bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of brush cytology before or after biopsy for diagnosis of gastric carcinoma
Authors: Keighley M R B , Thompson H , Moore Janet , Hoare A M , Allan R N , Dykes P W
Published: March 2007

A randomized trial has compared the results of brush cytology before or after biopsy in patients with solitary gastric lesions. One hundred and eleven carcinomas were identified in 324 patients. False positive histological reports were recorded in 2 patients but there were no false positive cytology results. The cumulative accuracy of biopsy and cytology in patients with carcinoma was 97 per cent, which was significantly better than biopsy alone (83 per cent, P < 0.001) or cytology alone (87 per cent, P < 0.001). The cumulative results of brushing before biopsy were significantly better than results obtained by brushing after biopsy (P < 0.05) and indicate that brush cytology should normally be performed before biopsy.
Complete liver dearterialization and the carcinoid syndrome
Authors: Khoury George A , Divine Terry , Bolt David E
Published: March 2007

A variety of surgical procedures are available in the treatment of the carcinoid syndrome, the aim being the destruction of liver secondaries and amelioration of symptoms. Dearterialization of the liver may be considered when liver secondaries are extensive and medical treatment inadequate in controlling symptoms.

The patient reported here had severe symptoms of epigastric pain, anorexia, flushing, diarrhoea and recurrent syncope and was generally deteriorating ropidly. Complete dearterialization of the liver, however, resulted in a dramatic improvement. Now, 2 years later, the patient's hepatic scan, liver function tests and 24-h urine 5-hydroxyindolacetic acid (5-HIAA) are all within normal limits. Destruction of liver secondaries by dearterialization is a relatively simple procedure. Careful attention should be paid to large quantities of pharmacologically active compounds released from the liver during the procedure. Ascites, jaundice and liver cell failure are definite contraindications to surgery.
Hepatic artery aneurysm: A pitfall in biliary surgery
Authors: Hubens A , De Schepper A
Published: March 2007

This paper describes a patient operated upon for gallbladder and bile duct stones, who presented with an extrahepatic aneurysm of the main hepatic arterial trunk and with a central intrahepatic haematoma assumed to be caused by the rupture of an intrahepatic aneurysm or by secondary intrahepatic necrosis. Exploration of the bile ducts resulted in haemobilia. The presence of extrahepatic arterial collaterals precluded individualization of the left and right hepatic arteries and subsequent distal arterial ligation or partial hepatectomy. Ligation of the common hepatic artery, although initially successful, was insufficient to avoid a recurrent and fatal haemobilia.
Abdominal wound closure—the Jenkins's technique: A registrar's experience
Authors: Love A
Published: March 2007

Jenkins's technique has been used to close 238 abdominal wounds. No dehiscence occurred in this series. It is suggested that this method, which gives strict guidelines on wound closure, is ideal for teaching good technique for wound closure.
Hypertrophic scarring: Dexon suture in a randomized trial
Authors: Simpson J E P , Ornstein M , Spicer C C , Cox A G
Published: March 2007

In a randomized prospective trial of three methods of skin suture an increased incidence of hypertrophic scarring in paramedian and inguinal wounds has been found to be associated with the use of 2/0 Dexon suture subcuticularly. However, the variance associated with the type of suture was less than that associated with the sex of the patient. The patient's opinion of the appearance of the scar was the same for all three suture methods used in skin closure.
Necrotizing sialometaplasia of palate
Authors: Chakravorty Ranes C , Yoneyama Tatsuo , Makooi Cyrus
Published: March 2007

A patient with necrotizing sialometaplasia of the hard palate was treated with wide resection on a biopsy diagnosis of carcinoma. The literature on this recently identified entity is reviewed and the characteristic clinical features, histopathology and ultrastructure are summarized. To the best of our knowledge, no ultrastructural study concerning this entity has been previously reported. Unless recognized early, an extensive resection might be done needlessly.
Wound drainage following radical mastectomy: the effect of restriction of shoulder movement
Authors: Flew T J
Published: March 2007

A randomized prospective clinical trial has been performed to determine the effect of temporary immobilization of the shoulder on wound drainage followitig radical mastectomy. In 64 patients admitted to the trial the mean volume of drainage was reduced by 40 per cent in those who had shoulder movement restricted for the first 7 days afer operation when compared with the group in whom early arm exercises were encouraged. The mean drainage time was reduced by 29 per cent. Shoulder immobilization did not result in increased shoulder stiffness, although there was an increased incidence of mild lymphoedema of the arm.
The management of suspected tumours of the colon: The role of colonoscopy in general surgery
Authors: McKelvey S T D
Published: March 2007

The role of colornoscopy in the management of 100 cases of suspected large bowel tumuour is described. Forty out of 47 patients with an equivocal barium enema examination were satisfactorily examined and the possibility of a tumour being present was either confirmed or refuted. Examination of 30 patients with otherwise unexplained blood loss from the bowel revealed the cause in 50 per cent of them. Twenty-nine patients had pedunculated polyps which were snared and removed, thus avoiding laparotomy and colotomy.

