bluuebunny/crossref_metadata_2025 huggingface dataset:
Choledochoscopy: Are stones missed? A controlled study
Authors: Gartell P C , McGinn F P
Published: March 2007

Although the choledochoscope has been available for several years, its use has not achieved universal acceptance. Enthusiasts claim that the incidence of retained stones in the common bile duct would be reduced by using the instrument, but no controlled study by the same team has been reported. Patients undergoing biliary surgery by one surgical team in Southampton were operated upon in one of three hospitals. The choledochoscope was available for use at only one hospital, but the other two were otherwise fully equipped, and no selection of patients was made for any particular hospital. Over a period of 7 years, 707 patients underwent elective or emergency cholecystectomy. Routine choledochography was performed and stones were found or suspected in the bile ducts in 103 (14.6 per cent). The choledochoscope was used in 54 of the bile duct explorations and in 10 patients residual calculi following routine exploration were identified by the instrument. Postoperative T-tube choledochography was performed in 35 patients following choledochoscopy, 31 with choledocholithiasis at operation, and no unsuspected retained stones were demonstrated. In the 49 patients undergoing duct exploration by the same team without the choledochoscope, 32 were found to have choledocholithiasis. Thirty-six postoperative choledochograms were performed and six patients were found to have retained stones. There were no additional complications attributed to the use of the instrument. We conclude that the use of the choledochoscope should reduce the incidence of retained bile duct stones.
The four to eight year results of the Sheffield trial of elective duodenal ulcer surgery—highly selective or truncal vagotomy?
Authors: Stoddard C J , Johnson A G , Duthie H L
Published: March 2007

In a prospective randomized trial between June 1973 and July 1978 highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP) in 137 male patients undergoing elective surgery for chronic duodenal ulceration. Ninety per cent of patients were followed up for between 49 and 102 months (mean 77). A good result was obtained in 49 of 59 patients (83 per cent) after HSV compared with 41 of 64 (64 per cent) after TVP (P < 0.02). The recurrent ulcer rate was 8.8 per cent after HSV and 9.4 per cent after TVP. Dumping and diarrhoea were significantly commoner after TVP (P < 0.05). We believe that HSV is a better operation than TVP for the treatment of uncomplicated duodenal ulcer.
Are bile bacteria relevant to septic complications following biliary surgery?
Authors: Willis R G , Lawson W C , Hoare E M , Kingston R D , Sykes P A
Published: March 2007

Bile bacteriology, wound sepsis and the effect of prophylactic antibiotics have been studied in a controlled prospective double blind randomized trial on 375 patients undergoing elective cholecystectomy at a district general hospital. We have examined the overall prevalence of bacteria in bile and have identified several factors associated with an increased incidence. The identity of organisms isolated from a total of 21 patients with infected wound swabs was compared with isolates from the bile at operation, and in only two instances was there a correlation. Cephazolin, given either pre-operatively, or into the wound, reduced wound infection rates compared with a control group (from 11·8 to 2·4 per cent, P < 0.005). We conclude that the majority of wound infections in this series were caused by organisms from the patients' skin or exogenous sources, rather than by bacteria from the biliary system.
Mediastinal parathyroid adenoma: A new method of localization
Authors: Ubhi C S , Hardy J G , Pegg C A S
Published: March 2007

201Tl-thallous chloride/99mTc sodium pertechnetate subtraction scanning is a simple and accurate means to demonstrate enlarged parathyroid glands. We report a case in which the intra-operative location of a mediastinal adenoma was greatly facilitated by using a probe radiation detector following intravenous injection of201Tl-thallous chloride. We believe this is the first reported use of this technique in parathyroid surgery.
Altered responses of prolactin, luteinizing hormone and follicle stimulating hormone secretion to thyrotrophin releasing hormone/gonadotrophin releasing hormone stimulation in cyclical mastalgia
Authors: Kumar S , Mansel R E , Scanlon M F , Hughes L E , Edwards Catherine A , Woodhead J S , Newcombe R G
Published: March 2007

A generalized abnormality of hypothalamopituitary function was found in 17 patients with cyclical pronounced mastalgia compared with 11 controls by using a combined thyrotrophin releasing hormone and gonadotrophin releasing hormone test. The release of prolactin, luteinizing hormone and follicle stimulating hormone was significantly greater in cyclical mastalgia patients than in controls. Basal thyrotrophin, T3 and T4 levels were within the normal range in both groups indicating normal thyroid status in benign breast disease. The single measurement of oestrogen and progesterone in the luteal phase was not abnormal. These data demonstrate an alteration in lactotroph and gonadotroph function in patients with cyclical mastalgia. It is unknown at present whether this represents an appropriate cellular response to altered central or peripheral signals. There is no evidence to suggest, however, that the anterior pituitary cell types are abnormal per se.
Prognostic factors and in vitro cytotoxic sensitivity in colorectal cancer
Authors: Trotter G A , Morgan G R , Goeting Nicola , Cooper A J , Taylor I
Published: March 2007

