bluuebunny/crossref_metadata_2025 huggingface dataset:
Maximal gastric secretion and duodenogastric reflux in patients with gastric or duodenal ulcer and in control subjects
Authors: Frizis H I , Whitfield P F , Hobsley M
Published: March 2007

Maximal gastric secretion was studied in 41 unoperated patients with gastric ulcer, 201 patients with duodenal ulcer, and 122 control subjects. The patients with a gastric ulcer were divided into high, body and prepyloric, according to the site of the ulcer. Both high and body gastric ulcers secreted significantly less than the controls, and the duodenal ulcer patients secreted significantly more. However, the patients with gastric ulcer were older and lighter than the controls and, since these factors are known to influence maximal gastric secretion, the controls and patients with duodenal ulcer were standardized to the mean weight (and age, for the controls) of the gastric ulcer group. After this standardization, there was no significant difference in secretion between the patients with body ulcers and normal controls. Pyloric loss was a similar percentage of maximal gastric secretion in all groups, but duodenogastric reflux was higher in the gastric ulcer group compared to the controls. The mean volume of duodenogastric reflux was greatest in the patients with a prepyloric gastric ulcer. It is commonly accepted that hyposecretion in patients with a gastric ulcer is due to gastritis consequent upon increased duodenogastric reflux. However, in this study, no gastric hyposecretion was evident in the body and prepyloric gastric ulcer groups, both of whom had greater than normal levels of duodenogastric reflux.
Perisplenitis and perinephritis in the Curtis–Fitz-Hugh syndrome
Authors: Gatt D , Jantet G
Published: March 2007

Four cases of the Curtis–Fitz-Hugh syndrome diagnosed laparoscopically and with microbiological or serological evidence of chlamydial pelvic infection are reviewed. The case histories emphasize the part played by renal angle and left upper quadrant symptoms. In one patient the surface of the spleen was affected by the same classical imflammation normally seen on the surface of the liver. In 3 patients bilateral or left-sided renal angle pain and tenderness constituted the presenting features, or a major manifestation, and in all patients renal tract investigations were entirely normal. The patient with laparoscopic perisplenitis also had perihepatitis and pelvic inflammation, the latter being florid in all cases. Perisplenitis and perinephritis are proposed as possible additional manifestations of this syndrome.
Present status of pharyngogastric anastomosis following pharyngolaryngo-oesophagectomy
Authors: Lam K H , Choi T K , Wei W I , Lau W F , Wong J
Published: March 2007

Pharyngolaryngo-oesophagectomy with pharyngogastric anastomosis was described more than 25 years ago. Since then it has been employed for the treatment of cancers of the hypopharynx, cervical oesophagus and larynx. Results of recent reports showed a wide variability. Our previous report of 157 such operations gave a significant morbidity and overall hospital mortality rate of 31 per cent. In the 6-year period between 1980 and 1985, 91 patients underwent this operation. The morbidity and mortality rates gradually decreased to 30 and 5 per cent respectively. Changes in the indications for the operation resulted in a reduction in the number of procedures performed in recent years. Resection of the oesophagus for cancers of the pharyngolaryngeal region is indicated only when there is actual oesophageal involvement, and would be the prime indication of pharyngogastric anastomosis.
Arrow wounds to the heart and mediastinum
Authors: Fingleton L J
Published: March 2007

Wooden tipped arrows are still used in tribal fighting in the Highlands of Papua New Guinea. Thirteen cases of arrow injury to the heart and mediastinum, presenting at Mt. Hagen Hospital in a 2-year period, are described. Ten cases presented early (within 3 days) while the remaining 3 cases presented late and suffered from mediastinal abscesses. Removal of the arrow, after full visualization with repair where possible, was performed in all cases with two deaths and little morbidity. Most of the 13 patients arrived in a stable condition, withstood surgery well and made a rapid recovery (average stay in hospital 20 days). Unstable presentations included 2 cases of mild shock, one with early cardiac tamponade and one case of acute aortic incompetence. Survival figures justify attempted salvage of these patients, even with the limited facilities available.
Kinetics of intra-operative pH of the canine corpus fundal mucosa before and after truncal vagotomy
Authors: Larsson J O , Hjelmquist U
Published: March 2007

The intra-operative surface pH of the corpus fundic mucosa in anaesthetized dogs was studied with a glass electrode during stimulation with graded doses of pentagastrin. The mucosal pH could be related to the dose of pentagastrin by a hyperbolic curve. With intact vagus ED50 averaged 0·67 µg kg−1 h−1 of pentagastrin and maximum effect corresponded to an average pH of 1·9. Immediately after truncal vagotomy there was a significant shift of the curve to the right corresponding to an average ED50 of 3·77 µg kg−1 h−1, an effect that could be described as that of a competitive inhibitor. Two weeks after vagotomy the value of ED50 had returned to the prevagotomy level. The high ED50 immediately after vagotomy is ascribed to the sudden fall in the subthreshold release of acetylcholine previously supplied by the intact vagus. The return to the low ED50 2 weeks later could be explained by denervation supersensitivity. The relation between the curves before and immediately after vagotomy suggests that the dose of the agonist be as low possible, when testing the completeness of a vagotomy intraoperatively.
Management of caustic ingestion in adults
Authors: Sarfati E , Gossot Dominique , Assens P , Celerier M
Published: March 2007

