bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidermoid cysts, polyposis coli and Gardner's syndrome
Authors: Leppard Barbara , Bussey H J R
Published: March 2007

One hundred and ninety-six members of 15 families with Gardner's syndrome were investigated to determine the type of skin cyst that is part of this syndrome. These were shown to be epidermoid cysts and not pilar cysts or steatocystoma multiplex. They were solitary or multiple and seldom large and disfiguring. The skin cysts often occurred before the intestinal polyps were detectable. The presence of epidermoid cysts in children should be an indication for sigmoidoscopy when the child reaches the age of 14 years, and at 3-yearly intervals thereafter up to the age of 30 years, whether or not there is a family history of polyposis coli.

At present it is not possible to say if Gardner's syndrome is the same as, or different from, familial polyposis. Until all patients with colonic polyps have a full clinical examination, looking for skin cysts and osteomas, X-rays of the skull and long bones to detect osteomas and dental X-rays for abnormalities of the teeth this question will remain unanswered.
The effect of hepatic ischaemia on liver function and the restoration of liver mass after 70 per cent partial hepatectomy in the dog
Authors: MacKenzie R J , Furnival C M , O'Keane Maureen A , Blumgart L H
Published: March 2007

Partial hepatectomy was performed in dogs either as the only procedure or following a period of ischaemia to the liver remnant produced by inflow occlusion for periods of 30–60 minutes before partial hepatectomy. Temporary portal decompression was maintained through the portion of liver subsequently excised. Survival in dogs subjected to partial hepatectomy and ischaemia to the liver remnant was similar to that in animals after partial hepatectomy alone.Metabolic changes were similar in both groups but dogs submitted to partial hepatectomy and ischaemia to the remnant had higher serum alkaline phosphatase and alanine amino-transferase levels with increased bromsulphthalein retention in the fourth to sixth postoperative weeks.Replacement of liver mass proceeded rapidly in all groups of animals.

It is concluded that ischaemia of the liver remnant for up to 60 minutes preceding partial hepatectomy in the dog is consistent with survival and produces little change in postoperative liver function or in the rate of restoration of liver mass.
Orthotopic liver transplantation utilizing a vascular stapling instrument
Authors: Barron P T , Vogelfanger I J , Waddell W G
Published: March 2007

A technique of orthotopic liver transplantation in the pig is described in which the main feature is the accomplishment of four of the five anastomoses by the use of the Vogelfanger NRC vascular suturing instrument. The advantage of this instrument is the rapid accomplishment of safe leak-proof anastomoses.
Renal transplantation in the unimmunosuppressed pig: An abnormal response
Authors: Terblanche John , Hickman Rosemary , Uys C J
Published: March 2007

A series of 82 kidney allografts and autografts in unimmunosuppressed pigs surviving for longer than 5 days has been compared with a previously reported series of 24 unimmunosuppressed pig kidney allografts. In the previous series 40 per cent survived for longer than 20 days. In the present series only 2 per cent of 55 transplants performed in cross-bred pigs obtained from different farms survived for longer than 20 days. The major causes of death were unrelated to rejection, principally gastric ulcer bleeding. In the further 16 transplants between different pure-bred animals (thereby ensuring genetic disparity) the ulcer incidence was lowered by a gastro-enterostomy, and 12 per cent survived for longer than 20 days. Histological assessment of rejection in the latter group revealed 20 per cent with minimal rejection, and 60 per cent in which rejection was considered insufficient to account for the death of the animals. Based on the evaluation of 95 unimmunosuppressed pig kidney allografts in both series, it is concluded that a wide and unpredictable range of survival time occurs. Therefore the pig kidney allograft model is an unsatisfactory model in which to study immunosuppressive régimes. Also the unimmunosuppressed pig appears to show less evidence of kidney allograft rejection than the dog, irrespective of genetic disparity. It is tentatively suggested that this might be a lesser manifestation of the unexplained phenomenon of minimal rejection of liver allografts noted in unimmunosuppressed pigs.
Injuries caused by rubber bullets: A report on 90 patients
Authors: Millar R , Rutherford W H , Johnston S , Malhotra V J
Published: March 2007

The injuries in 90 patients caused by rubber bullets are described. There was 1 death and 17 people in the series had permanent disabilities or deformities. In 41 patients the injuries necessitated admission to hospital. One fatality outside this series is known. Injuries to the head and neck were frequent and severe.
A prospective study of acute pancreatitis
Authors: Imrie C W , Whyte A S
Published: March 2007

All 78 patients with acute pancreatitis admitted to one hospital in a 2-year period were included in a prospective survey of conservative management. The overall mortality rate was 11·5 per cent, being 46 per cent for 11 patients subjected to early laparotomy and only 6 per cent for patients managed without operation. Twenty-six patients were considered to have severe acute pancreatitis and all 9 deaths occurred in this group.

Biliary disease was present in 51 per cent of patients, and the majority of those with biliary disease were over 60 years old. Alcohol-related acute pancreatitis occurred in 26 per cent of the total patients, and none of this group was over 60 years old. Acute pancreatitis was considered idiopathic in origin in only 13 per cent of the patients.

