bluuebunny/crossref_metadata_2025 huggingface dataset:
Fibrinolytic activity of the vein wall after surgery
Authors: Åberg M , Nilsson I M
Published: March 2007

The fibrinolytic system, including the fibrinolytic activator activity of vein wall and fibrinolytic activity in blood after venous occlusion, was analysed in 43 patients before and on the third day after operation. Twenty-two of the patients underwent abdominoperineal amputation of the rectum and 21 had a cholecystectomy. The incidence of postoperative thrombosis was assessed by means of the isotope method and phlebography.

The results indicate that a decrease in fibrinolytic activity of the vein wall and/or in the release of fibrinolytic activator from the vein wall is a regular postoperative phenomenon, especially after major surgery. Malignant tumour of the rectum did not have any depressing effect on the fibrinolytic activator. All the patients with thrombosis after operation had a postoperative fibrinolytic defect of the vein wall compared with about 60 per cent of the other patients. It is concluded that postoperative changes in the parameters studied might be of significance for the development of thrombosis after operation.
The place of surgery in the treatment of myasthenia gravis
Authors: Fraser K , Crawford J , Simpson J A
Published: March 2007

The clinical conditions, operative and postoperative management of 64 pateints submitted to thymectomy from 1965 to 1976 have been reviewed retrospectively. The results of 11 thymectomeis done before 1965 have been previously reported (Fraser, 1966). We consider that the duration of illness is a more important criterion than the age or sex of the patient or the distribution of weakness, and we recognize three stages (Simpson, 1974). Stage I, the active stage, is characterized by remissions and best response to thymectomy. it normally lasts for 5-7 years and is followed by stage 2, the inactive stage. In stage 2 there is less risk of death but few spontaneous reminssions and less response to thymectomy. In stage 3, the burned-out stage, there may be steady improvement but thymectomy is without benefit and responsiveness to anticholinergic drugs becomes less.

It has been our policy to perform thymectomy as early as possible in stage 1. In addition, stage 2 patients have been advised operation if the response to anticholinesterase medication has been unsatisfactory, Although major improvement is not anticipated until 2-3 years after operation, we have felt justified in offering thymectomy because we have had no death as a direct result of the actual operative procedure. One patient died suddenly and unexpectedly on the tenth day postoperatively (1.7 per cent). At follow-up there were 6 late deaths. Of the 52 patients available for review, 92.3 per cent had no symptoms or only mild disability.
Diabetic autonomic neuropathy in pateints with vascular disease
Authors: Quayle John B
Published: March 2007

An attempt has been made to determine the effect on vasomotor tone and sweating of perpheral neuropathy in the feet of diabetics with vascular disease. There was a loss of vasomotor tone in 48 per cent of patients with peripheral neuropathy and in 12 per cent of those without neuropathy (P <0.01). Complete loss of sudomotor activity was rare in both groups.
Hepatocellular carcinoma associated with oral contraceptives
Authors: Menzies-Gow N
Published: March 2007

A primary hepatic tumour occurred in a 36-year-old woman who had been taking oral contraceptives for 6 years; she was treated by partial hepatectomy. The neoplasm had the characteristics of a well-differentiated hepatocellular carcinoma and the regional lymph nodes contained similar tumour.
Abdominal apoplexy
Authors: Gough I R , Strong R W
Published: March 2007

Seven patients with abdominal apoplexy have been treated between 1975 and 1977 and their clinical features and management are reviewed. Accurate preoperative diagnosis is difficult but the condition should be considered in patients with abdominal pain and vomiting or diarrhoea who have signs of shock, peritonism or a falling haemoglobin level. Urgent laparotomy to identify and ligate the bleeding artery offers the best chance of survival.
A prospective study of the clinical value and accuracy of grey scale ultrasound in detecting gallstones
Authors: McKay A J , Duncan J G , Imrie C W , Joffe S N , Blumgart L H
Published: March 2007

The accuracy and possible clincial value of grey scale ultrasonography in the detection of gallstones has been prospectively studied in 100 unselected patients presenting with recurrent biliary colic, acute cholecystitis or acute pancreatitis. Adequate visualization of the gallbladder was obtained in 79 cases, with 3 false positive and no false negative reports. Oral cholecystography remains the initial investigation of choice in patients presenting with recurrent biliary colic, but grey scale ultrasound has been shown in this to be a reliable means of detecting gallstones in the ‘acute’ situation, when conventional contrast radiology is of limited value.
A new method of nerve repair: Repair of a lesion of the radial nerve with a branch to the triceps muscle
Authors: Gore R V
Published: March 2007

Regeneration of the radial nerve following a new technique of nerve anastomosis in the humeral spiral groove is reported. Neurorrhaphy was performed by anastomosing a branch supplying the medial head of the triceps to the distal cut end of the radial nerve at the level of the lateral intermuscular septum. The progress of the nerve is detailed and has been confirmed by electromyographic studies showing regeneration of the radial nerve 3 years after operation and 4 years after injury. This technique for repair of the radial nerve has not been previously described.
Postoperative amino acid infusions: An appraisal
Authors: Rowlands B J , Clark R G
Published: March 2007

