bluuebunny/crossref_metadata_2025 huggingface dataset:
The gastro-oesophageal junction before and after operations for duodenal ulcer
Authors: Thomas P A , Earlam R J
Published: March 2007

Thirty-seven patients with duodenal ulceration were studied with oesophageal manometry preoperatively and then again 6–12 months after operation. In 28 patients who had been treated by truncal vagotomy and either a pyloroplasty or a gastroenterostomy the length of the zone of elevated pressure at the gastro-oesophageal junction was reduced, although the maximum pressure was unchanged. In 9 patients who had had a Polya partial gastrectomy the zone was also shortened, but there was a significant fall in the maximum pressure as well. It is suggested that this reduction of the resting pressure in the sphincter may account for the gastro-oesophageal reflux which is frequently seen after a Polya partial gastrectomy, and may be caused by low circulating gastrin levels since the antrum has been removed.
An investigation into the spread of bacterial infection in lower-limb amputations
Authors: Weaver P C , Chattopadhyay B , Angel J
Published: March 2007

An investigation into the spread of bacterial infection in lower-limb amputations carried out for ischaemia and terminal gangrene of the limb is reported. Under the conditions described in the study the spread of infection through the deep tissues of the leg does not appear to be as important as external infection which occurs following contamination in the operating theatre or in the ward when the wound remains unhealed. In many cases where bacterial contamination or infection of the amputation site occurred the organisms responsible had also been isolated from the gangrenous lesions in the limb. Thus documentation of the bacterial flora at the gangrenous site should not be ignored.
A functional and social review of lower-limb amputees
Authors: Weaver P C , Marshall S A
Published: March 2007

The results of 119 lower-limb amputations for ischaemic disease in 105 patients over a 6-year period are reviewed to assess their progress and rehabilitation. The patients had an average age of 69.84 years at the time of the first amputation. The hospital mortality was 18.1 per cent. Life expectancy after amputation was seldom more than 3 years. A long period of hospitalization was accepted in order to achieve a high proportion of rehabilitated patients. Of those discharged, only 6 who came from their own homes had to be sent to an institution.

A study was made of the 52 surviving amputees. Forty-six patients were visited in their homes. The remaining 6 patients were traced and followed up by letter. A high standard of rehabilitation was maintained once amputees had been satisfactorily settled into the community, even though 11 out of 44 ambulant patients discontinued walking in favour of a wheelchair life.
Primary argentaffinoma of the ovary
Authors: Jagoe W S , Gallagher N G , Gearty G F , Logan P J
Published: March 2007

A case is presented of primary argentaffinoma of the ovary, without metastases, that gave rise to the systemic manifestation of the carcinoid syndrome. Removal of the tumour led to regression of all symptoms. This case illustrates that single argentaffinoma tumours which drain directly into the systemic venous system may cause the carcinoid syndrome and removal may be curative in that the disease process is arrested.
Duplication of the male urethra
Authors: Cullen T H
Published: March 2007

A brief report of 3 cases of duplication of the male urethra, 2 of which were complete duplications, is presented.
Radioactive iodine therapy for thyrotoxicosis
Authors: Greig William R
Published: March 2007

Radioactive iodine has been used to treat over 300,000 thyrotoxic patients since 1946. This paper reviews the knowledge gained in the past 23 years about the efficacy and safety of 131I therapy for thyrotoxicosis. Modifications with reference to case selection, dosage, and follow-up are discussed.
A review of 15 years' experience in the use of sclerotherapy in the control of acute haemorrhage from oesophageal varices
Authors: Johnston George W , Rodgers Harold W
Published: March 2007

The results of 15 years of sclerotherapy for acute variceal haemorrhage are reviewed retrospectively. One hundred and seventeen patients with portal hypertension received a total of 217 injections. Haemorrhage was controlled in 93 per cent of admissions. The mortality per injection was under 12 per cent, and the total admission mortality was 18 per cent. Even where a subsequent shunt was impracticable, sclerotherapy provided useful palliation with few serious complications.
Early changes in the post-phlebitic limb: Their clinical significance
Authors: Corrigan T P , Kakkar V V
Published: March 2007

The long-term results of treatment of the established post-phlebitic syndrome by compression sclerotherapy or by ligation of incompetent perforating veins were unsatisfactory in approximately 40 per cent of patients. Changes in superficial venous pressure during exercise occurred when the deep veins were recanalized and the perforating veins became incompetent. These pressure changes could be used to select patients likely to develop the full syndrome. It is suggested that development of an intractable syndrome might be prevented if ligation of incompetent perforating and deep veins is performed before tissue changes become established.
Inhibition of human gastric secretion by prostaglandin
Authors: Carter D C , Karim S M M , Bhana D , Ganesan P A
Published: March 2007

The synthetic analogue prostaglandin 15(R)15 methyl-E2 methyl ester is a potent inhibitor of basal and pentagastrin-induced acid secretion when given orally to male volunteers. Intravenous injection of the same dose of the analogue did not result in significant inhibition. The analogue is thought to reduce acid secretion by a direct effect on the parietal cell and differs from its parent prostaglandin E2 by its resistance to rapid enzymic degradation.

