bluuebunny/crossref_metadata_2025 huggingface dataset:
Hirschsprung's Disease
Authors: Davis P W , Foster D B E
Published: March 2007

Experience with 38 cases of Hirschsprung's disease seen over a 20-year period is described. Only 24 per cent of cases presented with a combination of symptoms and signs such as to suggest the correct diagnosis on clinical grounds. Barium-enema examination carries a high ‘true-positive’ rate, but cases reported as negative must be viewed critically. A radiological diagnosis of idiopathic megacolon should not be accepted without supplementary rectal biopsy and/or anorectal pressure studies. Survival without surgery is compatible with Hirschsprung's disease, but the dangers of enterocolitis must be acknowledged. Rectosigmoidectomy, which includes resection to an area of normal innervation proximally and excision of part of the internal sphincter of the rectum distally, produces a satisfactory late functional result at an acceptable mortality-rate. A colostomy prior to rectosigmoidectomy is advisable when there is a history of repeated attacks of subacute obstruction and one or more episodes of enterocolitis. A colostomy after rectosigmoidectomy is advisable in those cases which are submitted to laparotomy for intestinal obstruction in the period following operation, even when no mechanical cause for obstruction is demonstrable. Patients with problems relating to coprostasis following treatment of congenital anorectal disorders should be submitted to rectal biopsy, since a proportion of these patients reveal a deficiency of innervation of the distal large bowek which approximate to that seen in Hirschsprung's disease.
Carcinoma of the duodenum
Authors: Kenefick John S
Published: March 2007

Five patients with carcinoma of the second part of the duodenum, presenting with obstructive jaundice, are discussed. The diagnosis was established at operation and radical surgery was not possible in any case. Local excision of the tumour and the adjacent duodenal wall with reanastomosis of the bile-duct and pancreatic duct to the duodenum were performed. Three patients died from the disease within 1 year of operation and 2 patients are still alive 16 and 18 months after operation. The clinical features of this disease are reviewed.
Platelet adhesiveness and lipoprotein lipase activity in patients with benign and malignant disease of the prostate
Authors: Ham J M , Jones M , Kemp D
Published: March 2007

Platelet adhesiveness and lipoprotein lipase (clearing factor lipase) activity have been measured in 22 patients with benign prostatic obstruction and in 20 patients with prostatic carcinoma.

The total platelet counts and the number of adherent platelets were significantly higher and the lipoprotein lipase responses to heparin were significantly lower in the patients with carcinoma.
Reticulo-endothelial system activity during homograft rejection and immunosuppression
Authors: Blamey R W , Baker Jane M , Crosby D L
Published: March 2007

Reticulo-endothelial system activity was measured in the rat by the rate of colloid clearance. Activity was increased following homograft rejection, and in the presence of tumour-specific antigen. Increased activity was also found during immunosuppression with cyclophosphamide, and with methotrexate, despite marked lowering of the white blood-counts.

It is concluded that reticulo-endothelial system activity does not parallel the activity of the lymphoid system in transplantation immunity.
The effect of electrical stimulation of the legs on postoperative thrombosis
Authors: Moloney G E , Morrell M Tessa , Fell R H
Published: March 2007

Stimulation of the muscles of the lower limbs during surgery was evaluated as a means of preventing postoperative leg-vein thrombosis and pulmonary embolism. Of 285 patients submitted to a major operation, 113 were stimulated and 172 were not. The two groups were closely similar in age, operations, anaesthesia, diseases, and severity of disease, but there was a negligeible difference in the rates of postoperative thrombosis.
Hydropneumothorax complicating perforated peptic ulcer
Authors: Bradley J W P , Fielding L P
Published: March 2007

A case of duodenal ulcer perforation complicated by hydropneumothorax, probably due to a congenital diaphragmatic defect, is described. No such case has previously been reported.
The response to therapy of skeletal metastases from mammary cancer. Assessment by scintigraphy
Authors: Galasko C S B , Doyle F H
Published: March 2007

Clinical, radiological, and scintigraphic methods were used to assess the response of 30 patients undergoing treatment for advanced mammary cancer. Scintigraphy provided more information than radiology in 13 patients. In 2 patients scintigraphy indicated that sclerotic metastases which had not altered radiologically following treatment were probably ‘healing’. In another 4 patients who developed apparently ‘new’ sclerotic metastases on serial radiographs the scintigrams indicated that these lesions probably represented ‘healing’ of lesions which had been too small for identification on the original radiographs.
Carcinoma of aberrant breast tissue. A report of 3 cases
Authors: Smith G M R , Greening W P
Published: March 2007

Three cases of carcinoma of aberrant breast tissue are described and the literature is briefly reviewed. It is suggested that subcutaneous nodules of uncertain origin around the periphery of the breast should be viewed with suspicion and treated by early excision.
The effect of a single-dose parenteral antibiotic in the prevention of wound infection a controlled trial
Authors: Pollock A V , Tindal D S
Published: March 2007

In a series of 349 operations a single dose of 500 mg. of ampicillin was given immediately preoperatively to 164 patients selected at random. There was no significant reduction in the wound-infection rate in cases given ampicillin compared with the controls.
A modified technique of colostomy
Authors: Abeyatunge L R
Published: March 2007

