bluuebunny/crossref_metadata_2025 huggingface dataset:
A practical reappraisal of the anatomy of the extrahepatic bile ducts and arteries
Authors: Benson E A , Page R E
Published: March 2007

Two hundred and five dissections of the extrahepatic biliary tree have revealed that although the anatomy of this area is remarkably variable there are only three important vascular and five important ductal anomalies (the former occurring much more frequently than the latter). Each anomaly is, however, easily recognized at operation. A higher incidence of anatomical anomalies was found in patients with gallstones compared with those without and in women than in men, and there was a remarkably low incidence of accessory hepatic ducts overall. The significance and practical implications of these findings are discussed.
Gallstone pancreatitis with normal biliary radiology
Authors: Smith Rodney , Williams Russell , Cotton P B
Published: March 2007

Three patients with relapsing gallstone pancreatitis and normal routine biliary radiology are reported and discussed.

It is emphasized that when dealing with recurrent pancreatitis for which no cause is evident, normal conventional biliary radiology (oral cholecystogram and intravenous cholangiogram) should not necessariry be accepted as conclusive. The use of endoscopic cholangio-graphy in such a situation is encouraging.
Allergic starch peritonitis in the guinea-pig
Authors: Grant J B F , Davies J D , Jones J V
Published: March 2007

An experimental starch peritonitis in guinea-pigs previously immunized with starch glove powder and Freund's complete adjuvant is described. After peritoneal challenge by 10 mg starch glove powder, 22 per cent of the animals developed florid omental granulomas resembling those found in some patients with postoperative glove powder peritonitis. It is suggested that delayed hyper sensitivity to a component of the glove powder may be responsible for the clinical features of starch peritonitis in man.
A comparison of polyglycolic acid and catgut sutures in rat colonic anastomoses
Authors: Munday Clair , McGinn F P
Published: March 2007

Standard colonic wounds were closed in 44 rats by either polyglycolic acid or catgut sutures. Seven days later portions of the colonic wounds were measured for tensile strength and examined histologically. There was no difference in the mortality, strength of the anastomosis or the amount of inflammation induced by either of the suture materials used.
The burst abdominal wound: A mechanical approach
Authors: Jenkins T P N
Published: March 2007

The burst abdominal wound has a mechanical cause. It is the result of suture breaking, knot slipping, the intact suture cutting out of the tissues or protrusion of gut or ornentum between stitches.

Measurements of abdominal girth and the xiphoidpubis distance before and during abdominal distension show that a wound may lengthen by 30 per cent if distension occurs. An adequate reserve of suture length in the wound is necessary to allow this lengthening to occur and to ensure a minimal resulting rise in tension between the sutures and the tissues.

Three variables present in every continuous wound closure—the suture length inserted, the wound fascial length and the number of stitches—determine the stitch interval and the size of the tissue bite, which are the two vital factors in wound strength under the surgeon's control. These variables may be expressed by the ratio of the length of suture (SL) inserted to the wound length (W), the ratio SL : WL.

Analytical and clinical evidence is presented to show that: Deep wound disruption (evisceration and ventral hernia) is associated with the use of an SL : WL ratio of 2 : 1 or less—the lower the ratio, the greater is the risk of a burst wound.Wound disruption because of cutting out of sutures can be prevented by the use of non-absorbable continuous sutures at 1-cm intervals and an SL : WL ratio of 4 : 1 or more.
Shearing operation for incompetent perforating veins
Authors: Edwards J M
Published: March 2007

A new technique of treating incompetent perforating veins using a shearing instrument is described, and the results in 24 patients are reported.
The embryology and surgical management of gastroschisis
Authors: Thomas D F M , Atwell J D
Published: March 2007

Thirteen cases of gastroschisis are presented and a reduction in the operative mortality to 15 per cent is recorded. The aetiology of the condition is discussed and the opinion expressed that it represents the result of an intrauterine rupture of an incarcerated ‘hernia into the cord’ rather than any specific failure of development of the abdominal wall musculature. Early skin closure and the creation of a ventral hernia remain the surgical treatment of choice, but it is recognized that the use of a prosthetic sac may occasionally be necessary. Infection is now the most important single factor influencing mortality, and the prolonged administration of prophylactic antibiotics is justified on this basis. Skilled management of the protracted ileus is essential. In view of the low incidence of serious coexistent malformations the children who survive the initial operation can be offered the prospect of a life of normal duration and quality.
Mixed vascular deformities of the lower limbs, with particular reference to lymphography and surgical treatment
Authors: Kinmonth J B , Young A E , Edwards J M , O'Donnell T F , Thomas M Lea
Published: March 2007

A series of patients with congenital blood and lymph anomalies of the lower limb investigated and treated at St Thomas's Hospital, London, are reviewed. They fell into three classes: (1) those in which the venous element predominated (Klippel and other syndromes), (2) those with arteriovenous shunts and (3) those with angiomas of blood or lymph vessels scattered through the limb (diffuse mixed angiomas).

Most of the patients were investigated by angiography (of blood or lymph systems) as well as by plethysmography, dermal temperature measurements and other techniques in the thermal laboratory.

Phlebography showed most abnormalities in the Klippel group and was useful in delineating them before operation. The importance of confirming the existence of an adequate deep venous circulation prior to ablation of abnormal superficial vessels is emphasized.

