bluuebunny/crossref_metadata_2025 huggingface dataset:
The occurrence of desmoids in patients with familial polyposis coli
Authors: McAdam W A F , Goligher J C
Published: March 2007

Four cases of desmoid tumour are reported in conjunction with familial polyposis coli, and the salient clinical features of patients with this combination of conditions are examined in the literature and tabulated.

Desmoids occur very rarely in the general population but they are comparatively common in people with familial polyposis, in whom they may be situated in the abdominal wall, within the abdomen, or occasionally in other sites remote from the abdomen. They may antedate the discovery of polyposis by months or years. Any patient who is found to have a desmoid should therefore be examined for polyposis coli.

Intra-abdominal desmoids by virtue of their size and situation are often of serious significance to the patient, and their effects may belie the benign histological picture they present. Renal function may be impaired by pressure on the ureters, whilst surgical removal of the lesion, which is the principal method of treatment of desmoids, may be crippling to the patient or technically impossible. Radiotherapy seems to be of limited value in the management of these tumours.

No mass occurring within the abdomen or in the abdominal wall after surgery for polyposis coli should be regarded as a recurrent adenocarcinoma until proved to be so by adequate biopsy.
A case of gastrobronchial fistula
Authors: Milne R M , Thomson J W W
Published: March 2007

A rare complication of gastric surgery is reported and the aetiology of gastrobronchial fistula considered.
Burns and carbon-monoxide poisoning
Authors: Pollard John A
Published: March 2007

In the treatment of severe burns following fires in closed spaces, attention must also be directed to the possibility of severe carbon-monoxide poisoning and pulmonary burning.

Each of these conditions possesses a high mortality-rate of its own, although admission appearances may not indicate such.

An early active approach in management should be adopted despite the absence of overt clinical indications.
Delayed ileorectal anastomosis in the surgery of ulcerative colitis
Authors: Aylett Stanley O
Published: March 2007

A series of cases is reported in which, in spite of contrary advice, ileorectal anastomosis has been successfully achieved. Eighty-five per cent of these patients have returned to a normal life.

A plea is made for the retention of the rectum and restoration of continuity in most cases for which surgery is undertaken in ulcerative colitis.
The aetiology and management of branchial cysts
Authors: Paley W G , Keddie N C
Published: March 2007

The clinical features and management of a series of branchial cysts are described in detail. The problem of branchial fistula is discussed. A discussion of the origin of branchial cysts is given. The conclusion from our series and other evidence in the literature is that they arise from branchial cleft rests.
Some observations on the behaviour of isolated and interposed jejunal and ileal segments in the rabbit
Authors: Jenkins David H R , Macleod Ian B
Published: March 2007

Segments of jejunum and distal ileum of varying lengths and different vascular supply were isolated and interposed iso- and antiperistaltically. Pressures proximal to the interposed segment were recorded with a fine, soft, open-tipped cathether introduced via a Mann-Bollman fistula. The distal ileal segments supplied by a single vessel exhibit an unpredictable high degree of tone in some cases, and when these segments were interposed they caused a high degree of partial obstruction irrespective of whether they were interposed iso- or antiperistaltically. Distal ilcal segments supplied two or more vessels interposed antiperistaltically caused a degree of obstruction related to their lengths, and interposed isoperistaltically they caused no obstruction.Jejunal single-vessel segments of both polarities exhibited low obstructive qualities. Antiperistaltic jejunal segments of two or more vessels supply behaved in a similar manner to corresponding ileal segments in that the degree of obstruction was related to the length of the segment. Isoperistaltic segments supplied bt two or more vessels caused no obstruction.Possible mechanisms accounting for the differing findings in jejunum and ileum are discussed.Some clinical applications are discussed.
Carcinoma of the large intestine with survival in a child of nine and in his father. A study of carcinoma of the colon with particular reference to children
Authors: Pemberton Max
Published: March 2007

The case reports are presented of a child aged 9 and his father aged 43 both with colorectal cancer unassociated with polyposis.

A number of cases of carcinoma coli in children have been recorded but the outlook is depressingly poor; only I other long-term survival in a child appears to be authenticated.

The literature is reviewed and the reasons for the frequent errors and delays in diagnosis are analysed. The fact that the condition often masquerades as appendicitis or mesenteric adenitis in children is stressed.

A case is made for a positive approach when dealing with local recurrences even in anaplastic and colloid tumours.

It is suggested that certain bowel tumours may invade aggressively but not metastasize via the bloodstream or lymph channels; in these lesions the prognosis will be good if radical surgery is undertaken.