Elective biliary surgery in 30 patients has resulted in freedom from recurrent attacks of acute pancreatitis for the follow-up period (12–30 months).

The results compare favourably with those in which glucagon and high dosage aprotinin (Trasylol) have been utilized in the management of acute pancreatitis.
The use of the vas deferens in inguinal herniorrhaphy
Authors: Sames Patrick
Published: March 2007

A new method of repair of inguinal herniae is described using the vas deferens as a suture material. It is especially suitable in very large and recurrent herniae. Nineteen cases have been operated on in this way with an average of 38 months' follow-up. In none has recurrence been noted. It is suggested that the vas deferens, so readily to hand, forms a more natural barrier than man-made fibres. It may also, in fact, remain viable, though this has not, as yet, been proved.
Bile salts and gallstone disease
Authors: MacKay Colin
Published: March 2007

Bile salts play an important role in maintaining cholesterol in aqueous solution in bile. There is evidence that in some patients at least gallstones arise as a result of bile salt deficiency. The evidence to date suggests that although oral bile salts may be of use in treating some gallstone patients they are unlikely to replace chole-cystectomy in the foreseeable future. The instillation of bile salts via an indwelling T-tube may well be of great use in the management of stones retained in the common duct after choledocholithotomy. There is no doubt that in this branch of medicine as in all others prevention is better than cure and our aim should be to perfect our technique so that we do not leave stones behind. However, should the situation occur we may soon have safe effective physiological solvents to dissolve our mistakes.
Long term changes in total body water, total exchangeable sodium and total body potassium before and after ileostomy
Authors: Hill G L , Goligher J C , Smith A H , Mair W S J
Published: March 2007

In 10 patients with inflammatory bowel disease, total body water, total body potassium and total exchangeable sodium were measured both before and 6 months after the establishment of a permanent ileostomy. All 10 patients underwent elective surgery for their inflammatory bowel disease but all were malnourished before surgery when their body composition was first measured.

Six months later, when the body composition was again determined, all the patients were in good health and had normally functioning ileostomies. As a group they had gained 6–8 kg in body weight and 372 mEq total body potassium over the 6-month period. When the “normal” total body water was calculated for each patient, a deficit of 12.4 per cent for the group was found before surgery and this was still present (11.1 per cent) 6 months later. The concentration of exchangeable sodium in the body water fell from an abnormally high level before surgery to within the normal range 6 months later.

These data show that deficits in total body water occurring preoperatively are not repaired in the months following the establishment of a well-functioning ileostomy, and that a reduction of total exchangeable sodium is present in patients with an ileostomy who are otherwise well. It is suggested that these findings should encourage the surgeon managing patients with intractable inflammatory bowel disease to strive for good nutrition and normal body composition before embarking on excisional surgery and the establishment of a permanent ileostomy.
Results of surgery for Crohn's disease in the Glasgow region, 1961–70
Authors: Young S , Smith I S , O'Connor J , Bell J R , Gillespie G
Published: March 2007

During the period 1961–70,283 patients in the Glasgow region have been studied with regard to the outcome of 418 surgical procedures performed for Crohn's disease.

Resection was followed by an overall recurrence rate of 33 per cent, but in disease confined to the large bowel the rate was 18 per cent.

Exploratory operations and bypass procedures were followed by a recurrence rate of 70 per cent. Evidence is provided that recurrence following bypass procedures for small bowel disease and ileocolitis occurs at a later stage than after exploratory operations alone.

By the end of the study period 77 per cent of patients in this series had required one or more resections.
Recurrent pleural effusion in chronic relapsing pancreatitis
Authors: Rasaretnam Rudra , Perera A B V , Kumarasinghe M
Published: March 2007

A case of recurrent pleural effusion occurring in a patient with chronic relapsing pancreatitis is presented. Although it is one of the less common manifestations of the pleuropulmonary complications of pancreatitis, the presence of such a lesion is of diagnostic importance when the enzyme content of the effusion is elevated above the levels in the serum. In most of the reported cases resolution has occurred with conservative therapy, but failure to do so necessitated subtotal pancreatectomy, following which the patient made an uneventful recovery.
Xanthogranulomatous pyelonephritis: A report of 2 cases
Authors: Morgan O S , Nicholson G D , Johnson P S , Atkinson D W
Published: March 2007

Two cases of xanthogranulomatous pyelonephritis are reported in Negroes. The clinical findings are similar to those in previously reported cases. In 1 case nephrolithotomy was followed by the development of a perinephric abscess 8 months later. Late diagnosis has limited experience with more conservative management, which should be reserved for demonstrably focal disease.
Ossification in extradural fat in Paget's disease of the spine
Authors: Clarke Patrick R R , Williams H I
Published: March 2007

A case of cauda equina compression by ossification in extradural fat at a level above the site of Paget's disease in a vertebra is described. Good recovery followed laminectomy and exposure of the dura mater.
Peritoneal mesothelioma
Authors: Chan P S F , Balfour T W , Bourke J B , Smith P G
Published: March 2007

