bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of solcoseryl on the survival of skin-grafts and the healing of donor sites in rats
Authors: Malaker K , Sellwood R A
Published: March 2007

The effect of daily intraperitoneal injections of Solcoseryl on the survival of full-thickness skin-grafts and the healing of donor sites was studied in male albino rats. In rats treated with Solcoseryl there was a slight but significant increase in the rate of healing of the donor sites when compared with that in controls treated with normal saline. There was a similar trend but no significant difference in the survival of skin-grafts.
Mass reduction of inguinal hernia. Description of a new physical sign of diagnostic value and aetiological significance
Authors: Barker K , Smiddy F G
Published: March 2007

Mass reduction of an inguinal hernia is a rare cause of intestinal obstruction, and the diagnosis may be overlooked if there is a temporary cessation of symptoms.

Two personal patients with this complication are now recorded, in both of whom a previously undescribed sign is recorded, consisting of retraction of the testicle on the affected side into the upper part of the scrotum, tautness of the spermatic cord, and pain deep in the iliac fossa when attempts were made to draw the testicle down.

The diagnostic value of this sign is stressed and also its significance in the current controversy as to the exact mechanism of production of this complication.
Injection-compression treatment of varicose veins. A follow-up study
Authors: Dejode L R
Published: March 2007

The results of treating 146 patients with varicose veins by injection compression were analysed from 1 to 5 years after the initial treatment. Very good and good results were obtained in 83 per cent of 201 legs and only 3 per cent were not improved. The number of further courses of injection necessary increased directly with the length of follow-up. The best results followed an ‘endosclerotic’ initial reaction to injection.
The failure of compression stockings (tubigrip) to prevent deep venous thrombosis after operation
Authors: Rosengarten David S , Laird James , Jeyasingh K , Martin Peter
Published: March 2007

With this method of investigation it appears that compression stockings have no value in preventing venous thrombosis after operation. Clinical diagnosis is unreliable in detecting the presence of deep-vein thrombosis. We have confirmed that the incidence of deepvein thrombosis after operation is of the order of 30–35 per cent.
Spontaneous extravasation of urine during emergency intravenous pyelography
Authors: Hale J E , Whitehouse G H
Published: March 2007

During intravenous pyelography, spontaneous extravasation of contrast from the pelvicaliceal system into the renal sinus and beyond is rarely seen. The diagnosis in 4 patients with ureteric colic was confirmed by emergency pyelograms, and in each case extravasation of contrast was noted.

The most likely explanation of spontaneous ‘pyelosinus back-flow’ is that the sudden increased intrapelvic pressure which occurs during ureteric colic results in minute tears of the caliceal fornix. Spontaneous extravasation of urine could explain the severe loin pain and pyrexia associated with ureteric colic. Complications are rare provided the calculus is passed and no treatment is required. The condition must be clearly distinguished from true rupture of the renal pelvis and ureter which may present as an acute abdomen, requiring urgent exploration and drainage.
The prophylactic value of cooling strangulated herniae locally. An experimental study in dogs
Authors: Boerema W J , Catchpole B N , Finlay-Jones L R
Published: March 2007

In 10 anaesthetized dogs bilateral groin herniae were created, each containing a loop of small bowel which was strangulated with binding tape. One side was cooled locally, the other acted as a control.

After 7 1/2 hours the two loops of bowel were inspected and compared as regards viability. In every case the cooled bowel was in a better state than the bowel on the control side. This was confirmed by microscopical examination.

It is suggested that the application of a polythene bag filled with crushed ice may offer a considerable degree of protection to strangulated bowel in a groin hernia prior to operation.
The surgical treatment of hydatid disease of the liver
Authors: Papadimitriou J , Mandrekas A
Published: March 2007

A consecutive series of 227 patients with hydatid disease of the liver is reported. During the first period when marsupialization or drainage of the cyst was applied, long hospitalization and bilious leakage were reported.

During the second period omentoplasty superseded the above methods. As a result, hospitalization was lowered from 36 or 52 to 12 days, while the incidence of biliary leakage was minimized from 25.2 or 60.7 per cent to 2.5 per cent respectively. The overall mortality is about 3.5 per cent.

Consequently omentoplasty is considered the treatment of choice when dealing with hydatid cyst of the liver. Marsupialization or partial hepatectomy is the alternative for huge, infected cysts.

ECHINOCOCCOSIS is a well-known disease, but its surgical treatment has markedly changed during the past years. The word ‘echinococcus’ is Greek in origin and means ‘hedgehog berry’. Hydatid disease of the liver was known to Hippocrates, who refers to a ‘liver full of water’. It was not until 1782 that Goeze recognized microscopically the small taenias with their characteristic hooklets. Since then numerous reports have made absolutely clear both the pathology and epidemiology of the disease. In Greece, with a population of up to 8 million, an average of 500 cases yearly are reported, i.e., a frequency of 6 per 100,000 inhabitants (Toole, 1969).
The changing epidemiology of subphrenic abscess and its clinical and radiological consequences
Authors: Sanders R C
Published: March 2007