A modified technique of colostomy is described which avoids the disadvantages of the more widely used technique employing a glass rod and rubber tube. The use of a rubber drain, instead of a glass rod, which is brought out through two small stab incisions allows the immediate fitting of a bag, thus avoiding contamination of the main incision.
Inhibition of the growth of tumour cells in culture by noxytiolin
Authors: Jamieson C W
Published: March 2007

The effect of noxytiolin on the viability of human tumour cells (HeLa) in monolayer culture was determined by vital staining, impairment of plating efficiency, and measurement of concentrations causing inhibition of growth. Concentrations of more than 0·0025 per cent cause significant inhibition of growth. This is much lower than its bacteriostatic concentration, suggesting that its bacteriostatic effect is non-specific.
Primary skin-grafting in the treatment of chronic osteomyelitis
Authors: Naylor A , Crockett D J
Published: March 2007

Attention is called to the value of primary splitthickness skin-grafting, as opposed to secondary grafting, used in conjunction with radical excision of avascular, sclerotic bone in the treatment of chronic osteomyelitis.

Nine cases treated by this method are described. These have remained healed following this procedure after periods of recurrent infection and disability varying from 28 to 2 years, 6 patients having recurrent osteomyelitis for over 10 years before operation. Five cases have remained healed for periods varying from 3 to 5 years following operation, the more recent remaining cases being asymptomatic for 1½−3 years subsequently.
Extrahepatic biliary drainage in experimental liver injury
Authors: Faris Irwin
Published: March 2007

A case has been made by many authors for the routine drainage of the biliary tract in patients with liver injuries, and this case is summarized. To test the logic of such treatment the outcome of a standard lethal injury in dogs was studied and was found not to be influenced by drainage of the common bile-duct. Survival was improved by excision of the damaged tissue. The experimental evidence does not support the practice of routine drainage of the extrahepatic biliary tract.
Treatment of arteriovenous malformation by endarterial electrocoagulation
Authors: Gardner A M N , Stewart I A
Published: March 2007

The successful treatment of an arteriovenous malformation in the parotid region is described. Endarterial electrocoagulation was used and damage to the facial nerve was avoided. The possible use of this method in other situations is discussed.
Idiopathic pseudomembranous colitis successfully treated by surgical excision
Authors: Jackson B T , Anders C J
Published: March 2007

A case is presented of acute idiopathic pseudomembranous colitis successfully treated by panproctocolectomy. The barium enema showed “thumb printing”, an appearance normally associated with ischaemic colitis. The histology of the specimen, however, did not confirm an ischaemic aetiology.
The battered buttock syndrome-fat fractures a report on a group of traumatic lipomata
Authors: Meggitt B F , Wilson J N
Published: March 2007

A group of 12 women with traumatic fat swellings around the buttock region is presented. The structure of the subcutaneous tissue and the mechanism in formation of the lipomata are described. Treatment of the essentially cosmetic deformity is discussed and excision of the lipomatous mass is advised when symptoms indicate this.
The maintenance of maldescended testicles within the scrotum using a dartos pouch
Authors: Pryn W J
Published: March 2007

A method of maintaining a testicle within the scrotum in the operation of orchidopexy for maldescent using a dartos pouch is described.
Wound antibiotics in gastro-intestinal surgery comparison of ampicillin with penicillin and sulphadiazine
Authors: Stoker T A M , Ellis Harold
Published: March 2007

Ampicillin was compared with a penicillin and sulphadiazine combination as a topical wound application in patients undergoing biliary or gastrointestinal surgery in a controlled study. Eleven of the 53 patients having a topical application of penicillin and sulphadiazine developed wound sepsis (20·8 per cent) compared with 4 of the 59 patients receiving ampicillin (6·8 per cent). This difference is significant (P<0·01).
Mediastinoscopy. An analysis of 320 consecutive cases
Authors: Gunstensen J , Wade J D
Published: March 2007

Three hundred and twenty consecutive cases of mediastinoscopy are analysed. Mediastinoscopy is a safe procedure and causes little disturbance to the patient.The preoperative assessment of patients with presumably resectable bronchial carcinoma was the main indication for mediastinoscopy, and its use was associated with a fall in the non-resectability rate at thoracotomy from 28 to 15 per cent over two 3-year periods.The policy of exclusion from exploratory thoracotomy of patients with bronchial carcinoma and mediastinal lymph-node metastases is discussed in relation to the histological nature of the lesion and the site and extent of the mediastinal node involvement.It is concluded that there is a case for offering resection to selected patients with limited mediastinal node invasion from bronchial carcinoma.The value of mediastinoscopy as a diagnostic procedure for mediastinal and pulmonary hilar masses and for undiagnosed pulmonary opacities is shown.
A new non-invasive technique for assessment of superficial femoral artery obstruction
Authors: Woodcock J P , Gosling R G , Fitzgerald D E
Published: March 2007

