bluuebunny/crossref_metadata_2025 huggingface dataset:
A trial of preoperative radiotherapy in the management of operable rectal cancer
Authors:   First Report of an MRC Working Party, Duncan W , Smith A N , Freedman L S , Alderson M R , Arnott S J , Bleehen N M , Bond W H , Crowther D , Deeley T J , Duthie H L , Dykes P W , Fielding L P , Flatman G E , Goligher J C , Hawley P R , Hughes L E , Joslin C A F , Koriech O M , Morson B C , Oates G D , Peckham M J , Sandland M R , Schofield P F , Slack W , Slaney G , Smith J A R , Stewart Scott J , Whitehouse J M A , Wrigley P F M , York-Mason A
Published: March 2007

In a multicentre study, 824 patients with operable rectal cancer were randomized to receive surgery alone, surgery plus a single fraction of 500 rad (5 Gy) and surgery plus 2000 rad (20 Gy) in 10 equal daily, i.e. multiple, fractions. The ratio of abdominoperineal excision to anterior restorative operations was 3:1. There was no evidence of an increased morbidity or mortality following irradiation. The multiple fraction 2000 rad group had tumours which were significantly smaller than those of the other groups. There was also a reduction in the Dukes' C cases in the multiple fraction group. Neither the tumour size nor the lymph node status was altered in the single fraction group.
Conservative surgery for peptic oesophageal strictures
Authors: Cabré-Martínez C A , Sierra-Gil E , Miquel-Collell J M , Curto-Cardús J A
Published: March 2007

Vagal denervation of the stomach and, in most cases, intermittent dilatation for a limited time after the operation have been employed in the treatment of 14 patients with fibrous stricture and shortening of the oesophagus due to chronic gastro-oesophageal reflux. In 2 patients the stricture was widened by means of a gastric patch at the same operation.

The results have been quite encouraging, all patients being able to swallow solid food, most of them normally, and the improvement appears to be permanent. The change in the quality of the refluxed fluid brought about by gastric denervation seems to play a leading role in improving local oesophageal conditions and rendering the stricture amenable to dilatation by bougies or by ingested solid food.
Linear ulcers of the greater curvature of the stomach in patients with mucosal pyloric stenosis
Authors: Gough M J , Savage P T
Published: March 2007

Two patients with linear ulcers of the greater curvature of the stomach are reported. These patients formed part of a series of 18 patients with mucosal pyloric stenosis seen between 1963 and 1981. The mechanisms that may be important in the pathogenesis of these unusual ulcers are discussed.
Dumping symptoms after vagotomy treated by reversal of pyloroplasty
Authors: Ebied F H , Ralphs D N L , Hobsley M , Le Quesne L P
Published: March 2007

Eight patients with intractable dumping symptoms following truncal vagotomy and Heineke–Mikulicz pyloroplasty for duodenal ulcer had the pyloroplasty reversed. These patients were assessed, both clinically and by a dumping provocation test, before operation, within 3 months of reversal of the pyloroplasty, and again at 1 year postoperatively. Six of them had no symptoms during the year and results of their dumping provocation tests have reverted to normal. Five have been followed up for a further year and in all the clinical improvement is maintained. Two patients developed recurrent dumping symptoms within 6 months of the reversal procedure.
The Hartmann procedure
Authors: Bakker F C , Hoitsma H F W , Den Otter G
Published: March 2007

During a 10-year period, 59 patients had a Hartmann operation for diverticular disease (n = 19), carcinoma (n = 21), anastomotic disruption (n = 5), injury (n = 3) and various other conditions (n = 11). Twenty-two patients (37·3 per cent) died postoperatively. Wound infection or wound dehiscence occurred in 26 patients. Other complications inherent in this operation were colostomy necrosis or retraction (n = 12) and leakage of the rectal stump (n = 3). The mean hospital stay of the surviving patients was 28·4 days. Colorectal continuity was subsequently restored in 12 patients (32·4 per cent) and no difficulties were encountered with this procedure.
The identification of patients at high risk following curative resection for colorectal carcinoma
Authors: Finlay I G , McArdle C S
Published: March 2007

Thirty-five consecutive patients undergoing apparently curative resection for colorectal carcinoma were staged by conventional methods (Dukes', degree of tumour differentiation and pre- and postoperative CEA). In addition, the presence or absence of occult hepatic metastases at the time of surgery was determined by sequential CT scanning.

Thirteen patients died within 30 months of surgery. Conventional prognostic indices failed to define clearly those patients who died. In contrast, the presence or absence of occult hepatic metastases at the time of surgery clearly defined two groups of patients. Only 9 per cent of patients who possessed occult hepatic metastases survived 30 months compared with 88 per cent of patients in whom these metastases were not detected. The clinical implications of these results are discussed.
Results of highly selective vagotomy in a non-university teaching hospital
Authors: Busman D C , Munting J D K
Published: March 2007

