bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of lower limb ulceration in an urban health district
Authors: Lees T A , Lambert D
Published: March 2007

Before establishing a community leg ulcer programme, a survey was performed to assess the incidence and prevalence of lower limb ulceration in the Newcastle Health District. The prevalence was 1.9 per 1000 in patients over the age of 45 years, and the annual incidence 3.5 per 1000 in the same age group. Recurrent ulcers represented 47 per cent of the total and 50 per cent of all ulcers had been present for >6 months. District nurses spent 190 h per week in the community dressing leg ulcers, making a total number of 25 922 visits each year. In the treatment of leg ulcers 35 different types of dressing were used and only 14 per cent of ulcerated limbs were treated by appropriate compression. Of all patients with leg ulcers, 35 per cent had been seen by a hospital specialist but only 7 per cent had been examined by a vascular surgeon at any time.
Needle core biopsy of the breast with a spring-loaded device
Authors: McMahon A J , Lutfy A M , Matthew A , Walls A D F , McOrmicky J Stc , Henderson M A , Auld C D
Published: March 2007

Over a 2-year period, 151 outpatients with a palpable breast lump requiring needle core biopsy were randomized to a Tru-Cut 14-G (T14), Bioptycut 14-G (B14) or Bioptycut 18-G (B18) needle. Use of a Biopty gun resulted in less pain than a Tru-Cut needle. An inadequate sample was obtained after two needle passes in 11 of 49 (T14), none of 51 (B14) and two of 51 (B18) patients (X2 = 14.6, 2 d.f., P = 0.0007). Tissue samples were assessed by a single pathologist for tissue volume and overall diagnostic value; the B14 group scored better than the B18 and T14 for both of these parameters (P < 0.003). The sensitivities were 68(T14), 88(814) and 96 (B18) per cent (overall X2 = 7.3, 2 d.f., P = 0.026). The Biopty gun with a 14-G needle results in a higher sampling success rate, greater diagnostic sensitivity and a better specimen quality than the Tru-Cut, and is much easier to use.
Safety of fibreoptic endoscopy: Analysisa of cardiorespiratory events
Authors: Thompson A M , Park K G M , Kerr F , Munro A
Published: March 2007

Cardiorespiratory function during upper gastrointestinal endoscopy and colonoscopy was studied prospectively in 164 patients. Cardiorespiratory events, which were defined as oxygen saturation <90 per cent, electrocardiographs changes, heart rate < 50 or > 100 beats/min and systolic blood pressure <100 mmHg, occurred in 111 patients. In 24 of these, changes were attributed solely to intravenous sedation. In the remaining 140 patients, events were noted in 34 (52 per cent) of 66 upper gastrointestinal endoscopies and during 53 (72 per cent) of 74 colonoscopies. One patient suffered a myocardial infarction during colonoscopy. Although cardiorespiratory events were common (111 of 164; 68 per cent), the actual morbidity rate was low (one of 164; 0.6 per cent). Cardiorespiratory events were significantly more common in patients with a history of cardiac disease for both upper gastrointestinal endoscopy and colonoscopy (overall X2 = 7.41, 1 d.f., P < 0.05) and more common for oesophageal dilatation than for diagnostic endoscopy (X2 = 5.56, 1 d.f., P < 0.05). It is recommended that patients with a history of cardiac problems undergoing upper gastrointestinal endoscopy or colonoscopy and all those requiring therapeutic endoscopy should be monitored carefully to allow early detection of cardiorespiratory events, and that oxygen should be administered routinely.
Barrett's oesophagus: Effect of antireflux surgery on symptom control and development of complications
Authors: Attwood S E A , Barlow A P , Morris T L , Watson A
Published: March 2007

Forty-five patients with histologically proven Barrett's columnar-lined oesophagus (CLO) were treated in one unit over a 9-year period. Patients were studied prospectively as part of a surveillance programme; all initially received standard conservative treatment including high-dose H2-receptor antagonists. A satisfactory initial response was seen in 21 patients, but in 24 the symptoms were unchanged or progressed; 19 patients in the latter group were considered suitable for antireflux surgery and underwent fundoplication. Symptoms of heartburn or dysphagia persisted or recurred in 88 per cent of patients receiving medical treatment alone and complications developed in 38 per cent, including nine strictures and one adenocarcinoma. In patients undergoing antireflux surgery, symptoms persisted or recurred in 21 per cent and complications developed in 16 per cent (P < 0-01). Complete regression of Barrett's CLO occurred in two patients (11 per cent) after antireflux surgery. The results of this study suggest the superiority of antireflux surgery over pharmacological acid suppression in the control of symptoms and prevention of complications in patients with Barrett' CLO.
Psychomotor testing and the ability to perform an anastomosis in junior surgical trainees
Authors: Steele R J C , Walder C , Herbert M
Published: March 2007

Ten junior surgical trainees underwent objective testing of manual dexterity and visuospatial ability and were required to carry out five consecutive anastomoses on fresh porcine jejunum. Anastomoses were scored by a single observer and a cumulative error score (CES) derived for each procedure. In the first anastomosis there was little correlation between the psychomotor test results and the anastomosis scores. In subsequent trials there were significant negative correlations between aspects of manual dexterity and the CES. Over the five anastomoses there were significant negative correlations between improvement and manual dexterity, but there was a positive correlation between improvement and visuospatial ability (rs = 0.76, P < 0.005). Visuospatial skills are more important than pure motor ability in predicting the capacity to perform an anastomosis and tests of manual dexterity may be misleading in this context.
Prospective randomized trial comparing the shouldice technique and plication darn for inguinal hernia
Authors: Kingsnorth A N , Gray M R , Nott D M
Published: March 2007

