bluuebunny/crossref_metadata_2025 huggingface dataset:
Volvulus of the transverse colon
Authors: Anderson J R , Lee D , Taylor T V , McLean Ross A H
Published: March 2007

Volvulus of the transverse colon is rare. Seven cases, 6 acute, are presented. Early diagnosis and prompt surgical management prevented complications. At laparotomy, extended right hemicolectomy or end colostomy and distal mucous fistula are the procedures of choice. Nonresection was associated with recurrence in three cases.
Endoscopic insertion of palliative oesophageal tubes in oesophagogastric neoplasms
Authors: Jones D Brian , Davies Phillip S , Smith Paul M
Published: March 2007

Fifty-five patients have undergone fibreoptic endoscopy under diazepam sedation with attempted insertion of a Celestin tube by the Nottingham introducer for an unresectable oesophagogastric malignant stricture.

There were 4 perforations in 48 successful intubations (8·3 per cent), 3 patients subsequently dying and the fourth healing spontaneously. There were 4 proximal tube displacements; 3 patients later returned with bolus obstruction.

Thirty-five (73 per cent) of the 48 patients who were successfully intubated left hospital with relief of dysphagia for periods ranging from 10 days to 18 months antil death (mean 5·5 months). Of the 13 deaths in hospital, 6 occurred as a result of the procedure (mortality rate 12·5 per cent).

We conclude that endoscopic insertion of palliative oesophagogastric tubes is relatively safe, simple to perform and could replace surgical introduction. It is technically more difficult in cases of gastric neoplasm involving the cardia.
Arginine vasopressin release following surgical operations
Authors: Cochrane John P S , Forsling Mary L , Gow Neil Menzies , Le Quesne Leslie P
Published: March 2007

A study of plasma arginine vasopressin (AVP) concentrations in 16 patients undergoing uncomplicated cholecystectomy was carried out to determine the relative importance of the various stimuli to AVP secretion during and after an operation. Eight of the 16 patients were given a high epidural blockade from T4 to T12 and blood samples were taken before, at frequent intervals during and for two days after operation for determination of plasma AVP and osmolality; systolic blood pressure was measured each time a blood sample was taken.

In the 16 patients there was a 1·8-fold rise of plasma AVP after induction of anaesthesia (from 1·7 pmol/l median basal value to 3·1 pmol/l) and an 8·8-fold rise after skin incision, the highest concentration during operation being 102 pmol/l. There was no significant difference in AVP concentrations, urine volumes or plasma osmolality in the control and epidural groups. Systolic blood pressure fell in all patients during operation bybetween 14 and 54 per cent, the fall being significantly greater in the epidural group.

Notwithstanding the evidence that certain nervous impulses do cause an increased secretion of AVP during operation, these results clearly show that in the absence of such stimuli there is still an increased secretion, almost certainly caused by a fall in the blood pressure.
A low volume burn resuscitation regimen: Assessment of performance by probit analysis
Authors: Griffiths R W , Cross N L , Laing J E
Published: March 2007

The findings are presented of a 10-year retrospective review of burn admissions to the Wessex Regional Burn Centre, where a low volume colloid resuscitation regimen is employed. An analysis of mortality probability has been conducted using probit analysis, and the areas of burn injury associated with a 50 per cent mortality probability (LA50) were determined for four different age groups. LA50 values obtained were 0–14 years 59 per cent body surface area (BSA) burn, 15–44 years 70 per cent BSA burn, 45–64 years 38 per cent burn, 65 years and over 17 per cent BSA burn. The figures obtained parallel closely those reported from another large burn centre in the United Kingdom where a widely different fluid regimen is used. The results of this analysis suggest that wide variations in fluid resuscitation regimens, particularly with regard to volume, do little to affect the mortality associated with burn injury as assessed by probit analysis.
Pancreatic fistula complicating pancreatectomy for malignant disease
Authors: Papachristou Dimitrios N , Fortner Joseph G
Published: March 2007

The incidence of pancreatic fistula in a series of 178 pancreatic resections was 25 per cent and was influenced by thetype of pancreatectomy, the management of the remaining pancreas and the size of the pancreatic duct. Thus, fistulas appeared in 52 per cent of patients undergoing pancreatoduodenectomy as compared to only 7 per cent of those undergoing distal pancreatectomy (P<0·001). Ligation of the pancreatic duct in pancreatoduodenectomy led to a 70 per cent incidence; the incidence was 33 per cent if the pancreas was anastomosed to the jejunum instead (P<0·001). Fistulas were rare in patients who had dilated pancreatic ducts. Fistulas, once they were established, were rarely influenced bytreatment. One out of 5 patients developing pancreatic fistula died, while fistulas were responsible for half of the operative deaths. The study indicated that pancreatojejunostomy is safe in the presence of ductal dilatation; it does not, however, protect from fistula if the pancreatic duct is normal. It also indicated that radiation of the pancreatic remnant in selected patients with persistent fistulas might be a useful therapeutic alternative.
The importance of pain, pruritus and soiling as symptoms of haemorrhoids and their response to haemorrhoidectomy or rubber band ligation
Authors: Murie John A , Sim Andrew J W , Mackenzie Iain
Published: March 2007