Amino acid infusions either as a 7 per cent solution or as an isotonic 3.5 per cent solution produce a nitrogensparing effect in the postoperative period. The nitrogensparing effect is independent of the concentration and rate of infusion of the amino acid solution; or of any changes in plasma substrate and hormone concentrations. These solutions have no advantage over conventional intravenous therapy with isotonic glucose and saline solutions and there is no indication for their routine use in the management of postoperative patients.
The effect of hepatic interposition on insulin-stimulated gastric secretion after proximal gastric vagotomy
Authors: Wastell C , Millington H T
Published: March 2007

The peak acid output to insulin 10-14 days after proximal gastric vagotomy (PGV) for uncomplicated duodenal ulcer in a control group of 11 men was 1.5 mmol/h, and this rose significantly (P <0.01) after a mean interval of 26.1 months to 5.3 mmol/h. The rise in the PAOI in 7 male patients undergoing PGV and hepatic interposition for duodenal ulcer was from 1.0 mmol/h to 4.5 mmol/h (P <0.05) over a mean interval of 13.1 months. No significant difference between the changes in the PAOI in the two groups of patients could be detected. It is concluded that separation of the lesser curve of the stomach from the cut edge of the lesser omentum by the left lobe of the liver after PGV in an attempt to block vagal regeneration does not alter the postoperative rise in acid secretion.
Amylase thermolability as a screening test for pancreatic pseudocysts
Authors: Donaldson L A , Brodie M J , McIntosh W B , Joffe S N
Published: March 2007

Amylase thermolability was determined by heating sera from control patients and patients with acute pancreatitis and pancreatic pseudocysts at 65 ° C for 15 min. Normal serum amylase was 44 per cent thermolabile, but increased to 84 per cent thermolability during the hyperamylasaemia of acute pancreatitis, and returned to normal on resolution of the pancreatitis. In 9 patients with a pancreatic pseudocyst, although the total amylase level had almost returned to normal limits, 79 per cent of the amylase remained thermolabile. Amylase thermolability appears to be a simple screening test for pancreatic pseudocyst formation secondary to acute pancreatitis.
The role of IgA in the prevention of bacterial colonization of the jejunum in the vagotomized subject
Authors: McLoughlin G A , Hede J E , Temple J G , Bradley J , Chapman D M , McFarland John
Published: March 2007

The efficacy of three mechanisms of defence against jejunal bacterial colonization (i. e. gastric acid, vagal and pyloric integrity and intestinal IgA) has been investigated. Only in subjects with disturbance of all three mechanisms did significant jejunal colonization occur, and this was invariably associated with severe diarrhoea. Clearly normal intestinal IgA is of critical importance in the prevention of jejunal bacterial colonization in the vagotomized subject.
Graft avulsion: An unreported complication of axillofemoral bypass grafts
Authors: Daar A S , Finch D R A
Published: March 2007

A case of avulsion of a unilateral axillofemoral Dacron bypass graft 3 weeks after insertion is reported. Surface measurements on healthy volunteers suggest that when the thoracolumbar spine is in full lateral flexion the length of the graft may increase by up to 21 per cent. Such movements should be restricted during the early postoperative period.
Vein surgery during defibrinogenation
Authors: Browse N L , Clemenson G
Published: March 2007

The effect of defibrinogenation on thrombosis after thrombectomy and on the patency of Dacron femoral vein grafts has been studied in dogs. In all experiments the defibrinogenation significantly reduced thrombosis. Bleeding from suture lines and through the Dacron prostheses was not increased.
The reduction of bacteria in the operation room through the use of non-woven clothing
Authors: Whyte W , Hodgson R , Bailey P V , Graham J
Published: March 2007

Operation room clothing manufactured from disposable non-woven fabric (Barrier ‘450’ fabric supplied by Johnson & Johnson Ltd) was assessed in a dispersal chamber and in plenum-ventilated operation rooms. If proved to be very comfortable to wear and was shown to be equally effective bacteriologically as the closely woven and uncomfortably hot Ventile material. As the majority of bacteria are known to be generated from below the waist, and hence not contained by an operation room gown, trousers were used as well as gowns. Dispersal chamber experiments suggested that when all staff wore non-woven trousers and the scrubbed staff wore gowns as well, a 55 per cent reduction would be achieved in the number of bacterial particles in the air of an operation room. In practice, 60 per cent reduction was achieved in one operation room and 43 per cent in another.

The number of bacteria which could easily be removed from the surface of the gowns was surprisingly few. However, use of non-woven, as compared to cotton, clothing reduced these surface bacteria by 50-60 per cent. These bacteria would not be as easily dispersed into the air from the surface of non-woven gowns, as it was demonstrated that non-woven gowns, as well as gowns manufactured from certain artificial fibres, shed substantially fewer fibres.
Acute hiatal hernia with oesophageal perforation following Heller's operation
Authors: Fletcher P R
Published: March 2007

The unusual complication of acute hiatal hernia with oesophageal rupture following transthoracic oesophagomyotomy is described in 2 cases. Inadvertent disruption and sidening of the oesophageal hiatus at the time of surgery coupled with increased intragastric and intraabdominal pressure were the probable causes. The hiatus should be carefully inspected on completion of the myotomy and anatomical restoration performed if necessary in order to avoid this complication. Urgent surgical intervention, gastric fundal serosal patch repair and intravenous alimentation proved successful in the management of these patients.
Multiple congenital aneurysms in childhood: Report of a case
Authors: Short D W
Published: March 2007

This paper reports the case of a girl who, at the age of 7 years, presented with a saccular aneurysm of a brachial artery. Over the following 8 years a further 15 aneurysms appeared, involving limb and visceral arteries and the aorta. Some, but not all, of these aneurysms have been operated upon. Complications included renovascular hypertension due to bilateral intrarenal aneurysms. She had been followed up for 15 years.