The evidence is in favour of a genetic basis for primary carcinoma of the colon and acceptance of this imposes the need for care in observing close relatives.
Pathology and prognosis of carcinoma of the stomach
Authors: Hawley P R , Westerholm P , Morson B C
Published: March 2007

The pathology and prognosis of 205 patients treated by total or partial gastrectomy for carcinoma of the stomach during the years 1951-5 have been evaluated. One hundred and sixteen patients (61 per cent) had a partial gastrectomy and 74 (39 per cent) had a total gastrectomy. The overall postoperative mortality was 25 per cent and this was greater for total than for partial gastrectomy. The crude survival rate was 19.4 per cent at 5 years and 11.4 per cent at 10 years. Carcinoma of the cardia had a worse prognosis than tumours at other sites. There were no 5-year survivors among patients with the linitis plastica type of carcinoma of the stomach. Tumours classified as poorly differentiated or anaplastic carcinoma had a poorer prognosis than well-differentiated adenocarcinomas. The amount of lymphocytic and plasma-cell infiltration of the tumour has a very significant effect on prognosis. Five out of the 7 patients with a heavy infiltrate of such cells survived over 5 years. Lymph-node involvement is the feature having the greatest influence on prognosis. There was a 40 per cent 5-year survival rate in the absence of node involvement and an 11 per cent 5-year survival rate with involved nodes. Patients with involved nodes surviving over 5 years had, on the average, fewer positive glands than those with involved nodes who survived for less than 5 years. No benefit follows from total rather than partial gastrectomy provided the cancer and regional lymph-nodes can be removed with the simpler procedure. Four case reports are presented to illustrate the difficulties in assessing the prognosis of gastric cancer.
Collagenase activity in the gastro-intestinal tract
Authors: Hawley P R , Faulk W Page , Hunt T K , Dunphy J E
Published: March 2007

An experimental study in rabbits demonstrates that a significant postoperative decrease in bursting wall pressure is associated with a similar reduction in the colonic collagen from around the anastomosis.

Mature collagen is broken down by the action of specific enzyme collagenase. This has been estimated by a tissue-culture method and is produced by viable explants of mucosa. There is a significant increase in the amount of this enzyme produced post-operatively and it is suggested that this is responsible for the decrease in collagen and weakness of the colon.

An increased amount of enzyme is produced by explants from the colon than from those of other parts of the gastro-intestinal tract. This is regarded as an important reason for the high incidence of colonic and rectal anastomotic breakdown compared with breakdown of anastomoses in other parts of the gastro-intestinal tract.

Following colonic anastomosis there is increased collagenase production not only locally but throughout the gastro-intestinal tract, suggesting that wound healing is not only under local control.
Electrical activity of the gastric antrum in man
Authors: Kwong N K , Brown B H , Whittaker G E , Duthie H L
Published: March 2007

The electrical activity of the gastric antrum, up to 6 cm. from the pylorus, has been studied at operation by means of electrodes implanted through the serosa in 68 patients; electrodes were also attached to the mucosa in 13. Records made from the mucosal electrodes show the same frequency as the serosal electrodes. Control records made in 12 patients with gall-stones showed a frequency of electrical waves in the region of 3 per minute (median 2.85 cycles per minute), which is significantly less than the frequency in 11 patients with gastric cancer, in 8 patients with gastric ulcer, and in 24 patients with duodenal ulcer.
The use of a new absorbable suture material (polyglycolic acid) in general surgery
Authors: Anscombe A R , Hira N , Hunt B
Published: March 2007

The chemistry and pharmacology of a new polymer, polyglycolic acid, are described. Experimental studies have shown this substance to be a suitable suture material in animals. The present study details experience with the material in 120 patients in a variety of general surgical operations. The results show polyglycolic acid sutures to be superior to catgut and to fulfil the criteria laid down for the ideal absorbable material.
Gastric ulcers: A comparison of surgical, radiological, and pathological diagnosis
Authors: Barson A J , Kirk R S , Lewis F W
Published: March 2007

The surgical, radiological, and pathological diagnoses of 319 patients who had had a partial gastrectomy for a preoperative diagnosis of benign gastric ulcer were compared. Pathological examination of the excised stomach showed 79.6 per cent with ulcers, 8.1 per cent with scars only, and 12.3 per cent without evidence of active or healed ulceration. This latter group comprised 38 patients, in 17 of whom there was no definite radiological evidence of ulceration. Barium meals demonstrated gastric ulcers in 214 patients; 193 (90.2 per cent) of these were confirmed pathologically.
Meckel's diverticulum in an umbilical hernia
Authors: Castleden W M
Published: March 2007

This patient merits description for two reasons: It would appear from her history that she ruptured her umbilical hernia in the seventh month of her eighth pregnancy. This would therefore be the third reported case of this complication (De Glanville, 1955; Young, 1965). Also, she seems to be only the second adult whose umbilical hernia has contained an uncomplicated Meckel'S diverticulum. Logically and mathematically the chances are that this event would occur more frequently, and it is possible that undiscovered Meckel'S diverticula are unwittingly being replaced into the abdominal cavity during the repair of umbilical herniae. The literature clearly indicates that where a Meckel'S diverticulum is discovered incidentally, it should be removed, and that its removal is not associated with significant increase in operative morbidity or mortality.
Acute renal failure in surgical patients
Authors: Marshall V C
Published: March 2007

A group of 215 patients with acute renal failure is discussed.

Acute renal failure in surgical practice is due to obstruction, trauma, operation, or miscellaneous causes. The high mortality can be reduced by early diagnosis and treatment. Infective complications are common.

Treatment of renal failure is aided by peritoneal dialysis and by haemodialysis. Renal failure can usually be controlled by one or both of these methods of treatment.