Bowel habit, anal pain or discomfort, pruritus ani and faecal soiling have been assessed in 82 patients with uncomplicated, prolapsing haemorrhoids before and after successful treatment (improvement in rectal bleeding and haemorrhoidal prolapse) by haemorrhoidectomy or rubber band ligation. An age and sex-matched control group of patients without haemorrhoids was similarly assessed. The bowel habit of the haemorrhoid group was not different from that of the control population. Pain or discomfort, pruritus and faecal soiling were much commoner in the pretreatment haemorrhoid group, compared to controls. Treatments designed to abolish rectal bleeding and prolapse (the cardinal symptoms of haemorrhoids) also reduced the incidence of these three symptoms. Only anal pain or discomfort, however, was reduced to the incidence found in the control group. Haemorrhoidectomy and rubber band ligation appeared equally effective in controlling all three symptoms. It is concluded that anal pain or discomfort, pruritus ani and faecal soiling are common symptoms of uncomplicated haemorrhoids and that they are abolished in the majority of patients by successful treatment for rectal bleeding and haemorrhoidal prolapse.
The effect of dihydroergotamine and heparin on the incidence of thromboembolic complications following total hip replacement: A randomized controlled clinical trial
Authors: Morris W T , Hardy A E
Published: March 2007

A randomized blind clinical trial was carried out to assess the effect of dihydroergotamine (DHE) alone and in combination with heparin on the incidence of thromboembolic complications of total hip replacement. It was found that a combination of DHE 0·5 mg and heparin 5000 units subcutaneously, given 8-hourly in separate injection sites, reduced the incidence of thromboembolic complications from 63 per cent in the untreated controls to 7·4 per cent in the treated group. This difference was highly significant. DHE alone produced a reduction in the incidence of thromboembolism but this reduction was not statistically significant. Blood loss was calculated using pre- and postoperative haemoglobin levels, taking into account the amount of blood transfused. It was found that the blood loss in the DHE/heparin-treated patients was identical to that in the untreated controls. The patients who received DHE alone had a significantly lower mean blood loss than the other two groups. It is concluded that this reduction in blood loss by DHE may be due to its venoconstrictor properties.
The effect of acute haemorrhage and of delayed blood replacement on wound healing: An experimental study
Authors: Nasution Ahmed F , Taylor David E
Published: March 2007

Haemorrhage whether untreated or with volume replacement delayed for 1 h has been shown by other workers to result in weaker scars 7–10 days after wounding. Studies have been carried out 6 weeks and 3 months after median laparotomy in three groups of Wistar rat: control, bled 10 ml/kg without replacement and bled 10 ml/kg with replacement of heparinized shed blood after 1 h. At 6 weeks the burst pressure of the laparotomy scar was significantly less (Mann—Witney U) in both the haemorrhage group (n = 6; 181·7±30·5 mmHg s.e.m.; P = 0·026) and the replacement group (n = 6; 207·8±27·4 mmHg s.e.m.; P = 0·037) than in the control animals (n = 7; 301·9±42·0mmHg s.e.m.). At 3 months there were no significant differences between the groups. On histology there was no difference in cellularity between the groups, but in both the haemorrhage and replacement animals collagen was less abundant and less well organized. These differences also had disappeared by 3 months. Neither collagen nor the fibroblast ultrastructure showed significant differences between groups, all animals showing patchy vacuolation of endoplasmic reticulum of fibroblasts at 6 weeks. It is concluded that oligaemia slows wound healing but does not affect the ultimate strength of the scar.
A comparison of two methods of whole gut lavage for colonoscopy
Authors: Gilmore I T , Ellis W R , Barrett G S , Pendower J E H , Parkins R A
Published: March 2007

Two forms of bowel preparation for colonoscopy were compared—19 patients were given 5 per cent mannitol solution orally while a further 19 were infused with isotonic saline via a nasogastric tube. Both methods proved equally acceptable to the patients and endoscopists. Saline led to a rise in body weight (+0·75±0·35kg) and blood pressure (+7·5±2·8 mmHg) while mannitol caused a significant fall in both body weight (−0·74±0·28 kg) and blood pressure (−3·8±2·9 mmHg).

Plasma volume measurements were carried out on 17 patients; 8 receiving saline showed a rise (+0·22±0·08l) while 9 taking mannitol experienced a fall (−0·17±0·08l). Twelve further subjects prepared with a combination 10 per cent mannitol and isotonic saline showed a small fall in plasma volume (−0·08±0·05l).

Mannitol proved an acceptable preparation for colonoscopies but a fall in body weight, blood pressure and plasma volume posed a small risk to the elderly subject and in view of the known risks of mannitol during diathermy this form of preparation was not considered a suitable alternative to isotonic saline.
To strip or not to strip the long saphenous vein? A varicose veins trial
Authors: Munn S R , Morton J B , Macbeth W A A G , McLeish A R
Published: March 2007

A double blind controlled trial of surgery for varicose veins was conducted on the legs of patients with bilateral symmetrical varicose veins. The two treatments, saphenofemoral ligation and avulsion of varices, with and without stripping of the long saphenous vein from ankle to groin, were randomly allocated among the legs of individual patients. At follow-up, between 2·5 and 3·5 years, an objective (observer) assessment was that stripping conferred a significant advantage, but the incidence of paraesthesia and pain biased patient's opinion against stripping.
Proximal gastric vagotomy in stenosed or perforated duodenal ulcer
Authors: Ferraz Edmundo Machado , Filho Horacio Alipio Ferreira , Bacelar Tercio Souto , Lacerda Claudio Moura , de Souza Ayrton Ponce , Kelner Salomao
Published: March 2007

