bluuebunny/crossref_metadata_2025 huggingface dataset:
Changes in colonic motility during the development of chronic large bowel obstruction
Authors: Coxon J E , Dickson Caroline , Taylor I
Published: March 2007

The effect of chronic progressive distal large bowel obstruction on colonic motility was studied in six mini-pigs. Motility was detected in vivo during the development of obstruction with chronically implanted Ag/AgCl electrodes using an impedance technique. When the obstruction was complete the segments of bowel were resected and spontaneous contractile activity and response to cholinergic stimulation were studied in an organ bath. Any hypermotility resulting from obstruction was shortlived and a gradual state of hypomotility supervened proximal to the obstruction. Decompression of the bowel did not result in the immediate return of motility and the resected bowel was unresponsive to carbachol. These results suggest that spontaneous resolution of large bowel obstruction is unlikely and that motility disturbances are unlikely to be a cause of anastomotic dehiscence.
Intra-operative colonic irrigation in the management of left-sided large bowel emergencies
Authors: Koruth N M , Krukowski Z H , Youngson G G , Hendry W S , Logie J R C , Jones P F , Munro A
Published: March 2007

In a consecutive series of 93 patients who required emergency surgery for distal colonic lesions, 61 had primary bowel resection with immediate anastomosis after intra-operative antegrade colonic irrigation. The operative mortality was 8 per cent, anastomotic leakage rate 7 per cent and superficial wound infection occurred in 3 per cent of patients. The mean hospital stay was 13 days. Of the remaining 32 patients, 3 did not have a resection and 29 had a primary resection and end colostomy without anastomosis: bowel continuity was later restored in 17 of 28 survivors (61 per cent) but 11 (39 per cent) were left with a permanent colostomy. The hospital mortality in this group was 6 per cent, superficial wound infection rate 14 per cent and the mean hospital stay 26 days. The results of this study suggest that intra-operative colonic irrigation is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.
The results of surgery for epidermoid carcinoma of the anus
Authors: Pyper P C , Parks T G
Published: March 2007

A series of 89 cases of anal carcinoma presenting over a 20-year period is reviewed. The majority were epidermoid carcinomas, 57 arising in the anal canal and 13 at the anal margin. The remainder were melanomas and basal cell carcinomas, and these were not considered further. The main presenting symptoms of epidermoid anal carcinomas were bleeding and pain. Tumours arising in the anal canal were commoner in women whilst those at the margin were more frequent in men. The majority (51/70) had a clinical diagnosis of malignancy made but in 19 cases this was not considered initially. The necessity for routine early histological diagnosis is stressed. Treatment was mainly surgical, either abdominoperineal resection (37 canal, 2 margin) or wide excision (8 canal, 11 margin). The 5 year survival of patients with anal margin tumours was better than those with canal lesions (50 per cent compared with 36 per cent).
Peculiarities of mucinous colorectal carcinoma
Authors: Umpleby H C , Ranson D L , Williamson R C N
Published: March 2007

The clinical and pathological features of 54 mucinous carcinomas of the large intestine were compared with those of 576 non-mucinous carcinomas. Tumours were only categorized as mucinous if they contained at least 60 per cent of mucin by volume. Those with a moderate mucin content (60–80 per cent) were indistinguishable in behaviour from ‘non-mucinous’ tumours. By contrast, those with a high mucin content (> 80 per cent) showed several differences from non-mucinous cancers: they had a more proximal distribution through the large intestine, they comprised a greater fraction of cancers in the under 50 age group (24 versus 7 per cent: P < 0·01), they were more likely to be Dukes' stage ‘D’ (58 versus 31 per cent: P < 0·01) and local fixity was commoner (70 versus 37 per cent: P < 0·001). Consequently the overall resection rate was reduced from 90 to 73 per cent (P < 0·01), the curative resection rate from 69 to 42 per cent (P < 0·01) and the 5-year survival rate from 37 to 18 per cent (P < 0·05). Colorectal carcinomas of high mucin content require wide excision, tend to recur locally and carry a poor prognosis.
Patterns of flap recurrence following mastectomy
Authors: Blacklay P F , Campbell F C , Hinton C P , Blamey R W , Morgan D A L , Elston C W , Haybittle J L
Published: March 2007

Flap recurrence after mastectomy is divisible into three distinct entities: spot recurrence, multiple spot recurrence and field change. Spot recurrence and multiple spot recurrence are usually controlled by local measures and are not associated with any particular characteristics of the primary tumour. The field change type of flap recurrence is difficult to control and is associated with aggressive primary tumours (grade III, node positive, oestrogen receptor negative) and a very poor prognosis. The appearance of field change type of flap recurrence is an indication for systemic therapy.
The prediction of local or regional recurrence after simple mastectomy for operable breast cancer
Authors: Williams M R , Hinton C P , Todd J H , Morgan D A L , Elston C W , Blamey R W
Published: March 2007

Both the histological grade of the primary tumour and lymph node status have been found to contribute significantly towards the development of a local or regional recurrence after simple mastectomy for operable breast cancer. No other factor, from a series of seven studied, has been found to be of independent significance. A small group of patients with grade III tumours, lymph node positive at mastectomy, has been identified in whom more than 40 per cent of all symptomatic local or regional recurrences occurred. The chance a patient in this group has of developing a local or regional recurrence requiring treatment within 4 years approaches 50 per cent.
A retrospective study of male breast cancer in Holland
Authors: van Geel A N , van Slooten E A , Mavrunac M , Hart A A M
Published: March 2007

