bluuebunny/crossref_metadata_2025 huggingface dataset:
A clinicopathological review of 68 carcinomas of the gallbladder
Authors: Donaldson L A , Busuttil A
Published: March 2007

A clinical and pathological review of 68 patients with a primary carcinoma of the gallbladder was undertaken. A prolonged preceding history of biliary disease was noted. Preoperative radiological and biochemical investigations were not helpful, but an isolated elevation in serum alkaline phosphatase level in the absence of any biliary obstruction or hepatic dysfunction was noticed in some patients. The significance of stones in relation to pathogenesis is discussed. A more radical surgical approach involving a partial hepatectomy appears to be the only possible treatment in view of the mode of spread of this tumour and the bad overall prognosis.
The continent ileostomy of Kock (ileal intra-abdominal reservoir)
Authors: Halvorsen Jan F , Heimann Peter
Published: March 2007

A series of 9 patients with ulcerative colitis undergoing proctocolectomy and ileal intra-abdominal reservoir is reported. Eight patients are continent and 1 is incontinent. Early and late postoperative complications, work capacity and social and sexual functions are described.
Torsion of the testis: A review of 22 cases
Authors: Greaney M G
Published: March 2007

Greater awareness of the possibility of torsion of the testis and earlier exploration has led to the saving of 14 out of 19 acutely twisted testicles.
Trans-sphenoidal hypophysectomy in disseminated carcinoma of the breast
Authors: Robin P E , Powell D Jean , Waterhouse J A H , Dalton G A
Published: March 2007

One hundred and eight patients with advanced carcinoma of the breast were treated by trans-sphenoidal hypophysectomy and followed up for at least 1 year. The results were assessed both by clinical response and objectively by survival following hypophysectomy, as expressed by the survival ratio. The two methods showed close correlation.

The results show that there is a variation in response relating to menopausal status and age at diagnosis, subsequent hormonal manipulation and physical condition at hypophysectomy. Younger patients whose carcinoma is diagnosed after menopause carry a good prognosis, yet the older premenopausal patients, especially if their clinical condition is poor, do not benefit. Easily available clinical information can be a guide to prognosis.
Extrinsic duodenal obstruction in infants and children
Authors: Tryfonas G , Young D G
Published: March 2007

A series of 34 patients with extrinsic duodenal obstruction is described. The diagnosis and treatment are discussed. Five infants died and the findings are given. The remaining 29 have progressed normally.
Plasma catecholamines in severely injured patients: A prospective study on 45 patients with multiple injuries
Authors: Jäättelä A , Alho A , Avikainen V , Karaharju E , Kataja J , Lahdensuu M , Lepistö P , Rokkanen P , Tervo T
Published: March 2007

Plasma catecholamine levels were studied in 45 severely injured patients for 8 days after the trauma. Sixteen of the patients were classified as critically injured and 29 as seriously injured.

The total plasma catecholamine values of the whole group immediately after the injury were almost twice as high as the eighth day reference values and remained significantly higher than these values for 6 hours after the trauma. On admission both the plasma adrenaline and noradrenaline levels were elevated. The plasma adrenaline levels on admission correlated with the blood volume replacement which was required within the first 6 hours.

The plasma noradrenaline levels in the critically injured group were significantly higher throughout the observation period than in the seriously injured group. A corresponding difference was observed in the plasma adrenaline concentrations only during the first 12 hours.

The results showed that strong stimulation of the sympathetic nervous system occurs in severely injured patients. Factors stimulating the sympathetic nervous system apparently included hypovolaemia, tissue hypoxia, acidosis and the pain produced by the truama and therapeutic measures.
Postoperative problems and management after hepatic resection for blunt injury to the liver
Authors: Vajrabukka T , Bloom A L , Sussman M , Wood C B , Blumgart L H
Published: March 2007

The postoperative problems and management of 8 patients following right hepatic lobectomy for blunt liver injury are discussed. Multiple injury and in particular chest injury are of importance. Respiratory distress may be insidious in onset and must be anticipated. Most patients require at least temporary positive pressure ventilation.

Liver regeneration is rapid and histological evidence of regenerative hyperplasia is present within 3 days of injury.

Hypoglycaemia of a degree sufficient to threaten life may occur postoperatively, particularly in the first 48 hours. Jaundice may be a worrying postoperative feature, but the use of T-tube drainage after hepatic lobectomy will enable any possible extrahepatic obstruction to be excluded. Hypoproteinaemia and hypo-albuminaemia occur in the immediate postoperative period, and recovery rapidly follows the peak period of regenerative activity of the liver. Normal levels are regained by the fourth to sixth postoperative weeks.

Prophylactic antibiotics have no place in the postoperative management of blunt liver injury.