Three other similar cases have been found in the medical literature, and these are also referred to. In two of these cases the affected persons also exhibited some of the other connective tissue anomalies associated with the Ehlers–Danlos syndrome. These were not present in our patient. The relationship between the syndrome of multiple congenital aneurysms and the Ehlers-Danlos syndrome is discussed.
Abdominal wound healing in jaundiced patients
Authors: Irvin T T , Vassilakis J S , Chattopadhyay D K , Greaney M G
Published: March 2007

Abdominal wound healing was studied in 48 patients undergoing laparotomy for jaundice and 281 anicteric patients undergoing elective operations for cholelithiasis at the Sheffield Royal Infirmary during the period 1967 to 1976.

Wound dehiscence or incisional hernia occurred in 27.1 per cent of jaundiced patients and in 4.3 per cent of anicteric patients (P <0.001). There was a slightly higher incidence of deshiscence and herniation in deeply icteric patients (plasma bilirubin> 170 μmol), but patients who developed these complications did not appear to have a more severe degree of malnutrition or impaired liver function.

The results of the study suggest that malignant disease may be an important factor in the pathogensis of wound complications in jaundiced patients. Wound dehiscence or incisional hernia occurred in 59.1 per cent of patients with obstructive jaundice resulting from malignant disease but patients with jaundice resulting from biliary stones or benign pathology did not develop these complications.
Randomized multicentre trial of oral bowel preparation and antimicrobials for elective colorectal operations
Authors: Matheson D M , Arabi Y , Baxter-Smith D , Alexander-Williams J , Keighley M R B
Published: March 2007

A study of 120 patients undergoing elective colorectal operations has investigated the effect of adding oral neomycin and metronidazole to bowel preparation in a double-blind randomized controlled trial. Comparisons have also been made between a standard mechanical preparation and the use of an elemental diet. The addition of neomycin and metronidazole to bowel preparation significantly reduced the rate of wound sepsis (P<0.01), septicaemia (P<0.02) and anastomotic dehiscence (P<0.02); anaerobic infections were abolished and there was a significant reduction in the incidence of aerobic Gram-negative infections. Elemental diets were shown to have no advantage over mechanical preparation.
Excluded loop syndrome: A complication of jejuno-ileal bypass for obesity
Authors: Bubenstein Richard B , Mbawa Naboth
Published: March 2007

Excluded loop syndrome may develop in patients who undergo jejuno-ileal bypass surgery with the excluded smal intestine drained via an ileosigmoidostomy. A unique case of a morbidly obese male who underwent the procedure while on methadone maintenance therapy is presented. The major factor in the development of this disorder appears to be the high intraluminal pressures within the sigmoid colon which prevent adequate egress from the excluded loop. Narcotic medications tend to induce or intensify the syndrome.
Early results with human umbilical cord vein allografts for haemodialysis
Authors: Kester R C
Published: March 2007

Six patients requiring intermittent haemodialysis for chronic renal failure underwent construction of an arteriovenous fistula using modified human umbilical cord vein allografts. Three grafts soon showed degenerative changes and were removed–2 thrombosed and 1 became infected. Satisfactory haemodialysis was achieved with the remaining 3 grafts. Two grafts are currently patent at 9.5 and 11 months respectively, while another graft became aneurysmal after 8 months, requiring its removal.
Results of a controlled randomized trial of proximal gastric vagotomy with and without pyloroplasty
Authors: Aeberhard P , Walther M
Published: March 2007

The 1-5-year results of a prospective randomized trial of proximal gastric vagotomy (PGV) with and without pyloroplasty in 64 men operated upon electively for chronic duodenal ulcer are reported. The effects of the operation on gastric secretion, as tested at 6 months with pentagastrin and insulin, were the same in both groups. There was no statistically significant difference in the clinical results between the two groups.

The authors conclude that the addition of pyloroplasty makes little, if any, difference to the results of PGV. Pyloroplasty is thus better omitted as it adds nothing of value and may increase the risk of the procedure.
The relationship between the rate of gastric emptying and the dumping syndrome
Authors: Ralphs D N L , Thomson J P S , Haynes S , Lawson-Smith C , Hobsley M , Le Quesne L P
Published: March 2007

Following an oral hypertonic glucose challenge, gastric emptying and changes in plasma volume were measured in 15 subjects before and in 36 subjects after a truncal or selective vagotomy with a drainage procedure. The symptoms experienced during the test were noted, and the postoperative patients divided into two groups, (a) 20 patients who experienced dumping symptoms during the test and (b) 16 patients who did not.