A retrospective study has been undertaken of 104 men with breast cancer, all of them having a follow-up period of at least 5 years. In 78 cases a histological diagnosis was obtained. The preferred treatment for operable cases was radical mastectomy, in which 60 per cent positive axillary nodes were found. Five-year survival is 54 per cent and the disease-free interval is 42 per cent. Local recurrence occurred in 26 per cent and 16 per cent had developed distant metastases. The overall results are similar to those in the literature with the exception of those for stage III who did better in this series. The generally held beliefs that Klinefelter's syndrome is the strongest predisposing factor to developing male breast cancer and that gynaecomastia is not a premalignant condition are supported by this study. Comparison of results from this series, with those of women of the same age having breast cancer leads to the conclusion that the prognosis in male breast cancer is no worse than for women with comparable disease.
Sigmoid exclusion: a new technique in the management of radiation-induced fistula
Authors: Aitken R J , Elliot M S
Published: March 2007

Colovesical and colovaginal fistulas following irradiation for pelvic malignancy represent a formidable surgical problem. Although complex surgical procedures to close the fistulas and restore continence have been described, often a defunctioning colostomy with an associated urinary conduit is the only feasible option. Three patients who have successfully undergone an original procedure (sigmoid exclusion) are presented. Sigmoid exclusion restores continence but avoids a permanent stoma. The involved sigmoid colon was isolated on its mesentery ensuring that the area incorporating the fistulas was not disrupted. The ends of the isolated sigmoid colon were closed and bowel continuity then restored by a colorectal or colo-anal anastomosis. Following closure of a temporary colostomy the patients were continent with no ill effects or sepsis from the excluded colon. This procedure has the dual advantage of restoring continence yet avoiding both an urinary conduit and a permanent colostomy, and represents a useful advance in the surgical management of radiation induced colonic fistulas.
Maydl's hernia: report of a series of seven cases and review of the literature
Authors: Ganesaratnam M
Published: March 2007

Seven cases of Maydl's herniae with two patients needing resection of bowel are presented. This condition is rare and may be lethal if unrecognized. The hernial sac contains two loops of bowel with another loop of bowel being intra-abdominal. The intra-abdominal loop of bowel may become strangulated, either alone or in combination with bowel in the hernial sac. It is more often seen in men, and predominantly on the right side. Maydl's hernia should be suspected in patients with large incarcerated herniae and in patients with evidence of intra-abdominal strangulation or peritonitis. Postural or manual reduction of the hernia is contra-indicated as it may result in non-viable bowel being missed.
Peripheral resistance measurement in the assessment of severe peripheral vascular disease
Authors: Parvin S D , Evans D H , Bell P R F
Published: March 2007

Thirty-seven patients undergoing femoropopliteal, fifteen undergoing femorodistal reconstruction and seven below knee amputees were subjected to prospective measurement of peripheral resistance. Resistance was significantly higher in the amputation and femorodistal groups than in the femoropopliteal group (P < 0.03 and P < 0.005 at 76 ml/min). In the femoropopliteal group patients with three vessel runoff had a significantly lower resistance than those with two or single vessel runoff (P < 0.01). In the femoropopliteal group resistance of patent grafts at four months was significantly less than thrombosed grafts (P < 0.006). Patients with a resistance<1200 mPRU had a significantly better patency than those in whom the resistance was > 1200 mPRU (P < 0.05). Taking all the failed grafts there was a significant correlation between graft patency and resistance (P < 0.003). Resistance measurement has been shown to correlate with the severity of the disease, with runoff defined radiographically and with graft patency. In a simplified form it may prove a useful adjunct to other methods of assessment in patients with distal disease.
Study of cardiothoracic wound infection at St. Thomas' Hospital
Authors: Farrington M , Webster Margaret , Fenn A , Phillips I
Published: March 2007

Wound infection occurred after 14.3 per cent of 433 open heart operations. In 309, saphenous veins were harvested for coronary artery bypass grafting (CABG) and 8.7 per cent of sternal wounds and 12.9 per cent of leg wounds were infected. Only 1.6 per cent of the remaining 124 patients who had open heart operations without leg surgery suffered sternal wound infections. In the CABG group sternal infection was theatre-related and significantly associated with length of pre-operative stay, diabetes and re-operation. Similar organisms were isolated from both leg and sternal wounds which suggest that organisms were transferred from legs to sternum with the veins. No clinically relevant cross infection was demonstrated. Skin disinfection and surgical technique seem more important than antibiotic prophylaxis in the control of these infections.
The influence of surgical operations on components of the human immune system
Authors: Lennard T W J , Shenton B K , Borzotta A , Donnelly P K , White M , Gerrie Linda M , Proud G , Taylor R M R
Published: March 2007