The problem of distinguishing tumours from other lesions or retained faeces by radiology arises most often in the sigmoid colon. This segment is easily examined using a short flexible endoscope. General surgeons taking up colonoscopy will find a 1-m single-channel instrument convenient to use and capable of renching approximately 90 per cent of colonic tumours that require further investigation or endoscopic resection. Facilities for the examination of the whole colon should be available in established endoscopy units.
Cancer of the large bowel in a defined population: Canterbury, New Zealand, 1970–4
Authors: Stewart R J , Robson R A , Stewart A W , Stewart Joanna M , MacBeth W A A G
Published: March 2007

A total of 1024 new cases of cancer of the large bowel occurred in Canterbury, New Zealand (population 400 796), in the 5 years 1970–4. Of these, 992 were diagnosed before death and are reviewed in this paper.

The high incidence of this disease in New Zealanders of European origin is illustrated. A significant difference in site distribution of primary tumours between the sexes was found, with a female preponderance of cancer of the proximal colon gradually changing to a male preponderance of cancer of the rectum. In all, 61.5 per cent of the patients had lymph node metastases or advanced disease at the time of diagnosis or tretment. Largely as a consequence of this, only 65 per cent were able to have potentially curative treatment.

The estimated crude 5-year survial rate of the whole group was 32.7 per cent (relative rate 42.8 per cent) and the crude 5-year survival rate after otentially curative surgery was 48.4 per cent (relative rate 62.4 per cent).

The results are compared with those of other outhors. They emphasize the generally unsatisfactory outcome of treatemtn.
Axillary vein entrapment
Authors: Boontje A H
Published: March 2007

This paper describes a patient with right axillary vein obstruction resulting from compression of the vein due to anomalous muscle tissue extending from the latissimus dorsi muscle across the neurovascular bundle to the pectoralis major muscle. This ‘axillopectoral muscle’ causing entrapment of the axillary vein has been described in only a few cases. These previous reports are discussed, with special reference to the symptoms and phlebographic findings. The obstruction and the symptoms caused by it are intermittent; the phlebographic features are characteristic.
Partial and complete atrophy affecting hepatic segments and lobes
Authors: Ham J M
Published: March 2007

Thirty-four patients with atrophic lesions of liver segments or lobes are described. The primary diagnoses included alcoholic liver disease, various forms of cirrhosis, hydatid disease, tumours and sclerosing cholangitis. Seventeen patients had complete atrophy of the segment or lobe and the other 17 patients had partial atrophy (i.e. a reduction of at least 50 per cent in the size of the affected area). Complete atrophy affected the left lobe more frequently than the right. The condition is important, first, because it is more common than is generally recognized, and second, because it may create considerable diagnostic and therapeutic problems.
Acute pancreatitis in Hong Kong
Authors: Ong G B , Lam K H , Lam S K , Lim T K , Wong John
Published: March 2007

A series of 311 Chinese patients with acute pancreatitis admitted to Queen Mary Hospital, Hong Kong, over a 10-year period is reviewed. Biliary tract disease was associated with pancreatitis in 52.4 per cent of patients and 77.9 per cent of them had stones, mud or parasites in the common bile duct. Fever and jaundice were present in 55 per cent and 41.2 per cent of patients respectively. Because of the prevalence of recurrent pyogenic cholangitis among the indigenous population, emergency operation, with the aim of common duct decompression, was conducted in 54.3 per cent of patients during the acute episode, with a mortality rate of 14.8 per cent. Five of 142 patients (3.5 per cent) died whilst on conservative treatment and all 5 had haemorrhagic pancreatitis. The overall mortality rate was 9.6 per cent. Exploration of the common bile duct, which was carried out in 57.4 per cent of patients in the acute phase, was not associated with a higher mortality than when laparotomy alone was performed, and 19 patients had sphincteroplasty without any death. Subtotal pancreatectomy was performed in 2 patients with haemorrhagic pancreatitis with 1 death.
The Celestin tube in the palliation of carcinoma of the oesophagus and cardia
Authors: Saunders N R
Published: March 2007

A series of 105 patients with dysphagia due to inoperable carcinoma of the oesophagus or cardia of the stomach, and 11 patients with dysphagia secondary to malignant mediastinal nodes, was treated by intubation with a Celestin tube. The hospital mortality was high but 81 patients left hospital and 29 were still alive at 6 months. The prognosis for those with dysphagia due to malignant posterior mediastinal nodes was very poor, with no survivors at 6 months. Oesophageal perforation was a serious operative complication, with a hospital mortality of 83 per cent. Chest and wound infections were the most common postoperative complications occurring in 28 and 20 per cent of the patients, respectively.

The restoration of swallowing was satisfactory in the majority of survivors although readmission with a blocked or displaced tube was not uncommon.
Intrarectal metronidazole in the prevention of anaerobic infections after emergency appendicectomy: A controlled clinical trial
Authors: Rodgers J , Ross D , McNaught W , Gillespie G
Published: March 2007

A series of 102 patients with presumptive acute appendicitis entered a prospective, randomized, clinical trial of intrarectal metronidazole given over a 48-h period commencing before surgery. Adequate levels of circulating metronidazole were achieved. A significant reduction in the incidence of anaerobic wound infection was observed in the treated group (P < 0.02). The convenience and short duration of the prophylactic regimen allowed early discharge from hospital. No untoward effects were observed.
A double-blind trial of a single intravenous dose of metronidazole as prophylaxis against wound infection following appendicectomy
Authors: Greenall M J , Bakran A , Pickford I R , Bradley J A , Halsall A , MacFie J , Odell M , Cooke E Mary , Lincoln Christine , McMahon M J
Published: March 2007