Over the past 200 years subphrenic abscess first evolved from being a clinical entity that was nearly always fatal into an acute illness following perforation of a viscus which could often be cured by surgery, and over the past 30 years it has changed again so that currently its usual presentation is insidious and in the majority of cases apparently localized to the chest. This last phase is a consequence of the widespread postoperative use of antibiotics and corticosteroids.
Recovery of ureteric function after ureterolysis in malignant retroperitoneal disease
Authors: Abercrombie G F , Hanley Howard G , Joekes A M
Published: March 2007

Two cases of ureteric obstruction and anuria are described. Each case was due to disseminated malignant disease. One patient had an ovarian and I a vesical origin. Each patient was treated by extraperitoneal ureterolysis, temporary proximal drainage, and subsequent chemotherapy. Recovery of ureteric function and a period of useful survival were achieved in each case. The use of renography and the place of surgical treatment in malignant ureteric obstruction are briefly discussed.
Thermography in breast cancer
Authors: Nathan B E , Galasko C S B , Pallett J E
Published: March 2007

The thermographic findings in 97 patients referred to the Breast Clinic, Hammersmith Hospital, are analysed. In 4 of 16 patients with a mammary carcinoma the thermograms were normal. A large number of false positives was found. Our experience suggests that thermography is likely to have serious limitations when used as a screening procedure and that it cannot replace clinical palpation.
Diverticulum formation after oblique end-to-end anastomosis for jejuno-ileal atresia
Authors: Nade S M L , Dickson J A S
Published: March 2007

Three patients are described who developed a diverticulum about the anastomotic line after successful surgical treatment for neonatal jejunoileal atresia. In 2 patients an oblique end-to-end anastomosis, and in the other an end-to-side anastomosis, had been constructed. Clinical presentation with this complication occurred several years after the original operation. The features were bleeding per rectum, anaemia, and ‘failure to thrive’. All 3 were successfully treated by resection of the segment of bowel containing the diverticulum.
The treatment of advanced sarcomas with cytotoxic drugs
Authors: MacPhee Ian W
Published: March 2007

The treatment of 6 patients is described. In sarcomas treated with cyclophosphamide it is suggested that regular daily doses throughout may offer a better form of treatment than repeated intensive courses of treatment.
Abdomino-anal pull-through resection of the rectum
Authors: Kennedy J T , McOmish D , Bennett R C , Hughes E S R , Cuthbertson A M
Published: March 2007

Three independent observers have surveyed the results in 158 patients treated by abdomino-anal pull-through excision of the rectum and reached the following conclusions:— The operative mortality of the procedure (4·5 per cent) was low and quite comparable with that following alternative methods of rectal excision.The operation compares favourably with anterior resection and combined excision as a cancer-curing procedure for growths similarly sited in the rectum.Some degree of morbidity following operation occurred in almost half the patients, but significant complications occurred in only about 20 per cent. Colonic necrosis (4·6 per cent) and pelvic sepsis (18 per cent) were the most important. Permanent colostomies were ultimately established in 6 per cent of patients.In the majority of patients the operation was ultimately compatible with good anorectal function. Continence usually improved after about 1 year, though adequate control was often achieved within 6 months. Of those patients with stable bowel function at the time of interview, 89 per cent had a satisfactory result.
Occlusive arterial disease of the lower limbs with special reference to the indications for direct arterial surgery
Authors: Macpherson A I S , Hanid T K , Baird Affra
Published: March 2007

Five hundred and forty-one new patients with chronic occlusive arterial disease of the lower limbs were seen over a 3-year period. Surgical treatment was considered necessary in 139 (25·5 per cent). One hundred and eighty-eight operations were performed in these patients, of which 41 (25 per cent) were reconstructive procedures. The indications for direct operation, the results in these patients, and the contra-indications are discussed and reasons put forward for a policy of very careful selection for direct operation.
Operative cholangiography
Authors: Havard Cyril
Published: March 2007

Three hundred consecutive operations for calculous biliary-tract disease are reviewed with particular reference to the influence of routine operative cholangiography. The technique and instruments used in cholangiography have been described and the operative and follow-up statistical data have been analysed. The value of operative cholangiography before and after duct exploration is discussed with particular reference to the problem of the residual stone and the fruitless duct exploration.
Malignant melanoma of the anal canal
Authors: Sinclair D M , Hannah G , McLaughlin I S , Patrick R S , Slavin G , Neville A M
Published: March 2007

The clinical and pathological features of 4 cases of primary malignant melanoma of the anal canal are described. These cases further exemplify the difficulties of early diagnosis and the very poor prognosis in spite of radical therapy.
A case of polycystic adventitial disease of the left external iliac and femoral artery
Authors: Campbell R T , McCluskey B C , Andrews M I J
Published: March 2007

A case of lower-limb ischaemia in a 46-year-old man, caused through polycystic disease and associated with atherosclerosis, is described. Excision of the affected segment provided a good basis for pathological study. The significant features in the literature are reviewed. It is considered that trauma plays a major part in the aetiology of arterial adventitial cystic disease.
A case of obstructive jaundice due to a duodenal diverticulum
Authors: Sykes David
Published: March 2007