The lowest recurrence rates after inguinal hernia repair have been achieved by specialized hernia clinics. The Shouldice repair achieves success through application of a meticulous standardized operation carried out by specialist hernia surgeons. In a trial designed to rule out surgeon-dependent variables, 322 inguinal hernias were randomized prospectively to Shouldice repair or plication darn. Fifteen general surgeons operated on 322 patients. Fourteen surgeons in training not familiar with Shouldice repair received constant supervision for six repairs before independent operation. The mean(s.d.) patient age was 58·3(1·5) (range 20·84) years for Shouldice repair and 57·s0(1·2) (range 18·85 years) for plication darn. The sex ratio (M:F) was 17:1 and right side to left side ratio 1.8:1. Six-week complication rates for wound infection (Shouldice repair, 5 per cent; plication darn, 4 per cent) and haematoma (Shouldice repair, 7 per cent; plication darn, 5 per cent) were similar in both groups. There were a similar number of sliding hernias in the Shouldice repair (14) and plication darn (20) groups. After a mean follow-up of 30 (range 24-48) months there were seven recurrences in the Shouldice group and four in the plication darn group (P >0.05). The recurrences suggest that additional supervision of junior surgeons is required during the Shouldice repair learning period.
Role of the rectum in the physiological and clinical results of coloanal and colorectal anastomosis after anterior resection for rectal carcinoma
Authors: Lewis W G , Holdsworth P J , Stephenson B M , Finan P J , Johnston D
Published: March 2007

This study investigated the relationships between length of residual anorectum, anorectal physiological function and clinical outcome after anterior resection for rectal carcinoma. Thirty-four patients were studied a median of 13 (range 4–100) months after anterior resection. They were compared with a control group often patients who had undergone sigmoid colectomy for carcinoma without rectal excision. Resting anal pressure was found to be lower after coloanal than after colorectal anastomosis, and the capacity of the (neo)rectum was less after coloanal than after colorectal anastomosis. The (neo)rectoanal inhibitory reflex was found to be present in each patient, but maximum anal pressure during this “sampling” reflex was significantly lower (P < 0.01) after coloanal than after colorectal anastomosis, and the volume required for maximal inhibition of the sphincter was also less (P < 0.01). At 1 year after operation, median bowel frequency was greater after coloanal (4 per day) than after colorectal (2 per day) anastomosis and the degree of urgency of defaecation was also greater (P < 0.01). Quality of life in terms of anorectal function after anterior resection is thus significantly influenced by the length of rectum that is left. This, in turn, influences the functional capacity of the neorectum and the degree of inhibition of the anal sphincter during the neorectoanal inhibitory reflex.
Survival after hepatic resection for malignant tumours
Authors: Savage A P , Malt R A
Published: March 2007

A retrospective analysis of 194 patients who underwent hepatic resection for primary or metastatic malignant disease from January 1962 to December 1988 was undertaken to determine variables that might aid the selection of patients for hepatic resection. Hepatic metastases were the indication for resection in 126 patients. The 5-year survival rate was 17 per cent. For patients with resected metastases from colorectal cancer (n = 104), the survival rate at 5 years was 18 per cent. The 5-year survival rate was 27 per cent when the resection margin was >5 mm compared with 9 per cent when the margin was ≤5 mm (P < 0.01). No patient with extrahepatic invasion, lymphatic spread, involvement of the resection margin or gross residual disease survived to 5 years, compared with a 23 per cent 5-year survival rate for patients undergoing curative resection (P < 0.02). The survival rate of patients with poorly differentiated primary tumours was nil at 3 years compared with a 20 per cent 5-year survival rate for patients with well or moderately diflerentiated tumours (P not significant). The site and Dukes' classification of the primary tumour, the sex and preoperative carcinoembryonic antigen level of the patient, and the number and size of hepatic metastases did not afect the prognosis. The 5-year survival rate for patients with hepatocellular carcinoma (n = 42) was 25per cent. An improved survival rate was found for patients whose α-fetoprotein level was normal (37 per cent at 5 years) compared with those having a raised level (nil at 3 years) (P < 0.01). Involvement of the resection margin, extrahepatic spread and spread to regional lymph nodes were associated with an 8 per cent 5-year survival rate versus 44 per cent for curative resection (P < 0.005). The presence of cirrhosis, the presence of symptoms, and the multiplicity and size of the tumour did not affect the prognosis. The 5-year survival rate of 11 patients with hepatic sarcoma was 25 per cent. No patient with peripheral cholangiocarcinoma survived to 1 year in contrast to patients with hilar cholangiocarcinoma, all four of whom survived for more than 14 months.
Physiological variation in rectal compliance
Authors: SøRensen M , Rasmussen O ø , Tetzschner T , Christiansen J
Published: March 2007