Two patients with primary peritoneal mesothelioma are reported. They had abdominal symptoms, no symptoms referable to the respiratory system and normal chest X-rays. There was no clinical evidence of impaired respiratory function. One of the patients had a history of brief asbestos exposure over 20 years before diagnosis. The procedure for obtaining compensation is outlined and the protean uses of, and hence possible exposure to, asbestos are noted. In screening programmes consideration should be given to both pulmonary and abdominal symptoms. Laparoscopy may have a part to play in earlier diagnosis of peritoneal mesothelioma.
Observations on peripheral and central temperatures with particular reference to the occurrence of vasoconstriction
Authors: Brock Lord , Skinner J M , Manders J T
Published: March 2007

The importance is emphasized of the inadequacy of the term “body temperature”, but that both core temperature and the peripheral temperature must be considered. The assessment of vasoconstriction is informative, and advantage should be taken of the exact information that can be provided by an electro-thermometer as opposed, for example, to a touch of the hand. The core temperature is taken from the rectum, the nasopharynx or tympanic membrane, and the peripheral temperature from the great toe.

If the peripheral temperature falls the loss of body heat is prevented and the core temperature rises. If this is not understood or not recognized misguided attempts may be made to try to reduce the raised central temperature by cooling the skin. This can result in a further rise of central temperature. The recognition of peripheral vasoconstriction enables a proper assessment to be made of its basic cause and of the necessary treatment.

The most important cause is hypovolaemia from blood loss and a detailed account is given of how this should be recognized, especially by a study of the gradient between central and peripheral temperatures. Such studies should be a routine in any severe illness, whether medical or surgical, in which circulatory deterioration is likely, especially after major operations or injuries.

Study of the temperature of the heel (hindfoot) as well as of the toe (forefoot) can indicate a selective shutdown of peripheral circulation that reveals an especially critical circulatory state.
Oesophagogastrostomy without a drainage procedure in oesophageal carcinoma
Authors: Angorn I B
Published: March 2007

Ten patients with carcinoma of the lower third of the oesophagus who had oesophagogastrectomy followed by oesophagogastrostomy without a drainage procedure were investigated 6 months postoperatively. Postoperative symptomatic evaluation and modified Visick grading of the results were carried out by an independent observer. Objective assessment included fibre-optic endoscopy of the oesophagus, stomach and duodenum, gastric acid secretory studies and measurement of gastric emptying times following the ingestion of a barium food mixture.

Eight of the 10 patients had an excellent or very good result and the remaining 2 were graded as satisfactory. No evidence of macroscopic oesophagitis or gastritis was detected and pyloric obstruction was never observed. Gastric emptying time was not prolonged. The results obtained support the concept that a drainage procedure is unnecessary after oesophagogastrostomy.
Primary gastric tuberculosis: A case report
Authors: Page R E , Williams R E , Benson E A
Published: March 2007

A case of primary gastric tuberculosis is reported in a 34-year-old Negro male. The difficulty in diagnosis is emphasized. Surgical resection with postoperative anti-tuberculosis chemotherapy was followed by satisfactory recovery.
Congenital hepatic fibrosis: Aspects of diagnosis and surgical management
Authors: Sokhi G S , Morrice J J , McGee J O' D , Blumgart L H
Published: March 2007

Five cases of congenital hepatic fibrosis are described. In all the patients the diagnosis was delayed as a result of either failure to perform liver biopsy or misinterpretation of the histological features. Four patients had multiple operations for the control of haematemesis or the relief of portal hypertension. It is stressed that a high index of suspicion, the use of endoscopy and a liver biopsy are essential to avoid delay in diagnosis. The patients have a good prognosis provided that the diagnosis is established at an early stage and portacaval anastomosis performed.
Immediate operative fitting of upper limb prosthesis at the time of amputation
Authors: Robinson K P , Andrews B G , Vitali M
Published: March 2007

Three patients are described–-2 with an above-elbow amputation and 1 with a through-wrist amputation–-in whom a temporary prosthesis was applied on the operating table and in all of whom function was rapidly established. The patients did not become one-handed, with the result that they have all continued to wear their prosthesis throughout their working hours and use their artificial hand for all everyday functions. The value of this technique in making the patient accept the prosthesis and therefore to make full use of it suggests that this procedure should be more widely applied in patients who require upper limb amputation.
The bacteraemia associated with burns surgery
Authors: Beard C H , Ribeiro C D , Jones D M
Published: March 2007

Fifty-four surgical procedures on 39 burnt patients were studied with serial blood cultures. In 25 (46 per cent) of these procedures the cultures were positive. In spite of the absence of prophylactic systemic antibiotics there were no clinical manifestations and not one of the bacteraemias developed into a septicaemia.

