bluuebunny/crossref_metadata_2025 huggingface dataset:
What is involved in endoscopic sphincterotomy for gallstones?
Authors: Slooff M , Baker R , Lavelle M I , Lendrum R , Venables C W
Published: March 2007

This study reports our first year's experience of endoscopic sphincterotomy for common bile duct stones. Forty patients were considered for the procedure and it was attempted in 37. An effective endoscopic sphincterotomy was eventually achieved in 32 (86 per cent), 7 after a ‘pre-cut’. Twenty-three patients passed stones spontaneously (72 per cent), 6 could not be reassessed and 3 still had stones present (9 per cent). Bed occupancy was 9·5±5·9 days.

Complications occurred in 30 per cent, the most common being pancreatitis in 6 cases with 1 death.

It is concluded that endoscopic sphincterotomy offers a valuable alternative to surgery in the management of common bile duct stones.
Present concept of the Belsey mark IV procedure in gastro-oesophageal reflux and hiatus hernia
Authors: Singh S V
Published: March 2007

One hundred patients with gastro-oesophageal reflux and hiatus hernia were treated at the North Middlesex Hospital, Regional Cardiothoracic Centre, between 1968 and 1969. All patients received surgical treatment by the Belsey mark IV technique with no significant complications. The 9–10 year follow-up has shown a recurrence rate of 10 per cent. The majority of recurrences occurred within 2 years of the initial operation. Seven of these recurrences had excellent results after a second mark IV repair. The improved quality of life in the successful cases was dramatic. This series indicates that a left transthoracic mark IV type of repair is a safe and reliable procedure and gives excellent results with relief of symptoms.
Clinical results of 229 patients with duodenal ulcer 1–6 years after highly selective vagotomy
Authors: Adami H O , Enander L K , Ingvar C , Rydberg B
Published: March 2007

The aim of this study was to assess the clinical results after highly selective vagotomy (HSV) when used routinely at a district general hospital. A total of 229 patients with chronic duodenal or prepyloric ulcers was included in a 92 per cent complete follow-up 1–6 years after an elective HSV without drainage. There was no postoperative mortality, and the frequency of postoperative complications was low. Transient dysphagia and early fullness each occurred in about a quarter of the patients, whereas persistent dumping was found only in 1·3 per cent and diarrhoea in 2·2 per cent of the patients. Recurrent ulcer was diagnosed in 12·7 per cent of the patients, but this figure decreased to 9·3 per cent after exclusion of one of the 24 surgeons involved. The overall clinical results according to the modified Visick classification were recorded as excellent or very good in 70 per cent and unsatisfactory in 20 per cent. The failures were almost exclusively due to a proved or suspected recurrence or to gastric retention, and further operations have been performed on 27 of these patients. After reoperation only 8 patients (3·5 per cent) remained failures according to the patient's own judgement at the time of follow-up.

The recurrence rate in this study was considered disquietingly high with regard to the short observation time. However, other obvious advantages of the method and the possibility of improved results after adjustment of the surgical technique were considered to justify continued use of HSV as a routine procedure.
The management of childhood intussusception in a district hospital
Authors: Thomas D F M
Published: March 2007

Fifteen out of 34 infants with intussusception admitted to a district hospital were found to require resection of gangrenous bowel or an anatomical lead point. This resection rate (44 per cent) is considerably higher than those reported from specialist centres which rely on hydrostatic reduction as their primary form of treatment. The difference is probably a reflection of the greater proportion of late cases seen in a district hospital. Complications were virtually confined to those children who had undergone resection and it is concluded that earlier referral to hospital is the single factor most likely to reduce morbidity. Operative management is advocated, although barium enema is a safe valuable adjunct to surgery.
Intramural haematoma of the duodenum
Authors: Vellacott K D
Published: March 2007

Five cases of traumatic intramural haematoma of the duodenum occurring in children are presented. Four of the cases were treated conservatively with nasogastric aspiration and intravenous fluids and it is suggested that this should be the treatment of choice in the majority of cases. Two of the cases were diagnosed initially as having appendicitis and during the exploratory procedure in one of these cases the haematoma was evacuated.
The clinical significance of the pattern of elevated serum carcinoembryonic antigen (CEA) levels in recurrent colorectal cancer
Authors: Wood C B , Ratcliffe J G , Burt R W , Malcolm A J H , Blumgart L H
Published: March 2007

Serial serum carcinoembryonic antigen (CEA) assays were performed in 148 patients after potentially curative surgery for colorectal cancer. Thirty-seven patients developed proved recurrent tumour in a follow-up period of 2–5 years. Elevated CEA levels recorded in 36 of these patients and in 27 rising levels preceded clinical symptoms of recurrent tumour. Two distinct patterns of CEA rise were observed: a ‘fast’ rise in which serum concentrations reached 100 μg/l within 6 months of the first elevation and a ‘slow’ rise in which concentrations remained less than 75 μg/l for at least 12 months. The majority of patients with the ‘fast’ rise had metastatic spread, whereas most patients with a ‘slow’ rise had local recurrence alone. This differential pattern may help to predict the site of recurrent tumour.
Operative mortality following excision of the rectum
Authors: Hughes E S R , McDermott F T , Masterton J P , Cunningham I G E , Polglase A L
Published: March 2007