Death is usually due to the severity of the original disease, and to infective complications.
Perfusion of the isolated pig liver functional assessment under control normothermic conditions
Authors: Hickman R , Saunders S J , Simson E , Terblanche J
Published: March 2007

A study of the isolated perfused pig liver has been made to assess function for hepatic assist and to provide baseline values for altering techniques in liver storage. In 23 analogous perfusions lasting 6 hours, pre- and post-perfusion tests of liver function were compared. These results suggest that during the perfusion period, cell-membrane integrity was maintained and that oxidative metabolism including gluconeogenesis was unimpaired. A rise in aspartate transaminase indicated some cellular damage and the fall in bile production was ascribed to altered solute load.

Preliminary results from the J. S. Marais Surgical Laboratory suggest that there is good correlation between the biochemical assessment of liver vialbility and the capacity of the perfused liver to support life after transplantation into another animal. At this time, the latter procedure remains the ultimate test of liver function after perfusion.
The peemeter: An apparatus for measuring urinary force
Authors: Nundy S
Published: March 2007

A new apparatus for measuring voiding force is described; it has been used in the assessment of normal and obstructed micturition.
Epithelial cell division in acute renal failure: A radio-autographic study in the oesophagus of the mouse
Authors: McDermott F T , Nayman J , De Boer W G R M
Published: March 2007

The effect of acute renal failure, induced by intraperitoneal injection of the nephrotoxic agent uranyl nitrate or by urinary obstruction, upon cell division in the epithelium of the oesophagus was investigated in mice. Radio-autography with tritiated thymidine demonstrated that inhibition of cell division was pronounced when acute renal failure was severe and that less severe degrees of renal failure did not always inhibit cell division in this epithelial tissue. In conjunction with previous investigations it would appear that acute renal failure inhibits cell division in rapidly proliferating tissues. Inhibition of epithelial cell division may be a contributing factor in the development of uraemic lesions in the digestive tract.
Upper retroperitoneal injuries
Authors: Attard J
Published: March 2007

One hundred and ten cases of upper abdominal injuries have been reviewed. A significant proportion of them is retroperitoneal. It will be shown that an increased awareness of the importance of vague physical signs and the willingness to submit these patients to relevant investigations will result in an accurate diagnosis. A more logical and often vigorous approach to treatment has resulted in a dramatic reduction in the morbidity and mortality associated with such injuries.
Clinical applications and complications of umbilical vein cannulation
Authors: McK. Watts J , Douglas M C
Published: March 2007

Cannulation of the obliterated umbilical vein provides direct access to the portal venous circulation; by this means the portal venous pressure may be measured and venography performed to demonstrate the anatomy of the intra- and extrahepatic portal venous system and the presence of space-occupying lesions within the liver. Following dilatation the umbilical vein may also be used for temporary or permanent decompression of the portal system in patients with portal hypertension and bleeding oesophageal varices.

The technique of cannulation of the umbilical vein is described. The results of attempted umbilical vein cannulation in 26 patients are reported; in 16 for the investigation or treatment of portal hypertension and in 10 for the diagnosis of suspected space-occupying lesions in the liver. Cannulation was successful in 12 patients: the reasons for failure and the complications of the technique are described. One patient with bleeding oesophageal varices was treated by a shunt between the umbilical vein and the upturned saphenous vein; the shunt functioned initially but later thrombosed, possibly owing to insufficient dilatation of the umbilical vein.

The value of and indications for umbilical vein cannulation are discussed. The procedure may be technically difficult and is not free of complications, but can give valuable information in selected patients with portal hypertension and in patients with suspected, intrahepatic, space-occupying lesions. The high failure rate in this series may be related to initial lack of experience with the technique.
Detection of urethral carcinoma using a soluble SWAB
Authors: Trott P A
Published: March 2007

Swabs of acetone-soluble cellulose acetate were used to obtain fragments of tissue in cases of urethral carcinoma.

The histological appearances of tissue obtained in this way were comparable with those following biopsy and orthodox histology.

The method is relatively automatic and appears to be valuable in the diagnosis of carcinoma of the urethra.
“Spontaneous” perforation of the oesophagus treated by utilization of a pericardial flap
Authors: Millard A Henry
Published: March 2007

A case of “recurrent” spontaneous perforation of the oesophagus treated by the utilization of a pericardial flap is reported. It is suggested that this manœeuvre, which does not appear to have been described previously, may be life-saving when there has been delay in operating or major secondary leakage has occurred.
Multiple pathology in A unilateral supernumerary kidney
Authors: Browne M K , Glashan R W
Published: March 2007

Two separate unilateral renal masses, both replaced by tumour, are described. We suggest that one of these was, in fact, a supernumerary kidney which is a rare anomaly of the urinary tract. The lesions were associated with hypertension, apparently cuased by a renal artery stenosis and remedied by excision of both renal masses.
Late development of A false aneurysm of the common carotid artery
Authors: Beale Major P J
Published: March 2007