The poor response rates to chemotherapy for colorectal cancer justify attempts to rationalize selection of patients for treatment, and the development of systems to evaluate new cytotoxic agents. Refinement of prognostic indices may identify colorectal cancer patients at a higher risk of recurrence who merit more aggressive treatment. We report our experience with the stem cell assay and pulse thymidine labelling in 43 primary colorectal cancers. Thirty-six tumours were evaluable, and clonogenic growth was obtained in 30 (83 per cent). In 24 tumours (67 per cent) growth was adequate for meaningful interpretation of a cytotoxic drug assay. Frequency of growth and colony forming efficiency did not correlate with histopathological grade, Dukes' stage or tumour cell kinetic indices. Thymidine labelling indices correlated with Dukes' stage (A and B versus C and D, P<0·01, Mann–Whitney U test). Cytotoxic assays with 5-fluorouracil and 5′-deoxy-5-fluorouridine were undertaken in 18 cases (14 primary carcinomas, 4 malignant ascites), of which 14 were evaluable and 3/14 (21·5 per cent) were chemosensitive in vitro. Both drugs were equally effective in vitro at clinically attainable plasma concentrations. This is in accordance with the response rates observed clinically with 5-FU chemotherapy in colorectal cancer.
Iatrogenic biliary stricture: Presentation and management
Authors: Collins P G , Gorey T F
Published: March 2007

Repair of iatrogenic biliary stricture was carried out in 38 patients of whom five are now dead, three causally related. Thirty-one patients were followed up between August 1983 and March 1984 (mean time since repair 7·9 years). Fifty reparative operations were carried out, six patients first having a temporary end fistula performed. Cholangiography during cholecystectomy had been performed in only eight patients (21 per cent). All but one patient had gastroscopy and barium meal examination and the incidence of duodenal ulceration was 6·7 per cent and of oesophageal varices 5·6 per cent. Liver biopsies taken during the first reparative operation were normal in 5 per cent, obstructive in 65 per cent and cirrhotic in 30 per cent. Intra-operative cultures were mainly coliforms (66·7 per cent). Liver function tests were normal in 19 (61·3 per cent) but there was no correlation between abnormal values and clinical status. Twenty-nine patients (93·5 per cent) are now completely well. 99mTc HIDA scans, liver ultrasonography, intravenous cholangiography and BSP excretion were of limited value in planning further surgery. The most useful investigation before reoperation was transhepatic cholangiography.
Prediction of recurrence after mastectomy for operable breast cancer
Authors: Nixon S J , Steele R J C , Hawkins A R , McGregor J , Forrest A P M
Published: March 2007

A patient's risk of early recurrence after mastectomy for breast cancer has been estimated by using a combination of four prognostic factors. A computer program, designed to calculate the exact probability of recurrence within 2 years of mastectomy, was accurate when tested on 240 patients. A simple scoring system could identify patients at lower and greater risk than any single factor alone.
Survival following local skin recurrence after mastectomy
Authors: Fentiman I S , Matthews P N , Davison O W , Millis R R , Hayward J L
Published: March 2007

Seventy-three patients with breast cancer, treated by radical mastectomy, who subsequently developed a local skin recurrence without clinical evidence of disseminated disease, have been reviewed. There were significant differences between the survival of patients with single and multiple recurrences. Only 10 per cent of those with multiple lesions survived 5 years, and none was alive at 10 years, whereas 42 per cent of those with single lesions survived 5 years and 22 per cent were alive and well at 10 years’ postrecurrence. Adequate local treatment of a single skin nodule may enable a subset of patients to survive without subsequent development of breast cancer metastases.
Electrically evoked activity in the human external anal sphincter
Authors: Wright A L , Williams N S , Gibson J S , Neal D E , Morrison J F B
Published: March 2007

Following electrical stimulation of perianal skin, short latency evoked electromyographic (EMG) responses from the external and sphincter have been interpreted as the electrophysiological correlate of the anal reflex. Delayed responses in patients with idiopathic faecal incontinence have been interpreted as evidence for denervation of the external anal sphincter. Electrically evoked responses were studied in normal subjects, either before and during spinal anaesthesia (n = 8), or before and during competitive neuromuscular blockade (n = 4), instituted for operative purposes. Short latency responses persisted unchanged in either latency or duration during spinal anaesthesia whereas long latency responses were completely abolished. Both short and long latency responses were abolished during competitive neuromuscular blockade. Short latency responses are not spinal reflex in nature, but due to stimulus activation of α-motoneuronal terminal branches. Delayed responses in incontinent patients cannot be interpreted as evidence for pudendal neuropathy. Long latency (i.e. > 40 ms) responses demand a functional sacral spinal cord and represent the true anal reflex. Their wide range of latency in normal subjects suggests this measurement will be of little use in confirming the presence or absence of pudendal neuropathy, and that other measures of neuropathy may be more appropriate.
Catheter-related sepsis in patients on intravenous nutrition: A prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis
Authors: Pettigrew R A , Lang S D R , Haydock D A , Parry B R , Bremner D A , Hill G L
Published: March 2007