Thirty-five patients suffering from stenosed or perforated duodenal ulcer, who were submitted to surgical treatment in the form of proximal gastric vagotomy, are presented. There were no deaths in the series and the results were considered to be very good in the cases of perforation, whereas a high incidence of poor results (27 per cent) occurred in the cases of stenosis submitted to a proximal gastric vagotomy combined with digital dilatation of the pylorus.
Obstructive jaundice caused by an intrapancreatic hydatid cyst
Authors: Morton P C G , Terblanche J T , Bornman P C , Tyrrell J C H
Published: March 2007

A rare case of obstructive jaundice caused by an intrapancreatic hydatid cyst in a 60-year-old Black female patient is presented.
Dacron graft erosion of the duodenum: A complication of interposition mesocaval shunt operations
Authors: Osborne D R , Hobbs K E F
Published: March 2007

Two cases are reported of patients presenting with septicaemia as a late complication of a Dacron interposition mesocaval shunt operation. In both cases the prosthesis had eroded through the duodenal wall and the Dacron was in direct contact with intestinal contents. One patient died and the diagnosis was only made at postmortem examination. The other patient recovered after the problem had been recognized and treated surgically.
Delorme's operation for complete rectal prolapse
Authors: Christiansen John , Kirkegaard Preben
Published: March 2007

Twelve patients with a median age of 73 years were treated for complete rectal prolapse by Delorme's operation. The patients were mildly sedated, and local anaesthesia with lidocaine—adrenaline was administered submucously. No postoperative mortality or cardiopulmonary complications occurred. After a median follow-up of 3 years, two recurrences were found. The Delorme procedure seems to be superior to the Thiersch operation, and the postoperative mortality and morbidity is equally low. Delorme's operation should be considered as an alternative treatment for complete rectal prolapse in patients who are not suitable for a transabdominal procedure.
Postoperative gastric emptying
Authors: Ingram D M , Sheiner H J
Published: March 2007

Postoperative intolerance of oral fluids is common after abdominal surgery, and their premature administration may result in abdominal distension, nausea and vomiting. The ability of the stomach to empty 100 ml of water was investigated in patients undergoing elective cholecystectomy. Patients were studied preoperatively and on the first postoperative day using a radio-isotopic method of measurement of gastric emptying. Factors such as age, electrolyte disturbance, duration of operation and the many drugs used during the perioperative period were analysed in relation to postoperative gastric emptying rates.

Postoperative gastric emptying showed wide variation, being normal in some patients but absent in others. No correlation was found between postoperative gastric emptying and age, plasma potassium and the duration of operation and anaesthetic. A significant correlation was found, however, between gastric emptying and drugs administered in the perioperative period. In particular, gastric emptying was grossly retarded following an injection of opiate, but this returned to normal if more than 5 h had elapsed since the last injection of opiate. It is suggested that opiate therapy is a major factor in a patient's inability to tolerate fluids following cholecystectomy.
Perforation of a suppurative solitary renal cyst
Authors: Finlay D B L , Lowe J S , Kaur K
Published: March 2007

A fatal case of rupture of a large infected renal cyst is presented. Antibiotic therapy is indicated after aspiration of a suppurative renal cyst, and recurrence, particularly if large, is an indication for prompt surgical intervention.
Vertical forces acting on the feet of diabetic patients with neuropathic ulceration
Authors: Ctercteko G C , Dhanendran M , Hutton W C , Quesne L P Le
Published: March 2007

The vertical forces acting on the sole of the foot in walking have been measured in 24 diabetic patients with neuropathic ulceration of the foot using a load-sensitive surface divided into 128 load cells, and compared with those in two groups of controls: (a), 21 diabetic patients with peripheral neuropathy but no ulceration and (b) 47 normal individuals.

The results showed that the patients with neuropathic ulceration were significantly heavier, that diabetic patients with neuropathy, with or without ulceration, transmitted proportionally less force through the toes than normal individuals, and showed a medial shift of the force transmitted through the metatarsal heads. All plantar ulcers occurred at the site of maximum loading. The absolute force at the site of maximum loading was significantly greater in the patients with ulcers than in both control groups, though there was a considerable overlap. A significant difference remained even when the absolute force had been corrected for differences in toe loading and body weight, indicating that a further factor (or factors) must contribute to the development of these localized areas of high loading.
Recurrent ulceration after highly selective vagotomy for duodenal ulcer
Authors: Blackett Richard L , Johnston David
Published: March 2007

Recurrent peptic ulceration was diagnosed in 9 per cent of 433 patients who were treated by elective highly selective vagotomy (HSV) for duodenal ulcer (DU) between 1969 and 1980. In 233 patients followed up for 5–12 years (12 per cent being lost to follow-up), the incidence of recurrence was 10.7 per cent. The site of recurrence was duodenal in 23 patients, pyloric in 4, gastric in 6 and combined duodenal and gastric in 2 (total of 35 patients). One patient presented with a perforation, 4 with haemorrhage and 30 with epigastric pain. Asymptomatic patients were not endoscoped and so asymptomatic recurrence would have been missed. Nine patients were treated by reoperation (5 Polya partial gastrectomy, 4 vagotomy + antrectomy), the remainder with cimetidine. There was no mortality.

