bluuebunny/crossref_metadata_2025 huggingface dataset:
Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma
Authors: Parc R , Tiret E , Frileux P , Moszkowski E , Loygue J
Published: March 2007

Sphincter-saving operations are now generally accepted for the treatment of mid-rectal cancers. Many techniques have been described: low colorectal anastomosis, pull-through procedures, and colo-anal anastomosis. The functional results following these operations are impaired by loss of the reservoir function of the rectum. In order to improve these results, a modification of Parks' colo-anal anastomosis is proposed. A J-shaped colic reservoir is constructed and its end is anastomosed to the anal canal. We have operated upon 31 patients using this technique. Mortality was 3.3 per cent. Functional results were evaluated in 24 patients having a follow-up of more than 3 months. All were continent; mean number of bowel movements was 1.1 per day. Defaecation was spontaneous in 75 per cent of cases; in the remaining 25 per cent, evacuation of the reservoir was elicited by a small enema each two days. This technique, creating a neo-rectum, can achieve an important place among the sphincter-saving operations.
Clinical investigations of lymphadenopathy, including lymph node biopsies, in 24 homosexual men with antibodies to the human T-cell lymphotropic virus type III (HTLV-III)
Authors: Farthing C F , Henry Kristin , Shanson D C , Taube M , Lawrence A G , Harcourt-Webster J N , Gazzard B
Published: March 2007

The findings of 27 lymph node biopsies performed on 24 homosexual patients with lymphadenopathy are presented. Six had acquired immune deficiency syndrome (AIDS) and 18 lymphadenopathy only, of whom one subsequently developed AIDS. All these patients had antibodies to the human T-cell lymphotropic virus type III (HTLV-III) suggesting that HTLV-III is currently the commonest cause of lymphadenopathy in homosexual men. The histopathological findings of six of seven nodes from AIDS patients showed either follicular depletion alone or follicular and paracortical lymphocyte depletion. Nodes from four patients showed Kaposi's sarcoma, three of which also showed follicular hyperplasia. In two of these patients there were no cutaneous manifestations of this condition. One lymph node from a patient with persistent generalized lymphadenopathy (PGL) showed Mycobacterium tuberculosis. Six nodes from six other patients have had features oftoxoplasmosis although there was no serological or clinical evidence of recent toxoplasma infection. The remaining 11 lymph nodes from patients with PGL and one node from a patient with transient lymphadenopathy, showed reactive follicular hyperplasia only. We conclude that homosexuals with lymphadenopathy who are HTLV-III antibody positive do not need a routine node biopsy unless an alternative diagnosis is strongly suspected.
Major amputation compared with graft occlusion as the end point for assessing results of bypass surgery in lower limb ischaemia
Authors: Mikulin T , Hopkinson B R , Makin G S
Published: March 2007

Cumulative graft patency rates calculated using graft occlusion as the end point are the standard method of presenting results of bypass surgery for lower limb ischaemia. The problems of using graft occlusion as the end point are that this is not easily documented and it gives no indication of the condition of the patient's limb after the graft occludes. The date of amputation is a well defined end point and it means treatment has failed. It is used to calculate cumulative limb salvage rates. Using the two techniques to assess different risk factors (age, calf vessel run-off, diabetes, position of distal anastomosis and hypertension), it was found that the limb salvage rate was a better indicator of patient progress. Whereas graft patency rates for diabetics and non-diabetics were similar (χ2 = 0·8, P > 0·1), diabetics had a higher amputation rate and the limb salvage rate was significantly worse (χ2 = 5·0, P < 0·05). Cumulative survival is rarely presented in vascular series but it could be used as an indicator of the general condition of patients being selected for bypass surgery. The cumulative survival of diabetics was 23 per cent (s.e.m. ± 12 per cent) at four years, while for non-diabetics this was 55 per cent (s.e.m. ± 15 per cent), (χ2 = 10.6, P < 0.001). Diabetic patients have such different limb salvage and survival rates compared with non-diabetic patients that their results should be presented separately. A better indication of patient progress following bypass surgery is obtained if limb salvage rates and survival rates are reported as well as graft patency rates.
Emergency presentation and mortality from colorectal cancer in the elderly
Authors: Waldron R P , Donovan I A , Drumm J , Mottram S N , Tedman Susan
Published: March 2007

We have assessed the influence of age on the mode of presentation and perioperative mortality in 1033 patients with colorectal cancer. There were 522 patients (51 per cent) over 70 years (group I) and 511 patients (49 per cent) under 70 (group II). In group I, 301 patients (58 per cent) were admitted as emergencies compared with only 222 (43 per cent) in group II (P < 0·001). Perioperative mortality was especially high in the elderly emergencies, 38 per cent, compared with 18 per cent for elective operations. Of the patients presenting as emergencies in either age group 66 per cent had localized ‘potentially curable’ disease. The incidence of colorectal cancer is highest in the elderly. A larger number of these elderly patients present as emergencies and die from the consequences of complications of localized disease. Earlier diagnosis by pre-symptomatic screening is therefore especially desirable in these old patients.
Colonic healing: A role for polymorphonuclear leucocytes and oxygen radical production
Authors: Shandall A A , Williams G T , Hallett M B , Young H L
Published: March 2007