A case is reported of an obstructive jaundice caused by compression of the common bile-duct by a duodenal diverticulum. The obstruction was relieved by a cholecystojejunostomy and it is suggested that this is the treatment of choice for this rare condition occurring in the elderly.
Fibrosarcoma at the site and immediately following small-pox vaccination
Authors: Archampong E Q , Clark C G
Published: March 2007

A case of fibrosarcoma following a small-pox vaccination using the gun device has been described. This is probably the first case of its type. The causal relationship is briefly discussed in the light of modern research and the conclusion is drawn that a casual association would appear unlikely.
Ileus: The restoration of alimentary-tract motility by pharmacological means
Authors: Neely Julian , Catchpole Bernard
Published: March 2007

The nature of ileus and the clinical problem it poses are discussed. A consideration of the previous multiplicity of treatments is presented. The concepts behind the present mode of treatment are outlined. This consists of removing the sympathetic inhibition of the alimentary tract in the condition and potentiating or supplementing tone. Case histories are presented to illustrate the use of the drugs suggested, and the indications for therapy are discussed. The mistaken concept that the gut is “paralysed” in ileus should be finally abandoned.
Reduction of the microbial contamination of surgical wound areas by sterile laminar air-flow
Authors: Cook R , Boyd N A
Published: March 2007

A standard laminar air-flow cabinet was modified to increase the velocity of the sterile air it delivered. The modified unit was used in a general operating theatre to produce a current of sterile air over operation sites during a number of surgical procedures. The numbers of bacteria detected in areas protected in this way were substantially less than those found at the same time elsewhere in the theatre. No such difference was found during operations when the unit was not employed.
Familial polyposis of the colon with special reference to regression of rectal polyposis after subtotal colectomy
Authors: Shepherd John A
Published: March 2007

Two families with familial polyposis of the colon are reported. One family conforms to the established pattern and in the other there is a risk of an additional inheritance of sebaceous cysts and fibromata. Initially prophylactic surgery should usually consist of a one-stage subtotal colectomy with ileorectal anastomosis. Thereafter the polyps in the rectal remnant are left untreated for 6 months in the hope of spontaneous regression of some years' duration. This routine is preferable to immediate total colectomy and ileostomy for the adolescent or young adult. Fulguration of residual polyps is deferred but may be necessary if there is no spontaneous regression. A second-stage excision may be required if polyposis becomes uncontrollable or if there is malignant change. A case may be made for prophylactic rectal excision about 10 years after subtotal colectomy. The technique of ileorectal anastomosis is discussed briefly and a plan for family supervision is outlined. It is suggested that the phenomenon of spontaneous regression of polyps in the rectal remnant may be more frequent than accepted at present and that a long-term follow-up of patients with regression is required.
Nasal carriage of Staphylococcus aureus in a general surgical unit
Authors: Doig Caroline M
Published: March 2007

Nasal carriage of staphylococci was found in 50 per cent of in-patients in a general surgical unit and in 26 per cent of out-patients. While 32 per cent of in-patients carried resistant organisms in their noses a high percentage of out-patients (17 per cent) also were carriers of resistant organisms. Eighty per cent of staff carried staphylococci in their noses, 67 per cent being resistant organisms. Although the ‘hospital staphvlococcus’ was found in 5 per cent of patients and 15 per cent of attending staff, only 1 per cent of in-patients and none of the out-patients or staff carried multiple-resistant organisms. Age does appear to have some bearing on the carriage of bacteria in the anterior nares.

In contrast to other studies, this work failed to reveal any relationship between wound infection and nasal carriage of staphylococci. These findings suggess that general dissemination of bacteria in the hospital environment may be of greater importance than autoinfection as a cause of wound sepsis.
Studies on the isolated perfused pig liver
Authors: Jablonski P , Douglas M C , Gordon E , Owen J A , Watts J McK
Published: March 2007

Eighty perfusions of the isolated pig liver were performed using diluted pig blood. Although a high proportion of these perfusions were successful, there was sporadic filure of perfusion, usually manifested by rising hepatic arterial blood-pressure and decreasing total hepatic blood-flow.

The success rate of perfusion was improved by addition of low-molecular-weight dextran to the perfusate, the use of a less soluble siliconizing agent for the perfusion apparatus, and the use of new tubing for each perfusion. Preliminary flushing of the liver with Ringer-lactate reduced the success rate and, in unsuccessful perfusions, vaso-active drugs were ineffective in reducing raised vascular resistance.

Changes in the perfusate electrolyte, glucose, and enzyme patterns were sometimes observed but could not be related to perfusion success.

Perfused livers synthesized urea and bilirubin and incorporated 75Se-labelled methionine into protein. Perfused livers also conjugated bromsulphthalein (B.S.P.), but in unsuccessful perfusions the uptake of the dye from the perfusate was reduced and there was marked entry of conjugated B.S.P. into the perfusate.

Careful attention to the details of perfusate composition and perfusion conditions does increase the number of successful perfusions. Suggestions for further improvements are discussed.

The technical innovations suggested by these investigations are probably relevant to the preservation of the liver prior to clinical transplantation or to the preparation and perfusion of the porcine liver in the treatment of patients with acute liver failure.
Intrabiliary rupture of hydatid cyst of the liver
Authors: Al-Hashimi H M
Published: March 2007

One hundred and fifty cases of hydatid cysts affecting different organs were studied and of these 78 cases were hepatic. Intrabiliary rupture is the commonest complication and was found in 32 cases.