One hundred and ninety-five central venous catheters used for intravenous nutrition in 113 patients were studied prospectively. Catheter-related sepsis (CRS), defined by recovery of the same organism from the catheter tip and peripheral blood cultures, occurred with only 3.3 per cent of catheters or 2.3 per 1000 days of therapy. In contrast, CRS was suspected with 30 per cent of catheters and catheter contamination occurred in 37 per cent. Contamination was defined by a positive catheter tip culture without recovery of the same organism from the blood. CRS was present in 4 of 12 cases (33 per cent) with > 1000 colony forming units on the catheter tip but in only 2 of 54 (4 per cent) with fewer organisms. Thirty-eight cases suspected of having CRS were randomized to have catheter removal and later replacement, or replacement over a guidewire. There were no significant differences in the catheter contamination rate but there were significantly fewer problems of insertion in the guidewire group. However, transfer of Klebsiella sp., during the guidewire procedure, resulted in subsequent sepsis in one case. It is concluded that replacement of catheters over a guidewire is a safe and convenient way of establishing whether sepsis is catheter-related. Because organisms may be transferred, the procedure is not an appropriate treatment for catheter-related sepsis.
Fibronectin, complement and immunoglobulins in serum after surgery
Authors: Gauperaa T , Giercksky K-E , Revhaug A , Rekvig O P
Published: March 2007

In recent years it has been suggested that fibronectin is a non-specific opsonic protein of significance in host resistance against septic complications following trauma and surgery. The aim of the present study was to investigate the fluctuations in serum levels of fibronectin, immunoglobulins IgG and IgM, and complement factors C3 and C4 postoperatively. Serum samples were obtained pre-operatively and at different intervals postoperatively in 72 patients admitted for elective surgical procedures on the alimentary tract, the heart and the hip joint. The mean pre-operative fibronectin values were 257±79 μg/ml. The lowest values (166±65 μg/ml) were found immediately after the operation, followed by an increase which did not reach pre-operative levels within 120 h. Five patients who developed postoperative complications and 14 patients with malignant disease did not differ significantly either in their pre- or postoperative fibronectin levels, compared with the whole group. The lowest fibronectin levels seen were also significantly above the concentrations necessary to promote binding of gelatinized test particles to macrophages and monocytes in vitro. There was a significant decrease in C3, C4 and IgG levels postoperatively whereas IgM levels were unaltered. The observed reduction did not extend below the lower normal levels for these proteins. The probable mechanism behind the reduction in serum levels seems to be a sequestration at the site of tissue injury. The postoperative reduction in circulating fibronectin levels has probably no implications for host resistance against septic complications. When sequestered into the site of injury, it may, however, be of significance for normal wound healing, due to its cell-matrix interactions.
Treatment of acute abscesses by incision, curettage and primary suture without antibiotics: A controlled clinical trial
Authors: Stewart M P M , Laing M R , Krukowski Z H
Published: March 2007

One hundred and thirty-seven consecutive acute superficial abscesses were randomly allocated to incision, curettage and primary suture without parenteral antibiotics (64 cases) or to conventional treatment with incision, drainage and dressings (73 cases). Wound healing was faster; 7.0 days: 25.1 days (P<0.01, Wilcoxon's rank sum test), the number of hospital visits was smaller; 3.8 visits: 11.1 visits (P < 0.01) and the time off work was shorter; 4.0 days: 14.1 days (P<0.01) in the group treated by primary closure compared with those managed conventionally. In this study no complications attributable to the withholding of antibiotics occurred. Incision and primary closure of abscesses is safe and more economic than conventional drainage. Routine antibiotic cover is not necessary.
A 13-year review of jejunoileal bypass
Authors: McFarland R J , Gazet J-C , Pilkington T R E
Published: March 2007

One hundred and eighty patients had a jejunoileal bypass performed during the years 1971-1982. By leaving only 14 in. (35 cm) of intestine in continuity a mean weight loss of 34.4 per cent (s.d. = 8.5) was achieved over 2 years and, unless the operation had to be reversed for complications, this weight loss was maintained. The improvement in quality of life for a majority of patients should not be undervalued. Two-thirds of patients required admission for complications and eight patients died (4 per cent). Many of these problems were provoked by an inability to control eating. There have been no hospital deaths since 1976 which we attribute to better management of complications and a policy of early reversal for patients with excessive weight loss and signs of metabolic failure. Despite performing jejunoileal bypass less often in recent years we are still frequently reversing patients with electrolyte disturbances, metabolic failure, urinary calculi or arthritis. Thirty patients (16-7 per cent) have been reversed, half more than 5 years after bypass. Metabolic failure may occur even after many years of stable weight reduction. Because this is not well known the insidious onset of new weight loss and malaise may not be recognized, or not associated with the bypass many years before. Indefinite outpatient surveillance is mandatory. Changes in the operation have not significantly affected results. There has been no serious liver dysfunction in the 7:7:CJ group but this may reflect better management of lesser metabolic disturbances. Jejunoileal bypass remains the most effective operation for gross obesity and, with experience, can be performed safely. However, the complication rate and difficulty maintaining satisfactory follow-up on large numbers of young patients makes it an unacceptable procedure on any major scale.
A randomized trial of oral 5-fluorouracil versus placebo as adjuvant therapy in colorectal cancer Dukes' B and C: Results after 5 years observation time
Authors:   The Swedish Gastro-Intestinal Tumour Adjuvant Therapy Group, Hafström L , Rudenstam C-M , Domellöf L
Published: March 2007