The volume (V) of air inflated in a latex balloon placed in the rectum and the corresponding pressures (P) were measured in 48 subjects (24 men and 24 women) at three points: (1) earliest defaecation urge; (2) constant defaecation urge; and (3) maximum tolerable volume (MTV). The rectal pressures in all three cases were higher in men than in women. Woman aged over 60 years had higher rectal compliance (ΔV/ΔP) than men in the same age group, while no difference was found between men and women below the age of 60 years. Day-to-day variation of the measurements was tested in ten subjects. Reproducibility was good only for MTV (95 per cent confidence interval 57–183 per cent). Reproducibility of rectal compliance decreased with increasing values for this parameter. No such trend was found for the other parameters. In conclusion, MTV is a reproducible parameter and suitable for clinical use in evaluation of patients with faecal incontinence or constipation.
Editorial Board of The British Journal of Surgery
Authors: Williamson Robin
Published: March 2007

Continuing our series, we present the Editorial Board of the Journal, starting with the representatives from Great Britain and Ireland, who make up the Members of The British Journal of Surgery Society.
Mycetoma
Authors: Fahal A H , Hassan M A
Published: March 2007

Mycetoma is a chronic infective condition of tropical and subtropical regions. It is commoner in males, especially those in their third or fourth decade who work on the land. The clinical triad of subcutaneous nodule, sinuses and discharge usually leads to diagnosis; the disease is commonly painless. Treatment is by extensive surgical excision of afected areas and may include limb amputation. Recurrence is common, rates ranging from 20 to 90 per cent. Medical treatment may be used on its own or as an adjunct to surgery. Although such therapy may cure over half of those with actinomycetoma (caused by bacteria, mainly aerobic actinomycetes), those afected by eumycetoma (caused by fungi) have a poorer prognosis and may require many years of drug therapy.
Serotonin-induced contractility in human saphenous vein is inhibited by naftidrofuryl
Authors: Vashisht R , Sian M , Sharp E J , Leathard H L , O'Malley M K
Published: March 2007

Vascular endothelial denudation contributes to vasospasm by causing platelet aggregation und the subsequent releuse of vasoconstrictors such as serotonin. It has recently been suggested that naftidrofuryl fumarate (NFT) may oppose serotonin-induced vasoconstriction. Fourteen rings of human saphenous vein from 14 patients undergoing varicose vein surgery were tested in standard organ bath experiments. Cumulative dose—response curves and maximal Contraction in response to serotonin were recorded and this was repeated in the presence of NFT at 10−6 and 10−3 mol/l. The difference in maximal contractility between the three sets of curves was significant (P < 0.0001). Sensitivity to serotonin in each of the three curues was meusured using the concentration for half-maximal response; differences were again significant (P < 0.0001). It is concluded that NFT reduces serotonin-induced contractility in a dose-dependent fashion in rings of human saphenous vein in vitro. These results suggest a possible role for NFT in reducing vasospasm and support further investigation of this drug.
Laser recanalization versus endoscopic intubation in the palliation of malignant dysphagia: a randomized prospective study
Authors: Carter R , Smith J S , Anderson J R
Published: March 2007

Forty patients with histologically confirmed malignant dysphagia were randomized to either endoscopic intubation or laser recanalization. Age, sex, tumour histology and site were evenly distributed between the groups. Results were analysed on an ‘intention to treat’ basis. All patients treated by laser achieved patency; there was one failed intubation. The best swallowing grade achieved was significantly better with laser recanalization (median 4 (range 3–4)) than with intubation (median 3 (range 2–4)) (P < 0.001). The median survival was 21.5 (range 4–62) weeks in the group receiving laser treatment, compared with 14.5 (range 7–102) weeks in the intubated group (P = 0.09). The median inpatient stay as a proportion of survival time was 14 per cent in the group receiving laser treatment compared with 15 per cent in the intubated group (P > 0.05). The median weight loss was less in the laser-treated patients (2.0 (range 2–8) versus 3.0 (range 0–10) kg, P = 0.04). These results indicate that laser recanalization provides better palliation of dysphagia than does intubation, but this is not reflected in an improvement in survival time.
Closure of laparotomy wounds: skin staples versus sutures
Authors: Ranaboldo C J , Rowe-Jones D C
Published: March 2007

To investigate the routine use of a skin stapling device for the closure of midline abdominal wounds, 48 patients were randomized to receive skin staples or subcuticular polydioxanone sutures. The mean (range) time for closure with staples was 8.0 (3.4–14.8) s cm−1 while subcuticular closure took 12.7 (9.6–28.0) s cm−1. The mean time saved per patient with skin staples was 77s. Wound pain and requirements for analgesia were significantly lower in the sutured group. The mean cost per patient was £ 1.41 for subcuticular closure and £7.72 for stapling; the latter also incurred an additional cost of £6.27 for staple removal. No clear benefit derives from the use of staples in the closure of abdominal wounds.
Significance of intracystic pressure in abdominal hydatid disease
Authors: Yalin R , Aktan A Ö , Yeǧen C , Döşlüoǧlu H H
Published: March 2007

A prospective study was performed in 32 patients (24 female, eight male) with 50 abdominal hydatid cysts, to assess whether intracystic pressure (ICP) could predict viability. The median ICP, measured during operation, was 35 cmH20 for 31 viable cysts and zero for nine non-viable cysts located in the liver (P < 0.05). The median ICP was significantly higher in cysts located in the left lobe of the liver than in those in the right (P < 0.05). The ICP was not significantly different in unilocular or multilocular cysts. ICP increased as the diameter of the cysts increased. The sensitivity of the indirect haemagglutination test was 86 per cent and the specificity 75per cent. It is concluded that measurement of ICP is a simple and reliable method for assessment of the viability of abdominal hydatid cysts.
Liver transplantation for fulminant hepatic failure and late-onset hepatic failure in children
Authors: Tan K C , Mondragon R S , Vougas V , Mieli-Vergani G , Heaton N D , Mowat A P , Chiyende J , Baker A , Koukoulis G , Portmann B , Williams R
Published: March 2007

