bluuebunny/crossref_metadata_2025 huggingface dataset:
WOUND INFECTION IN ELECTIVE BILIARY SURGERY: CONTROLLED TRIAL USING ONE DOSE CEPHAMANDOLE*
Authors: Kune Gabriel A. , Hunt Roland F. , Jed Andrew , Lusink Christopher , Mclaughlin Stephen , Carson Peter
Published: January 2008

In aprospective randomized double‐blind trial using a 1 g single dose of cephamandole versus placebo, given I h before surgery, the wound infection rate after elective surgery for gallbladder stones in 200 consecutive cases was 11%, being 15% in the placebo group and 7% in the cephamandole group (x2= 4.03; P <0.05). The average hospital stay was 7.7 days in the absence of wound infection and 13.6 days in the presence of wound infection. Contaminated bile was significantly positively related to wound infection, and cephamandole significantly protected the culture‐positive group from wound infection.
BREAST RECONSTRUCTION USING A RECTUS ABDOMINIS MUSCULOCUTANEOUS FLAP: 5 YR FOLLOW‐UP
Authors: Robbins Thomas H.
Published: January 2008

A 5 yr follow‐up of a method of breast reconstruction is presented. It is considered the operation has stood the test of time.
POST‐PROCTECTOMY PERINEAL HERNIA: CASE REPORT AND DISCUSSION
Authors: McMullin Neil D. , Johnson William R. , Polglase Adrian L. , Hughes E. S. R.
Published: January 2008

Perineal hernia is a rare complication of pelvic surgery. Women are more commonly affected, and development of the condition is usually gradual. Although the true incidence of this problem is unknown, few cases are severe enough to require operative repair. We report the experience of one of the authors (E.S.R.H.) in postproctectomy perineal hernia. One case required surgical repair and is presented, with a discussion of the operative management.
INTUSSUSCEPTION, VOLVULUS AND MALROTATION
Authors: Burke T. E. , Fitzgerald RayJ.
Published: January 2008

A case of ileocolic intussusception, associated with mid‐gut volvulus and malrotation with bowel necrosis is reported. There is evidence to suggest that the intussusception preceded the volvulus.
THE MANAGEMENT OF METASTATIC GERM CELL TUMOURS AND THE CLINICAL UTILITY OF LACTATE DEHYDROGENASE ESTIMATIONS
Authors: Gill P. Grantley , Abbott Richard , Jones Alan M. , Thomas David W.
Published: January 2008

Forty‐five patients with metastatic germ cell tumour were treated with chemotherapy. Complete remission was achieved in 63% of all cases and in 65% of patients whose primary tumour arose in the testis or ovary. Surgical resection of abdominal masses persisting after chemotherapy was performed in seven patients, two of whom were found to have persistent tumours. Twenty‐seven of the 33 patients with teratoma originating in the gonads remain in complete remission. Total serum LDH activity was elevated in 28 of the patients with measurable disease. The increased LDH was not accompanied by significant alteration in other hepatic enzymes nor were hepatic metastases demonstrable in these patients. Fractionation of the LDH demonstrated that the increased LDH in these patients was located in either iso‐enzymes 1 or fractions 1 + 2. Alteration of the serum LDH activity correlated with the response to therapy and warrants further study.
COLORECTAL CARCINOMA IN THE YOUNG
Authors: Wong S. K. Cyril , Cheung P. S. Y. , Boey John , Lai C. K. , Cheung H.
Published: January 2008