The greatest incidence is at about 40 years of age. Males are affected more than females.

The clinical presentation of occult intrabiliary rupture with suppuration is described and the source of infection of the cyst is proved to be biliary in origin.

Jaundice which is obstructive might develop and a convenient term, “hydatid jaundice”, is suggested.

Evaluation of various surgical procedures for the management of such cases is discussed.
Gastrografin as an aid to the diagnosis of perforated peptic ulcer
Authors: Wellwood J M , Wilson A N , Hopkinson B R
Published: March 2007

Sixty-four patients with suspected perforated peptic ulcer were assessed by clinical methods and abdominal radiographs before and after a Gastrografin meal. Thirty-eight patients were shown to have a perforated ulcer at operation. The initial clinical diagnosis was correct in 84 per cent. The plain films showed evidence of perforation in 61 per cent and the films after Gastrografin showed evidence of perforation in 50 per cent. The combined evidence of clinical and radiographic findings indicated the diagnosis correctly in 97 per cent of perforations. Perforations over 8 hours old were more commonly closed at operation and showed a lower incidence of Gastrografin leak.
Aneurysm of the hepatic artery: Reconstruction with saphenous vein-graft
Authors: Rutten A P M , Sikkenk P J H
Published: March 2007

The symptomatology and treatment of treatment of aneurysm of the hepatic artery are discussed with reference to a personal observation. In the case described, the aneurysm was resected with reconstruction by means of an autogenous vein-graft–a procedure so far described only twice in the literature.

In spite of serious complications the patient made a good recovery initially, but died 18 months after the original operation as a consequence of a duodenal ulcer that had perforated into the graft.

Reconstruction with a vein-graft seemed to us the most recommendable technique, but after this experience we feel that a synthetic graft probably should be preferred in the neighbourhood of stomach and pancreas if a direct anastomosis is not possible.
The operation of orthotopic renal allografting in the pig and its complications
Authors: Golby Michael , White H J O
Published: March 2007

Operating upon paired pigs simultaneously and performing bilateral nephrectomy with use of the left kidney for orthotopic renal allografting and pelviureteric anastomoses produces a constant, reproducible experimental model. The technique requires little practice and because of relative lack of anatomical variation in pigs has a high success rate. It is economical of animals and staff. Special postoperative support of the animals beyond normal animal husbandry practice is not required.

This model has been used on 101 occasions. Seven operations were initial practice procedures and 94 operations were performed to evaluate various immunosuppressive agents (to be reported elsewhere).

There were 11 technical failures, 5 of which, now that spinal-cord blood-flow is understood, would be much reduced in future series. Similarly 9 deaths with “no demonstrable cause” would be less with the understanding of post-transplantation lymph loss.

The 3 deaths from preoperative feeding were nonrecurring factors. Failure within 36 hours was 25 per cent; experience and practice should reduce this to less than 10 per cent. Mean ischaemic time was 22 minutes; there was no demonstrable tubular necrosis up to 28 minutes.
An experimental evaluation of the optimal method of use of streptokinase in venous thrombosis
Authors: Karmody A M , Galloway J M D , Mavor G E
Published: March 2007

Experiments have been carried out in dogs to determine the optimal method of use of streptokinase in venous thrombosis.

The experiments show that:– High-dose regional infusion is the most efficient system of producing thrombolysis.Occlusive thrombi are readily removed by this system.Low-dose regional infusions and high-dose systemic infusions are much less efficient but, in general, regional delivery is preferable when possible.

As a result of these experimental conclusions a number of patients have been successfully treated with high-dose regional infusions of streptokinase (Mavor, Bennett, Galloway, and Karmody, 1969; Mavor, Galloway, and Karmody, 1970).
Ruptured sinus of valsalva aneurysm after lung resection
Authors: Houghton G R , Harrison G Kent , Braimbridge M V
Published: March 2007

A patient is described who previously had a lobectomy for a Pancoast tumour involving her brachial plexus and who subsequently developed a ruptured sinus of Valsalva aneurysm from the right coronary sinus into the righ atrium. The classic mode of presentation and successful operation are described.
Subtotal colonic replacement of the oesophagus in infancy
Authors: Singh Ajmer , Rickham P P
Published: March 2007

Twelve subtotal replacements of the oesophagus by the colon in infants with oesophageal atresia were performed. The right colon was used and it was led through a retrosternal tunnel. This procedure was carried out when the child was at least 8 kg. in weight and was thriving and in good health. The literature on the subject is reviewed and the technique and results in this small series are presented. Although this is an extensive operation and complications are not uncommon, colonic substitution of the oesophagus can confidently be recommended in infancy.
Reversibility of femorosaphenous reflux
Authors: Quill R D , Fegan W G
Published: March 2007