The possible physiological significance of prostaglandin E2 in human gastric secretion is considered and the potential therapeutic role of its 15(R)15 methyl analogue is discussed.
Phytobezoar after vagotomy with drainage or resection
Authors: Mir A M , Mir M A
Published: March 2007

Two cases of bezoar formation after vagotomy and drainage are reported. A review of the literature reveals the stomach to be the most common site of bezoar formation after operations involving vagotomy, whereas most bezoars occurring after gastrectomy are found in the small intestine. The reasons for this difference are discussed, as well as the clinical features and treatment of bezoar.
Cigarette consumption and atherosclerosis their relationship in the aorta and iliac and femoral arteries
Authors: Lawton G
Published: March 2007

The relationship between cigarette consumption and stenotic and occlusive atherosclerotic disease of the lower abdominal aorta and iliac and femoral arteries has been investigated by means of lumbar aortography. Cigarette smoking appears to be associated with atherosclerosis of these vessels. This association seems to be quantitatively related in the lower abdominal aorta, but the relationship is less marked for the iliac vessels and the severity of the disease in the femoral arteries does not appear to be related quantitatively to cigarette consumption. The failure to show a quantitative association in the more peripheral vessels could either be due to limitations and artefacts produced by the method of measurement, or suggest that the atherosclerotic lesions at different levels in the arterial tree are not necessarily homogeneous in nature.
Effect of corporal and antral gastrojejunostomy on canine gastric emptying of solid spheres and liquids
Authors: Kelly Keith A , Morley Kenneth D , Wilbur Bruce G
Published: March 2007

Gastric emptying of solids and liquids was measured in 12 dogs with and without corporal or antral gastrojejunostomy. Both types of stoma hastened the onset but did not alter the time from onset to complete emptying of 40 small plastic spheres. Corporal gastrojejunostomy slowed the emptying of 400 ml. of 154 mM NaCl but not of 500 mM glucose, whereas antral gastrojejunostomy slowed the emptying of both.
Abo blood groups in occlusive and ectatic arterial disease
Authors: Morris Tom , Bouhoutsos John
Published: March 2007

A study of 864 patients with occlusive disease and 246 with ectatic disease was made with reference to their ABO blood groups. The results confirmed the findings of other workers that occlusive disease and myocardial infarction occur more commonly in group-A individuals and that blood group O seems to confer some immunity to occlusive disease. There was also a probable correlation between group A and ectatic disease, but belonging to group O did not seem to confer any protection in this disease. It was also found that the incidence of myocardial infarction was much lower in ectatic disease than in occlusive disease. It is suggested that ectatic disease and occlusive disease are two distinct entities.
Primary retroperitoneal hydatid cyst
Authors: Mukerjee S , Nigam M , Saraf J C
Published: March 2007

A case of a primary retroperitoneal hydatid cyst in an Indian adult which was treated by marsupialization is described. Attention is drawn to the rarity of the lesion, the probable mode of spread, and the difficulties encountered in its diagnosis.
Villous papilloma of the rectum (with unusual complications)
Authors: Berrill W T
Published: March 2007

A case is reported in which a villous papilloma of the rectum was complicated by severe electrolyte losses and acute renal failure. Successful management by peritoneal dialysis and early surgery is described.
Strangulated external hernia associated with generalized peritonitis
Authors: Ekwueme O
Published: March 2007

Thirteen patients are described in whom strangulated external hernia was associated with generalized peritonitis. The causes of this combination are discussed.

Although the features of peritonitis are usually quite distinguishable from those of an uncomplicated strangulated hernia, in virtually all the cases previously reported in the literature the presence of peritonitis was not recognized until operation for the hernia was undertaken. Increased awareness of this complication and a conscious effort to exclude it resulted in the correct preoperative diagnosis in 4 of our patients.

When the peritonitis is recognized preoperatively it is suggested that a laparotomy should be performed to deal with the intraperitoneal lesion, and that the associated groin hernia should be repaired by a preperitoneal approach through the laparotomy incision.
The problem of local recurrence following conservative surgery for carcinoma of the breast
Authors: Bailey M E , Ratnavel K , Wyatt A P
Published: March 2007

Follow-up of patients after local excision of carcinoma of the breast indicated that there was a high incidence of local recurrence and that this could be a difficult problem to manage. A retrospective study was performed comparing 50 patients who had undergone local excision and radiotherapy with 50 patients following simple mastectomy and radiotherapy. Local recurrence occurred in 16 per cent of the local excision group compared with 2 per cent in the simple mastectomy group.
Regeneration of parietal and visceral peritoneum in the immature animal: A light and electron microscopical study
Authors: Raftery A T
Published: March 2007

The healing of visceral and parietal peritoneum has been investigated in the immature animal by both light and electron microscopy. Healing has been found to occur more rapidly in the immature animal when compared with the adult animal. Parietal peritoneum was covered by a new mesothelium in 7 days, while the liver was covered in 5 days. The new mesothelium developed from subperitoneal perivascular connective-tissue cells but it was not possible to determine whether these were primitive mesenchymal cells or fibroblasts. The findings are discussed in relation to the pathogenesis of peritoneal adhesions.
Human toxocariasis (visceral larva migrans) causing an abscess of the rectus sheath in an infant
Authors: Griffiths Richard W
Published: March 2007

A patient is described with an abscess of the rectus sheath associated with the clinical features and operative findings of toxocariasis (visceral larva migrans).