Four hundred and five patients with colorectal adenocarcinoma were seen over a five year period in the Department of Surgery, University of Hong Kong. These patients were divided into two concurrent groups according to the age of 40. Thirty patients (7.4%) were below age of 40 at the time of presentation. This young group of patients had both a higher combined proportion of C and D tumours (76.6% to 50%) and a higher proportion of poorly differentiated tumours (20% to 5.5%). The curative and palliative resections rates were similar. Life tables of patients who underwent curative resections showed young patients to have a significantly poorer overall disease‐free interval as well as overall determinant survival. In comparing only the Dukes C patients, the young patients still showed a higher recurrence rate.
RECURRENT NASOPHARYNGEAL CARCINOMA—TWO LONG TERM DISEASE‐FREE REMISSIONS WITH NON‐CISPLATINUM BASED COMBINATION CHEMOTHERAPY
Authors: Haines I. E. , Schwarz M. A. , Hurley R. A. , Rundle H. M. P.
Published: January 2008

Two cases of locally recurrent nasopharyngeal carcinoma following maximal radiotherapy are presented. Both patients had complete resolution of disease with outpatient combination chemotherapy using Vincristine, Adriamycin and Cyclophosphamide (VAC), and are disease free, and working full time, 3 and 4 years later, respectively. The significant relapse rate of nasopharyngeal carcinoma after initial radiotherapy is outlined, and the reported limitations of radiotherapy and chemotherapy in this situation are discussed. The survival curve for this disease appears to plateau at 2–3 years. This appears to be the first reported outpatient combination chemotherapy programme to produce long term disease‐free remission in recurrent disease.
JAW WIRING IN THE TREATMENT OF MORBID OBESITY
Authors: Ramsey‐Stewart George , Martin Luise
Published: January 2008

Fourteen patients originally presented with hyperphagia and intractable morbid obesity have had maxillomandibular fixation (MMF) applied in an effort to control their obesity. In 10 patients who were massively obese or considered poor risk candidates for surgical control of their obesity, MMF was applied with the aim of reducing the obesity to a level where a surgical gastric restrictive bariatric procedure could be safely carried out. Eight of these patients had been rejected for surgical control of obesity elsewhere and two were edentulous. Five of these patients after successful weight loss over periods from 16 to 40 weeks (mean percentage overweight lost 84.8, range 39–150) safely underwent a gastric restrictive procedure. All five patients have had continuous weight loss after bariatric surgery. Two patients requested removal of MMF 1 and 2 weeks after application. The remaining three patients, who were candidates for surgery, after successful weight loss over periods from 12 to 28 weeks (mean percentage of overweight lost 45, range 38–50) decided not to proceed with surgical control. All have subsequently regained the lost weight. Four originally morbidly obese patients, who had had a previously successful gastric restrictive procedure followed by weight loss, requested MMF in an effort to lose further weight. Over periods from 8 to 16 weeks three of the four had further weight loss (mean percentage of overweight lost 18.3, range 5–30). After removal of MMF all four patients regained some weight. In only one was there a significant maintenance of weight lost during MME We conclude that MMF is a relatively simple, safe and effective procedure in producing weight loss in the morbidly obese. It can be successfully carried out on edentulous patients. Because of a high recidivism rate, it probably has no place as a single treatment modality. However, in an integrated approach to obesity management, it has a role, in particular in preparing giant and high surgical risk morbidly obese patients for a safe surgical procedure. When followed by a gastric restrictive operation, weight loss can be maintained and further weight loss anticipated. A period of pre‐operative MMF in selected high risk candidates for bariatric surgery may reduce the small but significant mortality and morbidity reported in most series of the increasingly popular gastric restrictive procedures.
PHARYNGOCUTANEOUS FISTULAE FOLLOWING LARYNGECTOMY
Authors: Mendelsohn Martyn S. , Bridger G. Patrick
Published: January 2008

This retrospective analysis of 100 patients revealed a postoperative pharyngocutaneous fistula rate of 15.3% following total laryngectomy, and 21.4% following partial pharyngolaryngectomy. All fistulae were benign. None resulted in mortality. The most significant risk factor for the development of fistulae is prior radiotherapy, especially high dose (greater than 5000 rads). Other factors include postoperative haemoglobin less than 12.0 g/dl, pyriform sinus tumour, and larger tumour size. Both the prior administration of radiotherapy and the site of the fistula opening most influence management problems.
TOTAL HIP REPLACEMENT COMBINED WITH BONE GRAFTING FOR ACETABULAR DYSPLASIA CAUSING SEVERE OSTEOARTHRITIS OF THE HIP JOINT
Authors: Dooley B. J. , Clifford M. J. , Hjorth D. P.
Published: January 2008