The mortality rate of fulminant hepatic failure (FHF) and late-onset hepatic failure (LOHF) in childhood has remained between 70 and 95 per cent despite recent improvements in medical therapy. Liver transplantation has become an important therapeutic option in adults with this condition but has been performed infrequently in children. Between March 1988 and August 1991, 12 children aged between 1 month and 14 years with FHF or LOHF received 13 liver transplants. The aetiology was viral hepatitis in eight children (non-A non-B in six, A in two), drug hepatotoxicity (carbamazepine) in two, autoimmune hepatitis in one and congenital haemochromatosis in one. Reduced-size livers were used for ten of the 13 transplants. Morbidity after operation included infective complications and abdominal bleeding. Two patients died from graft versus host disease, one from brain aspergillosis and another from graft infarction after portal vein thrombosis. Eight patients survive after a median follow-up of 18 months. Liver transplantation should be the therapeutic choice for children with FHF and LOHF for whom the chances of recovery are poor.
Antihepatitis C virus status in hepatocellular carcinoma and the influence on clinicopathological findings and operative results
Authors: Takeda S , Nagafuchi Y , Tashiro H , Abe Y , Fukushige H , Komori H , Okamoto K , Ohsato K , Haratake J
Published: March 2007

Antihepatitis C virus (HCV) status was investigated in 100 patients undergoing hepatectomy for hepatocellular carcinoma (HCC) between 1980 and 1989. The clinicopathological findings and operative results, inpatients with or without HCV marker, were compared retrospectively. The positivity rate of anti-HCV was 51 per cent. In this group there was a higher mean age, fewer symptoms, raised alanine aminotransferase level, higher 15-min indocyanine green clearance rate and earlier tumour stage compared with the anti-HCV negative group. Positive tumour margins and vascular invasion were seen less frequently in the anti-HCV positive group. HCC with HCV marker showed characteristic features of chronic non-A non-B hepatitis and of HCC originating from liver cirrhosis. There was a better cumulative 1-year survival rate for anti-HCV positive patients, but 3- and 5-year survival rates after hepatectomy were similar in both groups. Although HCV-related HCC had typical features of chronic non-A non-B hepatitis and a relatively early stage of tumour, biological features and operative results were similar with or without the HCV marker.
Rectal cancer risk in older patients with familial adenomatous polyposis and an ileorectal anastomosis: a cause for concern
Authors: Nugent K P , Phillips R K S
Published: March 2007

The risk of rectal cancer in 224 patients with familial adenomatous polyposis with an ileorectal anastomosis has been estimated by life-table analysis. Until the age of 50 years the cumulative risk is reasonably low at 10 per cent (95 per cent confidence interval 4.5–16 per cent), increasing sharply to 29 per cent (95 per cent confidence interval 18–40 per cent) by the age of 60 years. This means that surveillance of the retained rectum in older patients must either be improved or they should undergo restorative proctocolectomy in earlier middle age.
Mucin changes in ileoanal pouches monitored by metabolic labelling and histochemistry
Authors: Corfield A P , Warren B F , Bartolo D C C , Wagner S A , Clamp J R
Published: March 2007

The pattern of mucin synthesis and secretion in mucosal biopsies from the proximal ileum, distal ileum, rectum and pouch before and after ileostomy closure was monitored in patients undergoing restorative proctocolectomy by metabolic labelling with [3H]glucosamine and [35S]sulphate and compared with the mucin histochemistry in each patient. Metabolic labelling clearly demonstrated a reduction in sulphation associated with the rectal mucosa in colitis. Significant diferences in the turnover of isolated secreted mucin between proximal and distal ileum and rectum were also found, as was a metaplastic change towards a colonic-type mucosa in the pouch before and after ileostomy closure relative to the proximal and distal ileum, and rectum. This technique can be used to monitor colonic metaplasia in the pouch mucosa and is suitable for comparative studies where mucin changes are implicated.
General surgery in patients aged 80 years and older
Authors: Rørbæk-Madsen M , Dupont G , Kristensen K , Holm T , Sørensen J , Dahger H
Published: March 2007

This study reviews 594 surgical admissions, of patients aged 80 years and older, to departments of general surgery during 1 year. Half of the patients were admitted as emergencies and 60 per cent underwent surgery. The operative mortality rate was 8 per cent and the overall mortality rate for all admissions 9 per cent. The number of complications and the mortality rate after surgery increased in emergency cases and in patients with coexisting disease. Of all admissions, 72 per cent were uncomplicated and in 70 per cent patients could be discharged directly home; such patients do not generally take up beds and are discharged as soon as medical care is no longer indicated. The number of admissions of patients over 80 years of age will increase by about 30 per cent during this decade and, unless additional resources are provided to meet this challenge, new standards must be considered for the distribution of resources and of indications for surgery in both young and old.
Prosthetic vascular graft infection
Authors: O'Brien T , Collin J
Published: March 2007