Resection of the rectum was performed in 1395 patients. There were 94 (6·7 per cent) operative deaths. The operative mortality was similar in the three types of excision. Mortality was high in the male, in the older age groups and in those having palliative resection. Cardiopulmonary complications and sepsis were the two chief causes of the operative deaths.
Clinical and manometric evaluation of rectal prolapse and incontinence
Authors: Keighley M R B , Makuria T , Alexander-Williams J , Arabi V
Published: March 2007

The clinical presentation and manometric findings in 46 patients with rectal prolapse and/or incontinence are reported. Basal and maximal squeeze pressures in the anal canal of patients with prolapse alone did not differ from the pressures in age- and sex-matched controls whereas anal pressures in both groups of patients with incontinence were significantly lower than in controls. Physiotherapy and faradism had no therapeutic value in rectal prolapse but gave improvement in 30 per cent of patients with incontinence. Rectopexy gave satisfactory results in all the patients with prolapse and improved incontinence in 70 per cent. Post-anal repair cured 87 per cent of patients with idiopathic anorectal incontinence or with persistent incontinence after rectopexy. No form of treatment was associated with any signicant elevation of anal pressures.
The effect of bile salts on the pancreatic duct mucosal barrier
Authors: Reber Howard A , Mosley John G
Published: March 2007

The effects of various bile salts on the permeability of the pancreatic duct in cats have been investigated. The sodium salts of cholic, glycocholic, taurocholic, chenodeoxycholic, glycochenodeoxycholic, deoxycholic and glycodeoxycholic acids were perfused through the main duct in concentrations similar to those found in the duodenal contents (15–42 mM). HCO3− and Cl− fluxes were determined before and after perfusion. The unconjugated dihydroxy bile salts increased permeability to these anions to a greater degree than the trihydroxy bile salt, but all were damaging to the duct when they were perfused at an alkaline pH (8·4–9·1). The glycine conjugates of the bile salts were as damaging as the unconjugated form, but 42 mM taurocholate was more damaging than 42 mM glycocholate. When 25 mM glycocholate was perfused at pH 2·4 there was potentiation of the damage produced during perfusion of glycocholate at pH 8·7. Sterile cat bile did not damage the duct, but infected bile did. The ability of bile salts to increase the permeability of the pancreatic ducts must be considered as a possible aetiological factor in the pathogenesis of inflammatory and malignant diseases of the pancreas.
The saline dilution test—a preoperative predictor of DVT
Authors: Heather Brian P , Jennings Stella A , Greenhalgh Roger M
Published: March 2007

In vitro dilution of blood with normal saline produces an increase in coagulability which can be accurately measured by the thrombelastograph. The degree to which the coagulability of an individual patient's blood is increased by such dilution appears to be directly related to that patient's risk of developing a postoperative deep venous thrombosis. In a small group of patients undergoing major abdominal surgery, a preoperative test based on the coagulability increase after in vitro saline dilution successfully predicted all those who subsequently developed a postoperative deep venous thrombosis on 125I-fibrinogen scanning.
The insertion of prostheses at mastectomy for carcinoma of the breast—a preliminary report
Authors: Logan Hume
Published: March 2007

There has been a move away from radical surgery for carcinoma of the breast to more conservative measures. However, even simple mastectomy causes considerable mutilation and is psychologically very upsetting for most patients. This has led to attempts at reconstruction of the breast and more recently to prostheses being inserted at the time of mastectomy (1). The early results of this procedure in 30 patients—the total experience of a general surgeon—are reported in this paper.
Upper thoracic sympathectomy by transthoracic electrocoagulation
Authors: Weale Felix E
Published: March 2007

Transthoracic electrocoagulation (TTEC) of the upper thoracic sympathetic chain is described. In 10 patients the technique was relatively simple and denervation was satisfactory in 9. One temporary Horner's syndrome was produced. The merits of this technique in a preliminary series are compared with other forms of treatment.
The effect of hypovolaemia on colonic blood flow in the dog
Authors: Gilmour D G , Aitkenhead A R , Hothersall A P , Ledingham I Mca
Published: March 2007

The effects of a minor degree of hypovolaemia on colonic blood flow and on systemic haemodynamics have been studied in nine greyhound dogs.

A loss in blood volume of 10 per cent over 20 min produced no change in blood pressure and only a 7 per cent rise in heart rate. Cardiac output, however, fell by 26 per cent and central venous pressure also fell significantly. Colonic blood flow fell by 28 per cent and oxygen availability by 29 per cent. All these changes were statistically highly significant. Retransfusion of shed blood resulted in a slow and incomplete return to pre-bleed status.