The role of natural immunity in controlling the bacteraemia is discussed and it is suggested that prophylactic systemic antibiotic therapy covering burns surgery is unnecessary in the presence of normal immunoglobulin levels.
The significance of occult skeletal metastases, detected by skeletal scintigraphy, in patients with otherwise apparently “early” mammary carcinoma
Authors: Galasko C S B
Published: March 2007

Fifty patients with apparently “early” mammary carcinoma on clinical, radiological and biochemical grounds had a skeletal scintigram carried out when they first presented. Twelve (24 per cent) of the patients had a positive scintigram. All these patients have developed metastatic disease in the first 5 years following mastectomy, and at least 9 (75 per cent), and probably 10 (83 per cent), have died from mammary carcinoma during this period. This compares with 10 (26 per cent) of the patients with a negative scintigram who have developed recurrent or metastatic disease, of whom 8 (21 per cent) have died from their disease. Five years following mastectomy none of the patients with a positive scintigram was alive and free from disease, compared with 25 (66 per cent) of the patients with a negative scintigram.

It would appear that skeletal scintigraphy is the most sensitive method of detecting skeletal metastases and of staging breast carcinoma at the moment. Where practicable, this investigation should be carried out before embarking upon treatment for any particular patient, and this certainly should become part of any clinical trial comparing different therapeutic regimens. However, before some of the newer bone-seeking isotopes are used in this way, further studies are required to determine their false positive rate.
The effect of heparin and of acid-citrate-dextrose solution on screen filtration pressure of blood in experimental hypotension
Authors: Pardy B J , Dudley H A F
Published: March 2007

Anticoagulation with heparin may not always adequately protect an ischaemic vascular bed. A screen filtration device has been employed to study the in vitro actions of acid-citrate-dextrose (ACD) and heparin on blood from the dog in haemorrhagic shock. With both anticoagulants, blood obtained during shock caused greater filter obstruction than blood taken before shock. However, the increased obstruction was nearly four times greater with heparinized blood than with acid-citrate-dextrose blood. These findings suggest that the anticoagulant action of heparin may be markedly diminished in low blood flow states.
Factors influencing local recurrence after abdominoperineal resection for cancer of the rectum and rectosigmoid
Authors: Moossa A R , Ree P C , Marks J E , Levin B , Platz C E , Skinner D B
Published: March 2007

One hundred and fifty-two patients who underwent abdominoperineal resection for cancer of the rectum and rectosigmoid are reviewed. Six physicians were selected to predict which of these patients would have a local recurrence. All the information available at the end of the operation was duplicated and submitted to the observers. None of the physicians was able to predict local recurrence significantly better than random. There were 31 local recurrences, i.e. an incidence of 20·4 per cent. Low level of tumour in the rectum, local spread into perirectal fat or serosa, lymph node involvement and age below 60 years at time of operation were the only factors that were statistically related to local recurrence. The strategy for careful follow-up of patients at risk is outlined and a plea is made for a controlled trial of postoperative radiotherapy.
Collagen biosynthesis in normal and hypertrophic scars and keloid as a function of the duration of the scar
Authors: Peter Craig R D , David Schofield J , Jackson David S
Published: March 2007

The rates of collagen biosynthesis and the tissue concentrations of collagen in normal scar, hypertrophic scar and keloid were determined as a function of the duration of the lesions. The rate of collagen synthesis in normal scar was approximately constant between 6 months and 20 years after the initial wounding, but in both hypertrophic scar and keloid the rate was initially approximately twice that in normal scar, and 2–3 years after wounding it fell to approximately the same level as in normal scar. The tissue concentration of collagen appeared to be relatively constant in normal scar with respect to the time elapsed after wounding, but in both types of abnormal scar it was initially somewhat lower than normal scar and then rose to values higher than in normal scar after about 2–3 years. Since similar results were obtained for both types of abnormal scar in terms of the rates of collagen biosynthesis with respect to the time elapsed after wounding and also in terms of the tissue concentrations of collagen, this may indicate that the events in the pathogenesis of both abnormal scar types are similar. The results also raise the possibility that the formation of both types of abnormal scar may occur in two phases: an initial phase characterized by abnormally high rates of collagen biosynthesis, and a later phase characterized by essentially normal rates of collagen biosynthesis.
A technique for re-exploration of the saphenofemoral junction for recurrent varicose veins
Authors: Li Arthur K C
Published: March 2007

A safe and simple method is described for re-exploration of the saphenofemoral junction in patients with recurrent varicose veins following incomplete “Trendelenburg operation”.
Parathyroid identification by methylene blue infusion
Authors: Gordon Donald L , Airan Mohan C , Thomas William , Seidman Leon H
Published: March 2007

The intravenous infusion of methylene blue was investigated as a procedure that would identify parathyroid glands during operation in 17 patients with primary hyperparathyroidism. The dye was found to stain all adenomas, most hyperplastic glands and occasionally normal parathyroid glands. In addition, the frequency of glandular staining was directly related to the size of the gland, although size and histology may have been independent variables. Methylene blue infusion is a safe effective method of localizing abnormal parathyroid glands.
Selective surgery for abdominal stab wounds
Authors: Thavendran A , Vijayaragavan A , Rasaretnam Rudra
Published: March 2007