Using a model of ‘reperfusion injury’ as a mechanism of oxygen radical (OR) production in vivo, we have demonstrated that superoxide (O2-) is the major source of damage. Inhibition of its production from polymorphonuclear leucocytes (PMNs) by aprotinin, a protease inhibitor, or by scavenging with superoxide dismutase (SOD), resulted in reduced oxidation of of tissue glutathione (P < 0·002). Colonic healing after anastomosis was also improved by aprotinin as measured by histology (P < 0·05), breaking energy (P < 0·001), breaking strength (P = 0·02), and by hydroxyproline content (P = 0·01). Allopurinol, although inhibiting glutathione oxidation, had no effect on PMN leucocyte OR production and did not protect against histological damage. These data demonstrate that PMNs endogenous to the tissue or attracted there as a result of trauma are the source of OR production in ‘reperfusion’. Their inhibition improves colonic healing.
Comparison of the mortality, morbidity and incidence of local recurrence in patients with rectal cancer treated by either stapled anterior resection or abdominoperineal resection
Authors: Gillen P , Peel A L G
Published: March 2007

One hundred patients with rectal cancer treated by one surgeon over a 7 year period are reviewed. Fifty-five patients were treated by stapled anterior resection (SAR) and 45 by abdominoperineal resection (APR). Dukes' classification, degree of differentiation and local spread were similar in both groups. Operative mortality was 7.2 per cent for SAR and 2.2 per cent for APR. Anastomotic leakage following SAR occurred clinically in two patients (3.6 per cent), one of which proved fatal, and radiologically in five patients. Morbidity after SAR and APR was otherwise similar. There was no significant difference in local recurrence rates after SAR (14.7 per cent) and APR groups (25.0 per cent). The results of this study suggest that for patients with rectal cancer radical excision with sphincter preservation using the circular stapler has a mortality, morbidity and risk of local recurrence comparable with radical excision with a permanent colostomy.
Incidence of locally metastatic(‘recurrent’) cutaneous malignant melanoma following conventional wide margin excisional surgery for invasive clinical stage I tumours: Importance of maximal primary tumour thickness
Authors: Griffiths R W , Briggs J C
Published: March 2007

In a minimum 5-year follow-up study of 638 primary clinical Stage I invasive cutaneous malignant melanomas (excluding lentigo maligna melanomas) excised with conventional wide normal tissue margins, the incidence of local tumour metastasis was 48/638 (8 per cent). The incidence of locally metastatic tumours rose from 2 per cent for tumours < 0.99 mm thick, to 14 per cent for tumours between 5 and 6 mm in thickness. The rate of local metastasis was significantly greater for tumours > 2.0 mm compared with tumours < 2.0 mm thick (P < 0.01). Despite the anatomical restrictions to wide resection margins in the head and neck, these areas had the lowest regional incidence for local tumour metastasis (2 per cent). Over the prolonged postoperative follow-up period (median 11 years) 67 per cent (32/48) of patients with locally metastatic disease died of disseminated malignant melanoma, compared with a 31 per cent mortality (180/590)for those without local disease metastasis. The term ‘local recurrence’ is unhelpful in our attempts to understand the pathology of malignant melanoma, and the term ‘local metastasis’ could replace it with benefit.
The ‘sandwich technique’ in the management of the open abdomen
Authors: Schein M , Saadia R , Jamieson J R , Decker G A G
Published: March 2007

A management technique of the open abdominal wound is described. It consists of a ‘sandwich’ composed of a Marlex mesh and an Op-Site wound dressing with interposition of suction tubes. Such a technique prevents evisceration, protects the skin, decreases evaporation, allows accurate fluid replacement, facilitates nursing and adds to the patient's comfort.
Incidence of fistula-in-ano complicating anorectal sepsis: A prospective study
Authors: Henrichsen S , Christiansen J
Published: March 2007

The incidence of fistula-in-ano following anorectal abscesses was studied prospectively in 50 consecutive patients. A total of 13 patients (26 per cent; 95 per cent confidence limits: 14–40) had a fistula diagnosed either in the acute phase or during follow-up within 6 months. Half of the fistulas diagnosed at follow-up were unrecognized by the patients and no fistulas developed in patients where culture from the abscess only revealed skin-derived bacterias. X-ray examination was of no value in the diagnosis of anal fistula.
Colonic haemorrhage: A technique for rapid intra-operative bowel preparation and colonoscopy
Authors: Scott H J , Lane I F , Glynn M J , Theodorou N A , Lloyd-Davies E , Reynolds K W , Parkins R A
Published: March 2007

We describe a new technique of operative orthograde colonic washout followed by colonoscopy for use in patients with severe colonic haemorrhage. We report its use in four patients in whom the exact source of bleeding was localized and treated. In two of these cases a policy of ‘blind’ hemicolectomy would have been incorrect. The technique is simple and safe, and we advocate its use during laparotomy for major colonic haemorrhage.
Prostatic carcinoma cell DNA content measured by flow cytometry and its relation to clinical outcome
Authors: Fordham M V P , Burdge A H , Matthews Joyce , Williams G , Cooke T
Published: March 2007