Gastric emptying was significantly faster and the fall in plasma volume significantly greater in those patients who experienced symptoms after the ingestion of hypertonic glucose than in those who did not, clearly demonstrating that the dumping syndrome is associated with an increased rate of gastric emptying. In addition, there was a significant positive correlation between the rate of gastric emptying and the fall in plasma volume.
The value of pregnancy-associated α2-glycoprotein in patients with colorectal cancer
Authors: Wood C B , Horne C H W , Towler C M , Bohn H , Blumgart L H
Published: March 2007

Serum pregnancy-associated α2-glycoprotein (α2PAG) levels have been measured in 67 patients with colorectal cancer. Postoperative changes in α2PAG concentrations were observed in patients undergoing apparently curative surgery and compared with results in patients with residual local or metastatic tumour. Significant increase in α2PAG levels were found only in those patients with residual or disseminated tumour. In this study α2PAG levels closely paralleted the clinical course of the disease in many patients.
Liver function and lactate metabolism in the ill surgical patient
Authors: Royle G , Kettlewell M
Published: March 2007

Liver function and lactate metabolism were investigated in non-shocked, severely ill surgical patients. Fasting venous blood lactate concentration was increased and plasma liver function tests were abnormal in ill patients compared with controls. III patients were glucose-intolerant and blood lactate changes following intravenous glucose infusion were similar in both ill and control patients. Blood lactate half-life was increased in ill patients following a sodium L-lactate infusion, suggesting that the increased fasting lactate concentration may have been due to decreased hepatic removal rather than to increased peripheral production of lactate.
The effect of highly selective vagotomy on the relationship between gastric mucosal blood flow and acid secretion in man
Authors: Knight S E , McIsaac R L , Fielding L P
Published: March 2007

Previous work has shown that the duodenal ulcer population can be defined by a lower ratio between gastric mucosal blood flow and acid secretion (during pentagastrin stimulation) than is found in normal subjects. The results of the present investigation have shown that the ratio is restored to normality by highly selective vagotomy. This suggests that increased tonic activity of the vagus on the parietal cell is one of the important disorders in duodenal ulceration.
Evidence for an enterotropic homone: Compensatory hyperplasia in defunctioned bowel
Authors: Williamson R C N , Bauer F L R
Published: March 2007

The relative contributions of luminal and systemic factors to the development of compensatory intestinal hyperplasia were assessed by comparing the adaptive response to jejunal resection in functioning and defunctioned ileum. In Thiry-Vella loops of upper ileum, mucosal contents of RNA and DNA increased by 16–21 per cent 2–7 days after jejunectomy (P=0·05–0·01), but DNA specific activity was unchanged, In lower ilcum remaining in continuity with the nutrient stream, nucleic acids were elevated by 27–86 per cent (P<0·001) and specific activity by 34–36 per cent (P=0·05–0·005). Proximal to the site of resection, duodenal hyperplasia was equally rapid but less intense than in the distal bowel, Full adapation requires both intraluminal nutrients and enterotropic homones to be present.
Penetrating injuries of the popliteal artery
Authors: O'Reilly M J G , Hood J M , Livingston R H , Irwin J W S
Published: March 2007

Military experience has consistently emphasized the unacceptably high amputation rate associated with popliteal arterial trauma. In this group of patients there were 23 arterial injuries and 26 injuries involving both an artery and a vein. The loss of only 5 limbs in this series was directly related to the policy of repair of the artery by both single segment vein grafts and by ‘panel’ grafts. Panel grafts are prepared by removing the long saphenous vein at ankle level, splitting it longitudinally and then dividing it transversely at the midpoint. The two segments of vein are placed side by side and sutured along each side, a no. 14 or 16 Ch. Foley catheter being used as a stent. Fasciotomy, carried out at an early stage in the postoperative course, and prompt re-exploration of repair sites when suspicion arose as to the effectiveness of limb circulation, were also major factors in establishing a successful outcome in so many patients.
The treatment of perforated duodenal ulcer
Authors: Kay P H , Moore K T H , Clark R G
Published: March 2007

The prognosis of 189 patients with a perforated duodenal ulcer was analysed. There were three treatment groups, non-operative, simple closure and definitive ulcer surgery. The prognosis of the patients was analysed in terms of the chronicity of the ulcer. Perforations occurring in acute duodenal ulcers have an excellent prognosis, with similar results in each group in this series. All perforations of chronic duodenal ulcers should be treated by emergency surgery.
Disinfection of the skin of the abdomen
Authors: Davies Jean , Babb J R , Ayliffe G A J , Wilkins M D
Published: March 2007

The skin of the abdomen of 106 staff and 358 patients was sampled 5 min and 2 h after disinfection using contact plates. Control areas of skin were treated with water only or left untreated.

A reduction of 99 per cent (log reduction factor = 2) or more in colony counts was obtained in 5 min with 70 per cent ethyl alcohol and alcoholic solutions of chlorhexidine, povidone-iodine and chloroxylenoll EDTA. Aqueous solutions of chlorhexidine (0·5 per cent), Savlon (5 per cent), povidone-iodine (10 per cent) and chloroxylenoll EDTA (× 10 recommended concentration) also showed similar reductions. Weaker aqueous solutions of chlorhexidine (0·05 per cent), Savlon (1 per cent) and chloroxylenoll EDTA (recommended concentration) were significantly less effective than the alcoholic and the most effective aqueous solutions, although all were more effective than water. Total bacterial counts were lower from the skin of female than from male staff and lower from staff than from patients. Pathogens (staphylococcus aureus or Gram-negative bacilli) were isolated from only one member of staff in small numbers and irregularly and rarely in large numbers from patients. Few pathogens were isolated after application of any of the disinfectants.
Congenital solitary cysts of the liver and spleen
Authors: Williamson R C N , Ramus N I , Shorey B A
Published: March 2007