The aetiology, diagnosis and management of prosthetic vascular graft infection are reviewed. The importance of contamination at the time of surgery as the crucial aetiological factor is highlighted. Staphylococcus epidermidis is the causative organism in over 50 per cent of cases and the reasons for this are explored. Sound surgical technique, use of prophylactic antibiotics and the avoidance of a groin incision are emphasized as the most important factors in prevention of graft infection. Difficulties of diagnosis are highlighted and the diagnostic role of various imaging methods is assessed. Graft excision with extra-anatomic revascularization is presented as the conventional surgical solution, while the roles of less radical surgical solutions and non-operative management are discussed.
Mechanical properties of the aneurysmal aorta
Authors: Macsweeney S T R , Young G , Greenhalgh R M , Powell J T
Published: March 2007

The mechanical properties of the abdominal aorta were investigated non-invasively in 30 patients with aortic anaeurysm and II with peripheral arterial disease. The distensibility of the aorta was measured using M-mode ultrasonography, permitting non-invasive assessment of the pressure-strain elastic modulus or aortic stiffness, Ep. The median Ep value increased, from 4.0 N/cm2 in control subjects in their third decade of life (n = 10) to 10.4 N/cm2 in middle age (n = 11) to 14.0 N/cm2 in the elderly (n = 13). In the presence of a normal diameter.peripheral arterial disease with aortic atherosclerosis had little effect on aortic stiffness, median Ep being 16.0 N/cm2. Aneurysmal dilatation was associated with a significant increase in aortic stiffness, median Ep being 31.3 N/cm2 (P < 0.001). For aortas of normal diameter, Ep was at all ages dependent on mean arterial pressure. In patients with aortic aneurysms there was no clear relationship between Ep and mean arterial pressure or aortic diameter. Of the patients studied, 15 underwent aortic rcconstruction; increasing aortic stiffness (log Ep) was associated with a decreased medial elastin content of the aortic biopsy (r = −0.63, P < 0.02). This study demonstrates the marked stiffness or inelasticity of dilated or aneurysmal vessels, part of which is attributable to the loss of elastin.
Effect of free radical scavenging on skeletal muscle blood flow during postischaemic reperfusion
Authors: Hardy S C , Homer-Vanniasinkam S , Gough M J
Published: March 2007

After 6-h tourniquet ischaemia of one hindlimb in male Sprague-Dawley rats, gastrocnemius muscle blood flow was measured following 10, 120 and 240 min of reperfusion using radiolabelled microspheres. A perfusion index was calculated (experimental limb: contralateral limb) for each of these times. Comparison of perfusion indices in ten control animals (6 h ischaemia, 4 h reperfusion) with similar measurements in ten normal rats with no ischaemia and in ten ischaemic animals with the tourniquet in situ demonstrated low median (interquartile range (i.q.r.)) reflow after 10 min (control 0.12 (0.02–0.43), ischaemia 0.04 (0.00–0.07), normal 1.05 (0.68–1.18); control versus ischaemia, P not signficant; control versus normal, P < 0.01). Relative reperfusion occurred at 120 min (control 0.48 (0.11–0.70), ischaemia 0.02 (001–0.07), normal 0.97 (0.79−1.13); control versus ischaemia, P < 0.05; control versus normal, P < 0.05) and reperfusion injury after 240 min of revascularization, with muscle blood flow being little diflerent from that in the ischaemic group (control 0.05 (0.01−0.38), ischaemia 0.03 (0.00–0.07), normal 1.01 (0.73–1.16); control versus ischaemia, P not significant; control versus normal, P < 0.01). Two groups of 12 rats were given either intravenous superoxide dismutase and catalase or dimethylthiourea 30 min before tourniquet release, continuing throughout the period of reperfusion. Superoxide dismutase and catalase reversed low reflow, producing a median (i.q.r.) perfusion index of 0.94 (0.54−1.12) (P < 0.01 versus control, P not significant versus normal), but had no effect on relative reperfusion (0.66 (0.42–1.01), P not significant versus control) or on reperfusion injury (0.27 (0.01–0.35), P not significant versus control). In contrast, dimethylthiourea had no effect on perfusion at either 10 min (0.10 (0.03–0.15), P not significant versus control) or 240 min (0.04 (0.00–0.11), P not significant versus control), but abolished the phase of relative reperfusion at 120 min (0.04 (0.02–0.21), P < 0.01 versus control). These results indicate that, although superoxide radicals are harmful during postischaemic reperfusion, hydroxyl radicals may be beneficial.
Comparison of POSSUM with APACHE II for prediction of outcome from a surgical high-dependency unit
Authors: Jones D R , Copeland G P , De Cossart L
Published: March 2007

POSSUM and APACHE II scores from 117 consecutive admissions to a high-dependency unit after major surgery were correlated with 30-day morbidity and mortality rates. Thirteen patients (II per cent) died and 59 (50 per cent) developed a postoperative complication. Receiveroperating characteristic curve analysis showed POSSUM to have good predictive value for mortality (area under curve 0.75) and morbidity (area under curve 0.82). APACHE II scores had a significantly inferior predictive value for mortality (area under curve 0.54) (P < 0.002). POSSUM was superior to APACHE II in prediction of mortality in patients admitted to a high-dependency unit after general surgery. Prediction of postoperative complications by POSSUM is accurate and may be useful for audit.
Autopsy analysis in surgical patients: A basis for clinical audit
Authors: Barendregt W B , De Boer H H M , Kubat K
Published: March 2007