DNA content of prostate tumour cells has been measured by flow cytometry of cell suspensions prepared from fixed tissue by an enzyme disaggregation technique. Two classes of tumours have been identified: diploid tumours, with a DNA content similar to benign cells and aneuploid tumours with grossly abnormal DNA values. The prognosis for the aneuploid tumours was significantly worse than diploid tumours (P < 0.001). When ploidy is combined with histological grading, here using the Gleason numerical system, it is possible to predict which patients, whatever their age at diagnosis, will die from their tumour and which patients will probably die before their tumour kills them. With these facts it is possible to select patients for active or expectant treatment.
Pancreatic debridement in acute necrotizing pancreatitis: An obsolete procedure?
Authors: Smadja C , Bismuth H
Published: March 2007

Thirty-eight patients treated by pancreatic debridement for acute necrotizing pancreatitis were studied. Group 1 consisted of 12 critically ill patients who underwent early surgery. Group 2 was formed from 15 patients operated upon secondarily for supervening complications and group 3 contained 11 patients operated upon electively for gallstone pancreatitis. The operative mortality was 100, 27 and 0 per cent for groups 1, 2 and 3 respectively. Pancreatic debridement was associated with a high morbidity whether performed for complications (66 per cent) or elective biliary surgery (36 per cent). These data suggest that there is probably only limited indication for pancreatic debridement in patients with acute necrotizing pancreatitis.
Factitious breast disease
Authors: Ward H C
Published: March 2007

No Abstr act.
New cervical approach for tracheopexy
Authors: Vaishnav A , Mackinnon A E
Published: March 2007

Deficiency of the tracheal cartilage is known to occur with oesophageal atresia resulting in abnormal compressibility. It does not require treatment unless symptomatic. Symptoms comprise apnoeic or cyanotic spells, often precipitated by feeds, and recurrent chest infections. When other causes such as stricture, recurrent fistula and gastro-oesophageal reflux have been excluded, the abnormality can be diagnosed radiologically and endoscopically. Previously tracheopexy through a lateral thoracic approach has been described. We describe three patients who had a successful tracheopexy through an anterior cervical approach, which is simpler, and a fourth in whom there was partial alleviation.
Gastric polyposis and malignancy
Authors: Harju E
Published: March 2007

Gastric malignancies developed in 15 patients with gastric polyps (seven men, eight women; mean age 66 ± 8.8 years) during a 14-year follow-up of 170 patients (8.8 per cent). The polyps were hyperplastic in 90 per cent of the patients, adenomas in 8.2 per cent and leiomyomas in 1.8 per cent. During follow-up 4.7 per cent of the patients had both adenomas and hyperplastic polyps. Ten patients developed adenocarcinoma, two lymphoma, one lymphoid sarcoma, one carcinoid tumour and one severe dysplasia. The incidence of malignancy was sevenfold higher than expected (P < 0.01). There is an associated but lower risk of malignancy in stomachs with hyperplastic polyps than with adenomas; 2 of the 15 stomachs with adenomas and 3 of the 142 hyperplastic polyps showed later malignancy (P < 0.001). Before the diagnosis of malignancy 1.1 ± 1.4 (0–4) gastroscopies were done and 12 ± 19 (0–48) months had elapsed since the first examination and detection of polyps, whereas the mean number of gastroscopies and length of follow-up period in all patients with polyps was 1.9 ± 0.9 (0–10) and 68 ± 35 (0–156) months, respectively. Eleven patients had a stage I malignancy and four had a stage IV tumour. The survival rate of the eight patients with malignancy found at the first examination was better (6/8) than for those diagnosed during the follow-up period (3/7) (P < 0.01; x2 test). The results show the high risk of malignancy in stomach polyps, adenomas or hyperplasia, and stress the importance of careful and repeated examination of these patients.
Haemodynamic assessment of the femoropopliteal segment: Comparison of pressure and Doppler methods using ROC curve analysis
Authors: Baker A R , Evans D H , Prytherch D R , Bell P R F
Published: March 2007

Combined aorto-iliac and femoropopliteal vascular disease remains a problem in vascular surgery. Arteriography does not provide information on the relative contributions of the two lesions to the presenting symptoms. Aorto-iliac haemodynamics may reveal occult aorto-iliac disease but does not show whether combined proximal and distal reconstruction will be required to provide symptomatic relief. Haemodynamic assessment of both segments may help in this respect. A haemodynamic assessment of the femoropopliteal segment of 72 limbs in 38 patients is reported. The segmental pressure drop between a common femoral arterial cannula and a below-knee occlusion cuff is compared with a non-invasive Doppler method combining both transit time and damping factor. Comparison is made using receiver operating characteristic (ROC) curve analysis. The measurement of segmental pressure drop is more accurate than the Doppler method in detection of femoropopliteal stenoses of greater than 50 per cent of the luminal diameter (P < 0.05).
Effect of the cyclo-oxygenase inhibitor indobufen on platelet accumulation in prosthetic vascular grafts
Authors: Lane I F , Irwin J T C , Jennings S A , Poskitt K R , Meek A C , McCollum C N
Published: March 2007