A transcutaneous technique is described utilizing two ultrasonic Doppler-shift flow-velocity meters simultaneously at sites down the arterial system of the leg in patients with superficial femoral disease. The change in shape of the blood-velocity/time wave-form over the cardiac cycle and the pulse propagation time between the two sites are measured. The transit time and change in pulse shape are used to assess limb viability. This method is compared with two other non-invasive techniques: whole-limb flow measured by a strain-gauge plethysmograph and with the systolic pressure difference between the arm and the calf. It is shown that as the pulse propagation time and the degree of damping of the blood-velocity/time wave-form increase, then limb perfusion decreases, and a nomogram is presented relating these parameters.
Crossed renal ectopia without fusion associated with carcinoma of the renal pelvis a case report
Authors: Castro J E , Ashken M Handley
Published: March 2007

A case of crossed renal ectopia complicated by hydronephrosis, calculus, pyelonephritis, and tumour is described. The aetiology of the complications is discussed and the incidence of tumours in non-fused, crossed renal ectopia is described.
A case of traumatic rupture of the thoracic aorta associated with hypothermia
Authors: Thompson M R
Published: March 2007

This communication reports a case of traumatic rupture of the thoracic aorta. The literature on this subject is reviewed, the problem of diagnosis is discussed, and the importance of acute hypertension as a diagnostic sign is stressed. In view of the fact that the hypertension in the case reported here occurred in the presence of good femoral pulses and persisted after operation, the cause of the hypertension may not be simply an acute coarctation syndrome but may be due to damage to the cardiac plexuses around the site of rupture. It also emphasizes the importance of not rewarming severely traumatized hypothermic patients until facilities are available to replace blood-loss.
Twelve-hour liver preservation in the pig using hypothermia and hyperbaric oxygen
Authors: Spilg Harold , Uys C J , Hickman Rosemary , Saunders Stuart J , Terblanche John
Published: March 2007

In an attempt to prolong successful storage of the pig liver beyond the 6–8 hours previously described from this laboratory, the addition of cell-membranestabilizing drugs to the preserving solution and the use of a potassium-rich solution were investigated. Using simple hypothermia alone, 10- and 12-hour storage was unsuccessful. Using the previously described hypothermic technique, but with the addition of hyperbaric oxygen at 3 atmospheres absolute (A.T.A.), consistently successful 12-hour preservation was achieved.
Choledochoduodenostom a reappraisal of its indications based on a study of 64 patients
Authors: Johnson A G , Rains A J Harding
Published: March 2007

The indications for choledochoduodenostomy in 64 patients are discussed and compared with those in other series from the literature. The essential indications are the presence of a dilated common bileduct with calculous disease or associated pathology at the lower end of the common bile-duct, particularly in the elderly and poor-risk patients. It is a safe procedure with few complications provided that a stoma of 2.5 cm. or more is made.
Gastric necrosis: A rare complication of chloral hydrate intoxication
Authors: Vellar I D A , Richardson J P , Doyle J C , Keating M
Published: March 2007

A rare complication of chloral hydrate intoxication is described. Added to the initial acute cardiorespiratory and central nervous system depression, subsequent gastric necrosis and perforation provided a difficult problem in management. A satisfactory outcome was finally achieved using the Roux-en-Y technique to by-pass the stricture at the oesophagogastric anastomosis.
Ulcerative Colitis Treated by Ileostomy and Excisional Surgery Fifteen Years' Experience at St. Mark's Hospital
Authors: Ritchie Jean K
Published: March 2007

The results of excisional surgery with the eastablishment of a permanent ileostomy in 246 patients with ulcerative colitis operated on in the years 1955–69 at St. Mark's Hospital, London, are presented. The overall mortality of the primary surgery was 8·1 per cent, being 9·3 per cent in the years 1955–9, 10–6 per cent in the years 1960–4, and 5·3 per cent the years 1965–9. This mortality was 1·6 per cent in 128 patients treated electively, 10·7 per cent in 75 cases coming to urgent surgery, and 23·3 per cent in 75 cases coming to urgent surgery, and 23·3 per cent in 43 patients undergoing emergency operations. The mortality in this third group fell from 36·4 per cent in the years 1955–9 to 25 per cent in the years 1960–9. The indcidence of major postoperative complications for patients treated by total proctolectomy or colectomy and ileostomy was also clearly related to the preoperative servertity of the disease, being 18·8 per cent in the elective cases, 31·3 per cent in the urgent cases, and 40 per cent in the emergency cases.

Late complications of surgery were, with the exception of intestinal obstruction requiring surgery, infrequent in this series and showed a marked fall in the last 5 years of the study. With the possible exception of urolithiasis, the investigation revealed no increased susceptibility to diseases or conditions of a general nature in the long-term study of these patients (average length of follow-up 7 years) and emphasized the excellent life expectancy in patients in whom radical surgery had been carried out in the absence of malignant change.
Pneumoperitoneum in the Management of Abdominal Incisional Hernia
Authors: Hamer D B , Duthie H L
Published: March 2007

From a group of 30 patients with incisional hernia, 10 were selected for preoperative treatment with an artificial tension pneumoperitoneum to expand the abdominal cavity sufficiently so that a repair could be completed without tension. There were no serious complications from the method and no recurrences of the incisional hernia. It is suggested that this simple and neglected adjuvant should be considered to ensure the successful repair of any large abdominal incisional hernia.
Calcifying Epithelioma of Malherbe
Authors: Jones S M , Crumplin K H
Published: March 2007