Few cases of this condition are ever submitted to laparotomy, and the complication of rectus sheath abscess has not previously been reported. A brief review of the literature is given in order to outline the salient features of the condition.
Thrombosis of the subclavian-axillary artery following radiotherapy for carcinoma of the breast
Authors: Mavor G E , Kasenally A T , Harper D R , Woodruff P W H
Published: March 2007

Two cases of subclavian-axillary-brachial artery occlusion following irradiation damage are reported. Both followed radiotherapy for carcinoma of the breast at intervals of 11 and 26 years respectively.
The surgical treatment of occult insulinomas: A review of the problem
Authors: Stefanini Paride , Carboni Manlio , Patrassi Neri , Basoli Antonio
Published: March 2007

The data from a previously reported large series (1067 cases) of insulin tumours of the pancreas have allowed study of the problem of management of so-called ‚occult’︁ tumours. Of the occult tumours in the whole series, 54 per cent were situated in the head of the pancreas, as opposed to 26.5 per cent similarly located at the initial operation.

Analysis of the records of 542 single benign beta-cell adenomas showed no correlation between the size of the tumour and the duration of symptoms. There were 168 cases of single benign tumours which could not be located at the first operation, but which were cured at a subsequent operation. In 65 per cent of these cases the tumour could not be located at the subsequent operation and was only found after blind resection.

These results indicate that the growth of these tumours is not regular and constant. They lend no support to the suggestion that if an insulin tumour cannot be located blind resection should be avoided in the hope that after 1–2 years, during which symptoms can be controlled by diazoxide, the tumour is likely to he located at a second operation. It is concluded that if the tumour cannot be located the treatment likely to give the best results is progressive blind pancreatic resection from left to right, with careful examination of the excised specimen and frequent estimation of the blood sugar concentration.
Survival after primary and after staged resection for large bowel obstruction caused by cancer
Authors: Fielding L P , Wells B W
Published: March 2007

Of 388 patients with carcinoma of the large bowel, 90 presented with obstruction, In this group 50 patients (56 per cent) were treated by a curative resection, 22 by primary resection and 28 by staged resection. The prognosis was considerably better after primary resection than after staged resection. Crude 5-year survival figures are 50 and 25 per cent respectively. It is concluded that a prospective trial of immediate resection in the management of obstructing large bowel cancer seems justified.
The effect of blood on disinfection of surgeons' hands
Authors: Lowbury E J L , Lilly H A
Published: March 2007

The effect on skin flora of spreading 2 ml of blood over the hands after a 2-minute disinfectant handwash and then wearing rubber gloves for an hour was assessed by a trial in which 6 volunteers used each of six preparations, once with blood and once, as a control experiment, with water on their hands. Bacterial counts of handwashings and of glove washings showed significant interference by blood with the effectiveness of povidone iodine detergent solution (Disadine). With a 3 per cent hexachlorophane detergent cream (Disfex) significant interference by blood was shown in bacterial counts of glove washings and a nearly significant interference was shown in counts of handwashings. There was no evidence of any interference by blood with the effectiveness of a 4 per cent chlorhexidine detergent solution (Hibiscrub) or a 3 per cent hexachlorophane liquid soap containing 0.3 per cent chlorocresol (Ster-Zac).
Injuries of the inferior vena cava
Authors: Rasaretnam Rudra , Vijayaragavan A , Thavendran A
Published: March 2007

Four cases of inferior vena caval injury seen recently at the Accident Service of the Colombo General Hospital are reported. Three patients presented in shock, white 2 had active bleeding at the time of operation. Direct suture was successful in 3 cases. Methods of access to the various segments of the inferior vena cava are discussed together with a review of the literature.
The metabolic response to abdominal surgery in a tropical environment
Authors: Elebute E A
Published: March 2007

Nitrogen balance studies were conducted in 17 adult male Nigerian patients. All the patients had vagotomy and a drainage operation for chronic duodenal ulceration. In 9 patients the postoperative regimen employed was the intravenous administration of isotonic dextrose and dextrose-saline solutions, while the remaining 8 patients had intravenous supplements of nitrogen and calories in the form of amino acids and 50 per cent dextrose respectively. Detailed records of ward temperature and humidity were obtained during the studies.

A significantly increased amount of urinary nitrogen which showed no correlation with either nitrogen or calorie intake indicated increased catabolism of endogenous protein in the immediate postoperative period. The negative nitrogen balance which results from this response can be abolished by increased intake of nitrogen and calories, but the level of intake required is much higher in the early than in the late postoperative period. A significant negative correlation of maximum air temperature with the deviations of nitrogen balance from the nitrogen balance/nitrogen intake regression line indicates that in the humid climate of Lagos higher environmental temperatures may increase the extent of the catabolic response. It is possible that in a hot humid environment higher temperatures add to the stress of an abdominal operation.