An in vivo method of measuring thrombus deposition and pseudo-intimal thickening in prosthetic arterial grafts in an animal model is described. The effect of indobufen, a new cyclo-oxygenase inhibitor, was evaluated and compared to aspirin plus dipyridamole and placebo in 24 greyhounds. Luminal platelet accumulation expressed as thrombogenicity index was 0.33 ± 0.07 in the placebo group. This was significantly reduced to 0.14 ± 0.01 by indobufen (P<0.05). The reduction to 0.19 ± 0.04 by aspirin plus dipyridamole failed to achieve statistical significance. Pseudointimal thickness when measured 28 days after implacement was significantly reduced to 21.4 ± 10.6 per cent by indobufen (P<0.01) and 29.4 ± 10.6 per cent by aspirin plus dipyridamole (P< 0.02) compared to 75 ± 10 per cent found in the placebo group. This prosthetic graft model has considerable advantages in the evaluation of potential platelet inhibitory drugs for use in vascular surgery.
De-functioning stomas: A prospective controlled trial comparing loop ileostomy with loop transverse colostomy
Authors: Williams N S , Nasmyth D G , Jones D , Smith A H
Published: March 2007

Patients undergoing colorectal surgery who required a defunctioning stoma were randomly allocated to receive either a loop ileostomy (n = 23) or transverse loop colostomy (n = 24). Assessment was made during construction, immediately postoperatively, during the period of outpatient supervision and before and after stoma closure. The ileostomy was associated with significantly less odour than the colostomy (P<0.01) and required significantly less appliance changes (P<0.05). Furthermore eleven patients (58 per cent) with a colostomy experienced three or more problems with stoma management compared with only three patients (18 per cent) with an ileostomy (P<0.05). Wound infection was also significantly more common after closure of the colostomy compared with the ileostomy. Both types of stoma were demonstrated objectively to defunction the distal bowel almost completely. These results indicate that a loop ileostomy is the procedure of first choice when a stoma is needed to defunction the distal colorectum.
Management of the septic complications of diverticular disease
Authors: Lambert M E , Knox R A , Schofield P F , Hancock B D
Published: March 2007

One hundred and five patients underwent surgical treatment of septic complications of diverticular disease. In nine cases, operation was carried out for acute large bowel obstruction and in the remainder for peritonitis. An inflammatory mass and/or localized abscess was found in 23 cases. Free pus without evidence of ‘communicating’ perforation was found in a further 33 and ‘communicating’ perforation in 40. Treatment by primary resection or by transverse colostomy and drainage were both associated with significantly lower mortality from sepsis than treatment by drainage alone. In cases without ‘communicating’ perforation, there was no difference in mortality between primary resection and transverse colostomy with drainage. Although the advantage of primary resection was most apparent in cases with ‘communicating’ perforation, it did not reach statistical significance. In three cases treated primarily without resection the pathology was subsequently found to be that of carcinoma. In ‘favourable’ circumstances, i.e. without ‘communicating’ perforation, defunctioning colostomy with drainage has an acceptably low mortality rate and may be undertaken by a less experienced surgeon to avoid a difficult resection. Ideally these problems should be dealt with by an experienced surgeon; we prefer to treat the septic complications of diverticular disease by primary resection.
Carcinoma of the breast associated with pregnancy
Authors: Ribeiro G , Jones D A , Jones M
Published: March 2007

A series of 178 patients in whom carcinoma of the breast was associated with pregnancy has been analysed. In 121 patients the carcinoma was diagnosed during pregnancy (CP group) and in 57 patients the pregnancy occurred subsequent to definitive treatment for primary breast carcinoma (SP group). Patients presented with more advanced disease in the CP group, 72 per cent being axillary node positive. Only 37 per cent of the 121 patients survived 5 years, although 79 per cent of the node negative patients survived 5 years. Survival was not affected by age, nor by the phase of pregnancy during which the carcinoma was diagnosed or treated. The majority of pregnancies (79 per cent) ended in the delivery of a normal child. The 5 year survival of the 57 patients in the SP group was 69 per cent. However only 26 per cent of the patients who had positive nodes at the time of primary surgery were disease free 10 years later. This fact should be borne in mind when considering the continuation of the pregnancy.
Supplement feeds and nitrogen and calorie balance following femoral neck fracture
Authors: Stableforth P G
Published: March 2007

A 10 day study of nitrogen and calorie balance has been undertaken in 61 women patients aged 65–96 years (mean age 81 years) with femoral neck fractures. All underwent fracture surgery with an inhalation anaesthetic lasting from 45 min to 2 h. Intake of ward food varied widely but was always low with a mean of 127 mg N kg−1 and 17 kcal kg−1 daily. Daily nitrogen production was 85–250 mg N kg−1 (mean 158 mg N kg−1) and calorie expenditure was 17–48 kcal kg−1 (mean 32 kcal kg−1). These were greatest in trochanteric fracture patients. Of the 61 patients, 90 per cent were in negative nitrogen balance with a mean 8 day deficit of 411 mg N kg−1 and all in negative calorie balance, mean 141 kcal kg−1. The deficits were greatest in trochanteric fracture patients. Sip feeding with supplementary enriched drinks raised protein and calorie intake substantially. Both nitrogen and calorie balance were significantly improved, but large calorie deficits remained; intolerance of the supplements proved to be a handicap in correcting the deficits in many patients.
Total parenteral nutrition: A four-year audit
Authors: Chang R W S , Hatton I , Henley Judith , Richardson Rosemary , Egail S
Published: March 2007

A four-year audit was carried out on 278 patients who received 289 courses of total parenteral nutrition (TPN) over 5213 patient days in a Saudi Arabian hospital. One hundred and forty-seven patients were discharged healthy, two of these after home TPN. The overall mortality was 36 per cent. ICU patients had the highest mortality (53 per cent). Among the survivors, 74·8 per cent showed an improvement in nutritional status. The incidences of metabolic complications and catheter sepsis were 2·9 per cent and 3·6 per cent, respectively. As a direct result of the audit, changes have been made in protocols and staffing patterns, and an attempt is being made to address the major problem of better selection of patients.
Effect of steel wire sutures on the incidence of chemically induced rodent colonic tumours
Authors: Phillips R K S , Cook H T
Published: March 2007