A double-blind randomized trial of daily oral 5-fluorouracil (5 mg kg−1 bodyweight) for 3 months versus placebo as adjuvant therapy to surgical treatment of colorectal cancer Dukes' B and C was conducted. In total 421 patients were randomized; 198 patients with Dukes' B, 159 with Dukes' C and 64 were referred to a limited resection group. The distribution of prognostic variables was similar in both groups indicating the absence of any bias and the efficacy of the randomization. Disease-free interval and survival time were analysed as end points. After 5 years of follow-up of all patients there was no significant difference between treatment or placebo group in the total material or the subgroups regarding either of the end points. There was no difference in localization of first recurrence between treated and control group. A high withdrawal of therapy was found in the 5-FU group (40 per cent) and in the placebo group (13 per cent).
Successes, failures, early complications and their management following endoscopic sphincterotomy: Results in 394 consecutive patients from a single centre
Authors: Leese T , Neoptolemos J P , Carr-Locke D L
Published: March 2007

The indications and results of 394 endoscopic sphincterotomies (ES) performed over a 6 year period from a single centre are described. The indications for ES were common bile duct (CBD) calculi (81 per cent), papillary stenosis (9 per cent), periampullary tumours, insertion of endoprostheses, sump syndrome and biliary dilatation for benign strictures. ES was achieved in 98 per cent of patients. In the calculus group the CBD was cleared of stones in 93·3 per cent following a successful ES (92 per cent overall success rate for CBD clearance). Early complications (⩽ 1 month) occurred in 41 patients (10-4 per cent) of which haemorrhage accounted for nearly half. Emergency surgery following ES was undertaken in 15 patients (3·8 per cent). There were 13 deaths within one month of ES (3·3 per cent) of which three were directly attributable to ES (0·8 per cent). The diagnosis and management of complications following ES is important with increasing numbers of patients being treated from outside the referral centre.
Intraperitoneal low-pressure suction drainage following splenectomy
Authors: Ugochukwu A I , Irving M
Published: March 2007

A consecutive series of 282 patients undergoing splenectomy on one surgical unit has been studied to ascertain the incidence of postoperative subphrenic abscess. Only two atypical subphrenic abscesses occurred (0·17 per cent), a rate of abscess formation much lower than that reported in other series. We believe that the use of low-pressure closed suction drainage to the splenic bed accounts for this low rate.
Resection of ‘inoperable’ rectal cancer following radiotherapy
Authors: James R D , Schofield P F
Published: March 2007

Forty-two patients with fixed inoperable adenocarcinoma of the rectum due to local extension in the pelvis have been treated using high dose radiotherapy followed by surgery when possible. Inoperability was determined initially by laparotomy in 15 patients and in the remainder by examination under anaesthetic. Twenty-nine patients underwent laparotomy following radiotherapy and resection was performed in 18. In three of these cases there was no residual tumour in the operation specimen. The median survival of the resected group was 28 months compared with 7 months for the unresected group. Treatment related mortality in the resected group was confined to five patients, two postoperative deaths and three small bowel fistulae which developed as late complications. Analysis of prognostic factors indicates that patients most likely to benefit from this approach are those with no evidence of distant metastases or of urinary obstruction at presentation. Patients who have a good clinical response to radiotherapy are more likely to achieve resection and subsequent long-term survival.
Malignant large bowel obstruction
Authors: Phillips R K S , Hittinger R , Fry J S , Fielding L P
Published: March 2007

Of 4583 patients in the Large Bowel Cancer Project, 713 (16 per cent) were obstructed. The site of greatest risk was the splenic flexure (49 per cent). Advanced stage was neither the full reason why some patients obstructed nor for their subsequent poor prospects (age-adjusted 5-year survival: not obstructed, 45 per cent; obstructed, 25 per cent). Also, there was no greater risk of vascular invasion, no heavier lymph node burden and no worse tumour differentiation in patients with obstruction. In-hospital mortality was high (23 per cent), was not reduced by either a policy of primary or staged resection and was not influenced by the site of obstruction. There was no survival advantage for either policy, but hospital stay after primary resection was half that of staged. Immediate anastomosis in the obstructed left colon had a high clinical leak rate (18 per cent versus 6 per cent elective; P < 0·001). Both registrars and consultants had similar mortality rates for elective primary resection and for the management of obstruction itself (as evidenced by results after the first stage of a staged resection). Selection probably accounts for the very much better results achieved by consultants for primary resection in the presence of obstruction (in-hospital mortality: consultants, 13 per cent; registrars, 24 per cent).
Barrett's oesophagus
Authors: Hennessy T P J
Published: March 2007

The bulk of available evidence supports the view that Barrett's oesophagus is an acquired condition due to chronic gastro-oesophageal reflux. It is possible that a few cases are congenital. Barrett's oesophagus gives rise to severe stricture and ulceration and has a significant malignant potential. Treatment is designed to prevent reflux and, if possible, to reverse the metaplastic change. Dysplasia is of ominous significance and requires frequent careful surveillance.
Is tissue copper deficiency associated with aortic aneurysms?
Authors: Senapati Asha , Carlsson Linda K , Fletcher C D M , Browse N L , Thompson R P H
Published: March 2007