One hundred patients undergoing appendicectomy through a right iliac fossa incision were randomized to receive normal saline or 500 mg metronidazole as an intravenous infusion during the operation. One patient in the saline group developed an erythcmatous rash. There were 13 wound infections (as defined by the discharge of pus), 12 (out of 51) in the saline group and 1 (out of 49) in the metronidazole group. Bacteroides spp. were frequently cultured from the lumen of removed appendices and from pus obtained from infected wounds. This work supports the value of metronidazole but suggests that a single-dose regimen is adequate for prophylaxis.
The morbidity of carotid endarterectomy
Authors: Bouchier-Hayes D , De Costa A , MacGowan W A L
Published: March 2007

The results of 72 carotid endarterectomy operations carried out by three consultant surgeons were analysed. Thirty-eight operations (32.8 per cent) were performed in patients with mild or resolving stroke and 33 operations (45.9 per cent) in patients with transient ischaemic attacks and/or amaurosis fugax. Five patients (7 per cent) died in the early postoperative period, 2 as a result of strokes and the others from cardiac causes. Seventy-six per cent of patients had a satisfactory long term result, remaining free from stroke, blindness or recurrent transient ischaemic attacks over the follow-up period of 1–7 years.

There were 10 patients (13.8 per cent), including 2 who died, who developed early postoperative neurological deficits; 4 (5.5 per cent) had transient defects and 6 (8.3 per cent) had permanent deficits. Of these patients, 4 had proved occlusions of the reconstructed artery. In 3 patients, cerebral embolization during operation was suspected as the cause. There were, in addition, 2 asymptomatic patients whose reconstruction was shown to be occluded on follow-up postoperative angiography. The continued absence of symptoms, therefore, is no guarantee that the reconstruction is patent and some more objective method of assessment is necessary if the results of carotid endarterectomy are to be critically analysed. The incidence of neurological deficits could, it is believed, be reduced by greater experience with the operation, the routine use of per-operative intra-arterial shunting and peroperative angiography to confirm the patency of the reconstruction.
The clinical relevance of radiologically revealed Paget's disease of bone (osteitis deformans)
Authors: Guyer P B
Published: March 2007

Radiological and hospital records of 400 patients with Paget's disease that was shown radiologically have been examined in an effort to establish the clinical significance of the disease. Twenty-eight per cent of the patients were considered to have symptoms related to their disease, the most frequent symptom being bone pain, deformity and fracture. It appears that Paget's disease may predispose to the formation of urinary calculi. Malignant change and neurological and cardiovascular complications are rare, and osteitis deformans does not appear to predispose to osteoarthrosis.
Distribution of plasma-bound hydroxyproline in breast cancer, benign breast disease and healthy females
Authors: Nehlawi M F , Cuschieri A , Clark J , Wood R A B
Published: March 2007

In normal adult females, patients with benign breast disease and patients with breast cancer, hydroxyproline (OHPro) was found in the plasma attached to the protein fractions which were separated by Sephadex gel filtration. In addition, a distinct moiety, probably a protein sub-unit, containing substantial amounts of this imino acid, occurred in between gel filtration fractions III and IV. Quantitative differences in the OHPro content of these various fractions were observed in the groups of patients studied. Significant elevations in the peptide-bound OHPro (fraction IV) were found only in patients with breast cancer and the level appeared to correlate with the degree of advancement of the disease. Similar findings relate to the OHPro content of the sub-protein moiety which is found between gel filtration fractions III and IV. A reduced level of high molecular weight hyproprotein (fraction I) was found in the breast cancer group.
Does obstructive jaundice adversely affect wound healing?
Authors: Greaney M G , Van Noort R , Smythe A , Irvin T T
Published: March 2007

The effect of obstructive jaundice on wound healing has been investigated in an experimental study of abdominal wounds in rats following ligation and division of the common bile duct. Animals were jaundiced for 2 weeks before a second operation at which the abdominal wounds were made. The wounds in jaundiced and control animals showed no significant differences in mechanical strength during a 21-day period of study but there was a significant delay in the accumulation of collagen in the wounds of jaundiced animals. The findings suggest that the biochemical changes in the wounds of jaundiced animals did not interfere with wound repair and cast doubt on the thesis that jaundice has an adverse effect on wound healing.
The surgical treatment of axillary hyperhidrosis
Authors: Bergkvist Leif , Engevik Lennart
Published: March 2007

Axillary hyperhidrosis is a common condition and young people often suffer unnecessarily for many years in spite of the availability of good surgical methods for cure. We describe our own modification of Pettersson and Strömbäck's (1970) method of excision of the sweat glands. During the years 1972-6 218 axillary operations have been performed on 109 patients at the surgical clinic in Västerås for axillary hyperhidrosis. We reviewed 104 of these and found that 71 patients were completely satisfied and only 7 unsatisfied. Twelve patients wanted to be reoperated either because they still sweated or because they were unhappy with their scars. Thus, we found that overall the surgical methods are safe, simple and give good results.
The effect of levamisole on postoperative immunosuppression
Authors: Windle R , Wood R F M , Bell P R F
Published: March 2007