Since colonic blood flow and oxygen availability during and after surgery may be important for colonic healing, it is suggested that even the slightest degree of hypovolaemia should be avoided in cases involving colonic anastomosis. Systemic blood pressure may be an inadequate index of the need for transfusion in these cases.
Asymptomatic hyperparathyroidism: An assessment of operative intervention
Authors: Graham J J , Harding P E , Hoare L L , Thomas D W , Wise P H
Published: March 2007

The incidental finding of hypercalcaemia during multichannel screening was the initiating event in 33 (45 per cent) of 79 consecutive cases of surgical treated primary hyperparathyroidism. This subgroup was asymptomatic as defined. Altough significant biochemical differences existed between symptomatic and asymptomatic cases, a range of metabolic indices of bone turnover fell postoperatively in almost all asymptomatic subjects, although initially abnormal in only 35 per cent. Achievement of normocalcaemia was significantly surgeon-dependent.
How long do compression bandages maintain their pressure during ambulatory treatment of varicose veins?
Authors: Raj T B , Goddard M , Makin G S
Published: March 2007

Compression bandages are normally applied for 6 weeks after sclerotherapy. The changes in pressure exerted by such bandages have been measured over 8 h. The results show that different surgeons applied bandages over a wide range of pressures but the range for each individual surgeon was surprisingly narrow. The pressure falls with time and approaches zero at 6–8 h of normal activity by the subject, but more slowly if the knee and ankle joints are excluded from the bandage. The initial pressures were higher when STD compression pads were used, although the rate at which the pressure fell was the same.
Tuberculosis of the breast
Authors: Alagaratnam T T , Ong G B
Published: March 2007

Sixteen cases of tuberculosis of the breast are presented. The clinical features were a firm mass or a recurring abscess of the breast, sometimes associated with discharging sinuses. Diagnosis relied on histological appearance, acid-fast bacilli being present in only 3 specimens and positive cultures obtained in 4 patients. Local excision of the mass and chemotherapy proved effective treatment.
The delayed treatment of wounds of the hand and forearm under antibiotic cover
Authors: Morgan W J , Hutchison D , Johnson H M
Published: March 2007

In wounds of the hand and forearm treated within 4 h of injury, prophylactic clindamycin, in a dose of 150 mg 6-hourly for 5 days, did not reduce the infection rate. In wounds treated after 4 h the infection rate was reduced, but not significantly so. There was a significant reduction in the infection rate comparing all wounds treated within 4 h with those treated after 4 h. Early treatment of wounds is more important than prophylactic antibiotics, although these may have a part to play where late treatment is unavoidable.
A clinical trial in the management of operable cancer of the breast
Authors: Langlands Allan O , Prescott Robin J , Hamilton Thomas
Published: March 2007

The results of a randomized controlled clinical trial in the management of operable breast cancer are given. Between 1964 and 1971 498 women, aged 35–69 years, were treated within the trial protocol. Those under 60 years of age on entry underwent ovarian ablation, usually by surgery, and were allocated randomly to treatment by either radical mastectomy (RM) or simple mastectomy and postoperative radiotherapy (SM). Follow-up data for the first 12 years are presented and show that survival in the radical mastectomy group is significantly better (P < 0·05), particularly in clinical stage 1 disease.

The pattern of survival once recurrence was detected also showed interesting differences between the two treatment groups. Overall there was a significantly prolonged survival after detection of recurrence in the RM group (P < 0·05) which was most marked when local recurrence and distant metastases coincided (P < 0·01). The duration of survival once recurrence had taken place was independent of tumour size, clinical stage of the disease or menstrual status at the time of presentation, but was directly proportional to the duration of the disease-free interval (P < 0·01).
Focal nodular hyperplasia of the liver
Authors: Evans John E , Dick Robert , Sherlock Sheila
Published: March 2007

Focal nodular hyperplasia of the liver (FNH) in a fit young Iranian girl of 19 months presented with asymptomatic hepatomegaly. Liver scan and ultrasound examinations demonstrated a space-occupying lesion involving both hepatic lobes. Arteriography revealed a vascular pattern suggestive of liver cell carcinoma with dilated arterial branches and tumour blush on the capillary phase. At laparotomy the large mass involved both right and left hepatic lobes and was not resected. Tissue diagnosis was established by surgical wedge biopsy.

FNH should be considered in the differential diagnosis of an hepatic mass in a clinically well child, particularly female, in which the liver biopsy suggests cirrhosis but arteriography favours liver cell carcinoma. If FNH is diagnosed and the lesion is not resected it is recommended that patients be advised against sex hormone therapy as there may be an increased risk of rupture with intraperitoneal haemorrhage.
The measurement of arterial perfusion of the liver in man using the radioisotope xenon-133
Authors: Holroyd A M , Peters A M
Published: March 2007

The washout from the liver of xenon-133 injected into the thoracic aorta of human subjects undergoing cardiac investigation was monitored externally with a sodium iodide scintillation detector. The washout curve displayed an initial peak of activity, followed by a brief decline, and then a second, slower rise. The initial peak was thought to be due to isotope arriving in the liver via the hepatic artery, and the second rise due to isotope arriving via the portal vein. A method of analysis is presented which uses the height of this arterial peak to calculate arterial perfusion of the liver.
Midline or transverse laparotomy? A random controlled clinical trial. Part I: Influence on healing
Authors: Greenall M J , Evans Mary , Pollock A V
Published: March 2007

Five hundred and seventy-nine patients undergoing major laparotomy were randomly allocated to have midline or transverse incisions. Transverse incisions took longer to make and caused more bleeding but (in the absence of wound sepsis) no transverse wound burst and there were only 2 incisional hernias. In the midline group, without wound sepsis, there were 2 burst abdomens and 9 incisional hernias.