When the 35 patients with recurrence were compared with the patients, without recurrence, no preoperative factors could be identified that might be used to predict recurrence. Thus, for the two groups, the sex distribution, age, length of ulcer history, previous ulcer complications and preoperative acid outputs (basal and maximal) were very similar. This was true also when the data for patients with true recurrence in the duodenum were examined separately. Hence, contrary to some previous reports, no evidence was found that patients who are hypersecretors of acid, either basal or maximal, before operation should be treated by vagotomy combined with antrectomy.

After HSV, however, patients with recurrent DU secreted more acid (basal, insulin and pentagastrinstimulated) than patients without recurrence, the difference between the two groups being statistically significant for basal acid output (BAO) and the response to insulin. The only factor which was found to influence the incidence of recurrent ulceration after HSV strongly was the surgeon who performed the operation.
Do prostacyclin and thromboxane play a role in endotoxic shock?
Authors: Webb P J , Westwick J , Scully M F , Zahavi J , Kakkar V V
Published: March 2007

The role of prostacyclin and thromboxane during endotoxic shock is unknown. Using new radioimmunoassay techniques, we have studied the plasma levels of stable metabolites of prostacyclin (6-keto-PGF1α) and thromboxane (TxB2) in a porcine model of endotoxic shock. TxB2 levels were markedly elevated but the production of prostacyclin appears to be impaired. Correction of this prostanoid imbalance by the infusion of prostacyclin or pre-treatment with a specific thromboxane synthetase inhibitor produces significant and beneficial effects on blood pressure and pre-kallikrein activation.
A controlled trial of colostomy management by natural evacuation, irrigation and foam enema
Authors: Doran J , Hardcastle J D
Published: March 2007

Twenty patients entered a prospective controlled trial of colostomy management by three techniques—natural evacuation, colostomy irrigation and foam enema. Every patient spent 2 months using each technique.

The mean number of colostomy actions weekly was 17 during natural evacuation, 6 during irrigation and 10 with the enema. There was no significant difference in the time taken to manage the colostomy by each technique. Eighteen patients considered that both irrigation and the foam enema improved the quality of their life, and opted to continue with irrigation on completion of the study. There were no major complications during the trial but leakage of foam and an increase in flatus were problems with the foam enema. It is concluded that patients should be made aware of the alternative methods available for colostomy management and be encouraged to use the method of their choice.
Mechanical and humoral factors in wound healing
Authors: Li A K C , Koroly Mary Jo
Published: March 2007

As wound contraction can be prevented by full-thickness skin graft and enhanced by licking and since saliva contains growth-promoting macromolecules, we have studied the mechanical and humoral aspects of wound healing.

Standardized burn and freeze-produced wounds were produced in rats. Contraction did not occur in wounds caused by freezing (n = 30), while burn wounds (n = 30) contracted to less than one-third of the original size in 3 weeks. If the centres of the freeze-produced wounds (n = 12) were excised, contraction would then occur and proceed at the same rate as open wounds (n = 12). The collagen contents of the burn wounds (n = 24) showed a greater initial loss followed by rapid replacement, while that of the freeze-produced wounds (n = 24) demonstrated a slower removal and more gradual replacement.

Submandibular sialadenectomized mice (n = 34) and sham controls (n = 34) had excision of a standard sized patch of sacral skin. Through a separate abdominal incision polyvinyl sponges of known weight were introduced subcutaneously into all the animals. Mice without the submandibular salivary glands showed a slower rate of wound contraction than the sham controls (P<0.001). However, this delay in wound contraction was abolished if sialadenectomized mice were caged with mice having intact salivary glands. Collagen synthesis as determined by the hydroxyproline concentrations in the polyvinyl sponges were the same in both groups of animals irrespective of cage environment. Further standard sacral wounds in submandibular sialadenectomized mice (n = 120) were treated with different salivary components. Only high molecular weight nerve growth factor was able to accelerate wound contraction in these sialadenectomized animals to control values.

In conclusion, the degree of wound contraction following injury is dependent on the integrity of the matrix, while the initiation of contraction is likely to be chemically induced.
Solitary rectal ulcer syndrome in Northern Ireland, 1971–1980
Authors: Martin C J , Parks T G , Biggart J D
Published: March 2007

Fifty-one cases of solitary rectal ulcer syndrome diagnosed over the past 10 years have been studied. The syndrome, of which solitary ulceration was a feature in only 35 per cent of cases, included patients with multiple ‘solitary’ ulcers (22 per cent), broad-based polypoid lesions (25 per cent) and patchy granular hyperaemic rectal mucosa (18 per cent). The syndrome was found to be strongly associated with abnormal rectal descent. Full-thickness prolapse to or beyond the anal verge was present in 59 per cent of patients while a further 32 per cent had lesser degrees of rectal descent. In only 9 per cent was no such abnormality demonstrated. Treatment with high roughage diet supplemented with bulking agents benefited two-thirds of 27 patients so treated. Ivalon sponge rectopexy has been performed in 6 patients with associated complete rectal prolapse, and in the first 3 of these (followed for a sufficient period) the results have been satisfactory.
Early versus delayed cholecystectomy: The effect of a change in management
Authors: Van Der Linden Willem , Edlund Gunnar
Published: March 2007