Comparison of the results of this study with results obtained in a similar study in Newcastle (Spivey and Johnston, 1972) shows that in permanent inhabitants of a tropical area of the world abdominal surgery of moderate severity produces a metabolic response of similar magnitude to that observed in a temperate part of the world.
Long-term results of surgical treatment for dumping after partial gastrectomy
Authors: Eldh J , Kewenter J , Kock N G , Olson P
Published: March 2007

Forty-seven patients with moderate or severe dumping after partial gastric resection have been observed for 8 years, Twenty patients had been treated for dumping by conversion of the gastrojejunostomy to gastroduodenostomy and in 14 patients an isoperistaltic segment of jejunum had been interposed between the gastric remnant and the duodenum. Thirteen patients with post-gastrectomy dumping had not been operated upon secondarily and served as controls. Fifty per cent of the patients who were surgically treated for dumping improved during the observation time. In the group of patients treated conservatively for dumping improvement was recorded in approximately 60 per cent. The finding of frequent socio-psychiatric manifestations in patients with postgastrectomy dumping emphasizes the importance of considering the mental conditions when selecting patients for gastric surgery. The high proportion of patients who improved spontaneously in the control group stresses also the importance of delaying surgical treatment for a time in patients with postgastrectomy dumping.
Management of the pelvic space after proctectomy
Authors: Broader J H , Masselink B A , Oates G D , Alexander-Williams J
Published: March 2007

Closed-suction drainage with peritoneal and perineal suture has been used in 106 patients undergoing proctectomy for carcinoma or ulcerative or Crohn's colitis. This technique resulted in primary wound healing in 63 per cent of all the patients. Wound breakdown and delayed primary healing were particularly likely to occur in the young, in patients with Crohn's disease, in those who had contaminated wounds and in those on prolonged systemic steroid therapy. Even in the high-risk patients primary wound healing could still be achieved in 33 per cent. If haematoma or infection of the wound occurs the wound can be opened and the patient is no worse than if the wound had been packed initially.
Cancer of the biliary system: A study of 445 cases
Authors: Shani Mordechai , Hart Jacob , Modan Baruch
Published: March 2007

The data for 445 patients admitted to all the general hospitals in Israel during a 4-year period in whom a definite diagnosis of biliary system cancer was made were studied. The findings confirm those of previous reports and indicate that the pattern of the disease in the community is similar to that in selected hospital material.
Disappearing gallstones: Report of 2 cases
Authors: Gray Robin
Published: March 2007

Two cases of disappearance of gallstones confirmed by operation are described. It is suggested that a contributory factor in the disappearance Was the Patient's adherence to a jut-free diet. Recommendations are made concerning the management of patients with multiple small gallstones.
‚Circumflex’︁ arterial bypass for ischaemia of the lower limbs-another imitation of natural collaterals
Authors: Louw J H , Birkenstock W
Published: March 2007

Occasionally revascularization of the lower limb by direct aortofemoral or iliofemoral bypass graft is impracticable because of sepsis in the femoral triangle. In such cases the femoral triangle has been circumvented by using an alternative route via the obturator foramen for the bypass. It is pointed out that this obturator bypass is simply an imitation of natural collaterals (obturator and medial femoral circumflex arteries), but that it has certain limitations. Another alternative pathway is described and named the ‚circumflex’︁ bypass because it is an imitation of the circumflex collaterals (deep circumflex iliac and lateral femoral circumflex arteries). This bypass has been used successfully in 2 patients-from the common iliac to the superficial femoral in the first, and from the axillary to the superficial femoral in the second.
Infected synthetic arterial grafts
Authors: Bouhoutsos John , Chavatzas Demetrios , Martin Peter , Morris Tom
Published: March 2007

A retrospective study of 532 patients with synthetic arterial grafts was made. The results showed that when the distal anastomosis has to be made via the groin the incidence of infection is reduced by placing the anastomosis above the inguinal ligament. This reduction in incidence is highly significant (P<0 001). If for some reason anastomosis to the femoral artery is unavoidable it is suggested that the sartorius muscle should be detached from its origin and sutured to the inguinal ligament to cover the anastomosis.

In addition the management of patients with infected grafts is discussed.
Pancreatic trauma and idiopathic retroperitoneal fibrosis: a long-term follow-up study of 4 patients
Authors: Pollock A V
Published: March 2007

Four cases are presented of long-term follow-up after pancreatic trauma. In none of these was any evidence found on intravenous pyelography of late ureteric obstruction by retroperitoneal fibrosis.
Giant fibro-adenoma (cystosarcoma phyllodes) in adolescent females-a clinicopathological study
Authors: Nambiar R , Kannan Kutty M
Published: March 2007

1. An analysis of the findings in a series of 25 cases of giant fibro-adenoma of the breast in adolescent females is presented together with a review of the relevant literature. The clinical features, histology, prognosis and treatment of these tumours are discussed.

2. Follow-up of from 2 to 8 years after total excision of the tumours has shown that normal breast development occurred in all the cases. There was no recurrence or distant metastasis.