Haemorrhagic diathesis is common after hepatic resection and is of a complex nature. Intravascular coagulation may occur and factor V deficiency is common. The mainstay of treatment is transfusion of fresh blood.
Report of a family with inherited medullary carcinoma of the thyroid and phaeochromocytoma
Authors: Beaugie J M , Belchetz P E , Brown C L , Frankel R J , Lloyd Margaret H
Published: March 2007

A family in which several members have medullary carcinoma and phaeochromocytoma is described. Four of the 5 patients in this family who had a phaeochromocytoma have died; in one of these the medullary carcinoma may have contributed to death but in general the thyroid cancers were slow growing. In our experience successful diagnosis and treatment of the phaeochromocytomas have presented the greatest challenge. The welfare of future generations with this syndrome would seem to depend upon regular clinical and biochemical surveillance of the individuals and expeditious diagnosis and treatment of their tumours, particularly the phaeochromocytomas.
Tuberculous peripheral lymphadenitis in the Igbos of Nigeria
Authors: Onuigbo Wilson I B
Published: March 2007

Peripheral lymphadenitis is a leading manifestation of tuberculosis. Among the Igbos, who constitute one of the largest ethnic groups in Nigeria, it presents most commonly in the neck, as in other parts of the world. An inguinal presentation, however, is also common. The nodes are often of considerable size. The maximal incidence occurs in the 10-29-year age group, males outnumbering females slightly. It is only in the 40-59-year range that tuberculosis is less common than lymphoma or carcinoma of the peripheral lymph nodes.
Small doses of subcutaneous sodium heparin in the prevention of deep vein thrombosis after elective hip operations
Authors: Thrombosis Clinical Study Group Venous
Published: March 2007

The efficacy of small perioperative doses of subcutaneous heparin in preventing deep vein thrombosis has been studied in a controlled clinical trial on 64 patients undergoing elective hip surgery. The results indicate that the regimen of sodium heparin used was safe provided that the correct dose is given. It reduced the frequency of postoperative deep vein thrombosis from 37 to 7 per cent.
Injury of the facial nerve during surgery of the parotid gland
Authors: Ward C M
Published: March 2007

The notes of 158 patients who had undergone surgery of the parotid gland for benign and malignant disease were studied to discover the circumstances in which the facial nerve might be injured.

Limited surgery carried as great a risk of injury to the facial nerve as during extended surgery. Extended surgery provided greater risk of injury to the facial nerve on secondary exploration (71 per cent) than on primary exploration (6.5 per cent).

It is concluded that every primary exploratory procedure of the parotid gland should be a formal conservative parotidectomy unless the tumour is obviously malignant.
Effect of surgical trauma on plasma concentrations of cyclic AMP and cortisol
Authors: Gill G V , Prudhoe K , Cook D B , Latner A L
Published: March 2007

The response of plasma cortisol and cyclic AMP concentrations to surgical trauma was examined in 7 general surgical patients. Five patients made uncomplicated recoveries and showed peak cortisol levels at 6 hours postoperatively, returning to normal by 24 hours. One patient developed postoperative pneumonia and the plasma cortisol remained elevated up to 48 hours, and the final patient showed no cortisol response at all. The plasma cyclic AMP concentrations showed a consistent rise during the operation itself, which was statistically significant when compared with preoperative levels (P < 0.0125). Concentrations had fallen to normal by 6 hours in all the cases, except in the patient who developed pneumonia, where the plasma cyclic AMP also showed a prolonged elevation. The significance of these findings requires further elucidation, but the temporal relationship of the cyclic AMP and cortisol peaks would support the hypothesis that cyclic AMP may play a part in the mediation of ACTH release following surgical trauma.
Environmental tests of linear flow ventilation for an operating theatre
Authors: Scott Charles C , Guthrie Thomas D
Published: March 2007

Criticisms have been levelled against linear air flow operating enclosures because of their alleged physical and biological conditions and the effects of these, both on the surgical team and on the patient's tissues.
Incidental appendicectomy with laparotomy for trauma
Authors: Norton Lawrence W , Sweeney Marna , Eiseman Ben
Published: March 2007

Incidental appendicectomy was performed in 83 of 206 patients undergoing laparotomy for abdominal trauma. No organs were injured in 42 per cent of the appendicectomy patients and in 17 per cent of the non-appendicectomy patients, thus making comparison between the groups unreliable. While the incidence of intestinal perforation was 21 per cent in the appendicectomy patients, the rate of wound infection was only 7 per cent. One complication (pelvic abscess) was possibly attributable to incidental appendicectomy.

Since males below the age of 50 face a significant risk of future appendicitis and represent the majority of patients with abdominal trauma, it may be advisable to perform incidental appendicectomy with laparotomy for trauma in such patients. Specific indications for incidental appendicectomy during laparotomy for trauma are suggested.
Significance of faecoliths in the diagnosis of acute appendicitis
Authors: Gill B , Cudmore R E
Published: March 2007

Three cases are presented which demonstrate the significance of faecoliths in the diagnosis of acute appendicitis in infants. A wide spectrum of symptoms is noteworthy. The usefulness of a plain X-ray of the abdomen in infants with acute abdomen is stressed.
Undetected aorto-iliac insufficiency: A reason for early failure of saphenous vein bypass grafts for obstruction of the superficial femoral artery
Authors: Charlesworth D , Harris P L , Cave F D , Taylor Linda
Published: March 2007

A series of 29 femoropopliteal bypass operations is described. The patients were selected carefully to exclude those with clinical and aortographic evidence of aorto-iliac disease. A pulsatility index was calculated from the velocity waveforms recorded over the common femoral and popliteal arteries. The pulsatility index is the ratio of the amplitude of the waveform to its mean height over one cardiac cycle. There was a highly significant difference in the result of the operation between patients with a pulsatility index of 4 or more in the common femoral artery and patients with a pulsatility index of less than 4. We concluded that calculation of this pulsatility index provides useful additional evidence when selecting patients suitable for a femoropopliteal bypass.
Abdominoscrotal hydrocele
Authors: Parekh B R , Reinboth G , Mishra O P
Published: March 2007

The number of cases of abdominoscrotal hydrocele reported in the literature has been brought up to date, which, including the 3 cases reported here, is 83 of which 21 are from India.