Three symptomatic cases of congenital solitary cyst are reported, one in the liver and two in the spleen. Recurrence of the hepatic cyst after partial excision and drainge was complicated by fistula formation between the cyst and the duodenum. The fistula was successfully closed at a second operation. Calcification of the cyst wall occurred in one of two epithelial cysts of the spleen in young women, which were treated by splenectomy. Besides their rarity, congenital solitary cysts of the liver and spleen have several other features in common. Isotopic and ultrasonic scanning assist diagnosis in both conditions.
Progress of acute appendicitis: A study in children
Authors: Doraiswamy N V
Published: March 2007

The results of six simple investigations are compared with the duration of the disease in 100 children with acute appendicitis. The results indicate that during the first day on which the appendix becomes inflamed the local defence mechanisms of the appendix are impaired sufficiently to allow invastion by the bacterial organisms in its lumen. This initially inflamed and subsequently infected appendix may develop in the manner indicated. Local and jor generalized complications may follow, i. e. acute appendicities in its successive stages of development, which may be regarded as (a) inflamed, (b) infected and (c) complicated, and thesed changes take place at intervals of 1 day. Bacteria and faecoliths are present in the lumen of the appendix, whether inflamed or not, and it is suggested that they complicate the disese rather than being responsible for causing it.
A curious occipital polyp
Authors: Gaber M
Published: March 2007

Muscles which lose their attachments are uncommon. During development this normally occurs in certain muscles, e.g. the muscles of the face and epicranius; these muscles lose their skeletal connections before migration. In the case presented here a muscle in the occipital region had lost its attachment and formed a peculiar swelling.
The value of corpus–antrum border determinations in highly selective vagotomy
Authors: Ahonen J , Hoepfner-Hallikainen D , Inberg M , Scheinin T M
Published: March 2007

In order to know whether the exact determination of the corpus–antrum border is of importance in highly selective vagotomy (HSV) the operation was performed on two matched groups of patients with duodenal ulcers. In group 1 (35 patients) HSV was performed using anatomical landmarks to define the distal extent of dissection. In group 2 (35 patients) HSV was performed using the same technique and then a gastrotomy was made and any remaining acid-secreting mucosa was identified using pH-metry under pentagastrin stimulation. In 22 cases secretion of acid was observed distal to the anatomically defined corpus-antrum border. In these patients afurther distal division of vagal branches was done until no acid secretion was observed. Two months and 1 year after the operation, basal acid output (BAO), pentagastrin-stimulated acid output (PAOpg), insulin-stimulated acid output (PAO1) and basal serum gastrin determinations were done and compared with the corresponding preoperative data. Our results show that despite the more extensive division of the antral vagal branches in group 2, BAO and PAOpg were similar in both groups postoperatively. Postoperative PAOI was also similar. Differences were observed, however, in postoperative serum gastrin levels–group 1 42.5 ± 6.0 pmol/l and group 281.7 ± 7.4 pmol/l 1 year after the operation. In no cases did the more extensive dissection of antral vagal branches lead to clinical or radiological gastric stasis. Thus, if the branches of the nerves of Latarjet are used as landmarks in performing HSV, in many cases vagally innervated, acid-secreting mucosa will be left in the stomach, but apparently this is quantitatively of minor importance. On the other hand, a more extensive distal vagal dissection leads to disturbingly high postoperative serum gastrin values.
Sequential patterns of haemodynamic and metabolic changes in experimental hypovolaemic shock. I. Responses to acute haemorrhage
Authors: Pardy B J , Dudley H A F
Published: March 2007

Little is known about cardiorespiratory changes during the development of hypovolaemia. This study attempts to provide such information and compares the period of bleeding with that of established hypovolaemia.

Eleven anaesthetized and ventilated greyhounds were bled and analyses of cardiopulmonary function made at fixed intervals both during and after haemorrhage. Six sequential patterns of cardiopulmonary and metabolic change were recognized. It was apparent that bleeding caused the first three phases of change, recovery from the effects of bleeding the next two and steady hypovolaemia the last. The event of bleeding is the main factor that elevates total peripheral resistance and reduces tissue perfusion with consequent lowering of oxygen consumption and alkalosis secondary to impaired carbon dioxide production; when bleeding ceases these changes partially reverse in a manner characteristic of that induced by the reinfusion of shed blood; and hypovolaemia per se has a relatively weak influence.

These findings provide an explanation for disparities in previous published reports and have obvious clinical implications.
The value of different forms of treatment for varicose veins
Authors: Jakobsen Bjarne Hamilton
Published: March 2007

In a controlled clinical investigation 516 patients with previously untreated saphenous varices were divided into three treatment groups according to a stratified group comparative design. The patients in treatment group 1 underwent a radical operation under full anaesthesia; the patients in group 2 were treated by means of minor operations followed by injection/compression therapy; the patients in group 3 were treated by means of injection/compression therapy alone. The results were evaluated both objectively and subjectively 3 months and 3 years after treatment, the follow-up being 100 per cent and 98.1 per cent complete at those times. With regard to the period of disability among those patients with jobs outside the home (63.8 per cent), there was a statistically significant difference between the three groups, the median period of disability being 14.2, 7.6 and 0 days respectively. In all three treatment groups the results were worse after 3 years than after 3 months, but the difference was significantly less following radical operation than after combined treatment, and significantly less following combined treatment than after injection/compression therapy alone. The patients were randomized and treated by the author and the results of treatment were evaluated by the author and partly controlled by another investigator.