A case is presented of false aneurysm formationo f the common carotid artery occurring in a young soldier 8 months after his original injury, and immediately preceded by a severe hemiplegia. The relative frequency of such aneurysms is given, and also an account of the frequency of neurological complications from carotid arterial injuries. A possible explanation is given of the timing of events in this particular case, and the problem of follow-up is discussed.
Adrenal apoplexy report of a case
Authors: Roberts G D D , Blumgart L H
Published: March 2007

A case of spontaneous adrenal haemorrhage is reported. The clinical presentation, diagnosis, and management are discussed and compared with previous case reports of the condition.
The effect of vagotomy and a drainage procedure on alcohol tolerance
Authors: Fleming J A , Haynes S , Le Quesne L P
Published: March 2007

An oral alcohol-tolerance test using a bodyweight-related dose of alcohol was performed on two groups of patients undergoing truncal vagotomy and a drainage procedure for uncomplicated chronic duodenal ulcer. Eight patients received 0.65g. of absolute alcohol per kg. body-weight and 12 received 0.35 g. per kg. body-weight. The test was performed before operation and 4 months after operation on each patient. After operation the peak blood-alcohol concentration was significantly higher than before operation, and occurred significantly sooner after the ingestion of alcohol. The cause of these changes is discussed, and it is concluded that they are probably due to an increased rate of gastric emptying. The relevance of these results to the Road Safety Act, 1967, is discussed.
The treatment of anal fissure by lateral subcutaneous internal sphincterotomy—A technique and results
Authors: Notaras M J
Published: March 2007

A technique of internal anal sphincterotomy for anal fissure by the mid-lateral subcutaneous route is described. The operation avoids the “key-hole” deformity which occasionally follows the standard midposterior sphincterotomy. Lateral subcutaneous internal sphincterotomy resulted in rapid healing of the fissure with little discomfort and disturbance of anal function.
The prevention of infection in appendicectomy wounds
Authors: Longland C J , Gray J G , Lees W , Garrett J A M
Published: March 2007

Fifty cases of acute appendicitis were examined at operation for the presence of free organisms on or around the appendix in situ, and for bacterial contamination of the wounds after removal of the appendix. Fifty-four per cent had free organisms around the appendix, 40 per cent of the wounds probably became contaminated, and 18 per cent became clinically infected.

The operative technique was modified in 50 cases to minimize the chance of contaminating the wounds. There were 2 infections (4 per cent). In another series in which the usual operative technique was used the wounds were irrigated with tetracycline solution; there was 1 infection in 50 cases, an incidence of 2 per cent. In a similar trial the use of a mixture of powdered antibiotics in 50 cases did not influence the wound infection rate which remained at 18 per cent.

The use of tetracycline solution and care in avoiding contamination of the wound are recommended.
Carcinoma of the stomach, colon, and rectum: A survey of 772 surgical biopsies from Malaya
Authors: King M S , Kutty M Kannan
Published: March 2007

A survey of surgical biopsy material from carcinoma of the stomach, colon, and rectum in Malaya with its multiracial population was carried out.

The difficulty of interpretation of local frequency figures, owing to differences in rates of hospital utilization in the various races, is discussed.

The frequency of occurrence of carcinoma of the stomach would seem to be the same for all three races, Chinese, Indian, and Malay.

Carcinoma of the colon and rectum are not the uncommon diseases they had previously been thought to be in the region. The incidence of carcinoma of the colon and rectum is lower in Indians compared with the Chinese and Malays.
Leiomyosarcoma of the rectum
Authors: Somervell J L , Mayer P F
Published: March 2007

A patient with leiomyosarcoma of the rectum is presented with a brief review of 7 other patients seen in the Birmingham region from 1950 to 1967. A short discussion is given concerning the difficulties of diagnosis and treatment. We would concur with Diamante and Bacon's view (1967) that abdominoperineal excision is the treatment of choice, but that for small border-line tumours local excision may be adequate if intensive follow-up is used. Radical excision is practised at the first sing of possible local recurrence. The Birmingham cases seem unusual because of the predominance of distant metastases when compared with the local spread more commonly reported by other workers.
Benign polypoidal tumour of the ureter
Authors: Bose B , Williams J P
Published: March 2007

A case of benign fibrous polyp of the ureter successfully treated by conservative surgery is reported. The clinical features, diagnosis, pathology, and treatment of the lesion are briefly discussed.
The Accurate assessment of maximal gastric secretion in control subjects and patients with duodenal ulcer
Authors: Hassan M A , Hobsley M
Published: March 2007

Maximal gastric secretion was studied in 34 control subjects and 29 patients with duodenal ulcer using the histamine-infusion test with the addition of an inert marker, phenol red, to correct for pyloric losses of gastric secretion.

In the control group, statistically significant correlations were found between maximal gastric secretion and almost all the indices of body stature. Correction for pyloric loss improved all the correlations and raised those correlation coefficients which were not significant to levels of confidence of 95 percent or more.

The validity of calculation of lean body mass from height and weight was checked by the estimation of total body potassium in 26 subjects.

When lean body mass was taken into account it was confirmed that maximal gastric secretion decreased with age, but the sex difference in maximal gastric secretion was no longer statistically significant.

In the duodenal ulcer group, maximal gastric secretion was also significantly correlated with stature, though not with age. It is, therefore, proposed that stature should be taken into account when defining hypersecretion.