Cell mediated immunity was studied before and after surgery in patients with colorectal cancer. Thymus-derived (T) lymphocytes were enumerated and their non-specific activity was measured by assessing phytohaemagglutinin (PHA)-induced blastogenesis. Specific T lymphocyte activity was measured by leucocyte migration inhibition in response to purified protein derivative of tuberculin (PPD) and autochthonous tumour extract. One group of patients received levamisole postoperatively and the other group consisted of controls. There was a more rapid return to preoperative levels of leucocyte migration inhibition to both antigens by the levamisole group. However, levamisole administration had only a marginal efect on the postoperative depression of cell counts and did not restore depressed lymphoblast transformation.
Effect of epidural analgesia on metabolic profiles during and after surgery
Authors: Kehlet H , Brandt M R , Hansen A Prange , Alberti K G M M
Published: March 2007

Blood concentrations of glucose, lactate, alanine, free fatty acids, glycerol and 3-hydroxybutyrate were measured during 24 h in 12 females undergoing elective hysterectomy under either general anaesthesia or epidural analgesia extending from T4 to S5. The results showed that the peroperative and immediate postoperative metabolic profiles in the group receiving general anaesthesia reflected substrate mobilization (increased glucose, lactate, 3-hydroxybutyrate), and that epidural analgesia blocked these changes, probably mediated through an inhibited adrenaline response to surgery. Peroperative values of free fatty acids and glycerol were significantly lowered by epidural analgesia, indicating inhibition of lipolysis. Alanine decreased similarly in both groups. In the later postoperative period metabolic profiles were similar in the two groups, indicating that the influence of fasting may override the effect of the relatively minor trauma.
Experiences with head injuries in a regional neurosurgical unit
Authors: Jeffreys R V , Azzam N I
Published: March 2007

A review of all patients with major head injuries transferred to a regional neurosurgical unit for the years 1975 and 1976 has been carried out for comparison with the total number of patients with head injury admitted to district general hospitals of the region. Fifty-four per cent of patients admitted to the neurosurgical unit have resumed their old occupation and 20 per cent died. The significance of these figures is discussed, particularly in the light of the need for a more comprehensive policy for treating head injuries within the United Kingdom.
Leg haemodynamics during reconstructive vascular surgery
Authors: Sonnenfeld T , Cronestrand R , Nowak J
Published: March 2007

The aim of this study was to find the best haemodynamic variables for a correct assessment of the function of a femoropopliteal bypass graft. The results are based on intraoperative measurements performed on 11 patients undergoing surgical reconstruction of the femoral artery with a femoropopliteal reversed saphenous vein bypass graft.

Both blood transfusion and local intra-arterial injection of 40 mg of papaverine resulted in a significant increase in common femoral arterial and graft blood flows as well as in femoropopliteal pressure difference. At the same time there was a significant decrease in total leg and lower leg resistance, whereas the resistance over the graft was not significantly altered by changes in blood volume or by pharmacological vasodilatation.

It was shown that, for a complete assessment of the bypass function, both the resistance in the graft and in the lower leg must be evaluated. This can be effected by simultaneously measuring both the blood pressure and the blood flow. It was also shown that the femoropopliteal pressure difference per se does not indicate the true capacity of the graft. It is concluded that, during reconstructive vascular surgery, leg haemodynamic variables are influenced by variations in blood volume and vasomotor tone. This is of importance for the correct interpretation of a single haemodynamic variable and for the correct quantitative evaluation of the results of vascular surgery.
Bleeding duodenal ulcer: Reduction in mortality with a planned approach
Authors: Hunt P S , Korman M G , Hansky J , Marshall R D , Peck G S , McCann W J
Published: March 2007

In a 6-year prospective study from 1972 to 1978 266 patients were admitted to a haematemesis and melaena unit with bleeding duodenal ulcer. There were 13 deaths, a mortality of 5 per cent. A comparison between the three consecutive 2-year periods of study showed an intial mortality of 6 per cent for the first 4 years falling to 2 per cent for the 93 admissions during the final 2 years of experience. Of the 120 patients treated surgically, 10 died in hospital, giving an operative mortality of 8 per cent. The trend in operative mortality was from 13 per cent for the initial 2-year period to 8 per cent for the second period and to 3 per cent for the final 2 years. The operative rate was consecutively 45, 50 and 34 per cent. There was 1 death in conservatively treated patients during each 2-year period of study. Three types of operation were performed: vagotomy, pyloroplasty and oversewing of the ulcer; Polya gastrectomy; and vagotomy and antrectomy. There was no difference in morbidity and mortality between these operations. At a mean follow-up of 3·1 years, 90 per cent of the patients had a good result from their operation. It is concluded that a prospective system of management with an active policy of early endoscopy, surgery and regular audit reduces the mortality from bleeding duodenal ulcer.
Anti-Xa factor as a predictor of postoperative deep vein thrombosis in general surgery
Authors: Gunn Iain G
Published: March 2007

This study was stimulated by a recent report linking a low preoperative level of an endogenous coagulation inhibitor (anti-Xa factor) with an increased incidence of postoperative deep venous thrombosis (DVT) (Stamatakis et al., 1977).