An autopsy study was performed to quantify diagnostic fallibility in clinical surgery. Autopsy results in 312 surgical patients were compared with clinical findings. The primary clinical diagnosis was correct in 93 per cent of patients: complications had been correctly diagnosed in 60 per cent and error in treatment was found in 16 per cent. Error in treatment had an adverse impact on the course of disease in 11 per cent of patients. Infective complications such as abdominal sepsis and bronchopneumonia were encountered most often. Sensitivity was low for the clinical diagnosis of pulmonary embolism, bronchopneumonia, myocardial infarction and terminal haemorrhage. Statistical analysis showed that sudden unexpected death is the most obvious condition in which a high yield is expected from a post-mortem examination. Autopsy remains a valuable means of quality control in clinical surgery and could be a basis for surgical audit.
Subcutaneous mastectomy with immediate reconstruction as treatment for early breast cancer
Authors: Palmer B V , Mannur K R , Ross W B
Published: March 2007

Subcutaneous mastectomy and axillary dissection combined with immediate reconstruction was used to treat primary breast cancer in a consecutive series of 111 patients. Local recurrence occurred in 19 patients (17 per cent) during a mean, follow-up of 30 (range 6–60) months. Complete control of local disease was achieved in all patients except one, who had terminal disease. Prophylactic radiotherapy was avoided for 83 per cent of patients, and good cosmetic results were obtained in 89 per cent. These results support the use of this technique in the treatment of early breast cancer.
Regional variation in the surgical treatment of early breast cancer
Authors: Morris J
Published: March 2007

A questionnaire survey of consultant surgeons in England was undertaken to establish the preferred surgical management of early breast cancer. The Regional Health Authority in which each surgeon worked was recorded to document regional variation. The 14 Regional Health Authorities were divided into three geographical areas: north, central and south. The main finding was that proportionately more surgeons in the north would recommend mastectomy (P < 0.0001) rather than conservative surgery compared with those in the central and southern areas. The nature of the study does not allow explanations for such variation.
Tumour oestrogen receptor content allows selection of elderly patients with breast cancer for conservative tamoxifen treatment
Authors: Low S C , Dixon A R , Bell J , Ellis I O , Elston C W , Robertson J F R , Blarney R W
Published: March 2007

Immunocytochemical analysis was used to determine tumour oestrogen receptor (ER) content in elderly patients with primary operable breast cancer. Only those ER positive were selected for conservative treatment with tamoxifen alone. Initial response was compared with that of historical controls not selected according to ER status. Early progressive disease was markedly reduced at 6 months, from 30 per cent in the unselected control group to 2 per cent in the study group (P < 0.001). Immunocytochemical analysis is useful for the initial selection of elderly patients with breast cancer who may be treated with tamoxifen alone.
Liver trauma: A 10-year experience
Authors: John T G , Greig J D , Johnstone A J , Garden O J
Published: March 2007

The management of 73 patients with liver trauma (58 male, 15 female; mean age 30 (range 6–68) years) presenting from January 1980 to August 1990 is reviewed. There were 29 cases of penetrating injury and 44 of blunt trauma. Seven patients were successfully managed without operation (five with blunt injury) and were discharged after a mean hospital stay of 8 days, Fifty-one cases were classified as simple injuries (grade I or II) and were managed by suture (with or without drainage) or required no intervention, with three deaths. Fifteen cases were classified as complex injuries (grade III or IV) and underwent one or more of the following: perihepatic packing, resectional debridement, hemihepatectomy and hepatotomy with direct suture ligation. Six of these patients died from uncontrolled haemorrhage. The continued use of suture for simple injuries and of resectional debridement and/or packing for complex injuries is supported. Judicious clinical assessment and radiological monitoring may reduce the number of unnecessary laparotomies.
Abdominal inflammatory myofibroblastic tumours in children
Authors: Stringer M D , Ramani P , Yeung C K , Capps S N J , Kiely E M , Spitz L
Published: March 2007

Inflammatory myofibroblastic tumours (inflammatory pseudotumours) occurring at intra-abdominal sites in children have rarely been described. This paper reports three patients with this tumour, two of whom presented with fever, anaemia and an abdominal mass, the third with chronic duodenal obstruction. All had experienced significant weight loss. At operation, each had a large fibrous tumour (7–18 cm in diameter) originating from the transverse mesocolon, small bowel mesentery and duodenum respectively. Intraoperative frozen section histological examination in one patient was misinterpreted as a sarcoma. All the lesions were judged to have been completely excised, but one was ruptured during operation and the patient subsequently developed recurrent tumour nodules. Abdominal inflammatory myofibroblastic tumours are rare. They may be suspected before operation but their clinical, radiological and pathological features may be confused with those of malignancy. Complete excision is necessary to avoid local recurrence.
Incidence and prognosis of Krukenberg tumour in Northern Ireland
Authors: Gilliland R , Gill P J
Published: March 2007