Eleven patients with varicose veins of the long saphenous system and associated femorosaphenous reflux were investigated by means of phlebography, before and after treatment by compression sclerotherapy, in order to determine if any changes, particularly of dilatation and valvular competence, took place in the proximal, untreated part of the long saphenous vein. In 9 cases narrowing of the proximal part of the long saphenous vein occurred. In 4 cases valves which had not been detected or which had been poorly outlined on the pre-treatment films were well outlined on the post-treatment films. In 2 cases the long saphenous vein was not outlined on the post-treatment films. As clinical evidence of thrombosis of the vein was not present, this appeared to be due to restoration of valvular competence.
The combined surgical and medical treatment of retroperitoneal fibrosis
Authors: Ross J Cosbie , Goldsmith H J
Published: March 2007

While the cause of retroperitoneal fibrosis remains obscure, it is clear that a systemic disturbance often occurs at the onset. The treatment of choice remains ureterolysis combined with extraperitoneal lateral displacement of the ureter. Steroid therapy plays a part in dealing with the acute systemic phase, acts as a valuable adjuvant to surgery, and occasionally may obviate the need for operation in aged and debilitated subjects.
Two cases of subungual malignant melanoma
Authors: Rushforth G F
Published: March 2007

Two cases of subungual malignant melanoma are reported and the recent literature reviewed. It is noted that this condition is frequently misdiagnosed and hence treated later with resulting poorer prognosis.
Oesophageal manometric studies of dysphagia in Vernet's syndrome
Authors: Serebro H A , Mieny C J , Webster A , Jackson H
Published: March 2007

The case history is reported of a patient who developed Vernet's syndrome following radical excision of a chemodectoma involving the lower four cranial nerves on the left side. Immediately after operation there was a complete failure of deglutition, but normal swallowing returned spontaneously in 3 months. Radiological and manometric studies of the pharynx and oesophagus indicated that the main cause of the dysphagia was spasm in the upper oesophagus, distal to the cricopharyngeal sphincter. This is the first report of oesophageal pressure studies on this condition.
Uretero-ileal fistula due to Crohn's disease
Authors: Blumgart L H , Thakur K
Published: March 2007

The literature is briefly reviewed and the rarity of uretero-ileal fistulas confirmed. A case of right-sided uretero-ileal fistula associated with Crohn's disease is described.
Vascular injuries resulting from arterial puncture or catheterization
Authors: Hall Robert
Published: March 2007

Diagnostic puncture or catheterization is probably the commonest cause of serious arterial injury in current civilian surgical practice. The most frequent complications are arterial thrombosis, bleeding from the puncture site, false and arteriovenous aneurysm formation, and cerebral embolism. Eight instances of arterial occlusion have been treated in one hospital in less than 18 months–1 followed arterial puncture, 3 followed operative insertion of catheters maintained for repeated blood-sampling, I followed Seldinger catheterization for arteriography, and 3 followed cardiac catheter studies–during which time 1400 such procedures were carried out.

Arterial spasm and trauma, large catheter size, protracted catheter maintenance, and low cardiac output seem to be factors particularly liable to produce sufficient damage to precipitate complications, together with thrombosis consequent to sustained heavy local pressure to arrest haemorrhage from the site of arterial puncture.

Early surgical correction was successful on each of 6 occasions, but in the 2 cases in which procrastination had occurred major arm amputations became necessary.
The effect of an antibiotic spray in the prevention of wound infection: A controlled trial
Authors: Jackson D W , Pollock A V , Tindal D S
Published: March 2007

In a random controlled series of 704 operation wounds the use of an antibiotic spray was not found to cause a statistically significant improvement in the overall wound infection rate. The use of this spray has accordingly been discontinued.
Small-vessel thrombosis following vascular injury: Successful treatment with a low-dose intra-arterial infusion of streptokinase
Authors: Chesterman C N , Nash T , Biggs J C
Published: March 2007

Streptokinase may cause excessive haemorrhage if administered systemically in the presence of vascular injury. A patient in this situation was treated with a low dose of streptokinase administered intra-arterially. Using this régime there was little evidence of systemic activation and insignificant bleeding, but there was satisfactory dissolution of the occlusive thrombus.
Carcinoma of the gall-bladder: A clinical appraisal and review of 57 cases
Authors: Solan M J , Jackson B T
Published: March 2007

The clinical and pathological features of 57 cases of primary carcinoma of the gall-bladder are described.

Gall-stones were associated with the tumour in only 54 per cent of cases. the relationship betweeen gall-stones and carcinoma is discussed.

Preoperative diagnosis is rare, treatment is usually ineffective, and the prognosis is bad.
Surgical treatment of carcinoma of the oesophagus and cardia
Authors: Collis J Leigh
Published: March 2007

Experience in the management of a personal series of 837 cases of carcinoma of the oesophagus and cardia is described. It is evident from this that the subject is not a static one. Improvement is occurring and there are good reasons to expect this to continue. The aspects affected by this improvement include morbidity, mortality, the well-being of patients, and the long-term survival. Unfortunately, in the majority of cases, treatment is only palliative, but palliation is good and it relieves the patient of his main symptom–dysphagia. In view of the great benefits which good palliation provides, no treatment can be considered as satisfactory unless the relief of symptoms is of a high standard.

It is maintained that too much emphasis has hitherto been placed on long-term survival, which is only possible in the minority of cases.