Over a 10 year period 18 total hip joint arthroplasties (THJA) were performed on 15 patients with disabling osteoarthritis of the hip joint secondary to congenital dislocation or subluxation. In all cases reconstruction of the deficient acetabulum was necessary in order to provide total bony containment of the acetabular prosthesis. This was achieved using a bone graft, fashioned from the femoral head and securing it above the true acetabulum. At follow‐up all patients were pain free. Radiographically, there had been no loosening of the acetabular prosthesis and all grafts appear to have united. The operative technique is described in detail.
AN ORTHOSIS FOR THE POSTOPERATIVE MANAGEMENT OF FIRST METATARSOPHALANGEAL JOINT RECONSTRUCTION
Authors: Miller Dale , Horne Geoffrey
Published: January 2008

There is described a simple and readily made orthosis designed to improve results after surgical treatment of hallux valgus.
ILEOCAECAL INTUSSUSCEPTION OF A PREVIOUSLY RECOGNIZED MECKEL'S DIVERTICULUM
Authors: Simpson R. L.
Published: January 2008

A case is reported of an ileocaecal intussusception caused by a previously recognized Meckel's diverticulum. The case offers the opportunity to discuss the management of an asymptomatic Meckel's diverticulum found incidentally. The conclusion is reached that, in general, diverticulectomy is appropriate.
EARLY GASTRIC CANCER
Authors: Hartley L. , Evans E. , Dickey D. , Deth A. Van
Published: January 2008

Thirty patients with early gastric cancer were studied as part of a consecutive series of 308 gastric cancers, giving a proportion of 9.7%. Twenty‐eight of the early gastric cancer patients were symptomatic, pain being the most common symptom. Endoscopy proved more effective than barium studies as a first investigation but the diagnosis rate at first examination was still only 69%. Seven patients with early gastric cancer had lymph node spread at the time of presentation. Five patients eventually died of cancer metastases. There was a high incidence of benign peptic ulceration (50%) and this with lymph node metastasis was an unfavourable prognostic feature. Only four of the 26 patients submitted to standard surgical resections died of cancer. This study supports the concept that early gastric cancer does indeed occur in Westem man and the five year survival rate (65%) is much higher than for late gastric cancer (13%). The high incidence of metastasis at the time of presentation may account for the difference between our survival rate for early gastric cancer, and that reported from Japan.
A SIMPLIFIED TECHNIQUE FOR CONSTRUCTION OF A GASTRIC POUCH FOR MORBID OBESITY SURGERY
Authors: Rij A. M. van
Published: January 2008

A simple method for the construction of the gastric pouch used as a step in surgery for the morbidly obese is described.
BILE DUCT OBSTRUCTION BY VILLOUS PAPILLOMA OF DUODENUM
Authors: Lubowski David , Carle David de , Hunt David R.
Published: January 2008

Two cases of peri‐ampullary villous adenomas involving the common bile duct are reported. The pathology of benign duodenal tumours is discussed, and the possibility of common bile duct involvement, albeit uncommon, is stressed. Obtaining an endoscopic histologic diagnosis is important in planning appropriate operative treatment. Although benign, these tumours should be removed; they are a cause of serious symptoms and have proven premalignant potential. Endoscopic removal is usually not possible. Endoscopy for dyspepsia should include examination of the second part of duodenum, to avoid overlooking duodenal tumours.
SPLENECTOMY FOR MASSIVE SPLENOMEGALY
Authors: Sharp P. , Grace C. S. , Rozenberg M. C. , Ham J. M.
Published: January 2008

