bluuebunny/crossref_metadata_2025 huggingface dataset:
Stimulatory immunotherapy in mammary cancer
Authors: Anderson J M , Kelly F , Wood Suzanne E , Halnan K E
Published: March 2007

Stimulation of rejection reactions by attenuated cancer cells is the most widely studied and the safest type of immunotherapy feasible at present. Transfer of serum and non-specific stimulation can increase the growth of cancers and carry risks of hypersensitivity reactions and granulomatous hepatitis. No such dangers accompany sensitization with irradiated cancer cells which augments the effect of subsequent irradiation of residual cancer in animals. Therefore we have examined the effects of autografts of irradiated cancer (AIC) added to conventional first treatment of mammary cancer by mastectomy and radiotherapy at a time when any residual or disseminated cancer could reasonably be expected to he small and more readily controlled by any systemic component of the putatively radiosensitizing immunotherapy.

Two premenopausal and 14 postmenopausal women with prognostically unfavourable mammary cancer (11 with proved axillary lymph nodal metastases, I without such metastases and 4 in whom the nodal status was unknown because dissections were partial) were treated in this way 4–7 years ago. Twelve (75 per cent) patients are still alive. One survivor had many metastases in bones and subcutaneous tissues which appear to have regressed completely following chemotherapy. The other II survivors have no biochemical, clinical, radiological or scintigraphic signs of disseminated cancer.

Three of the patients have died from metastases; one whose axillary nodal status was unknown developed cancer therein 52 months after first treatment, and another died of distant metastases after 50 months. The third had extensive axillary metastases at operation and died 6 months later. Another patient aged 78 years with unknown axillary nodal status died of pneumonia with no known metastases after 15 months.

In vitro measurements of cancer-directed cellular immunity in the II survivors who are well have been compared with two age-matched groups of females. One group had comparable primary mammary cancer treated by mastectomy and postoperative radiotherapy but no AIC. A second age-matched group consisted of non-cancer-bearing females attending hospital for the treatment of simple conditions. These carefully controlled immunoassays of lymphocytotoxicity and leucocyte migration inhibition (performed twice) show that AIC strengthens cancer-directed cellular immunity, indicating a need for definition of the optimum application of AIC so that a controlled clinical trial may be designed to measure any benefit conferred by AIC upon patients bearing mammary cancers.
The control of plasma glucose in the surgical patient
Authors: Giddings A E B
Published: March 2007

In a controlled merabolic study of 18 surgical patients alterations in the relationship of plasma glucose to insulin and non-esterified fatty acids could be divided into two phases. In the immediate postoperative period insulin resistance allowed a simultaneous increase in glucose and fatty acids, a situation which does not occur in the normal subject. On subsequent days resistance subsided and the reciprocal relationship of glucose to fatty acids was restored. It is suggested that insulin resistance is an adaptive feature which permits an augmented supply of energy substrate to meet the demands of injury. In adequate amounts intravenous carbohydrate spares tissue protein and fat during recovery. This is mediated by a long term change in the relationship of insulin to the more stable plasma glucose.
Carotid flow disorders in patients with cerebrovascular disease: Their atraumatic assessment by carotigraphy
Authors: Britton K E , Duplock G , Hudson G Vaughan
Published: March 2007

Carotid arterial narrowing less than that considered to be ‘critical’ may cause turbulent blood flow. Eddying may aid the deposition of material from blood, and vortices may aid its embolization, leading to transient ischaemic attacks, the Cassandra of the stroke. Two scintillation detectors were collimated to monitor the distal portion of each internal carotid through the orbits, and a third, the root of the aorta. After the intravenous injection of 10–15 mCi of technetium-Wm, activity/time curves were obtained from 58 patients. Fourteen out of 24 patients considered to have cerebrovascular disorders had significantly different values of measured indices of carotid blood flow from a group of 24 ‘normal’ patients (P<0.02). Improvement in these indices was associated with clinical improvement in 6 patients studied bejore and after carotid endarterectomy. In 38 patients a comparison of the results of this technique (carotigraphy)and angiography was made, In unilateral carotid disease, results of carotigraphy correlate significantly with results of angiography, but bilateral symmetricnl carotid artery disease gives normal results of carotigraphy. Analysis by deconvolution of the inflow and outflow activity/time curves obtained during carotigraphy allows study of the individual artery and indicates that normal carotid arterial flow is effectively non-turbulent. The prediction of turbulent flow by carotigraphy may allow assessment of the pathogenesis and a means of prevention of many strokes.
Torsion of the testis in childhood
Authors: Macnicol M F
Published: March 2007