The pathogenesis of this lesion is discussed. It is concluded that all cases of abdominoscrotal hydrocele are due to progressive involvement and distension of the patent processus vaginalis which is cut off from the general peritoneal cavity.

A new classification of abdominoscrotal hydrocele is suggested on the basis of experience gained from the 3 cases reported here.
Lymphosarcoma of the breast
Authors: Ross Charles F , Eley Arnold
Published: March 2007

A case of lymphosarcoma presenting as a breast tumour in a 68-year-old woman is described and the condition briefly reviewed.
Carcinoma arising in thyroglossal duct remnant: Case reports and review of the literature
Authors: Saharia Prakash C
Published: March 2007

Two cases of thyroglossal duct cyst carcinoma are presented and the world literature is reviewed. There are only 74 cases reported to date. In nearly all the cases the clinical diagnosis was thyroglossal cyst. Although the great majority of the tumours were papillary adenocarcinomas, 13·15 per cent were of other histological types. The treatment has been quite variable, but the most common initial treatment was Sistrunk's (1928) operation. Following the establishment of the diagnosis of malignancy, thyroidectomy was done in several cases, but it failed to show any evidence of malignancy in most of the thyroids removed, which establishes firmly the de novo origin of these tumours from the thyroglossal duct remnant. In only one case had tumour disseminated to distant organs, the lung, liver, etc. The scepticism as to whether some of the carcinomas associated with thyroglossal duct remnants may not in fact represent metastases from a small primary tumour of thyroid gland is examined. It appears that, though a possibility of primary or metastatic tumour in the thyroid does exist, the probability does not appear to be high. From our own experience it is suggested that local excision followed by radiotherapy, irrespective of recurrence, may be worth considering for the treatment of such carcinomas.
False abdominal aortic and iliac aneurysms
Authors: Chavatzas Demetrios , Jamieson Crawford
Published: March 2007

A case of late postoperative false abdominal aortic and iliac aneurysms complicated by malposition of the inferior vena cava is presented and attention is drawn to its presentation, diagnosis and management. Several factors assumed to be responsible for the formation of the false aneurysms 7 years after the previous grafting operation are discussed.
Serum α-1-acid glycoprotein as an index of dissemination in breast cancer
Authors: Roberts J G , Keyser J W , Baum M
Published: March 2007

Assay of the serum α-1-acid glycoprotein (SAGP) produced by the liver in response to many disease states is shown to reflect prognosis and monitor progress in patients with early, recurrent and disseminated breast cancer. Eighteen of 26 patients with localized breast cancer and positive bone scans had elevated SAGP when first seen, but within 5 months of treatment 5 further patients with positive bone scans developed an elevated SAGP. Furthermore, an initally abnormal SAGP. evel became normal within 5 months in 5 of 6 patients with negative bone scans. While elevated SAGP in breast cancer correlates with positive bone scans, a series of normal values may indicate patients without early haematogenous dissemination of their disease.
The place of frozen section in the practical management of melanoma
Authors: Hughes L E
Published: March 2007

A selective policy is proposed for the use of frozen section in suspected melanoma which provides maximal help while minimizing false frozen section diagnosis. It is based on the fact that suspected melanomas fall into two broad groups which present different problems in diagnosis and management.

A raised lesion is likely to be a highly malignant melanoma or a lesion of non-naevoid cells. Differentiation is readily made on frozen section and allows immediate radical excision. A flat pigmented lesion is usually of obvious naevoid origin, and the problem is whether early malignant change has occurred. It is better managed by urgent paraffin section to avoid sampling error.

Frozen section has a place in the management of a single doubtful node in a patient being managed by a “watch” policy.
The surgical cure of primary varicose veins
Authors: Rivlin Stanley
Published: March 2007

A prime requisite of successful varicose vein surgery is a detailed clinical examination. This reveals a new test for short saphenous incompetence and shows that 14 per cent of varices stem from a saphenopopliteal reflux. The intimate details of juxtafemoral and juxtapopliteal ligation are emphasized and the common causes of failure pointed out. The technique of “scarless” varicose vein surgery is described. A 6–10-year follow-up of some 2000 patients reveals an overall recurrence rate of 7 per cent.
Bilateral simultaneous rupture of the quadriceps tendons
Authors: Brotherton B J , Ball D J
Published: March 2007

A case of bilateral simultaneous rupture of the quadriceps tendons associated with intra-tendon diabetic arteriolosclerosis is described.
Surgical complications of implanting pacemakers
Authors: Siddons Harold , Nowak K
Published: March 2007

An analysis of the complications of implanting pacemakers at St George's Hospital between 1967 and 1973 highlights the difficulties of implanting foreign bodies. During this 7 years 1543 pacemakers were implanted in 779 adults. In 91 patients there were 118 implants with surgical complications, most of them due to a pressure necrosis or local infection; 3 septicaemias occurred. The various complications are classified and related to technique of implantation. Methods of management of the complications are presented.