The value of selective surgery for abdominal stab wounds was assessed in a prospective study of 226 patients admitted over an 18-month period. Two died soon after admission and before operation, the indications for which were signs of peritoneal irritation or haemorrhage, evisceration of bowel and omental protrusion. Of the 226 patients, 113 were selected for immediate surgery, which was carried out within 3 hours of admission. There were 12 deaths (10·6 per cent). Of the III patients initially selected for observation, 47 (42·3 per cent) underwent delayed operation with 4 deaths (8·5 per cent), but in only 1 (2·1 per cent) of these patients could the delay have influenced the adverse result. There were no deaths in the 64 patients treated conservatively. The overall mortality rate for patients who were initially selected for observation was 3·9 per cent.

One hundred and fifty patients underwent laparotomy, positive findings justifying operation being present in 134 (89 per cent). Six patients required thoracotomy for concomitant thoracic injuries, including 2 patients who required cardiorraphy. Four other patients required combined thoracic and abdominal exploration. The selection of patients for either conservative or operative management was based entirely on clinical criteria; abdominal X-rays were not helpful in the early diagnosis of visceral lesions. The indications for operation were evident within 12 hours of admission in 156 of the 160 patients who were treated surgically.

A substantial reduction in the incidence of “negative laparotomy” can be made by this process of selection, and without an associated increase in the morbidity and mortality rates.
The aetiology and diagnosis of malignant tumours of the thyroid gland
Authors: Wade J S H
Published: March 2007

Known aetiological factors of thyroid tumours are: genetic, hormonal, irradiation and auto-immune thyroiditis. Some medullary carcinomas are familial. Thyroid-stimulating hormone plays a significant part in the initiation and maintenance of many well-differentiated thyroid carcinomas. Small doses of irradiation in childhood and probably also in adolescence may induce a papillary or follicular carcinoma. Some malignant lym-phomas develop in a previous auto-immune thyroiditis.

Diagnosis of a malignant thyroid tumour is usually obvious once there has been extrathyroidal spread. Intrathyroidal tumours are suspect if they are hard and irregular. The real diagnostic problem is the clinically solitary nodule which is smooth, firm and mobile in a euthyroid patient. Ultrasound and scanning may increase or decrease the suspicion of malignancy but excisional biopsy is the only certain diagnostic procedure.
The surgery of thyroid cancer
Authors: Johnston Ivan D A
Published: March 2007

Thyroid cancer accounts for just under 1 per cent of malignant disease. The prognosis varies from excellent with papillary carcinoma in young people to very poor in anaplastic carcinoma in the elderly. Modified rather than radical dissection of lymph nodes is indicated with well-differentiated tumours. The level of calcitonin in the blood is a sensitive marker for medullary carcinoma occurring either as sporadic or familial disease. The outcome of management in 7 patients with medullary carcinoma indicates that the prognosis is variable and that thyroidectomy is effective treatment.
Gram-negative septicaemia in surgical practice
Authors: Litton Adrian
Published: March 2007

Septicaemia in surgical patients usually occurs after operation or a manipulative event. The incidence of bacteraemia in one surgical unit was observed over a 7-year period. Gram-negative infections occurred three times more frequently than bacteraemia caused by Gram-positive bacteria. The clinical features of septicaemia, the portals of entry of the infection and the bacteria isolated from blood cultures are described.
Septic shock
Authors: Ledingham I McA
Published: March 2007

The problems associated with septic shock are highlighted, including those which arose during a 3-year prospective study. Mortality in the first year of the study was 71 per cent, falling to 38 per cent in the third year. The reasons, for this fall are detailed. The pattern of survival times changed over the 3 years, giving rise to the longer term complications such as stress bleeding, multiple organ failure and superadded infection.
The value of the radio-isotope hepatogram in the jaundiced patient
Authors: Watson A , Bone D E , Testa H J , Torrance Bruce
Published: March 2007

The distinction between ‘medical’ and ‘surgical’ jaundice is often difficult due to the lack of specificity of biochemical liver function tests, and the difficulty in assessing hepatocellular function and biliary tract patency in the jaundiced patient. We present a non-invasive isotopic technique which gives reliable information on these parameters, resulting in a high degree of accuracy in the classification of jaundice.

131I Rose Bengal, which is handled by the liver like bromsulphthalein, is administered intravenously and count rates during hepatic uptake and biliary excretion are recorded over the liver, biliary tract and duodenum using a gamma camera computer system, into which is built an electronic light pen, so that particular areas of interest can be studied. Blood clearance of the isotope is simultaneously measured, and from these data the T1/2 of uptake, the plasma retention and the excretion quotient are determined.