Preoperative and postoperative levels of anti-Xa were measured and correlated with the postoperative incidence of deep venous thrombosis assessed by the 125I fibrinogen uptake test to determine whether a high risk group could be isolated and a suitable regimen of prophylaxis introduced.

In this study of 22 surgical patients the postoperative DVT rate was 41 per cent. However, preoperative measurements of anti-Xa activity failed to show any statistically significant difference between those patients with DVT and the non-DVT group. The findings do not support the use of anti-Xa levels as a preoperative predictor of postoperative DVT in the individual.
Small bowel strictures after blunt abdominal trauma
Authors: Marks C G , Nolan D J , Piris J , Webster C U
Published: March 2007

Two patients with strictures of the small intestine after blunt abdominal trauma are reported. In the first there were multiple severe injuries and the ileal stricture due to a mesenteric tear was not diagnosed until 6 weeks later. In the second an apparently minor injury was responsible for direct damage to the wall of the jejunum and a subsequent stricture.
A lung colony clonogenic cell assay for human malignant melanoma in immune-suppressed mice and its use to determine chemosensitivity, radiosensitivity and the relationship between tumour size and response to therapy
Authors: Thomas J Meirion
Published: March 2007

A lung colony assay for clonogenic cells of human tumours in immune-suppressed mice is presented. The assay was used to determine the chemosensitivity of two malignant melanomas. One tumour reproduced the spectrum of chemosensitivity associated clinically with three cytotoxic agents. The other melanoma reproduced the chemosensitivity demonstrated in the patient from whom the tumour was biopsied.

The importance of tumour size as a determinant of response to melphalan was investigated and the clonogenic cell survival in smaller tumours was found to be slightly but significantly lower than in larger tumours.

An investigation of the importance of size as a determinant of response to radiotherapy demonstrated that 0·5-mm diameter tumour nodules were significantly more sensitive to irradiation than 2-cm diameter nodules. The hypoxic fraction of the larger tumours was 65 per cent, which is higher than that reported for experimental animal tumours or a human pancreatic tumour. This could be a factor in the clincical radioresistance of malignant melanoma.
The interpretation of mammographic ductal enlargement in cancerous breasts
Authors: Mansel R E , Gravelle I H , Hughes L E
Published: March 2007

The xeromammograms of 128 women with breast cancer were coded radiologically according to Wolfe's gradings. The mastectomy specimens were then histologically examined for the presence of ductal abnormality.

The ducts were found to be normal in the cases coded as normal radiologically but they were not always abnormal histologically when considered to be abnormal radiologically. ‘Ductal prominence’ may be due to duct ectasia, intraduct hyperplasia or periductal collagenosis.
Plasma exchange and Raynaud's phenomenon—Its assessment by Doppler ultrasound velocimetry
Authors: O'Reilly M J G , Dodds A J , Roberts V C , Cotton L T
Published: March 2007

In a group of 47 patients with Raynaud's phenomenon, Doppler ultrasound velocimetry was used to establish the severity of the disease by detecting the patency of the digital arteries. In conjunction with small digital occlusion cuffs, digital artery systolic pressure was measured on either side of the finger. A significant variation in systolic pressure was detected in each finger, and on each side of individual fingers. A more sensitive index of the severity of the disease was noted when the digital systolic pressure was compared to the brachial systolic pressure.

Plasma exchange, a potent method of lowering whole blood viscosity and plasma fibrinogen, was used to treat 18 of these patients. There was a significant improvement in digital vessel patency at both 21 °C and 13 °C after plasma exchange. Both the digital artery systolic pressure and the pressure index improved significantly after treatment.
Fine needle catheter jejunostomy—An assessment of a new method of nutritional support after major gastrointestinal surgery
Authors: Yeung C K , Young G A , Hackett A F , Hill G L
Published: March 2007

The results of our experience with the technique of fine needle catheter jejunostomy and early postoperative feeding through the catheter over a 12-month period are presented. Of the 43 patients who had the catheter inserted, 27 (63 per cent) completed a course of feeding with an elemental diet without complications, 3 (7 per cent) were not fed for different reasons and 13 (30 per cent) developed complications that led to temporary or permanent cessation of the feeding. One patient in this group died of inhalation pneumonia.

The voluntary food intake of 12 of the patients who were fed by jejunostomy after major colorectal surgery was assessed daily for 2 weeks after operation and compared with that of 12 control patients who did not have nutritional support. No significant difference in voluntary food intake was found between the two groups.

The changes in body composition and plasma proteins and the clinical outcome of 20 of the patients fed by jejunostomy after major colorectal surgery were also compared with those of 20 matched controls. Body weight and lean body mass (as assessed by total body potassium and arm muscle circumference) and plasma prealbumin fell significantly in the control patients but not in those fed by jejunostomy. However, plasma transferrin decreased in both groups and there was no significant difference in clinical outcome in terms of complication rate or duration of postoperative hospital stay.

The study would suggest that this technique of jejunostomy feeding should be reserved for selected cases where it may prove to be of real value, rather than being used routinely.
Lesser curve superficial seromyotomy—An operation for chronic duodenal ulcer
Authors: Taylor Thomas V
Published: March 2007

Lesser curve superficial seromyotomy has been investigated in the dog and in man. The anatomical basis for the operation, which produces an easily performed denervation of the parietal cell mass, is discussed. Acid studies in the dog confirmed that the operation was capable of producing secretory inhibition in keeping with vagotomy of the parietal cell area.