It has been suggested that patients with abdominal aortic aneurysms are deficient in tissue copper. Levels of copper and zinc in liver and aortic wall were therefore measured in 11 patients with aortic aneurysms and 11 fresh cadavers with normal aortas. The concentrations of copper were similar in both groups. Zinc concentration was higher in the normal aortic wall, probably because of the greater thickness of the media in the normal aorta. We found no evidence that aortic aneurysms are associated with reduced tissue copper concentrations.
Increased flow in the superior mesenteric artery in dumping syndrome
Authors: Aldoori M I , Qamar M I , Read A E , Williamson R C N
Published: March 2007

Transcutaneous Doppler ultrasound was used to measure resting and postprandial blood flow in the superior mesenteric artery (SMABF) in nine patients with dumping syndrome and in ten normal volunteers of matching age and sex. All nine patients experienced signs and symptoms of dumping during the investigation, but none of the controls did so. At rest, SMABF in the dumping patients (567.47 ml/min) (mean±s.e.m.) did not significantly differ from that of the normal volunteers (493.72 ml/min). Five minutes from the end of a balanced liquid meal, flow had approximately doubled in each group (1232 ± 140 and 941 ± 128 ml/min). Compared with controls, increased SMABF was observed in patients with dumping syndrome at 10 min (76 per cent), 15 min (66 per cent), 30 min (55 per cent) and 45 min (42 per cent) (P = 0.05−0.01). Splanchnic pooling and abnormal redistribution of blood probably contribute to the pathogenesis of the early dumping syndrome.
Inguinal herniotomy in children: A five year survey
Authors: Harvey M H , Johnstone M J S , Fossard D P
Published: March 2007

This retrospective review covers our experience over 5 years of 436 hernia repairs in 392 children upto the age of 15 years. The number of emergency presentations was 71 (18.1 per cent) and 66.2 per cent of these were under the age of 12 months. Most cases were initially treated conservatively and only 18 children required operation on the day of admission. There were 11 recurrences (7 elective and 4 emergency cases) giving a recurrence rate of 2.5 per cent. In all eleven cases the original operation was performed by a junior surgeon. The complication rate (excluding recurrences) was 2.8 per cent but may be an underestimate because of the limitations of a retrospective study. We suspect our results are typical of those to be found in any large British hospital and that with careful training and supervision of junior staff in the technique of inguinal herniotomy the results could be improved and approach those found in specialist paediatric units in America.
Treatment of rectal prolapse by sphincteric support using silastic rods
Authors: Hunt T M , Fraser I A , Maybury N K
Published: March 2007

The use of silastic perianal rings to control rectal prolapse in the elderly has been reviewed. Forty-one patients were treated over a 6 year period by a total of 52 operations. Their mean age was 80 years and there was no operative mortality. Prolapse was adequately controlled in 71 per cent of patients, and a further three patients had no recurrence despite failure and removal of the ring. The results of this procedure are inferior to those obtained by abdominal operations for rectal prolapse, but deserve serious consideration in those elderly patients who may be unfit for laparotomy.
Artefactual breast disease: A report of three cases
Authors: Rosenberg M W , Hughes L E
Published: March 2007

Three cases of suspected artefactual conditions of the breast are presented, one case each of recurrent bleeding, recurrent infection and atypical eczema. Involvement of the breast is rare, but may go undiagnosed in many cases. Patients are usually married and in the second half of their reproductive life. An unusual pattern of disease appearance and behaviour, lack of response to treatment, inappropriate affect and a request for mastectomy are helpful in suggesting the diagnosis. A disturbance in personal relationships can often be elucidated by psychiatric assessment. Treatment is difficult and may be limited to suspecting the diagnosis, excluding organic disease and avoiding unnecessary and repetitive surgery.
The Da Silva method of incisional hernia repair
Authors: Hope P G , Carter S St C , Kilby J O
Published: March 2007

A technique of incisional hernia repair originally devised by da Silva is described. The operation was performed on 30 patients and no recurrence was found in the 27 cases examined 1 to 4·5 (mean 2·5) years later.
The outcome following sphincter-saving resection and abdomino-perineal resection for low rectal cancer
Authors: Williams N S , Durdey P , Johnston D
Published: March 2007

The introduction of new techniques has enabled more patients with low rectal carcinoma to undergo sphincter-saving resection (SSR). This policy, however, has provoked controversy concerning the adequacy of excision and fear of increased rates of recurrence compared with abdominoperineal resection (APER). We have therefore compared our results of SSR for low and mid-rectal cancers performed between 1978 and mid 1982 with those obtained with APER before this period. One hundred and fifty-nine patients presented with tumours between 3 and 12 cm from the anal verge; 153 (96 per cent) underwent resection, of whom 46 (30 per cent) had disseminated disease. One hundred (68 per cent) underwent SSR, 33 (22 per cent) had an APER and 16 (10 per cent) had a local procedure. Operative mortality was 4 per cent following APER and 7 per cent after SSR (n.s.). Patients were followed for a mean of 4·6 years (range 2–6 years), only four (2·5 per cent) being lost to follow-up. The incidence of recurrence after radical SSR (n = 74) was compared with the historical control group which underwent radical APER, the two groups being matched for Dukes' stage and height of the lesion. After 2 years, local recurrence cumulative rates were 13·6 per cent after SSR and 18·8 per cent after APER. Distant recurrence rates were 14·5 and 20 per cent respectively. Ten patients (13·5 per cent) died of their disease within 2 years of a radical SSR, 15 (15 per cent) after radical APER. Corrected 5-year survival and recurrence rates were similar. Thus, SSR does not appear to carry an increased risk of recurrent disease compared with APER after an equivalent follow-up period.
Staples or sutures for low colorectal anastomoses: A prospective randomized trial
Authors: McGinn F P , Gartell P C , Clifford P C , Brunton F J
Published: March 2007