The treatment of 484 adults with caustic ingestion injury is discussed. Signs and symptoms are an unreliable guide to injury and a chest X-ray and fibreoptic endoscopy should be performed as soon as possible. All of the 250 patients who developed superficial lesions of the oesophagus, stomach or duodenum experienced healing without sequelae. Forty-four patients required emergency surgery of whom twenty-four died and oesophagectomy without thoracotomy is now advocated for this group, followed by interval surgery to restore continuity. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complication, 3 succumbed to aorto-oesophageal fistula, 12 survived following delayed surgery for complications and 83 developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment.
Survival after resection for carcinoma of the oesophagus
Authors: Schattenkerk M Eeftinck , Obertop H , Mud H J , Eijkenboom W M H , Van Andel J G , Van Houten H
Published: March 2007

During the period 1978–1984, 525 patients referred with cancer of the oesophagus or gastro-oesophageal junction were assessed for operation and cure. After investigation, 276 patients were selected and operaten upon, as a rule, 4 weeks after radiotherapy (40 Gy/4 weeks). In 224 patients (81 per cent) the oesophagus and cardia were resected and reconstructed with stomach (69 per cent), colon (21 per cent), free ileal graft (7 per cent) or Roux-en-Y-oesophagojejunostomy (3 per cent). The postresectional hospital mortality was 14 per cent in all patients and decreased to 5 per cent in 1983. Mortality was higher when the colon was used for reconstruction than when the stomach was used. By postresection staging, 82 patients were found to have stages I and II tumours and 14. patients stage III tumours. Estimated 3-year survival after resection for all male patients was 28 per cent and for all female patients was 42 per cent. Estimated 3-year survival for all patients treated for adenocarcinoma was 31 per cent. Survival was better for stages I and II patients with adenocarcinoma (52 per cent) than for stage III patients (18 per cent) (P <0·01). Estimated 3-year survival for all patients treated for squamous cell carcinoma was 33 per cent. Estimated 3-year survival was better for stages I and II patients with squamous cell carcinoma (48 per cent) than for stage III patients (25 per cent) (P <0·001). It can be concluded from this study that resection of oesophagus and cardia after radiotherapy offers hope for cure in a subgroup of patients with non-advanced oesophageal cancer. The operation can be performed with acceptable mortality by experienced surgeons, especially when the stomach is used for reconstruction.
Management of traumatic rupture of the diaphragm
Authors: McCollum C , Anyanwu C H , Umeh Beatrice U O , Swarup A S
Published: March 2007

Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25·6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.
Absorptive and motor function of orthotopically vascularized segmental ileal autografts
Authors: Dennison A R , Collin J , Watkins R M , Millard P R , Morris P J
Published: March 2007

In 24 dogs a 100 cm length of terminal ileum was autografted as an orthotopically vascularized Thiry—Vella segment. In six dogs absorption, motility and histology were studied in detail and in two intestinal myo-electrical activity was recorded. At a second operation 5 weeks after autotransplantation the Thiry—Vella segment was returned to its normal anatomical position in the intestinal stream and 2 months later all the non-transplanted intestine was resected. Eighteen grafts were technically successful. Intestinal myo-electrical activity was normal by the second day after transplantation while intestinal transit and contractile activity recovered within 10 days. Mucosal morphology and intestinal absorption had largely recovered by 10 days after grafting but absorption of oleic acid was impaired for 4 weeks. Ten dogs with severe short bowel syndrome but intact ileocaecal valve were maintained in good health for more than 7 months by a 100 cm ileal autograft.
Single dose antibiotic prophylaxis in high risk patients undergoing transurethral prostatectomy
Authors: McEntee G P , McPhail S , Mulvin D , Thomson R W
Published: March 2007

In a randomized controlled clinical trial single dose antibiotic prophylaxis (gentamicin 80 mg IV) was evaluated in 36 patients with indwelling urethral catheters undergoing transurethral prostatic resection. Prophylaxis resulted in a significant reduction in postoperative bacteriuria (P <0·01), pyrexia (P <0·001), bacteraemia (P <0·01) and septicaemia (P <0·05). During the same period there was one case of postoperative bacteriuria but no systemic infection in 25 consecutive patients undergoing elective prostatectomy with no local risk factors and in the absence of prophylaxis. A policy of selective antibiotic prophylaxis is justified and in high risk patients with in-dwelling catheters single dose prophylaxis is highly effective.
Endoscopic management of common duct stones without cholecystectomy
Authors: Martin D F , Tweedle D E F
Published: March 2007

Endoscopic sphincterotomy was attempted in 81 patients with gallbladders for the primary management of symptomatic common duct stones and was successful in 80. Immediate complications occurred in six (7 per cent) and one patient died (1 per cent). Clearance of the common duct was achieved in 70 (86 per cent). Eight patients required surgery for failed clearance of the duct and suffered no operative mortality. Of 70 patients with cleared ducts, 5 underwent elective cholecystectomy. Four other patients with persistent or recurrent symptoms have required cholecystectomy, also without mortality. Sixty-one patients were reviewed 12–44 months (mean 24; median 22 months) after endoscopic sphincterotomy. Eighteen have died, none from biliary disease. Forty-three patients remain alive and well, free of biliary symptoms since endoscopic sphincterotomy. When the surgical risk of cholecystectomy and choledocholithotomy is high, endoscopic sphincterotomy is effective and safe. Routine cholecystectomy is not indicated when the common duct has been cleared.
Carcinoma of the head of the pancreas: Bypass surgery in unresectable disease
Authors: La Ferla G , Murray W R
Published: March 2007