Experience with 34 cases of calcifying epithelioma of Malherbe is analysed, and the frequency of misdiagnosis is noted. The apparent dramatic rise in incidence over the past few years may be due to an increasing awareness of the existence of this benign tumour by both clinicians and pathologists. Evidence is cited to support the view that the lesion arises from the hair-forming cells of the dermis.
Damage From the Fogarty Balloon Catheter
Authors: Mavor G E , Walker M G , Dahl D P , Pegg C A S
Published: March 2007

The Fogarty balloon catheter is an instrument which greatly facilitates arterial thrombo-embolectomy. However, it should be used with gentleness and care, particularly in relation to the lower leg vessels. The peroneal artery is particularly susceptible to damage, and arteriovenous fistula formation may result. Even though the incidence of damage is low, when it occurs the morbidity produced may compromise an otherwise satisfactory result.
Proximal Jejunal and Distal Ileal Extrinsic Innervation in the Rabbit and Dog
Authors: Jenkins D H R , Macleod I B
Published: March 2007

The varying patterns of motor behaviour of isolated and interposed jejunal and ileal segments in the rabbit and the dog previously reported (Jenkins and Macleod, 1970) were examined by selective denervation techniques. One hundred and twenty-three paired experiments were conducted on rabbits and 55 similar experiments were performed on dogs.

Length-matched paired segments of proximal jejunum and distal ileum were isolated and filled with saline at a constant rate. Segmental resistance to filling was regarded as an index of tone. The influence of vagotomy and of sympathectomy on the tone of the segments was studied in segments supplied by one or by two vessels.

Vagotomy caused a decrease in tone in the proximal jejunal segments, while sympathectomy had little effect. In segments of distal ileum sympathectomy resulted in segments behaving in a similar fashion, while vagotomy had an unpredictable effect on tone.

The results suggest a uniform distribution of the vagus to the whole length of the small bowel in the rabit and the dog, serving to maintain the tone of the bowel. It is deduced that sympathetic supply to the proximal jejunum isabsent in these animkals and is distributed to the distal ileum only in an irregular fashion.

The relevance of these observations to the clinical use of interposed small-bowel segments is considered.
Post-Irradiation Femoral Aneurysm Treated by Iliopopliteal By-pass Via the Obturator Foramen
Authors: Ross Harvey B , Sales John E L
Published: March 2007

This unusual case is presented for two reasons. First, it illustrates the value of a long by-pass graft from the common iliac artery to the popliteal artery passing through the obturator foramen when there are complications which forbid operation through the femoral triangle. Secondly, it provides clinical and histological evidence of the late effects upon neighbouring large arteries of radiotherapy—given in this instance for a fibrosarcoma in a thigh muscle.
Does Squamous Carcinoma of the Colon Exist?
Authors: Balfour Tom W
Published: March 2007

A patient with a histologically unusual carcinoma of the colon had a successful surgical resection and primary anastomosis. The tumour showed certain squamous features. It is doubtful if any of the previously reported cases of „squamous carcinoma”︁ represents more than squamous metaplasia with variable degrees of differentiation in existing adenocarcinomas.

To find „squamous”︁ malignant tissue in the colon is not necessarily to imply that the tumour is metastatic or inoperable.
Simultaneous Flow and Pressure Measurements in Intermittent Claudication
Authors: Lewis J D , Papathanaiou C , Yao S T , Eastcott H H G
Published: March 2007

In a series of 12 normal and 68 atherosclerotic patients a relationship between flow and pressure changes following moderate exercise correlates well with the anatomical level of the disease. Both flow and pressure studies provide a good objective assessment of the extent of the disease and of the functional results of reconstructive surgery.
Secondary Enlargement of the Mandibular Coronoid Process
Authors: Bramley P A , Norman J E DeB
Published: March 2007

Enlargement of the coronoid process of the mandible is a rare cause of limited jaw movement.

Primary causes fall into two categories: benign tumours and developmental hyperplasia.

Two cases of clinically important enlargement of the coronoid process secondary to other longstanding causes of difficulty in opening the mouth are described.

It is suggested that significant appositional bone growth secondary to abnormal stresses mediated by the tendon of the temporalis muscle does occur.
The Results of 101 Operations For Symptomatic Hiatus Hernia a Comparison of Two Different Methods
Authors: Magarey C J
Published: March 2007

The results of all the operations for symptomatic sliding hiatus hernia carried out by 1 surgeon during 5½ years are reviewed. One hundred and six operations were done and 101 patients were available for review after 6 months to 5 years. The earlier patients in the series underwent transthoracic or transabdominal hiatus hernia repair, and the later patients underwent fixation of the lesser gastric curve to the anterior abdominal wall, as described by Boerema (1969). Before operation the two groups were clinically comparable. There were significantly less clinical failures after the Boerema operation, and less radiological recurrences. This simple and rapid operation is, therefore, preferred to the more complicated procedure.
Non-Gangrenous Ischaemic Colitis a Review of 17 Cases
Authors: Brown Alastair R
Published: March 2007

Ischaemic lesions of the colon can be divided into gangrenous and non-gangrenous groups.

In this paper 17 patients with non-gangrenous ischaemic colitis are reported; 16 of these occurred spontaneously and 1 followed an anterior resection of the rectum.