As expected, patients with duodenal ulcer produced as a group significantly higher levels of maximal gastric secretion than did control subjects, but the effect appeared to be due to a minority of patients with hypersecretion.

Patients with a history of less than 4 years secreted proportionately less gastric juice than those with a longer history. This finding raises the possibility that gastric hypersecretion is a result of duodenal ulceration rather than a cause.
The cardiovascular complications of intravenous regional anaesthesia
Authors: Kew M C , Lowe J P
Published: March 2007

In view of the uncertainty over the safety of intravenous regional anaesthesia the heart-rate, blood-pressure, and electrocardiogram were recorded seriany in 100 Bantu gold-miners in whom this form of anaesthesia was used for minor surgical procedures on the extremities. Changes in blood-pressure were infrequent and mild. In 31 patients the heart slowed by more than 10 beats per minute after release of the tourniquet, falling to less than 60 beats per minute in 27. One patient with sinus bradycardia developed sino-atrial block with cardiac standstill of short duration, a second developed an intermittent idioatrial tachycardia and premature atrial beats, and in 3 others sinus bradycardia was complicated by atrial escape beats, nodal rhythm, and premature ventricular beats respectively. These toxic effects were thought to be due either to direct myocardial depression or to increased vagal or decreased sympathetic tone, or to both of these mechanis. It is suggested that the cardiovascular depression caused by large doses of lignocaine may be aggravated by coexisting ischaemic heart disease. The importance of monitoring the patients carefully after release of the tourniquet and having facilities available for resuscitation is stressed.
The effect of leg elevation on the incidence of deep-vein thrombosis after operation
Authors: Rosengarten David S , Laird James
Published: March 2007

Leg elevation during and after operation did not reduce the incidence of deep-vein thrombosis in patients undergoing elective surgery over the age of 40 years. The incidence was 31 per cent in the control group and 33 per cent in the patients in whom the legs were elevated.
A new test for complete nerve section during vagotomy
Authors: Grassi G
Published: March 2007

A new test of completeness of vagotomy based upon the evaluation of pH variations in the stomach is presented.

The test is performed during the operation through a minimal gastrotomy with a glass electrode after vagotomy and maximal histaminic stimulatin. In order to avoid errors a study of 28 ulcer patients had been performed previously. This study showed that under general anaesthesia with unsectioned vagi the pH can be used to evaluate the variations of gastric secretion, that there is no basal secretion, and that the maximal histminic test is able to stimulate the acidsecreting cells. The test performed later in 40 patients showed a completed denervation as demonstrated by pH values between 5·5 and 7 on the whole mucous gastric surface in 36 patients, while in 4 patients the presence of a limited zone of gastric mucosa with a pH of 1·2–2 surrounded by mucosa with a pH between 5·5 and 7 showed not only an incomplete vagotomy but also, on the basis of their localization on the wall of the stomach, whether the unsectioned branches were anterior or posterior.

Furthermore, the test performed in four series of patients, in which the vagotomy was left temporarily incomplete on purpose, showed that the presence of more than one acid zone in the gastric mucosa was due to one unsectioned fibre of the oesophageal plexus, while in the case of a single acid zone it was due to a terminal gastric branch.

Long-term follow-up (up to 1 year after the operation) showed that after amaximal histaminic tests the values found were similar to those found intraoperatively, and after Hollander tests, values for complete vagotomy without so-called “adequate vagotomies” were found.
Duodenal diverticulum treated by excision of mucosal pouch only
Authors: Slater R B
Published: March 2007

The incidence of duodenal diverticulum and complications is discussed. The incidence of symptoms is probably about 10 per cent. It is suggested that more cases merit operative treatment than receive it at present.

Operative procedures are discussed and a simplified method, involving removal of the mucosal pouch only after duodenotomy, is described and a case presented illustrating the method.
The results obtained with emergency surgery in the treatment of persistent haemorrhage from gastro-oesophageal varices in the cirrhotic patient
Authors: Rothwell-Jackson R L , Hunt Alan H
Published: March 2007

The management of the cirrhotic patient with bleeding gastro-oesophageal varices is discussed with particular reference to the role of emergency surgery. An analysis is made of the results obtained in 77 patients with emergency surgery to control recurrent haemorrhage.

The deleterious effect of failing to control haemorrhage immediately and effectively in these cases is emphasized. If haemorrhage recurs in spite of conservative measures, including tamponade, surgery is considered mandatory. Only 8 cases have had an emergency portacaval anastomosis, with 4 survivors, all good-risk cases. More patients might benefit from this operation but only if haemorrhage is rapidly and effectively brought under control in the first instance. The poor-risk case has a 30 per cent chance of survival with a Boerema-Crile operation. However, this is not a definitive operation and patients who survive this procedure should have a portacaval anastomosis as soon as their liver function has sufficiently recovered.
Congenital duodenal stenosis in an adult presenting with severe electrolyte imbalance
Authors: Ward E E , Walrond E R , Davison J S
Published: March 2007

