endarterectomy during the study. Six of twelve subjects with > 75 per cent stenosis suffered a stroke (five fatal and one non-fatal). There were no premonitory signs except in one patient with non-focal cerebral ischaemia for 2 months before an hemispheric stroke. There was one fatal stroke in the < 75 per cent stenosis group and none in the control group. In all, 17 (28 per cent) patients died (myocardial infarction, 8; stroke, 6; malignant disease, 3). These results confirm that asymptomatic carotid murmurs are associated with increased mortality with most having non-severe carotid disease on duplex scanning and few strokes during follow-up. There is an important minority with tight carotid stenosis who carry a worrying risk of stroke if left untreated.
Effect of pre-operative blood transfusion on tumour metastases
Authors: Clarke Patricia J , Tarin D
Published: March 2007

The effects of allogeneic blood transfusion on the subcutaneous growth and metastatic spread of two types of mouse tumour (B16 melanoma syngeneic to the C57/BL6 mouse and UV-2237 fibrosarcoma syngeneic to the C3H/He mouse) were studied. The growth rates of the primary tumour were not altered by transfusing the animals with allogeneic blood 14 days before tumour inoculation, but spontaneous metastasis from tumours formed at the inoculation site was augmented and accelerated for both tumour types. This effect was dependent on the strain of the blood donor, metastases of B16 melanoma being augmented by transfusion with blood from Balb/c animals, and UV-2237 fibrosarcoma by transfusion with C57/BL6 blood, but not by blood from other donor strains tested.
Inhibition of intestinal carcinogenesis by dietary supplementation with calcium
Authors: Appleton G V N , Davies P W , Bristol J B , Williamson R C N
Published: March 2007

Dietary supplementation with calcium reduces colonic crypt cell production rates in both normal and hyperplastic mucosa. Calcium can bind intraluminally with bile salts and fatty acids thus reducing their mitogenic effect. The protective role of oral calcium on intestinal carcinogenesis (induced by azoxymethane) was tested in 60 male Sprague-Dawley rats submitted to either 80 per cent mid jejuno-ileal resection (n = 30) or jejunal transection (n = 30). Half the rats in each group received calcium lactate 24 g/l added to their drinking water. Rats were killed 25-27 weeks postoperatively. Enterectomy increased colonic tumour yield by 60–106 per cent (P = 0·002–0·005) and duodenal tumour yield by 70–86 per cent. Calcium abolished this effect at both sites, halving intestinal tumour yields in rats with both transection and resection (P<0.05). Doubling the dietary intake of calcium inhibits experimental carcinogenesis.
Appraisal of the management of bile duct stones
Authors: Johnson A G , Hosking S W
Published: March 2007

This review discusses the natural history, diagnosis and treatment of stones in the bile ducts. A rational plan of management is outlined.
New approach in the management of oesophageal varices
Authors: Ono J , Katsuki T , Kodama Y
Published: March 2007

Combined therapy consisting of sclerotherapy, embolization and splenopneumopexy was established for the treatment of oesophageal varices. These procedures were safely performed in 16 patients. No serious complications and no recurrent bleeding have been observed. The varices disappeared or were significantly improved as determined by periodic endoscopic evaluations. Portopulomonary shunt by splenopneumopexy is an alternative technique in the eradication of varices following sclerotheraphy.
Treatment of postoperative gastrointestinal atony
Authors: Verlinden M , Michiels G , Boghaert A , de Coster M , Dehertog P
Published: March 2007

One hundred and eighteen patients in whom postoperative gastrointestinal atony had lasted for 48–72 hours, were given one or two intravenous injections of different doses of cisapride (2, 4 or 8mg), or vehicle. The first occurrence of flatus was taken to mark the cessation of ileus. There was no significant difference in remission of ileus between the groups in the first hour following injection. All patients not responding to treatment in the first hour were given a repeat dosage and observed for the following 3 hours. Among this group, there was a significant remission of ileus in patients who had received 2 × 8 mg, which was particularly marked in those who had undergone intraperitoneal surgery. This study suggests that cisapride in repeated dosage may be of value in inducing remission in prolonged surgical ileus, particularly in patients who have undergone intraperitoneal operations.
Accuracy of identification of early gastric cancer
Authors: Ballantyne K C , Morris D L , Jones J A , Gregson R H , Hardcastle J D
Published: March 2007