One hundred patients who underwent bypass surgery for unresectable, histologically proven carcinoma of the head of the pancreas were studied to determine: (1) the incidence of a second operation for duodenal obstruction in survivors who had a biliary diversion only; (2) whether the addition of a prophylactic gastroenterostomy is associated with increased mortality. Eighty-six patients (Group A) had a biliary diversion alone while fourteen (Group B) had a biliary diversion and a prophylactic gastroenterostomy. Both groups were comparable regarding sex, age, symptomatology and clinical findings. The postoperative mortality was similar for both groups (Group A, 27·9 per cent; Group B, 14·3 per cent). The mean surgically related hospital stay was 22·6·5 days (Group A) and 20·7 days (Group B). Of the 62 patients in Group A who left hospital, 8 (13 per cent) required a second operation for duodenal obstruction (mean interval 5·4 ± 2·7 months). The in-hospital stay for the second operation was 14·4·7·7 days. The overall survival for both groups was identical at 6 months (35·5 versus 33·3 per cent) and 12 months (19·3 versus 16·7 per cent). This study suggests that prophylactic gastroenterostomy adds no risk to patients requiring biliary diversion for carcinoma of the head of the pancreas. Its routine use is therefore justified since 13 per cent of the patients who survived the biliary diversion required further surgery for duodenal obstruction before death.
Preliminary results of the Nottingham breast self-examination education programme
Authors: Dowle C S , Mitchell Anna , Elston C W , Roebuck E J , Hinton C P , Holliday H , Blamey R W
Published: March 2007

Between June 1979 and December 1984, 49573 women (study population) between the ages of 45 and 64 years and living in one health district were invited to attend breast self-examination sessions as part of the DHSS ‘UK Trial of Early Detection of Breast Cancer’. Of the women invited 50·2 per cent attended for education. A total of 319 breast cancers were diagnosed in the study population during this period. The tumour characteristics, patient prognostic groups and survival have been compared with a control population consisting of the 319 consecutive breast cancers diagnosed immediately before the start of the DHSS trial, in women of the same age group and living in the same health district. There has been a significant reduction in the size at presentation of operable tumours (P <0·01) and there has been a small (3·4 per cent) reduction in lymph node involvement, but this is not significant. The rates of presentation of both in situ and advanced carcinoma have not significantly changed following the introduction of a breast self-examination education programme. At this stage no overall survival difference has been identified between the two groups but the median follow up of the study population is limited (25 months).
Mitogenicity of human fibroblasts in vivo for human breast cancer cells
Authors: Horgan K , Jones D L , Mansel R E
Published: March 2007

Stromal factors have been implicated in the regulation of mammary epithelial cell behaviour, but their influence on human breast cancer is unknown. Fibroblasts were grown in monolayer cell culture from explants of benign and malignant breast tissue and normal skin. MCF7 human breast cancer cells alone (2 × 106 cells) or in combination with live fibroblasts (MCF7 + F) were inoculated into the mammary fat pads of 6–8-week-old female nude mice. After 5 weeks tumours were excised, weighed and fixed for histological examination. Addition of live breast fibroblasts significantly increased the retrieval (127/135 versus 52/106, P <0·01, χ2 test) and growth (tumour weight 174·11 versus 41·4 mg, mean ± s.e.m., P <0·01, Mann—Whitney U test) of subsequent tumours. Histological examination did not reveal any morphological difference between the two tumour groups. Injection of fibroblasts alone did not produce tumours. Addition of skin fibroblasts was also stimulatory. Glutaraldehyde-killed fibroblasts increased tumour take but did not stimulate tumour growth. Mononuclear blood leucocytes were ineffective. The results demonstrate that, in this model, fibroblasts exert stimulatory influences on human breast cancer xenograft growth and development.
Random control trial of a short course of aspirin and dipyridamole (Persantin) for femorodistal grafts
Authors: Clyne C A C , Archer T J , Atuhaire L K , Chant A D B , Webster J H H
Published: March 2007

The effect of a short course of anti-platelet agents, started pre-operatively, on the patency of femorodistal bypass grafts is unknown. One hundred and forty-eight such grafts were randomized to act as controls or to receive dipyridamole 200 mg b.d. for 48 h pre-operatively and dipyridamole 200 mg b.d. with aspirin 300 mg daily for 6 weeks after surgery. Patients were well-matched and the mean pre-operative pressure index of 0·37 rose to 0·78 during the first postoperative week. No deaths were attributable to the treatment. Ninety-three grafts were autogenous vein and the remainder were prosthetic (GORE-TEX* (PTFE), human umbilical vein or externally supported Dacron). At 1 year autogeneous vein cumulative patency was 75 per cent. Overall results showed higher patency in the treated group (P = 0·012) which was entirely accounted for by the difference between prosthetic dipyridamole and aspirin group (85 per cent patency) and prosthetic control groups (53 per cent patency, P = 0·005) and arose during the first postoperative month. There were 11 deaths and 8 amputations in the dipyridamole and aspirin group and 8 deaths and 12 amputations in the control group. It is concluded that a six week perioperative course of dipyridamole and aspirin allows the patency of prosthetic femorodistal bypass to approach that of autogenous vein, and the regimen therefore is recommended for patients who may require a prosthetic graft.
Use of a gamma camera for measuring limb blood flow in peripheral vascular disease
Authors: Parkin A , Wiggins P A , Robinson P J , Vowden P , Kester R C , Ware Fiona M
Published: March 2007