3. Despite clinical features and histological characteristics suggestive of malignancy the tumour has been found in our experience to be strictly benign in patients under the age of 20 years.
Acute appendicitis complicating pregnancy in the Oxford region
Authors: Finch D R A , Lee Emanoel
Published: March 2007

A study of 75 patients who were admitted to the Oxford group of hospitals with suspected acute appendicitis during pregnancy is presented, and the findings are compared with those in a similar group of non-pregnant patients. In general the disease was found at operation to be more advanced in the pregnant group, and this was probably a reflection of a delay in diagnosis. This delay, which was seen most commonly in the third trimester, led to a number of fetal deaths which might have been avoided by earlier operation. Furthermore, the dangers resulting from a negative laparotomy were sufficiently minor for a policy of early surgery for suspected acute appendicitis to be advocated during all stages of pregnancy.
The reduction of surgical wound infections by topical cephaloridine: A controlled clinical trial
Authors: Evans Christine , Pollock A V , Rosenberg I L
Published: March 2007

Four hundred and one consecutive patients having surgical operations were studied. Of these, 188 cases selected at random had 1 g of cephaloridine in 2 ml of water instilled into the wound before closure, the remainder being controls. In the group receiving cephaloridine 9 per cent of the wounds became infected and in the control group 22.1 per cent. The difference could have arisen by chance less than once in a thousand times.
Choledochal cyst
Authors: Kirwan W O
Published: March 2007

This paper reports a series of 8 children with a choledochal cyst. The pathology, diagnosis and treatment of choledochal cyst are discussed. All the cases have been fully followed up and 1 patient has been examined 21 years after operation. The importance of choledochal cyst as a cause of obstructive neonatal jaundice is emphasized. Radical excision of the cyst with choledochoduodenostomy has been found to be the most satisfactory operation. If choledochal cyst is properly managed the prognosis is excellent.
Associated midgut malrotation and Meckel's diverticulum presenting in adult life
Authors: Harvey J S , Giles G R
Published: March 2007

The details of 2 adult patients are reported who presented with abdominal colic and were found to have malrotation of the midgut. However, in both cases the clinical presentation resulted from the association of the malrotation with a persistent Meckel's diverticulum. This particular association does not appear to have keen stressed or commented upon before.
Amoebic perforation of the colon
Authors: Prakash A , Sharma Lalit K , Pandit P N
Published: March 2007

A case of multiple large amoebic perforation of the colon is presented. Although amoebiasis is common in the developing countries of the world, reports of bowel perforations needing surgical treatment are few. A high index of suspicion, early surgery and intensive anti-amoebic and antibiotic therapy, as in the present case, may save a patient in an otherwise fatal complication of amoebic infection.
Multiple intestinal malignancies and prolonged survival in a young woman
Authors: Thomas E , Hall P , Hislop I G
Published: March 2007

An unusual case of long survival after multiple primary gastrointestinal malignancies is reported. A 30-year-old woman developed a carcinoma of the cardiac region of her stomach with local extension to the oesophagus; 11 years following limited resection she is alive and well. During the intervening period she developed three separate predominantly poorly differentiated cancers of the colon and another in the rectum. Lymph node metastases were present in association with the first colonic carcinoma; local involvement of the uterus and pericolic veins was observed with the rectal tumor Factors known to influence the prognosis of gastric and colonic carcinomas are briefly reviewed.
Penetrating craniocerebral missile injuries in the civil disturbances in Northern Ireland
Authors: Byrnes D P , Crockard H A , Gordon D S , Gleadhill C A
Published: March 2007

The management of 93 patients with craniocerebral gunshot wounds is reviewed. The contrast between the injuries of urban guerilla warfare, conventional warfare and civilian life is outlined. Emphasis is placed on the need for early and adequate transfusion and for immediate airway control to limit cerebral oedema. Principles of wound surgery evolved in other conflicts were followed and developed.
Gastric mucosal pH
Authors: Earlam Richard J
Published: March 2007

During routine studies of oesophageal motility the lowest pH recorded from the stomach has been measured by a stomach electrode on 263 separate occasions.

The mean pH of 117 male patients with duodenal ulceration was 1.3 ± 0.3 (mean ± 1 standard deviation), and this was lower than in 17 patients with a gastric ulcer (1.7 ± 0.3) and 19 with a hiatal hernia (1.6 ± 0.4). Patients with a gastric ulcer had a lower pH than those with gastric carcinoma (2.3 ± 0.9).

The lowest pH of duodenal ulcer patients was changed by truncal vagotomy (37 patients) to 1.3 ± 0.8 and by a Polya partial gastrectomy (25 patients) to 3.2 ± 1.8.

If a stomal ulcer was present after a partial gastrectomy the pH was 1.1 and this changed to above 1.9 after vagotomy.
Total body water and total exchangeable sodium in patients after ileorectal anastomosis
Authors: Hill G L , Watts J McK , Iseli A , Clarke A M , Hughes E S R
Published: March 2007

Total body water and total exchangeable sodium were measured in 29 patients who had undergone subtotal colectomy with ileorectal anastomosis for chronic ulcerative colitis more than I year previously and in a control group of 28 normal persons. Significant dehydration and sodium depletion in the patients were not demonstrated when compared with the controls. These findings are in contrast to the dehydration and sodium depletion previously demonstrated in ileostomy patients. Faecal loss of sodium in patients with ileorectal anastomosis was found to be less than in patients with ileostomies. The findings suggest that ileorectal anastomosis carries less risk of long-term, fluid and electrolyte depletion than ileostomy.
Postoperative fibrinolytic activity and deep vein thrombosis
Authors: Gordon-Smith I C , Hickman J A , Le Quesne L P
Published: March 2007

The changes in blood fibrinolytic activity, measured by an isotopic method, have been studied in 50 patients following a major surgical operation.