Arteriography showed most abnormalities in the group with suspected arteriovenous shunts. The most commonly performed operations in this group were for control of overgrowth of the limb or for ulceration.

Lymphography showed many of the Klippel group to suffer from insufficiency of the main pathways, either aplasia or hypoplasia. In addition many had vesicles, fistulas and lymph cysts.

Patients in the arteriovenous shunt group had large hyperplastic lymph pathways, which were possibly either congenital or a hypertrophic response.

One hundred and thirty-eight operations were performed in 46 patients for a variety of lesions and disabilities. These are reviewed. The scope and benefit of surgery in these children are greater than has been accepted in the past.

Three patients required amputation of a limb.

There were 5 deaths in the series, 4 of these being in the scattered angioma group and in patients in whom the deformities extended beyond the limb into the trunk.
Pulsatile changes of electrical impedance in the lower limb
Authors: Schraibman I G , Naylor G P , Smith K , Patel P , Charlesworth D
Published: March 2007

The ratio of the pulsatile and the mean value of the volume of blood flowing through the calves of normal subjects with each heart beat was calculated from electrical impedance changes during venous occlusion plethysmography.

Measurements made concurrently by proven Doppler ultrasound techniques did not correlate with ratios derived from the impedance measurements. The pulsatile change in electrical impedance in the limbs appears to be due more to changes of resistance in the blood than to pulsatile changes in the volume of the limb.
Successful repair of an idiopathic spontaneous aortoduodenal fistula
Authors: Mansel R E , Powley P H
Published: March 2007

A case of idiopathic spontaneous aortoduodenal fistula treated surgically is reported. This case is probably the first successful repair of an idiopathic fistula to be recorded in the literature. The difficulty in diagnosis and possible aetiology are discussed.
Special problems associated with abdominal aneurysmectomy in spinal cord injury patients
Authors: Kwaan Jack H M , Jones S Austin , Juler George L , Connolly John E
Published: March 2007

There were 8 patients with spinal cord injury in the last 100 consecutive patients with abdominal aortic aneurysm resected at the Long Beach Veterans Administration Hospital. Emphasis is placed upon the problems in management not found in individuals without spinal cord injury. A successful outcome is dependent upon: (a) aggressive control of foci of infection, (b) early diagnosis and planned surgical intervention, (c) continuous intra-operative arterial and central venous pressure monitoring and (d) alertness to the prevention of postoperative complications, with emphasis upon careful tracheal toilet and anticipation of delayed wound healing.
Limited intertransverse fusion using iliac grafts
Authors: Harrold A J
Published: March 2007

Fusion of the lower lumbar spine or lumbosacral joint can be achieved by the use of limited intertransverse iliac grafts inserted by a lateral approach. The method offers certain special advantages and is no less successful than other techniques in common use.
Hyperparathyroidism associated with a parathyroid cyst: An unusual presentation
Authors: Simkin E P
Published: March 2007

In a case of hyperparathyroidism associated with a large parathyroid cyst a causal association was demonstrated by the presence of enormous quantities of parathormone in the cyst fluid. Assay of hormone levels in the cyst fluid in future cases may be helpful in elucidating the aetiology of this rare condition.
Obstructive uropathy due to primary retroperitoneal tumour (leiomyosarcoma): Report of 2 cases and review of the literature
Authors: Bose B , Boake R C
Published: March 2007

Two cases of primary retroperitoneal leiomyosarcoma presenting with obstructive uropathy which were successfully treated by surgical excision are reported. The classification of primary retroperitoneal tumours and their symptomntology, treatment and prognosis are discussed in detail based on a review of the literature and the current experience of treating these tumours by combination therapy. It is felt that with advances in the diagnosis and therapy the prognosis is likely to improve.
Clinical diagnosis of abdominal tuberculosis
Authors: Das Pritam , Shukla H S
Published: March 2007

One hundred and eighty-two cases of abdominal tuberculosis admitted to Swaroop Rani Nehri (SRN) Hospital, Allahabad, in the past 7 years have been reviewed.

The clinical diagnosis of abdominal tuberculosis was made correctly only in 50 per cent of cases. About half the cases presented with chronic or acute on chronic intestinal Obstruction. The remaining patients had vague pains, tender abdomen, constitutional symptoms or a mass in the abdomen. Diarrhoea was not frequent and fistula formation was rare. A chronic obstructive type of lesion was found not only in cases with a bowel lesion but also in patients with chronic miliary peritonitis and tuberculous mesenteric adenitis. Similarly, a lump was present not only in hypertrophic bowel tuberculosis but also in chronic miliary peritonitis and tuberculous mesenteric adenitis. On radiological examination false positive features such as fluid levels, bowel dilatation or even the ‘string’ sign were encountered. Liver and endometrial biopsies were positive in only a very few cases. Peritoneal biopsy was of considerable help, being positive in 88 per cent of ascitic cases and in 42·1 per cent of non-ascitic cases.