When, however, those patients who suffered wound sepsis were also considered, there were no significant differences between the two groups.
Midline or transverse laparotomy? A random controlled clinical trial. Part II: Influence on postoperative pulmonary complications
Authors: Greenall M J , Evans Mary , Pollock A V
Published: March 2007

In a series of 579 patients undergoing major laparotomy, the direction of incision (midline or transverse/oblique muscle-cutting) was decided randomly. The severity of postoperative pulmonary complications was expressed by a scoring system which allowed categorization into mild (score 0–3), moderate (score 4–6) and serious (score 7 or more) complications.

The important determinants of high scores were found to be male sex, preoperative pulmonary dysfunction, postoperative ventilatory depression, hypovolaemic and septic shock, inhalation of gastric contents and embolism. In no stratum did the direction of incision have any significant effect.
The long term effect of sphincter preserving operations for rectal carcinoma on function of the anal sphincter in man
Authors: Williams Norman S , Price Robert , Johnston David
Published: March 2007

Anal function was studied in 20 normal subjects and in 20 patients who had undergone sphincter-saving resection of the rectum for carcinoma. In each the anastomosis had been constructed 3–7 cm from the anal verge. Inhibition of the internal sphincter was judged to have taken place when distension of a balloon 10 cm from the anal verge produced an immediate fall of at least 20 per cent in resting anal pressure as measured by a balloon probe: inhibition of the external sphincter in response to the same stimulus was defined as complete cessation of EMG activity. Threshold for sensation was the minimal volume of balloon distension required to elicit a response. Maximum tolerable volume was the largest volume of distension tolerated.

Inhibition of the activity of the internal sphincter was found in all controls and in 17 of 20 patients. External sphincter activity was inhibited in 16 of 20 controls and 11 of 19 patients. Threshold for sensation and its quality were similar in both groups. Patients had more frequent bowel actions than the controls which is probably explained by significant reductions in resting anal pressure and maximum tolerable volume found in patients.

These results suggest that some, at least, of the physiological mechanisms subserving continence remain intact after complete or nearly complete excision of the rectum.
Intussusception: A study of its surgical management
Authors: Pollet J E
Published: March 2007

Seventy-seven consecutive records of patients with intussusception presenting to the Royal Aberdeen Children's Hospital have been reviewed. The clinical features of the disease, the methods and the results of treatment are described. An attempt has been made to correlate clinical findings with the use, success and safety of operative intervention. Retrospectively, over 40 per cent of the cases possibly justified surgical intervention, but 10 per cent of those operated on had complications. There were no deaths in this series.
Meckel's diverticulum: Its association with congenital malformation and the significance of atypical morphology
Authors: Simms M H , Corkery J J
Published: March 2007

Retrospective analysis of the records of a children's hospital shows an increased incidence of Meckel's diverticulum in children born with major malformation of the umbilicus, alimentary tract, nervous system or cardiovascular system in descending order. A consideration of the risks associated with Meckel's diverticulum suggests that elective resection is indicated only for diverticula that are atypical on inspection or palpation.
Three-year experience with glutaraldehyde-stabilized umbilical vein for limb salvage
Authors: Dardik Herbert , Ibrahim Ibrahim M , Jarrah Mamoon , Sussman Barry C , Dardik Irving I
Published: March 2007

During the past 3 years, 361 vascular reconstructions were performed employing glutaraldehyde-stabilized umbilical veins. The distal anastomosis terminated at the popliteal segment (n = 183), at either of the tibial arteries (n = 108) or at the peroneal artery (n = 70). One hundred and forty-one (77 per cent) of the popliteal reconstructions were below the knee. Many of the patients undergoing these bypasses had a previous failed reconstruction and were operated upon for limb salvage. Operative mortality rates for the popliteal, tibial and peroneal reconstructions were 2·7, 2·8 and 4·3 per cent respectively. Cumulative graft patency rates at 36 months for each of the three types of reconstruction were 76·4 per cent (popliteal), 63·4 per cent (tibial) and 39·8 per cent (peroneal). Failures were usually due to inappropriate case selection or progressive disease, particularly in the distal circulation. Two grafts were removed because of wound and secondary graft infection. There were no instances of biodegradation, either by aneurysm formation or by myointimal proliferation. These data confirm that attempts at revascularization are definitely preferable to amputation. The use of the glutaraldehyde-stabilized umbilical vein has facilitated the performance of these operations. In appropriately selected cases and with expert surgical technique, long term graft function with limb salvage can be obtained.
The evaluation of blood flow measurement using a gravimetric plethysmograph
Authors: Humphrey C S , Leveson S H , Wiggins P A , Wilde D T , Kester R C
Published: March 2007

The gravimetric plethysmograph is a simple, robust and inexpensive device which measures blood flow in the limb in terms of the increase in weight which follows temporary venous occlusion. Validation of the instrument using an artificial circuit shows that it is accurate and gives reproducible results.

The mean resting blood flow in the legs of 18 healthy volunteers was 3·95 ml 100 ml−1 tissue min−1 and this measurement was not reproducible. A 3-min period of arterial occlusion resulted in an immediate hyperaemic response of a mean 43·5 ml 100 ml−1 min−1, and this result was much more reproducible (r = 0·18).