The case notes of 15 patients with Krukenberg tumours were studied to determine the incidence, presentation, clinical findings and prognosis of the disease in Northern Ireland. Patients tended to be young and premenopausal. A short history of abdominal pain was the most frequent presenting complaint, abdominal swelling being second. Menstrual irregularities occurred infrequently and no patient was virilized. Tumours tended to be large, bilateral and associated with ascites. The stomach was the commonest primary site. The overall prognosis was poor, especially if the primary tumour remained covert at the time of diagnosis. The prognosis was unaflected by subsequent discovery of the primary source; extensive investigation is inconvenient for the patient and wasteful of resources. The incidence of the tumour in Northern Ireland was 0.16 per 100 000 per annum: it will be rarely encountered by general surgeons.
Rectal cancer risk in patients treated for familial adenomatous polyposis
Authors: De Cosse J J , Bülow S , Neale K , Järvinen H , Alm T , Hultcrantz R , Moesgaard F , Costello C
Published: March 2007

Total colectomy with ileorectal anastomosis (IRA) in familial adenomatous polyposis (FAP) leaves patients at risk for rectal cancer. To assess this risk, the rectal cancer incidence in 297 patients with FAP undergoing IRA since 1951 was determined in the population-based registers of Denmark, Finland and Sweden. At the same time, detailed data on 50 patients with FAP and invasive rectal cancer were obtained from 11 international polyposis registries. The cumulative incidence of rectal cancer was 13.1 per cent at 25 years. The 5-year survival rate of patients with FAP developing rectal cancer was 71 per cent. Combining both studies, the risk of dying from rectal cancer after IRA was 2.0 per cent at 15 years of follow-up. These results justify IRA as primary treatment for most patients; restorative proctocolectomy is preferred for some subgroups. The high all-cause mortality rate observed in this relatively young population necessitates lifelong surveillance of patients with FAP.
Role of the neutrophil in adult respiratory distress syndrome
Authors: Windsor A C J , Mullen P G , Fowler A A , Sugerman H J
Published: March 2007

Adult respiratory distress syndrome (ARDS) remains a significant cause of morbidity and mortality in surgical practice. Despite the continued advance of surgical technique and therapy, the mainstay of treatment of ARDS remains supportive. In the past decade cytokines have been found to be primary chemical mediators of the host response to inflammatory disease. The polymorphonuclear leucocyte has also emerged as a possible cellular mediator of the end-organ damage that characterizes these inflammatory processes. The role of the neutrophil as the primary cellular mediator of alveolar capillary membrane injury in ARDS remains controversial. This article reviews the relevant current literature and considers the implications of the prevailing evidence on future management of this syndrome.
Outcome 5 years after 3600° fundoplication for gastro-oesophageal reflux disease
Authors: Johansson J , Johnsson F , Joelsson B , Florén C-H , Walther B
Published: March 2007

Forty patients with a mean age of 45 (range 22–65) years were operated on between 1982 and 1985 for gastro-oesophageal reflux disease with a short floppy 360° fundoplication. The results of the operation were determined by endoscopy, oesophageal manometry, ambulatory 24-h pH recording and symptom evaluation 6 months and 5 years after operation. These results were compared with findings in healthy controls. The median pressure in the lower oesophageal high-pressure zone was 13·3 (interquartile range (i.q.r.) 11·3–21·3) mmHg after 5 years, which did not differ significantly from the value at 6 months' follow-up or from that in controls. It was, however, significantly higher than the preoperative pressure. The median intra-abdominal length of the high-pressure zone was 1·7(i.q.r. 1·3–2·3) cm after 5 years, significantly less than at 6 months but equal to control length. Measurement of the proportion of total time at pH < 4 at 5 years (median 0·2 (i.q.r. 0·0–0·6) per cent) and 6 months after operation revealed a significant reduction in acid reflux compared with preoperative values and normal controls. There was no significant difference in acid exposure between the two postoperative investigations. Endoscopy showed that 27 patients had no oesophagitis, three had erythema and three persistent Barrett's oesophagus 5 years after operation. Normal belching was possible in 22 patients and 18 experienced increased flatulence 5 years after fundoplication. An independent gastroenterologist found that the result was excellent in 16 patients, good in 16 and fair in four; two patients had a poor overall outcome of the operation. It is concluded that a 360° fundoplication provides good long-term control of reflux and that slight symptoms of overcompetence are common among patients operated on without affecting the overall result.
Liver transplantation in patients with thrombosis of the portal, splenic or superior mesenteric vein
Authors: Moreno González E , Garc García I Ía , Sanz R G ÖMez , González-Pinto I , Segurola C Loinaz , Jim Romero C Énez
Published: March 2007

Fourteen cases are presented of preoperative portal vein thrombosis complicating orthotopic liver transplantation from an experience of 195 transplants carried out between April 1986 and April 1991. In four patients who suffered rethrombosis of the portal vein, the mortality rate was 100 per cent from various causes. Overall there were six deaths; two of those who died had a patent portal vein at death. Three patients underwent retransplantation: one for primary non-function, two for rejection. It is concluded that: (1) portal vein thrombosis should not represent an absolute contraindication to liver transplantation; (2) preoperative screening of prospective transplant recipients for portal thrombosis should be routine; (3) postoperative anticoagulation therapy and periodic Doppler ultrasonographic assessment of portal vein flow are important elements of post-transplant management; and (4) with thrombectomy and portal vein resection an end-to-end portal anastomosis may be performed with good results.
Minimally invasive treatment for common bile duct stones
Authors: Martin I G , Curley P , McMahon M J
Published: March 2007