Sixty cases of clinically diagnosed torsion of the testis have been admitted to a paediatric surgical unit over a period of 25 years. Of the 42 cases proved at operation to have torsion, 19 (46 per cent) underwent immediate orchidectomy, and a further 14 (33 per cent) showed partial or complete atrophy of the testis at follow-up at least 2 years postoperatively. The salvage rate was therefore only 21 per cent. Early diagnosis and immediate exploration may save a few cases from orchidectomy, but delay in referral remains the substantial factor determining viability. The importance of fixation of the surviving testis is stressed and contralateral orchidopexy at the time of the emergency procedure is recommended, Twelve cases of idiopathic scrotal oedema and 6 cases of proved torsion of the appendix testis were encountered over the same period and their clinical features are described. Symptomatology is milder in these two conditions and it is possible that a proportion of the 30 cases diagnosed as having epididymo-orchitis in fact suffered from torsion of the appendix testis.
Nodular lymphoid hyperplasia of the stomach and small intestine with hypogammaglobulinaemia
Authors: Munro A , Simpson J G
Published: March 2007

A 16-year old youth who presented with haematemesis and melaena from a duodenal ulcer was found to have multiple polyposis of the stomach and small intestine due to nodular lymphoid hyperplasia with hypogammaglobulinaemia.
Urinary excretion of corticosterone metabolites in demonstrating the adrenocortical remnant
Authors: Blichert-Toft Mogens , Nielsen Meta Damkjær , Lockwood Knud , Hasner Eivin
Published: March 2007

The spontaneous excretion and the secretory reserve of corticosterone and its metabolites (total B) after bilateral adrenalectomy were determined at an early postoperative date in 22 patients with ACTH-dependent Cushing's syndrome. On the basis of these early results two groups of patients could be distinguished. Group I comprised 19 patients with an immeasurable or negligible excretion, unresponsive to ACTH. The patients of this group exhibited lasting remission. Group 2 comprised the remaining 3 patients who had an abnormally high spontaneous excretion and/or an abnormally high secretory reserve. Primary remission was merely transitory or failed to appear. All the patients in this group exhibited residual adrenocortical tissue at reoperation or at autopsy.

At follow-up the biochemical investigation was repeated. The early results proved to be a reliable indication of the excretion pattern throughout the follow-up period (mean 5 years).

It is concluded that determination of urinary total B excretion early after bilateral adrenalectomy is valuable in assessing whether the adrenalectomy was total or whether residual adrenocortical tissue was left. In patients with Cushing's syndrome associated with adrenocortical hyperplasia the test was also reliable in predicting the probability of subsequent primary long term remission.
Racial incidence of postoperative deep vein thrombosis in South Africa
Authors: Joffe S N
Published: March 2007

Postoperatiue deep vein thrombosis is considered to be rare in non-Europeans (Burkitt, 1972). The 125I fibrinogen test, Doppler ultrasound and venography were used to determine the true incidence of postoperative deep vein thrombosis in a South African population. The results show that the European, Coloured, African and Indian patients were all at a similar high risk.
Long survival after operation for cancer of the lung
Authors: Brock Lord
Published: March 2007

A survey is presented of 293 cases of lung cancer operated on by one surgeon over a period of 35 years. Lobectomy was done in 86 cases with a mortality of 3.5 per cent. Simple pneumonectomy was done in 89 cases with a mortality of 20 per cent, and radical pneumonectomy in 118 cases with a mortality of 15.25 per cent.

The survival rate after 5 or more years for lobectomy was 41 per cent (34 patients). After simple pneumonectomy 21 patients (30 per cent) lived 5 years or more, and after radical pneumonectomy 39 patients (39 per cent) lived 5 years or more. The survival of the patients in whom the excised lymph nodes were involved by growth is presented. It is pointed out that at least 1 in 3 patients with cancer of the lung treated by operation was alive 5 years later.

The very good long term results are presented including the 10-year and 20-year survival rates. Two patients are still alive after 30 and 34 years respectively. One patient is alive 29 years after a lobectomy and 13 years after a contralateral lobectomy for a new primary cancer. A second new cancer occurred in 9 patients. Continuance of smoking is shown to be harmful.

The factors affecting the long term freedom from recurrence are discussed. The cell type of the cancer is shown to be important. Squamous-celled growths have the best results and oat-celled and small-celled the worst, although long term survival can follow operation for both these. The occurrence of a pleural infection after operation may be favourable to long term freedom from recurrence and this was probably so in 2 patients who lived 25 and 27 years respectively and 1 patient who is still alive after 34 years.

On the whole the evidence is unconvincing that much benefit may follow radiotherapy combined with operation.
Fatal cardiac tamponade and other mechanical complications of central venous catheters
Authors: Dane T E B , King E G
Published: March 2007

A fatal cardiac tamponade caused by an intact polyethylene central venous catheter perforating the wall of the right ventricle is reported. A retrospective review of 105 central venous catheters used in an intensive care unit revealed a high incidence of catheter malposition and a 20 per cent mechanical complication rate. The possible causes of these malpositions and complications are discussed. Guidelines for the safer use of central venous catheters are presented.
Atrophic gastritis in gastrectomy specimens
Authors: Skinner J M , Heenan P J , Whitehead R
Published: March 2007

Examination of gastrectomy specimens has shown that atrophic gastritis and intestinal metaplasia are widespread and have the same distribution in cancer of the stomach as in gastric ulcer affecting the body. Their distribution is restricted to the distal part of the stomach in pyloric ulcer. After gastrojejunostomy the distribution is also like that seen in cancer. There is a close association of widespread atrophic gastritis and intestinal metaplasia with the development of cancer and a high cancer rate after stomach operation for benign conditions. The similarity of distribution of atrophic gastritis and intestinal metaplasia in the stomach with body ulcer to that in cancer and after gastrojejunostomy points to a higher cancer risk in the stomach containing a body ulcer.
Surgical sterilization by vasectomy and its effect on the structure and function of the testis in man
Authors: Gupta A S , Kothari L K , Dhruva A , Bapna R
Published: March 2007

The early and late effects of vasectomy have been investigated in 40 men. Besides histopathological examination, the volume of the testis and its total content of testosterone-secreting Leydig cells have been measured.