The clinical and radiological findings are described.

The lesions varied in extent and severity from a short segment of transient mucosal damage to a long permanent stricture.

An early barium-enema examination is essential for the initial diagnosis. Repeat barium enemas are necessary to ascertain the final outcome. The radiological changes are at least partially reversible and even extensive strictures may show a marked improvement over a period of months.

In this group five lesions were resected but none of the resections was performed during the acute phase. It is concluded that non-gangrenous lesions can usually be managed conservatively. The indications for surgical intervention are discussed.
Ruptured Angiomatous Spleen Presenting as a Severe Coagulation Defect
Authors: Heading R C , McClelland D B L , Stuart A E , Hamilton T
Published: March 2007

A case is decribed in which spontaneous rupture of an angiomatous spleen presented with an acute disorder of blood coagulation. Splenectomy was performed after successful correction of the coagulation defect by the administration of blood and blood-products. The presence of amyloidosis associated with myeloma may have increased the liability of the spleen to rupture. Indentation of the right lobe of the liver by the lower ribs produced a misleading appearance of the hepatic scintiscan.
Abdominal aortic aneurysm and horse-shoe kidney
Authors: Frawley John E , Dickson G H , Jamieson C W , Eastcott H H G
Published: March 2007

Successful abdominal aortic replacement for aneurysm in 3 patients with horse-shoe kidney is reported. The anatomy of the horse-shoe kidney, particularly in relation to its blood-supply, is described. Because of the lack of correlation between the radiological and operative findings it is suggested that the final decision for replacement of the aorta must be taken at opertion. Techniques for grafting which obviate the need to divide the isthmus of the horse-shoe kidney and decrease the operating time are described.
Brachial plexus lesions associated with traumatic asphyxia
Authors: Leech Peter , Cuthbert Hugh
Published: March 2007

Among 19 patients admitted to hospital following a major disaster it was noted that 15 showed evidence of traumatic asphyxia and 7 had sustained brachial plexus injury. Three such cases are presented, the possible pathogenesis of the brachial plexus lesions is discussed, and the diagnostic difficulty presented by unconscious traumatically asphyxiated patients with monoparesis is highlighted.
A comparison of portal and systemic venous drainage in porcine renal allografts
Authors: Mazzoni G , Di Martino C , Demofonti A , Valli A , Pellegrini S , Gentili B , Melis M
Published: March 2007

The results obtained when both kidneys were allografted in the pig are described. The experiments were performed in two groups of animals. In one group both kidneys were transplanted with portal venous drainage and in the other group caval drainage was used. Animals with portal venous drainage of the renal grafts survived for more than 4 months whereas those with caval drainage died within 15 days.
The single thyroid nodule
Authors: Psarras A , Papadopoulos S N , Livadas D , Pharmakiotis A D , Koutras D A
Published: March 2007

Between November, 1966, and March, 1970, 2736 patients with single thyroid nodules were investigated at the Alexandra Hospital. Females were more frequently affected than males, with a ratio of females to males of about 7:1. The right lobe was one and a half times more frequently involved than the left. In both lobes the lower pole was six to eight times more commonly involved than the upper pole. Pathological data after surgical excision were available in 692 of these patients. Malignancy was proved in 81 cases. The overall incidence of carcinoma was 11.7 per cent. Malignant nodules were two to three times more frequent in persons aged below 20 and over 60 and in males than in females. The incidence of carcinoma in cold and warm nodules was 12.8 and 6.6 per cent respectively. No malignancy was foun in a hot nodule or in a toxic adenoma. The location of the nodule was not helpful in predicting malignancy. It is concluded that the incidence of malignancy in cold and warm single thyroid nodules in high, and for this reason surgical removal supplemented with replacement therapy is recommended.
The relationship between blood-flow and failure of femoropopliteal reconstructive arterial surgery
Authors: Terry H J , Allan J S , Taylor G W
Published: March 2007

Blood-flow measured at operation in 80 limbs was found to be significantly related to the patency of the reconstruction 12 months later. The incidence of failure was 14 per cent when the flow exceeded 100 ml. per minute and was 54 per cent when the flow was less than this figure.

Although blood-flow was significantly lower in patients with obstructed distal arteries, there were wide variations in flow between limbs with similar degrees of obstruction. There was, however, a significant increase in the failure rate with increasing arterial obstruction, and where two or all three of the tibial arteries were obstructed the long-term failure rate was 48 per cent.
The effects of posture, exercise, and bandage pressure on the clearance of 24na from the subcutaneous tissues of the foot
Authors: Chant A D B
Published: March 2007

The effects of posture, exercise, and bandage compression on the clearance of 24Na from the subcutaneous tissues of the foot in 12 control subjects and in 32 patients with venous abnormalities have been investigated. Lowering the foot slowed clearance in the control subjects and in the patients with varicose veins, but no slowing occurred in patients with chronic deep venous thrombosis (D. V. T.). Exercise increased the clearance in the controls but this increase was less in the varicose vein and D. V. T. groups and absent in the group with venous ulcers. Treatment of the patients with varicose veins by sclerotherapy returned their exercise increment in clearance of 24Na to control levels. Bandage compression increased clearance until a maximum was reached at approximately the intravascular hydrostatic pressure. Thereafter it declined. A significantly higher bandage compression was required to produce maximum clearance of 24Na in patients with D. V. T. In two further experiments when bandage compression was maintained at intravascular hydrostatic pressure the effect of posture on clearance was abolished.