Clinical and laboratory results are presented of 229 patients treated by highly selective vagotomy for duodenal ulcer in a non-university teaching hospital. Sixty-two per cent of the operations were performed by residents as part of their training. After 1–8 years follow-up (97 per cent complete) there were 22 recurrences (9·6 per cent). The residents had fewer recurrences than the consultants, but their patient follow-up was shorter. The usual Visick grading is presented (1, 2: 83·5 per cent; 3, 4: 16·5 per cent) as well as an additional way of grading described by Visick in 1948 which suggests that 4 per cent appear to be permanent failures. Mortality rate was 0·4 per cent, complications rate was low and side effects were in general of minor importance. Laboratory results are presented showing that the basal acid output (BAO) was reduced permanently by 65 per cent, and the PAO by 50 per cent. In patients with recurrences BAO was not reduced and the PAO was less reduced than in the non-recurrence group. Metabolic parameters did not deteriorate. Basal serum gastrin rose after operation while serum vitamin B12 remained constant with a minimal tendency to decrease.
Endotoxin, prostaglandins and renal fibrin deposition in obstructive jaundice
Authors: Fletcher M S , Westwick J , Kakkar V V
Published: March 2007

The delayed clearance of endotoxins in obstructive jaundice may cause renal impairment by inducing renal vasoconstriction and glomerular fibrin deposition as a consequence of intravascular coagulation. As endotoxins activate arachidonic acid metabolism we have examined the effects of selective inhibitors on mortality, plasma TxB2 and 6-oxo-PGF1α production and renal fibrin deposition in rats with obstructive jaundice following endotoxin administration. Jaundiced rats had a high mortality following endotoxin—58 per cent at 4 h and 83 per cent at 24 h. Pretreatment with indomethacin 3 mg/kg i.p., dazoxiben 3 mg i.p. or prostacyclin 300 ng/kg i.v. produced significant improvements in survival. Endotoxaemia was associated with significant elevations of plasma TxB2 and early inhibition of plasma 6-oxo-PGF1α generation. Renal fibrin deposition, assessed using indirect immunofluorescence and a 125I-labelled fibrinogen uptake ratio, occurred in jaundiced kidneys following endotoxin and could be prevented using indomethacin, dazoxiben and prostacylin. These results suggest that endotoxin-induced TxA2 production can cause renal fibrin deposition in obstructive jaundice, thus contributing in the pathogenesis of the renal impairment.
Nadolol and potassium iodide in combination in the surgical treatment of thyrotoxicosis
Authors: Peden N R , Gunn A , Browning M C K , Crooks J , Forrest A L , Hamilton W F , Isles T E
Published: March 2007

With the two aims of rapidly reducing circulating thyroid hormone levels and controlling the symptoms of thyrotoxicosis, we have prepared 17 thyrotoxic patients for subtotal thyroidectomy, using a combination of potassium iodide administered for 10 days and the long acting beta-adrenoceptor antagonist nadolol. All 17 patients had normal serum thyroxine levels after 10 days of such treatment although 10 still showed elevation of serum tri-iodothyronine and considerable elevation in the most severely toxic patient. All patients were, however, clinically euthyroid preoperatively.

Nadolol was adminstered once daily, hence avoiding the problems of drug administration in the immediate postoperative period, and plasma nadolol concentrations were high throughout the perioperative period. Serum thyroxine and tri-iodothyronine levels were significantly lower and reverse tri-iodothyronine levels higher 24 h postoperatively than before operation. All patients remained stable throughout the perioperative period.

We conclude that this regimen has a number of advantages in the preparation of patients for thyroidectomy, in reducing the degree of thyrotoxicosis, in convenience of drug administration and in ensuring adequate circulating concentrations of beta-adrenoceptor antagonist whilst still retaining a relatively short preoperative phase of drug treatment.
Urinary stones in subjects with a permanent ileostomy
Authors: Kennedy H J , Fletcher E W L , Truelove S C
Published: March 2007

The prevalence of urinary stones in a group of subjects living with a permanent ileostomy has been determined by intravenous urography. Thirty-nine of the ileostomists had previously suffered from ulcerative colitis, while the remaining 12 suffered from Crohn's disease. Four of the ileostomists who had had ulcerative colitis had urinary stones (10·3 per cent). These four subjects were all male, so that among the 23 male ileostomists who had had ulcerative colitis 17·4 per cent had urinary stones. No urinary stones were found in the ileostomists with Crohn's disease. Various factors thought to be associated with a liability to urolithiasis have been examined in the ileostomists and also in a control group of 39 healthy subjects matched for age and sex with the ileostomists who had had ulcerative colitis. The ileostomists commonly showed a reduced urinary volume, a low urinary sodium and magnesium content and low urinary pH. The ileostomists were much more prone to be hyperuricaemic than the controls, and hyperuricaemia was strongly associated with the presence of urinary stones.
The ultrasonic demonstration of portacaval and interposition mesocaval shunts
Authors: Holmin T , Alwmark A , Forsberg L
Published: March 2007

This study demonstrates direct as well as indirect ultrasonic signs of shunt patency in 11 patients with end-to-side portacaval or prosthetic interposition mesocaval shunts. The shunt was visualized in 8 of the 11 patients. Dilation of the inferior vena cava was demonstrated in 7 out of 11 patients, and an increased diameter of the superior mesenteric vein was observed in all of the 7 patients with a mesocaval shunt.
The effect of preoperative bile salt administration on postoperative renal function in patients with obstructive jaundice
Authors: Evans H J R , Torrealba V , Hudd C , Knight M
Published: March 2007