As an Appendix the operative techniques of first and subsequent implantations are outlined.
The effect of posture on the emptying of the intrathoracic vagotomized stomach
Authors: Hinder R A
Published: March 2007

Ten patients were studied at periods ranging from 4 months to 25 years after oesophagogastrostomy and gastric drainage. Gastric emptying studies and overnight gastric aspirates in both the supine and erect positions were carried out, Evidence was found in these patients of increased duodenogastric refrux and poor gastric emptying in the supine posture. All of the patients had gastritis, and some had gastric mucosal ulceration. These findings have led to the conclusion that in the supine posture the combination of duodenogastric reflux and poor gastric emptying leads to gastric mucosal damage.
Changes in the blood fibrinolytic activity after surgery (the effect of deep vein thrombosis and malignant disease)
Authors: Browse N L , Gray L , Morland M
Published: March 2007

The changes in blood fibrinolytic activity before and after operation have been investigated in 56 patients. The results have been analysed to assess the effect of the presence of malignant disease and the development of deep vein thombosis.

The results show that patients with malignant disease and those with thrombosis have a fibrinolytic shut-down. This shut-down appears to be secondary to these two conditions and not the cause of the thrombosis. Patients without carcinoma and without thrombosis do not have a significant shut-down. The fibrinolytic shut-down results from a reduced release of activator from the peripheral store, not a reduction in the size of the store itself.
Resection of an unusually large goitre
Authors: Manoppo Adrie E
Published: March 2007

This paper reports the resection of a benign non-toxic goitre measuring 75 × 60 × 45 cm in a patient aged 48 who was unable to walk or sit because of the size of the goitre. The tumour proved to arise from the right half of the thyroid. A right-sided hemistrumectomy was performed under local anaesthesia with the patient prone. A temporary tracheostomy was established. The postoperative course was uneventful apart from slight necrosis of the wound edge. The patient was discharged in good health on the twentieth postoperative day.
The mechanisms of traumatic rupture of the thoracic aorta
Authors: Sevitt Simon
Published: March 2007

This paper reviews evidence and ideas on closed accidental rupture of the aorta, and refers to an analysis of 37 subjects in whom traumatic aortic ruptures were found at necropsy. The mechanisms of rupture of the ascending aorta and the proximal and distal parts of the descending aorta are discussed.

Aortic rupture is one of the major causes of rapid death after traffic accidents, especially in occupants of motor vehicles. However, about 20 per cent of subjects survive for hours, days or longer after the accident, allowing time for surgical repair in some cases.
Arterial hypoxia in acute pancreatitis
Authors: Imrie C W , Ferguson J C , Murphy D , Blumgart L H
Published: March 2007

Severe arterial hypoxia while breathing ambient air (Pao2 < 60 mm Hg) was recorded in 38 (45 per cent) of a group of 84 patients with acute pancreatitis when arterial blood gas monitoring was performed during the first week of illness. This contrasted with an incidence of 19 per cent severe hypoxia in a heterogeneous group of 68 patients with acute abdominal pain admitted as surgical emergencies. Clinical evidence of respiratory embarrassment was rarely present in either the patients with acute pancreatitis or the other patients. Arterial hypoxia was related to the prognosis in both groups.

It is recommended that all patients with acute pancreatitis have routine arterial blood gas monitoring performed during the first 5 days of illness. Furthermore, all older patients (over 60 years) and younger patients with moderate hypoxia (Pao2 <70 mm Hg) should be given supplementary humidified oxygen. An awareness of occult respiratory insufficiency in surgical emergency admissions, and especially in acute pancreatitis, is of importance.
Superficial sepsis: The antibiotic of choice for blind treatment
Authors: Page R E , Freeman R
Published: March 2007

When all cases of superficial sepsis were considered together Staphylococcus aureus was the most frequently encountered organism. Various anatomical sites were considered separately and it was found that the axilla and breast were particularly prone to infection by Staph. aureus. The incidence of infection by coliform bacilli in Bartholin's and anorectal abscesses was significantly higher than in abscesses elsewhere. The importance of these observations in relation to antibiotic therapy is discussed.
Chylothorax: A complication of Dwyer's anterior instrumentation
Authors: Eisenstein Steve , O'Brien John Patrick
Published: March 2007

The authors report the development of an extensive right chylothorax several days after Dwyer's anterior instrumentation in a 6-year-old girl with a severe progressing infantile scoliosis. Instrumentation extended from T11 to L4 with removal of the tenth rib and with splitting of the diaphragm. The postoperative course was initially without any problems. However, respiratory distress on the tenth day after surgery was accompanied by mediastinal shift and the symptoms were relieved with aspiration of 600 ml of chyle from the right pleural cavity.