The results of the first 80 examinations show that by qualitative assessment of the uptake and excretory phases of the ‘hepatogram’ and by determination of the T1/2 and excretion quotient, jaundice has been classified with an 86per cent accuracy in cases where the diagnosis is not apparent from clinical and biochemical data. The T1/2 of uptake correlates well with bromsulphthalein retention in the non-jaundiced patient, and when applied to patients with obstructive jaundice enables the progress of hepatocellular impairment with time to be studied, and its recovery after relief of the obstruction. Preliminary results suggest that the technique may also have applications in the study of biliary tract dynamics in patients with post-cholecystectomy syndromes and relapsing acute pancreatitis.
Observations of gastric mucosal blood flow using 99Tcm in rat and man
Authors: Taylor T V , Pullan B R , Elder J B , Torrance Bruce
Published: March 2007

The 99Tcm clearance technique is shown to be a useful method of assessing gastric function. It is easily carried out and is relatively non-toxic–the dose of isotope could be reduced to 100 μCi or less without sacrificing the accuracy of the investigation. Although the results are preliminary and the number of cases investigated so far is small, they suggest that the measurement of pertechnetate clearance is directly related to gastric mucosal blood flow; it is a use ful parameter of gastric function and may well prove to be a more accurate discriminant in cases of peptic ulceration than the conventional measurement of gastric acid secretion.
Prophylactic interparietal povidone-iodine in abdominal surgery
Authors: Gilmore O J A , Sanderson P J
Published: March 2007

This study sought to determine in a district general hospital (a) the frequency and nature of bacterial contamination at operation, (b) the incidence of consequent infection and (c) the prophylactic effect, if any, of inter-parietal povidone-iodine against postoperative wound infection.

Bacterial contamination was shown in 49 per cent of all the abdominal surgical wounds at the end of operation. From 61 per cent of the subsequently infected wounds, organisms identified as contaminants at operation were again found. Interparietal instillation of povidone-iodine resulted in a statistically significant reduction in wound infection (P<0.01) in treated patients compared with untreated, randomized, matched controls. It was of significant value in cases of intestinal resection and peritonitis, in obese patients and in those with paramedian incisions.

Laboratory studies indicate that povidone-iodine does not induce bacterial resistance. This chemical antibacterial agent may thus provide a preferable alternative to antibiotics in preventing such infections.
Sex hormones in breast disease
Authors: England P C , Skinner L G , Cottrell K M , Sellwood R A
Published: March 2007

Serum concentrations of oestradiol 17β and progesterone were measured daily throughout one menstrual cycle in 32 normal women, 32 women with benign disease of the breast and 10 women with cancer of the breast.

In normal women concentrations varied with age. Women with cysts had concentrations of oestradiol 17β which were significantly higher than normal. In women with cancer the concentrations of oestradiol 17β and progesterone were significantly higher than normal, but the difference was very small and much larger numbers of patients need to be studied. Concentrations of oestradiol 17β and progesterone in post-menopausal women were consistently very low.
Measurement of cell production rates in human gastro-intestinal cancer-a guide to treatment?
Authors: Britton D C , Bone G , Wright N A , Camplejohn R S
Published: March 2007

Cell production rates were measured in 19 cases of rectal carcinoma and in 11 cases of gastric carcinoma using a stathmokinetic technique. These measurements were compared with results from normal rectal and gastric mucosa. It was found that most of the cases of rectal cancer were proliferating more slowly than morphologically normal rectal mucosa. This was true for the majority of gastric cancers, but a small proportion appeared to be proliferating more rapidly. These results are discussed with their relevance to appropriate therapy.
A controlled clinical trial of three methods of closure of laparotomy wounds
Authors: Goligher J C , Irvin T T , Johnston D , De Dombal F T , Hill G L , Horrocks J C
Published: March 2007

A controlled clinical trial was conducted of three methods of closing elective paramedian laparotomy wounds-catgut layer suture alone, catgut layer suture with tension sutures and wire sutures alone. Three hundred and twenty-four patients were entered in the trial. The combined incidence of wound dehiscence and subsequent incisional herniation in patients who did not manifest overt dehiscence in the immediate postoperative period was significantly higher after catgut layer suture alone (14 per cent) than after catgut layer suture with tension stitches (4.8 per cent) or wire sutures alone (0.9 per cent). There seemed to be more wound sespis and sinus formation associated with catgut layer suture and tension sutures than with either of the other methods of closure. In 4 patients a wire suture had to be extracted, because of sinus formation in 2 and on account of pain in 2.
Is a “second look operation” justified in suspected recurrences after abdominal cancer surgery?
Authors: Ellis Harold
Published: March 2007

Seventy-three patients have been submitted to 74 further laparotomies for suspected recurrent malignant abdominal disease over a period of 13 months. The original tumour was situated in the large bowel in 42, oesophagus or stomach in 24, ovary in 3, small intestine in 2 and pancreas and retroperitoneum in 1 instance each.