Open peritoneal biopsy obtained after making a small incision in the right iliac fossa was found to be the most useful investigation in the diagnosis of abdominal tuberculosis. An ascitic fluid protein content of 2·5 g or more and a predominantly lymphocytic count of over 100/mm3 are diagnostic, but a cell count of 10/mm3 was recorded in one tuberculous case.
A simple method for the introduction of an oesophageal tube in advanced carcinoma of the oesophagus
Authors: Anscombe A R , Pearson K , Taylor T V
Published: March 2007

A simple technique is described which facilitates the introduction of an oesophageal tube in cases of advanced carcinoma of the oesophagus. The method has proved satisfactory in cases with the tightest of strictures.
Results of Heller's operation for achalasia of the oesophagus. The importance of hiatal repair
Authors: Black J , Vorbach A N , Collis J Leigh
Published: March 2007

A survey of 108 patients with achalasia treated by cardiomyotomy is reported. All the operations were done by the abdominal approach and all the patients were followed up for a minimum of 4 years. Fifty-five patients had some form of hiatal reconstruction, I1 of these having a formal plastic repair as practised for oesophageal reflux problems.

At 4 years after operation 71 patients (65·5 per cent) had entirely satisfactory results. Twenty-seven patients had recurrent dysphagia and 20 patients had symptoms of reflux oesophagitis. The group who had had a formal repair of the hiatus had no reflux symptoms after operation and also had better swallowing than the other groups.

These results suggest that much of the dysphagia following Heller's operation is due to occult gastro-oesophageal reflux and can be avoided by a reflux-preventing procedure.

Adequate hiatal repair after myotomy is strongly recommended.
Mesocoloplasty for sigmoid volvulus: A preliminary report
Authors: Tiwary R N , Prasad S
Published: March 2007

A technique of mesocoloplasty for the prevention of recurrence of sigmoid volvulus is described. The maneuvre is simple, and does not open the gut. It can be performed confidently by junior doctors undergoing surgical training and appears to be an eminently safe technique as a routine procedure in any emergency service.
The pattern of intestinal obstruction in Malaysia
Authors: Ti T K , Yong N K
Published: March 2007

This is a review of 261 patients operated for 271 instances of mechanical intestinal obstruction over a 5-year period in a developing country in the tropics. The pattern of intestinal obstruction in Chinese is similar to that in Caucasians, where adhesions account for the largest number of cases. The occurrence in Malays, Indians, Pakistanis and Ceylonese is similar to that in other developing communities where external hernia is commonest while adhesive or tumour obstruction is rare; however, these racial groups do not exhibit the high incidence of intussusception and volvulus found in Africa and India. The operative mortality was 13·9 per cent, which is comparable to that in Western series. The major adverse factors in intestinal obstruction, i.e. extremes of age, associated disease, gangrenous bowel, large bowel obstruction and malignancy, were confirmed. Fluid and electrolyte imbalance was frequent, as in other tropical series, but with intensive preoperative correction it was not an important adverse factor.
Cancer of the large bowel in the African: A 15-year survey at Kinshasa University Hospital, Zaïre
Authors: Kenda J F Ngala
Published: March 2007

In a 15-year survey at Kinshasa University Hospital, 954 solid cancers were recorded. Among these, 46 malignant tumours arose in the colon, rectum and anal canal, a proportion of 4·8 per cent. A review of the patients' age and clinical presentation, and pathology and aetiology of the tumours revealed that: The incidence of this cancer in young Africans is higher than in Western countries.The clinical presentation of this illness in young people is frequently unusual, but older African patients commonly present with classic symptoms.The incidence of mucous carcinonia tends to be higher, but could be explained by the larger number of young people suffering from the condition.Intestinal amoebiasis was associated with cancer in 3 cases. Its significance remains uncertain.
Noxytiolin and peritoneal adhesion formation
Authors: Gilmore O J A , Reid Clare
Published: March 2007

Clinical and experimental studies have suggested that intraperitoneal noxytiolin prevents adhesion formation. A reliable experimental animal model was therefore established and the effect of noxytiolin on adhesion formation was evaluated in a controlled trial using 80 rats. All 40 rats given Ringer solution developed adhesions, whereas in 7 out of 40 given noxytiolin no adhesions were found (P < 0·02). Noxytiolin reduced both the total and the mean number of adhesions formed (P < 0·2) and their mean length of attachment (P < 0·05). The anti-adhesive effect of noxytiolin may be due to its anticoagulant, cytotoxic or antibacterial properties.
The effect of surgical biopsy on the cell production rate of a murine tumour
Authors: Baxter-Smith D , Thomas D Brynmor , Riches A C
Published: March 2007

The rate of cell production of a mammary adenocarcinoma following surgical biopsy has been investigated using vincristine sulphate as a metaphase arrest agent. Small implants of the tumour were implanted into the inguinal region of young mice of both sexes and were seen to have a constant rate of cell production both between different tumour generations and during tumour growth. Such a constant rate of tumour cell production provides an extremely useful model for exploring the effects of surgical biopsy.