It is concluded that the primary treatment for incompetence of the saphenous veins should be a radical operation.
The fibrinolytic activity of varicose veins
Authors: Wolfe J H N , Morland M , Browse N L
Published: March 2007

The plasma fibrinogen concentration, plasma fibrinolytic activity and the vein wall fibrinolytic activity of hand, groin, knee, ankle and perforating veins have been studied in 10 patients with skin changes in the lower leg secondary to venous disease (lipodermatosclerosis), in 10 patients with uncomplicated varicose veins and in 17 normal volunteers undergoing surgery. There was significantly more vein wall fibrinolytic activity in normal volunteers than in the patients with lipodermatosclerosis, not only in the ankle (P < 0.001) but also in the hand (P < 0.05).

It is suggested that the reduced tissue fibrinolytic activity is a causative factor in the skin changes and ulceration of the post-phlebitic leg, and that since the reduced activity is not confined to the leg, it may be a primary systemic defect rather than a state secondary to venous congestion.
Prevention of intraperitoneal adhesions: A comparison of noxythiolin and a new povidone-iodine/PVP solution
Authors: Gilmore O J A , Reid Clare
Published: March 2007

Peritoneal adhesions were induced in 250 female Wistar rats by the excision and closure of a right lower quadrant parietal peritoneal defect. After closure of the defect each rat was randomly allocated to one of five treatment groups: A, control with no instillate; B, control with Ringer solution; C, noxythiolin 0.5 per cent solution; D, noxythiolin 1 per cent solution; E povidone-iodine/PVP solution. Two millilitres of the appropriate solution were injected into the peritoneal cavity just before closure of a standard 4-cm midline incision. Assessment of adhesion formation was mad at 1 week in ignorance of the treatment group. Noxythiolin 1 per cent was more effective than Ringer solution and noxythiolin 0.5 per cent in reducing the mean number of adhesions (P < 0.05) but was inferior to povidone-iodine/PVP (P < 0.05). Povidone-iodine/PVP solution significantly reduced the number of adhesions compared with the four other groups. In addition, it significantly reduced the mean length of attachment of each adhesion compared with the two control groups (P < 0.001).
Cytological study of fluid from breast cysts
Authors: Cowen P N , Benson E A
Published: March 2007

A series of 215 patients with breast cysts has provided 348 specimens of cyst fluid for cytological diagnosis. Only one of these specimens was reported positive for malignant cells and this patient had a carcinoma. Nine specimens were reported as suspicious, but none of these patients had or subsequently developed carcinoma. In 338 specimens cytology was negative. A total of 178 patients (294 specimens) was available for follow-up. Of these 2 proved to have carcinomas on immediate follow-up, i.e. a lump persisted after aspiration, rind a further 2 patients developed cancers in the same breast, one 4 and the other 7 years after aspiration. We therefore conclude that the routine submission of' breast cyst fluid for cytology is wasteful of time and resources.
Haematogenous osteomyelitis of the metatarsal sesamoid
Authors: Cartlidge I J , Gillespie W J
Published: March 2007

A case of haematogenous osteomyelitis of the medial first metatarsal sesamoid is presented and the differential diagnosis discussed. Review of the literature suggests that the condition is rarely seen and tends to present in childhood and adolescence. This contrasts with metatarsal sesamoid osteomyelitis due to direct spread of infection, which occurs in the elderly as an important complication of the diabetic foot.
Loop colostomy closure
Authors: Henry M M , Everett W G
Published: March 2007

The records of 74 patients who had loop colostomies closed at Addenbrooke's Hospital between 1970 and 1975 were studied retrospectively. One death from a pulmonary embolus occurred and the incidence of fistula from the site of closure was found to be 5.4 per cent.

A number of differing factors were assessed. Closure 6 weeks after the colostomy's formation and preoperative antibiotic (antimicrobial) bowel preparation appeared to be factors associated with a favourable outcome. On the other hand, an initial operation for carcinoma and closure less than 6 weeks after the colostomy's formation were factors related to a less favourable outcome.
Extra–intracranial revascularization
Authors: Lumley J S P
Published: March 2007

Twenty-four extra-intracranial revascularization procedures were undertaken in 23 patients with occlusion of the ipsilateral internal carotid artery. The superficial temporal artery was anastomosed to a cortical branch of the middle cerebral artery in 23 cases and a vein graft inserted between the external carotid artery and the cortical vessel in 1, a microsurgical technique being used.

Twenty-one patients were suffering from transient ischaemic attacks (TIAs) and 2 had developing strokes. Nineteen patients had radiologically demonstrated bilateral disease of the carotid vessels, 9 having undergone contralateral carotid artery surgery before the intracranial procedure.

No improvement was noted in the 2 patients with developing strokes; one patient developed a stroke contralateral to the intracranial procedure 24 h postoperatively, this being accompanied by occlusion of the anastomoses, and one patient had progression of the stroke syndrome following occlusion of the intracranial vein graft. All other patients have shown a reduction or abolition of TIAs over a follow-up period of 24 months.