The volume of the testis showed a wide normal variation (5·3–23·3 ml) but was not significantly changed by vasectomy. One month after vasectomy widespread degeneration of the germinal epithelium, thickening of the basement membrane and some intertubular fibrosis were observed. Spermatogenesis had ceased. However, cases examined 2–3½ years later showed an essentially normal structure with active spermatogenesis. This indicates that regeneration does occur spontaneously, even without recanalization. Whether the sperms formed are functionally normal remains uncertain.

The normal total Leydig cell volume was 2·2 ± 0·4 miltestis in young adults and showed a modest increase after vasectomy, rising to 2·5 ± 0·5 ml after 1 month and 2·6 ± 0·5 ml after 2–3½ years. The findings have been discussed in the light of Steinach's (1927) original hypothesis that vasectomy can rejuvenate ageing males by improving the endocrine function of the testis.
A clinical trial designed to discover if the primary treatment of varicose veins should be by Fegan's method or by an operation
Authors: Doran F S A , White Mary
Published: March 2007

1. The current practice of operating upon patients with varicose veins as the treatment of choice costs more than £15 millions a year.

2. The bulk of this expense is due to the length of time that patients are kept in the ward. If they were treated as outpatients, either by Fegan's method or by operation, the cost would be reduced to one-tenth of what is now spent. Even if the operation were done on a ‘short-stay’ basis the cost would be reduced to one-third or less.

3. Although the long term results of Fegan's method are uncertain there is no doubt that it gives better immediate results than an operation. Moreover, there is no particular type of varicosity or shape of limb which precludes its use.
Raised intracranial pressure due to spinal tumours: 3 rare cases with a probable common mechanism
Authors: Maurice-Williams R S , Lucey J J
Published: March 2007

Three cases are reported of raised intracranial pressure associated with spinal tumours. The theories which have been advanced to explain this complication are discussed and it is suggested that in many of the reported cases the underlying mechanism may have been intracranial spread of the tumour and not a blockage of the cerebrospinal fluid pathways with proteinaceous deposits, as has been widely maintained. Autopsy revealed the former process to have operated in 2 of the 3 cases and it may have done so in the third. Two cases had unusual features in common: they were malignant schwannomas (a very rare spinal tumour) and they had both developed within the field of irradiation given for benign conditions many years previously.
Arteriographic exposition of the parathyroids
Authors: Efsen F , Bruun E , Lockwood K , Hasner E
Published: March 2007

Arteriographic exposition of the parathyroids in 52 patients consecutively referred for primary hyper-parathyroidism is reported. Thirty-nine patients underwent neck exploration. In 29 patients pathologic parathyroids were found. The arteriographic evaluation was based on observation of the course of the inferior thyroid artery and the presence of parenchymal opacification. Comparison of arteriography and surgical findings revealed that selective angiography of the inferior thyroid artery had a high sensitivity and specificity in the detection of pathologic parathyroids far exceeding that of a non-selective technique.
Abdominal approach for the ligation of bleeding oesophageal varices
Authors: Miller Stanley S
Published: March 2007

The conventional surgical treatment of bleeding oesophageal varices in the emergency situation is based upon the Boerema-Crile operation of transthoracic oesophagotomy and ligation of the varices. This and the other methods of treatment of this condition in current practice are discussed.

Two cases are reported in which a transabdominal oesophagogastrotomy was used to approach the site of bleeding. This operation is described and the theoretical and practical advantages it appears to offer over the standard approach are considered.
The aetiology of hypocalcaemia in acute pancreatitis
Authors: Condon John R , Ives David , Knight Michael J , Day John
Published: March 2007

Plasma calcitonin, glucagon and parathyroid hormone were measured in patients with acute pancreatitis.

Plasma calcitonin was not detectable in 6 specimens obtained from the hypocalcaemic patients.

Plama glucagon values were similar in patients with acute pancreatitis and control subjects and were unrelated to hypocalcaemia, which was not even induced by glucagon infusion.