A method for measuring limb blood flow during reactive hyperaemia is described. Pneumatic cuffs inflated to 300 mmHg are used to isolate the blood in the limbs from the rest of the circulation. The remaining blood is labelled with technetium. The increase in radioactivity in the limb following release of the cuffs is measured using a gamma camera. The mean rate of flow of blood to the limb (in ml (100 ml)−1 tissue min−1) is derived from the graph of radioactivity versus time and from the radioactivity in a sample of venous blood. The results of measurements carried out in patients with peripheral vascular disease (30 limbs) and normal controls (24 limbs) are presented. Repeated studies in 10 subjects (20 limbs) showed the method to be highly reproducible at high and low flow rates (r = 0·99). Case studies illustrating the use of the method as a screening test for peripheral vascular disease and to monitor the effects of treatment are presented.
Perforated duodenal ulcer managed by simple closure versus closure and proximal gastric vagotomy
Authors: Christiansen J , Andersen O B , Bonnesen T , Baekgaard N
Published: March 2007

A prospective randomized trial of simple closure versus closure and proximal gastric vagotomy was conducted in 50 consecutive patients with perforated duodenal ulcer. There was one postoperative death in each group and no difference in postoperative morbidity. After a median follow-up of 54 months (24–96) the cumulative recurrence rate after simple suture was 52 per cent against 16 per cent after proximal gastric vagotomy and closure (P <0·01). The recurrence rate after proximal gastric vagotomy for perforated duodenal ulcer was comparable to the recurrence rate seen after the electively performed operation.
Fine-needle aspiration biopsy and the diagnosis of thyroid cancer
Authors: Anderson J B , Webb A J
Published: March 2007

Conventional criteria for the evaluation of thyroid nodules are inaccurate in identifying the small proportion of malignant neoplasms. The diagnostic accuracy of fine-needle aspiration biopsy (FN AB) for cytology was therefore assessed in 562 patients with nodular thyroid disease, 373 of whom (66·4 per cent) had histological confirmation of the cytological diagnosis. Sixty-one aspiration biopsies were positive for malignancy, and the diagnosis was confirmed histologically in 59 of these (96·7 per cent). Thus, there were two false positive cytology results among 310 patients with proven benign disease (0·6 per cent). Four of sixty-three patients with proven carcinoma had a benign cytological diagnosis, a false negative rate of 6·3 per cent. In 57 of the 59 malignancies (96·6 per cent) correctly diagnosed by FNAB the histological type of tumour was successfully identified. Overall 367 of 373 patients received correct cytological discrimination between benign and malignant nodules, an overall accuracy of 98·4 per cent for FNAB. The sensitivity of the test was 93·7 per cent and the specificity 99·4 per cent. Besides being safe, cost-effective and reliable, FNAB directs the appropriate selection of patients for surgery and enables the correct operation to be performed for each type of tumour.
Blood viscosity in patients with bone fractures and long term bedrest
Authors: Ernst E , Schmidt-Pauly E , Mühlig P , Matrai A
Published: March 2007

Eighteen patients with bone fractures and without systemic disease were studied for blood rheology. Blood and plasma viscosities, haematocrit, red cell aggregation and filterability as well as plasma colloid oncotic pressure were measured. Results show that patients exhibit a substantial haemorheological deficit on admission. During bedrest this returns to normal, owing to marked ‘autohaemodilution’. It is concluded that trauma causes increased viscosity of blood in these patients. This change could predispose to deep vein thrombosis. However, such a risk is reduced by ‘autohaemodilution’ which is most probably an effect of immobilization.
Effect of topical and systemic antibiotics on bacterial growth kinesis in generalized peritonitis in man
Authors: Krukowski Z H , Al-Sayer H M , Reid T M S , Matheson N A
Published: March 2007

Quantitative bacteriology in peritoneal exudate was studied in 40 patients with generalized peritonitis of small intestinal, appendicular or colonic origin. Bacterial growth kinesis was measured in 28 of the patients. Systemic antibiotics given before operation resulted in a significant reduction in both the concentration and growth rate of viable bacteria in the peritoneal fluid. Lavage of the peritoneal cavity with saline resulted in a further reduction in growth rate in patients given pre-operative systemic antibiotics by an effect attributable to simple dilution. In contrast, peritoneal lavage with tetracycline (1 mg/ml) resulted in complete inhibition of bacterial growth in the residual peritoneal fluid. These observations support the policy of giving systemic antibiotics to patients with generalized peritonitis as soon as the diagnosis has been made and provide bacteriological evidence for the value of peroperative antibiotic peritoneal lavage.
Improved wound healing response in surgical patients receiving intravenous nutrition
Authors: Haydock D A , Hill G L
Published: March 2007