These findings suggest that intracranial revascularization is of value in patients with total internal carotid artery occlusion and continuing TIAs.
Postoperative hypophosphataemia
Authors: England P C , Duari M , Tweedle D E F , Jones R A , Gowland E
Published: March 2007

The possible mechanisms of postoperative hypophosphataemia were studied in women undergoing uncomplicated cholecystectomy. Six patients were allocated to each of three groups. Group I received no intravenous fluids, group II received dextrose/saline solution alone and group III received dextrose/saline solution with phosphorus supplementation. The serum concentration of inorganic phosphorus fell in all three groups, the greatest fall being in the group receiving dextrose/saline solution. However, the lowest level reached (0.82 mmol/l) was within the normal range for our laboratory. Concentrations of red blood cell adenosine triphosphate and 2,3-diphosphoglycerate showed similar changes. The operations were not associated with a large catabolic response nor with an increase in urinary phosphorus excretion. The postoperative reduction in serum concentration of inorganic phosphorus appeared to be due mainly to haemodilution. There is no indication for routine phosphorus supplementation following uncomplicated elective surgery.
Midline cancer of the floor of the mouth: role of suprahyoid dissection
Authors: El-Domeiri Ali A
Published: March 2007

Of 37 patients with squamous cell carcinoma of the floor of the mouth seen during a 5-year period, 28 were treated primarily by surgery. Ten of the 28 patients presented with midline cancers measuring between 1·0 and 3 cm (T1 and T2). Three of these patients had local excision only. Metastases to the submandibular lymph nodes later occurred in 1 of these 3 patients. The remaining 7 patients with midline lesions had wide excision of the tumour, marginal resection of the mandible and bilateral suprahyoid node dissection. Of these 7 patients 4 remained free of disease for periods ranging between 2 and 5 years. Two of these had lymph node metastases. These results suggest that en bloc excision of relatively small midline cancers (i.e. not exceeding 2 cm (T1) in largest diameter) with bilateral suprahyoid node dissection gives effective control of these lesions.
Congenital chylothorax: report of unique case associated with ‘H’-type tracheo-oesophageal fistula
Authors: Harvey J G , Houlsby W , Sherman K , Gough M H
Published: March 2007

A case of congenital chylothorax associated with a congenital ‘H’-type tracheo-oesophageal fistula is reported. The development of the thoracic duct is described and the possible embryological association with tracheo-oesophageal fistula is discussed. The management of the case is reaiewed.
Use of circular stapling gun with peranal insertion of anorectal purse-string suture for construction of very low colorectal or colo-anal anastomoses
Authors: Goligher J C
Published: March 2007

A technique is described for construction of the colorectal or colo-anal anastomosis in low rectal resection by using an automatic circular stapling device and inserting the anorectal purse-string suture peranally from below. This method was employed in 4 patients resulting in complete healing in 3 cases and a moderate leak in 1, which, however, eventually healed satisfactorily.
The management of gross refractory obesity by jejuno-ileal bypass
Authors: Baddeley R M
Published: March 2007

Jejuno-ileal bypass has been performed in 226 massively obese patients, 190 of whom have been followed for a minimum of 1 year. End-to-side and end-to-end anasto-moses were compared and no difference in the weight reduction achieved by either technique was seen throughout the 5-year follow-up. There was no significant difference in weight reduction achieved between groups of patients in which the jejunal length varied from 10 to 35 cm and the ileal length from 35 to 10 cm.

The weight reduction achieved in the entire series averaged 36·7 ± 9·4 per cent at 2 years, after which no further loss occurred. Good psychological benefits were recorded. Remission of diabetes occurred in 12 of 13 patients and marked long term lowering of serum lipids was seen.

Side effects included fluid and electrolyte disturbances and fatty changes in the liver during the first year, improving thereafter. Early cirrhosis of the liver occurred in 8·6 per cent. Other side effects included abdominal bloating, arthralgia and renal colic.

The operative mortality was 0·9 per cent and the late mortality directly attributable to the jejuno-ileal bypass, 3·1 per cent. In 19 patients the bypass was discontinued because of severe side effects.
Influence of thyroid surgery on voice function and laryngeal symptoms
Authors: Watt-Boolsen Steen , Blichert-Toft Mogens , Boberg Arthur
Published: March 2007

A comprehensive examination of voice function and laryngeal symptoms was applied systematically to 20 patients undergoing thyroid surgery. Patients were excluded from the series if there had been previous neck surgery or if postoperative indirect laryngoscopy showed abnormal cord mobility. Examination before operation showed that patients with sporadic non-toxic goitre or medically pre-treated toxic goitre had impaired voice function based on stroboscopy, electroglottography, phono-oscillometry and determination of voice range, phonation time, pitch, and peak flow. Three months after thyroid surgery the voice function was significantly improved although not normal in nontoxic goitre patients, whereas the voice function in patients with thyrotoxicosis was unchanged. The number of laryngeal symptoms was significantly reduced in non-toxic goitres following surgery and unaltered in the group with thyrotoxicosis.
Carcinoma of the thyroid
Authors: Alagaratnam T T , Ong G B
Published: March 2007

Total thyroidectomy with excision of any enlarged cervical lymph nodes was the usual operation practised for carcinoma of the thyroid in this series. Extended thyroidectomy afforded cures in some patients with locally advanced disease. Preoperative drill biopsy of the goitre was a useful procedure. Other noteworthy features were the increasing occurrence of papillary carcinoma and the comparatively high incidence of malignancy in solitary nodules.
Bilio-pancreatic bypass for obesity: I. An experimental study in dogs
Authors: Scopinaro Nicola , Gianetta Ezio , Civalleri Dario , Bonalumi Umberto , Bachi Virgilio
Published: March 2007

Bilio-pancreatic bypass is a new procedure that tries to obtain a maldigestion syndrome with selective malabsorption of the main high calorie foods. The operation consists of a gastric resection and division of the proximal jejunum just distal to the ligament of Treitz. A gastroentero-anastomosis is then constructed using the distal end of the transected jejunum, while the proximal jejunum is anastomosed to the side of the distal ileum.