Measurements of the cell production rate showed a 60 per cent decrease for the first 48 hours following biopsy after which recovery ensued to reach control levels again. Sham-anaesthetized controls and sham-resected controls demonstrated none of these changes. Similar depression in the rate of cell production was seen following biopsy of one tumour in mice bearing bilateral tumours. The 48-hour depression was observed both in the ipsilateral remnant tumour and in the contralateral implant which has not been biopsied.
Coagulation changes in sensitized canine renal allografts
Authors: Brennan T G , Giles G R , Rajah S M , Davison A M , Guillou P J
Published: March 2007

Coagulation changes within kidney homotransplants to sensitized canine recipients have been studied by assessing the arteriovenous gradients of formed blood elements and coagulation factors across the organ. It is confirmed that hyperacute rejection is accompanied by evidence of intravascular coagulation within the graft, which is maximal during the first 20 minutes after revascularization. Attempts were made to prolong the survival of the grafts by the use of cytotosine arabinoside, methylprednisolone, heparin and azathioprine. In some instances, the severity of the intravascular coagulation was reduced but it did not prove possible to extend the survival of the kidneys beyond 24 hours.
Improvement in experimental vascular graft patency by controlled defibrinogenation
Authors: Postlethwaite J C , Goyle K B , Dormandy J A , Hynd J W
Published: March 2007

A sensitive animal model was used to investigate treatment designed to improve vascular graft patency. A Dacron graft was inserted into the infrarenal vena cava of 30 rabbits. Half were treated with subcutaneous Arvin for 28 days after operation. This produced a significant lowering of the postoperative plasma fibrinogen. The patency rate of the grafts in the treated rabbits was significantly greater than in the control rabbits.
A report on the use of Arvin in patients with pre-gangrene of the lower limb
Authors: Humphreys W V , Walker A , Charlesworth D
Published: March 2007

Sixteen patients with arteriosclerosis and pre-gangrene of a lower limb were treated for 5 days by intravenous injection of Arvin. The effects of the injection on plasma fibrinogen, the viscosity of blood and the patient's symptoms were measured. There was a 90 per cent reduction in plasma fibrinogen and a significant reduction in the viscosity of blood. Five patients experienced some relief of pain during the treatment. In only one patient were the symptoms relieved permanently.
Gastric ulceration after vagotomy for duodenal ulcer
Authors: De Miguel Jacinto
Published: March 2007

Fourteen instances of gastric ulceration following 415 vagotomies for duodenal ulcer have been reviewed with special reference to the relative incidence of this complication after different types of vagotomy, and to its clinical and radiological features and treatment. The aetiology is discussed.
Quinacrine in the management of malignant pleural effusion
Authors: Taylor S A , Hooton N S , Macarthur A M
Published: March 2007

Twenty-five patients with malignant pleural effusion were treated with a single intrapleural dose of Quinacrine. Eighteen patients (72 per cent) had a significant response, with no reaccumulation of fluid for at least 2 months following treatment up to a maximum of 18 months in 2 patients. Seven patients (28 per cent) survived for longer than 1 year without evidence of recurrent effusion.
Assessment of prognosis in cutaneous malignant melanoma
Authors: Barclay T L , Crockett D J , Eastwood D S , Eastwood J , Giles G R
Published: March 2007

A retrospective study of 103 patients with histogically proved cutaneous malignant melanoma was made in order to assess the validity of a simple prognostic index, based upon a multivariate analysis of weighted pathological and clinical factors, in predicting the expected outcome in a given case. The results of the study were almost identical to those observed by Cochran (1968); 16 per cent of the patients with a low prognostic index (less than 20) died or developed recurrence of melanoma during the period of follow-up, in contrast to those with a high prognostic index (greater than 25) of whom 64 per cent were similarly affected. It is concluded that the predicted outcome based upon such an index is valid for the 5 postoperative years in some 90 per cent of patients with cutaneous malignant melanoma. It is suggested that the use of such an index may be of great value in selecting patients in whom the expected outcome to surgical therapy is poor and in whom adjuvant therapy may be of value.
Foramen magnum impaction in a case of acro-osteolysis
Authors: Williams Bernard
Published: March 2007

A case of a rare, non-familial, generalized, congenital, osseous dysplasia is described with features which have previously been described under the name ‘acroosteolysis’. Basilar invagination followed defective bone formation in the skull and this produced occipital headache and progressive neurological deterioration with involvement of the lower cranial nerves and cerebellar function. Hydrocephalus and valvular impaction of the cerebellum in the foramen magnum were demonstrated. Partial relief was obtained by foramen magnum decompression; death supervened from infection and respiratory inadequacy at the age of 20.
Ulcerative colitis and Crohn's disease: Results after colectomy and ileorectal anastomosis
Authors: Watts J McK , Hughes E S R
Published: March 2007

Eighty-one patients who had had colectomy and ileorectal anastomosis for ulcerative colitis or Crohn's disease of the colon from 1 to 13 years previously were interviewed and examined by a surgeon with whom they had had no previous contact.

Sixty-four patients (79 per cent) had a satisfactory result. In 12 patients the operation had failed and an ileostomy had been established, and in a further 5 patients the result was considered unsatisfactory.

Despite a high incidence of frequent loose stools and minor anorectal complications, most of the patients were satisfied with the result and would not contemplate the alternative of an ileostomy. No patient had developed rectal cancer.

Provided that the rectum is examined regularly for pre-malignant or malignant change, colectomy and ileorectal anastomosis offer a satisfactory alternative to proctocolectomy and ileostomy for many patients with ulcerative colitis or Crohn's disease.
The internal sphincter and anal fissure
Authors: Hancock B D
Published: March 2007

The activity of the internal anal sphincter in patients with fissure has been studied by measuring anal pressure and motility with a small balloon probe.