The literature on this complication of chylothorax is reviewed; it has been observed in cardiothoracic surgery. The management of the case is reported in detail and methods of detection and treatment are discussed.
The neutrophil count in childhood acute appendicitis
Authors: Doraiswamy N V
Published: March 2007

A study was made of the total leucocyte count, neutrophil percentage and absolute neutrophil count in 100 consecutive childre with acute appendicitis and in 25 children from whom, following a provisional diagnosis of acute appendicitis, a normal appendix had been removed, no other infective or inflammatory lesion having been found. In the first group there was a raised total leucocyte count in 42 per cent, a raised neutrophil percentage in 93 per cent and a raised absolute neutrophil count in 77 per cent. In the second group the corresponding figures were 4, 24 and 16 per cent. Acute appendicitis is associated with changes in the total leucocyte and neutrophil counts and a correct interpretation of the results of these investigations requires that account be taken of the age of each child. A probable maximum absolute neutrophil count has been calculated. An explanation has been suggested for the presence of normal total leucocyte counts in certain cases in spite of acute appendicitis.
The results of arterial reconstruction utilizing the profunda femoris artery in the treatment of rest pain and pre-gangrene
Authors: Hill D A , Jamieson C W
Published: March 2007

Arterial reconstruction utilizing the profunda femoris artery was performed for rest pain and pre-gangrene in 45 limbs. The preoperative mean ankle arterial pressure index of 0·21 (s.d. 0·12) was increased to 0·52 (s.d. 0·16) in the 22 limbs salvaged by the reconstruction.

In 38 limbs a proximal reconstruction was necessary in addition to profundaplasty. At a mean follow-up time of 15·4 months 41·6 per cent of the 36 patients were dead.
Carcinoma of the male breast: A review of 200 cases
Authors: Ribeiro G G
Published: March 2007

Two hundred cases of male breast carcinoma were treated at the Christie Hospital, Manchester, between 1942 and 1971. The survival rate of the group following curative treatment is presented; the response to palliative treatment is also discussed. The survival rate was particularly good for stage I cases, with 79 per cent surviving for 5 years and 56·3 per cent surviving for 10 years. However, the later stages did less well, particularly when compared with female patients of the same age and stage. With such a rare disease it would be of help to centralize the treatment of these patients as much as possible.
Pulmonary function in the early postoperative period
Authors: Parfrey P S , Harte P J , Quinlan J P , Brady M P
Published: March 2007

To the authors' knowledge, an intensive investigation of pulmonary function during the first 2 postoperative days has not previously been reported. Consequently, in this study the effect of regional surgery on respiratory function, monitored every 4 h during the first 2 postoperative days, was analysed. Hypoxaemia was a constant finding in all patients undergoing general anaesthesia. The degree and duration of hypoxaemia and spirometry changes were related to the site of surgical incision. Clinical signs of atelectasis were commonly observed during the first postoperative day and occurred after the change in Po2 and spirometry. Atelectasis was more common in patients having upper abdominal surgery. The current investigation reveals that the earliest postoperative change indicative of atelectasis is the fall in Po2; that auscultatory changes do not always occur in the presence of postoperative hypoxaemia; that auscultatory signs are not indicative of the extent of the Po2 fall; and that radiology represents a crude method of assessing postoperative atelectasis.
Saddlebag hernia
Authors: Qvist George
Published: March 2007

Saddlebag hernia occurs most commonly as a small indirect sac in association with an obvious direct inguinal hernia. It may be easily overlooked at operation. Hoguet's manœuvre is the most satisfactory method of operative treatment of saddlebag hernia. It is suggested that an overlooked indirect sac associated with a direct inguinal hernia is a common cause of recurrent inguinal hernia.
Carcinoma of the thyroid gland in Iran
Authors: Hashemian Hassan , Keyhani Amanelah
Published: March 2007

Of the 1698 cases of thyroid disease seen during the 17 years 1956–72 in the Taj Cancer Institute, Tehran, 398 were cases of carcinoma, an incidence of 23·4 per cent. The factors involved in this high incidence of malignancy are discussed and the treatment of these patients is described.
The effect of vagotomy on the lower oesophageal sphincter: A manometric study
Authors: Angorn I B , Dimopoulos G , Hegarty M M , Moshal M G
Published: March 2007

The pressure profile of the gastro-oesophageal junctional zone was studied at rest and during abdominal compression in 26 duodenal ulcer patients after subdiaphragmatic truncal vagotomy with a drainage procedure. An ‘early’ group of 9 patients was investigated 10–14 days after surgery and a ‘late’ group of 17 patients more than 1 year after operation. Comparisons were made with 25 control subjects.

The resting lower oesophageal sphincter pressures after vagotomy in both the early and late groups were similar to the levels of sphincter pressure in the controls. However, the increase in sphincter pressure always observed during abdominal compression in normal subjects was significantly decreased by complete vagotomy, and the normal increase in the gastrosphincteric pressure gradient was not produced.

All 26 patients were tested for completeness of vagotomy using the insulin/pentagastrin test. In 19 patients the vagotomy was complete and in 7 patients it was judged to be incomplete. A decrease in the gastro-sphincteric pressure gradient on manometric study of the lower oesophageal sphincter was interpreted as indicating complete vagotomy. Accurate correlation between secretory response and compression response was achieved in all patients with complete vagotomy and in 5 of the 7 patients with incomplete vagotomy.
Stricture-plasty for tubercular strictures of the gastro-intestinal tract
Authors: Katariya R N , Sood S , Rao P G , Rao P L N G
Published: March 2007

Twenty stricture-plasties have been performed for multiple tubercular strictures of the gastro-intestinal tract in 9 patients, who in total had 35 structures. The procedure has been found to be safe, simple and effective in relieving obstructive symptoms. It does not appear to carry the disadvantages of entero-anastomosis or multiple and/or massive resections in cases of multiple tubercular strictures of the small bowel.
Volvulus of the sigmoid colon
Authors: Khoury George A , Pickard Robert , Knight Michael
Published: March 2007

The clinical presentation and treatment of 31 consecutive patients with sigmoid volvulus are reviewed. Nearly half of these patients had a history of mental illness and one-third of all patients were chronically constipated. The main clinical features of abdominal pain and gross abdominal distension had been present for an average of 8 days before presentation of the patient to hospital. The clinical diagnosis of sigmoid volvulus was not difficult but the presence of non-viable bowel was more difficult to establish. A silent abdomen was the most valuable indication of the presence of gangrenous bowel.