High or rising parathyroid hormone levels were noted in association with hypo- and normocalcaemia, suggesting that parathyroid hormone rises and maintains plasma calcium within normal limits. Plasma parathyroid hormone was, however, undetectable in 8 patients with prolonged hypocalcaemia. Deficiency of parathyroid hormone due to its destruction by proteolytic enzymes or because of parathyroid gland exhaustion is suggested as the major factor inducing persistent hypocalcaemia in acute pancreatitis. Administration of parathyroid hormone should, therefore, be considered in patients with acute pancreatitis when hypocalcaemia does not respond to intravenous calcium therapy.
Abdominal lavage in blunt trauma
Authors: Gill William , Champion Howard R , Long William B , Jamaris Joseph , Cowley R Adams
Published: March 2007

A technique for abdominal lavage is described and was used to evaluate the abdomen of 671 multiple trauma victims. In 44 per cent (299 cases) there was a bloodstained return and these were regarded as positive. Patients with a positive result underwent exploratory laparotomy which revealed that 89 per cent had significant intra-abdominal trauma requiring a surgical procedure, 8 per cent had trauma which did not require any active surgical correction and 3 per cent had no abnormal findings. Of all the lavages performed, there were 0.11 per cent false positive and 0.03 per cent false negative results. The value of the test in the context of multiple trauma is emphasized.
Carcinoma of the pancreas and periampullary region: A clinical study in a district general hospital
Authors: Webster D J T
Published: March 2007

One hundred patients with pancreatic and periampullary carcinoma have been reviewed. Diabetes mellitus may be an early presentation. Painless jaundice has a relatively good prognosis. Fifteen patients have had curative procedures with a 31 per cent operative mortality. Mortality is influenced by age and serum bilirubin levels. Where palliative procedures are undertaken, this should include biliary diversion and gastro-enterostomy.
A comparison of one layer and two layer techniques for colorectal anastomosis
Authors: Everett W G
Published: March 2007

In a randomized prospective clinical trial one layer and two layer techniques have been compared in 92 patients undergoing colorectal anastomosis. The results were assessed radiologically by barium studies on the tenth postoperative day. There was no significant difference in the incidence of anastomotic breakdown with either technique when the anastomosis was performed above the pelvic peritoneal reflection. When the anastomosis was situated below the pelvic peritoneum the incidence of dehiscence was significantly greater when a two layer technique was used.
Cervical spinal interbody fusion with Kiel bone
Authors: Ramani P S , Kalbag R M , Sengupta R P
Published: March 2007

Experience with the use of the Kiel bone graft in anterior cervical interbody fusion in cervical spondylosis is reported. The survey reviews the results of operations on 73 disc spaces in 65 consecutive patients, from 2 to 5 years after the operation. We have failed to confirm that any bony fusion in the true sense occurs with Kiel bone in anterior cervical interbody fusion. However, the aims of the operations are achieved, namely removal of the disc and osteophyte, fixation of the spine to prevent compression of the neural tissues, distraction of the adjacent vertebral bodies providing increased room in the intervertebral foramina and stability of the spine.
The early detection of postoperative deep vein thrombosis: An assessment of Doppler ultrasound, physical examination and the temperature chart
Authors: Rickford C R K , Negus David
Published: March 2007

The results of 12 months' experience in screening for deep vein thrombosis in one surgical unit are presented. A case is made for restricting screening to certain high risk patients. The inadequacies of available methods make reliable prophylaxis preferable.
Surgical management and problems of heart pacing
Authors: Borrje J , Lichter I
Published: March 2007

Experience with 40 patients and 150 pacemakers is reviewed. In 13 patients the initial pacing was by epicardial electrodes and in 27 by transvenous catheter electrodes. When epicardial systems were used, two electrodes were always fixed to the heart, the additional electrode being provided for temporary pacing and as a spare in case of future need. The battery unit was usually buried behind the rectus abdominis muscle. Vacuum drainage of the pacemaker pocket was used and was considered helpful in avoiding some complications.

The right cephalic vein was preferred for transvenous pacing but existing venous abnormalities sometimes required use of the external jugular vein. Five patients had epicardial systems changed to transvenous ones, and in 5 the reverse procedure was needed. Pacemaker battery problems included inadequate soft tissue protection for the unit, epoxy resin fracture, titanium case leak and problems relating to design change and the special needs for overseas travel. While the danger from diathermy and radiofrequency is now recognized, similar dangers exist for those paced by ‘demand’ units in large electromagnetic fields.
The application of the 99Tcm phosphate bone scan to the study of breast cancer
Authors: Citrin D L , Bessent R G , Greig W R , McKellar N J , Furnival C , Blumgart L H
Published: March 2007

Comparison of the gamma camera bone scan and radiological survey in 190 patients with breast cancer has confirmed the superiority of the bone scan in the positive diagnosis of skeletal metastases. In 47 patients with known (X-ray positive) bony metastases the scan was positive in all but 2, and in 24 (50 per cent) the scan showed more lesions than the X-ray had indicated. In 60 patients with a clinical suspicion of bone metastases but negative X-rays, the scan was positive in 29 (48 per cent). Eighty-three patients with primary breast cancer were studied at the time of initial presentation. All had a normal radiographic skeletal survey but 24 (27 per cent) had scan evidence of occult metastases. It is concluded that a bone scan is indicated in all patients with breast cancer where skeletal metastases are suspected.