The mean resting blood flow of 45 patients with occlusive arterial disease of the legs was 2·1 ml 100 ml−1 min−1, and this flow rate was variable (r = 0·71). Their immediate hyperaemic response of 5·18 ml 100 ml−1 min−1 was much less than that in normal volunteers, but was quite reproducible (r = 0·93). Following arterial reconstruction, their mean immediate hyperaemic response rose to 10·35 ml 100 ml−1 min−1, which was a significant increase compared to their preoperative values (P < 0·0005, Student's t test) and was associated with concomitant improvement in symptoms, treadmill performance and ankle/brachial systolic pressure indices. Measurement of the immediate hyperaemic response to temporary arterial occlusion with the gravimetric plethysmograph may assist in the evaluation of patients with occlusive arterial disease of the legs, and in their medical and surgical management.
Incidence of postoperative deep vein thrombosis in Hong Kong Chinese
Authors: Nandi P , Wong K P , Wei W I , Ngan H , Ong G B
Published: March 2007

Postoperative deep vein thrombosis is considered to be rare in Chinese. The125 I-labelled fibrinogen test was used to determine the true incidence of postoperative deep vein thrombosis in Chinese. Deep vein thrombosis was found in 2·6 per cent, a very low incidence compared with Caucasian series.
Necrotizing enteritis
Authors: Pujari B D , Deodhare S G
Published: March 2007

Clinicopathological feazures and follow-up of 150 cases of necrotizing enteritis observed over the period of 8 years at Miraj, India, are presented. This is a distinct pathological entity with seasonal occurrence, frequently affecting male patients of the low socioeconomic groups between the third and fifth decades of life. The symptoms are disproportionately greater than the physical. signs. The ischaemic lesions, which mainly affect the jejunum, show a variable degree of severity ranging from segmental congestion and ulceration to extensive gangrene and perforation. In the early stage of the disease recovery is complete. Conservative treatment is preferred in early cases, surgery being indicated only for advanced lesions. No definite aetiology has been detected.
Intrahepatic biliary intestinal diversion for biliary obstruction: Experience in 34 patients
Authors: Moreno-González E , Sanmartin J Hebrero , Herruzo J A Solis , Azcoita M Moreno
Published: March 2007

Intrahepatic biliary intestinal diversion for biliary obstruction was performed in 34 patients. Benign strictures were found in 15 patients and malignant disease in 19. Central cholangiojejunostomy was performed on 15 patients with iatrogenic strictures of the hepatic junction and on 2 patients after removal of a common hepatic duct carcinoma. In 14 patients an isolated jejunal loop interposed between the hepatic ducts and duodenum was used. In patients with malignant obstruction of the common hepatic duct peripheral cholangiojejunostomy was performed using the left hepatic duct radicals in 14 patients, a bilateral cholangiojejunostomy in 3 patients and a left cholangiogastrostomy in 2 patients.

One patient died on the twenty-first postoperative day. The follow-up of patients with benign disease varied between 5 months and 6 years; all patients were free of symptoms at the time of their last follow-up examination. In patients with malignant disease, the follow-up varied from 6 months to 29 months, 7 patients being still alive 8–29 months after operation.

We believe cholangiojejunostomy is the best biliary diversion procedure in obstructions of the common hepatic duct.
Cystic degeneration of the femoral vein: A case report
Authors: Annetts D L , Graham A R
Published: March 2007

A case of cystic degeneration of the femoral vein in a 23-year-old woman is reported. The condition caused obstruction of the femoral vein with leg swelling and was treated successfully by deroofing the cyst.
Studies of the immediately vascularized skin allograft
Authors: Perlof Leonard J , Barker Clyde F
Published: March 2007

In order to evaluate the effect of the nature of revascularization on survival rates of skin allografts, a rat model was devised which provided simultaneous and immediate establishment of arterial and venous blood supply to a composite skin–renal allograft. For 5 days after transplantation the skin portion of the composite grafts appeared normal, with minimal inflammation in 11 recipients. From 6 to 11 days, in 6 rats, active rejection developed with a marked inflammatory reaction of the skin–kidney interface. In 10 rats in which the composite grafts remained in the secondary hosts for 12–21 days rejection of the skin was complete. The renal portion of all composite grafts appeared normal in all three panels and all recipients of composite grafts rejected subsequent orthotopic skin grafts in an accelerated manner, with median survival times of 8·2 ± 0·3 days compared with median 11·5 ± 0·7 days in untreated Fischer → Lewis controls.

These results demonstrate that the skin on the composite graft retained its immunogenicity, that immediately vascularized skin allografts between AgB compatible rats will be rejected in a normal time and that anatomical factors are not sufficient to account for the difference in survival times between skin and solid organs.
An evaluation of 99Tcm-labelled HIDA in hepatobiliary scanning
Authors: Taylor T V , Sumerling M D , Carter D C , McLoughlin G P , Miller A M
Published: March 2007

99Tcm-labelled HIDA administered intravenously is promptly taken up by the liver and excreted into the bile duct and gallbladder. In this study the use of this agent in hepatoscintigraphy was evaluated. Thirty patients with a variety of hepatobiliary pathology were studied. After an overnight fast 2 mCi of 99 Tcm HIDA were given intravenously and the patient was scanned continuously for 1 h. A rapid outline of the liver and biliary tract was usually obtained and the T½ of the tracer in the blood stream was 20 min. In total obstructive jaundice, isotope was excreted through the renal tract without visualization of the liver. Hepatoscintigraphy was compared with conventional radiographs and ultrasonography in 19 patients presenting as emergencies with suspected hepatobiliary disease and was found to be comparable to the latter modes of investigation. In the jaundiced patients hepatoscinsigraphy was inferior to percutaneous transhepatic cholangiography and to ultrasonography. No adverse side effects have followed the use of the radiopharmaceutical.
Penetrating injuries of the popliteal vein: A report on 34 cases
Authors: O'Reilly M J G , Hood J M , Livingston R H , Irwin J W S
Published: March 2007