The technique, and short and long term results, of splenectomy for massive splenomegaly are presented. The latter was defined as a spleen weighing in excess of 1.5 kg. Thirty‐five of the 38 patients had a serious haematological disorder as the indication for the operation, usually non‐Hodgkin's lymphoma or myelofibrosis. All operations were carried out through abdominal incisions. Accessible splenic attachments were divided, and the splenic artery was ligated in continuity, prior to posterior mobilization. Two patients (5.3%) died as a result of the operation, both deaths being due to sepsis. Septic and thrombo‐embolic complications were common, and occurred both early and late after the operation. Overall, eight of the 12 deaths during the first postoperative year were due to the primary disease, whereas all of the five deaths after that time were due to causes other than the primary disease. Twenty‐four patients lived at least 1 year, and 10 patients are alive for more than 5 years.
A PUBORECTAL SLING IN THE MANAGEMENT OF ANAL INCONTINENCE AND RECTAL PROLAPSE
Authors: O'Rourke D. A. , Egerton W. M. F.
Published: January 2008

A review is presented of 11 years experience in the use of a synthetic puborectal sling in the treatment of rectal prolapse and faecal incontinence. This perineal approach operation has been performed on 24 patients from 1973 to 1984. In over 60% of the patients rectal prolapse and anal incontinence were controlled.
VOLAR APPROACH AND SCREW FIXATION TECHNIQUE FOR FRACTURES AND NON‐UNIONS OF THE CARPAL SCAPHOID
Authors: Breit Robert , Segelov Phillip M. , Caspary Eric J.
Published: January 2008

Delayed or non‐union of the carpal scaphoid may be treated in a variety of ways. This article describes the operative technique and clinical results of a volar approach and screw fixation technique, which offers distinct advantages over other approaches. The volar approach to the scaphoid is simple, safe and rapid. It allows access to the fracture for fixation, the radioscaphoid joint for assessment and the distal radius for the procurement of a bone graft where necessary. Access to the volar aspect of the scaphoid is also biomechanically sound as it allows insertion of a wedge‐shaped bone graft into the ‘collapsed’ area of the scaphoid in established non‐unions. Compression screwing of the fracture site has the same advantages of stability and early mobilization that applies in other sites. Our clinical experience in 32 fractures has involved a low complication rate with early return of mobility and activity.
IS COLORECTAL CARCINOMA IN THE YOUNG A MORE DEADLY DISEASE?
Authors: D'Onofrio G. M. D. , Tan E. G. C.
Published: January 2008

Of the 2923 cases of colorectal carcinoma treated from 1970 to 1, only 12 (0.4%) were under the age of 30 years, Analysis of this group confirmed the higher incidence of more advanced tumours, as well as a higher frequency of predominantly mucin‐secreting adenocarcinoma. Regardless of the mode of treatment, survival is particularly poor in the young patients, and, in our opinion, this is a reflection of the more aggressive behaviour of the type of carcinoma afflicting young patients.
ANATOMICAL LOCALIZATION OF ATHEROSCLEROTIC LESIONS USING THE PULSE VOLUME RECORDER
Authors: Stricker Philip D. , Travers Philip L. , Mitchell Robert M.
Published: January 2008

The pulse volume recorder has been used in studying 62 limbs to assess its accuracy in localization of arteriosclerotic lesions of the lower limbs, realising the limitations of clinical examination and simple pressure measurements. Its advantages over simple pressure measurements are illustrated. It was shown to be most accurate in locating isolated stenoses. The technique helps differentiate aorto‐iliac from high superficial femoral artery obstruction. It can be used when severe medial sclerosis is present and is very helpful when distal pulses cannot be detected for technical reasons.
ASCENDING CINEVENOGRAPHY IN CHRONIC VENOUS INSUFFICIENCY: A COMPARISON WITH AMBULATORY VENOUS PRESSURE MEASUREMENTS
Authors: Gray‐Weale A. C. , Burgh M. M. de , E. Lippey  , Palme A.
Published: January 2008