Bearing all factors in mind a strong case can be made for the overall surgical plan in the management of growths affecting the middle and lower parts of the oesophagus.
Acute pancreatitis associated with recurrent pyogenic cholangitis
Authors: Ong G B , Adiseshiah M , Leong C H
Published: March 2007

Twenty-nine cases of acute pancreatitis complicating recurrent pyogenic cholangitis, a clinical entity which has been previously described as a common disease in the Far East, occurred in 237 cases operated upon during the acute stage of the disease. This review concerns 657 cases seen during a period of 5 years. The pancreatitis is usually mild and is diagnosed mainly at operation. Unlike pancreatitis of other aetiology surgery should be undertaken early, because if obstruction by stones and infection of the biliary tract are relieved, recovery from the pancreatitis usually follows.
Parathyroid cyst
Authors: Kirwan W O
Published: March 2007

The condition of parathyroid cyst is discussed and 4 cases are reported. It is believed that one of these patients suffered from primary hyperparathyroidism resulting from a parathyroid cyst.
The incidence of postoperative deep vein thrombosis in Malaysia
Authors: Cunningham Ian G E , Yong N K
Published: March 2007

The incidence of postoperative deep vein thrombosis in a series of Asian patients has been studied using 125I-labelled fibrinogen. Deep vein thrombosis was found in 12 per cent, which is a much lower incidence than in comparable Western series. The cause of this difference is discussed.
Treatment of axillary abscesses by incision and primary suture under antibiotic cover
Authors: Page R E
Published: March 2007

Axillary abscesses can be conveniently treated by incision, curettage and primary suture under antibiotic cover. Most patients attended hospital on three occasions, and the average duration of treatment was 6·6 days. Of the organisms isolated, staphylococci accounted for 93 per cent. The axilla is particularly prone to infection by these organisms. A recurrence rate of 6.6 per cent was recorded and this was partly due to proteus infections which were insensitive to lincomycin. Shaving of axillary hair probably contributes to the formation of axillary abscess and accounts for their preponderance in females.
Wandering spleen: 11 cases from Uganda
Authors: Carswell J Wilson
Published: March 2007

Eleven cases of wandering spleen are described of which 8 were in children. Six patients presented with a chronic abdominal mass and 5 with acute torsion. In the chronic case the diagnosis may be clarified by the use of radioactive 51 Cr, and the plain abdominal X-ray is of value in chronic and acute presentations. Splenectomy is required for all acute cases but a technique for preservation of the spleen is feasible in the chronic case. The condition may arise from association of splenomegaly and maldevelopment of the dorsal mesogastrium.
Amputation of the finger
Authors: Scott J E
Published: March 2007

A review of 151 partial or total amputations of the finger is presented. Emphasis is placed on the incidence of postoperative tenderness and the time taken off work by patients suffering digital amputation. It is concluded that in patients who, following injury, require digital amputation the best results aye obtained by early primary proximal reamputation and the avoidance, where possible, of skin grafting.
The effect of postoperative peritoneal lavage on survival, peritoneal wound healing and adhesion formation following fecal peritonitis: An experimental study in the rat
Authors: Cleaver C L Tolhurst , Hopkins A D , Wong K C Ng Kee , Raftery A T
Published: March 2007

The effect of postoperative peritoneal lavage on survival, peritoneal wound healing and adhesion formation has been studied in rats both with and without fecal peritonitis. Peritoneal lavage with both Hartmann's solution and noxytiolin through an indwelling peritoneal cannula resulted in a delay in peritoneal wound healing in the absence of fecal peritonitis. There was also an increase in the incidence of adhesions. Induction of a fecal peritonitis followed by operation 2½–3 hours later resulted in 100 per cent mortality within 24 hours. This mortality was reduced by 66 per cent following peritoneal lavage with Hartmann's solution alone, although this resulted in a delay in peritoneal wound healing. Peritoneal lavage with noxytiolin did not reduce the mortality rate.
Selective catheterization of the thyroid veins for preoperative localization of parathyroid tumours
Authors: Tomlinson Stephen , Clements V R , Smith M J G , Kendall B E , O'Riordan J L H
Published: March 2007

Samples obtained from the thyroid veins as well as from the great veins of the neck of 35 patients with primary hyperparathyroidism were assayed for parathyroid hormone. The overall distribution of the hormone was used to predict the location of the parathyroid tumour. In 27 patients the site of the adenoma was correctly predicted, and in a further 4 the side of the neck in which the tumour was to be found was forecast correctly; in only 4 patients was the technique unsuccessful. Thus, useful information was obtained in 31 of the 35 patients studied (88 per cent). Preoperative localization of parathyroid tumours in this way is of greater value than merely sampling large veins alone, particularly when there has been previous exploratory surgery.
Colonoscopy in the management of colon polyps
Authors: Williams Christopher B , Hunt R H , Loose H , Riddell R H , Sakai Y , Swarbrick E T
Published: March 2007