These observations indicate that 24Na clearance may be of value in the investigation of patients with venous abnormalities.
Persistent and recurrent hyperparathyroidism
Authors: Clark Orlo , Taylor Selwyn
Published: March 2007

During the past 11 years at Hammersmith Hospital 11 patients have had parathyroid operations following a previous neck exploration. Six had persistent hyperparathyroidism and 5 had recurrent hyperparathyroidism with a “lucid interval” of biochemical normality of from 5 months to 11 years. Sucessful results were obtained in 9 of the 11 patients after a total of 29 operations, 4 of which were combined with sternotomy. The reasons for failure at operation and the medical and surgical management of these patients are reviewed.
A randomized prospective trial comparing three established methods of gastric decompression after vagotomy
Authors: Miller D F , Mason J R , McArthur J , Gordon I
Published: March 2007

One hundred and thirty-two patients who were about to undergo vagotomy and drainage were randomly allocated nasogastric tubes, gastrostomy tubes, or no decompression postoperatively. Significantly fewer patients with no decompression developed respiratory infections postoperatively. The role of smoking in the production of post-operative chest complications was again confirmed. Neither the choice of decompression nor its absence appeared to affect postoperative electrolyte control. Postoperative dysphagia was more common in the group with a nasogastric tube. Wound infections were commoner in the gastrostomy group. While most patients with gastrostomies expressed a preference for this type of decompression a proportion of those with nasogastric tubes expressed a preference for a gastrostomy.
Post-angiographic vertebral arteriovenous fistulae
Authors: Sangruchi Vira , Hitchcock Edward , Donaldson A A
Published: March 2007

Four cases of arteriovenous fistula of the high cervical vertebral artery are presented as a complication of direct puncture of the vertebral artery using the lateral atlanto-occipital approach. One case is reported in detail. The management of such cases is discussed together with a brief review of the literature.
Postoperative changes in blood viscosity and the influence of haematocrit and plasma-fibrinogen
Authors: Kemble J V Harvey , Hickman J A
Published: March 2007

The blood of 25 patients undergoing surgery has been investigated for levels of whole-blood and plasma viscosity, haematocrit, and plasma-fibrinogen before and after operation.

The whole-blood viscosity diminished by between 14 and 23 per cent after operation. The haematocrit fell from a mean preoperative level of 42.3 per cent (S.D. ± 5.2) to a mean postoperative level of 36.3 per cent (S.D. ± 5.5). When the effect on viscosity of this reduction in haematocrit was removed the blood viscosity rose after operation by 9–14 per cent.

The level of plasma-fibrinogen rose from a mean preoperative level of 360 mg. per cent (S.D. ± 78) to a mean postoperative level of 714 mg. per cent (S.D. ± 155), an overall increase of 98 per cent. This postoperative rise in the plasma-fibrinogen concentration exerted an effect on the blood viscosity opposite to that of the haematocrit.

The deleterious effects of a rise in blood viscosity on tissue perfusion and oxygenation are outlined, and the relevance of the reported findings to the maintenance of an adequate microcirculation in the postoperative period is discussed. Attention is drawn to the benefits of a slight fall in haematocrit during this period.
Malignant melanomata: An aid to preoperative diagnosis
Authors: Mackie Rona M
Published: March 2007

The use of the Zeiss operation microscope in the preoperative diagnosis of malignant melanomata has given an overal accuracy rate of 85 per cent. The method is quickly and simply carried out, and is without risk to the patient and the operator. The machine is portable and can therefore be used at the bedside in a patient who is not ambulant. Only a normal domestic power supply is required. The use of this machine in the assessment of such cases is therefore advocated.
Pedunculated teratoma of rectum infested with bilharziasis
Authors: El-Katib Y
Published: March 2007

A teratoma presenting as a pedunculated rectal polyp is reported. The teratoma was infested with Bilharzia ova.
Joint rupture in Reiter's disease
Authors: Garner Richard W , Mowat Alastair G
Published: March 2007

A case of knee-joint rupture in Reiter's disease, in which a posterior communicating cyst was excised, is reported. The mechanisms of joint rupture and the differentiation of the clinical signs from those of deep venous thrombosis in the calf are discussed. The relevant literature has been reviewed.
Femoro-femoral cross-over grafts. A report of 7 cases
Authors: Baker R , Parker E J C
Published: March 2007

Seven patients who had femoro-femoral by-pass grafts are reported and the results are noted.