The impact of endoscopic surgery on the management of stones in the common bile duct (CBD) was studied. All patients with proven common duct stones managed by a single consultant during a 21-month period were included. Of a total of 60 patients, 48 were referred because of symptoms or signs of calculi in the CBD and 12 were found to have common duct stones although symptoms were related primarily to the gallbladder. Of the 48 patients referred with common duct stones, 41 (85 per cent) were successfully treated by endoscopic retrograde cholangiography (ERC) and endoscopic sphincterotomy (ES) (complications were cholangitis (one patient), mild acute pancreatitis (one), impacted retrieval basket (one)). Of the remaining seven patients, two underwent open exploration (one after failed laparoscopic exploration) and five had successful laparoscopic duct exploration. One patient underwent laparoscopic exploration of the CBD but subsequently died. Of the patients with primary gallbladder symptoms, eight underwent preoperative ES, one was treated by laparoscopic duct exploration, one by conversion to open operation and in two patients duct stones were removed at postoperative ERC. The overall mortality rate was 2 per cent and the incidence of complications 12 per cent. Open exploration of the CBD was performed in three patients (5 per cent). This experience suggests that open duct exploration will become increasingly infrequent and may be replaced by endoscopic surgery in the majority of patients.
Future directions for conservative treatment of gallbladder calculi
Authors: O'Leary D P , Johnson A G
Published: March 2007

Recent conservative gallstone treatments provide rapid relief from symptoms, but all have a potential for stone recurrence. They are indicated in patients who are unfit or unwilling to undergo cholecystectomy. Wider application will depend on selection of patients who are at least risk of recurrence, or on development of effective prophylactic strategies.
Interleukin 2 therapy: current role in surgical oncological practice
Authors: Heys S D , Franks C R , Eremin O
Published: March 2007

The use of recombinant interleukin 2 (rIL-2) in clinical practice has opened up new and beneficial avenues in the treatment of certain malignant diseases. Although rIL-2 can stimulate a range of host antitumour defence mechanisms, only 30–40 per cent of patients who are treated will respond to such therapy as assessed by a reduction in tumour volume. The effect of rIL-2-based treatment schedules on delaying progression of disease and on overall survival in comparison with standard current treatments and chemotherapeutic regimens is not clear. Randomized clinical trials are required to evaluate precisely the role of rIL-2 in various therapeutic combinations and to ascertain the optimum therapeutic regimens for individual tumour types. Studies currently under way should provide more insight into the possible beneficial effects of immunotherapy with rIL-2. More basic research is required to ascertain how rIL-2 may produce its antitumour effects and why the therapeutic results obtained in humans have been so selective and less beneficial than those in experimental animals.
Quality-of-life measurement in surgical practice
Authors: Fraser S C A
Published: March 2007

Assessment of quality of life is gaining momentum in areas of medical practice where standard measures of outcome are not sensitive enough to determine treatment strategies. Such methods have not been widely adopted in the surgical specialties, although this is changing. The techniques used are easily understood but they have not been standardized and are subject to several confounding factors. Nevertheless, quality-of-life measurement may provide additional information in the research environment and surgical audit.
Early results and 1-year follow-up after intra-arterial thrombolysis
Authors: Browse D J , Torrie E P H , Galland R B
Published: March 2007

Intra-arterial thrombolysis (IAT) was used as first-line treatment for 100 occlusions causing acute, subacute or chronic ischaemia. Streptokinase was used in 90 cases and tissue plasminogen activator in the remaining ten. Complete lysis, as determined radiologically, was achieved in 55 per cent of cases and partial lysis in 20 per cent. Lysis was more effective the earlier it was used. Major complications occurred in seven cases: five patients suffered major haemorrhage, two of whom died, and two had haemorrhagic cerebrovascular accidents. Of the patients with complete or partial clearance of thrombosis, 19 had no underlying apparent cause, 23 underwent angioplasty and 15 had an operation. The 1-year patency rate following complete lysis was 58 per cent. The 1-year patency rate after successful treatment commencing within 1 week of symptoms starting was 71 per cent, compared with 36 per cent for later treatment. Aortofemoral bifurcation grafts were cleared in three of five cases and all remain patent. Eight popliteal aneurysms were demonstrated by IAT and were ligated and bypassed; all these grafts remained patent at follow-up. IAT is less effective in chronic than acute occlusion. It should be reserved for patients in whom the occlusion is of short duration or for those with a thrombosed aortofemoral bifurcation graft or popliteal aneurysm.
Effect of foot compression on the velocity and volume of blood flow in the deep veins
Authors: Andrews B , Sommerville K , Austin S , Wilson N , Browse N L
Published: March 2007

The A-V Impulse System reduces the incidence of deep vein thrombosis by pneumatically compressing the venae comitantes of the lateral plantar artery, causing an increase in the velocity of blood in the proximal axial veins. Using a duplex scanner the effects of altering the pressure, pulse duration and frequency of foot compression on the velocity and volume of blood flow in the superficial femoral and popliteal veins were quantified. In 20 legs, foot compression of 50, 125 and 200 mmHg significantly increased the maximum venous blood flow by 9·10, 13·4 and 15·1 ml/s respectively (P < 0·001). Conversely, reducing the frequency of compression from 6 to 3 cycles per min significantly increased the rise in peak flow from 10·1 to 14·8 ml/s (P <0·001). Changing the duration of compression from 1 to 3 s had no significannt effect on peak flow. Increased blood flow is best achieved with high-pressure low-frequency foot compression. Increasing the duration of compression beyond 1 s has no effect on augmentation of flow in the deep veins.