Two hundred and nineteen patients underwent gastrectomy for cancer in Nottingham University Hospital between January 1978 and December 1985. Twenty of these patients had early gastric cancer (EGC). Barium meal was performed in 15 patients and upper gastrointestinal endoscopy in 15. In all cases, barium meal failed to define the early nature of this disease. Only two lesions were thought to be EGC endoscopically and at laparotomy three were considered to be EGC. As neither radiologist, endoscopist nor surgeon can reliably identify EGC, all patients with gastric cancer in the absence of proven metastases should undergo gastrectomy.
Prospective randomized controlled trial of urethral versus suprapubic catheterization
Authors: Sethia K K , Selkon J B , Berry A R , Turner Christine M , Kettlewell M G , Gough M H
Published: March 2007

Sixty-six patients requiring catheterization in the course of general surgical operations were randomly allocated into two groups. Of the 34 patients catheterized urethrally 16 developed urinary tract infections whereas of the 32 suprapubically catheterized patients only 2 developed an infection (P<0.001). Five patients required recatheterization after removal of their urethral catheters. There were no major complications associated with the use of suprapubic catheters. We propose that, when catheterization is required during a general surgical procedure, the suprapubic route is to be preferred.
Surgical treatment of chronic pancreatitis: An overview
Authors: Moossa A R
Published: March 2007

The correct management of chronic pancreatitis remains undecided. The aims of surgical treatment are to relieve pain, treat complications and preserve pancreatic function. The appropriate surgical procedure to achieve these ends must be carefully chosen.
Neural control of internal anal sphincter function
Authors: Lubowski D Z , Nicholls R J , Swash M , Jordan M J
Published: March 2007

The effect on anal tone of electrical stimulation of the presacral (hypogastric) sympathetic nerves has been studied in eight patients during abdominal rectopexy or restorative proctocolectomy. A sharp fall in anal pressure occurred in seven patients (mean fall 59 cmH2O; range 35-80 cmH2O). In one patient given a β- and α-sympathetic blocking drug (labetalol 200 mg) intra-operatively, the anal pressure decreased by 15 cmH2O. These observations show that stimulation of the presacral sympathetic nerves causes relaxation of the internal anal sphincter and implies that these nerves may induce relaxation of the sphincter in vivo. The pathway of the recto-anal reflex has been studied intra-operatively in three patients undergoing rectal excision. The recto-anal reflex is present after presacral nerve blockade and after full mobilization of the rectum, but is abolished by circumferential rectal myotomy. The reflex has a local intramural pathway. This observation validates the assumption that absence of this reflex is a feature of aganglionosis, as in Hirschsprung's disease.
Unaltered risk of colorectal cancer within 14–17 years of cholecystectomy: Updating of a population-based cohort study
Authors: Adami H-O , Krusemo Ulla B , Meirik O
Published: March 2007

The incidence of colorectal cancer after cholecystectomy was analysed in a historical population-based cohort study comprising 16439 patients who were completely followed up for 14-17 years after operation. The observed number of colorectal cancers (150) was lower than the expected number of 166·3 (relative risk (RR) = 0·90:95 percent confidence limits 0·77-1·05) and the overall risk for colon cancer (RR = 0·95) did not differ significantly from that of rectal cancer (RR = 0·82). Separate analyses by sex, age at operation and duration of follow-up revealed relative risks close to or lower than unity. Some deviations indicating a substantially reduced risk might have been due to the play of chance alone. Our results contradict the idea both of a causal and of a non-causal association—through common aetiological factors—between surgically confirmed gallbladder disease and colorectal cancer.
Natural history of anterior mucosal prolapse
Authors: Allen-Mersh T G , Henry M M , Nicholls R J
Published: March 2007