A consecutive series of 25 patients with chronic duodenal ulcer has been treated by lesser curve myotomy without a drainage procedure. The operation has the advantages of being easily performed and the risk of damage to the nerve of Latarjet or of ischaemic necrosis of the lesser curvature is obviated. In 20 insulin tests performed within the first month postoperatively all patients have been negative within the first 75 min and there were 4 late positive responses. Early clinical results have been encouraging, there has been no dumping or diarrhoea and all patients are well. It is suggested that further investigation of lesser curve myotomy is warranted.
Bone scanning: Its lack of value in the follow-up of patients with breast cancer
Authors: Bishop H M , Blamey R W , Morris A H , Rose D H , Preston B , Lane Joyce , Doyle P J
Published: March 2007

Three hundred and fifty-four women with primary operable breast cancer had a bone scan performed within 6 weeks of a simple mastectomy. Eight (2·3 per cent) were positive, but 7 of these patients had radiological evidence of bony metastases. Follow-up bone scans 1 year postoperatively on 278 patients showed only 12 (4·3 per cent) positive, and of these, 9 had other radiological evidence of metastatic disease. At 2 years postoperatively there were 13 (9·2 per cent) positive bone scans amongst 141 patients. Only 2 of these 13 had no other evidence of metastases. Although a bone scan is a useful investigation in patients with bone pain, there is no place for routine bone scanning in either the staging or follow-up of women with operable breast cancer.
Gastric reduction for morbid obesity: Technique and indications
Authors: Kark A E , Burke M
Published: March 2007

The results of gastric reduction for obesity in 12 patients are described. Emphasis is laid on preoperative weight loss, using jaw wiring in 9 patients. The successful outcome of the operation was found to depend on the formation of a small gastric pouch and a narrow gastrojejunal anastomosis. A constant-sized pouch was achieved by forming the pouch around a 100-ml silicone balloon devised for the purpose. Postoperative results were good in 7 patients, partial success was achieved in 3 patients and there were 2 failures.
The effect of bile acids on colonic myoelectrical activity
Authors: Flynn M , Darby C , Hyland J , Hammond P , Taylor I
Published: March 2007

The effect of different concentrations of sodium cholate, sodium chenodeoxycholate and sodium deoxycholate on colonic myoelectrical activity was studied in 4 dogs. There was no statistically significant difference in percentage motility, motility index, basal pressure or mean slow wave frequency with either cholic or chenodeoxycholic acid (5–15 mm). Deoxycholic acid (15 mm), however, caused a marked increase in percentage motility (median control value 4·1, range 0–23; after installation, median value 27·0, range 20·6–45·0, P < 0·001). This was accompanied by an increase in spike activity, but no alteration in mean slow wave frequency or basal pressure was seen. Cholestyramine inhibited the motor response. It appears that only deoxycholic acid affects both motility and absorption, presumably by different pathways, and may thus assume importance in disorders of colonic motility.
The early diagnosis of ectopic pregnancy
Authors: Hughes Graeme J
Published: March 2007

In a survey of 235 consecutive cases of ectopic pregnancy it was found that over 50 per cent were incorrectly diagnosed by the general practitioner and 36 per cent by a hospital doctor. Ten per cent of patients were sent home before the diagnosis was made.

Over 30 per cent of patients were sent to general surgical wards and these patients had different characteristics from those sent to gynaecological wards.

High risk patients can be identified from their past history. The increasing use of the laparoscope has been associated with earlier detection of ectopic pregnancy before the stage of rupture.
Multiple intestinal perforation due to Celestin tube
Authors: Shaw J F L , Coombes G B
Published: March 2007

Two cases of multiple intestinal perforation caused by the nylon from the core of disintegrating oesophageal Celestin tubes migrating down the alimentary tract are described. It is suggested that Celestin tubes should not be used in patients likely to survive for more than a few months.
Granular cell myoblastoma of the breast: A report of 2 cases
Authors: McCracken M , Hamal P B , Benson E A
Published: March 2007

Two cases of granular cell myoblastoma of the breast are presented occurring in women aged 20 and 22 years. The clinical findings, mammographic and naked eye appearances suggested carcinoma. The difficulties of diagnosis and the pathogenesis of this rare tumour are discussed. A definitive histological diagnosis of an apparently malignant breast lump, particularly in a young woman, is mandatory before proceeding to major surgery.
Emergency treatment of variceal haemorrhage
Authors: Sagar S , Harrison I D , Brearley R , Shields R
Published: March 2007

For the initial control of haemorrhage from oesophageal varices, two methods of vasopressin administration have been compared—the conventional bolus of 20 units and a low dose infusion of 0·4 units per minute.