A man of 55 years presented with a 12-year history of intermittent vomiting and in a semi-comatose state. He had severe water and electrolyte disturbances, with a plasma chloride of 27 mEq./1., and a chloride deficit in excess of 2500 mEq.; he also had acid-base disturbances. Gastric acid studies suggested the possibility of the Zollinger-Ellison syndrome. At operation, the rare condition of congenital duodenal stenosis in an adult was found. He made an uneventful recovery.
Preparation of the intestine in patients undergoing major large-bowel surgery, mainly for neoplasms of the colon and rectum
Authors: Rosenberg I L , Graham N G , de Dombal F T , Goligher J C
Published: March 2007

This paper reports the results of a randomized prospective trial of three régimes of preparation of 150 patients for major large-bowel surgery, the criterion being the frequency of postoperative sepsis. One régime provided only mechanical preparation of the bowel, another gave the same mechanical preparation and also phthalylsulphathiazole, and the third included mechanical measures plus phthalylsulphathiazole plus neomycin.

As regards the use of bowel antiseptics, the combination of neomycin and phthalylsulphathiazole was not found to possess any advantage over sulphonamide alone. However, patients prepared by purely mechanical means fared substantially worse than those who had a combination of mechanical and antiseptic preparation. Gross faecal loading of the bowel and peritoneal contamination at operation were associated with a higher incidence of septic complications.

These findings suggest that in the prevention of postoperative infection at least three precautions are desirable–the correction of gross faecal loading before operation, the use of preoperative intestinal antiseptics, and the avoidance of peritoneal contamination during operation.
The effect of mechanical obstruction on tissue regeneration in the rabbit's ear
Authors: Joseph J , Dyson Mary
Published: March 2007

Tissue of area 1 cm.2 was excised through the full thickness of both ears of a group of rabbits. The excision site of one ear of each rabbit was blocked with Perspex for a time varying between 7 and 49 days. The other ear was allowed to heal and regenerate normally as a control. The growth of new tissue in the experimental ears was measured after block removal and compared with that of the opposite control ears. The regenerated tissue was also examined histologically for changes produced by blocking. Blocking for any period up to 49 days results in an increased growth rate on block removal. Only blocking for 14 days or less has a permanent stimulatory effect. All other blocking periods investigated (21, 28, 35, 42, and 49 days) were ultimately deleterious. The presence of the mechanical blocking device stops the development of a blastema in the normal position. The blastema cells gather in the uninjured tissue behind the wound edge and take up their normal position once the block is removed. The harmful effect of long-term blocking may be due to reduction of the vascularity of the marginal tissue and subsequently to damage to the blastema. Blocking for 14 days or longer results in deformation of the regenerating elastic cartilage.
Total thymectomy by the transcervical approach
Authors: Kark A E , Kirschner P A
Published: March 2007

The transcervical method of removal of the thymus gland is the preferred method especially in myasthenia gravis. This technique substantially reduces the postoperative complications permitting a rapid painfree convalescence with a minimum of postoperative psychiatric problems and cosmetic disfigurement.

Fifty-two patients with non-thymomatous myasthenia and 7 with high-lying thymoma have been operated on in the past 3 years by this method. In addition, in 1 case of hyperparathyroidism this technique proved invaluable immediately following a negative neck exploration.

The morbidity and complication rate is so much reduced that the trans-sternal technique is now reserved for selected cases of thymoma only.

One death has occurred in a near moribund patient with uncontrollable myasthenia and severe hyperthyroidism.
The value of a plastic adhesive drape in the prevention of wound infection a controlled trial
Authors: Jackson D W , Pollock A V , Tindal D S
Published: March 2007

A series of 921 operations was studied. Random cases were treated by preliminary application of a plastic adhesive drape, the remainder being controls. No significant difference was observed in the rate of wound infection between the two groups.
Ganglioneuromatosis of the sigmoid colon
Authors: Munro Kathleen M H
Published: March 2007

A man, aged 72 years, who came to hospital with a 9-month history of increasing constipation, had a narrowed segment of sigmoid colon removed. Increased numbers of nerve fibres and ganglion cells were found histologically in the plexuses of Auerbach and Meissner, and in the muscular layers of the affected bowel. This is apparently the first recorded case of this type of ganglioneuromatosis of the pelvic colon. The lesion was radiologically indistinguishable from a stenosing carcinoma of the colon.
Carcinoma in situ of the bladder
Authors: Yates-Bell A J
Published: March 2007

Five cases of carcinoma in situ of the urinary bladder are reviewed. The clinical features, difficulties in diagnosis, and surgical management are discussed.
An approach for operations on the iliac arteries
Authors: Rosengarten David S , Knight Barry , Martin Peter
Published: March 2007

An alternative approach to the iliac arteries, needing divisison of the inguinal ligament, is described by which operations on these vessels are simplified. The operation is a relatively minor one. There have been no serious complications from the divsion of the inguinal ligament nor has there been detectable weakness in the rectus abdominis muscle. Incisional hrenia above the inguinal ligament occurred in 3 of 150 patients so treated after wound haematoma and infection, and 1 patient suuffered a minor direct inguinal hernia.
A technique for the insertion of holter ventriculoatrial shunt for infantile hydrocephalus
Authors: Tsingoglou Stavros , Forrest D M
Published: March 2007

A technique for the insertion of the Holter ventriculo-atrial shunt for the treatment of infantile hydrocephalus and the pre- and postoperative management of such patients is described.