Conservative measures, including sigmoidoscopy and therapeutic barium enema, successfully reduced the volvulus in half of the cases so treated.

In those patients undergoing surgery the procedure associated with the lowest mortality was sigmoid resection with end-to-end anastomosis. The overall mortality was 35 per cent.
Function of the anal sphincters following colo-anal anastomosis
Authors: Lane R H S , Parks A G
Published: March 2007

Developments in sphincter-saving operations for carcinoma of the rectum have led to renewed interest in the function of the pelvic floor muscles and the anal sphincters. Twelve patients with a colo-anal anastomosis have been investigated physiologically with reference to sphincter function. It has been shown that the rectum is not essential for the appreciation of impending evacuation, nor for the sphincter inhibitory reflexes, which in this study were elicited by balloon distension above the anastomosis.
Giant diverticula of the colon
Authors: Camprodon R , Guerrero J A , Mendoza C G , Crespo C
Published: March 2007

A case of a gas-filled intra-abdominal abscess cavity is reported. The literature is reviewed for similar cases and with reference to the cause and differential diagnosis of abdominal air cysts.
The value of ultrasonic B-mode scanning in the diagnosis of persistent jaundice
Authors: Armitstead P R , Addison N V , Follows O J
Published: March 2007

The use of ultrasonic B-mode scanning of the liver and biliary tract in patients with persistent jaundice is described. Sixty-seven consecutive jaundiced patients have been scanned. A correct diagnosis was obtained in 66 per cent, useful information in 26 per cent and in only 8 per cent was the information misleading or of no diagnostic value. In our opinion this simple and non-invasive technique is of great value in the definitive diagnosis of persistent jaundice and should allow earlier surgery in the obstructive cases.
Breast screening and surgical problems
Authors: Owen A W M C , Forrest A P M , Anderson T J , Samuel E , Young G B , Scott A M
Published: March 2007

The Edinburgh Breast Screening Clinic in its first year completed the initial screening examination of 3005 invited women, who were apparently in good health, aged between 40 and 60 years; 141 were referred for a surgical opinion; 70 women ultimately underwent biopsy and 9 proved to have carcinoma. The indications for biopsy are described together with methods of management of the various lesions.
Haemodynamics of axillofemoral grafting in a case with normal inflow and outflow vessels
Authors: Delin A , Swedenborg J
Published: March 2007

Intra-operative haemodynamics were studied in a case of axillofemoral grafting. When the normal axillary artery acted as the donor artery no steal from the arm occurred, even after vasodilatation in the leg. When, conversely, the very poor arterial collaterals to the leg were required to serve as donor arteries because the axillary artery proximal to the anastomosis was occluded by a clamp, a steal from the leg to the arm was observed. The study supports the concept that only if the donor artery has a high resistance to flow can a steal develop.
Mesenteric venous thrombosis occurring late after splenectomy
Authors: Nagasue Naofumi , Inokuchi Kiyoshi , Kobayashi Michio , Saku Motonori
Published: March 2007

Two patients with mesenteric venous thrombosis which occurred late after splenectomy are reported. In the first case the thrombosis was seen, with preceding thrombocytosis, 3 years after splenectomy. In the second case the thrombosis occurred 2 years and 5 months postoperatively. Platelet counts had not been obtained before the mesenteric thrombosis in this case. In both instances persistent severe anaemia for several weeks preceded the symptoms and signs of mesenteric venous thrombosis. Both patients were treated by extended resection of the affected small bowel. Thus, dangerous thrombocytosis may occur in the presence of persistent severe anaemia even late after splenectomy. Thrombocytosis occurring immediately after splenectomy, which is almost inevitable, should be treated with heparin or other anticoagulants. In the late period the avoidance of persistent severe anaemia seems to be important in the prevention of thrombotic complications due to reactive thrombocytosis in splenectomized patients.
Ammonia absorption from the canine colon after portacaval shunt
Authors: Harrison I D , Smith A Hardy , Shields R
Published: March 2007

Ammonia absorption was studied from Thiry–Vella colon loops in 6 dogs. Four underwent an end-to-side portacaval shunt and it was shown that absorption of ammonia from the colon significantly increased postoperatively. Absorption of ammonia from various solutions was also measured before and after portacaval shunt and it was shown that absorption was increased from a high pH solution and from a solution with a high bicarbonate content and reduced from a low pH, low osmolality and high osmolality solution. Increased deposits of stainable iron were demonstrated in the livers of dogs following portacaval shunt.
Foreign body in the oesophagus: Review of 2394 cases
Authors: Nandi P , Ong G B
Published: March 2007