An experiment is presented which shows that colonic primary tumours cluster around a previously constructed anastomosis and that the choice of suture materials (but not the technique of their insertion) can influence this. In a rodent model where dimethylhydrazine was administered 2 months after surgery, anastomotic tumours were most often seen when wire sutures — as used in the staples of anastomotic stapling guns — had been employed (10 out of 16 large bowel tumours were anastomotic as compared with 2 of 12 in a silk sutured group, P = 0·019). An explanation may be that wire sutures persist much longer than silk (in the experiment, 10 months after insertion, 4 per cent of silk sutures were still present, 15 per cent of wire, P < 0·01). This was translated into a greater degree of scarring at the anastomosis, being most severe in the presence of persisting sutures. Of the 12 anastomotic tumours found in both groups, 7 (58 per cent) were in the minority (17–26 per cent) who had persisting sutures and the remaining 5 in the 47 who had none. Techniques of suturing (needle always passed from the serosa in; needle from mucosa out — the latter in such a way that mucosal cells could be displaced into the bowel wall where it was supposed that they might be more susceptible to subsequent carcinogenesis) did not affect tumour yield. We suggest that non-absorbable sutures, and especially stainless steel wire, should not be used when constructing an anastomosis after large bowel cancer surgery.
Long term follow-up of 100 patients with portal hypertension treated by a modified splenorenal shunt
Authors: Rigau J , Terés J , Visa J , Bosch J , Conesa A , Grande L , Vilar J A , García-Valdecasas J C , Pera C
Published: March 2007

One hundred consecutive Child's A or B patients with portal hypertension who survived the index episode of variceal bleeding were electively treated by a distal splenorenal shunt modified by a retroperitoneal approach. The operative mortality of the whole series was 11 per cent, but fell from 16 per cent in the first 50 patients to 6 per cent in the second half of the series. The median survival probability (68 months) and the 5 year survival rate (52 per cent) of Child's A patients differed significantly from those of Child's B patients (8 months and 15 per cent respectively; P < 0.001). The probabilities of freedom from rebleeding and hepatic encephalopathy at 5 years were also significantly greater in Child's A patients (70 per cent and 70 per cent respectively) than Child's B patients (25 per cent and 30 per cent respectively). These results suggest that the modified distal splenorenal shunt is an effective and relatively safe procedure for the elective treatment of variceal bleeding in Child-Campbell ‘A’ patients but that patients in group B should be considered for other forms of therapy.
Non-operative management of penetrating liver injuries: A prospective study
Authors: Demetriades D , Rabinowitz B , Sofianos C
Published: March 2007

This is a report of a study of 63 cases of penetrating liver injuries. Forty-two patients (67 per cent) who presented with signs of an acute abdomen were operated on. The liver was routinely sutured and drained. There was no incidence of postoperative intra-abdominal sepsis or haematobilia. In the remaining 21 patients (33 per cent) liver involvement was suggested by the fact that the wound was over the liver region, and penetrated the peritoneum, and abdominal paracentesis for blood was positive or the patient was shocked or pale. The patients in this group had a soft abdomen and they were treated conservatively with observation and blood transfusions if necessary. No complications were recorded in this group. It is concluded that many civilian penetrating injuries of the liver may be managed non-surgically. If an operative approach is selected suturing of the liver with drainage is the recommended procedure.
Controlled trial of transcutaneous electrical nerve stimulation (TENS) for postoperative pain relief following inguinal herniorrhaphy
Authors: Gilbert J M , Gledhill T , Law N , George C
Published: March 2007

We have evaluated the effect of transcutaneous electrical nerve stimulation (TENS) on postoperative pain following inguinal herniorrhaphy in a prospective randomized controlled trial. Forty male patients undergoing unilateral inguinal herniorrhaphy for the first time were randomized to receive either active or inactive TENS. Electrical stimulation was delivered by electrodes placed along either side of the wound following operation. An identical apparatus, which did not deliver an electrical current, was applied to control patients. Pain was assessed over the first 3 postoperative days by visual analogue pain scores, expiratory peak flow rates and analgesic requirements. There was no difference between the two groups for pain scores, peak flow rates or analgesic requirements and we conclude that TENS as used in this trial does not reduce postoperative pain. However TENS had considerable patient appeal and many patients believed that it was effective.
Specimen radiology of excised breast lesions
Authors: Farmer E , Kirkpatrick A E , Forrest A P M
Published: March 2007

The value of specimen radiology in the surgical management of palpable breast lesions was assessed in 100 consecutive patients undergoing excision of a palpable breast lump. Only 41 per cent of palpable breast lesions were demonstrable as a radiological abnormality on the excised specimen. The greatest sensitivity was found for lesions which proved to be malignant. Only 27 of 88 benign palpable breast lesions were radiologically visible in the specimen. Surprisingly, only 8 of 13 fibroadenomas were identified as discrete opacities. No residual breast lump was detected on clinical examination in patients reviewed postoperatively, including those patients who had a demonstrable pre-operative mammographic abnormality and a negative specimen radiograph. We conclude that specimen radiology does not contribute to the surgical management of palpable breast lesions.
Antiprotease capacity in acute pancreatitis
Authors: Goodman A J , Bird N C , Johnson A G
Published: March 2007