Thirty‐seven patients (49 limbs) with chronic venous insufficiency who were being considered for venous surgery were studied using a modified technique of ascending venography (Ascending cinevenography) and ambulatory venous pressure (AVP) measurements. AVP and ascending cinevenography results, in each patient, were assessed by a different investigator, each of whom was blind to the other result. The results of AVP measurements and ascending cinevenography were then compared. There is good correlation between AVP measurements and results of ascending cinevenography. Ascending cinevenography can be used instead of combined ascending and descending venography.
SHOULD POLYTETRAFLUOROETHYLENE GRAFTS BE USED IN PREFERENCE TO SAPHENOUS VEIN FOR FEMOROPOPLITEAL ARTERIAL BYPASS?
Authors: Harris J. P. , O'Brien C. J. , Stephen M. S. , Sheil A. G. R. , May J.
Published: January 2008

Some surgeons have advocated using polytetrafluoroethylene (PTFE) as the graft material of choice for femoropopliteal arterial bypass so that the saphenous vein could be preserved for future cardiovascular surgery. We have examined our results to see if this approach could be justified in our patient population. PTFE was used for 101 femoropopliteal reconstructions in 96 patients (56 male and 40 female). Thirty‐eight (40%) complained of debilitating claudication and 58 (60%) had limb‐threatening ischaemia. There were 83 primary PTFE femoropopliteal reconstructions and 18 repetitive procedures after failure of an earlier ipsilateral bypass. Twenty‐nine of the 101 PTFE grafts were anastomosed distally to the popliteal artery above knee and the remaining 72 below knee. At 5 years, the cumulative patency for all grafts was only 11%. The 4 year cumulative patency was better for claudicants (40%) than for those with threatened limb loss (11%) but two of the 38 claudicants required amputation when their grafts failed. Patency rates were not significantly affected by the site of the distal anastomosis or by a previous failed ipsilateral femoropopliteal bypass. Worthwhile limb salvage was achieved only by frequent re‐operation. Our results with PTFE are not good enough to use it in preference to an adequate saphenous vein for femoropopliteal bypass.
OPERATIVE AID TO COMBINED SYNCHRONOUS MASTECTOMY AND LATISSIMUS DORSI BREAST RECONSTRUCTION
Authors: Wilkinson S. , Chetty U. , Forrest A. P. M.
Published: January 2008

A special frame is described which has been designed to hold the upper trunk and arm of patients firmly in the lateral position during the operation of combined synchronous mastectomy and latissimus dorsi breast reconstruction. The frame has prevented movement at the shoulder joint and distraction on the brachial plexus which resulted in brachial plexus palsy in two out of 15 patients in whom the operation was performed with a conventional arm support.
BRACHIO‐CEPHALIC REVASCULARIZATION FROM THE INTRATHORACIC AORTA: USE OF A T‐PIECE GRAFT
Authors: Bourke Bernard M. , Greenhalgh Roger M.
Published: January 2008

Ready made T‐piece dacron grafts have been available for some time for use in axillo‐bifemoral procedures. This report illustrates the use of such a graft in two cases of brachiocephalic revascularization from the intrathoracic aorta. In each case the aortic arch branches were severely diseased. The technique allows placement of the 8 mm diameter limb on the ascending aorta deep to the sternum, where, because of its lack of bulk, it can sit without compression. The 8 mm side piece can be manoeuvred to follow any direction required and avoids placement of an anastomosis in an otherwise awkward area. If required, a third limb can be sutured onto the proximal limb beyond the region where compression would occur.
BLEEDING ULCER: TIMING AND TECHNIQUE IN SURGICAL MANAGEMENT
Authors: Hunt P. S.
Published: January 2008