The wound healing response was assessed in 90 surgical patients by measuring the accumulation of hydroxypyroline that occurred over a 7 day period, in fine tubes of thin walled GORE-TEX placed in the subcutaneous layers of the arm. In 47 patients presenting for intravenous nutrition, the wound healing response was less (0·34 ± 0·23 μg hydroxyproline/cm of tubing) than that of 36 normally nourished patients (0·49·0·30 μg/cm; P <0·01). However, it was higher when measured after intravenous feeding had commenced (0·88 ± 0·62 μg/cm; P <0·005). In 29 patients two sequential studies of wound healing were conducted over a 14-day period of intravenous nutrition. The mean accumulation of hydroxyproline during the first week of intravenous nutrition was 0·36 ± 0·24 μg/cm and this was increased significantly over the second week of feeding to 0·78 ± 0·67 μg/cm; P <0·005. The wound healing response that occurred in wounds made after a period of pre-operative nutrition was better than that which occurred when only postoperative nutrition had been given (P <0·02). These results show that the wound healing response in surgical patients requiring intravenous nutrition is improved by this treatment. This improvement is seen after only one week of therapy and before there is an obvious change in nutritional status. It also appears that the improved wound healing response is more marked when intravenous nutrition is given before, rather than after the surgical procedure.
Major hepatic resection for colorectal liver metastases
Authors: Bradpiece H A , Benjamin I S , Halevy A , Blumgart L H
Published: March 2007

A 6 12 year experience in the management of hepatic colorectal metastases in a specialist unit is reviewed. During the period studied, 48 patients were referred of whom only 24 actually came to resection. There were two in-hospital deaths, at 20 and 60 days, and six patients had non-fatal complications. Although the extent of resection was greater than in most reported series (13 right hepatectomies and 6 extended right hepatectomies), the results of resection were broadly the same as those of others, with a median survival of 30 months and 2 and 3 year survivals of 50 and 44 per cent respectively. A number of factors which others have considered to be of prognostic significance were examined. Tumour clearance was the only important prognostic indicator, where a 5 mm clear margin between the tumour and cut surface produced a significant difference in survival. It is suggested that a much larger number of patients in the UK with hepatic colorectal metastases might be considered for resection.
Carcinoid tumours of the rectum and anus
Authors: Burke M , Shepherd N , Mann C V
Published: March 2007

Carcinoid tumours of the anorectum comprise only 0·1 percent of all rectal tumours. Their behaviour and treatment are still debatable. We identified 35 cases from the records of St Mark's Hospital; 31 were benign and 4 were malignant. Benign tumours were of three distinct histopathological patterns. All benign tumours were cured by local treatment. Malignant tumours can be identified clinically; the only consistent microscopic feature was invasion of the muscularis propria. All patients with malignant tumours died, despite radical surgical treatment; lymph node metastases were invariably present in the operation specimens. Because radical treatment for malignant carcinoid tumours of the anorectum is largely unsuccessful, a flexible surgical approach is advocated.
Anorectal myectomy for outlet obstruction
Authors: Yoshioka K , Keighley M R B
Published: March 2007

Anorectal myectomy has been evaluated in 29 patients with chronic constipation associated with outlet obstruction. Eight patients had histological evidence of aganglionosis. No patient was able to defaecate spontaneously more than once a week before operation. Eighteen (62 per cent) patients were able to defaecate spontaneously more than 3 times a week after operation (good results) whereas 11 patients were not. There was a significant fall in maximum resting anal pressure after operation in the patients having a good result (102·7±16·7 to 79·5 ± 27·8 cm H2O) whereas there was no significant fall in those having a poor result (118·4±25·0 to 108·8±28·5 cm H2O). The operation had no influence on squeeze pressures, length of the high pressure zone, rectal sensation or the anorectal angle. These results seem to indicate that the therapeutic effect of anorectal myectomy is merely due to reduced resting anal canal pressures.
Acute pancreatitis associated with carcinoma of the ampulla of Vater
Authors: Robertson J F R , Imrie C W
Published: March 2007

Acute pancreatitis associated with pancreatic carcinoma or tumour metastases in the pancreas is well documented. In this paper we show a similar association between acute pancreatitis and ampullary carcinoma. Of 41 patients with ampullary carcinoma seen at a single centre over a 25 year period (1959–83), 6 developed acute pancreatitis. Three other patients with a history of obstructive jaundice were noted to show mild transient hyperamylasaemia. Endoscopic retrograde choledochopancreatography is mandatory in the investigation of such patients.
Alcohol induced pancreatitis: Social and surgical aspects
Authors: McEntee G P , Gillen P , Peel A L G
Published: March 2007