The technique and indications for colonoscopic polyp-ectomy are reviewed. The results compare very favourably with those of surgical polypectomy and represent a major advance. Three hundred polyps of up to 4.5 cm diameter were removed with the diathermy snare from 169 patients, and a further 107 smaller polyps were destroyed with a new ‘hot-biopsy’ technique. There were no serious complications, but I patient sustained a ‘closed’ perforation, which was managed conservatively, and in 2 others signifcant haemorrhage occurred. Comparison of colonoscopy with the Malmö double contrast enema shows that up to 95 per cent of polyps over 5 mm in diameter can be demonstrated radiologically. High quality X-rays allow limited colonoscopy and justify radiological rather than colonoscopic follow-up. Colonoscopic removal of all polyps saves the patient unnecessary irradiation, since barium enema examination need then be repeated only every 3–5 years.
Removal of ingested coins utilizing fibre-endoscopy and special forceps
Authors: Larkworthy W , Jones R T B , Mahoney M , Holgate P F L
Published: March 2007

In 2 patients coins were removed from the stomach utilizing art Olympus fibre-endoscope and specially designed foreign-body-retrieval forceps. In both cases the procedure was welt tolerated, gastrotomy avoided and the patients were quickly discharged from hospital.
Primary carcinoma of the gallbladder
Authors: Prakash A T M , Sharma Lalit K , Pandit P N
Published: March 2007

The clinical and pathological features of 100 consecutive cases of primary carcinoma of the gallbladder, treated by a single surgical unit, are described. Females outnumbered males by 2 to 1. The maximum incidence was seen in the fifth decade. Pain and the presence of a mass were the two most common clinical features. Gallstones coexisted in 45 per cent of cases. Ancillary investigations were of little value in preoperative diagnosis. At laparotomy biopsy alone was possible in a large number of cases owing to the advanced disease process. Two patients were alive 5 years after surgery. Prophylactic cholecystectomy for all diseased gallbladders, whether symptomatic or not, is advocated.
The natural and unnatural history of pancreatic pseudocysts
Authors: Sankaran S , Walt Alexander J
Published: March 2007

Experience with 131 pseudocysts of the pancreas in 112 patients has been analysed with a view to answering specific questions. Spontaneous regression was documented in 8 per cent. Complications occurred in 33·5 per cent of the pseudocysts, including obstruction of adjacent organs, rupture, haemorrhage and pancreatic ascites. In 14 pseudocysts, rupture into the gastrointestinal tract, the peritoneal cavity or the pleural cavity, when unassociated with haemorrhage, had a mortality rate of 14 per cent. Sixteen patients with significant haemorrhage associated with a pseudocyst had a mortality rate of 61 per cent; early direct surgical control is advocated. Pancreatic ascites was associated with 14·5 per cent of the pseudocysts and had a 40 per cent recurrence rate, which can be greatly diminished when operative procedures are guided by pancreatography. The mortality rate for the surgical treatment of 97 uncomplicated pseudocysts was 6 per cent and the recurrence rate was 11 per cent. The prime cause of death was haemorrhage. Seven of the 131 pseudocysts were synchronous and 12 were metachronous. The actual figure is probably higher. Small cysts of the head of the pancreas, impalpable at operation but demonstrable by pancreatography, may be the cause of severe, continuing or recurrent symptoms.
The management of peptic oesophageal stricture
Authors: Williamson R C N
Published: March 2007

Eighty-three adult patients with peptic oesophageal stricture are reviewed with regard to diagnosis and treatment. Sliding hiatus hernia was present in 94 percent of cases. The strictures were graded according to the degree of stenosis encountered at initial oesophagoscopy, but several other factors influenced the management of each case. Bouginage should always be attempted before proceeding to surgery. Thirty-eight patients were treated by bouginage alone, with 21 (55 per cent) good results and 3 deaths. Forty-five patients came to surgery, with 32 (71 per cent) good results and 3 deaths. Six patients sustained instrumental perforation of the oesophagus with 1 fatality. There was in addition 1 case of silent perforation following selfbouginage, which is believed to be unique. Hiatal herniorrhaphy combined with simple bouginage is recommended where reflux oesophagitis dominates the clinical picture. Local plastic repair (oesophagoplasty) has proved a simple and effective method of treating low annular strictures. Oesophagogastrostomy was carried out in 12 patients without operative loss and with good results in 8 cases; the addition of a pyloroplasty is believed to lessen postoperative reflux.
General anaesthesia during early pregnancy
Authors: Strunin Leo , Knights K , Strunin J M , Ward Michael E
Published: March 2007

General anaesthesia in the early stages of pregnancy may carry an increased risk of embryotoxicity. One hundred and six women scheduled for non-emergency surgery were interviewed preoperatively and their menstrual history taken. Forty-three (41 per cent) were considered to be using adequate contraceptive therapy. Thirty-one (29 per cent) of the patients could have been in the early stages of pregnancy, and of these women, 19 (61 per cent) were undergoing surgery of a minor nature. Simple history taking identified the women “at risk” and it is suggested that surgery could have been delayed without detriment in many cases.
The removal of retained gallstones from the common bile duct: Experience with sodium cholate infusion and the Burhenne catheter
Authors: Britton D C , Gill B S , Taylor R M R , James Oliver
Published: March 2007