The technique has been applied to 330 hydrocephalic children with minimal operative mortality and with a greatly reduced incidence of morbidity over previous methods. Simplification of the original method is considered an important factor in the satisfactory results.

The technique can be carried out in a general hospital without special equipment and by a surgeon with paediatric surgical experience but without special neurosurgical training.
Complications from holter ventriculo-atrial shunts
Authors: Tsingoglou Stavros , Forrest D M
Published: March 2007

Three hundred and thirty cases of infantile hydrocephalus were treated at the Westminster Children's Hospital over a 6-year period with the Holter ventrculo-atrial shunt. The complications of the treatment are studied and methods of management discussed.
Silicone fluid and steroids in the prevention of adhesions
Authors: Sachdeva H S , Gutierrez L V , Cox Alan G
Published: March 2007

A standard method was developed in the rat for making peritoneal adhesions which could be measured. The method was used to measure the effect of silicone fluid and of hydrocortisone on the formation of adhesions. Locally applied hydrocortisone and silicone fluid both reduced significantly the number and area of adhesions. Parenteral hydrocortisone had no effect on the formation of adhesions.
Bleeding pancreaticoduodenal artery aneurysm
Authors: Douglas J B , Gillespie J A , Wilding R P
Published: March 2007

A case of ruptured pancreaticoduodenal artery aneurysm diagnosed by arteriography and successfully treated surgically is presented.
Acute intestinal obstruction caused by lithopaedion
Authors: Zaheer S A
Published: March 2007

A case of acute small-gut obstruction caused by lithopaedion following an intra-uterine pregnancy is reported. Other instances of lithopaedion described in the literature have largely related to extra-uterine pregnancies and appear to have presented in a different way.
Epithelial hamartoma of liver
Authors: Roy A D , Bremner A D
Published: March 2007

The successful removal of an epithelial hamartoma from the liver of a 7-month-old African child is reported. This hamartoma weighed 1875 g. and is believed to be the largest tumour of this type described in such a young patient. This case indicates that a ‘hopeless abdomen’ is always worth exploring in anticipation of the occasional happy outcome.
The natural history of liver allo- and autotransplantation in the pig
Authors: Dent David M , Hickman Rosemary , Uys C J , Saunders Stuart , Terblanche John
Published: March 2007

A series of 40 pig liver transplants surviving for at least 5 days is presented. Twenty orthotopic allografts are compared with 20 autograft controls, and in each group biliary drainage by a cholecystoduodenostomy (gall-bladder to duodenum anastomosis) is compared with a choledochocholedochostomy (direct bile-duct to bile-duct anastomosis).

The pigs with liver allotransplants usually demonstrated low-grade liver rejection, maximal during the second week, which subsequently spontaneously subsided without immunosuppression. However, in 15 per cent of the pigs the rejection process was more intense with death from rejection between the fifth and seventh days. Although prolonged survival was achieved in the remaining allografts, the final outcome was invariably a fatal one, owing either to gastric ulceration with haemorrhage or to infection. The mean survival time in the autograft controls was similar, and even when gastric ulceration was virtually eliminated in this group by a bile-duct to bile-duct anastomosis, death owing to infection usually occurred in the third week.

The autograft controls demonstrated the superiority of a direct bile-duct to bile-duct anastomosis in the pig, and reduced the incidence of biliary stasis and cholangitis as well as gastric ulceration in this group.

Repeated liver biopsies in both groups revealed that biochemical changes suggestive of rejection did not always represent rejection, but merely cholestasis, which could be caused by rejection or by other factors such as a cholestatic biliary anastomosis (cholecystoduodenostomy). This has important implications in human liver transplantation.
Cystadenoma of the pancreas. A report of two cases
Authors: Lewis Adam , Dormandy John
Published: March 2007

Two cases of cystadenoma of the pancreas are described, 1 presenting with bleeding gastric varices and the other showing tumour replacement of the entire pancreas. The cases are discussed with reference to the literature.
The technique of peritoneoscopy
Authors: McBrien M P
Published: March 2007

Peritoneoscopy has received little attention in the field of general surgery. A technique of visualizing the abdominal viscera and taking liver biopsies under direct vision is described.
Intracerebral haemorrhage in closed head injury
Authors: Bishara S N
Published: March 2007

All cases of intracerebral haematoma after closed head injury admitted to the Dunedin Neurosurgical Unit since its establishment in 1943 are reviewed. Attention is drawn to the not-infrequent occurrence of this type of traumatic intracranial haemorrhage, and its pathogenesis is discussed. An attempt is made to find some characteristic clinical features in the less acute cases. The importance of angiography in the diagnosis is emphasized and surgical treatment discussed. The results in the series reviewed were most encouraging with no operative mortality in 18 haematomas surgically evacuated and with complete recovery in 66 per cent. The factors influencing the prognosis are discussed, and a classification on a temporal and pathological basis is suggested.
Acute emphysematous cholecystitis
Authors: May Roy E , Strong Russell
Published: March 2007

Three cases of acute emphysematous cholecystitis are described and the literature reviewed. After considering clinical and radiological features, it is suggested that occlusion of the cystic artery may be the cause of this condition.
Mammary osteogenic sarcoma
Authors: Aubrey D A , Andrews G S
Published: March 2007

A rare breast tumour, an osteogenic sarcoma, is described and the literature relative to osseous neoplasia in the breast is briefly reviewed.
An unusual case of congenital oesophageal stricture
Authors: Jewsbury P
Published: March 2007

An unusual case is reported, in which an 8-month-old baby presented with an apparent congenital stricture of the oesophagus, brought to light by an obstruction from a foreign body.