After a controlled trial, conservative treatment followed by delayed operation was replaced by early operation as the treatment of choice for acute cholecystitis. Results before and after this change were compared. The comparison confirmed that early cholecystectomy leads to more rapid recovery and to less time spent in hospital. There was no significant difference between the two procedures in the duration of operation and the incidence of wound infection. Early operation caused fewer biliary fistulas and was accompanied by a lower mortality.
Choledochoduodenostomy in calculous biliary tract disease
Authors: Lygidakis N J
Published: March 2007

During a 14-year period ending in June 1979, 342 patients with calculous biliary disease underwent choledochoduo-denostomy either as a primary procedure or during reoperation. Eighty per cent of the patients were aged 50 years or more. Follow-up was either by personal interview and physical examination or by means of a questionnaire, 90 per cent of the patients being assessed at periods ranging from 6 months to 14 years. A high incidence of common bile duct dilatation was found in older patients, in patients with a long history and in patients submitted to reoperation. There were no operative deaths. Postoperative complications occurred in 22 cases (6·4 per cent) and, in particular, no patient developed ascending cholangitis or symptoms related to the ‘blind segment’. Choledochoduodenostomy is a valuable and safe procedure and can be used on wide indications, especially where peroperative cholangiography is not available.
Thrombotic risks of staging laparotomy with splenectomy in Hodgkin's disease
Authors: Dawson A A , Bennett B , Jones P F , Munro A
Published: March 2007

No significant excess of deep vein thrombosis (DVT) as measured by the 125I-labelled fibrinogen method was observed in patients having staging laparotomy and splenectomy for Hodgkin's disease (HD) compared with patients having elective cholecystectomy under highly standardized surgical conditions. Patients who did have DVT all had splenic involvement with HD. There was no correlation between the post-splenectomy thrombocytosis and the occurrence of DVT. Patients with non-Hodgkin's lymphoma (NHL) and splenomegaly had a high incidence of DVT after splenectomy.
Features of mammographically negative breast tumours
Authors: Cahill C J , Boulter P S , Gibbs N M , Price J L
Published: March 2007

Mammography is a highly sensitive and specific technique in the diagnosis of breast cancer, but some tumours show no radiological features of malignancy. A total of 9·3 per cent of 323 consecutive patients with operable breast cancer had negative mammographic reports, and the clinical radiological and pathological findings in these cases are compared with those in the mammographically diagnosed group. Misinterpretation of carcinoma as a benign lesion and diagnostic difficulties in the dense dysplastic breast were found to be the main causes of error.
A double-blind trial of suloctidil v. Placebo in intermittent claudication
Authors: Jones N A G , De Haas H , Zahavi J , Kakkar V V
Published: March 2007

In a recent double-blind trial lasting over 6 months, 40 patients suffering from intermittent claudication were randomly allocated to receive 300 mg of suloctidil per day or exactly matching placebo capsules. In addition to treadmill walking distance, other objective criteria including ankle blood pressure response and muscle blood flow measured by 133Xe clearance were used to assess the effectiveness of therapy.

Nine patients (4 in the suloctidil group and 5 controls) did not complete the trial according to the protocol. Of the remaining 31 patients, 17 were in the control group and 14 received suloctidil. A significant improvement in the absolute walking distance, the level of β-thromboglobulin (βTG) compared to pre-therapy value and the time for the ankle pressure index to return to the pre-exercise value was observed in patients receiving suloctidil.
Stenosis of the common bile duct in chronic pancreatitis
Authors: Wisløff F , Jakobsen J , Osnes M
Published: March 2007

The incidence of common bile duct stenosis in patients with chronic pancreatitis was studied in a consecutive series of patients admitted for endoscopic retrograde cholangiopancreatography (ERCP). Thirty-six out of 79 patients (46 per cent) with moderate or advanced chronic pancreatitis as defined by radiological criteria were found to have a stenosis of the intrapancreatic portion of the common bile duct. There were no age or sex differences between the patients with and without biliary stenosis, but significantly more patients with stenosis had advanced chronic pancreatitis. In about two-thirds of the patients the stenosis was smooth, symmetrical and tapering. In the remaining cases, a shorter stricture of the hour-glass type was found. A complete obstruction was never seen. About one-half of the patients with bile duct stenosis were icteric at the time of the investigation. The jaundice resolved spontaneously in all but 1 patient in 3–42 (median 14) days. Stenosis of the common bile duct is a frequent complication of chronic pancreatitis, but biliary–enteric bypass operation seems to be unnecessary in the great majority of the patients.
The complications of injection sclerotherapy of bleeding oesophageal varices
Authors: Barsoum Maged Sami , Mooro Hisham Abdel-Wahab , Bolous Fathi Iskander , Ramzy Adel Fouad , Rizk-Allah Mounir Azmy , Mahmoud Fikry Ibrahim
Published: March 2007

The complications of injection sclerotherapy were retrospectively studied in 122 patients with acute variceal bleeding. Initial control of bleeding was achieved in 72·5 per cent of patients and the final success rate of sclerotherapy was 86·1 per cent. The overall morbidity rate was 30·3 per cent. Minor complications occurred in 13·9 per cent of patients and major complications were recorded in 16·4 per cent. Twenty patients developed complications directly attributable to sclerotherapy: 14 minor and 6 major. The overall mortality rate was 21·3 per cent, and 7·4 per cent of the patients died due to complications.