We have studied the effect of the preoperative administration of bile salts on postoperative renal function in jaundiced patients undergoing surgery. Nine patients did not receive bile salts and in this group there were 2 cases of acute renal failure in the postoperative period. Furthermore, creatinine clearance values fell in this group from a mean value of 85 ml/min preoperatively to a mean postoperative value of 55 ml/min. Nine patients received preoperative bile salts with no case of renal failure. Creatinine clearance values increased in all but 2 patients from a mean preoperative value for the group of 79 ml/min to a mean postoperative value for the group of 99 ml/min. The difference between the changes in creatinine clearance in the two groups was statistically significant (P < 0·01). The results of this study suggest that the oral administration of bile salts to jaundiced patients in the preoperative period prevents deterioration in renal function postoperatively and also reduces the incidence of postoperative renal failure.
Bleeding patterns in colorectal cancer: The effect of aspirin and the implications for faecal occult blood testing
Authors: Doran J , Hardcastle J D
Published: March 2007

Faecal occult blood testing for 3 consecutive days is recommended for the detection of colorectal cancer. Is this adequate? Haemoccult tests were performed for 6 days on the faeces of 50 patients with colorectal cancer. Enteric-coated aspirin was given during the final 3 days to see if its systemic effect on coagulation would increase tumour bleeding. In 25 patients blood loss was quantified by radiochromium assay. Bleeding was slight and intermittent with large daily fluctuations in individual patients. Median daily loss before aspirin was 1·2 ml and after aspirin 2·5 ml. Thirty per cent of the tumours were Haemoccult negative using the standard 3-day regimen and 18 per cent were negative after aspirin. Over the 6-day period, 10 per cent were persistently negative. We conclude that new methods are required to improve the diagnostic yield from faecal occult blood tests.
The water soluble contrast enema after rectal anastomosis
Authors: Shorthouse A J , Bartram C I , Eyers A A , Thomson J P S
Published: March 2007

A retrospective study of 135 consecutive postoperative water soluble contrast enemas has been performed to establish the safety of the technique and indications for its use. Normal and abnormal appearances at various levels of rectal anastomsis have been described. Postrectal fluid collections are associated with anastomotic dehiscence and may be a cause rather than effect. One low colorectal anastomosis was disrupted during administration of the enema; the procedure was otherwise safe and free from complication. The postoperative water soluble contrast enema is presented primarily as a research tool to define the true anastomotic leak rate, but may be useful in the diagnosis of a postrectal collection and to define the extent of an established leak.
Conservative treatment of inoperable arterial occlusions of the lower extremities with intra-arterial prostaglandin E1
Authors: Gruss J D , Bartels D , Ohta T , MacHado J L , Schlechtweg B
Published: March 2007

Prostaglandin E1 has a strong vasodilator effect, it inhibits the aggregation of platelets and improves the microcirculation. The hormone is synthesized from arachidonic acid and 80–90 per cent is eliminated in the first transit of the pulmonary circulation. From 1 January 1978 to 30 June 1981 100 patients suffering from inoperable occlusion of the arteries of the lower limbs and facing amputation were treated with intra-arterial PGE1 by prolonged perfusion over an average period of 34 days. PGE1 0·1–0·2ng kg−1 body weight min−1 was administered. Forty-even of 100 legs were saved; 22 of 29 patients suffering from diabetes requiring insulin had to undergo amputation, but only 1 of 18 patients suffering from thromboangiitis obliterans had to have an amputation. The results of treatment in the 52 cases of uncomplicated arteriosclerosis lie in between, with 18 amputations. The complications that followed treatment were haemorrhage, arterial thrombosis, infection and mycotic aneurysms.
Can drugs help patients with lower limb ischaemia?
Authors: Boobis L H , Bell P R F
Published: March 2007

The prevalence of symptomatic arterial disease of the lower limbs is 2 per cent of the population aged 45–60, but it has a relatively benign course, with 70 per cent of patients requiring no therapy. Of the numerous drugs used in the treatment of the disease, there is no evidence to suggest that antilipaemic drugs, anticoagulants, vasodilators or rheological agents confer any benefit to the patient. The initial use of antiplatelet drugs and prostaglandins has been disappointing despite the undoubted importance of the platelet/endothelial interaction in the aetiology of atherosclerosis. As it is unlikely that we can reverse advanced disease, this is hardly surprising. Long term use of these drugs may prevent deterioration in those patients with progressive disease, and controlled trials on this aspect of treatment are now required. Symptomatic relief in the claudicant may perhaps be obtained with naftidrofuryl and suloctodil and with the former in more severe ischaemia, but their use should not replace the beneficial effects of exercise and cessation of smoking.
Transaxillary sympathectomy—is a one-stage bilateral procedure safe?
Authors: Campbell W B , Cooper M J , Sponsel W E , Baird R N , Peacock J H
Published: March 2007

During an 11-year period, 80 transaxillary sympathectomies were performed on 51 patients (hyperhidrosis 24, Raynaud's syndrome 18, Buerger's disease 4, others 5).