A phase of enhanced fibrinolytic activity occurred at the time of operation. Subsequently no evidence of prolonged depression of fibrinolytic activity was demonstrated.

Patients who developed postoperative deep vein thrombosis, as diagnosed by the 125I fibrinogen technique, exhibited significantly lower fibrinolytic activity on the first postoperative day than patients with no thrombosis (P < 0.01); apart from this the two groups of patients showed no demonstrable difference in fibrinolytic activity in the 7 days after operation.
Portacaval transposition in the rat: A new technique and its effects on liver and body weight
Authors: Ryan C J , Benjamin I S , Blumgart L H
Published: March 2007

Portacaval transposition by direct end-to-end anastomoses has been established in rats, with negligible mortality and with survivors up to 150 days. The operation was associated with an early fall in body weight, followed by a recovery period the rapidity of which was related to the preoperative weight (and thus age) of the animal. At sacrifice after 35 days the relative liver weight of the animals with portacaval transposition was significantly reduced (P < 0.01), though it remained significantly higher (P < 0.001) than that in a group of animals with a portacaval shunt. The only histological change was minimal congestion of the sinusoids in the animals with portacaval transposition.
Superior mesenteric artery aneurysm
Authors: Mukerjee S , Nigam M , Awatramani M
Published: March 2007

A case of mycotic aneurysm of the superior mesenteric artery is presented. The aneurysm was successfully treated by ligation and excision of the superior mesenteric artery. A review of the relevant literature is also included.
Highly selective vagotomy and drainage for duodenal ulcer stenosis
Authors: El-Katib Yehia , Mashhoor Nabil
Published: March 2007

Thirteen cases of duodenal ulcer complicated by stenosis have been subjected to highly selective vagotomy and a gastro-enterostomy, the gastric stoma of which was situated on the greater curvature in order not to interfere with the antral motility. There was no radiological or clinical evidence of postoperative gastric retention.
Measurement of gastrow-oesophageal acid reflux: Its significance in hiatus hernia
Authors: Lichter Ivan
Published: March 2007

Gastro-oedophageal reflux may be responsible for symptoms and sometimes for the development of oesophageal damage. These effects are inconstant when reflux is demonstrated by radiography or by conuentional pH studies. This unpredictability may be accounted for by the observation that during the day refluxed material is rapidly cleared from the oesophagus by swallowing, while during sleep little swallowing occurs. To explore the hypothesis that reflux during deep is the important factor, prolongedintra-oesophageal pH studies have been done and a method has been developed for quantifying nocturnal gastro-oesophageal reflux.

The investigation has Ahown that persistence of acid within the oesophagus is associated with prolonged periods during sleep when no swallowing occurs. Measurements of nocturnal intra-oesophageal pH were made in 41 patients with symptomatic sliding hiatus hernia. In 12 patients with mild symptoms reflux measured by this index did not exceed 15 minutes, with one exception, and no patient showed oesophagitis. In 10 patients with moderate symptoms reflux did not exceed 1 hour, with one exception, and mild to moderate oesophagitis was present in 4 cases. Nineteen patients had severe symptoms; in all hut one the period of reflux was in excess of 1 hour, and oesophagitis was found in 13.
The experimental production of gastric ulcers by induced muscle spasm
Authors: Qvist George , Dormandy John , Brown Colin , Slome David , Scott G B D
Published: March 2007

A new technique is described for the experimental production of gastric ulcers in dogs. It depends on producing an intermittent but severe localized increase in the contractility of the stomach by means of electrodes implanted in the gastric muscle. A suitable stimulator is attached to the animal's back. Following some early technical, failures an adequate stimulus was applied for 2–3 weeks in 16 animals. In 13 cases macroscopic lesions developed in the stimulated area, varying from frank perforation to superficial erosions. Confirmation by barium meal examinations and histology is provided.

It is suggested that the responsible mechanism may be a localized ischaemia, due to the increased muscle spasm, predisposing to the necrosis and ulceration of the mucosa followed by the more superficial layers of the stomach wall.
The doubtful place of the raised heel in patients with intermittent claudication of the leg
Authors: Chavatzas Demetrios , Jamieson Crawford W
Published: March 2007

Thirty legs in 24 patients with intermittent claudication in the calf secondary to atherosclerosis have been studied. All the patients walked on a treadmill with and without their heel raised. The evaluation of the response of each patient to the exercise was achieved by subjective and objective means, including the severity of pain, walking time and distance to onset of pain, walking time and distance to pain tolerance and post-exercise ankle systolic blood pressure response using the percutaneous ultrasound Doppler. The results indicate, contrary to those of the limited available literature, that the raised heel deserves no serious place in the treatment of intermittent claudication.
The use of Dexon and plain catgut in circumcision
Authors: Mouzas G L , Pompa Peter
Published: March 2007