The mean maximum anal pressure in 12 patients with fissure (116·8 ± 21·8, s.d., cm H2O) was significantly higher lhan that in 40 control subjects (85·0 ± 20·5 cm H2O; P < 0·01). Ultra-slow pressure waves were present in 80 per cent of the patients and in 5 per cent of the controls. Both the high pressure and ultra-slow waves were due to abnormal activity of the internal sphincter. This could be corrected equally well by either dilatation or lateral subcutaneous sphincterotomy.
The role of oxygen therapy in the healing of experimental skin wounds and colonic anastomosis
Authors: Kirk D , Irvin T T
Published: March 2007

A number of experimental studies have indicated that wound healing is adversely affected by hypoxia, and it has been suggested that healing can be improved by increasing inspired oxygen tensions. However, this hypothesis is based on observations on simulated wounds or tissue implants in experimental animals, and the clinical relevance of these observations is uncertain.

The effects of oxygen therapy on the healing of skin wounds and colonic anastomoses were examined in rats. Sutured skin incisions and normal and ischaemic colonic anastomoses were studied in control animals breathing air and in test animals breatliing 50 per cent oxygen. Wound healing was assessed by measurements of wound breaking strength, colonic bursting wall tension and wound collagen after 7 days' treatment with oxygen.

There was no significant difference in the measurements in skin wounds or colonic anastomoses in test and control animals, and there was a similar incidence of anastomotic dehiscence in the ischaemic colon of test animals and controls.

Oxygen therapy had no apparent effect on wound healing in this study, and it was concluded that further studies are required to determine whether or not there is a rational basis for the clinical use of oxygen therapy to help wound healing.
Ultrasound and amoebic liver abscess
Authors: Vicary F R , Cusick G , Shirley I M , Blackwell R J
Published: March 2007

Eight of 12 patients referred to an ultrasound clinic were eventually found to have a liver abscess. All 8 abscesses were confirmed positively by ultrasonic examination. Using ultrasound, an amoebic abscess can be accurately located within the liver and the optimal site for needling suggested to the clinician. Ultrasound is an accurate, non-invasive, diagnostic aid in this condition.
Mechanical suture methods in thoracic and abdominal surgery
Authors: Lawson W R , Hutchison J , Longland C J , Haque M A
Published: March 2007

Mechanical suturing procedures on the bowel, lung, bronchi and pulmonary vessels have been used on 264 occasions in 180 thoracic and abdominal operations. The instruments proved simple to use and produced reliable good quality closures, for the most part without manual reinforcement. There were 2 technical failures, one ending fatally, after colo-colostomy. Two minor postoperative suture leaks were encountered in 122 operations on the alimentary tract, but no leakage or other problem has arisen in 58 pulmonary cases.

The staple-suturing methods described are safe and straightforward, and it is believed that they represent a significant advance in the techniques of thoracic and abdominal surgery, which can usefully be applied in many situations.
The influence of penicillin on experimental wound contamination with staphylococci: Studies with chromic catgut and monofllament nylon closure
Authors: McCullough C J , Wheeler M H , Neale M L , Heard G E
Published: March 2007

This study examines the ability of penicillin to eradicate or modify the pattern of infection in experimental wounds contaminated with Staphylococcus pyogenes in the presence of chromic catgut or monofilament nylon suture. Penicillin therapy initiated within 4 days of the onset of infection was successful in eradicating infection when compared with untreated controls (P < 0·01). Infection was modified but not eradicated if penicillin was administered from the seventh day. The response of infection to penicillin was identical in wounds containing monofilament nylon or chromic catgut over a 21-day period. Antibiotics given before wound drainage permitted healing of all chronically infected wounds even in the presence of monofilament nylon. When antibiotics were begun at the time of drainage, wound healing occurred in 50 per cent (P < 0·01).
Parenteral nutrition in carcinoma of the oesophagus treated by surgery: Nitrogen balance and clinical studies
Authors: Moghissi K , Hornshaw J , Teasdale P R , Dawes E A
Published: March 2007

Nitrogen balance studies and clinical observations were made on two groups of patients suffering from obstructive carcinoma of the oesophagus.

In 10 patients (group A) parenteral nutrition with a high calorie and nitrogen content was given pre- and early postoperatively. Five patients (group B) received intravenous dextrose saline solution pre- and postoperatively with no nitrogen supply.