One hundred and eighteen patients undergoing low colorectal anastomoses were randomly allocated to reconstitution by either single layer interrupted extramucosal sutures or circular staple gun. In the 60 patients undergoing sutured anastomosis there were 2 (3 per cent) clinical leaks and 4 (7 per cent) radiological leaks, and no failures of the 58 patients who underwent stapled anastomosis there were 4 failures, 7 (12 per cent) clinical leaks, 14 (24 per cent) radiological leaks and 1 death. Stapled anastomoses were more than ten times as expensive as sutured anastomoses and there were no savings in time or numbers of associated colostomies. An interrupted extramucosal suture technique remains the ultimate standard for low colorectal anastomosis.
The value of staging and serial follow-up investigations in patients with completely resected, primary, cutaneous malignant melanoma
Authors: Kersey Patricia A , Iscoe N A , Gapski J A P , Osoba D , From L , Deboer G , Quirt I C
Published: March 2007

The purpose of this study was to determine the value of staging and serial follow-up investigations in newly diagnosed patients with completely excised primary cutaneous malignant melanoma. We reviewed the records of the 393 patients with completely excised primary malignant melanoma who were referred to the Ontario Cancer Institute and the Toronto-Bayview Regional Cancer Centre between 1 January 1978 and 31 March 1982. Initial investigations included history and physical examination in all 393 patients, complete blood count (199 patients), liver function tests (198 patients), urinary melanins (159 patients), chest X-rays (345 patients), whole lung tomography (182 patients), radionuclide liver-spleen scans (207 patients), and bone scans (116 patients), bipedal lymphangiograms (78 patients), CT scans of the chest (59 patients), and CT brain scans (51 patients). The clinical stage of ten patients was changed as a result of history and physical examination or lymphangiogram. All other investigations failed to detect metastatic melanoma. Follow-up investigations included history and physical examinations, complete blood counts, liver function tests, radionuclide liver spleen and bone scans. History and physical examinations, chest X-rays and patients' awareness of abnormalities were responsible for detection of subsequent melanoma recurrences. All other tests failed to identify metastatic melanoma at the time of its occurrence. Therefore, we recommend that initial staging investigations be limited to history and physical examination with clinical photographs, and baseline chest X-ray. We recommend that subsequent follow-up include only history and physical examinations and chest X-rays.
Gastric surgery and the risk of subsequent colorectal cancer
Authors: Bundred N J , Whitfield B C S , Stanton E , Prescott R J , Davies G C , Kingsnorth A N
Published: March 2007

A matched case control study has been conducted in order to determine whether an association exists between gastric surgery and the subsequent development of colorectal carcinoma. Two hundred and eighty-nine patients (151 women and 138 men) presenting with large bowel cancer have been studied. Case controls were matched according to age, sex and date of admission. The case notes of each patient in the study were reviewed to determine the prevalence of peptic ulceration and gastric surgery. Significantly more patients with colorectal carcinoma had undergone gastric surgery P<0·05, although the prevalence of peptic ulceration was similar in both groups. Colorectal carcinoma is more common in patients who have undergone gastric surgery for benign peptic ulcer disease than in the general population.
Gastric emptying after anterior lesser curve seromyotomy and posterior truncal vagotomy
Authors: Taylor T V , Holt S , Heading R C
Published: March 2007

Anterior lesser curve seromyotomy with posterior truncal vagotomy (ASPTV) provides a simple, safe and expeditiously performed method of denervating the parietal cell mass, whilst preserving the pylorus. Dumping and diarrhoea are uncommon after this procedure. Gastric emptying has been assessed after ASPTV and other elective operations for duodenal ulcer. Liquid and solid phase gastric emptying studies were performed in control subjects (17), patients before and at least six months after ASPTV (14), vagotomy and pyloroplasty both without (8) and with (6) diarrhoea, vagotomy and gastroenterostomy (11), and Polya gastrectomy (7). There was no delay in emptying time for liquids or solids between ASPTV patients and controls. With the exception of an increase in the early emptying of liquids (P = 0·02) after ASPTV, gastric emptying was not different from normal. After truncal vagotomy and pyloroplasty in patients without diarrhoea the gastric emptying of solids, but not of liquids, was markedly increased (P = 0·00001), whereas in those with diarrhoea both liquid and solid phase emptying were markedly increased (P < 0·001). When gastroenterostomy was used as the drainage procedure both phases of emptying were increased. After Polya gastrectomy, both early and late emptying of liquids and solids were increased (early phase P < 0·05, overall emptying P < 0·001).
A survey of registrars undertaking general surgical research in the United Kingdom on 1 October 1983
Authors: Dehn T C B , Blacklay P F , Taylor G W
Published: March 2007