Pulmonary complications occurred in 15 patients and resulted in 3 deaths. Retrosternal pain developed in 8 patients, but dysphagia and oesophageal ulceration were rare. No stricture was recorded. The incidence of liver failure in 17 Child's grade C cases was almost certainly a complication of the underlying disease rather than the injection therapy. It is suggested that injection sclerotherapy is an effective and relatively safe treatment for variceal bleeding.
Achalasia in siblings
Authors: Stoddard C J , Johnson A G
Published: March 2007

The occurrence of achalasia in two brothers who were successfully treated by oesophagomyotomy is reported. There was no evidence of oesophageal motor dysfunction in their parents or two other siblings who were also studied. The possibility that genetic factors may be important in the aetiology of achalasia is discussed.
Management of retained cystic duct stones
Authors: Jennings Stephen A , Lusby Robert J , Drife James O , Davidson Colin M
Published: March 2007

A 20-year-old woman underwent cholecystectomy and common bile duct exploration. Seven days later, T-tube cholangiography showed two stones retained in a developmentally anomalous cystic duct stump. She was treated with thrice-daily flushings of large amounts of saline through the T tube, and after 7 days of treatment the biliary system was free of stones. The conditions necessary for successful non-operative management of retained cystic duct stones are discussed.
Resection of the liver with a water jet
Authors: Papachristou Dimitrios N , Barters Richard
Published: March 2007

Intrahepatic dissection in ablative liver surgery can be accomplished easily and safely with a jet of normal saline generated by a standard agricultural electric sprayer. The jet washes away the intrahepatic parenchyma leaving the ducts and vessels undamaged and easily controlled during dissection. The technique, applied in 45 lobectomies in the dog and in 4 liver resections in man, reduced blood loss.
The efficacy of peritoneal lavage at elective abdominal operations
Authors: Ambrose N S , Donovan I A , Derges Sheila , Minervini S , Harding L K
Published: March 2007

Human serum albumin microspheres of 1 μm diameter labelled with technetium-99 m were evaluated as a model for bacteria in two animal species. Peritoneal lavage recovered comparable amounts of an inoculum of microspheres and simultaneously instilled Escherichia coli. A prospective study was undertaken of 38 patients undergoing elective abdominal operations. Three lavages, each of 500 ml normal saline, were used. Over 80 per cent of the saline was recovered in 37 of the 38 patients with a median of 93 per cent. Recovery of microspheres was assessed from above the spleen, from Morison's pouch and from the pouch of Douglas. There was no difference in the recovery rates from the three sites of placement but significantly fewer microspheres were recovered via a right subcostal incision (median 59 per cent) compared with an upper midline incision (median 91 per cent).
Ureteric obstruction due to pelvic actinomycosis
Authors: Brown R , Bancewicz J
Published: March 2007

A case is presented of ureteric obstruction due to pelvic actinomycosis associated with an intra-uterine contraceptive device. Resolution of ureteric obstruction occurred with antibiotic therapy alone.
Inpatient treatment of prolapsing piles: Cryosurgery versus Milligan–Morgan haemorrhoidectomy
Authors: O'Callaghan James Desmond , Matheson Thomas S , Hall Robert
Published: March 2007

A comparative retrospective study, based on clinical assessment and questionnaire analysis, of 97 patients treated by cryosurgical haemorrhoidectomy and 99 patients treated by Milligan – Morgan haemorrhoidectomy, at 4-year average follow-up, has shown that 70 per cent of patients in each group derived complete and lasting relief from their symptoms. Two patients in each group required further treatment. There was no significant difference between the numbers who remembered severe, moderate or mild pain, or in its duration, although fewer cryosurgical patients required opiates. Postoperative discharge ceased in 70 per cent of patients within 2 weeks. When skin tags remained, they were usually inconsequential. Anal stenosis following cryohaemorrhoidectomy did not occur, and has not been reported. Cryohaemorrhoidectomy gave results equal to Milligan – Morgan haemorrhoidectomy in patients with prolapsing piles, with fewer complications, and has the economic advantages of less time in hospital (P < 0·01) and less time off work (P < 0·01).
Does the type of suture material contribute to the strength of the lateral paramedian incision?
Authors: Donaldson D R , Hall T J , Zoltowski J A , Guillou P J , Brennan T G
Published: March 2007

A prospective randomized trial was carried out on 231 consecutive laparotomies in which the lateral paramedian incision was used in all cases. Closure of the wound was identical except for the anterior rectus sheath where closure was randomized to (a) chromic catgut, (b) polyglycolic acid or (c) polypropylene. Follow-up for 1 year has revealed no wound dehiscences and only one incisional hernia (in the catgut group). We conclude that the lateral paramedian incision is inherently strong, and that this strength is due to splintage of the wound by the rectus abdominis muscle itself and is unrelated to the type of suture material used.
Aorto-iliac reconstructions for intermittent claudication
Authors: King R Barry , Myers Kenneth A , Scott David F , Devine Terence J
Published: March 2007

Over a 12-year period, 290 aortofemoral reconstructions were performed for intermittent claudication involving 449 legs in 262 patients. The accumulative patency rate in surviving patients was 79 per cent at 5 years. The patency rate was significantly better in patients who stopped smoking after operation, and in men compared with women. Dacron grafts were significantly more successful than endarterectomy in men. If there was no associated superficial femoral artery occlusion, endarterectomy and Dacron bypass grafts were equally successful, but Dacron bypass grafts were significantly superior to endarterectomy if the superficial femoral artery was severely stenosed or occluded.