During the period 1977–1985, 38 patients with alcohol related pancreatitis (37 men, 1 woman) were referred to a specific pancreatic follow-up clinic; their mean age was 42·4 years (range 20–69 years). At initial presentation 14 patients were unemployed (37 per cent) and 11 worked as unskilled labourers (29 per cent). Twenty-seven patients (71 per cent) required more than one hospital admission. Surgery was indicated in 14 patients (37 per cent): 4 diagnostic laparotomy, 3 cholecystectomy, 3 drainage of pancreatic pseudocyst and 1 pancreatic abscess, 3 biliary bypass and 4 pancreatic resection. Four patients required more than one operative procedure. Five deaths occurred during the study period: one following biliary bypass, one following total pancreatectomy and three not directly related to pancreatitis. Follow-up attendance rates at 1, 3 and 5 years were 76, 47 and 34 per cent respectively. Alcohol induced pancreatitis in Teesside, UK, is a disease of young adult males of lower socio-economic status with a recurring pattern leading to repeated hospital admissions and an unexpectedly high incidence of surgery. The study demonstrates the problem of ascertaining data related to long term follow-up in a condition where, despite intensive efforts, patient compliance is poor.
Effects of epidural administration of local anaesthetics or morphine on postoperative nitrogen loss and catabolic hormones
Authors: Tsuji H , Shirasaka C , Asoh T , Uchida I
Published: March 2007

To examine the effects of postoperative epidural analgesia with local anaesthetics or morphine on the excess nitrogen loss after upper abdominal surgery and to assess the roles of catabolic hormones in the nitrogen loss, urinary excretion of nitrogen and catecholamines and plasma concentrations of cortisol and glucagon were measured in three groups of patients undergoing elective gastrectomy. Group G patients received the operation under general anaesthesia, and their postoperative pain was relieved by intermittent injections of analgesics. Group PE received prolonged epidural analgesia with local anaesthetics during and after surgery. Group EM received epidural analgesia intra-operatively and epidural morphine postoperatively. Urinary nitrogen excretion during the first three postoperative days was significantly less in the PE and EM groups than in the G group, and the PE group excreted slightly less nitrogen than the EM group. In the G group, urinary excretion of adrenaline increased mainly on the day of operation, and noradrenaline chiefly on postoperative days. These catecholamine responses were almost completely abolished in the PE group, and significantly inhibited in the EM group. Plasma cortisol response was most remarkable shortly after the operation and then decreased in all groups, but was significantly lower in the two epidural groups than in the G group throughout the study. Plasma glucagon increased postoperatively in all groups, and the increase was less pronounced in both epidural groups than in the G group. These results suggested that an elevated sympathic activity, represented by increased noradrenaline excretion and elicited by painful nociceptive and sympathetic nervous afferents, is responsible for the postoperative nitrogen loss which is mediated by glucagon and cortisol.
Value of nutritional parameters in the prediction of postoperative complications in elective gastrointestinal surgery
Authors: Leite J F M S , Antunes C F , Monteiro J C M P , Pereira B T V
Published: March 2007

The following nutritional parameters were assessed in 117 patients before major gastrointestinal surgery: percentage recent weight loss; percentage ideal body weight; tricipital skinfold; arm muscular area; grip strength dynamometry; serum albumin (ALB); serum transferrin (TFN); delayed hypersensitivity skin tests (DH); total lymphocyte count; prognostic nutritional index (PNI) and clinical assessment of malnutrition. Comparing the results in patients without complications (n = 99) with those in patients with complications (n = 18) and the results in patients who survived (n = 109) with those who died (n = 8), we found that only ALB, DH, TFN and PNI showed significant differences in both comparisons. Correlations of complications with combined parameters was made by multiple linear regression analysis; a modified PNI (mPNI), including these three single variables, has emerged. Considering its risk values, the nutritional parameters showed the following sensitivity and specificity, respectively: ALB<3·2 g/dl (72 and 71 per cent), anergy (67 and 64 per cent), TFN <205 mg/dl (67 and 55 per cent) and mPNI <20 (72 and 70 per cent). Using Bayes' theorems, ALB, DH and calculated indices showed the same predictive capacity and we conclude that single or multiple association of nutritional parameters have no additive effect. To predict complications of nutritional origin it seems only necessary to consider ALB, taking into account the type of operation and the normal duration of postoperative hospital stay without oral intake.
Arterial healing in the dog after intraluminal delivery of pulsed Nd–YAG laser energy
Authors: Cross F W , Bowker T J , Bown S G
Published: March 2007

The application of laser energy to percutaneous recanalization of diseased blood vessels is of interest to vascular surgeons and radiologists. We have examined the effect of pulsed infrared light from a 100 μs pulsed Nd-YAG laser on the dog aorta in order to determine the dose response, perforation thresholds and healing properties in vascular tissue. We used 100 μs pulses of 0·5 J energy at 10 Hz repetition rate via a 400 μm optical fibre to make 205 craters in 10 dogs at total energies of 5–25 J. The perforation threshold was 15 J in six animals and 20 J in four. The dose response was linear at 10 μm tissue vaporized per Joule delivered. Animals were killed immediately and at intervals of 24 h, 4, 7, and 10 days, 2, 3 and 6 weeks, and 3 and 6 months. Material was retrieved for histology and examined by light and scanning electron microscopy. The tissue exhibited features of laser damage that were less marked than those seen with continuous wave lasers; there was less heat damage surrounding the craters which healed well, even after perforation. This laser is likely to be suitable for human laser angioplasty provided the energy is given in increments of 15 J or less.
The future of external beam irradiation as initial treatment of rectal cancer
Authors: Papillon J
Published: March 2007