Surgical operations have been shown to cause a variety of immunological disturbances in man both in vivo and in vitro. With few exceptions the overall picture is one of a generalized state of immunodepression in the postoperative period. The implications of these observations are that host defences may be compromised by surgical procedures, thus providing a ‘fertile soil’ for bacterial invasion and tumour cell metastasis at the very time when risks from invading pathogens and viable tumour cells are maximal. We have studied the effects of surgical operations on the immune system in 35 patients with benign disease. Surgical procedures were classified as either minor (n = 15) or major (n = 20). A panel of monoclonal antibodies was used to identify peripheral blood lymphocyte subpopulations and analysis was performed using flow cytometry. Simultaneous estimations of plasma alpha-1 proteinase inhibitor (alphal-PI), alpha-2-macroglobulin (alpha-2-M), alpha-2-pregnancy-associated glycoprotein (alpha-2-PAG) and plasma suppressive activity (PSA) on stimulated allogeneic lymphocytes were performed before operation and on postoperative days 1, 3, 7, 14 and 21. Circulating numbers of all lymphocyte subpopulations fell significantly following surgery, except for B lymphocytes which did not change. The magnitude, and duration of the reduction in cell numbers and the subpopulation affected was significantly related to the degree of surgical trauma, and returned to pre-operative values by postoperative day 7. Changes in alpha-1-PI, alpha-2-M, alpha-2-PAG and PSA were also significantly related to the degree of surgical trauma, and these plasma changes persisted longer than the cellular disturbances. Surgical operations induce a reversible depression of cellular immunity which precedes plasma suppressive activity in its return to pre-operative levels. Immunostimulating agents such as interferon and the interleukins deserve evaluation as prophylactic agents pre-operatively.
Efficacy and safety of low-molecular-weight heparin (CY216) in preventing postoperative venous thrombo-embolism: A co-operative study
Authors: Kakkar V V , Murray W J G
Published: March 2007

The efficacy and safety of a low-molecular-weight (LMW) heparin fraction in preventing postoperative venous thrombo-embolism, was assessed in a double blind, randomly allocated trial, and in an ‘open’ study. of 395 patients included in the double blind trial, 199 received unfractionated (UF) calcium heparin, and 196 the LMW heparin fraction. The data were analysed on an ‘intention to treat’ basis. The two groups were well matched for risk factors which could predispose to the development of venous thrombosis. Fifteen (7·5 per cent) of one hundred and ninety-nine patients receiving UF heparin, and five (2·5 per cent) of one hundred and ninety-six patients in the LMW heparin group developed DVT (P<0·05). There was no significant difference between the two groups in terms of excessive incisional or total blood loss during surgery, postoperative drainage or wound haematoma formation. Of 910 patients included in the ‘open’ study who received a single injection of LMW heparin every day, 30 (3·2 per cent) died during the postoperative period; in none of the autopsied patients were pulmonary emboli detected. Thirty-one (3·4 per cent) patients developed isotopic DVT; twentyseven (2·9 per cent) were receiving prophylaxis at the time the DVT was diagnosed. Thirty-six (3·9 per cent) patients developed wound haematoma; twenty-five (12·4 per cent) of those were in the two hundred and one undergoing surgery for gynaecological conditions, and eleven (1·5 per cent) in the seven hundred and nine patients having general abdominal surgery. This difference is statistically significant (P<0·001). The results of a double blind trial indicate that a single daily injection of 1850 APTT units (7500 antifactor X a units) of a LMW heparin is more effective than 10000 APTT units of commercially available UF heparin in preventing postoperative DVT. The findings of the ‘open’ study suggest that this regimen also provides an effective prophylaxis against postoperative major pulmonary embolism.
Gastro-oesophageal reflux and oesophagitis before and after vagotomy for duodenal ulcer
Authors: Flook D , Stoddard C J
Published: March 2007

Fifty patients undergoing elective vagotomy for the treatment of chronic duodenal ulceration have been investigated pre-operatively and again 3 months postoperatively to determine the extent and severity of associated gastro-oesophageal reflux. Pre-operatively all patients had a normal lower oesophageal sphincter pressure but 50 per cent had symptoms of gastro-oesophagel reflux, 42 per cent had excessive reflux on 24 h pH monitoring and 30 per cent had oesophagitis on endoscopy and/or oesophageal biopsy. Postoperatively, reflux symptoms were present in only 12 per cent of patients but pH studies were still abnormal in 36 per cent and oesophagitis was observed in 32 per cent. Lower oesophageal sphincter pressure was unaffected by vagotomy. Gastro-oesopheageal reflux is common in pre-operative duodenal ulcer patients and is not significantly reduced by vagotomy. Careful pre-operative oesophageal assessment is necessary to determine which duodenal ulcer patients require an anti-reflux procedure in addition to vagotomy.
The detection of renal allograft rejection by fine-needle intrarenal manometry
Authors: Wilson R G , Taylor R M R , Proud G
Published: March 2007