The value of the operation in poor-risk patients with unilateral disease and ischaemic rest pain is confirmed. It is suggested that the indications for doing this procedure could be extended.
Axillary-femoral by-pass grafts in the treatment of aorto-iliac occlusive disease
Authors: Pollock A V
Published: March 2007

Seventeen patients with aorto-iliac occlusive disease have been treated by inserting a Dacron by-pass prosthesis subcutaneously from the axillary artery to the common femoral artery, with acceptable immediate and poor late results. Only 4 grafts remained patent for more than a year.
Neurological complications of ruptured abdominal aortic aneurysm
Authors: Bolton P M , Blumgart L H
Published: March 2007

Two cases of neurological complications of abdominal aortic aneurysm are described, with a brief review of the other neurological complications of this condition.
Cryosurgery in the treatment of head and neck neoplasia
Authors: Holden H B , McKelvie P
Published: March 2007

The clinical and cellular changes which occur after cryosurgery are described. Its advantages as a form of therapy in the treatment of neoplasia are discussed, particularly with regard to pain relief in palliation. However, the limitations of the effectiveness of cryosurgery in cancer therapy are emphasized.

The results of cryosurgery are presented in 30 cases of recurrent or persistent neoplasia, which followed more formal treatment. In 5 cases healing appeared to be complete; good palliation was achieved in 6 cases, and useful palliation in 13 cases. There was no response in 6 cases.
The fate and function of the thyroid remnant. A surgical and radioactive iodine study
Authors: Young H B , Macleod N
Published: March 2007

Clinical, radioactive iodine uptake, and scan studies on a series of measured thyroid remnants indicate that after thyroidectomy one lobe only actively functions in a significant number of cases and that the subthyroid state only appears in toxic cases, usually those with certain pathological, familial, or therapeutically induced changes.

Remnant size did not appear to be critical, but under-function did not occur over 8 c.c. Above this size of residuum hypothyroidism does not appear to be directly due to the operation per se and should not therefore be called postoperative.

A fall in the assessment parameters after 6 months in a toxic case with a remnant measuring less than 8 c.c. and one or more of the associated features mentioned above would be an indication for commencing thyroxine.

Minor degrees of lymphocytic infiltration did not correlate directly with under-function.

There was a suggestion of right-sided dominance in the remnant as in normal and diseased glands.
Foreign-body perforation of a jejunal diverticulum
Authors: Fidler Malcolm
Published: March 2007

Perforation of a jejunal diverticulum is usually the result of inflammation. A second example of a much rarer cause of perforation due to a foreign body is described together with a brief review of the literature.
Regression of axillary lymph-nodes in cancer of the breast
Authors: Edwards M H , Baum M , Magarey C J
Published: March 2007

A multicentre, prospective trial on the treatment of Stage-I and Stage-II breast cancer by simple mastectomy plus radiotherapy versus simple mastectomy alone is described. So far 1050 patients have been collected within 2 years. Data on the first 161 patients treated by simple mastectomy alone are analysed. Axillary lymph-nodes have regressed within 3 months of mastectomy in 75 per cent of patients in clinical Stage II. Regression may be due to resolution of reactive changes in lymph-nodes following removal of the primary tumour.
The value of preserving the pylorus in the surgery of duodenal ulcer
Authors: Humphrey C S , Wilkinson A R
Published: March 2007

Highly selective vagotomy without a drainage procedure (H.S.V.) has been use in the surgical treatment of 120 cases of duodenal ulcer in Leeds over the past 3 years. In this operation preservation of the vagal nerve-supply to the antral region of the stomach permits preservation of an intact pylorus. In the present paper the results which have been achieved are assessed, both clinically and experimentally, by comparison with the results in patients after truncal or selective vagotomy and pyloroplasty at a comparable stage after operation.

Studies of gastric emptying provide no evidence of gastric stasis after H.S.V., and symptoms of flatulence and food vomiting are found no more frequently than after vagotomy and pyloroplasty. After both truncal and selective vagotomy and pyloroplasty gastric emptying and small-bowel transit were abnormally fast, whereas after H.S.V. there was much less departure from the values found in preoperative ulcer patients. At the clinical and experimental level dumping and diarrhoea were singnificantly less frequent after H.S.V. than after vagotomy and pyloroplasty.

To date there has been no operative mortality, no case of recurrent ulcer, and no reoperation for gastric stasis after H.S.V. Preservation of a more normal pattern of gastric emptying, by reducing the incidence of dumping, diarrhoea, and bile vomiting, has led to better overall (Visick) results after H.S.V. than after truncal or selective vagotomy and pyloroplasty.
Treatment of gastric ulcer by highly selective vagotomy without a drainage procedure: An interim report
Authors: Johnston D , Humphrey C S , Smith R B , Wilkinson A R
Published: March 2007

Fourteen patients with gastric ulcer alone and 5 patients with combined gastric and duodenal ulceration- have been treated by highly selective (parietal-cell) vagotomy without a drainage procedure (H.S.V.) the past 3 years. Before operation no evidence of gastric stasis was found, clinically, radiologically, or during tests of gastric secretion. Spontaneous acid out was low. Acid output in response to a test meal of meat extract was also found to be low. There no evidence that in the patients with gastric ulcer alone the ulcer was due to pyloric channel disease with excessive release of gastrin by the antrum.

Each gastric ulcer was proved by frozen-section examination to be benign at the time of operation. Problems with gastric stasis were encontered in early postoperative period. The vagotomy was shown to be complete on insulin testing in each of 17 patients tested.