Several trials have demonstrated that pre-operative irradiation for rectal cancer decreases significantly the incidence of pelvic recurrence. However, this method is far from being generally accepted. It is now possible to enhance the effectiveness of external beam irradiation and to use it to extend the field of sphincter-saving and conservative procedures. Our protocol consists of a split-course regimen with a short course of cobalt-60 arc rotation (3000 cGy in 12 days). After 2 months rest, the second stage of treatment depends upon the pressure of residual disease and the site of the tumour. It consists of either radical surgery (82 cases) or conservative treatment by intracavitary irradiation in the event of a favourable initial response or in the case of poor risk patients (73 cases). In the radiotherapy-surgical group, the subsequent operative specimens were tumour free in 17 per cent of cases and assigned to Dukes' A category in 32 per cent of cases. Of 91 patients with T2 or T3 tumour involving the lower third of the rectum (followed up for more than 3 years) 72 (84 per cent) had no recurrence. Thirty-three of these patients (46 per cent) underwent a colostomy while 39 (54 per cent) had normal anal function. These results demonstrate the major place that a properly planned external beam irradiation can have in the curative management of cancers of the low rectum.
Mammillary fistula
Authors: Bundred N J , Dixon J M , Chetty U , Forrest A P M
Published: March 2007

Forty women presenting with mammillary fistulas over a 6 year period have been reviewed. The events preceding the fistula were incision of a periareolar breast abscess (n = 24), breast biopsy (n = 13) and spontaneous discharge of an inflammatory mass (n = 3). Only two of the women with abscesses were lactating. Two patients had granulomatous mastitis. The remaining 36 patients were all considered to have periductal mastitis/mammary duct ectasia as the cause of their fistulas. The two mammillary fistulas associated with lactation healed spontaneously. Nine patients had the fistula excised and the wound packed; this resulted in satisfactory healing in all but one patient. Twenty-one patients had excision of the fistula and primary closure, without antibiotic cover, but only ten healed without complications and six patients required further surgical procedures for a recurrent fistula. Six patients had primary excision and closure under antibiotic cover with a penicillin and metronidazole; all healed. Mammillary fistulas are complications of the periductal mastitis/duct ectasia syndrome. They should be treated by excision and primary closure under appropriate antibiotic cover or alternatively excised and left open to granulate.
Evaluation of hepatic resection for hepatocellular carcinoma in the elderly
Authors: Ezaki T , Yukaya H , Ogawa Y
Published: March 2007

The results of 139 hepatic resections in 154 patients with hepatocellular carcinoma (HCC) operated upon in the last 6 years are reported. These 139 Japanese patients were classified into three groups according to age. Group I included 58 patients under 55 years of age, group II 44 aged from 56 to 65 years and group III 37 aged over 66 years. Fewer cases in group III had histological evidence of cirrhosis than in the other two groups. There was a statistically significant marked decline in the pre-operative cardiac and pulmonary function in group III patients. However, there was no statistical difference in postoperative complications, mortality and survival rate among the three groups. The results after hepatic resection seemed to depend on pre-operative liver function and histology, and on control of the haemorrhage at operation. The results indicate that liver surgery for elderly patients with hepatocellular carcinoma is justifiable given careful patient selection.
Nissen fundoplication and pyloroplasty in the management of gastro-oesophageal reflux in children
Authors: Davidson B R , Hurd Diana M , Johnstone M S
Published: March 2007

A retrospective study was carried out of children undergoing Nissen fundoplication and pyloroplasty for the correction of gastro-oesophageal reflux. Twenty children (thirteen males, seven females) aged 8 months to 12 years underwent surgery over a 10 year period. Forty per cent were mentally retarded. Presentation was failure to thrive in 19 (95 per cent), recurrent vomiting in 18 (90 per cent) and haematemesis in 14 (70 per cent). Four children had Barrett's oesophagus. There were no operative or perioperative mortalities. Follow-up (mean period 3 years, 9 months) revealed no further symptoms of reflux. The ‘normal’ children gained weight postoperatively whereas the ‘retarded’ group did not. Adhesion obstruction (10 per cent) was the major late postoperative complication. Regression of Barrett's epithelium was noted endoscopically. ‘Gas-bloat’ syndrome, a major complication following fundoplication, was not encountered.
Treatment of mesenteric infarction
Authors: Clavien P A , Muller C , Harder F
Published: March 2007

Eighty-one cases of mesenteric infarction documented by angiography, laparotomy or autopsy were reviewed to assess the cause of the persistently high mortality. Thirty-seven patients (46 per cent) were felt to have inoperable lesions and were treated by supportive care only, while forty-four (54 per cent) underwent bowel resection and/or revascularization. Of these 44 patients 20 (45 per cent) survived, 14 (32 per cent) died of an early recurrence of infarction and 10 (23 per cent) died of an unrelated cause. In view of the high recurrence rate in the early postoperative period, treatment must prevent the causes of persistent or recurrent ischaemia such as vasoconstriction and reperfusion tissue damage. On the basis of recent clinical and experimental research we suggest that treatment should include routine angiography with selective perfusion of vasodilators through the superior mesenteric artery, pharmacological prevention of ischaemic and reperfusion tissue damage before surgery, and postoperative anticoagulation.
A reliable and readily available method of measuring limb blood flow in intermittent claudication
Authors: Wilkinson D , Vowden P , Parkin A , Wiggins P A , Robinson P J , Kester R C
Published: March 2007