Data, concerning general surgical research, was obtained by means of a questionnaire from 103 junior surgeons undertaking full-time research. Most posts appeared to be adequately funded, though many respondents sustained a loss of salary on appointment. Less than half the posts were advertised in the national medical journals. All but one respondent were submitting their research for a higher degree. The majority felt that they were well supervised: a minority (24 per cent) were poorly supervised. The enjoyment of research and confidence of obtaining a higher degree were related to the standard of supervision.
Haematuria after blunt trauma: the role of pyelography
Authors: Demetriades D , Rabinowitz B , Sofianos C , Landau A
Published: March 2007

This study is a combined prospective and retrospective review of 208 patients presenting with haematuria after blunt abdominal trauma. One hundred and twelve patients had an urgent intravenous pyelogram (IVP) with cystogram performed, while the remaining ninety-six were observed with serial urinalysis without any further investigation. Nineteen of the twenty-three patients with a positive IVP had gross haematuria and the remaining four had microscopic haematuria. Twenty-two of the patients with an abnormal IVP had positive abdominal signs, whilst only one case (with severe head injury) had no abdominal signs. In the 96 cases who were observed without IVP no complications occurred. It is suggested that if certain clinical criteria are observed most patients with post-traumatic microscopic haematuria can safely be spared an IVP. Indications for emergency IVP should include: gross haematuria or microscopic haematuria associated with abdominal signs or severe head injury or fracture of pelvis or spine. Had these criteria been observed during this study, 130 patients (62 per cent) would have avoided the risks and expenses of an IVP, and no significant urological injury would have been missed.
Influence of diabetes mellitus on operative risk
Authors: Hjortrup A , Sørensen C , Dyremose Elly , Hjortsø N-C , Kehlet H
Published: March 2007

In a retrospective study postoperative morbidity was compared between 224 patients with diabetes mellitus and 224 non-diabetic control patients matched with regard to operative procedure (major vascular, abdominal and acute surgery for hip fracture), sex, age, complicating cardiovascular disease and weight. Forty-six patients in each group had complications, without any trend towards specific morbidity in the diabetic group. Incidence of morbidity was similar in diabetic patients treated with insulin, oral antidiabetic agents or diet. Diabetic patients with complications had significantly (P<0·01) lower blood glucose pre- and postoperatively than those without complications. The risk of overlooking (type II error) a 25 per cent increase in complication rate in the diabetic patients was less than 10 per cent and the risk of overlooking a 50 per cent increase in morbidity less than 0·5 per cent. These results do not support the common belief that diabetes per se may increase surgical risk.
Conservative pancreatectomy
Authors: Cooper M J , Williamson R C N
Published: March 2007

By convention, resection of the proximal pancreas includes the distal stomach (and duodenum) and resection of the distal pancreas includes the spleen. In 28 patients the stomach and spleen were preserved to minimize functional disability. In 13 patients with proximal pancreatectomy (7 men, median age 39 years) the pylorus and first 3 cm of duodenum were preserved. Indications were chronic pancreatitis (n = 9) and localized neoplasia (ampulla 2, duodenum 1, insulinoma 1). One patient died (aged 81 years), and 2 required re-operation for a pancreatic abscess or stenosed choledochojejunostomy. The 12 survivors are well at a median of 1·25 years (range 0·25–3·25 years) In 15 patients with distal pancreatectomy (6 men, median age 44 years) the spleen was preserved. Indications were islet cell tumour in 2 and chronic abdominal pain in 13, 9 of whom had an isolated dorsal pancreas and 6 of whom had histological evidence of chronic pancreatitis. Recovery was uneventful apart from 2 patients with a fluid collection in the lesser sac, 1 needing percutaneous aspiration. In the absence of gross inflammatory adherence, partial pancreatectomy need not entail removal of the adjacent stomach or spleen.
Pyloric reconstruction
Authors: Koruth N M , Krukowski Z H , Matheson N A
Published: March 2007

Fourteen patients with persistent and severe postcibal symptoms following vagotomy and pyloroplasty for duodenal ulcer had the pylorus reconstructed. A dumping provocation test was useful in patient selection and evaluation of results. When assessed between 6 months and 3 years after operation, nine patients had an excellent or good result and three were improved. Surgical technique is relatively simple and the operation should be considered and practised more often than it seems to be from documented experience.
Hypovolaemia and healing in colonic anastomoses
Authors: Foster M E , Laycock J R D , Silver I A , Leaper D J
Published: March 2007

Colonic anastomotic leakage is more common following emergency resections than after elective operations. Transient hypovolaemia, which is more likely to occur during emergency surgery, has been shown to impair collagen metabolism in abdominal and skin wounds but its effect on colonic anastomotic healing has not been previously examined. Acute intra-operative loss of 10 per cent circulating blood volume in rats significantly impaired collagen concentration in both ileocolic (P<0·02) and colocolic (P<0·05) anastomoses measured on the third postoperative day. This degree of blood loss did not significantly affect early anastomotic strength. Hypovolaemia leads to tissue hypoxia, and this in turn may lead to impaired anastomotic healing. Measurement of tissue oxygen tension may predict poor healing by identifying inadequate intestinal perfusion. Colonic pTO2 measured in rabbits was significantly lower than in small bowel (37±18 mmHg versus 42±18 mmHg; P<0·001), and fell significantly in colon following 10 per cent blood loss (P<0·001): We conclude that adequate intra-operative fluid replacement during colonic resection and anastomosis is a prerequisite for successful healing.
Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis
Authors: Toouli J , Roberts-Thomson I C , Dent J , Lee J
Published: March 2007