A total of 2394 patients with a foreign body in the oesophagus was treated in our unit between 1965 and 1976, including 343 children in whom fish bones (146) and coins (134) were most commonly responsible; in adults, bones (fish and chicken) were commonest. Most of the foreign bodies were impacted in the cervical oesophagus. Pharyngoscopy and oesophagoscopy were carried out under general anaesthesia in all cases except those in which the foreign body was ejected spontaneously or when the patient refused the examination. Oesophageal perforation due to a foreign body was encountered in only one child. Two patients in the series developed the fearsome complication of oesophagoaortic fistula.
The pattern of non-diabetic peripheral vascular disease in South India
Authors: Shead G V , Oomen Ranjit M , Savarirayan S S
Published: March 2007

One hundred and twelve South Indian males with nondiabetic peripheral vascular disease of the lower limb were classified clinically into three groups according to the level of obstruction (aorto-viliac, 26 patients; femoropopliteal, 46 patients; distal, 40 patients). Arteriography was done in 65 patients and serum lipid estimations in 69.

In the aorto-iliac group the mean age was 45 years (± 11·6 s. d.); 23 per cent had hypertension, 28 per cent polycythaemia and 55 per cent hyperlipidaemia. Aortography suggested atheroma in most. In the femoropopliteal group the mean age was 39 years (± 12·8); 22 per cent had hypertension, 11 per cent polycythaemia and 21 per cent hyperlipidaemia. Arteriography showed lesions typical of atheroma in many and was consistent with thrombo-angiitis obliterans in some. In the distal group the mean age was 37 years (± 9·8); 8 per cent had hypertension, 20 per cent polycythaemia, 25 per cent hyperlipidaemia and 20 per cent had distal arterial disease of the upper limb. Arteriography was consistent with thrombo-angiitis obliterans in most cases. Atheroma seemed to be implicated in 96 per cent of the aorto-iliac group and in 64 per cent of the femoropopliteal group.
Peritoneal lavage in faecal peritonitis in the rat
Authors: Stewart D J , Matheson N A
Published: March 2007

Intraoperative antibiotic peritoneal lavage was significantly better than systemic antibiotic in preventing death from induced faecal peritonitis in the rat. Its efficacy was due to the combined effects of lavage and intraperitoneal antibiotic, each factor alone being significantly inferior to the combined effect of both. Antiseptic lavage was less effective than antibiotic lavage.
Wound infection in emergency appendicectomy: A prospective trial with topical ampicillin and antiseptic solution irrigation
Authors: Tanphiphat Chanvit , Sangsubhan Chesada , Vongvaravipatr Viroj , La-Ongthong Banyat , Chodchoy Viroj , Treesaranuvatana Soontorn , Ittipong Poonpong
Published: March 2007

A randomized controlled trail in 374 patients requiring emergency appendicectomy to determine the value of topical ampicillin and antiseptic solution of chlorhexidine and cetyl trimethyl ammonium bromide (Savlon) in preventing wound infection is reported. The application of 1 g of ampicillin powder to the wound significantly reduced wound infection in perforated appendicitis, but not in unperforated appendicitis. Wound irrigation with 1 per cent cetyl trimethyl ammonium bromide was ineffective in preventing wound infection in all grades of appendicitis. When wound contamination is difficult to avoid, as in perforated appendicitis, topical ampicillin should be used to reduce the rate of wound infection.
The early use of fine-needle percutaneous transhepatic cholangiography in an approach to the diagnosis of jaundice in a surgical unit
Authors: Benjamin I S , Allison M E M , Moule B , Blumgart L H
Published: March 2007

Fine-needle percutaneous transhepatic cholangiography (PTC) was performed in a series of 46 patients with jaundice or suspected biliary tract disease. The ductal system was successfully outlined in each of 20 patients with dilated intrahepatic ducts and in 19 of 26 patients with intrahepatic ducts of normal calibre. There were two episodes of septicaemia after PTC, one of them fatal. Valuable accurate diagnostic information was obtained in all cases with biliary tract obstruction. A programmed approach to diagnosis of suspected obstructive jaundice is outlined. Fine-needle PTC is an acceptably safe procedure and need not be followed by immediate laparotomy.
Side-to-side choledochoduodenostomy in the management of choledocholithiasis
Authors: Engin A , Haberal M , Sanaç Y
Published: March 2007

Sixty patients with choledocholithiasis (either single or multiple stones of the biliary tree) were treated with lateral choledochoduodenostomy. Of these cases 83·3 per cent were followed up for from 1 to 7 years. Only 1 patient developed cholangitis, which responded well to conservative treatment. The other cases have been asymptomatic following surgery. The diameter of the common bile duct is not an important problem in constructing a functional anastomosis.
Gallstone disease presenting as septicaemic shock
Authors: Faber R G , Ibrahim S Z , Thomas D M , Beynon G P J , Le Quesne L P
Published: March 2007

Three patients are described who were admitted to hospital with septicaemic shock due to gallstones, but in none of whom had the presence of gallstones been diagnosed previously. All 3 had positive blood cultures, Clostridium welchii being isolated in one patient (in another patient this organism was isolated from the bile). Two patients had renal failure requiring dialysis. All 3 patients survived. The management of this serious presentation of gallstones, hitherto poorly described in British literature, is discussed.
Endoscopic retrograde cholangiography in hepatic hydatid disease
Authors: Cottone M , Amuso M , Cotton P B
Published: March 2007