The causes of early renal allograft malfunction include rejection, acute tubular necrosis, cyclosporin nephrotoxicity and vascular complications. Fine-needle intrarenal manometry is a potential method of distinguishing rejection from the other causes of malfunction and has been used by Salaman and Griffin1 in patients' treated with cyclosporin. The technique involves inserting a fine-needle, which is connected to a specially designed manometer, into the substance of the transplant kidney. One hundred and six measurements of intrarenal pressure have been made in 28 patients immunosuppressed with either azathioprine and prednisolone or cyclosporin. Thirteen rejection episodes were identified and confirmed by biopsy. These were treated by pulse steroid (methylprednisolone) therapy. Seven episodes of cyclosporin toxicity were identified and there were fifteen episodes of acute tubular necrosis. The mean intrarenal pressure in the rejecting group was 52-8 mmHg compared with 22·3, 24·1 and 24·3 mmHg for the normal function, acute tubular necrosis and cyclosporin nephrotoxicity groups, respectively (P<0·01; Wilcoxon unpaired test). There were no differences within these groups related to the type of immunosuppression used. There were no clinical complications associated with the procedure. Thus in newly transplanted patients, fine-needle intrarenal manometry accurately identified rejection and distinguished it from normal function, acute tubular necrosis and cyclosporin nephrotoxicity in all the patients regardless of the immunosuppressants used.
Use of a ringed intraluminal graft in the operative management of abdominal aortic aneurysms
Authors: Cave-Bigley D J , Harris P L
Published: March 2007

The efficacy of a non-sutured technique of anastomosis has been assessed in 20 patients who had bifurcated grafts inserted for aneurysms of the infrarenal aorta. The grafts had rigid Dacron-covered metal rings incorporated at each end and the anastomoses were effected by securing these rings within the lumen of the vessel with a firmly tied Dacron tape. In order to allow access of the ring to the lumen of the aorta it was necessary to employ an intraluminal occlusion balloon catheter for proximal control. The patients included in the study formed a particularly high risk group. There were 12 emergency and 8 elective procedures. The mean duration of the operations was 134±34 min (± s.d.); the mean blood loss during surgery was 3498±2660ml (±s.d.) and the mean length of inpatient stay after operation was 16±13 days (±s.d.). There were eight postoperative deaths and post-mortem examination, which was allowed in six cases, showed satisfactory appearances of the grafts and anastomoses. The surviving patients have remained free from complications for up to 18 months after operation. A non-sutured technique is possible for most aortic anastomoses but is of limited applicability for iliac and more distal anastomoses. With further technical refinements an intraluminal graft with a non-sutured aortic anastomosis may become a valuable alternative to the conventionally sutured prosthesis in the management of ruptured abdominal aneurysms.
Accuracy of aspiration cytology in the diagnosis of breast disease
Authors: Smallwood J , Herbert A , Guyert P , Taylor I
Published: March 2007

The accuracy of fine needle aspiration cytology has been assessed in 480 consecutive breast lesions where definitive histology was later available. The results in terms of specificity and sensitivity have also been compared to mammography and clinical examination. With adequate smears aspiration cytology was 100 per cent specific with no false positive diagnosis. This compares with 15 false positive mammograms and 12 false positive diagnoses on clinical examination. Cytology was unsatisfactory in 36 per cent of benign lesions owing to poor cellularity of the sample but when considered with mammography and examination led to a reduction in biopsies for benign disease. A definitive cytological diagnosis of malignant tumours resulted in a reduction in frozen sections with a substantial saving of resources and improvement in patient counselling. No mastectomy was performed for benign disease.
Are the lesions of duct ectasia sterile?
Authors: Bundred N J , Dixon J M J , Lumsden A B , Radford D , Hood J , Miles R S , Chetty U , Forrest A P M
Published: March 2007

A prospective study was established to determine whether, using suitable transport media, bacteria could be isolated from the lesions of mammary duct ectasia. The results indicate that both aerobic and anaerobic organisms are present in a high proportion of patients with nipple discharge associated with this condition and in all patients who develop peri-areolar sepsis (abscess and mammillary fistulae) as part of the syndrome. The lesions of duct ectasia are therefore not sterile and the possibility exists that bacteria have a role in the aetiology and pathogenesis of this condition.
Pre-operative staging of rectal neoplasm and its impact on clinical management
Authors: Williams N S , Durdey P , Quirke P , Robinson P J , Dyson J E D , Dixon M F , Bird C C
Published: March 2007

A sophisticated staging technique (extended staging, ES) employing modern technology has been compared prospectively with conventional clinical assessment (initial staging, IS) in 45 patients with low rectal carcinoma (less than 12 cm from the anal verge) to determine its potential merit and its impact on clinical management. ES consisted of computerized tomography of liver and pelvis, ultrasound scan of liver, measurement of serum concentrations of carcinoembryonic antigen (CEA) and acute phase reactant proteins and multiple superficial and deep biopsies to determine not only the histological grade of the tumour but also its DNA cellular content as measured by flow cytometry. ES proved statistically superior to IS in the assessment of local spread and dissemination. Although histological grade proved to be more accurate on ES than IS this was only true when one specialist pathologist interpreted the slides. When several pathologists were involved interobserver variation made interpretation unreliable. Assessment of DNA content using flow cytometry, being quantitative, was more accurate and perhaps should be used in the future as a prognostic indicator. The improved accuracy of ES would have altered both pre- and intra-operative clinical decisions. It would have prevented some patients receiving inappropriate adjuvant therapy as well as selecting patients more accurately for the correct treatment.
The management of colon injuries by primary repair or colostomy
Authors: Demetriades D , Rabinowitz B , Sofianos C , Prümm E
Published: March 2007