Case notes of 250 patients (M:F, 1:2·7; age 48·7±16·5 years) in whom anterior mucosal prolapse had been diagnosed, at one hospital between 1974 and 1976, were reviewed. The commonest symptoms were bleeding (56 per cent), pain (32 per cent) and a sense of prolapse (32 per cent). The prevalence of constipation was significantly higher among women (47 per cent) than men (29 per cent). Perineal descent was present in 20 per cent of cases and was significantly more frequently associated with excessive straining at defaecation (28 per cent) compared with patients in whom there was no history of excessive straining (12 per cent). Sixty-six patients (26 per cent) experienced recurring symptoms over the 10 year period following presentation but did not deteriorate, while 28 patients (11 per cent) deteriorated. Deterioration was associated with a history of symptoms for longer than 1 year at the time of presentation, female sex, and the presence of perineal descent on clinical examination. The risk of developing perineal descent was < 10 per cent over the 5 years after presentation while that of developing sphincter laxity among patients who had already developed perineal descent was 30 per cent over this period. Complete rectal prolapse occurred in 20 per cent (3/15) of patients with clinical perineal descent and sphincter laxity but was not seen in the absence of these signs. The results of treatment by submucosal phenol injection, mucosal rubber banding, or glycerine suppositories were the same.
Potential impact of immunobiotechnology on cancer therapy
Authors: Guillou P J
Published: March 2007

Genetic engineering techniques allow large scale production of substances generated during the immune response and these may have therapeutic value by modifying the biological response to cancer.
Role of computed tomography in selecting patients for hindquarter amputation
Authors: Watkins R M , Thomas J Meirion
Published: March 2007

Nine patients with soft tissue sarcomas close to the pelvic girdle and one patient with a primary malignant bone tumour of the pelvis were referred for consideration of hindquarter amputation. Patients were considered unsuitable for hindquarter amputation on clinical grounds if malignant disease infiltrated into the perineum or across the sacro-iliac joint. If disease in the femoral triangle extended above the inguinal ligament the tumour's operability was seriously questioned. Buttock tumours which had passed through the greater sciatic notch to become palpable on pelvic examination were also considered likely to be inoperable. On computed tomographic (CT) examination, tumours were considered inoperable if the psoas muscle was involved above the inguinal ligament, or if malignant disease involved the sacro-iliac joint, sacrum or perineal structures. Soft tissue tumours of the buttock extending significantly through the greater sciatic notch were also considered likely to be inoperable. Five patients thought suitable for hindquarter amputation on clinical assessment had no excluding features on CT; four undergoing hindquarter amputation were proven on histological examination to have good clearance of their tumours. In another patient, considered suitable for hindquarter amputation on clinical grounds, CT suggested that en bloc wide excision of the tumour was feasible enabling the affected limb to be preserved. Four patients after clinical examination were considered unsuitable for hindquarter amputation and in all cases inoperability was confirmed by CT. CT complements clinical examination and provides an objective and reliable means of selecting patients for hindquarter amputation which should avoid unnecessary surgical exploration.
Natural history and surgical management of radiation enteritis
Authors: Galland R B , Spencer J
Published: March 2007

Radiation enteritis is an increasing problem. The effect of ionizing radiation is due to a direct effect on proliferating cells and due to a progressive obliterative vasculitis. Predisposing factors include the dose of radiation, combination with chemotherapy, previous operations and vascular disease. Management is related to the stage of disease at presentation, and tailored to the clinical problem. Surgical management must take into account the poor healing associated with irradiated intestine.
Adhesion obstruction following Nissen fundoplication in children
Authors: Wilkins Barbara M , Spitz L
Published: March 2007

The incidence of postoperative adhesion intestinal obstruction among 156 children who had undergone Nissen fundoplication for intractable gastro-oesophageal reflux was determined. There were 18 episodes of obstruction in 16 patients (10·3 per cent). The mean interval between fundoplication and adhesion obstruction was 10 months (range 10 days-4 years). Additional procedures performed at the original laparotomy substantially increased the risk of developing obstruction. Re-laparotomy for adhesion obstruction was required by 21 per cent of patients who had a Ladd's procedure and 12 per cent who had appendicectomy. Presenting symptoms were not typical of intestinal obstruction because many of these children were unable to vomit. Only three did vomit but all had radiological appearances suggestive of small bowel obstruction. There were two deaths directly related to adhesion obstruction.