The use of cholic acid T tube infusion and of the Burhenne catheter has been investigated in the management of gallstones retained in the common bile duct following biliary surgery in 9 patients. Four of 7 patients treated with cholic acid infusion showed disappearance of the stones during treatment. The stones in a fifth subject were removed by a combination of cholic acid infusion (1 stone disappeared) and instrumentation with a Burhenne catheter (a second stone removed). Use of a Burhenne catheter was unsuccessful in 3 of 4 patients. Details of the technique of cholic acid infusion are given, and possible complications of the treatment are discussed. The use of cholic acid infusion for the dissolution of stones in the common bile duct is recommended.
The negative cholecystogram in gallbladder disease
Authors: Reid D R K , Rogers I M
Published: March 2007

Seventeen cases of radiologically negative gallbladder disease are presented. In all it was possible to explain the symptoms on the basis of the “disappearing stone” hypothesis. It is suggested that cholecystectomy should be advised in such patients provided that the symptoms are sufficiently characteristic and sufficiently severe.
Aorto-iliac reconstruction with special reference to the extraperitoneal approach
Authors: Helsby Raymond , Moossa A R
Published: March 2007

We have used the extraperitoneal approach for aortoiliac reconstruction for lower limb ischaemia in over 130 patients. The operative exposure is excellent. Operating time is shortened and the upset to the patient much less than in the transperitoneal approach. We now believe that the method is suitable for use in the majority of aorto-iliac reconstructions. Patency rate 4 years after surgery for claudication is 89 per cent.
Prognosis after portocaval anastomosis: A 15-year follow-up
Authors: Windle R , Peacock J H
Published: March 2007

A 15-year follow-up of 57 patients who underwent portocaval anastomosis is reported. Twenty-seven patients were still alive and the progress of these and of those who died is followed.

The young cryptogenic cirrhotic with no encephalopathy, normal liver function tests and absence of portal vein mural thrombus at the time of operation is best benefited.

The only factor from the series to suggest a poor prognosis is deterioration in liver function in the postjaundice cirrhotic, and the development of encephalopathy in cryptogenic cirrhotics suggests a poor long term prognosis, but its onset is not related to the time before death.
Acute segmental ischaemic enteritis in Thailand
Authors: Welch Theodore P , Sumitswan Somsak
Published: March 2007

A disease characterized by segments of ischaemic small intestine has been recognized in northern Thailand over the past decade. The clinical features and appearance of the diseased intestine are described. Most of the patients were treated by surgical resection of the affected bowel. The overall mortality was 14 per cent. Recently, some patients have been successfully treated by non-surgical means. The aetiology of the disease is still unknown.
Prediction of kidney viability before transplantation
Authors: Baxby K , Johnson R W G
Published: March 2007

A patient who receives a kidney transplant which fails suffers a physical and psychological disaster.

Almost one-third of the kidneys transplanted in the United Kingdom are primary failures; many others function only after a delay, and the long term prognosis for these kidneys is poor. There is a need to identify kidneys which will function immediately after transplantation, those which will function after a delay and those which will never function. Such identification is seldom possible from the history. By continuous hypothermic perfusion we can identify a group of kidneys which will probably never function. The perfusate lactate level predicts which of the remaining kidneys will function immediately and which will not. Kidneys which function immediately after transplantation have a very much better long term prognosis after transplantation than those with delayed onset of function.
Intrabiliary rupture of hydatid cyst of the liver
Authors: Kattan Y B
Published: March 2007

In a series of 136 cases of hydatid disease affecting various tissues and organs admitted to one surgical unit in the Medical City Hospital, Baghdad, and personally studied and treated by the author, the liver was involved in 94 cases (69.1 per cent) and intrabiliary rupture occurred in 15.

Pain in the right upper abdominal quadrant associated with tenderness and rigidity, radiating to the back and right shoulder, was the presenting feature in almost all the patients. Hectic fever was present in 14. Obstructive jaundice developed in all the patients at some stage of the illness, but was complete with clay-coloured stools in only half. Chills and rigors were present in 67 per cent, eosinophilia in 40 per cent, a positive Casoni's test in 87 per cent, itching with urticaria and weal formation in 20 per cent and a palpable mass in the liver in 67 per cent of cases.

Operative treatment is mandatory in order to clean the mother cyst of hydatid membranes, debris and daughter cysts, to explore and clear the common bile duct and to ensure free biliary passage to the duodenum. Sphincterotomy is neither necessary nor advisable, and when the gallbladder is not invaded by the cyst it should be preserved.
Pullthrough operation with delayed anastomosis for rectal cancer
Authors: Kirwan William O , Turnbull Rupert B , Fazio Victor W , Weakley Frank L
Published: March 2007

The technique of pullthrough resection with delayed anastomosis for carcinoma of the rectum as performed at the Cleveland Clinic is described. A series of 84 cases of rectal cancer treated in this way is reported.

The average tumour diameter was 4·5 cm, the average margin of resection was 4·1 cm and the average distance of the tumour from the anus was 7·6 cm, The incidence of necrosis of the pullthrough was 1·2 per cent. The overall 5-year survival was 63 per cent with 100 per cent, 57 per cent and 53 per cent for Dukes' A, B and C tumours respectively. The quality of bowel function following surgery is described in detail. It is felt that this procedure has an important place in sphincter conservation in carcinoma of the middle third of the rectum.