The success rates for improving the patients' intermittent claudication were 90 per cent at 3 months and 72 per cent at 3 years. The success rate at 3 years was 80 per cent if the superficial femoral artery was patent but only 62 per cent if the superficial femoral artery was severely stenosed or occluded. Mortality and morbidity rates fell markedly in the last 6 years of the study.
Diagnosis of granulomatous starch peritonitis by delayed hypersensitivity skin reactions
Authors: Grant J B F , Davies J D , Espiner H J , Eltringham W K
Published: March 2007

Intradermal skin tests were performed on 6 patients with histologically proved granulomatous starch peritonitis and on 15 control subjects. All patients with starch peritonitis developed an erythematous reaction at least 5 mm wide between 3 and 8 days after inoculation. Such a skin reaction was not seen at that time in any of the control subjects. The microscopic changes seen in the positive reactions were dense mononuclear perivascular exudates with organized giant cell or epithelioid cell granulomas in 4 patients and loose histiocytic aggregations in a fifth patient. This evidence of cutaneous delayed hypersensitivity suggests that an immunological response underlies granulomatous starch peritonitis and that intradermal skin tests are of value in its diagnosis.
Nerve growth factor potentiates stress-induced gastric ulceration
Authors: Li Arthur K C , Jo Koroly Mary , Jeppsson B W , Schattenkerk M E , Young Michael , Malt Ronald A
Published: March 2007

Increased salivary flow stimulated by intravenous isoproterenol (IPR) (6 mg/kg) doubled the incidence of gastric stress ulceration in normal male mice, but not after submandibular sialadenectomy. The submandibular salivary glands in these mice secrete large amounts of several growth factors, including epidermal growth factor (EGF) and nerve growth factor (NGF). Intragastric instillation of a quantity of high molecular weight NGF equimolar to that in IPR-stimulated saliva doubled the incidence of stress ulcers after submandibular sialadenectomy. This action of NGF in vivo is not mediated by its nerve growth promoting properties nor its plasminogen activating property.
Biliary-type pain as a manifestation of genital tract infection: The Curtis–Fitz-Hugh syndrome
Authors: Wood J J , Bolton J P , Cannon S R , Allan A , O'Connor B H , Darougar S
Published: March 2007

Ten patients with biliary-type pain, in whom investigations of the biliary tract were negative, are reported. All the patients were sexually active premenopausal women and all had evidence of infection with Chlamydia trachomatis. Five patients submitted to laparoscopy had fibrinous adhesions between the anterior surface of the liver and the parietal peritoneum (perihepatitis). All 10 patients were diagnosed as suffering from the Curtis—Fitz-Hugh syndrome caused by Chlamydia trachomatis. The clinical similarities between the Curtis—Fitz-Hugh syndrome (right upper quadrant abdominal pain, perihepatitis and genital tract infection) and acute biliary disease are emphasized and the diagnostic implications discussed.
Is an early ultrasound scan of value in acute pancreatitis?
Authors: McKay A J , Imrie C W , O'Neill J , Duncan J G
Published: March 2007

Grey scale ultrasound scanning has been performed within 1 week of admission in 114 patients with acute pancreatitis in order to establish its reliability in detecting gallstones and to document early pancreatic changes. When the gallbladder was identified (69·4 per cent of patients), grey scale ultrasound was 96·1 per cent accurate in predicting the presence of gallstones. Of 85 patients (74·5 per cent), in whom adequate pancreatic imaging was achieved on the initial scan, 35 were reported within normal limits, 28 had generalized pancreatic swelling and 22 a localized pancreatic mass of cystic collection. These ultrasound findings did not correlate significantly with the objective assessment of severity of disease. However, all 9 patients (8·1 per cent) who developed a pseudocyst were in the group shown to have early localized pancreatic swelling.

Grey scale ultrasound is a useful method of detecting gallstones in patients with acute pancreatitis, thus permitting early accurate biliary surgery. However, in almost one-third of our patients ultrasound failed to outline the gallbladder on the initial scan. While ultrasound scanning of the pancreas will detect the formation of pseudocysts and accurately chart their subsequent progress, we doubt whether an early scan is required to achieve this purpose. Although generalized pancreatic swelling is frequently reported, this finding was of no major clinical importance and did not relate to the severity of disease.
An assessment of dynamic gastric scanning with 99Tcm-pertechnetate
Authors: Keane F B , O'Connor M , Stephens R B , Freyne P J , Hennessy T P J
Published: March 2007

Following intravenous injection, technetium-99m (99Tcm) is selectively taken up by the stomach, and this uptake, which is stimulated by pentagastrin, may be quantified using a gamma camera. Using this property of 99Tcm as a means of assessing gastric function, we found that the mean rate of 99Tcm uptake was significantly greater in 24 duodenal ulcer patients than in 10 healthy controls (P<0·01). Scanning values did not correlate with BAO or MAO which were measured on a separate day. Both vagotomy (n = 10) and cimetidine infusion (n = 5) significantly reduced the rate of uptake of 99Tcm (P<0·01). Thus, although 99Tcm reflects a function of the stomach which is similar to acid secretion, scanning did not give a good estimate of acid secretion in this group of subjects.
A prospective study of the effect of haemorrhoidectomy on sphincter function and faecal continence
Authors: Read M G , Read N W , Haynes W G , Donnelly T C , Johnson A G
Published: March 2007