Patients in group A had a positive nitrogen balance before and after operation and had a satisfactory postoperative progress. The patients in group B had a negative nitrogen balance until the resumption of oral feeding and their postoperative progress was not as satisfactory as that of patients in group A.
Ten-year survival rates in breast cancer using combination chemotherapy
Authors: Hancock Kathleen , Peet B Gadsby , Price J J , Watson G Whyte , Stone Joan , Turner R L
Published: March 2007

The outcome in 254 patients with all stages of breast cancer treated by combination chemotherapy is presented. All the patients were treated 10 ormore years ago. The 10-year survival rate for Stages, and II corrt bined is 60 per cent, in Stage III 19 per cent and in Stage IV 3 per cent. The combined rate in Stages I and II differed markedly according to hormonal status. In premenopausal patients the rate was 84 per cent compared with 42 per cent in postmenopausal patients.
Quadruple chemotherapy for advanced malignant disease
Authors: Jamieson G G , Carter D C
Published: March 2007

The results of treatment of 48 cases of advanced cancer by quadruple chemotherapy are reported. In only 4 patients was an objective remission obtained, although equivocal remissions were observed in 9 patients. This report is at variance with other recent reports. The reasons for the discrepancy are discussed, and while combination chemotherapy may prove more effective if used earlier in the natural history of malignant disease, in this series the technique does not appear to offer any greater chance of remission than chemotherapeutic agents used singly.
Herpes zoster and paralytic ileus: A case report
Authors: Johnson J N , Sells R A
Published: March 2007

A case of herpes zoster presenting as intestinal obstruction is described. Clinical and radiological evidence of intestinal obstruction was obtained. The mechanisms by which herpes zoster may cause an ileus are discussed.
Carbohydrate tolerance with portal and systemic venous drainage of the pancreas
Authors: Collin Jack , Taylor R M R , Johnston Ivan D A
Published: March 2007

Carbohydrate tolerance was studied in 8 dogs with pancreatic venous drainage to the hepatic portal vein and 6 dogs with pancreatic venous drainage to the systemic veins. While systemic venous drainage of the pancreas was associated with higher fasting plasma insulin and lower fasting plasma glucose levels, no significant differences in either glucose clearance or insulin response to glucose were detectable. Therefore, in the maintenance of plasma glucose homeostasis, administration of insulin into the portal vein offers no significant advantages over the easier systemic route.
Portal hypertension treated by left gastro-epiploic to left renal vein anastomosis: Case report
Authors: Stipa S , Scaramuzza P , Lombard M
Published: March 2007

A case of portal hypertension is presented in which because of the presence of multiple thromboses of the main portal branches one of the usual portasystemic shunts could not be performed. An anastomosis between an enlarged left gastro-epiploic vein and the left renal vein was successfully carried out. Six months after surgery the patient was well and no further haemorrhage had occurred.
The amylase creatinine clearance ratio in acute pancreatitis
Authors: Murray W R , Mackay C
Published: March 2007

One hundred and twenty-two patients have been studied in order to evaluate the usefulness of the amylase creatinine clearance ratio (ACCR) as a simple diagnostic test for acute pancreatitis. Sixteen out of 17 patients with acute pancreatitis had significant elevations in ACCR; in only 10 of these 17 cases was the serum amylase greater than 1200 iu|l. The mean ACCR was within the normal range in control patients, in patients with chronic gastro-intestinal disease and in patients with acute abdominal conditions excluding pancreatitis; however, the mean serum amylase was significantly greater in patients with acute abdominal conditions than in the control group (P <0·05). The ACCR remained significantly elevated in patients with acute pancreatitis for longer than either serum or urine amylase values. The findings of the study suggest that the amylase creatinine clearance ratio is a simple yet reliable diagnostic test which could be used when screening patients suspected of having acute pancreatitis.
Multiseptate hypoplastic gallbladder
Authors: Jena P K , Hardie R A , Hobsley M
Published: March 2007

A case is presented of multiseptate hypoplastic gallbladder, which is an extremely rare combination of two congenital anomalies. The patient was diagnosed as having cholecystitis and was relieved of her symptoms following cholecystectomy, even though the specimen did not show evidence of inflammation or calculi. The significance of this is emphasized by reviewing the 5 authenticated cases of multiseptate gallbladder reported in the literature. Awareness of this condition should avoid misinterpretation of cholecystograms.
The medium term results after profundaplasty
Authors: Martin Peter , Bouhoutsos John
Published: March 2007

The medium term results of 112 profundaplasties for lower limb ischaemia are reviewed for periods of up to 9 years after operation. Death from cardiovascular causes was found to be more common than subsequent amputation. Though immediate relief from symptoms was not so dramatic as after a femoropopliteal graft, the longer term results showed a much lower late amputation rate. The only reasonable operation for failure of a previous femoropopliteal graft appears to be a profundaplasty.
Treatment of critical ischaemia of the lower limb by venous arterialization: An interim report
Authors: Sheil A G R
Published: March 2007

A method to revascularize the critically ischaemic lower limb by arterialization of the dorsal venous arch of the foot via the long saphenous vein is described. Satisfactory procedures were achieved in 5 of 6 patients for whom standard arterial reconstructions were not possible and who would otherwise have required amputation. Of these, 2 failed in the early postoperative period and amputation was performed. Two others failed after 1 year and 18 months respectively but amputation was not required. One patient died 8 months after operation with a functioning arterialized vein and pain-free limb. In the 5 patients with successfully revascularized limbs rest pain was relieved, and incisions, ischaemic ulcers and gangrene healed, showing that effective nutrition of the lower limb was achieved by delivering arterial blood through the venous system. Complications were minor and easily controlled. Although as a result of the procedure amputation was woided in 3 out of 6 patients, the place of the method in the treatment of critical ischaemia of the lower limb remains dubious. Further investigation and modification of the method are planned.
Carcinoma of the large bowel presenting as a subcutaneous abscess of the thigh: A report of 4 cases
Authors: Mair W S J , McAdam W A F , Lee P W R , Jepson K , Goligher J C
Published: March 2007