The case was successfully treated by resection of the oesophageal stricture.
A double-blind, controlled, clinical trial of spironolactone for benign prostatic hypertrophy
Authors: Castro J E , Griffiths H J L , Edwards D E
Published: March 2007

A double-blind, controlled, clinical trial of spironolactone (Aldactone-A), 50 mg. b. d., showed this to be better than a placebo for the short-term treatment of benign prostatic hypertrophy, although the advantage was not maintained over a longer period of time. There was considerable response to the placebo and the importance of comparative trials with objective measurements is discussed.
The effect of selective gastric or extragastric vagotomy on gastric secretion in conscious cats
Authors: Spencer John , Grossman Morton I
Published: March 2007

Earlier studies in dogs showed that in animals with gastric fistulas, selective gastric vagotomy decreased maximal acid secretion in response to gastrin but not to histamine, and that in animals with Heidenhain pouches, selective extragastric vagotomy increased maximal response to gastrin but not to histamine. The present study sought to determine whether similar changes occurred in cats. In cats with gastric fistulas, selective gastric vagotomy reduced maximal response to pentagastrin and to histamine by about the same extent. In cats with Heidenhain pouches, selective extragastric vagotomy had no effect on the response to pentagastrin. It is concluded that there is a species difference between the dog and the cat regarding the effects of selective gastric and selective extragastric vagotomy on gastric acid secretion in response to gastrin. It is not yet known whether man fits the pattern of the dog or the cat.
An appraisal of diagnostic paracentesis of the abdomen
Authors: McPartlin J F , McCarthy W
Published: March 2007

A simple method of paracentesis is described and shown to provide a safe, easy, and reliable means of examining abdominal fluid. The characteristics of the fluid associated with a variety of pathological conditions are discussed and the results of 100 consecutive taps are analysed. The technique is shown to be especially useful in certain groups of patients who otherwise present considerable diagnostic difficulty.
Aorto-Iliac occlusion in women using oral contraceptives: A report of 2 cases
Authors: Hall Robert , Bunch G A
Published: March 2007

Two patients whose ischaemic symptoms from aorto-iliac occlusions began during medication with oral contraceptives are reported. Both underwent major reconstructive vascular surgery.
Haemostatic incision of the liver: Carbon-dioxide laser compared with surgical diathermy
Authors: Hall R R
Published: March 2007

The haemostatic property of carbon-dioxide laser radiation has been compared with conventional cutting diathermy for experimental partial hepatectomy. The superiority of the laser in reducing haemorrhage from the liver is demonstrated, and possible clinical applications are suggested.
Superficial abscess formation: An unusual presenting feature of tuberculosis
Authors: Ward A S
Published: March 2007

Tuberculous abscess formation in the absence of underlying osteo-articular, tendon-sheath, or lymphnode infection is uncommon in this country, but is likely to become more important with increasing immigration. Details are reported of 32 patients notified to the City of Birmingham Public Health Department between January, 1964, and December, 1968. The disease was encountered mainly in immigrants attending casualty and surgical out-patient departments.

The presenting feature in all cases was a superficial, fluctuant, relatively painless swelling of several weeks' duration. Lesions were widespread although there was a tendency for the chest wall to be involved (15 patients). Chest radiographs showed evidence of pulmonary disease in approximately one-third of the case and an elevated erthroyte sedimentation rate with a normal white-cell count were constant findings. Prompt chemotherapy combined with either aspiration or incision and primary suture achieved rapid and complete resolution in nearly all patients. Incision without closure was inevitably followed by sinus formation and delay in healing.
Wound infection in undressed sutured wounds of the hand
Authors: Wood P B
Published: March 2007

A series of 265 sutured hand lacerations in an urban casualty department were grouped randomly into 3 groups: those receiving no dressing, an Elastoplast strip dressing, or a tubegauze dressing. Wounds showing microscopic or macroscopic pus at 10 days were deemed infected. Thirty-six per cent of wounds with no dressing became infected compared with 19 per cent and 16 per cent in the other two groups, this result being statistically significant (P<0.05). The doctor suturing the wound, the age of the patient, and the use of prophylactic Triplopen also appeared to have a statistically significant influence on infection.
Phytobezoar of the stomach complicating gastro-enterostomy: Report of a case
Authors: Isbister William H
Published: March 2007

A case of gastric bezoar producing intermittent stomal obstruction is reported. The known aetiology and symptomatology of gastric bezoar are discussed in relation to the case reported. The mode of production of the reported bezoar is suggested.