Bilateral procedures under one anaesthetic were performed in contrast with previous reports which advocated unilateral operations only. The advantages of the transaxillary route over other operative approaches are discussed.
Extrathoracic management of aortic arch syndrome
Authors: Criado F J
Published: March 2007

The English literature on extrathoracic procedures for aortic arch syndrome spanning the 19-year period 1962–1980 has been reviewed. Fifty publications reporting on 787 operations were selected for analysis. The overall results were excellent in terms of safety and long term symptomatic relief. Unilateral carotid-based operations appear preferable to longer crossover bypasses in the majority of patients. It is suggested that transthoracic reconstruction remain the approach of choice for innominate artery disease and multiple bilateral arch branch occlusions in good-risk patients.
The early diagnosis of massive acute intestinal ischaemia
Authors: Jamieson W G , Marchuk S , Rowsom J , Durand D
Published: March 2007

Intestinal ischaemia with ensuing gangrene has been a serious clinical problem. Delay in diagnosis has inevitably led to either massive gut resection or death.

It has been shown that the bowel contains high concentrations of both organic and inorganic phosphate. With gut ischaemia, phosphate is released from the bowel and elevated concentrations may be measured in peripheral blood, peritoneal fluid and urine. Associated leucocytosis and acidosis constitute a diagnostic laboratory triad.

The alteration in gut phosphate metabolism has been studied extensively in dogs and humans. Under hypoxic conditions, a time period exists before irretrievable gut necrosis ensues. During this vital interval serum phosphate is elevated.

In 20 clinical cases an accurate diagnosis of bowel ischaemia was made utilizing phosphate measurements. Three cases had an early diagnosis which led to embolectomy with no loss of gut.

Elevated serum phosphate is an accurate diagnostic finding in early cases of massive gut ischaemia. It is hoped that this simple test may help lower the staggering mortality and morbidity associated with massive intestinal ischaemia.
Acute necrotizing colitis and obstruction
Authors: Teasdale C , Mortensen N J McC
Published: March 2007

Acute necrotizing colitis is a rare complication of colonic obstruction. Six cases occurring during a 20-month period are described. The presenting features were those of colonic obstruction with shock but without perforation. At laparotomy changes ranged from mucosal necrosis to frank gangrene in the colon proximal to the obstructing lesion. Gram stains of resected colon showed Gram-positive bacilli, resembling clostridia, invading the mucosa and submucosa. Two patients treated by defunctioning colostomy alone died but the remaining 4 survived after total colectomy. The cause is not known but raised intraluminal pressure may result in terminal mucosal ischaemia allowing anaerobic organisms to invade the bowel wall.
The effect of faecal loading on colonic anastomotic healing
Authors: Smith S R G , Connolly J C , Gilmore O J A
Published: March 2007

The effect of faecal loading of the colon on the healing of rat colonic anastomoses has been investigated in a prospective randomized and controlled study. Anastomotic dehiscence occurred significantly more often when the bowel was loaded with faeces at the time of operation than when it was empty. Suture line cultures bore no relationship to the outcome of the anastomosis. This result emphasizes the importance of an empty colon as a contributory factor in successful colonic healing in the rat.
Rectus abdominis myocutaneous flap—clinical experience with ipsilateral and contralateral flaps
Authors: Parkash S , Palepu J
Published: March 2007

This study summarizes our experience with the use of 15 superior and inferior rectus abdominis myocutaneous flaps for filling defects in the chest wall, pectoral region, abdominal wall and groin. An extension of this flap above the costal margin, recommended in the study, provides valuable additional tissue. The flap is reliable and easily constructed.
A randomized clinical trial of PTFE versus human umbilical vein for femoropopliteal bypass surgery. Preliminary results
Authors: Eickhoff J H , Hansen H J Buchardt , Brommé A , Ericsson B F , Kordt K F , Mouritzen C , Myhre H O , Norgren L , Rostad H , Trippestad A
Published: March 2007

PTFE (Goretex) and modified human umbilical vein (Biograft) vascular grafts were compared in femorodistal popliteal artery bypass surgery in a randomized clinical multicentre trial. During 18 months 104 patients (104 limbs) entered the trial. Twenty-five patients suffered from claudication, 54 suffered rest pain and 25 patients had ulceration or gangrene. The median preoperative ankle–arm blood pressure index was 0·34. Twenty-three limbs had 3 patent tibial arteries, 45 limbs had 2 tibial arteries, 31 limbs had 1 tibial artery while 5 limbs had an isolated popliteal segment. Thirty-six of the operations were redo-operations. Fifty-four patients were allocated to PTFE and 50 to umbilical vein. During follow-up (maximum 650 days) 24 PTFE grafts occluded against 12 umbilical veins. The 1-year patency rate was 40 per cent in the PTFE group against 75 per cent in the umbilical vein group (P = 0·014, Gehans test). During the first year the PTFE failure rate was on average 3·1 times higher than that of the umbilical vein.
The Kock reservoir ileostomy: A review of its development, problems and role in modern surgical practice
Authors: Cranley B
Published: March 2007

The Kock continent ileostomy reservoir was designed in an attempt to overcome many of the problems associated with the conventional ileostomy. An account is given of the technical developments of this procedure since its inception. An intussusception valve within the reservoir is necessary for continence. However, valve failure is a common problem and the developments in construction which have helped to overcome this are described. The major complications associated with the continent ileostomy are discussed in detail, and an attempt is made to define its present role in the treatment of inflammatory disease of the colon.
The value of parotid sialography
Authors: Adam E J , Willson S A , Corcoran M O , Hobsley M
Published: March 2007