To evaluate isotope limb blood flow measurement in intermittent claudication we have assessed 58 non-diabetic patients comparing our new method with treadmill testing and Doppler assessment. Limb blood flow was applicable to all 58 patients; 25 patients were unable to walk on a treadmill and of the 33 who could 12 failed to walk for one minute, making a standard one minute exercise test inappropriate. In those patients who could perform exercise tests there was a significant correlation between maximum walking distance and limb blood flow (r = 0.35, P = 0.02). Resting, post-exercise and post-hyperaemic ankle-brachial systolic pressure indices bore no relationship to the maximum walking distance. Isotope limb blood flow measurement is reproducible (r = 0.97), can be applied to those patients who cannot walk on a treadmill and provides information about both legs. It correlated significantly with all the other tests and can be recommended for the minimally invasive assessment of intermittent claudication.
Mathematical prediction of ileal pouch capacity
Authors: Thomson W H F , Simpson A H R W , Wheeler J L
Published: March 2007

Restorative proctocolectomy is an operation still in the stage of development. Three main types of ileal pouch construction are used, but the advocacy of each probably arises more from familiarity and convenience than from scientific considerations. Since, other things being equal, pouch capacity can be expected to affect stool frequency, it seemed reasonable to examine calculable pouch capacity geometrically for different methods of construction. A mathematical model was therefore used to compare the double loop (‘J’) type with the quadruple loop (‘W’) construction. The W was estimated to have a capacity more than half as great again as the J. Similarly anastomotic methods which encroach on the ileal circumference by creating an inverted edge can be expected to reduce resultant capacity by 10 per cent or more.
Activated oestrogen receptor in human breast cancer: Clinical and biochemical correlates
Authors: White J O , Herschman M J , Parmar G , Philipson K A , Elder M G , Habib N A , Wood C B
Published: March 2007

The oestrogen receptor (ER) contains a DNA-binding site, the activity of which can be determined by its binding to oligo(dT)-cellulose. In premenopausal women with breast cancer, 53 per cent of ER-positive tumours were capable of binding to oligo(dT)-cellulose (activated ER); the corresponding proportion in postmenopausal patients was 70 per cent (P<0·005). Disease recurrence was significantly increased in patients whose tumours contained non-activated rather than activated ER. The presence of activated ER was associated with a significant increase in the median activity of creatine kinase in premenopausal and postmenopausal patients. In postmenopausal patients the incidence of progesterone receptor was higher in tumours that contained activated ER than in tumours that contained ER not capable of binding to oligo(dT)-cellulose (non-activated). The incidence of activated ER was not related to disease stage or nodal involvement at the time of sampling. The data suggest that ER-positive tumours can be divided, according to the activity of the DNA-binding site, into subgroups with differing biological properties.
Injection sclerotherapy in adult patients with extrahepatic portal venous obstruction
Authors: Kahn D , Terblanche J , Kitano S , Bornman P
Published: March 2007

Thirty-nine adult and teenage patients with extrahepatic portal venous obstruction (EHPVO) were treated with injection sclerotherapy. There were 22 males and 17 females with a mean age of 27 years (range 12–69). Oesophageal varices were eradicated in 33 patients after seven injections (range 1–17) over a mean of 14·5 months (range 1–48). Fewer injections were needed to eradicate varices in older patients. Variceal bleeding occurred on 13 occasions in 9 patients before eradication of varices and on 4 occasions in 4 of the 33 patients in whom varices had been eradicated, with a mean follow-up of 44 months (range 3–105). There were no deaths during the study period. Complications, mostly of a minor nature, occurred in 25 patients and included injection site leak in 5, stenosis in 7 and mucosal ulceration in 23. We conclude that injection sclerotherapy is the treatment of choice in patients with EHPVO.
Controlled trial of occlusive dressings in healing chronic venous ulcers
Authors: Backhouse C M , Blair S D , Savage A P , Walton Jackie , McCollum C N
Published: March 2007

Fifty-six patients with chronic venous ulcers present for a mean of 2.4 years were randomized to either a new occlusive hydrocolloid dressing (Granuflex, Squibb Surgicare) or a porous non-adherent dressing (N A, Johnson and Johnson). In all patients, dressings were applied beneath a standard graduated compression bandage. There was no difference between the two groups, with complete healing in 21 out of 28 (75 per cent) of occlusive dressing patients and 22 out of 28 (78 per cent) with N A dressings by 12 weeks. Careful graduated compression bandaging achieves healing even in the majority of so-called resistant chronic venous ulcers; there was no additional benefit from applying occlusive dressings which tend to be expensive.
Late ischaemic sequelae after umbilical artery catheterization
Authors: Bergqvist D , Bergentz S E , Hermansson G , Lundberg H O , Troeng T
Published: March 2007

Late ischaemic complications of umbilical artery catheterization are well recognized but very little is known about long-term consequences. Two cases are presented which indicate that umbilical artery catheterization during the neonatal period may give rise to late ischaemic complications.