Repeated bone scans may introduce new therapeutic possibilities, by providing an earlier objective index of progression of metastatic disease and also by providing a quantitative method of assessing the response to therapy.
Cystic thyroid nodules
Authors: Ma Michael K G , Ong G B
Published: March 2007

Among 300 patients with thyroid nodules subjected to a needle drill biopsy, 62 were found to contain cystic lesions. Analysis of these 62 cases showed that in 17 the swelling had completely disappeared after the biopsy. The remaining 45 had residual or recurrent swellings. Operative treatment was carried out in 35, which consisted of 28 (80 per cent) nodular goitres, 6 (17.1 per cent) adenomas and 1 (2.9 per cent) carcinoma.
Thyroid cancer: Twenty years' experience in a general hospital
Authors: Campbell D J , Sage R H
Published: March 2007

Twenty years' experience of thyroid cancer in a district general hospital has been reviewed. Its incidence, prognosis and natural history have been studied. Particular attention has been focused on the relationship of malignant to benign goitre. The relevance of this to the treatment of ‘apparently benign goitre’ is discussed.

Clinical evidence is presented supporting the hypothesis that differentiated thyroid carcinoma evolves from a solitary focus through a multinodular form before presenting the picture of a frankly malignant locally invasive cancer.

An increase in the incidence of papillary carcinoma is confirmed.
The management of bleeding acute gastric erosions: The role of gastric hypothermia
Authors: Himal H S , Watson W W , Jones C W , Maclean L D
Published: March 2007

Eighty-eight consecutive patients with bleeding acute gastric erosions were reviewed with the aid of a computer. Of the erosions, 31.8 per cent were related to the ingestion of ulcerogenic drugs and 40.9 per cent were associated with surgery and sepsis. The overall mortality was 20.5 per cent. Endoscopy was the most effective diagnostic examination. Conservative management was effective in the treatment of bleeding erosions due to the ingestion of ulcerogenic drugs. Gastric cooling successfully arrested haemorrhage from bleeding erosions due to surgery and sepsis.
Is ‘second look surgery’ justified in suspected recurrences of cancer of the stomach?
Authors: Ellis Harold , Jayasekar G
Published: March 2007

A series of 23 patients with suspected recurrent disease following ‘curative’ resection for gastric carcinoma was submitted to further laparotomy (24 operations). Three patients were found to have hopeless dissemination, 10 had palliative procedures performed which relieved their dysphagia, vomiting and jaundice, 4 had recurrences resected and 1 had a second primary of the gastric stump excised. No less than 6 were found to have benign lesions.

Although the reward as far as prolonged survival is small, we believe that the relief of symptoms and the occasional long term excellent result justifies judicious use of a ‘second look’ laparotomy for suspected recurrent disease.
Flatulent dyspepsia in patients with gallstones undergoing cholecystectomy
Authors: Kingston R D , Windsor W O
Published: March 2007

The incidence of flatulent dyspepsia and its relationship to gallbladder function has been studied in 100 consecutive patients with gallstones undergoing cholecystectomy. Thirty-three per cent of patients suffered significant flatulent dyspepsia of whom 80 per cent were cured or improved by operation.

In 15 patients gastric function was studied pre- and postoperatively and it was noted that there was no difference in gastric emptying times between patients with flatulent dyspepsia who were cured by operation and those who remained symptomatic.

Bacteriological studies on gallbladder bile from 39 patients suggested that infection within the gallbladder may be a factor in the causation of flatulent dyspepsia.
Temporary transcaecal ileal diversion in prevention of anastomotic leak in planned colonic surgery (an alternative to proximal colostomy)
Authors: Simpson Alan , Srivastava V K
Published: March 2007

An alternative to proximal colostomy in planned colonic resection is reported in 30 patients. The physiopathological background for this procedure of temporary transcaecal ileal diversion is explained together with details of the operation and the results obtained.
Operative biopsy of the pancreas
Authors: George Phyllis , Brown Colin , Gilchrist James
Published: March 2007

A review has been undertaken of the 47 patients who have had open pancreatic biopsy performed at the Royal Free Hospital between 1967 and 1972. It is concluded that not only is the procedure safe when using the technique described but also it is a valuable and accurate diagnostic procedure.
Carcinoma of the large bowel in the Sudan
Authors: Elmasri S H , Boulos P B
Published: March 2007

Large bowel cancer is not common but is showing increased frequency in the northern part of the Sudan. It is relatively uncommon among southerners, which may be due to the socio-economic factors prevailing in the Sudan.

The disease affected our population at a younger age than has been generally reported in the literature, and the lesions in nearly 30 per cent were of the mucoid and undifferentiated types.