One hundred consecutive parotid sialograms were reviewed to assess the clinical usefulness of the technique. In 54 per cent of patients significant information was provided by the sialogram, and in 22 per cent the diagnosis was made on sialographic appearances alone or the findings altered subsequent management. The highest proportion of useful investigations was found in those presenting with bilateral parotid swelling. No significant information was obtained in patients with an isolated lump in the parotid region.
Final inline filtration for intravenous infusions: A prospective hospital study
Authors: Allcutt D A , Lort D , McCollum C N
Published: March 2007

Phlebitis is the most common complication of intravenous therapy affecting more than 50 per cent of infusions. Particles in or added to infusions have been implicated, hence a filter with pore size of 0.2/ μm containing both hydrophobic and hydrophilic elements (Pall Biomedical) has been evaluated. All infusions of likely duration greater than 48 h, set up in a 2-month period at this hospital, were randomized to filter or identical dummy. The endpoints and statistical power of the study were determined at the outset. Of the 226 infusions randomized, 32 failed within 24 h and were excluded leaving 194 of whom 93 had dummy and 101 filter. Only 38 infusions with dummy survived until no longer required compared to 63 infusions with filter (χ2 = 7.68, P < 0.01). Analysed by life table, the trend for filtered infusions to survive longer failed to achieve statistical significance, but inline filtration prolonged the phlebitis-free survival of infusions (P < 0.01). These benefits were most marked in the 49 infusions where antibiotics were administered via the drip site. Inline filtration delays the onset of phlebitis, thus more infusions survive until they are no longer required. This effect is not sufficiently strong to institute an overall hospital policy but filters may be indicated in patients requiring intravenous antibiotics.
The preoperative detection of axillary lymph node metastases in breast cancer by isotope imaging
Authors: Osborne M P , Payne Julie H , Richardson V J , McCready V R , Ryman Brenda E
Published: March 2007

Axillary lymphoscintigraphy using 99Tcm-labelled liposomes was carried out in 40 patients with breast cancer as a part of pretreatment staging in an attempt to improve the accuracy of axillary evaluation. Patients were injected interstitially in the periareolar region of each breast with 250–300 μCi of 99Tcm-labelled liposomes. Subsequently the patients were imaged with a gamma-camera using computerized data processing. Interpretation of images was based on prior experimental data; a diminished uptake of isotope by the primary regional lymph node (PRLN) and the group of axillary regional lymph nodes (RLN) draining the tumour, when compared to the control side, was considered to be abnormal and to suggest node metastases. An equal or enhanced uptake by the PRLN or RLN draining the tumour, when compared to the control side, was considered normal, indicating an absence of lymph node metastases. Eighteen patients (45 per cent) had abnormal scans and 14 patients (35 per cent) had normal scans. Eight patients (20 per cent) had technically unsatisfactory images where axillary nodes could not be identified. Twenty-two patients of the 32 with evaluable scans had correlation of preoperative images with postsurgical axillary lymph node histopathology. One patient out of 12 with an abnormal scan had normal lymph nodes on serial sectioning, and 2 patients out of 10 with normal scans had lymph node metastases. Eight of the 32 patients (25 per cent) with evaluable images had enhanced uptake of isotope by the PRLN and RLN draining the tumour. In 3 of these cases a marked reactive hyperplasia only was shown on histopathological examination, in 2 cases the reactive hyperplasia was associated with lymph node metastases, accounting for the 2 false negative interpretations. This preliminary study suggests that axillary lymphoscintigraphy may be of value in preoperative staging in breast cancer. Long term studies are needed to evaluate the prognostic potential of such a test as a measure of macrophage function. Further studies, by blind replication, are required to evaluate the accuracy of axillary lymph node imaging.
Early or delayed cholecystectomy in acute cholecystitis? A clinical trial
Authors: Norrby S , Herlin P , Holmin T , Sjödahl R , Tagesson C
Published: March 2007

Patients with a preoperative diagnosis of acute cholecystitis were prospectively allocated to treatment with early cholecystectomy (ES) within 7 days of the onset of symptoms, or initial conservative treatment followed by delayed elective surgery (DS). Patients whose symptoms required emergency operation, patients older than 75 years and patients with pancreatitis were excluded from the trial but were followed up. During the study period 402 patients with acute cholecystitis were admitted, 101 fell into the ES group and 91 into the DS group. The conservative regimen had to be interrupted in 15 patients (13·8 per cent) because their clinical status deteriorated and 13 patients (11·9 per cent) in the DS group did not return for planned elective surgery. One patient in the DS group died. There was no difference in the frequency of intra- and postoperative complications between the 2 study groups, the incidence of bacterial complications being markedly low, especially in the ES group. The ES group had a moderate but significantly greater intraoperative blood loss. Hospital stay was almost 1 week shorter in the ES group and insurance payment for loss of working capacity was also shorter in the ES group. These results indicate that early cholecystectomy is the treatment of choice in acute cholecystitis in patients aged 75 years and under.
Proliferative cholangitis (cholangitis glandularis proliferans)
Authors: Krukowski Z H , McPhie J L , Farquharson A G H , Matheson N A
Published: March 2007