Four cases of carcinoma of the distal large bowel are described in which the presenting feature was a subcutaneous abscess of the lateral aspect of the thigh. The high morbidity and mortality of this presentation are discussed and the literature is reviewed.
Prostatectomy: Its safety in an Australian teaching hospital
Authors: Sach R , Marshall V R
Published: March 2007

A comparison of the results of prostatectomy in the same hospital after a 15-year interval has shown that there has been a significant reduction in the mortality (2·3 per cent versus 6·7 per cent). However, on reviewing the results of prostatectomy over the past 30 years it is evident that in spite of improved pre- and postoperative care the mortality and morbidity for high risk patients have remained constant. If the safety for this operation is to improve, it would seem that more care in patient selection is necessary and that other means of achieving urinary drainage will need consideration and evaluation in elderly men with significant cardiovascular and respiratory disease.
Secretagogue-produced duodenal ulcers in the rat
Authors: Joffe S N , Gaskin R J , Barros D'Sa A A J , Baron J H
Published: March 2007

Duodenal ulcers were produced in rats by the subcutaneous infusion for 6–48 hours of two gastric secretagogues in combination: pentagastrin (2 or 4 μg kg−1 min−1) and carbachol (0·4 or 0·8 μg kg−1 min−1). With increasing duration of infusion and higher doses there were increases in the incidence, severity, number and perforation rate of duodenal ulcers, their caudad distribution and mortality from peritonitis. This method of producing duodenal ulcers may sufficiently resemble the clinical situation to provide a model for the study of anti-ulcer drugs and the natural history of duodenal ulcers.
Penetrating airgun injuries of the head
Authors: Shaw M D M , Galbraith S
Published: March 2007

Five cases of intracranial airgun injuries are presented. The accepted principles of treatment of a compound depressed fracture of the skull are easily overlooked in these patients because of the rarity of the injury and the apparent well-being of the patient, who is usually fully Conscious with only a small scalp laceration.
Nine years' experience with internal arteriovenous fistulas for haemodialysis: A study of some factors influencing the results
Authors: Kinnaert P , Vereerstraeten P , Toussaint C , Van Geertruyden J
Published: March 2007

Data were collected concerning 314 internal arteriovenous fistulas created in 242 adult patients (92 women and 150 men). The immediate failure rate for the various techniques used ranged from 7·7 to 12·0 percent, except for ulnar fistulas which had a rate of immediate thrombosis of 20·7 per cent. Survival rates were significantly lower for patients submitted to a combined therapy of dialysis and kidney transplantation when compared with patients treated with dialysis alone. The probability of survival of an arteriovenous fistula was lower in women than in men but the difference was significant only in patients undergoing transplantation. Survival rates at 2 years in dialysed patients were 87·6 per cent for distal radial—cephalic side-to-side fistulas, 100 per cent for radial—cephalic end-to-side fistulas located in the mid-forearm, 78·5 per cent for radial—cephalic end-to-side fistulas created near the wrist, 53·1 per cent for distal radial—cephalic end-to-end fistulas and 60·9 per cent for ulnar fistulas. Thrombosis was responsible for 87·2 per cent of 109 late failures. The incidence of infection was 1 case|11 patient years of haemodialysis.
Diagnosis of acute abdominal pain in the accident and emergency department
Authors: Wilson D H , Wilson P D , Walmsley R G , Horrocks Jane C , De Dombal F T
Published: March 2007

This paper reports the findings in a study involving 1537 patients with ‘acute abdominal pain’ presenting over a 13-month period to the Accident and Emergency Department of the General Infirmary at Leeds. Of these, 341 patients who proved to have pain of greater duration than a week, pain incidental to some other identifiable condition or no pain at the time of their attendance were excluded. The remaining 1196 were diagnosed clinically (using a structured case sheet) and subsequently by a Bayesian computer system. Feedback of the results of clinical and computer systems was given to clinicians at regular intervals. Clinical diagnostic accuracy in patients with surgical disorders rose from 40 per cent before the study to 61 per cent. Computer accuracy in these patients was 69·9 per cent. The proportion of patients sent home without ill effects rose from 20 per cent to 39 per cent. In other areas (e.g. gynaecology) the effects were less marked. It is suggested that the introduction of a simple postgraduate educational service, aided by a small computer, might prove of practical benefit in this clinical situation.
The treatment of acute superficial abscesses: A prospective clinical trial
Authors: Macfie J , Harvey J
Published: March 2007

A total of 219 acute superficial abscesses was treated. Patients were randomly allocated to one of four treatment groups—primary suture with or without antibiotics and free drainage with or without antibiotics. No difference could be detected between the groups in duration of healing time. Eleven per cent of all abscesses sutured recurred and antibiotics did not affect this rate. It is suggested that free drainage following incision and drainage is the safest treatment for the majority of abscesses. Antibiotics do not have any significant effect on healing time or recurrence and their routine use is not recommended.
Zinc metabolism and surgical trauma
Authors: Hallböök T , Hedelin H
Published: March 2007