Serial measurements of circulating antiproteases were carried out on 42 consecutive patients admitted with acute pancreatitis. In the 7 days following admission the serum levels of α1 antitrypsin (α1 AT), α1 antichymotrypsin (α1 ACT) and the trypsin inhibitory capacity (TIC) increased by more than 300 per cent. The serum concentration of α2 macroglobulin (α2M) alone showed a decline which was most profound in those patients with severe acute pancreatitis. Initial experience of fresh frozen plasma as a source of extrinsic antiproteases in severe acute pancreatitis is that it fails to prevent the decline in α2M or increase the already elevated TIC of the patients' serum.
Duodenogastric reflux in rat gastric carcinoma
Authors: Mason R C
Published: March 2007

This study investigated the role of long-term reflux of bile and/or pancreaticoduodenal secretions in the genesis of gastric carcinoma in the rat. Adenocarcinoma, dysplasia and adenocystic proliferation were found only in those animals with reflux of pancreaticoduodenal secretions alone or in combination with bile. No such changes were found in control animals with no reflux or animals with bile reflux alone. The differences in incidence of adenocarcinoma were significant. The presence of adenocarcinoma was not related to the pH of the intragastric contents or to the bacterial flora. This suggests that duodenogastric reflux is implicated in gastric carcinogenesis in the rat and that pancreaticoduodenal secretions rather than bile are responsible.
Cosmetic results of immediate breast reconstruction post-mastectomy: A follow-up study
Authors: Mansel R E , Horgan K , Webster D J T , Shrotria Sunita , Hughes L E
Published: March 2007

We reviewed 95 patients who underwent immediate breast reconstruction at the time of mastectomy at least one year after operation for assessment of cosmetic results and complications. There were 45 rectus abdominis and 38 latissimus dorsi myocutaneous flaps used for reconstruction. Twelve patients had subpectoral implants without a flap. The results show a remarkable concordance of assessment by patient and surgeon: both found simple subpectoral prosthesis insertion to be inferior to flap reconstruction. Flap reconstruction gave satisfactory results in the majority of patients; latissimus dorsi and rectus abdominis flaps gave similar cosmetic results. However rectus abdominis flaps showed a higher complication rate of flap necrosis and incisional hernia of the abdominal wound. Psychological assessment showed no differences between the three types of reconstruction. We conclude that immediate breast reconstruction can give excellent cosmetic results, and provides an acceptable and safe means of ameliorating the effects of mastectomy. The number of grossly unsatisfactory results decreased notably as the series progressed. Experience and meticulous attention to detail are necessary, since many patients are unwilling to have revisionary procedures if the initial result is unsatisfactory.
Transformation of blood monocytes to giant cells in vitro from patients with breast cancer
Authors: Al-Sumidaie A M , Leinster S J , Jenkins S A
Published: March 2007

Monocytes from patients with breast cancer and from control subjects were cultured under agarose for 6 days. Giant cell formation occurred in 32 out of the 36 patients with breast cancer (89 per cent). In contrast giant cell formation was only observed in two of the control subjects (6 per cent). Menstruation and menopause had no effect on giant cell formation. Furthermore, under the experimental conditions of this study, it seems unlikely that serum factors, lymphokines or phagocytic stimulators induced giant cell formation. The results therefore, suggest that giant cell formation may be initiated by viruses already present in the monocytes from patients with breast cancer. Further studies are required to confirm this hypothesis and to elucidate the significance of giant cell formation in the pathogenesis of breast cancer.
Carotid endarterectomy in Great Britain and Ireland
Authors: Murie J A , Morris P J
Published: March 2007

A survey of the practice of carotid surgery by 245 vascular and neurological surgeons in Great Britain and Ireland was conducted with a 96 per cent response. Ninety-six surgeons (41 per cent) performed at least one carotid endarterectomy in 1984 and a total of 1374 such operations were carried out in that year. The indications for carotid endarterectomy in order of frequency were transient ischaemic attack, minor stroke and stroke. Operation was hardly ever undertaken for asymptomatic carotid bruit. Eighty-six per cent of surgeons who performed carotid endarterectomy generally assessed patients in the first instance using techniques less invasive than conventional angiography, principally Doppler ultrasonography or digital subtraction angiography. Nevertheless, conventional angiograms were usually performed before surgery by 89 per cent of surgeons. Almost all surgeons operated only under general anaesthesia, while opinion on the use of an intraluminal shunt during carotid endarterectomy was divided. Despite an increase in the number of carotid endarterectomies in recent years, this operation is currently performed nineteen times less frequently in Great Britain and Ireland than in the USA. The reasons for this are explored and certain controversies surrounding carotid endarterectomy are discussed.
Secondary aorto-enteric fistulae: Towards a more conservative approach
Authors: Thomas W E G , Baird R N
Published: March 2007