This retrospective study comprises 134 cases of penetrating colon injuries. In 92 cases the injury involved the left colon and in the remaining 42 the right colon. Death due to the colonic injury occurred in 1.5 per cent and the incidence of abdominal complications was 17.9 per cent. Patients treated by primary repair of the colon had less colon-related complications and a shorter hospital stay than patients treated by colostomy. Left and right colon injuries treated by primary repair had similar complication rates and hospital stay (P > 0.05). We believe that primary repair can safely be performed more frequently than is generally accepted. The site of colon injury, the presence of shock and the presence of multiple associated intraabdominal injuries do not exclude primary repair. It is suggested that colostomy should be reserved for both left and right colon injuries with gross peritoneal contamination, extensive colonic damage, and large amount of hard faeces in the colon.
Adult Hirschsprung's disease: results of the Duhamel procedure
Authors: Elliot M S , Todd I P
Published: March 2007

Hirschsprung's disease is a rare condition in the adult. The case reports of 39 patients managed by the Duhamel procedure were reviewed. One-third of the patients underwent at least one abdominal surgical procedure before the correct diagnosis was made. The operative mortality of the Duhamel procedure was zero. In 29 patients no defunctioning procedure was used to protect the anastomosis. The incidence of anastomotic dehiscence was 13 per cent. Thirty-six of the thirty-nine patients have excellent functional results.
Failure of Doppler ankle pressure to predict healing of conservative forefoot amputations
Authors: Welch G H , Leiberman D P , Pollock J G , Angerson W
Published: March 2007

Fifty minor foot and transmetatarsal amputations were studied to assess the reliability of Doppler ankle blood pressure (DABP) and skin blood flow (SBF) to predict healing. The level of amputation was determined solely on clinical criteria. Thirty-six (72 per cent) of the amputations healed. There was no statistical difference between mean DABP in healed 89±8 mmHg mean ± s.e.m.) and non-healed (91 ± 12 mmHg mean ± s.e.m.) amputations. SBF was assessed by 125I-iodoantipyrine clearance in 28 patients. There was no correlation between DABP and SBF (r = 0.038). SBF in patients with healed amputations was 14.8 ± 1.2 (mean ± s.e.m.) ml 100 g−1 min−1 in contrast to SBF of 5.9 ± 0.3 (mean ± s.e.m.) ml 100 g−1 min−1 in the patients with non-healing (P<0.01). Where the flow was in excess of 8 ml 100 g−1 min−1 healing was always obtained while a flow of less than 7 ml 100 g−1 min−1 was associated with healing failure. These results suggest that DABP should be interpreted with caution as this technique fails as an accurate means of identifying those patients suitable for forefoot amputations. Skin blood flow assessment appears to provide an absolute value for the prediction of healing potential at this level.
Noninvasive technique using thallium-201 for predicting ischaemic ulcer healing of the foot
Authors: Ohta T
Published: March 2007

A post-stress imaging study utilizing single intravenous doses of thallium-201 was performed on feet with trophic skin lesions. Forty-two ischaemic ulcers were classified into four basic types according to the presence and degree of the inherent inflammatory response of the ulcer in both the initial and delayed distributions. Both the relationship between ulcer type and prognosis and the effects of therapy within ulcer type were assessed. The results suggest that ulcers of Type I or Type II heal in response to conservative treatment, while ulcers of Type III, although undergoing healing, require surgical treatment to prevent a protracted hospitalization. In Type IV ulcers, healing is not to be expected at all with conservative therapy; therefore an early decision of amputation may be necessary if surgical measures are not indicated. The technique reported may be helpful not only in the prediction of spontaneous ulcer healing but also in the selection of appropriate treatment.
The fate of polytetrafluoro-ethylene grafts in lower limb bypass surgery: a six year followup
Authors: Charlesworth P M , Brewster D C , Darling R C , Robison J G , Hallet J W
Published: March 2007

The success of lower limb bypass surgery depends, in the major part, on the availability of autologous saphenous vein as the most satisfactory arterial substitute known to date. Although various prosthetic conduits, used in the absence of saphenous vein, have shown promising success on short term follow-up, more long-term comparative data are required for adequate assessment. This study analyses, by life table method, the results of 134 infra-inguinal bypass grafts using polytetrafluoroethylene (PTFE) over a 6 year period. The results reconfirm the superior long-term patency of vein bypasses compared with such prosthetic grafts. Analysis suggests that, while PTFE may give acceptable results in the immediate and shortterm follow-up period, 6 year patencies approach 20–30 per cent.
Abdominal aortic aneurysm in Chinese patients
Authors: Wei W I , Siu K F , Wong J
Published: March 2007

From 1975 to 1983, 120 Chinese patients with infrarenal abdominal aortic aneurysm were seen, 72 of whom underwent aneurysmectomy; 45 were performed electively and 27 as emergencies. The operative mortality in the former was 4.4 per cent and the latter 33.3 per cent. All 27 patients who presented with rupture were operated on. However, only 45 of 93 patients (48.4 per cent) with intact aneurysm underwent surgery; the remainder were either unwilling (35) or unfit (13). Peptic ulcer disease was noted in 26.4 per cent of patients.
The effect of pre-operative total parenteral nutrition on energy-rich phosphates, electrolytes and free amino acids in skeletal muscle of malnourished patients with gastric carcinoma
Authors: Sandstedt S , Lennmarken C , Symreng T , Vinnars E , Larsson J
Published: March 2007