Follow-up ranges from 1 month to 3 years. The clinical progress of the patients has been good, and has symptoms suggestive of recurrent ulceration gastric retention. Barium-meal examination in 11 patients who were follwed up for more than 9 months showed satisfactory gastric emptying, without recurrent ulceration. While the need for much longer follow-up is obvious, these preliminary results are encouraging. Further trial of H.S.V. for gastric ulcer, preferably in the form of a prospective, randomized comparison with Billroth-I gastrectomy, now seems desirable.
The value for diagnosis and research of special investigation on rectal biopsies in Crohn's disease
Authors: Dawson I M P
Published: March 2007

Proper processing and intelligent use of rectal biopsies and resected material from patients with Crohn's disease allow a wide range of histochemical and immunological, diagnostic and research procedures. Studies of enzyme distribution in biopsies have not fulfilled their early promise, and electron microscopy has not so far proved to be of great value in differential diagnosis. Techniques for determining mucosubstances, however, can be of considerable value in separating Crohn's disease from other conditions. Studies on the distribution of lymphocytes and plasma cells using selective antibodies to human immunoglobulins are practicable and likely to be of value. Close co-operation between the surgeon and the pathologist is essential.
Experiences of ivalon-sponge implant for complete rectal prolapse at St. Mark's Hospital, 1960–70
Authors: Penfold J C B , Hawley P R
Published: March 2007

Experience of using Ivalon-sponge implants in 101 patients with complete rectal prolapse at St. Mark's Hospital is reviewed. It is a straightforward operation with minimal complications producing long-term control of the prolapse in 97 per cent oof cases.

Of those patients who had been incontinent, satisfactory restoration of continence was achieved in 79 per cent of cases for solid faeces and in 33 per cent for fluid faeces.

Ivalon sponge is a foreign material that only produces moderate fibrosis in the tissues. In persists foor at least 6 years in humans.
A prospective study of the immediate and long-term results of polya gastrectomy for duodenal ulcer
Authors: McKeown K C
Published: March 2007

The results of a prosepective study of Polya-type gastrectomy in 800 cases of duodenal ulcer are recorded.

The series is an entirely personal one in which case selection and operative technique were standardized, through in the assessment of the results the opiniosn of many observers have been collated.

The resutls in the early years are recorded and the effects of revision surgery noted.

Special attention has been paid to the nutritional state after operation adn to the long-term metabolic consequences 10–20 years after gastrectomy.

The immediate and long-ter results of gastrectomy are compared and constrasted with those obtained by vagotomy and drainage.
The effect of clothing on the dissemination of bacteria in operating theatres
Authors: Doig Caroline M
Published: March 2007

The effect of different types of clothing in modifying the dissemination of bacteria was studied in an experimental chamber, using a slit-air sampler to quantify the aerial contamination. Observations were made on volunteers wearing conventional operating-theatre clothing, outdoor clothing, and specially designed theatre wear, both with and without a gown, mask, cap, and boots in all three groups.

The results showed that aerial contamination was least when outdoor clothing was worn. The addition of a sterile theatre gown, mask, cap, and boots reduced this dissemination by half in all the groups. Leaving aside considerations of comfort and hygiene of the staff, it is concluded that outdoor clothing need not be removed before entering an operating theatre (or clean area) provided that a gown, mask, etc., are worn.
The management of congenital hydronephrosis in the newborn
Authors: Williams H T , Wilkinson K W
Published: March 2007

Hydronephrosis due to pelvi-ureteric obstruction rarely presents in the neonatal period. When it does, the disease is advanced and it may be advisable to drain the obstructed kidney until the child is old enough and fit enough to withstand a pyeloplasty. In this paper 2 cases of neonatal hydronephrosis are reported and a satisfactory method of drainage is described.
Ruptured solitary cyst of the liver
Authors: Russell R C G
Published: March 2007

A further case of a ruptured solitary cyst of the liver is described. A brief review of the 7 previously described cases is given. The management of the condition is discussed, and surgical treatment by either total excision or excision of the roof of the cyst is recommended.
Metabolism after injury. 1: Effects of severity, nutrition, and environmental temperature on protein potassium, zinc, and creatine
Authors: Cuthbertson D P , Fell G S , Smith Catherine M , Tilstone W J
Published: March 2007

The effect of an environmental temperature of 28–30°C. and a relative humidity of 35–45 per cent on the protein metabolic response to injury of one or more major long bones of the lower limbs has been studied in 29 male patients and 28 similar controls housed at 20–22°C. The metabolic response was reduced at the higher temperature compared with the controls, the more severely injured showed a greater metabolic response than the less severely injured, and the ameliorating influence of environmental temperature was more noticeable in the former. The metabolic response seems to be principally one of catabolism of muscle, with increased urinary excretions of potassium, creatine, and zinc in the urine correlating well with those of nitrogen at 20°C. but not at 30°C. The response (i.e., catabolism of muscle) was not affected by post-injury diet at 20°C. ambient temperature. There was a reduction in the disturbance of the plasma proteins.

In general, the patients tolerated the warm drier conditions. Owing to the intrinsic difficult in assessing minor changes in bone healing it was not possible to assess what, if any, beneficial change occurred in the fracture site. From our experimental observations on the rat and the work of others on burned patients the reduction in heat production at the higher ambient temperature is accompanied by an enhanced rate of healing of surface wounds.