There were 10 examples of benign lesions, 16 of further primary cancer and 24 of resectable local recurrences or metastases. Seventeen patients underwent some palliative procedure, and only 7 were beyond any surgical help.
The internal sphincter and Lord's procedure for haemorrhoids
Authors: Hancock B D , Smith K
Published: March 2007

Anal pressure and motility have been measured in 56 patients with haemorrhoids and 40 asymptomatic subjects. The anal pressure of patients with haemorrhoids (93.6 cm H2O) was very significantly higher than that of the controls (66.8 cm H2O; P< 0.001). Ultra-slow pressure waves (amplitude 25–100 cm H2O, frequency 0.9–1.6lmin) were present in 39 per cent of patients with haemorrhoids, but in only 7.5 per cent of the controls (P< 0.001). Ultra-slow waves are present under anaesthesia with the voluntary muscles paralysed and are associated with the highest anal pressure, and so represent abnormal activity of the internal anal sphincter. Measurements after anal dilatation showed complete abolition of ultra-slow wave activity and a very significant drop in pressure.

One year after dilatation 19 patients had a mean anal pressure of 62 cm H2O. Very good results were obtained unless the haemorrhoids were so large that they prolapsed at times other than defaecation. Lord's procedure is a rational treatment since it corrects an underlying overactivity of the internal sphincter.
Prolonged symptomatic and radiological remission of colonic gas cysts after oxygen therapy
Authors: Wyatt A P
Published: March 2007

Colonic gas cysts invariably shrink and disappear and symptoms associated with them resolve if an adequate concentration of oxygen is inhaled over a sufficient period of time. Careful monitoring of inhaled oxygen levels and arterial oxygen tension is necessary to ensure effective therapy. Plain X-ray of the abdomen is the best method of assessing the size and response of the cysts to treatment and for following the patients subsequently. Six consecutive patients managed in this way are discussed and their subsequent progress is documented.
Measurement of the immune response to an allograft: Amino acid incorporation by peripheral white blood cells in man
Authors: Blamey R W , Bennett R C , Singer A M , Nicol Rita , Harrison J
Published: March 2007

The uptake in vitro of3H-thymidine and of3H-uridine by white blood cells freshly taken from the recipients of renal transplants has been followed at regular intervals during the period of the patients' hospitalization. In addition, groups of subjects without renal failure undergoing operation and of patients on chronic dialysis have been studied. Of 33 patients undergoing rejection of their kidney, 28 showed a marked rise in the incorporation of thymidine over the period of rejection. However, a similar rise appears to accompany episodes of inter-current infection.
Meckel's bleeding diverticulum diagnosed by mesenteric arteriography
Authors: Hall T J
Published: March 2007

The details of a young adult patient who presented with chronic gastro-intestinal blood loss as a complication of Meckel's diverticulum are reported. A preoperative diagnosis was made using superior mesenteric arteriography. The merits of superior mesenteric arteriography and other investigations currently available in the diagnosis of Meckel's diverticulum are discussed.
The complications of synchronous combined excision for adenocarcinoma of the rectum at St Mark's hospital
Authors: Marks C G , Ritchie Jean K
Published: March 2007

The complications of synchronous combined excision of the rectum for adenocarcinoma in 227 patients were analysed. Urinary retention with infection occurred in 78 patients (34-4 per cent) and was the commonest complication. There was a significant correlation between tumours involving the anterior quadrants of the rectum and urinary complications.

Primary suture of the perineal wound with closed drainage was associated with a higher incidence of complications than open drainage.

The cumulative risk of a paracolostomy hernia in the sixth postoperative year was approximately 33 per cent. Extraperitoneal colostomy gave some protection against paracolostomy herniation.
The efficiency of surgical masks of varying design and composition
Authors: Quesnel Louis B
Published: March 2007

Five different types of surgical mask of varying design and composition of natural and synthetic fibres were tested for their efficiency in vivo by means of a special test chamber. Contaminated particles escaping through or around the mask during speech by the wearer could be collected and sized. Analysis of the data showed that the gross efficiency of all the masks was high, but that some masks were distinctly better at small particle “filtration” than others. There was a significant difference in efficiency between the best and worst masks. The best masks contained more fabric, were softer and were pleated, while the worst were stiffer, smaller and not pleated. Reusable cotton fabric masks were as effective as synthetic fabric masks when made to a good design.
Does the choice of suture material affect the incidence of wound infection? A comparison of Dexon (polyglycolic acid) sutures with other commonly used sutures in an accident and emergency department
Authors: Mouzas G L , Yeadon A
Published: March 2007

One hundred and four patients with superficial lacerations were sutured with either Dexon (polyglycolic acid), silk, polyethylene or nylon sutures. The incidence of postoperative tissue reaction and wound infection was compared.

There were few complications and these occurred with almost the same frequency in each suture group, although there were slightly more cases of infection in the patients who were sutured with silk.