The results of treatment in 34 cases of penetrating injury to the popliteal vein are presented. In 26 cases there was associated damage to the popliteal artery. Satisfactory venous repair by lateral suture was achieved in 11 of 12 limbs. Autogenous vein grafts were used to repair the damaged popliteal vein in 10 limbs. In 4 the saphenous vein was anastomosed directly to the popliteal vein; in 6 cases it was used as a wide-bored panel or compilation graft. Three popliteal veins were ligated. Major postoperative limb oedema and chronic venous insufficiency were not a problem in those cases where the veins were repaired. Fasciotomy was performed in 19 of the 34 cases of venous injury. In 12 of these cases fasciotomy, performed as part of the original operation to repair the vascular injury, led to an excellent clinical result.
Computer-assisted diagnosis of acute Crohn's disease
Authors: Nixon S J , Rundle J S H
Published: March 2007

A study comparing the symptoms and signs of patients with acute Crohn's disease and those with acute appendicitis and intestinal obstruction is reported and a preliminary evaluation of computer-assisted diagnosis in this problem is given. There are significant differences between the three conditions. However, the accuracy of computer-assisted diagnosis in Crohn's disease is reduced by the high false positive rate of diagnosis in both appendicitis and intestinal obstruction. Computer accuracy in Crohn's disease may increase when further information is available to extend the data base.
Benign liver nodules presenting as apparent hepatic metastases: A report of 5 cases
Authors: Fletcher M S , Everett W G , Hunter J O , Smellie W A B , Wight D G D
Published: March 2007

Five cases are described in which hepatic nodules discovered as an incidental finding at laparotomy performed for other reasons were thought to be metastatic tumour. In each case histology and clinical course proved this assumption to be incorrect. It is emphasized that biopsy is mandatory in such circumstances to establish the diagnosis. Where the nature of the hepatic lesion might affect the choice of operative procedure frozen section examination should be performed at the time of surgery. Bacteriological culture may also be helpful.
The acute abdomen following cardiopulmonary bypass surgery
Authors: Wallwork J , Davidson K G
Published: March 2007

Over a 5-year period, 9 patients (0.85 per cent) developed a major acute abdominal complication after cardiopulmonary bypass surgery. Difficulties in the initial recognition and diagnosis of these complications in sedated, ill patients are highlighted. A high index of suspicion is important in the early diagnosis of these complications. The numbers are too small for statistical analysis, but experience suggests that each case should be dealt with on its merits in accordance with common surgical practice and that operative management should not be rejected because the patient has recently undergone a major cardiac operation.
Pancreatic pseudocyst with gastric and colonic connections treated conservatively
Authors: Dean Sandra , Kendall Martin J , Slaney Geoffrey
Published: March 2007

A case of pancreatic pseudocyst with gastric and colonic connections developing after acute pancreatitis is reported. The successful treatment by conservative means is described and alternative methods of management are reviewed.
Volvulus of the sigmoid colon in the Gezira
Authors: Taha Salah E , Suleiman Suleiman I
Published: March 2007

Out of 34 consecutive patients presenting with volvulus of the signoid colon in the Gezira area of The Sudan, 30 were western Sudanese farmers (age range 25–52 years) who habitually ate a single daily meal of high residue food: their colons were long and hypertrophied. In contrast, the 4 northern Sudanese (age range 60–92 years) ate a Western European type of diet and had a thin colon. This factor may have been responsible for the finding that the 5 patients presenting with gangrene of the sigmoid colon included all 4 northern Sudanese patients. Shock was a reliable indicator of gangrene but rebound tenderness was valueless. Deflation of the sigmoid volvulus via the sigmoidoscope succeeded in curing 19 of 25 patients in whom there was no suspicion of gangrene (4 later recurrences). Laparotomy was performed in the other 15 patients with operative untwisting in the absence of gangrene in 10 (2 later recurrences), and resections in the presence of gangrene (3 died).
Oesophageal squamous cell carcinoma: II. A critical review of radiotherapy
Authors: Earlam Richard , Cunha-Melo J R
Published: March 2007

There has been no controlled trial of radiotherapy versus surgery for squamous cell carcinoma of the oesophagus. Radiotherapy is generally used for those patients with extensive disease or those who are unfit for surgery. In spite of this, the 1-year survival of 18 per cent is similar to that for surgically treated patients and there is no equivalent operative mortality. The 5-year survival is 6 per cent compared with that for surgery of 4 per cent. There are no results available to suggest what would happen if a patient with a localized tumour, technically suitable for surgical resection, were treated instead by radiotherapy.
The reduction of postoperative chest infection by prophylactic co-trimoxazole
Authors: Morran C , McArdle C S
Published: March 2007

A prospective randomized double-blind study was conducted to evaluate the effect of a single prophylactic dose of co-trimoxazole on the incidence of pulmonary complications following upper abdominal surgery. Of 68 patients studied, 36 were judged clinically to have no postoperative pulmonary complications, 18 to have pulmonary atelectasis and 14 to have chest infection. Serial analysis of arterial oxygen tensions supported the clinical assessment.