The individual surgeon's training, experience and flexibility are decisive factors in the successful recovery of patients after surgery for acute bleeding peptic ulcer. With planned management, careful preparation for surgery should be considered as of equal importance to surgical skill. Early diagnosis and exact resuscitation are the two most important aspects of a plan of treatment which anticipates the need for early surgery. In the past, patients were often referred late for surgery after significant blood loss and transfusion. Surgeons have endeavoured to define the cases that are likely to rebleed and prepare them promptly for surgery. Probably the best indications for early surgery are severe haemorrhage, reflected by shock on admission, an age of over 50 and active bleeding from the ulcer seen at diagnostic endoscopy. Prospective studies have shown a reduction in mortality from bleeding ulcer where policy requires early endoscopic diagnosis, exact resuscitation in the intensive care unit and early surgery in high risk cases.
ILEORECTAL ANASTOMOSIS—FRIEND OR FOE?*
Authors: Cunningham Ian G. E.
Published: January 2008

Ileorectal anastomosis is a controversial operation. Its use has been promoted for the management of colonic cancer, familial polyposis, Crohn's disease, ulcerative colitis and in several rarer conditions. In the treatment of ulcerative colitis controversy has centered on the risk of malignant change in the retained rectum and on the long term quality of function. E. S. R. Hughes has been a proponent of this procedure and is one of those able to report a major series with long term follow‐up of function and cancer development in ulcerative colitis. Of 364 colitics treated by resection, 43% were selected for this operation. This group showed a success rate of 72% and after 15 years 57% remained functional. The probability of malignant change has reached 14% at 27 years with 8% of the series developing rectal carcinoma. The probability of this development following a diagnosis of moderate or severe mucosal dysplasia reached 42% at 13 years from histological assessment. Ileorectal anastomosis has a high degree of acceptability in appropriately selected ulcerative colitics; its continuing use is dependent on surveillance of sufficient quality to predict cancerous change or to detect it earlier enough to effect cure by proctectomy.
FIVE YEARS' EXPERIENCE IN A FREE‐STANDING OUTPATIENT SURGICAL CLINIC
Authors: Calcinai C. J. , Barrett J. C.
Published: January 2008

The design and function of a free‐standing outpatient surgical facility is described in which a wide range of surgical procedures have been carried out. In selected patients and with adequate facilities, outpatient surgery offers safe, convenient and relatively cheap surgery for a wide range of conditions.
MODIFIED VERTICAL BANDED GASTROPLASTY AS REVISION OF FAILED HIGH GASTRIC REDUCTION FOR MORBID OBSEITY
Authors: Ramsey‐Stewart George
Published: January 2008

Vertical banded gastroplasty is currently closest to the ideal gastric restrictive procedure for the surgical treatment of obesity. A modification of the technique of vertical banded gastroplasty can be successfully used to revise a failed high gastric reduction for morbid obesity.
PNEUMATIC RUPTURE OF THE POSTERIOR PHARYNGEAL WALL
Authors: Forer Martin , Flynn Peter , Hughes Clifford F. , Szasz John
Published: January 2008

A fourth case of pharyngeal injury after an attempt to open a bottle of ‘home brew’ is presented. For the first time the potential barotrauma causing this injury is recognized. The principles of diagnosis. investigation and treatment are described. Early surgical intervention will minimize contamination and allow adequate drainage of the contaminated space. Early institution of antibiotics will minimize local and generalized toxic phenomena. Alternate routes of alimentation allow local healing and rapid recovery of the patient.
SIGMOIDOSCOPY WITH FLEXIBLE ELECTRONIC ENDOSCOPY: A PRELIMINARY EXPERIENCE IN HONG KONG
Authors: Yip Y. L. , Tin H. , Yud W. M. , Tjia S. C.
Published: January 2008