Eight cases of secondary aorto-enteric fistulae are presented occurring 9 months to 10 years after aortic Dacron grafting. In four patients there was a simple fistula between the anastomosis and the adherent duodenum, three patients had clinically infected grafts and one had a false aneurysm that had ruptured into the bowel. The four patients with a simple fistula had direct suture repair of the defect. One developed a recurrent fistula at 2 months and was successfully repaired again by direct suture. All four patients remain well at a follow-up of 1–5 years. The other four patients had the grafts excised, with local regrafting in two cases, both patients remaining well at follow-up. One patient had an axillo-bifemoral graft, but died at 30 days of overwhelming sepsis. The final patient, a girl with diffuse aneurysmal disease, had the aortic stump oversewn but no reconstruction. She died at 9 months of aortic stump disruption. These results suggest that a more conservative approach to the operative correction of secondary fistulae should be used wherever possible.
Combined topical povidone–iodine and systemic antibiotics in postappendicectomy wound sepsis
Authors: Lau W Y , Fan S T , Chu K W , Yip W C , Chong K K , Wong K K
Published: March 2007

Three hundred and fifteen patients with appendicitis were randomized into two groups. One group received pre-operative systemic gentamicin and metronidazole while the other group received 1 per cent topical povidone–iodine solution in addition to the antibiotics. For early appendicitis including normal and acutely inflamed appendices, only one dose of antibiotics was used. The postoperative wound sepsis was very low in both groups of patients and there was no statistical difference between them. For late appendicitis including gangrenous and perforated appendices, the antibiotics were continued for 7 days. Eight out of 51 patients who had the topical agent developed wound sepsis compared with one out of 52 patients who received no topical agent. This difference is statistically significant (P = 0·03). All wound infections presented within 2 weeks of operation and were deep. Povidone–iodine, 1 per cent, adversely affects the wound infection rate in late appendicitis and should not be used.
Clinical factors in the prediction of further haemorrhage or mortality in acute upper gastrointestinal haemorrhage
Authors: Clason A E , Macleod D A D , Elton R A
Published: March 2007

Data collected prospectively from 326 admissions for acute upper gastrointestinal haemorrhage were examined to identify factors predicting further haemorrhage or mortality. Seven predictive factors were identified by univariate analysis for both further haemorrhage and/or mortality, but only age over 60 years, an admission haemoglobin <8 g/dl and the presence of endoscopic stigmata of recent haemorrhage were shown by stepwise logistic regression to have independent significance for further haemorrhage. An age over 60 years, the presence of clinical shock on admission and an episode of further haemorrhage following admission emerged as independently significant in the prediction of mortality.
Management of acute cholangitis and the impact of endoscopic sphincterotomy
Authors: Leese T , Neoptolemos J P , Baker A R , Carr-Locke D L
Published: March 2007

Ninety-four patients admitted to Leicester Hospitals with acute cholangitis since 1977 were reviewed to coincide with the availability of endoscopic sphincterotomy (ES). Thirty-four were men and sixty were women, their mean age was 69·7 years and the median hospital stay was 20 days. There were 15 deaths (16 per cent) by 30 days in patients with significantly lower initial serum albumin levels (P < 0·005) and significantly higher serum urea levels (P < 0·05) than survivors. Eighty-two patients had common bile duct (CBD) calculi of whom 71 underwent early decompression of the biliary tree either surgically (28) or by ES (43). Early surgical decompression was associated with a significantly higher 30 day mortality (6/28) than early ES (2/43) (P < 0·02) despite the fact that patients undergoing early ES were significantly older (P < 0·02) and had significantly more medical risk factors (P < 0·05). Of the 43 patients undergoing early ES 7 had had a previous cholecystectomy, 13 underwent subsequent elective cholecystectomy with no mortality and the remaining 23 had the gallbladder left in situ because of advanced age (mean age 79 years) and frailty. Only 2 of the 23 have since required cholecystectomy. We suggest that patients with acute cholangitis who do not rapidly respond to conservative treatment should undergo early ES with early surgery reserved for those who do not improve following ES. Elective cholecystectomy following successful ES can often be avoided in the elderly and frail.
Influence of intraperitoneal drains on subhepatic collections following cholecystectomy: A prospective clinical trial
Authors: Monson J R T , MacFie J , Irving H , Keane F B V , Brennan T G , Tanner W A
Published: March 2007

In this prospective randomized study, the influence of an intraperitoneal drain on the incidence and clinical significance of subhepatic collections occurring in patients after acute or elective cholecystectomy was assessed by ultrasound examination. A total of 112 patients entered the study, of whom 54 received a drain. There was no significant difference between the drainage and the non-drainage groups with respect to mean age or sex distribution, the number of patients in whom the gallbladder bed was formally closed (27 versus 21) nor in the number of acute cholecystectomies performed in either group (12 versus 13). Ultrasound detected 10 (18 per cent) collections in the drainage group and only one (1·8 per cent) in the non-drainage group (P < 0·01, χ2 test). None of the collections required any further treatment and no morbidity occurred that was directly attributable to the presence of the retained fluid. These results suggest that rather than preventing fluid collections, suction drains may predispose to the development of subhepatic collections after cholecystectomy.
Diagnostic value of serum elastase 1 in pancreatic disease
Authors: Gullo L , Ventrucci M , Pezzilli R , Platé L , Naldoni P
Published: March 2007