Of 34 controls, 6 developed pulmonary atelectasis and 11 (32 per cent) chest infection. Of the 34 treated patients, 12 developed atelectasis and 3 (9 per cent) chest infection. The reduction in chest infection was significant (P < 0·05). These results support the use of prophylactic cotrimoxazole to prevent chest infection following abdominal surgery.
Gastro-oesophageal reflux: An aetiological factor for bleeding in oesophageal varices?
Authors: Heil T , Mattes P , Loeprecht H
Published: March 2007

The precipitating factor in bleeding oesophageal varices is unkown. To Investigate this problem 10 patients who had bled from oesophageal varices were examined by manometry. pH monitoring and gastroscopy to determine whether gastro-oesophageal reflux occurred. No evidence for reflux was found.

These results, together with previously published reports cast doubt on peptic oesophagitis or reflux as an aetiological factor in the initiation of oesophageal variceal bleeding.
Anal cancer treated by fast neutron radiation
Authors: Franklin Alfred
Published: March 2007

Ten patients with anal cancer were treated with fast neutrons from the Medical Research Council Cyclotron at the Hammersmith Hospital. In all cases a temporary colostomy was established before treatment commenced. Three of the patients had advanced tumours that were exending into the pelvis; treatment for these patients was palliative and all died within 1 year. Four of the remaining 7 have normal and function with no evidence of local recurrence of the tumour. Two others developed necrosis in the irradiated area and in another, the tumour recurred locally. The colostomy was re-established in 1 and the 2 others had abdominoperineal resections, after which wound healing was prolonged. A majority of the surviving patients have thus been able to avoid a permanent colostomy.
Famoropopliteal vein grafts for intermittent claudication
Authors: King R Barry , Myers Kenneth A , Scott David F , Devine Terence J , Johnson Neil , Morris Peter J
Published: March 2007

Femoropopliteal vein grafts were performed for intermittent claudication in 160 patients (182 legs) over a 12-year period. The accumulative patency rate was 67 per cent at 5 years. However, patency rates improved significantly in the latter 6 years of the study, to 75 per cent at 5 years. Early postoperative occlusion and morbidity rates also markedly declined in this latter period. Patency rates were significantly better in males than in females, in patients who were able to stop smoking after operation and in legs with a three-vessel run-off compared with those with a two- or one-vessel run-off. The patients' age did not influence graft patency rates.
Inhibition of metabolic responses to surgery with β-adrenergic blockade
Authors: Tsuji Hideo , Asoh Tsukasa , Shirasaka Chiaki , Takeuchi Yoshihiko
Published: March 2007

Glucose, lactate, non-esterfied fatty acid and insulin levels in plasma were measured in two groups of 12 patients undergoing gastrectomy under general anaesthesia. Propranolol in a dose of 0·3 mg/kg body weight was intraoperatively infused in one of the two groups.

Surgery under general anaesthesia elicited a significant rise in blood glucose, lactate and NEFA concentrations. These metabolic responses were significantly inhibited by intraoperative infusion of propranolol without producing any undesirable side effect. Plasma insulin levels showed a slight decrease during the operation and no significant difference was noted between the two groups.

The results suggest that β-adrenergic activity is playing a major role in these metabolic responses, promoting the mobilization of substrates. Possible benefits of inhibiting β-adrenergic activation in surgical stress are discussed.
The occult rectal prolapse syndrome
Authors: White C M , Findlay J M , Price J J
Published: March 2007

Occult rectal prolapse is a condition of young adults which causes problems in diagnosis. Symptoms consist of tenesmus and the passage of blood and mucus associated with constipation and straining at stool. The rectal prolapse often remains unrecognized for a long time because demonstration of the prolapse is difficult. There are characteristic changes in the rectum on clinical examination and these should alert the clinician to the diagnosis. Treatment of the prolapse relieves the symptoms.
Tumour thickness and the site and time of first recurrence in cutaneous malignant melanoma (stage I)
Authors: Milton O W , Shaw H M , Farago G A , McCarthy W H
Published: March 2007

A study was made of 326 patients first treated for clinical stage I cutaneous malignant melanoma by a wide excision (with or without split-skin graft) but no nodal dissection and who subsequently developed recurrence of their disease. Thick lesions recurred far more frequently than very thin lesions, although evidence of partial regression in very thin lesions conferred upon the latter a liability to metastasize. Thicker lesions first recurred predominantly in the vicinity of the scar of primary lesion excision whilst very thin lesions first recurred either at regional lymph nodes or at remote sites. The disease-free interval fell with increasing tumour thickness. As a result of this, local first recurrences developed more rapidly than remote first recurrences. The cumulative 10-year survival rate for patients with local first recurrences was, however, significantly higher than for patients with remote first recurrences, as the survival period after local first recurrence was considerably longer than after remote first recurrence.