The incidence in young adults is difficult to explain in the absence of precancerous lesions, and there is not enough evidence to incriminate parasitic infestation.
Intra-abdominal symptoms arising from spinal osteophytes
Authors: Rawat S S , Jain G K , Gupta H K D
Published: March 2007

A case of abdominal pain caused by irritation of a segment of jejunum and another due to irritation of the ureter are reported. In both cases the cause of the irritation was established to be osteophytic growth from the 4th lumbar vertebra. After its excision the symptoms disappeared in both cases. To the best of our knowledge, osteophytes have not been reported before to be the cause of intestinal and ureteric pain, and it is therefore urged that in cases of intractable pain these must be considered as a possible cause.
Extended deep femoral angioplasty: An alternative to femoropopliteal bypass
Authors: Cotton L T , Roberts V C
Published: March 2007

The results of extended deep femoral angioplasty (EDFA) have been analysed for 74 legs in 72 patients. In 69 per cent a femoropopliteal bypass would have been possible, so EDFA is considered here as an alternative operation. The success rate was 66.9 per cent, the failure rate 25.6 per cent and no effect was achieved in 7.5 per cent. Diabetes adversely affected the results. Of the failures, 45 per cent were diabetic, while the incidence of diabetes was only 14 per cent in the group where the operation was successful. The long term results of the operation were reasonable, 75 per cent being successful for 10–39 months. Age had no bearing on success or failure.

The effects of EDFA were most dramatic on intermittent claudication. In 52 per cent it was abolished and in 92 per cent claudication distance was increased to over 200 yards. Good results were achieved after failed lumbar sympathectomy and failed femoropopliteal bypass.

Successful results of EDFA could be predicted best by inspection of angiograms. Success or failure could have been predicted from the state of the run-off in 81 per cent of the cases. Claudication and rest pain were the most relieved by EDFA, followed by ischaemic ulceration of the leg. Gangrene of digits was helped but less than had been hoped.

We conclude that the indications for femoropopliteal bypass are limited to cases of digital gangrene where angiography shows that bypass is possible or where an EDFA operation has failed.
Pneumatosis cystoides intestinalis with unexplained ascites in Ethiopian patients
Authors: Tsega Edemariam
Published: March 2007

Four cases of pneumatosis cystoides intestinalis associated with unexplained ascites in Ethiopian patients are described. The relationship between the two conditions has not previously been reported.
Recognition of infection associated with intravenous catheters
Authors: Freeman R , King B
Published: March 2007

Four cases are described in which the patients suffered from bacteriaemia due to infected intravenous infusions. Although all the patients were pyrexial, the white cell count was normal in all 4 cases at diagnosis and the infusion site appeared innocent.

Fllowing removal of the intravenous catheter and the institution of antibiotic therapy in each case, neutrophilia and localizing signs developed. It is stressed that a normal white cell count and an innocent appearance at the infusion site do not exclude this complication of intravenous therapy. Possible reasons for this presentation of sepsis are discussed.
Pilonidal sinus treated by phenol injection
Authors: Shorey B A
Published: March 2007

The method of using phenol injections for the treatment of pilonidal sinus is described in detail. This is a simple, safe and painless method which may be used as a day case procedure. The results are discussed and compare very favourably with the more radical forms of treatment.
Hepatic resection
Authors: Ong G B , Lee N W
Published: March 2007

One hundred and twenty-five hepatic resections were done in the University Surgical Unit at the Queen Mary Hospital, Hong Kong, from 1964 to 1974 for conditions varying from primary hepatoma and recurrent pyogenic cholangitis to spontaneous rupture of the liver due to a bleeding haemangioma.

The overall mortality was 17·6 per cent. A case was classed as an operative death unless the patient was discharged from hospital. There has been long term survival after resection for primary carcinoma of the liver and no mortality when resection was carried out for benign conditions.
Bilateral idiopathic parotid duct strictures
Authors: Adiseshiah M
Published: March 2007

Details of 2 patients with idiopathic bilateral parotid duct strictures are presented. The possible aetiology and treatment are discussed.
Fatal Clostridium welchii septicaemia following acute cholecystis
Authors: Clancy M T , O'Briain S
Published: March 2007

A case of Clostridium welchii septicamia following acute cholecystitis is described. The onset was acute and a rapidly fatal outcome ensued. Radiological findings were negative. An approach to the antibiotic treatment and general management is discussed.
Localization of parathyroid adenomas by computer-assisted parathyroid scanning
Authors: Ell P J , Todd-Pokropek A , Britton K E
Published: March 2007

In an attempt to localize adenomas of the parathyroid glands 36 patients with suspected hyperparathyroidism were studied with a computer-assisted double isotope scanning technique. Six patients were excluded from the statistical analysis because of uninterpretable scans. A definite localization was made with the computer-assisted scan in 16 patients. In 14 of these patients the site of the tumours was correctly predicted. In 14 patients no localization was seen on the scan. Four of these patients were classified as false negatives.

In 14 out of the 16 correctly localized tumours two-thirds had weights equal to or less than 1·5 g.
True recurrence of hyperparathyroidism: Proposed criteria of recurrence
Authors: Muller H
Published: March 2007

Although recurrent hyperparathyroidism should not be rare on theoretical grounds, only a few cases of proved recurrence have been reported in the literature. In the present author's series only 4 patients (1 per cent) had true recurrence. Criteria for recurrence were: Histological identification by biopsy and frozen section of all the parathyroid glands at the first operation.Complete removal of the enlarged gland(s).A normocalcaemic period of at least 1 year.The finding of a tumour at the site of a previously normal-sized gland.