We studied serum elastase 1 concentrations in patients with pancreatic disease to assess its diagnostic value and compare its sensitivity and specificity with that of amylase and pancreatic isoamylase. Markedly raised concentrations of elastase 1 were found in all twenty-nine patients with acute pancreatitis (amylase was elevated in all but three and pancreatic isoamylase in all but one). Serial measurements of the three enzymes in acute pancreatitis showed that elastase remained elevated longer than amylase and pancreatic isoamylase. The majority of chronic pancreatitis patients studied during a painful relapse (16 out of 21, 76 per cent) had elastase concentrations above the upper normal limit. Amylase and pancreatic isoamylase were elevated in 11 (52 per cent) and in 13 (62 per cent), respectively. Most patients with chronic pancreatitis studied during clinical remission (39 out of 43) had serum elastase levels either within (n = 24) or below (n = 15) the control range. The latter had severe exocrine pancreatic insufficiency and steatorrhoea. In carcinoma of the pancreas, 20 out of 32 (63 per cent) had abnormal serum elastase concentrations; 16 were higher and 4 lower than the control range. Amylase was abnormal in 10 (31 per cent) (8 high, 2 low), and pancreatic isoamylase was abnormal in 16 (50 per cent) (11 high, 5 low). In 46 control patients with non-pancreatic abdominal pain, serum elastase concentrations were not significantly different from those in healthy controls. Elastase was slightly raised in two, whereas amylase and pancreatic isoamylase were elevated in seven and eight, respectively. We conclude that serum elastase 1 is a highly sensitive and specific indicator of pancreatic disease.
Auditing the vascular surgical audit
Authors: Campbell W B , Souter R G , Collin J , Wood R F M , Kidson I G , Morris P J
Published: March 2007

The results are presented of vascular surgical audits in Oxford over the 10 years 1975–85. Changes observed include the decreasing use of endarterectomy (other than carotid), the introduction of transluminal angioplasty, and fewer lumbar sympathectomies. The number of major amputations has increased relative to arterial reconstructions. Our audit methods over the 10 years included the use of punch cards, two different computer programs, and a simple weekly audit of cases. The relative merits of these methods are compared. Numbers of procedures performed in Oxford were compared with expected figures calculated from the Hospital In-patient Enquiry, the Lothian audit, and the Vascular Surgical Society survey. In general the calculated and actual numbers are similar. Difficulties in finding comparable operation categories and the totally inadequate classification of nationally collected data highlight the need for improved audit in vascular surgery.
Pancreatic resection for carcinoma of the pancreas and the periampullary region in patients over 70 years of age
Authors: Kairaluoma M I , Kiviniemi H , Ståhlberg M
Published: March 2007

This study was undertaken to elucidate whether or not resection for cancer of the pancreas and the periampullary region can be performed with an acceptable survival rate in patients over 70 years of age (n = 21) as compared with patients under 70 years of age (n = 47), and whether resection provides an improvement in their prognosis and longevity. The operative mortality for patients over 70 years of age and under 70 years was 10 and 9 per cent respectively and the cumulative 5 year survival 12±11 and 20±9 percent respectively. The median survival was 11 months in both groups. It was concluded that an age of 70 years or more is not an absolute contra-indication for pancreatic resection. Prognosis is related to tumour histology.
Prognostic significance of the DNA content of human breast cancer
Authors: Dowle C S , Owainati A , Robins A , Burns Karen , Ellis I O , Elston C W , Blamey R W
Published: March 2007

The DNA content of paraffin embedded primary tumour tissue has been measured by flow cytometry in 354 patients with operable breast cancer. Tumour ploidy significantly correlated with tumour size, histological grade, and with menopausal status. No significant correlation with oestrogen receptor status or lymph node involvement was found. Patients with diploid cancers had a significantly improved short term survival and disease-free interval (DFI) compared with patients having aneuploid tumours. However, no difference in survival or DFI was shown after longer term follow-up (median 84 months). Multivariate analysis showed no independently significant prognostic value for tumour ploidy. No patient in this study received adjuvant therapy.
Chloroquine administration for malaria suppression after abdominal surgery
Authors: Schweizer W , Stahel E , Betschart B , Mwakilasa A , Burnier E , Stutz P , Tanner M
Published: March 2007

Administration of chloroquine after major surgery is indicated in malaria endemic areas. In emergencies it is commonly administered parenterally after the operation. The present study, undertaken at St. Francis Hospital, Ifakara (Kilombero District), Tanzania, compared plasma chloroquine levels after oral and subcutaneous administration of 300 mg of chloroquine base in 14 patients after abdominal, non-bowel-resective surgery and in 12 controls. There were no significant differences in the plasma chloroquine levels of all groups, and the chloroquine concentrations reached suppressive levels for at least 3 days (> 0·1 nmol/ml). Oral administration was well tolerated in both patients and controls. In all areas where the Plasmodium strains are still sensitive to chloroquine and where parenteral chloroquine may not be easily available, oral chloroquine represents a cheap, easy and safe alternative for postoperative prophylactic malaria suppression. It can be applied after abdominal non-bowel-resective emergency surgery.
Recurrent pancreatitis contributing to choledochal cyst formation
Authors: Ng W D , Chan Y T , Fung H
Published: March 2007

We report three cases of choledochal cyst. The calibre of the common bile duct in each of them was demonstrated by ultrasonogram, CT scan, radiography and laparotomy to be almost normal before recurrent attacks of pancreatitis, following which the common bile duct was shown to become grossly dilated. This observation leads us to surmise that recurrent pancreatitis contributes to the formation of choledochal cysts.