The effect of two weeks of total parenteral nutrition (TPN) on energy-rich phosphates, muscle water, electrolytes and free amino acids in skeletal muscle were determined in ten malnourished patients with gastric carcinoma. The total adenine nucleotide pool, phosphocreatine, creatine and glycogen were decreased before TPN, and only glycogen returned to normal after TPN compared with controls. Total muscle water and the intramuscular concentrations of sodium and chloride were initially increased and were not influenced by TPN. The total non-essential amino acids in muscle were decreased by 9 per cent, mainly due to a 15 per cent decrease in glutamine. The concentrations of free amino acids in muscle were not affected by two weeks of TPN. This study demonstrates disturbances in energy, water and amino acid metabolism in skeletal muscle of malnourished patients with gastric carcinoma, and that two weeks of TPN could not normalize these changes, except in the case of glycogen. The reason for this might be enzyme abnormalities due to adaptation to energy or protein deficit. A longer period of refeeding might therefore be necessary to improve peripheral metabolism in these patients.
Mortality and morbidity after anterior lesser curve seromyotomy with posterior truncal vagotomy for duodenal ulcer
Authors: Taylor T V , Gunnt A A , Macleod D A D , Van Vroonhoven Th J M V , Bornman P C , Terblanche J , Thomson J W W , Lythgoe J P , Macfarland J B , Salem R J , Gnarowski H
Published: March 2007

A survey has been performed of the mortality and morbidity of anterior lesser curve seromyotomy with posterior truncal vagotomy in the elective treatment of chronic duodenal ulcer. There was one death in a series of 605 patients due to a myocardial infarction, an operative mortality of 0.16 per cent. There was no case of ischaemic necrosis of the lesser curvature or fundus of the stomach. Eleven patients had symptoms of delayed gastric emptying (1.7 per cent) and seven of these underwent a drainage procedure (1.3 per cent). Postoperative dumping did not occur, significant diarrhoea was present in two patients (0.33 per cent). This operation is relatively simple, quick and extremely safe to perform. It is suggested that the more widespread use of this type of elective surgery for duodenal ulcer might reduce the mortality from the condition.
Maximal gastric secretion in smokers and non-smokers with duodenal ulcer
Authors: Whitfield P F , Hobsley M
Published: March 2007

Sex, stature, age and smoking habits were investigated as possible determinants of maximal gastric secretion in pre-operative patients with duodenal ulcer. Stimulation was by an intravenous infusion of histamine (130 nmol kg−1 h−1) in 201 patients. Men were found to secrete significantly more than women, and smokers secreted significantly more than non-smokers. By multiple regression analysis, height and the total number of cigarettes smoked were found to be significant positive, and age significant negative factors in the magnitude of maximal gastric secretion. Upon standardization for these factors, the differences between the sexes and the smoking groups disappeared. It is suggested that, at least in men, chronic smoking increases maximal gastric secretion, and therefore could have a role in the aetiology of duodenal ulcer.
To lay open or excise a fistula-inano: a randomized trial
Authors: Kronborg O
Published: March 2007

Two treatments for fistula-in-ano were compared in a randomized trial. Times of healing were significantly shorter when the fistula was laid open (median 34 days, n = 26) than after excision (41 days, n = 21) (P < 0.02). Revisional surgery was necessary before healing could be obtained in 3 of 26 patients after lay open operations and 2 of 21 after excision. Recurrence rates within 1 year were similar (3/24 and 2/21).
Appendicectomy: assessment of stump invagination versus simple ligation: a prospective, randomized trial
Authors: Engström L , Fenyö G
Published: March 2007

The appendix stump was ligated and doubly invaginated in 374 patients and was simply ligated in 361 in a prospective, randomized trial of 735 consecutive appendicectomies. The two groups were similar with respect to sex, age, degree of appendiceal inflammation and antibiotic treatment. The incidence of wound infection and postoperative pyrexia and the postoperative hospital stay showed no significant intergroup difference. The median operating time was slightly shorter in the group without invagination. Simple ligation facilitates and shortens appendicectomy. It produces no deformation of the caecal wall that subsequently may be mistaken for a caecal neoplasm. Simple ligation is therefore recommended as standard procedure in appendicectomy.
Elevated rates of whole body protein metabolism in patients with disseminated malignancy in the immediate postoperative period
Authors: Ward H C , Johnson A W , Halliday D , Sim A J W
Published: March 2007

Protein metabolism after surgery in the presence of disseminated malignancy has been investigated and compared with results obtained from patients undergoing similar surgical procedures for benign disease and localized malignancy. Whole body nitrogen turnover, measured by primed continuous infusion of15 N glycine, was highest with disseminated malignancy. Similarly rates of whole body protein synthesis and breakdown, calculated from turnover and nitrogen excretion (nitrogen intake being zero), were elevated in the presence of disseminated malignant disease. The increased rates of protein metabolism may represent adaptation to the demands of inevitably growing malignant tissue.
Surgical reasearch society. Pre-operative determination of oestrogen receptor status in breast cancer by immunocytochemical staining of fine needle aspirates
Authors: Crawford D J , Lope-Pihie Azimahtol , Cowan Sheila , George W D , Leake R E
Published: March 2007

A meeting of the Surgical Research Society with Professor R. Shields in the Chair, was held at Trinity College, Dublin on 4 and 5 July 1985. Eighty-four papers were presented during the scientific part of the meeting which was preceded by a Workshop entitled ‘Oesophageal Investigation’, the participants being Mr J. Clark, Mr G. O'Sullivan, Mr J. Bancewicz and Dr M. O'Connor. The Patey Prize was awarded to Mr P. R. O'Connell for his paper entitled ‘Neorectal emptying after ileal ‘J’ pouch-anal anastomosis’.