Endoscopic retrograde cholangiography provides safe preoperative documentation of the relationship of hepatic hydatid cysts to the biliary ductal system and accurate distinction from coincident calculus disease.
In vivo release of gastrin into human gastric juice
Authors: Knight N F , Fiddian-Green R G , Vinik A I
Published: March 2007

The release of antral gastrin has been examined in human subjects by infusing saline and albumin into their stomachs. Immunoreactive gastrin (IRG) was present in fasting serum but not in fasting gastric juice. Intragastric infusions of saline and albumin induced small but significant (P < 0.05) rises in the serum concentrations of IRG. There was no significant difference between the magnitude of the serum gastrin responses to these two stimuli. The stimuli induced a rise in the luminal concentration of IRG which was sixfold greater than that in the serum concentration of IRG. The response to albumin was significantly greater than the response to saline (P < 0.05). The IRG in gastric juice was chromatographically similar to heptadecapeptide gastrin. The stimuli also released IRG in patients with duodenal ulcers. The magnitude of the release into serum and gastric juice in these patients was significantly reduced by antrectomy (P < 0.05).
Prospective randomized multicentre trial of proximal gastric vagotomy or truncal vagotomy and antrectomy for chronic duodenal ulcer: Interim results
Authors: Dorricott N J , McNeish A R , Alexander-Williams J , Royston C M S , Cooke W M , Spencer J , de Vries B C , Muller H
Published: March 2007

In three centres, 222 patients (Birmingham 70, London 87 and Rotterdam 65 patients) with chronic duodenal ulcer were treated by proximal gastric vagotomy (PGV) (116 patients) or truncal vagotomy and antrectomy (TVA) (106 patients) in a prospective randomized trial. After 1 year 5 recurrent duodenal ulcers (4·3 per cent) have been recorded in the PGV group, compared with 1 (1 per cent) in the TVA group. The reoperation rate was high in both groups–6 after PGV, usually for recurrent ulcer, and 7 afer TVA, mostly for gastric retention.

PGV showed a marked superiority in the number of patients with a good clinical result (Visick I or II) at 1 year after operation, i. e. 82 per cent compared with 56 per cent for TVA.
Peroperative grading of pyuloric stenosis: A long term clinical and radiolgoical follow-up of patients with servere pyloric stenosis treated by highly selective vagotomy and dilatation of the stricture
Authors: Delaney Peter
Published: March 2007

Highly selective vagotomy (HSV) is now an accepted form of surgery for uncomplicated duodenal ulcer. Highly selective vagotomy and dilatation has been successfully used in some cases of pyloric stenosis, but many would regard severe pyloric stenosis as a contraindication to this procedure.

Eleven patients with severe pyloric stenosis, measured objectively at operation, have been treated by HSV and dilatation of the stenosis and reviewed for periods of up to 3 years. The clinical results, immediate and long term, were good in all cases. Barium studies and histopathological findings were slower to return to normal.

With intensive preoperative preparation to restore the tone of the dilated gastric muscle and gentle, controlled dilatation of the stricture, HSV in these patients should be as satisfactory as in those patients with uncomplicated duodenal ulcer.
Cell viability studies on the exfoliated colonic cancer cell
Authors: Rosenberg I L , Russell Carol W , Giles G R
Published: March 2007

Suspensions of desquamated colonic cancer cells were obtained from patients with cancer of the large bowel by colonic exfoliative cytology and from resected specimens of colonic cancer by an ex vivo exfoliation technique. In addition, a tumour suspension was obtained from the resected specimens. Cell viability studies were performed on these cell suspensions. Whereas 23 of the 25 tumour homogenate cell suspensions were shown to exclude trypan blue, none of the exfoliated colonic cancer cell suspensions had viable cells. This finding would cast some doubt on the hypothesis that suture line recurrence following large bowel cancer surgery is due to the implantation of cells desquamated from the surface of the growth.
The importance of plasma lipid, glucose, insulin and fibrinogen in femoropopliteal surgery
Authors: Harris P L , Harvey D R , Bliss B P
Published: March 2007

Fasting blood levels of cholesterol, triglyceride, glucose, insulin and fibrinogen were measured preoperatively in 44 patients who had reconstructive operations for occlusive disease in the femoral and popliteal arteries. Comparison of these preoperative biochemical measurements with the results of surgery over a 4-year period indicated that failure was associated with significantly higher mean preoperative levels of both glucose (P < 0.01) and fibrinogen (P < 0.01). High fasting blood glucose was associated with early failure (occlusion between 3 and 12 months) and high plasma fibrinogen was associated with late failure (occlusion between 1 and 4 years). The results of operation were not influenced significantly by preoperative blood levels of cholesterol, triglyceride or insulin.
The mechanism of calf claudication: Studies of simultaneous clearance of 99Tcm from the calf and thigh
Authors: Angelides N , Nicolaides A , Needham T , Dudley H
Published: March 2007

Simultaneous clearance of 99Tcm from the gastrocnemius and quadriceeps muscles has been studied in 74 limbs of 62 patients with claudication and in 20 normal limbs of 15 volunteers. The local decay curve for 10 min at rest and for 20 min after a 3-min treadmill walk at 4.5 km/h was recorded. The changes in blood flow which occurred after exercise were characteristic of the arteriographic lesions and they explain the haemodynamics of claudication.