Several investigations have shown that zinc deficiency impairs wound healing in surgical wounds and in chronic ulcers. It is also well established that surgical trauma produces a sharp decrease in serum zinc concentration. It has not been clearly shown that this decrease is due to a rise in urinary excretion. In the present investigation the relationship between urinary zinc excretion and the fall in serum zinc postoperatively was studied in 38 patients. Older patients usually had low preoperative serum zinc concentrations. Preoperative zinc substitution is therefore suggested for such patients.
Torsion of the testis
Authors: Wright J E
Published: March 2007

A series of 56 proved cases of torsion of the testis is reviewed. The condition is rare, only 2 patients per year being admitted to a large general hospital of 800 beds. The aim of this study was to assess the fate of testes in relation to the duration of symptoms: if less than 12 hours the outlook is good, between 12 and 24 hours survival of the testis is possible, over 24 hours the testis is most likely to be beyond salvage and beyond 48 hours there is virtually no hope of testicular survival and orchidectomy will be necessary.
Some surgical aspects of homozygous beta-thalassaemia
Authors: Craig R P , Bate C M , Humphries G
Published: March 2007

The surgical aspects of the management of patients with homozygous beta-thalassaemia are reviewed, and the operative findings in 10 patients with the disease who underwent splenectomy are described. Postoperatively, blood consumption was reduced and there was a longer time interval between transfusions needed to maintain the haemoglobin level.

Hyperplastic lymph nodes containing erythropoietic elements are always present, and the first reported case of extrabiliary obstructive jaundice caused by this tissue is included. All the patients survived for 2–3 years after treatment and there were no serious infections. All received prophylactic oral penicillin after surgery. Cholelithiasis was not found. Two malleolar ulcers were successfully grafted with split skin after preparation of the craters with silver sulphadiazine cream.
Plasma glucagon levels in haemorrhagic shock
Authors: Russel R C G , Pardy B J , Carruthers M E , Bloom S R
Published: March 2007

Eleven healthy dogs were subjected to haemorrhagic shock for 90 min, after which shed blood was reinfused. Detailed studies were made of cardiopulmonary function. Samples of blood were taken at frequent intervals for the measurement of glucagon, insulin and glucose. Three dogs had samples taken for catecholamine levels. The glucagon level rose during haemorrhagic shock but there was no relationship between this rise and the change in cardiorespiratory measurement, but there was a relationship between the plasma glucagon level, the blood glucose and the catecholamine level. It is suggested that the release of glucagon in haemorrhagic shock is mediated by sympathetic stimulation of the alpha cell and that the rise in glucagon is in part responsible for the hyperglycaemia which is found in shock.
Prevention of wound sepsis in gastro-intestinal surgery
Authors: Keighley M R B
Published: March 2007

After gastro-intestinal operations wound infection is usually caused by the inoculation of bacteria present within the intestinal tract into the incision during the surgical procedure. In theory, wound sepsis may be minimized by the following methods: (a) avoiding intestinal contamination of the incision; (b) altering the normal flora of the intestinal tract by adding oral antimicrobials to bowel preparation; (c) using topical or systemic prophylactic antibiotic administration for certain high-risk patients. The relative importance of these methods of prophylaxis is described.
Occlusion of the subclavian vein associated with cephalic vein pacemaker electrodes
Authors: Crook B R M , Gishen P , Robinson C R , Oram S
Published: March 2007

Thrombosis and occlusion of major veins have been described following the use of transvenous pacing electrodes for the establishment of permanent cardiac pacing. The frequency of such complications is, however, not well known. A series of 125 patients was therefore reviewed, all of whom had been paced with permanent transvenous electrodes through a cephalic vein. There was clinical and venographic evidence of subclavian vein occlusion in only 3 of these patients. A further 20 of these patients were also subjected to venography and showed no radiographic evidence of venous occlusion although minor thrombosis associated with the pacemaker electrode was found in one patient. It is concluded that the convenience of using the cephalic vein as a route for the insertion of transvenous pacing electrodes outweighs the small risk of major venous occlusion.
Relative risk of stump cancer following partial gastrectomy
Authors: Kivilaakso E , Hakkiluoto A , Kalima T V , Sipponen P
Published: March 2007

The relative risk of stump cancer following partial gastrectomy for a benign gastroduodenal condition was estimated using an individually matched retrospective study design based on autopsy material. Data on all patients dying with gastric cancer and autopsied at the Central Laboratory of Pathology, University Central Hospital, Helsinki, during 1961–75 were collected. Matched pairs of the same sex and age were used as controls. Of the 464 patients dying with gastric cancer, 9 had undergone previous partial gastrectomy, while the respective number among the controls was 5. This result suggests that the risk of cancer in the gastric stump was not significantly increased as compared to the normal unoperated population.
The role of the surviving pancreas in late fatalities of acute pancreatitis
Authors: Maclean N
Published: March 2007

The necropsy findings in 3 patients who died between 4 and 14 weeks after episodes of acute pancreatitis are described. The most striking features were the extent of extraperitoneal necrosis and the comparative normality of residual portions of the pancreas. It is suggested that when the duct system is disrupted, the secretions of the surviving pancreas cause progressive enzymatic destruction of extrapancreatic tissues and thus contribute to the mortality of the disease.