Eighty‐two cases of electronic flexible sigmoidoscopy were performed from October 1984 to October 1985 in a rural hospital in Hong Kong. The scope is a relatively new type of flexible endoscope, which has no optical fibre bundle for imaging. The image is taken with a solid state television camera and relayed via a videoprocessor to a television monitor. The image quality and ease of handling were satisfactory. Acceptance by the endoscopy team and the patients was good. The differences in comparison with conventional fibrescopes and television systems are discussed.
PHOTODYNAMIC THERAPY FOR EARLY SQUAMOUS CELL CANCER OF THE UPPER AERODIGESTIVE TRACT
Authors: Gluckman Jack L.
Published: January 2008

Photodynamic therapy (PDT) is a treatment modality that results in selective destruction of malignant cells by combining a photosensitizing agent (hematoporphyrin derivative), which is taken up by the cells, and a laser light. This therapeutic modality has been effectively used in managing cancers of the skin, bronchi and bladder. In the head and neck area, however, its use has been confined to the palliation of advanced lesions which have proved refractory to conventional therapy. While this is unquestionably a valid role, its true value, therapeutically, may be in the management of early cancers arising in the upper aerodigestive tract. At the University of Cincinnati, PDT has been used on a variety of such early cancers where, for a variety of reasons, conventional therapy was not possible. A preliminary experience with this modality in managing lesions of the larynx, oral cavity and oropharynx has demonstrated that this is a viable alternative.
THE RELATIONSHIP OF NUTRITIONAL PARAMETERS TO MORTALITY AND SEPTIC COMPLICATIONS
Authors: Fletcher J. P. , Little J. M. , Walker P. J.
Published: January 2008

The relationship of a number of nutritional parameters to mortality and sepsis was assessed in a group of 82 patients requiring total parenteral nutrition (TPN). Duration of TPN ranged from 9 to 105 days with a mean of 32.3 days. Parameters assessed were serum albumin, transferrin, absolute lymphocyte count (ALC), delayed hypersensitivity skin test reaction, mid‐arm muscle circumference, triceps skin‐fold thickness and weight. Combinations of parameters were found to be more useful than single parameters. The only single parameter of significance was ALC. The best overall predictor of death and/or sepsis was a combination of reduced serum albumin, transferrin, ALC and anergy, which was found to be related to a significantly higher mortality (P= 0.002) and incidence of septic complications (P= 0.003). This combination of parameters also had the best specificity (90%), accuracy (79%) and positive predictive value (65%) for prediction of death and/or sepsis. Increasing age was also found to be associated with a higher mortality (P < 0.001) and increased incidence of septic complications (P= 0.01).
LONG SAPHENOUS VEIN HARVESTING
Authors: Meldrum‐Hanna W. , Ross D. , Johnson D. , Deal C.
Published: January 2008

There is described an easy and rapid technique using the Mayo Vein Stripper to facilitate safe harvesting of the long saphenous vein for vascular reconstruction. It provides good quality vein and a superior cosmetic result without wound complications.
SPLENIC PROTECTION IN LEFT UPPER QUADRANT OPERATIONS
Authors: Hugh Thomas B. , Coleman Maxwell J. , Cohen Adrian
Published: January 2008

Splenectomy produces significant immediate and long‐term risks for the patient, and there is general agreement that it should be reserved for clear‐cut unavoidable indications. However, accidental injury to the spleen in the course of another operation (incidental splenectomy), accounts for almost 40% of splenectomies in some series. Incidental splenectomy is most likely to occur in left upper quadrant operations such as proximal gastric vagotomy, or in colonic operations involving mobilization of the splenic flexure. Incidental splenectomy rates of between 2% and 9% have been reported in association with these procedures. The results of an operative strategy of specific protection of the spleen as the first step in a left upper quadrant operation (‘defusing’ the spleen) are reported. It was not necessary to remove the spleen because of accidental injury in 417 consecutive operations over a 5 year period after implementation of this policy. There were several minor splenic capsular tears which were controlled by intraoperative haemostatic measures. There were no cases of postoperative splenic bleeding. ‘Defusing’ the spleen is an effective step in preventing splenic injury in left upper quadrant operations.
LONG TERM BILIARY ACCESS BY MODIFIED HEPATICOJEJUNOSTOMY FOR HIGH BILE DUCT STRICTURE
Authors: Hunt David R. , Travers Phillip L.
Published: January 2008