Published clinical literature on the handling properties and qualities of Dexon (polyglycolic acid) suture material is reviewed. Of 68 patients (aged 3 months to 56 years) requiring circumcision, 37 were sutured with Dexon and 31 with plain catgut. There was no tissue reaction to Dexon in 36 patients (97.3 per cent) nor did any infection develop, but there was delay in absorption. Only 7 patients (22.5 per cent) sewn up with catgut were free from tissue reaction, and infection occurred in 8 of these patients. Catgut was absorbed more quickly. Dexon sutures had disappeared by the twenty-first day in 19 patients (51.3 per cent) and catgut had disappeared in the same time in 19 patients (63.3 per cent). In 5 of I2 patients photographed postoperatively there was a knobbly-looking, foreskin at 19–27 days. This was associated with Dexon in 4 patients and was probably due to unabsorbed suture material. The relative lack of tissue reaction to Dexon in comparison with catgut supports the findings of other clinicians. A way of tying Dexon and slipping the knot into place (like catgut) is also described.
A technique for highly selective (parietal cell or proximal gastric) vagotomy for duodenal ulcer
Authors: Goligher J C
Published: March 2007

The designation and comparative effects of the various types of vagotomy in current use for the treatment of duodenal ulcer are discussed and the surgical anatomy of the form known as ‘proximal gastric’ vagotomy, ‘parietal cell’ vagotomy or ‘highly selective’ vagotomy is examined. A detailed and fully illustrated description is given of a well-tried technique for the performance of this latter operationW.

It is emphasized that really long-term results of proximal gastric vagotomy without drainage for duodenal ulcer are still lacking, but the possible legitimate uses of this procedure at the present time are considered as well as its potential place in the future if its achievements live up to their early promise.
The effect of cholecystectomy on oesophageal symptoms
Authors: Barker John R , Alexander-Williams J
Published: March 2007

A prospective study was made of 225 patients with gallbladder disease treated by cholecystectomy. Of these, 77 (34 per cent) complained of oesophageal symptoms; after cholecystectomy 44 continued to hace these symptoms, 33 having been cured. Patients in the 40–59-year age group had a higher incidence of oesophageal symptoms and significantly fewer were cured by choiecystectomy than in the other age groups. In patients with refru× on barium studies andlor an enlarged hiatus at operation the incidence of oesophageal symptoms was higher (60 per cent), and less than 20 per cent of these were improved by cholecystectomy.
Papilloma of the gallbladder
Authors: McGregor J C , Cordiner J W
Published: March 2007

Two cases of papilloma of the gallbladder are described. The literature of this rare condition is reviewed, with particular reference to the possibility that the condition may be premalignant, its capacity to cause symptoms and its treatment.
Antesternal pendulant goitre: a case report
Authors: Mullick R N , Merwaha D C , Gupta R L , Gupta R R
Published: March 2007

A case of antesternal pendulant goitre is reported, and its pathogenesis and an unconventional surgical approach are discussed.
Sleep and delirium after open heart surgery
Authors: Johns M W , Large A A , Masterton J P , Dudley H A F
Published: March 2007

The quantity and quality of sleep have been measured objectively in 4 patients before and after open heart surgery; 2 of these became delirious on the third postoperative day. A fifth patient was studied in relation to major abdominal surgery. The degree of sleep disturbance in the early postoperative period was greater after cardiac than abdominal surgery but was not consistently related to the ensuing delirium. Although patients were woken frequently by the necessity for nursing and other care, they were unable to remain asleep when left undisturbed during the period of delirium, which lasted for several days. Rapid eye movement (REM) sleep was absent and delta wave sleep markedly reduced after cardiac surgery and with delirium although the patients described frequent ‘dream-like’ experiences in their drowsy state. Delirium after cardiac surgery difsers from that which sometimes occurs after withdrawal of addictive drugs, when a high proportion of REM sleep is observed.
The treatment of varicose veins by compression sclerotherapy
Authors: Stother I G , Bryson A , Alexander S
Published: March 2007

Two hundred and eighty-four patients (348 legs) with varicose veins were treated by compression sclerotherapy and reviewed 1–4 years later. Successful results were obtained at the end of a course of treatment in 89 per cent and after an interval of 3–4 years in 68 per cent. The majority of recurrences presented within 2 years. Factors affecting the results were examined. Women whose varicose veins first appeared in relation to a pregnancy and those whose symptoms were aggravated at the time of menstruation had significantly better results than the group as a whole. Patients with varicose veins who had previously been treated by surgery or sclerotherapy had a success rate not significantly different to that for new patients. Local thrombophlebitis following injection was not uncommon and the success rate in this group was not significantly different from that in the whole group.
An evaluation of kidney preservation techniques
Authors: McLoughlin Gerard A , Sells Robert A , Tyrrell Irene
Published: March 2007

Experimental evidence is presented showing that progressive renal ischaemic damage results in an increase in intracellular water with eventual production of the ‘no reflow’ phenomenon. Preservation techniques have been compared in their ability to resist intracellular water gain. A colloidal perfusate with low lipid content and a potassium concentration of greater than 15 mEqll was the most effective preservation medium tested.
Maintenance of human tumours and tissues in immunosuppressed mice
Authors: Castro J E , Cass Wendy
Published: March 2007

Fragments of human tumours and tissues have been maintained in mice made deficient in cell-mediated immunity by thymectomy, lethal irradiation and reconstitution with syngeneic† bone marrow. Tissue fragments from 84 patients were implanted and 68 per cent were viable 2 weeks after transplantation beneath the kidney capsule. Many specimens survived for 12 weeks or more and some were passaged to secondary hosts. When tissues were implanted subcutaneously survival was slightly less.