Motor disorders of the sphincter of Oddi (SO) may play a role in the pathogenesis of idiopathic recurrent pancreatitis. We have compared manometric records from the SO in 28 patients with idiopathic recurrent pancreatitis with those from 10 control subjects. Patients with idiopathic recurrent pancreatitis had presented with episodes of upper abdominal pain associated with abnormal serum levels of amylase on at least two occasions, in the absence of alcohol abuse and biliary disease. Retrograde pancreatography was either normal or showed only minor changes in pancreatic ducts. A triple lumen low compliance manometric system was used to obtain a 5 min recording of spontaneous SO motor activity. From this recording were determined the SO basal pressure, SO phasic contraction amplitude, SO wave frequency and direction of wave propagation. The SO response to intravenous cholecystokinin-octapeptide (CCK-OP) 20 ng/kg was then recorded for at least 3 min. Twenty-five of the twenty-eight patients demonstrated one or more manometric abnormality when compared with data from the ten controls. The most frequent abnormality was an elevated SO basal pressure in 16 patients. In addition, excess of retrograde contractions in nine patients, high frequency of SO phasic contractions in nine patients, absence of phasic contractions in three patients, and paradoxical response to CCK-OP administration in two patients were recorded. This study has demonstrated a spectrum of sphincter of Oddi manometric disorders in patients with idiopathic recurrent pancreatitis and suggests that motility disorders of the sphincter of Oddi may be associated with episodes of pancreatitis.
Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury
Authors: Varma J S , Smith A N , Busuttil A
Published: March 2007

Continuous fluid-inflation proctometrograms were performed in men with the symptoms of chronic radiation proctitis and in age and sex-matched control subjects (n = 10). Rectal volumes and compliance were measured. There was a significant reduction in the rectal volumes at sensory threshold, constant sensation and maximal tolerance and in rectal compliance (P<0.01). Comparable pressure measurements did not demonstrate significant differences. The maximum tolerable volume, symptomatic and sigmoidoscopic scoring correlated to rectal compliance (r = 0.77, −0.8, −0.73; P<0.01, <0.01, <0.02, respectively). Reduction in volume and compliance is often not obvious radiologically. Histological evidence suggests that smooth muscle hypertrophy and myenteric plexus damage are contributory.
Assessment of myocardial function before aortic surgery by radionuclide angiocardiography
Authors: Mosley J G , Clarke J M F , Eii P J , Marston A
Published: March 2007

A consecutive series of 41 patients undergoing elective aortic surgery had pre-operative assessment of cardiac function by radionuclide angiocardiography. Their subsequent progress was monitored. There were 4 patients whose pre-operative left ventricular ejection fraction was <30 per cent and 3 of these patients died of cardiac failure postoperatively. There was only 1 death from cardiac failure amongst the 37 patients whose pre-operative left ventricular ejection fraction was > 30 per cent. Radionuclide angiocardiography is an accurate indicator of myocardial function of patients before major aortic surgery.
Isotope lymphography: a new method of investigating the role of the lymphatics in chronic limb oedema
Authors: Stewart G , Gaunt Judith I , Croft D N , Browse N L
Published: March 2007

A method of investigating the lymphatic system by radionuclide imaging in patients with chronic lower limb oedema is described. The clearance of 99mTc rhenium sulphur colloid from the interdigital space of 55 limbs and its appearance in the ilio-inguinal lymph nodes 30 min, 1, 2 and 3 h later has been measured using a gamma camera in 34 limbs (26 patients) with the clinical and radiological features of primary lyphoedema, 10 limbs (8 patients) with venous oedema and 12 control limbs (6 volunteers). On visual interpretation the sensitivity of this technique in diagnosing lymphoedema was 97 per cent and its specificity 100 per cent, while it clearly differentiated between lymphoedema and venous oedema. Estimation of the percentage uptake of the colloid in the ilio-inguinal lymph nodes at 1/2, 1, 2 and 3 h showed a markedly decreased lymph flow in the 34 lymphoedematous limbs and an increased flow in the 10 limbs with venous oedema. The results suggest that this technique can be used as a simple diagnostic outpatient technique in the investigation of chronic limb oedema.
The place of laparoscopy in the management of the impalpable testis
Authors: Boddy Su-Anna M , Corkery J J , Gornall P
Published: March 2007

In a four-year period 46 boys have been laparoscoped in the search for 55 impalpable testes. Thirty-three per cent of the testes were located intra-abdominally. Another 53 per cent were absent. This could be diagnosed by laparoscopy alone in 35 per cent. Laparotomy was needed in only 3 boys to locate the testes.
Intramural rupture and intramural haematoma of the oesophagus
Authors: Yeoh N T L , McNicholas T , Rothwell-Jackson R L , Goldstraw P
Published: March 2007

We report on two cases of spontaneous intramural rupture and haematoma formation in the oesophagus. This is an unusual and often misdiagnosed condition. Its diagnosis relies on the history and a barium swallow. Instrumentation can result in further damage to the oesophagus and should be avoided. Treatment is conservative and results in resolution of the haematoma and a return to normal swallowing.