The results of pre-operative staining of fine needle aspirate (FNA) samples from 48 breast cancers, with a polyclonal antibody raised against highly purified oestrogen receptor (ER) protein, have been compared with our standard biochemical method for measurement of cytosol and nuclear ER. FNA antibody staining correctly predicted the presence of ER in 20 of 21 ERC + /N+ tumours. There were 2 false positive results in 24 ER C-/N- tumours though both these tumours showed marked heterogeneity of staining. Three ER C + /N- tumours were negative by antibody staining, in keeping with the tendency for such tumours to be hormone independent in behaviour. This pre-operative method for ER determination appears to be a reliable alternative to other micro-assays for oestrogen receptors.
Hidradenitis suppurativa: evidence for an endocrine abnormality
Authors: Harrison B J , Kumar S , Read G F , Edwards Catherine A , Scanlon M F , Hughes L E
Published: March 2007

Women patients with premenstrual exacerbation of hidradenitis suppurativa have been studied to determine if an endocrine abnormality can be detected. A functional disorder of the hypothalamopituitary axis was found in 13 patients with hidradenitis when compared with 9 controls. In response to a combined thyrotrophin releasing hormone and gonadotrophin releasing hormone test, the prolactin and TSH responses were significantly greater in the hidradenitis patients than the controls. No significant differences were found in the mean basal levels of oestrogen, progesterone, testosterone, dehydroepiandrosterone sulphate, T3 and T4. These results may reflect a disturbance of feedback signals from peripheral hormones, rather than a primary dysfunction of the control of specific anterior pituitary cells.
Effects of a somatostatin analogue (SMS 201-995) on hepatic and splenic reticulo-endothelial function in the rat
Authors: Baxter J N , Jenkins S A , Day D W , Shields R
Published: March 2007

The effects of a long acting somatostatin analogue, SMS 201-995, on reticulo-endothelial system (RES) activity were studied in rats. Administration of 2 μg SMS 201-995 subcutaneously twice a day for 7 days significantly increased the splenic and hepatic uptake of 99mTc-sulphur colloid and damaged 51mCr-red blood cells. Furthermore, SMS 201-995 administration significantly increased the plasma clearance of colloidal carbon as indicated by a lower area under the curve and an increased elimination constant. SMS 201-995 administration also significantly improved survival after intraperitoneal injection of Escherichia coli endotoxin. These results suggest that SMS 201-995 stimulates RES activity in rats. It is suggested that SMS 201-995 may be of value in stimulating RES activity in patients with cirrhosis and portal hypertension.
Effects of a somatostatin analogue SMS 201-995 on hepatic haemodynamics in the pig and on intravariceal pressure in man
Authors: Jenkins S A , Baxter J N , Corbett W A , Shields R
Published: March 2007

The effects of a somatostatin analogue, SMS 201-995, on hepatic haemodynamics in the pig and on intravariceal pressure in man were studied. An infusion of 250 μg/h SMS 201-995 significantly reduced portal pressure, portal venous flow and hepatic artery flow in the pig. These changes in hepatic haemodynamics were accompanied by a reduction in cardiac output, a reflex slowing of the heart and an increase in arterial blood pressure. Splanchnic vascular resistance was increased following SMS 201-995 administration but hepatic vascular resistance remained unchanged. Administration of 50 μg SMS 201-995 reduced the intravariceal pressure from 27.4 ± 2.5 to 15.8 ± 2.1 mmHg in 9 patients with cirrhosis and portal hypertension. Administration of 50 μg SMS 201-995 also reduced portal pressure from 29 to 22 mmHg in a patient undergoing an elective portacaval shunt. These results suggest that SMS 201-995 may be of value in the control of bleeding oesophageal varices. Furthermore, because of its prolonged duration of action SMS 201-995 may be useful in the long term management of portal hypertension in patients with cirrhosis.
Reflux versus dysphagia: an objective evaluation of the Angelchik prosthesis
Authors: Morris D L , Jones J , Evans D F , Foster G , Smart H , Gregson R , Amar S , Doran J , Hardcastle J D
Published: March 2007

Twenty-seven patients with proven longstanding gastro-oesophageal reflux underwent insertion of an Angelchik anti-reflux prosthesis. Pre-operative studies included oesophageal manometry, endoscopy, acid reflux provocation test (ARPT) and 24h oesophageal pH recording (24h pH). Following operation mean lower oesophageal sphincter pressure was increased from 11 to 20 cmH2O. ARPT revealed significant pre-prandial reflux before operation in 16/24 compared with only 1/20 postoperatively; 24 h pH also showed an improvement in that 21/22 patients refluxed before operation compared with no significant reflux after. Dysphagia for solids of some degree was seen postoperatively in 26 patients and this was also demonstrated by delay in transit of a marsh-mallow swallow test. Severe dysphagia was seen in 4 patients and in 3 of these was related to rotation and displacement of the prosthesis necessitating removal.
The impact of percutaneous transluminal angioplasty on the management of peripheral vascular disease
Authors: Anderson J B , Wolinski A P , Wells I P , Wilkins D C , Bliss B P
Published: March 2007