A case of extrahepatic biliary obstruction is presented in a patient with a previously unrecognized condition of the bile ducts. Five other cases with similar histological features in the bile ducts are also presented. The possible relationship between this condition and other causes of biliary obstruction is discussed and its characteristic features are described. The problems of diagnosis and management are discussed. Because of clinical, radiological and pathological similarities to cholecystitis glandularis proliferans it is proposed that the condition be called proliferative cholangitis (cholangitis glandularis proliferans).
Effects of gastrocystoplasty on serum gastrin levels and gastric acid secretion
Authors: Lim S T K , Lam S K , Lee N W , Wong J , Ong G B
Published: March 2007

Hypersecretion of gastric acid and hypergastrinaemia occur when the antrum of the stomach is transposed as a diverticulum to the colon. Thus, when an antral pouch is transposed to increase bladder capacity or to replace the bladder as a gastrocystoplasty, similar pathophysiological disturbances can be anticipated. However, previous studies in our laboratories in dogs have shown that acid overproduction and stomal ulcerations do not occur. This paper reports the results of gastrocystoplasty in 13 patients followed up from 1 to 6 years. Gastric acid hypersecretion and hypergastrinaemia did not occur.
Adult intussusception in the tropics
Authors: Hadley G P , Simpson R L
Published: March 2007

Thirty-two cases are reported of intussusception occurring in patients over the age of 12 years, diagnosed in Papua New Guinea in the 8 years from March 1973. Malignant disease was found in only 2 patients (6·3 per cent), and in 21 cases (65·5 per cent) no associated pathology was detectable. Benign inflammatory polypi were encountered in 7 patients (22 per cent). A high proportion of primary intussusceptions is characteristic of series reported from tropical countries. Many may be due to the abnormal motility associated with acute diarrhoeal illnesses. Due to the rarity of associated malignancy a policy of conservative operative management is justifiable in a tropical environment.
Standardized diagnosis and treatment of fluid, acid–base and electrolyte disorders in the surgical patient with the aid of a programmable pocket calculator
Authors: Kievit J
Published: March 2007

The approach to fluid, acid–base and electrolyte disorders in the surgical patient has been standardized in a pocket calculator program that categorizes these disorders into formal diagnoses and subsequently uses these diagnoses to determine the appropriate therapy. The program was tested in 80 infusion regimens of patients in the intensive care and surgical wards. The advantages of a standardized approach to these disorders, using diagnostic and therapeutic algorithms, are briefly discussed.
Incisional hernias: When do they occur?
Authors: Ellis H , Gajraj H , George C D
Published: March 2007

Incisional herniation remains a major problem for the general surgeon. Most published studies have followed up patients for 6–12 months after operation. In this study, 363 patients, known not to have an incisional hernia at 1 year, were renewed between 2·5 and 5·5 years after operation. Twenty-one patients (5·8 per cent) were found to have developed incisional hernias. None of the causal factors previously implicated in the aetiology of incisional herniation (wound infection, male sex, obesity, age, postoperative chest infection or abdominal distension), was found to be associated with the development of these ‘late hernias’.
The effect of breast biopsy on reactive changes in the axillary lymph nodes
Authors: Steele R J C , Blackie R A S , McGregor J D , Forrest A P M
Published: March 2007

The reactive changes in the axillary lymph nodes of 50 breast cancer patients treated by mastectomy immediately following frozen section diagnosis have been compared with the changes in the nodes of 50 patients whose biopsy preceded mastectomy by between 2 and 5 days. The frequency of sinus histiocytosis was significantly greater in those patients who had been subjected to previous biopsy. This finding suggests that prior breast biopsy may negate the prognostic significance of sinus histiocytosis in breast cancer.
Causes and clinical significance of gastritis following Billroth II resection for duodenal ulcer
Authors: Fischer A B , Græm N , Christiansen L A
Published: March 2007

Billroth II resection was carried out in 1000 duodenal ulcer patients in the period 1948–1956. Twenty-two to thirty years later, gastroscopy and biopsy was performed in 196 of 423 survivors. Chronic atrophic gastritis appeared in 93 per cent of the cases, 47 per cent showed slight and 46 per cent severe changes. Seven per cent had normal mucosa. The microscopic grade of gastritis proved to be independent of age, alcohol and tobacco consumption and serum gastrin. No correlation between clinical status, such as dumping, diarrhoea, vomiting and pain, haematological parameters and the microscopic grade of gastritis, could be found. It is suggested that gastritis might be caused by reflux of bile, pancreatic and intestinal juices, and that postgastrectomy symptoms and anaemia do not depend on the microscopic grade of gastritis.
Surgical implications of malnutrition and immunodeficiency in patients with carcinoma of the oesophagus
Authors: Belghiti J , Langonnet F , Bourstyn E , Fekete F
Published: March 2007

A nutritional and immunological assessment was prospectively performed in 75 patients with squamous cell carcinoma of the oesophagus. Abnormal nutritional and/or immunological values were present in 37 patients (50 per cent) and absent in 38. The tumour was resectable in 27 patients (71 per cent) with normal values and only in 11 among the 37 (29 per cent) with abnormal values (P < 0·001). Complications after resection including death, pneumonia and anastomotic failure were not significantly different in the two groups of patients except for anastomotic failure. This observation suggests that reduction of surgical complications by preoperative nutritional therapy might be expected only in few patients with oesophageal carcinoma.
Long term follow-up of hyperthyroid patients treated by subtotal thyroidectomy
Authors: Sugrue D D , Drury M I , McEvoy M , Heffernan S J , O'Malley E
Published: March 2007