The histological appearances of maintained tumours were excellent and in some cases functional studies were undertaken. The implications of the method as a means for studying the sensitivity of human tumours to therapeutic agents are discussed.
Pathogenesis and prevention of disruption of colonic anastomoses in traumatized rats
Authors: Irvin Thomas T , Hunt Thomas K
Published: March 2007

Colonic operations complicated by excessive intra-abdominal trauma are followed by a high incidence of anastomotic disruption. Experimental studies have shown that the local effects of trauma result in impaired colonic healing and a significant incidence of disruption in colonic anastomoses.

The nature of the effect of local trauma on the healing of colonic anastomoses was studied in rats subjected to intra-abdominal trauma.

The incidence of anastomotic disruption in traumatized rats was 18·5 per cent, but disruption did not occur when the colon was defunctioned for 4 weeks prior to surgery, and the incidence of anastomotic disruption in animals given intraperitoneal cephalothin during surgery was only 3·6 per cent.

It was concluded that sepsis is the immediate cause of anastomotic disruption in traumatized rats, and it was suggested that the value of prophylactic intraperitoneal antimicrobial therapy in patients undergoing colonic surgery should be studied in a randomized prospective clinical trial.
Reduction in the incidence of stress incontinence complicating fistula repair
Authors: Hassim Abu M , Lucas Cynthia
Published: March 2007

The results of treatment of 11 gynaecological fistulae and 150 obstetrical fistulae over a period of 6¼ years is presented. Postoperative stress incontinence was the most serious complication. Its incidence following repair of obstetrical fistulae has been reduced to 7.3 per cent in this series. Meticulous technique, combining the appropriate operation for bladder neck reinforcement with the initial flap-splitting repair, contributed to the low incidence of postoperative stress incontinence. Suprapubic operations were utilized in 20 cases (13.3 per cent). Gross vesical contraction associated with incontinence in 7 cases responded to ileocystoplasty or sigmoidocystoplasty. The final functional cure rate in the series was 873 per cent. Closure was accomplished in about 95 per cent of fistulae. In 8 cases closure was unsuccessful; 4 of these were inoperable. There was I death due to endotoxic shock after ureterosigmoidostomy.
Initial experience with Helmstein's treatment by a hydrostatic pressure technique in carcinoma of the bladder
Authors: Glashan R W , Brown P R
Published: March 2007

Twenty cases of bladder tumour which have been treated by Helmstein's hydrostatic pressure technique are presented. Modifications to the technique are described and indications for its use suggested. Massive necrosis of tumour tissue has been shown to occur and it is suggested that this method of treatment requires further investigation in suitable cases.
The effect of vagotomy and drainage operations on the rate of gastric emptying in duodenal ulcer patients
Authors: Davies W T , Griffith G H , Owen G M , Shields R
Published: March 2007

The rate of gastric emptying was estimated in 29 patients with duodenal ulcers, before and after vagotomy and drainage operations, by measuring the disappearance from the stomach of a standard meal containing radioactive chromium. When Heineke-Mikulicz pyloroplasty accompanied vagotomy gastric emptying was observed to be slowed, whereas after vagotomy and Fitmey pyloroplasty the rate of gastric emptying was more rapid when compared with the preoperative rate. Gastric emptying after vagotomy and gastrojejunostomy showed no consistent alteration in rate. Temporary gastric stasis occurred in the early postoperative period after vagotomy and drainage procedures.
Reconstruction of the pylorus for postvagotomy diarrhoea and dumping
Authors: Christiansen P M , Hansen O Hart , Pedersen T
Published: March 2007

Five patients with incapacitating diarrhoea or severe dumping after vagotomy with pyloroplasty were treated by reconstruction of the pylorus. The operation was easily performed, and the postoperative course was unenventful in all the cases. All the patients had a significant improvement. The results suggest that pyloric reconstruction can be of benefit in patients who need revision operation for postvagotomy diarrhoea or dumping.
Transthoracic extended total gastrectomy for malignant obstruction of the cardio-oesophageal junction
Authors: Smith R Abbey
Published: March 2007

Results in a small series of extended total gastrectomies support what was said of the operation over 20 years ago—that reservations about its use in adenocarcinoma of the cardio-oesophageal junction should be abandoned.
Oesophageal replacement by a gastric tube: An experimental study of the properties of the gastric tube
Authors: Henderson R D , Boszko A , Mugashe F , Szczepanski M M , Marryatt G
Published: March 2007

The effects of gastric tube replacement have been studied experimentally in dogs. A gastric tube can replace the lower oesophagus and, if maintained 2.5-6 cm below the diaphragm, will prevent reflux.

The gastric tube acts as a pressure barrier which is important in the prevention of reflux. Myotomy of the tube lowers the pressure barrier and allows free reflux. Atropine decreases the pressure within the gastric tube and gastrin increases the pressure within the tube.