Twenty patients bleeding from oesophageal varices, confirmed by endoscopy, were allocated into either treatment group (10 in each). Vasopressin infusion stopped bleeding in 86 per cent of the episodes in contrast to 12·5 per cent (P < 0·01) with bolus doses. Balloon tamponade with a Sengstaken-Blakemore tube was used to control bleeding in only 2 episodes in patients on infusion and in 10 episodes in patients on bolus doses of vasopressin (P < 0·05). Our study confirms that low dose vasopressin infusion is more effective in controlling bleeding from oesophageal varices than conventional bolus doses.
A comparative randomized trial of heparin versus streptokinase in the treatment of acute proximal venous thrombosis: An interim report of a prospective trial
Authors: Elliot M S , Immelman E J , Jeffery P , Benatar S R , Funston M R , Smith J A , Shepstone B J , Ferguson A D , Jacobs P , Walker W , Louw J H
Published: March 2007

A controlled, prospective study comparing streptokinase and heparin treatment has been completed in 51 patients presenting with acute proximal venous thrombosis of less than 8 days' clinical duration. Patients were studied by means of pre-treatment, post-treatment, 3- and 12-monthly phlebography and pulmonary perfusion scanning and were followed up at 3-monthly intervals.

Of the 26 patients randomized to receive streptokinase, therapy was stopped in 3 because of complications. Phlebography 5 days after starting treatment showed 80–100 per cent lysis in 17 of the 23 patients who completed the course of streptokinase. Two patients later developed partial rethrombosis. One patient developed an asymptomatic pulmonary embolus during treatment. During follow-up (mean 19 months) only 1 of the 17 patients with 80–100 per cent lysis developed postphlebitic symptoms, 3 patients died of unrelated causes and 1 patient was lost to follow-up.

In patients randomized to heparin therapy no significant lysis was achieved in any of the 25 patients and only 2 of these patients were found to have asymptomatic legs on follow-up. Two patients in this group died and autopsy confirmed massive pulmonary embolus during treatment.

These data suggest that streptokinase is superior to heparin in the treatment of acute proximal venous thrombosis of less than 1 week's clinical duration especially if the thrombus is largely non-occlusive. It must be stressed that in order to avoid the bleeding complications of thrombolytic therapy, streptokinase must not be used within 10 days of major surgery, or even longer after vascular, neurosurgical or eye operations.
Circulating breast tumour antigen-sensitive T lymphocytes in early breast cancer and high risk benign breast disease
Authors: Ramey William G , Hashim George A , Fitzpatrick Hugh F
Published: March 2007

Levels of circulating T lymphocytes sensitized to breast tumour associated antigens (BTA) were correlated with pathological tumour stage or benign histopathology in preoperative studies of 180 patients by the antigen-stimulated active rosette-forming T cell (AgARFC) assay. Incubation of lymphocytes with allogeneic BTA extracts produced increased AgARFC compared with incubation without BTA. Significant levels of BTA-sensitive T cells were found in 78 per cent of breast cancer patients compared with 23 per cent of patients with benign disease (P < 0·0005, by Ch2). Over 93 per cent of stage I cancer patients responded to BTA, compared with 69 per cent of stage II patients (P < 0·0025) and 59 per cent of stages III–IV patients (P < 0·005). Twenty-nine per cent of 42 patients with fibrocystic disease were positive to BTA in contrast to 8 per cent of 25 patients with fibroadenomas. This was a 3·6-fold higher incidence of BTA-sensitive T cells associated with fibrocystic disease than with fibroadenomas, which was in agreement with the increased breast cancer risk rate associated with fibrocystic disease. These findings suggest that the AgARFC assay may detect early malignant change in fibrocystic disease. The AgARFC assay was found to reliably detect early invasive carcinoma.
Multi-element analysis of the living body by neutron activation analysis—application to critically ill patients receiving intravenous nutrition
Authors: Hill Graham L , King Roderick F G J , Smith Ross C , Smith Alan H , Oxby Clement B , Sharafi Ali , Burkinshaw Lewis
Published: March 2007

Neutron activation analysis has been used to determine the total content in the body of N, K, Na, Cl, P and Ca in 25 critically ill surgical patients before and after a 14-day course of intravenous nutrition. Muscle elemental compostion was also determined in these patients at the same time as the total body analysis.

Over the 14-day period of intravenous feeding the total body contents of all the measured elements increased (2–9·7 per cent) but only the increase in K was statistically significant. Muscle chemistry suggested an intracellular K depletion which was corrected over the study period. The results of the total body multi-element analysis were interpreted to show a mean gain of 1·25 l of extracellular fluid and 0·51 l of intracellular fluid and direct measurement of total body water suggested that this interpretation was probably valid.

The first application of the technique to patients with nutritional and metabolic problems has quantified the weight gained by two body compartments during a 2-week period of intravenous nutrition. Its further application should help to solve a number of nutritional and metabolic problems in clinical surgery.
Absorbable haemostatic materials and intraperitoneal adhesion formation
Authors: Raftery Andrew T
Published: March 2007

The effect of two absorbable haemostatic materials, oxidized cellulose gauze (Surgicel) and absorbable gelatin sponge (Sterispon) has been investigated in relation to intraperitoneal adhesion formation using the rat as experimental animal. Neither oxidized cellulose gauze nor absorbable gelatin sponge was associated with an increased incidence of adhesions. On the contrary, oxidized cellulose gauze was associated with a decreased incidence of adhesions. If haemostatic material is required in the peritoneal cavity, oxidized cellulose gauze may be preferable to absorbable gelatin sponge since it is associated with a lower incidence of adhesions.
Fibrinolysis and the prediction of postoperative deep vein thrombosis
Authors: Reilly D T , Burden A C , Fossard D P
Published: March 2007