The early and long term complications of subtotal thyroidectomy in 306 hyperthyroid patients (multinodular goitre and diffuse hyperplasia) followed for up to 30 yr are reviewed. There were no perioperative deaths. Sixteen patients (5·2 per cent) had transient symptomatic hypocalcaemia, while 9 (2·9 per cent) had permanent hypocalcaemia. Permanent unilateral vocal cord paralysis occurred in 11 (3·6 per cent) patients (1·8 per cent of nerves at risk). Cumulative per cent (± s.e.m.) relapse and hypothyroid rates at 30yr (life-table analysis) were 15·6 ± 2·4 per cent and 20·5 ± 2·1 per cent, respectively. Lifelong follow-up of post-thyroidectomy patients is mandatory because of the risk of relapse or hypothyroidism.
Does fixity affect prognosis in colorectal tumours?
Authors: Habib N A , Peck M A , Sawyer C N , Blaxland J W , Luck R J
Published: March 2007

In-a retrospective series of 301 colorectal tumours, tumour fixity was assessed, and was found to be of prognostic significance in relation to 5-year survival. Fixity of the tumour was associated with low curative resection rate and advanced tumour stage. Fixation did not correlate significantly with the site or differentiation of the tumour nor with operative mortality.
Function of liver, gallbladder and sphincter of Oddi after major surgery studied by computer-assisted cholescintigraphy and real-time ultrasonography
Authors: Van Der Linden W , Kempi V , Edlund G
Published: March 2007

Patients with normal gallbladders were subjected to computer-assisted Tc-HIDA cholescintigraphy at fixed intervals after major surgery. Hepatic time–activity curves showed that hepatic excretion of the material was first reduced and later a reduction of hepatic uptake followed. The gallbladder responded first by dilatation and reduction of motility and later by delay in or even absence of visualization. Postoperative dilatation was confirmed with real-time ultrasonography. No tracer passed into the duodenum in the early postoperative stage indicating spasm of the sphincter of Oddi. Healthy volunteers were studied with and without morphine and with and without a 24 h fast. The sphincter of Oddi closed after morphine but not after fasting. Transient non-visualization of the gallbladder after surgery makes the diagnosis of postoperative cholecystitis more difficult.
Reoperative parathyroid surgery
Authors: Billings P J , Milroy E J G
Published: March 2007

The increasing recognition of hypercalcaemia caused by primary hyperparathyroidism has led to a rise in the number of failed parathyroid explorations. We report a series of 37 parathyroid re-explorations on 33 patients with persistent hypercalcaemia following the failure of their previous parathyroid surgery. Of these patients, 27 have been cured of their hypercalcaemia but 7 are permanently hypocalcaemic. The results of the parathyroid localization tests used in this series are described, and the difficulties of reoperative parathyroid surgery are discussed. The reasons for failure of the original operations are analysed. Many are avoidable. Based on our experience strategies are described for parathyroid localization and reoperative surgery.
Changes in small bowel myoelectrical activity following laparotomy
Authors: Morris I R , Darby C F , Hammond P , Taylor I
Published: March 2007

Recordings of the myoelectrical activity have been obtained from the small intestine of 4 dogs by means of serosally implanted electrodes. The occurrence of the activity front (phase III) of the migrating myoelectrical cycle (MMC) in the recordings obtained each day after abdominal surgery have been compared. No activity fronts were seen on postoperative days 1 and 2. From days 3 to 6 there was a slightly reduced incidence, but from day 7 onwards an activity front was observed in each recording. It is concluded that the normal pattern of cyclic myoelectrical activity in the small intestine is disrupted for at least 2 days following a laparotomy, and the view that small bowel motility returns to normal soon after routine abdominal surgery may be inaccurate.
Should surgeons operate on the evidence of ultrasound alone in jaundiced patients?
Authors: Eyre-Brook I A , Ross B , Johnson A G
Published: March 2007

The biliary ultrasound scans of 132 patients having a laparotomy for jaundice have been reviewed to assess the role of ultrasound in the selection of patients for surgery. When scans were technically satisfactory the finding of a dilated extrahepatic duct (EHD) indicated obstructive jaundice in all cases, but the obstructing lesion in 5 per cent of such cases was too proximal for jaundice to be relieved by direct surgical decompression. Scans were further classified on the basis of abnormalities detected in the gallbladder. When EHD dilation was associated with gall bladder findings ‘typical’ of distal common bile duct (CBD) obstruction due to gall stones (small gallbladder with multiple gallstones) or tumour (dilated gallbladder without gallstones), surgically remediable obstruction was always present. Although ultrasound identified the obstructing lesion itself in a minority of cases, the cause of obstruction could be correctly inferred in 95 per cent of ‘typical’ scans. These results suggest that it is safe to proceed directly to surgery only when an experienced ultrasonographer demonstrates findings ‘typical’ of distal CBD obstruction due to gallstones or tumour.
The morphological basis of human breast cyst populations
Authors: Dixon J M , Miller W R , Scott W N , Forrest A P M
Published: March 2007