Percutaneous transluminal angioplasty is a well established technique with wide application, but its place in the overall management of peripheral vascular disease is not well defined. This study compares similar groups of patients with peripheral vascular disease in 1981 and 1984, before and after the introduction of the technique to a district general hospital. More patients are now being investigated and treated and this is almost entirely due to the availability of angioplasty. The rates for surgery have not changed. Percutaneous transluminal angioplasty should therefore be seen as a new and separate form of treatment for peripheral vascular disease, not necessarily influencing or replacing surgery, and requiring its own allocation of resources in accordance with the increase in the level of care afforded by the technique.
Haemodynamic effects of intra-arterial and intravenous administration of prostaglandin E1 in patients with peripheral arterial disease
Authors: Hirai M , Nakayama R
Published: March 2007

The purpose of this study was to compare the haemodynamic effects of intra-arterial and intravenous prostaglandin E1 (PGE1) both injected and infused into ischaemic legs. Continuous intra-arterial infusion of PGE1 induced a significantly greater increase in skin temperature and blood flow than did intravenous drip infusion. Furthermore, intra-arterial infusion caused no steal phenomenon in the toe as indicated by skin temperature. On the other hand, toe skin temperature decreased during intravenous drip in 33 per cent of the legs tested. Continuous intravenous infusion also produced a significantly greater increase in toe skin temperature than did brief intravenous drip. In three of ten ulcers healed by continuous intra-arterial infusion, no definitive effect was obtained from continuous intravenous infusion even when it was repeated up to three times before continuous intra-arterial infusion. Intra-arterial injection of PGE1 caused no significant increase in toe skin temperature.
A 5 year follow-up of Dacron femoropopliteal bypass grafts
Authors: Mosley J G , Marston A
Published: March 2007

Over a 5½ year period, 66 Dacron femoropopliteal grafts were performed for patients with an absent or unsuitable long saphenous vein. The minimum follow-up has been 6 months and cumulative patency was 50 per cent at 5 years. Twenty-five patients had critical ischaemia (pre-operative Doppler ankle pressure < 40 mmHg) and 41 patients had severe ischaemia (pre-operative ankle pressure > 40 mmHg). The procedure significantly improved ankle pressures in both groups and this was maintained at follow-up. In the group of 25 patients with critical ischaemia there were three operative deaths and in 10 the graft subsequently occluded, precipitating an amputation. In the group of forty-one patients with severe ischaemia, there was one operative death and in two patients the graft occluded at 18 and 24 months. In this small series there was no significant difference in patency, whether the graft was placed to the popliteal artery above or below the knee joint, or whether the popliteal had less than three patent branches at its trifurcation.
Opsonic dysfunction secondary to plasma fibronectin depletion after aortic surgery
Authors: Powell Janet T , Poskitt K R , Irwin J T , Attanoos R L , McCollum C N
Published: March 2007

Fibronectin is a plasma opsonin which is depleted after major injury or surgery. The effect of major aortic surgery on plasma fibronectin has been studied in patients and in an equivalent experimental model in pigs. On the day after aortic surgery in eleven patients mean fibronectin (±s.e.m.) had fallen from 363 ± 11 mg/l pre-operatively to 179 ± 19 mg/l (P < 0.01). No such fall was observed in patients undergoing herniorrhaphy. In fourteen pigs aortic surgery produced reproducible surgical shock and a fall in plasma fibronectin from 331 ± 10 mg/l to 43 ± 13 mg/l after resuscitation (P < 0.01). Whenever plasma fibronectin fell below 190 mg/l the circulating free fibronectin was consumed in complexes of 1000 kDa containing collagenous debris. More severe depletion of plasma fibronectin was related to higher concentrations of circulating non-opsonized collagenous debris and to subsequent mortality in pigs. The depletion of free fibronectin that occurs following major surgery may produce clinically important opsonic dysfunction. The clinical relevance of this fibronectin consumption may be missed if measurement is limited to circulating fibronectin levels without determining that proportion bound in complexes and no longer available as an opsonin.
Indicators of surgical risk and clinical judgement
Authors: Pettigrew R A , Hill G L
Published: March 2007

A number of indicators of surgical risk were measured in 218 patients awaiting major gastrointestinal surgery. The indices chosen had been used by others to identify high risk patients and they were compared with each other and with two clinical assessments of risk, one by the operating surgeon and the other by an independent clinician who performed a complete physical examination. Anthropometric indices did not pick out patients who were significantly at high risk but the plasma proteins (albumin, pre-albumin, transferrin) identified subgroups of high risk patients, about a third of whom developed major postoperative complications. Although some nutritional indicators which use plasma proteins for the computation selected patients who were significantly more at risk, some (20–30 per cent) of the patients with low levels of plasma proteins (particularly those who were septic) did not have depleted fat or muscle protein stores. Although the surgeons were able correctly to identify only a small number of very high risk patients the results showed that a carefully performed clinical examination was able to do this as effectively as the plasma proteins. It is suggested that something more than a global assessment by the operating surgeon is required to identify high risk patients. A careful assessment of medical risk noting in particular cardiorespiratory disease and pre-existing sepsis, as well as nutritional state, is as effective as any other currently used indicator of risk.