Fibrinolytic activity was measured in 28 patients undergoing elective abdominal surgery in order to assess the value of fibrinolytic activity as a predictive indicator of deep vein thrombosis. Eighty-nine non-smoking adults acted as controls. Fibrinolytic activity was estimated before and during operation, immediately postoperatively and 24 h and 48 h after operation. The onset of deep vein thrombosis was assessed daily for 5 days using 125 I-fibrinogen uptake scans. Fibrinolytic activity in 9 patients changed significantly and 7 of these developed deep vein thrombosis. Preoperative assessment of fibrinolytic activity cannot alone predict deep vein thrombosis but changes in the pattern of activity may be of help in defining those at risk.
Does a high fibre diet prevent the complications of diverticular disease?
Authors: Hyland J M P , Taylor I
Published: March 2007

The management of diverticular disease has altered radically with the widespread use of high fibre diet (HFD) over the past decade. However, whether this regimen has improved the prognosis in patients admitted with acute complications is still debatable.

In this study the outcome of 100 such patients admitted to hospital with acute episodes of diverticular disease has been reviewed. Seventy-five per cent were treated conservatively with HFD and review after 5–7 years showed that over 90 per cent remained symptom-free, suggesting that HFD may afford protection by preventing further complications.
Peroperative antibiotics in the prevention of chest infection following cardiac operations
Authors: Galland R B , Shama D M , Prenger K B , Darrell J H
Published: March 2007

Seventy-nine patients about to undergo cardiac operations were randomly allocated to two treatment groups in an attempt to reduce postoperative chest infections. The group receiving a short peroperative course of cefamandole, an antibiotic effective against both the pneumococcus and Haemophilus influenzae, had a significantly lower postoperative chest infection rate than the group receiving a 3-day course of cephradine, an antibiotic previously chosen to prevent intracardiac infection during the operation. By selecting an appropriate antibiotic it is possible, using a short peroperative course, to reduce the post-operative chest infection rate in patients undergoing cardiac operations.
Carcinoma of the tongue: Factors affecting the results of surgical treatment
Authors: Lam K H , Wong John , Lim S T K , Ong G B
Published: March 2007

Sixity-five cases of carcinoma of the tongue treated by surgery were reviewed. The types of operation included hemiglossectomy, subtotal and total glossectomy with or without hemimandibulectomy and laryngectomy. Simultaneous neck dissection was usually performed except for patients who had radiotherapy and did not have clinical lymph node involvement. The hospital mortality and five-year survival rates were analysed for individual subgroups of patients classified according to clinical and pathological features.

The overall hospital mortality rate was 21·5 per cent. The size of the tumour and the presence of extension posteriorly, to the opposite side and to the floor of the mouth increased the mortality. Lesions situated on the dorsum fared worse than those at the edge or undersurface. Clinically and pathologically involved lymph nodes adversely affected the mortality. The more extensive the resection, the higher the mortality. Old age and previous failed radiotherapy also increased mortality. The overall five-year survival rate was 46 per cent. Long term survival was not so much affected by the size of the primary tumour and degree of local extension as was the hospital mortality. Clinical as well as pathological staging of regional lymph nodes were more important in influencing long term survival. Recurrence after radiotherapy had a worse prognosis than previously untreated tumours.
Solitary abscess of the spleen
Authors: Simson Jay N L
Published: March 2007

Solitary abscess of the spleen is a potentially lethal condition. It is difficult to diagnose but relatively easy to treat, resulting in cure of the majority of the patients. A case is described to illustrate the important factors in aetiology, presentation, diagnosis and treatment. All cases reported since 1960 are reviewed: the mortality of untreated patients is shown to be 100 per cent. If this condition is sucessfully diagnosed and treated, without rupture, no patient should die from it.
Transrectal biopsy of the prostate and bacteraemia
Authors: Thompson P M , Talbot R W , Packham D A , Dulake C
Published: March 2007

Bacteraemia and urinary tract infection are wellrecognized complications of urological procedures. This paper compares, for the first time, the incidence of bacteraemia after cystoscopy and transrectal biopsy of the prostate with that following cystoscopy alone. The incidence of bacteraemia in those undergoing biopsy was 73 per cent; following cystoscopy alone the incidence was 13 per cent. In view of this high incidence we recommend prophylactic antibiotic cover of transrectal prostatic biopsy.
Recurrent torsion of the testis following previous surgical fixation
Authors: May Roy E , Thomas William E G
Published: March 2007

Two cases of recurrent torsion of the testis following previous surgical fixation are described. The significance of this rare occurrence is discussed and it is recommended that total excision of the parietal tunica vaginalis is used for surgical fixation.
Modification of the physiological disturbances produced by whole gut irrigation by preliminary mannitol administration
Authors: Donovan Ian A , Arabi Y , Keighley M R B , Alexander-Williams J
Published: March 2007

In a prospective non-randomized study of 42 patients it was found that the oral administration of 50 g of mannitol 2 h before whole bowel irrigation (WBI) improved the success rate of the bowel preparation and reduced the time required for the WBI. Mannitol is an osmotic cathartic, and it reduced fluid absorption from a mean value of 2·7 1 in patients who had WBI alone to a mean of 1·2 I in those who received mannitol beforehand. Sodium absorption was also significantly reduced.