We conclude that tumour thickness is an easily measured, objective predictor of the site and time of first recurrence from melanoma. Thus, by facilitating early detection of first metastastases, it may be possible to prolong survival time.
Removal of metronidazole by haemodialysis
Authors: Gabriel Roger , Page C M , Collier J , Houghton G W , Templeton R , Thorne P S
Published: March 2007

The removal of the anti-anaerobic antibiotic metronidazole has been studied in oliguric patients. The drug and its principal metabolite are rapidly removed by haemodialysis so that the plasma concentration quickly falls below the therapeutic range. Hence a further dose of metronidazole would be needed after dialysis to restore an adequate plasma concentration.
Ultrasound in the diagnosis of two unusual tuberculous abscesses
Authors: Taylor Rodney H , McNicol Martin W
Published: March 2007

A case report of a patient with two extraperitoneal tuberculous abscesses in the abdominal wall diagnosed by ultrasound is presented.
Usefulness of transhepatic portal catheterization in the treatment of insulinomas
Authors: Pedrazzoli Sergio , Feltrin Giampiero , Dodi Giuseppe , Miotto Diego , Pasquali Claudio , Cevese Pier G
Published: March 2007

Twenty-four per cent of β-cell tumours require more than one operation to control the hypoglycaemic syndrome. Almost all of them are small insulinomas undetectable by palpation of the pancreas. Arteriography is too insensitive to detect non-palpable tumours. Transhepatic catheterizaation of the splenic and portal veins (TPC) can detect the position at which there is an abrupt increase in insulin level indicating the site of the tumour. Routine use of TPC allowed us to locate all 9 insulinomas in which this technique was employed, whereas of 15 patients not studied by TPC only 12 tumours were located at first operation, 2 of which were found by blind resection of the tail of the pancreas. We believe that routine application of TPC to all cases of suspected insulinoma would reduce the incidence of surgical failures, unsuccessful blind resections and lengthy trials of medical therapy before laparotomy.
Fibrinogen in the ‘hepato-renal syndrome’: An experimental study
Authors: Sagar S , Shields R
Published: March 2007

The pathogenesis of renal failure in jaundice is controversial. Several factors have been incriminated, including intravascular coagulation. We have investigated this hypothesis by studying the deposition of radioactive fibrinogen in the kidney of jaundiced rats. Fibrinogen labelled with 125I was injected into rats whose bile duct was subsequently ligated. The radioactivity in the kidney was compared to that in blood and the renal uptake ratio calculated. This ratio (mean ± s.e.mean) rose from 0·24 (± 0·04) to 2·93 (± 0·43) after ligation of the common bile duct. In contrast, in control rats who underwent a sham operation, the uptake ratio rose from 0·31 (± 0·03) to 0·96 (± 0·08). This deposition of 125I fibrinogen in the kidneys of jaundiced rats was significantly greater (P < 0·001) than that in control rats. The deposition was specific to the kidney compared with that in the heart, bowel, muscle and liver. In the control animal the uptake of 125I fibrinogen by the kidney was not different from that by other viscera.
Penetrating injuries of the neck: A prospective study of 108 patients
Authors: Campbell F C , Robbs J V
Published: March 2007

One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetrating wound of the neck and were managed by a conservative policy. Intervention was undertaken if, and only if, there was an indication of damage to deep structures. Data were collected prospectively. Significant sequelae were seen in only 50 patients (46 per cent) and 26 underwent surgery. Three patients died from their neck injuries (2·8 per cent), 2 after operative intervention and 1 after conservative management. Morbidity was higher after surgery, though local sepsis in wound haematomas was more common in those treated conservatively.

A selective policy for surgical intervention is safe and justifiable. A minimum mortality and morbidity can be obtained by adequate preoperative evaluation which includes the use of contrast radiography and angiography.
Faecal bile acid excretion in diverticular disease
Authors: Flynn M , Hyland J , Hammond P , Darby C , Taylor I
Published: March 2007

Faecal bile acid excretion and sigmoid myoelectrical activity were measured on three separate occasions over a 12-month period in 21 patients with diverticular disease and the results were compared with those of 17 age-matched normal subjects. Statistically significantly lower faecal concentrations of both deoxycholic and lithocholic acid were found in patients with diverticular disease (96·7 ± 11·3 mg/100 g, 59·6 ± 6·0 mg/100 g respectively) when compared with normal subjects (219 ± 32·0 mg/100 g and 117·6 ± 14·6 mg/100 g respectively P < 0·001). These values persisted throughout the period of study. Patients with diverticular disease were found to have an abnormally rapid myoelectrical rhythm (frequency 0·2–0·3 Hz [12 – 18 c/min]) which returned towards normal after 1 year's bran treatment. Significant correlatzons were found between lithocholic acid concentrations and activity of 0·2–0·3 Hz (r = 0·67) and deoxycholic acid concentrations and activity of 0·1–0·15 Hz (6–9 c/min) (r = 0·62). It is suggested that increased colonic absorption of bile acids may occur in diverticular disease which may influence the myoelectrical activity.
Comparison of skin closure using continuous and interrupted nylon sutures
Authors: McLean N R , Fyfe A H B , Flint E F , Irvine B H , Calvert M H
Published: March 2007

Skin closure using continuous nylon sutures was compared with closure using interrupted nylon sutures in 105 consecutive patients undergoing laparotomy. Particular note was made of wound healing and wound infection.

The incidence of wound infection was similar (3·9 per cent and 3·7 per cent respectively) and all wounds healed satisfactorily. The continuous method was quicker and cheaper.