The low incidence of recurrent hyperparathyroidism might be explained by the long period of time needed for the recurrence to develop. However, since diagnosis of hyperparathyroidism is now more easily made and patients are treated surgically earlier in the course of the disease, the incidence of true recurrence might be expected to rise. A meticulous exploration during operation and careful follow-up of the patients are therefore required.
An incision for en bloc nephrectomy
Authors: Cassie G F
Published: March 2007

A surgical approach is described for en bloc removal of a large renal mass, enabling easy removal of such a mass with early palpation and ligation of the renal pedicle and with the minimum of assistance. The principle underlying the approach is that of detaching the costal margin and the free ribs from the abdominal musculature. In the experience of the author the wound always heals by first intention. No complications have been encountered and the patients have been discharged from hospital within 10 days of operation.
Nodular fasciitis: An unusual cause of extradural spinal cord compression
Authors: Sengupta R P , So S C , Perry R H
Published: March 2007

A case of nodular fasciitis causing extradural spinal cord compression with a successful outcome following removal is reported. Such a tumour within the spinal cord has never been reported. The pathogenesis of a nodular fasciitis in this situation and its differential diagnosis is discussed.
Antrectomy with Roux-en-Y anastomosis in the treatment of peptic oesophagitis with stricture
Authors: Royston C M S , Dowling B L , Spencer J
Published: March 2007

A series of 8 patients with severe oesophageal strictures secondary to reflux oesophagitis who have been treated by antrectomy with Roux-en- Y anastomosis is described. There was 1 postoperative death. The remaining patients have been completely relieved of heartburn and all have had a dramatic improvement in their dysphagia. This method of treatment is strongly recommended for patients who have had prior surgery to the hiatus which has failed, and for those who are too elderly or frail to withstand a direct attack on their oesophageal stricture.
Triorchidism with normal spermatogenesis: An unusual cause for failure of vasectomy
Authors: Hakami M , Mosavy S H
Published: March 2007

The wife of a vasectomized man became pregnant by her husband. He was examined and a supernumerary testis with intact vas and with normal histology and normal spermatogenesis were discovered.
The effect of noxytiolin in experimental peritonitis
Authors: King D W , Gurry J F , Brooke B N
Published: March 2007

The evidence for the value of noxytiolin (Noxyflex) in peritonitis is contradictory. In a controlled trial of the effect of noxytiolin in peritonitis in rabbits we have found a significant increase in mortality in the trial group compared with a control group, but no significant difference when a dose equivalent to the recommended human dose is used. The postoperative course is adversely affected in the animals receiving noxytiolin.
Results of modified Robert Jones operation for clawed hallux
Authors: M'Bamali E I
Published: March 2007

The results of modified Robert Jones operation for clawed hallux carried out on 36 feet were reviewed by clinical and radiological investigations. Twenty-nine feet (80 per cent) achieved good results while 3 feet (8.5 per cent) obtained fair results and in 4 feet (11 per cent) the results were poor. Better results were obtained in the poliomyelitis cases than in the other groups.

Correction of deformity appears to be achieved by the transferred extensor hallucis longus elevating the first metatarsal neck and by the flexor hallucis longus flexing the rigid toe obtained by interphalangeal arthrodesis.

Tendon regeneration which is associated with recurrent clawing remains a problem.

Internal fixation should be used for the interphalangeal arthrodesis.
Whither thyrotoxicosis?
Authors: Michie W
Published: March 2007

For 30 years the thyrotoxic patient has been subjected to a plurality of treatments by surgery, radio-iodine and long term anti-thyroid drugs. These therapies have been accepted as complementary to the needs of the individual patient, without regard for long term results or the economic situation as it affects both patient and hospital services. In the context of surgical treatment which is now available, it is suggested that the advantages of operation over other therapies presage a reversion to surgery as the treatment of choice.
Acute cholecystitis
Authors: Raine P A M , Gunn A A
Published: March 2007

One hundred and fifty-six successive patients have been admitted with the clinical diagnosis of acute cholecystitis and have been treated by operation on the next operating list. The diagnosis was correct in 154 and a diagnostic pathway has been determined. The clinical features, investigations, bacteriology and pathology are discussed.

There is an increased need for choledochotomy in acute cholecystitis and this bile is more commonly infected than in the elective patient. It is suggested that those with infection can be identified prior to operation and should be treated with antibiotics on admission.

The morbidity of operation on patients with uninfected bile is no greater than in those receiving elective surgery, and operative treatment is recommended for both groups of patients.
The effect of acute ethanol administration on the exocrine pancreatic secretion of the pig
Authors: Wheatley I C , Barbezat G O , Hickman Rosemary , Terblanche J
Published: March 2007

The acute effect of intravenous and intragastric alcohol on exocrine pancreatic secretion was studied in pigs with chronic pancreatic and gastric fistulas. A new H-type pancreatic cannula was designed for the study.

With intravenous alcohol and the gastric fistula open, increased gastric acid secretion occurred but pancreatic enzyme output was inhibited. When acid was allowed to enter the duodenum by closing the gastric fistula, intravenous alcohol produced a secretin-like effect of increased pancreatic volume and bicarbonate secretion.