An experimental study carried out on 12 dogs confirmed that the operation causes a selective malabsorption with loss of weight and no complications. On the basis of this study it is suggested that this procedure has the following advantages over jejuno-ileal bypass: (a) normal absorption of bile salts, water and electrolytes; (b) slow recovery of absorption; (c) absence of a blind loop.
The results of vaginoplasty in excision of the rectum
Authors: Johnston George W
Published: March 2007

Vaginoplasty was used in a consecutive series of 45 patients undergoing rectal excision for neoplastic and inflammatory bowel disease. Forty-three patients achieved primary perineal healing and none developed a persistent perineal fistula.

One patient with Crohn's disease developed a perianal fistula a year after operation but healing occurred after minor surgery. Another developed a pre-sacral abscess 9 years after operation; spontaneous discharge into the vagina occurred.
Hyperparathyroidism in pregnancy
Authors: Salem Richard , Taylor Selwyn
Published: March 2007

Primary hyperparathyroidism in pregnancy is uncommon and easily overlooked. It is associated with a complication rate of up to 80 per cent—mainly stillbirths, abortions and neonatal tetany. Surgical treatment during pregnancy offers the best chance for fetal and neonatal survival.
A technique for the difficult peripheral arterial aneurysm
Authors: Birkenstock W E
Published: March 2007

Complete external control of the vessels feeding some aneurysms may be very difficult and occasionally only achieved at the cost of damage to surrounding structures. A method is described in which Foley catheters are introduced into the feeding vessels from within the aneurysm and then cut distal to their clamped side branch to enable Dacron grafts to be passed over them and sutured in place. This technique has been used in 3 patients with very satisfactory results and is offered as an alternative when standard control is hazardous, or impossible.
Duct ectasia in the male
Authors: Mansel R E , Morgan W P , Hughes L E
Published: March 2007

Three cases of inflammatory duct ectasia occurring in the male breast are described. The clinical presentation of the disease in the male closely resembles that in the female. Nipple retraction, nipple discharge, periareolar inflammation and bilateral involvement are all seen. Conservative measures produced unsatisfactory results similar to those in women. A similar operative approach to that used in women is advocated.
Preservation of the injured spleen
Authors: Slim Michel S , Najjar Najwa E , Mishalany Henry G
Published: March 2007

Experience with suture repair of splenic lacerations in 14 children and 8 adults is reported. The youngest patient was 3 days old and the oldest 60 years. Adequate healing was confirmed by postoperative splenic scans with or without arteriography. The 2 deaths in this series were not related to the splenic repair and were due to associated major injuries. The course of illness in the remaining 20 survivors did not reveal a failure of this technique or a complication related to the use of this conservative approach. It is expected that salvage of the traumatized spleen will eliminate the risk of fulminant postoperative infections that may be fatal.
Long term results of autogenous vein bypass grafts in femoropopliteal arterial occlusion
Authors: Grimley R P , Obeid M L , Ashton F , Slaney G
Published: March 2007

The results of 329 consecutive autogenous vein grafts carried out between January 1962 and June 1973 have been reviewed. The 5- and 10-year mortality rates were 14·6 per cent and 18·7 per cent respectively.

The corresponding patency rates were 70 per cent at 5 years and 34 per cent at 10 years, the lowest patency (27·8 per cent) occurring in below-knee anastomoses with grafts of 5 mm or less in diameter. As others have noted, the state of the popliteal—tibial run-off vessels had a considerable influence on long term patency rates. In severely ischaemic limbs, the limb salvage rate following this operation was 77 per cent.

No valid conclusions could be made regarding the effect of lumbar sympathectomy and postoperative anticoagulants on long term patency.

This review has confirmed the findings of earlier studies that a satisfactory 5-year patency rate and a gratifying limb salvage rate can be achieved with an extremely low operative mortality rate of 0·37 per cent. Despite the presence of widespread atherosclerotic arterial disease, the 5-year mortality rate is 14·6 per cent, indicating that an attempt at reconstructive surgery is usually well worth while.
Antibiotic-associated colitis—A review of 66 cases
Authors: Mogg G A G , Keighley M R B , Burdon D W , Alexander-Williams J , Youngs Denise , Johnson Margaret , Bentley Sandra , George R H
Published: March 2007

We have reviewed 66 cases of antibiotic-associated colitis since March 1975, which have been associated with a 27 per cent mortality. We believe antibiotics may predispose patients to this condition which is caused by a toxin produced by Clostridium difficile. Although the disease is rare, it is more common than previously reported. The presentation, methods of diagnosis and treatment are discussed.