The effect of haemorrhoidectomy on anal sphincter manometry and continence to faeces and rectally infused saline was investigated in 24 unselected patients with third-degree haemorrhoids. Haemorrhoidectomy resulted in the abolition of ultra-slow waves and significant decreases in basal and squeeze pressures, though these were reduced to normal values from abnormally high levels. Pressures remained at normal levels up to a year after surgery. An association was found between mucous soiling following surgery and an abnormally low postoperative squeeze pressure. There was no alteration in the function of the recto-anal inhibitory reflex following surgery. Only two patients developed incontinence to rectally infused saline for the first time following surgery. The addition of four-finger dilatation of the anal canal to the operative procedure did not cause any significant differences in sphincter manometry.
Resection of lung metastases in large bowel cancer
Authors: Hughes E S R , McConchie I H , McDermott F T , Johnson W R , Price A B
Published: March 2007

A series of 14 patients had partial or, in one case, total excision of the lung for metastatic tumour originating in the large bowel. Two patients have survived long periods (9 years and 12 years) and are now apparently free of the disease. A third patient shows no recurrence after bilateral lobectomy 2 years ago. Six of the remaining 11 patients developed isolated pulmonary metastases 5 years and 4 months to 11 years and 4 months after the original bowel resection. All 6 survived for 9 months to 11 years after pulmonary resection before succumbing to the disease. In all 11 patients who died, death was caused by systemic metastases in the brain, spinal cord or bone.
Neoplasia and ureterosigmoidostomy: A colonoscopy survey
Authors: Stewart M , Macrae F A , Williams C B
Published: March 2007

Patients who have undergone implantation of ureters into the sigmoid colon (ureterosigmoidostomy) are known to be at high risk of developing cancer of the colon many years later. The operation is often performed in infancy for congenital abnormalities of the bladder, thus creating a long term surveillance problem.

Six of 34 patients (17·6 per cent) who had undergone ureterosigmoidostomy were found at a screening fibresigmoidoscopy to have adenomas of the left colon or severe dysplasia of the stoma, a mean interval of 22 years after their urinary diversion. Four other patients had previously had a sigmoid adenoma or cancer; thus, 29 per cent overall had developed colonic neoplasms, almost all closely related to their stomas. Another patient who, by error, was excluded from the surveillance, died of metastatic cancer of the sigmoid colon within the study period.

Regular surveillance by fibresigmoidoscopy of patients who have had urinary diversion affords the opportunity to detect and remove potentially malignant sigmoid lesions. In addition to its clinical importance, it allows a closer study of this unique model of colon carcinogenesis.
Control of malignant ascites with spironolactone
Authors: Greenway B , Johnson P J , Williams R
Published: March 2007

Thirteen of 15 patients with malignant ascites ashieved an excellent response to spironolactone, with an increase in urinary sodium excretion rates from less than 35 mEq/d before treatment to between 50 and 245 mEq/d after treatment. Plasma renin activity was raised in all of 5 patients in whom it was measured, whereas aldosterone was raised in only 3; these results are similar to those found in ascites due to cirrhosis.
The effect of gastrointestinal malignancy on resting metabolic expenditure
Authors: Macfie John , Burkinshaw L , Oxby C , Holmfield J H M , Hill G L
Published: March 2007

It is unclear whether or not the presence of a malignancy causes an increased energy demand in the patient. As energy expenditure is normally related to body cell mass, it might be expected that an alteration in the relationship between body cell mass and energy expenditure would be observed in patients with malignant disease. This study aimed to investigate this possibility and to attempt to quantify any change in order to determine its clinical relevance.

Three groups of patients were studied: a control group (group I), consisting of healthy volunteers and patients awaiting minor elective surgery for benign conditions, and two groups of patients with malignant disease the extent of which was assessed at laparotomy; group II comprised those with local disease and group III those with metastatic disease. Resting metabolic expenditure (RME) was measured by indirect calorimetry and the total body potassium (TBK) was measured as an indicator of body cell mass. The results show a close correlation between RME and TBK in all groups. The RME at a given potassium content was greatest in those patients with metastatic disease. The magnitude of the difference was small, however, amounting to a mean elevation of 289 kcal/d in this group compared to control subjects.

It is concluded that malignancy may result in an increased energy demand, particularly in patients with metastatic disease. The magnitude of the increase is small and probably of little consequence when planning nutritional support, although its cumulative effect over many months may be significant.
Angiodysplasia and Meckel's diverticulum: A congenital association?
Authors: Hemingway A P , Allison D J
Published: March 2007

Five patients under the age of 21 years are described in whom a Meckel's diverticulum was found in association with angiodysplasia of the caecum or ascending colon. Angiodysplasia has only been observed previously in patients over the age of 35 years and its demonstration in 5 young patients with Meckel's diverticulum points not only to an association between the two disorders, but suggests that angiodysplasia may have a congenital aetiology.