Intragastric alcohol caused an increase in volume, bicarbonate and enzyme output. This was probably due initially to direct gastroduodenal stimulation as the same response occurred following intragastric mannitol of similar volume, pH and osmolality. The subsequently sustained increase in volume and bicarbonate was possibly a secondary secretin-like response following absorption of alcohol.

It is concluded that the pig pancreas responds to alcohol as has been described in other animals. The use of a single model has allowed clarification of various phases of response invoking the effects of secretin, gastric and glucagon.
Cause and management of high volume output salt-depleting ileostomy
Authors: Hill G L , Mair W S J , Goligher J C
Published: March 2007

Ileostomy function was studied in 12 patients with an established ileostomy following proctocolectomy, in 6 of whom minimal amounts (less than 9 cm) and in 6 significant amounts (30–120 cm, mean 60 cm) of terminal ileum had been removed.

Patients who had undergone significant ieal resection had daily faecal volumes considerably greater than those with minimal ieal resection (1202 ± 284 ml versus 401 ± 92 ml, P< 0·001), and also greater daily outputs of sodium (146 ± 53 mEq versus 43 ± 12 mEq) and potassium (12·7 ± 9·0 mEq versus 4·0 ± 0·99 mEq). The percentage water content of the ileostomy fluid was greater in patients who had had the ileum resected (93·1 ± 1·8 per cent versus 89·8 ± 2·5 per cent). In addition, the sodiumfpotassium ratio in the urine in patients with a properly acting ileostomy after ileal resection was low.

It is Concluded that when recurrent inflammatory bowel disease, partial small bowel obstruction and intraperitoneal sepsis have been excluded there remains a number of patients whose high ileostomy output is due entirely to the amount of ileum resected.

The management of patients with a high output ileostomy with codeine phosphate, Lomotil and oral administration of sodium chloride tablets is discussed.
The transdiaphragmatic approach to the heart
Authors: Cameron E W J
Published: March 2007

A modification of the transdiaphragmatic approach to the heart is described. The technique has been used successfully in both adults and children, the youngest child being 8 years of age. The approach has advantages over others in gaining access to the heart for purposes of internal cardiac massage and drainage of suppurative pericarditis and is also a suitable manoeuvre in the surgical treatment of acute tamponade. Clinical experience in the use of this approach is summarized. The transdiaphragmatic approach is recommended as a standard technique for internal cardiac massage.
Use of logic-based flow patterns in the investigation and management of surgical disorders
Authors: Ellis B W
Published: March 2007

The principles used in the development of logic-based flow charts for use by computer have been applied to the decision-making processes encountered in surgical disorders. Such charts do not attempt to alter one's decisions, but rather present a more logical approach to a given problem, based on past experience. It has been shown that the use of flow charts may be of material benefit to the patient, as well as having other advantages.
Feasibility of screening for breast cancer
Authors: George W D
Published: March 2007

The feasibility of screening for breast cancer by clinical examination and X-ray mammography has been studied. The results suggest that a breast screening programme is safe from dangers of irradiation and can be conducted by non-medical staff. The response of women at risk suggests that the service is acceptable to the general public. The hospital service could deal with the additional surgical work.
The immune reaction to human breast cancer: A comparison of skin and leucocyte migration tests
Authors: Maureen Roberts M , Bathgate Eleanor M
Published: March 2007

In vivo and in vitro tests of cellular immunity using autologous tumour antigen have been performed in patients after mastectomy for cancer and in a control group with benign tumours of the breast. Overall, the incidence of positive immune reactions in both groups was 45 per cent. Poor correlation was found between the results of in vivo and in vitro tests, which could not be explained in terms of serum factors. The specificity of the reaction is questioned but the clinical relevance will be determined by long term follow-up.
The importance of an innervated and intact antrum and pylorus in preventing postoperative duodenogastric reflux and gastritis
Authors: Keighley M R B , Asquith P , Edwards J A C , Alexander-Williams J
Published: March 2007

This study has investigated the relationship between duodenogastric reflux, gastritis and certain symptoms 6–12 months after three operations for uncomplicated duodenal ulcer. The operations studied were proximal gastric vagotomy (PGV, 20 cases), truncal vagotomy and pyloroplasty (TV+P, 22 cases) and truncal vagotomy and antrectomy (TV+ A, 21 cases).

Duodenogastric reflux was assessed both by a radiological technique and by measuring the concentration of bilirubin in the gastric aspirate before and after operation. Incidence and severity of postoperative gastritis were determined by endoscopic biopsy. Symptoms were assessed by symptomatic score and Visick grading.

There was a significant correlation between duodenal reflux and histological evidence of both severe superficial gastritis and glandular atrophy (P<0.01). There was also a close association between the degree of reflux and the presence of severe heartburn, epigastric pain and bile vomiting after operation. The amount of reflux did not differ before operation. There was significantly less reflux following PGV than after either TV+P (P< 0.025) or TV+A (P< 0.001). The results indicate that an operation which preserves an innervated and intact antrum and pylorus will protect against postoperative duodenogastric reflux, gastritis and symptoms.