Forty human cysts have been examined to determine the relationship between the epithelial lining and the content of sodium (Na+) and potassium (K+) in the cyst fluid. The ratios of Na+ to K+ for cysts lined by flattened epithelium were higher in all cases than the values obtained for cysts lined by apocrine epithelium. These findings suggest a morphological basis for the two populations of human breast cyst fluids which can be defined on cationic content.
Differences in anorectal manometry between patients with haemorrhoids and patients with descending perineum syndrome: Implications for management
Authors: Read N W , Bartolo D C C , Read M G , Hall J , Haynes W G , Johnson A G
Published: March 2007

Anorectal manometry was carried out at rest, during balloon distension of the rectum and during rectal infusion of saline in 19 patients with haemorrhoids, 30 patients with descending perineum syndrome and 21 controls. Basal and squeeze pressures were significantly higher in patients with haemorrhoids than patients with the descending perineum syndrome. A lower rectal volume was required to inhibit internal sphincter tone in patients with descending perineum syndrome compared with control subjects or patients with haemorrhoids. During rectal infusion of saline basal and peak anal pressures in patients with the descending perineum syndrome were lower than in haemorrhoid patients. Peak rectal pressure was abnormally high in both groups. These differences in anorectal function suggest that despite a similar presentation, the two conditions have a different pathogenesis. Moreover, inappropriate anal sphincter stretch or mucosal excision in patients with descending perineum syndrome may lead to severe incontinence.
Adjuvant oral chemotherapy to prevent recurrence after curative resection for hepatocellular carcinoma
Authors: Yamamoto M , Arii S , Sugahara K , Tobe T
Published: March 2007

Adjuvant oral chemotherapy was studied in 67 patients with stage II hepatocellular carcinoma who underwent curative resection between May 1988 and December 1990. Patients were stratified into two groups according to preoperative liver dysfunction: 55 had stage I disease (mild dysfunction) and 12 had stage II (moderate dysfunction). A randomized controlled study of postoperative oral administration of 1-hexylcarbamoyl-5-fluorouracil (HCFU) was conducted in each group. From October 1994 HCFU administration was suspended because of side-effects in nine patients with stage I liver dysfunction and in three with stage II dysfunction who had received the drug for more than 4 weeks. Cumulative survival and recurrence-free survival rates of patients with stage I disease in the treatment group were higher (P = 0·08 and P = 0·04 respectively) than those in the control group. However, in patients with stage II disease no significant difference was observed (P = 0·77 and P= 1·0 respectively). This study suggests that the potential benefits of HCFU on tumour recurrence should be weighed against the risks of adverse reactions in patients with mild liver dysfunction.
Peritoneal and systemic cytokine response to laparotomy
Authors: Badia J M , Whawell S A , Scott-Coombes D M , Abel P D , Williamson R C N , Thompson J N
Published: March 2007

Cytokines are polypeptides produced mainly by activated leucocytes in response to infection and injury, including surgical trauma. Several reports have described the systemic cytokine response to a surgical operation, some of them in a sequential way1,2. This study was designed to determine the peritoneal and systemic cytokine response to elective abdominal surgery during the first 72 h after operation.
Laser Doppler blood flow measurement in rectal resection for carcinoma — comparison between the straight and colonic J pouch reconstruction
Authors: Hallböök O , Johansson K , Sjödahl R
Published: March 2007

Lower rates ot anastomotic leakage nave been reported after rectal resection with a colonic pouch-anal anastomosis than with a conventional straight anastomosis. The microcirculation in the bowel segment that was used for construction of a colonic pouch or a conventional straight anastomosis was examined. Transmural colonic blood flow was measured by laser Doppler flowmetry during the operation before the construction of a straight (n = 16) or pouch (n = 14) anastomosis. The blood flow recordings were first done before dissection of the bowel at one point close to the planned bowel end and at another point 8 cm more proximally. A second recording was done at the same sites after dissection and, where appropriate, after construction of the pouch, but before the anastomosis was completed. In the straight group (end-to-end anastomosis), blood flow levels at the site intended for the anastomosis were significantly decreased following dissection of the bowel. In the pouch group (side-to-end anastomosis), blood flow levels at the site of the anastomosis were similar following dissection of the bowel and pouch construction. It is concluded that unaffected blood flow at the site of the anastomosis of the pouch may be a favourable factor for anastomotic healing.
Value of a weekly surgical x-ray meeting
Authors: Charnley R M , Amar S S , Gregson R H S , Steele R J C , Bourke J B , Hardcastle J D
Published: March 2007

Surgical x-ray meetings attended by surgeons and radiologists are used for the clarification of x-ray reports and education of those present. Although the value of these meetings is generally accepted in terms of education, it is not known in what way they contribute to patient management. An audit of the authors' weekly surgical x-ray meeting to determine whether such reports and management decisions are modified following review and whether this is of benefit to patients is described.
Thoracoscopic implantation of an epicardial pacemaker
Authors: Robles R , Piñero A , Lujan J A , Parrilla P
Published: March 2007

The implantation of a pacemaker for the management of auriculoventricular block (AVB) is traditionally performed by inserting the electrocatheter into a peripheral vein and positioning the generator sub-cutaneously. In certain situations this is impossible and requires a subxiphoid approach or thoracotomy to implant an epicardial electrocatheter. This communication reports the thoracoscopic implantation of an epicardial pacemaker in a patient with AVB in whom insertion in the peripheral vein was impossible.