Dexon was seen to possess certain advantages in that it caused as little tissue reaction as the other sutures but did not have to be removed subsequently. This could clearly be of benefit to the patients and hospital staff alike.
Gangrene of the tongue following self-application of a rubber band
Authors: Dutta T , Vasudevan K
Published: March 2007

A case of dry gangrene of the tongue due to selfapplication of an elastic rubber band in a mentally retarded child is described. As far as is known, no such case of gangrene of the tongue has been described in the English literature.
In situ intraduct carcinoma of the breast: A long term follow-up study
Authors: Millis R R , Thynne G S J
Published: March 2007

Twenty-eight patients with in situ intraduct carcinoma of the breast are reviewed. Two patients had bilateral tumours. The numbers of patients treated by wide local excision, simple mastectomy and mastectomy with axillary dissection were approximately equal; none of these patients died of carcinoma. The conclusions regarding prognosis and treatment of in situ intraduct carcinoma of the breast are discussed.
Operative cholangiography: A reappraisal based on a review of 400 cholangiograms
Authors: Faris Irwin , Thomson James P S , Grundy D J , Le Quesne L P
Published: March 2007

In the period 1957–72, 426 patients were operated upon for calculous disease of the biliary tract. For various reasons pre-exploratory operative cholangiography was not performed in 26 patients, but in the remaining 400 patients this examination was the major determinant as to whether or not the common duct contained calculi, and hence required exploration. Analysis of this series of 400 patients shows that without operative cholangiography (a) ductal stones would have been overlooked in 16 of the 78 patients with stones in the common duct (4 per cent of the whole series; 20.5 per cent of those with stones in the common bile duct); (b) exploration of the common duct would have been required in a further 48 (15 per cent) of the 322 patients without stones in the common duct, giving a positive yield from operative cholangiography in 64 patients (16 per cent) in the whole series. Negative exploration of the common duct was performed in only 31 patients, that is 29 per cent of the patients whose duct was explored but only 7.8 per cent of the whole group.

The criteria by which an operative cholangiogram should be assessed were re-evaluated in the light of the findings in these 400 patients. In general the criteria of normality previously described were affirmed, and the following points established: In the absence of a filling defect the diameter of the duct is the most important indication of the presence of a stone.There is a statistically significant increase in the diameter of the common duct with age, and though not great this could, if neglected, give rise to error in the interpretation of the cholangiogram in younger patients.Even within the overall normal range of duct diameter (< 12 mm) the wider the duct, the greater is the chance of it harbouring a stone.Impaired flow of contrast material into the duodenum is significantly related to duct diameter.Impaired flow of contrast material into the duodenum and failure to delineate the terminal segment of the duct tend to occur together; they may occur in a duct free of stones and if they are the only abnormality the examination should be repeated after the inhalation of amyl nitrite.

This study confirms that operative cholangiography is the most accurate method at present available of determining whether or not the common duct contains a stone (or stones), and hence requires exploration.
Family studies in cancer of the colon and rectum
Authors: Lovett Eileen
Published: March 2007

Family histories were obtained from 209 patients undergoing treatment for cancer of the colon or rectum at St Mark's Hospital. Death certificates were obtained /or parents and siblings who had died. Among these, the number of deaths from cancer of the bowel was more than three times that expected for a comparable group from the general population.

There are three principal features which, if present in an index case, are associated with the likelihood that other members of the family will also have had cancer of the large bowel. These are, first, the presence of multiple benign or malignant tumors in the large bowel, secondly, a history of previous primary carcinoma or adenoma of the large bowel and, thirdly, early age of onset of carcinoma of the bowel.
Chronic intussusception in children
Authors: Rees B I , Lari J
Published: March 2007

Three children with chronic intussusception are reported together with a review of the literature. Neither the palpation of a mass nor the passage of blood per rectum was necessary for the diagnosis. Weight loss was seen in each case and I child was investigated for malabsorption. In all 3 children there was a delay in diagnosis, and it is suggested that a chronic intussusception should be considered more frequently in children with persistent abdominal symptoms for which no cause can be found. Although a barium enema was helpful diagnostically, it did not result in the reduction of the intussusception. The problem of a recurrence after a reduction arid its subsequent management is discussed.
Retained common bile duct calculi
Authors: Castleden W M
Published: March 2007

A method of elimination of grallstones remaining in the common bile duct after exploration of the duct is described. The retained stone is flushed through the common duct sphincter into the duodenum using rapid infusion of normal saline via a T rube. The method is quick and simple and is recommended as the first step to take in the management of this discomforting group of patients. The method is not without potential morbidity and should only he carried out under carefully controlled conditions.
Carcinoma of the renal pelvis: An analysis of the diagnostic problems in 23 cases
Authors: Leong C H , Lim T K , Wong K K , Ong G B
Published: March 2007

A series of 23 patients with carcinoma of the renal pelvis is presented. The different presentations are described and discussed, and the difficulties in establishing a preoperative diagnosis are considered. There were 3 squamous cell carcinomas in the series, all of them associated with renal stone and urinary tract infection.
Gallstone obstruction and perforation of the duodenal bulb
Authors: Lloyd Thomas T , Jaques P F , Weaver P C
Published: March 2007

A case of gallstone ileus is presented in which the stone became impacted in the first part of the duodenum and then caused perforation at the site of impaction. This is only the second published British case of gallstone impaction at this site. Perforation of the duodenum by a gallstone has not previously been recorded. The clinical and radiological features of this case are discussed.