Patients with recurrent high bile duct strictures pose special problems for management. Relief of obstruction by hepatieojejunostomy is usually possible but the standard technique does not permit long term access. Six patients with benign strictures involving hepatic ducts have been treated by a simple modification of hepaticojejunostomy retaining access for either balloon dilatation of intrahepatic strictures or investigation and treatment at a later stage if problems recur. Employing a longer than usual Roux‐en‐Y loop, the sutured anastomosis of right and left hepatic ducts is performed 10–15 cm from the free end of jejunum. Silastic tubes are placed into each hepatic duct crossing the anastomosis to exit from the free end of the jejunum which is closed around the tubes. The closed end of jejunum is buried in the peritoneum deep to linea alba and the tubes emerge in the epigastrium. Safe access is retained via the tubes. If the tubes are removed, a ‘mini‐lap’ will expose the Roux loop for endoscopic or radiological access.
PREDICTION OF POSTOPERATIVE COMPLICATIONS BY CLINICAL AND NUTRITIONAL ASSESSMENT
Authors: Katelaris Peter H. , Bennett Gregory B. , Smith Ross C.
Published: January 2008

This study evaluated a battery of nutritional measures and pre‐operative clinical assessment as predictors of postoperative morbidity. Fifty‐seven consecutive patients about to undergo major elective abdominal or thoracic surgery were surveyed. Thirty‐two per cent of patients had three or more abnormal measurements of nutritional indices. Thirty patients had a total of 52 complications and in 12 patients these were major. The Prognostic Nutritional Index (PNI), formulated by Mullen, was found to be the best predictor of postoperative outcome. It identified 10 of 12 (83%) patients who subsequently developed major complications with a specificity of 73%. Clinical assessment selected six of the 12 patients who developed major complications.
DETERMINATIONS OF GLUCOSE TURNOVER AND OXIDATION IN NORMAL VOLUNTEERS AND SEPTIC PATIENTS USING STABLE AND RADIO‐ISOTOPES
Authors: Shaw James H. F. , Wolfe Robert R.
Published: January 2008

Rates of glucose turnover and oxidation were isotopically determined in normal volunteers (n= 16) and in severely septic patients (n= 10). Glucose turnover was determined using primed constant infusions of either 6‐3H‐ or 6,6‐d‐glucose and glucose oxidation with either U‐14C‐glucose or U‐13C‐glucose after appropriate priming of the bicarbonate pool. Basal rates of glucose turnover, oxidation, and plasma clearance were significantly higher in the septic patients than in the volunteers. During glucose infusion (4 mg/kg·min) endogenous glucose production was virtually abolished in the volunteers (94±4% suppression). There was significantly less suppression in the septic patients (39±7%); (p<0.01). In addition, the percentage of available glucose oxidized (i.e. the percentage of glucose uptake oxidized) was significantly less in the septic patients. When the patients were studied during total parenteral nutrition (at a similar rate of glucose infusion) there was no further suppression of endogenous glucose production compared with that seen during 2h of glucose infusioin. However, the percentage of available glucose oxidized increased significantly. From these studies it is concluded that (i) septic patients continue to have ongoing consumption of host tissue despite receiving either glucose infusion or total parenteral nutrition, and (ii) septic patients are less able to oxidize glucose than normal volunteers when infused for only 2 h. However, adaptation occurs with the longer infusion time used in total parenteral nutrition (TPN).
ANTRAL GASTRIN CONCENTRATIONS IN DUODENAL ULCER PATIENTS AFTER CIMETIDINE AND HIGHLY SELECTIVE VAGOTOMY
Authors: Gehling N. , Lawson M. J. , Alp M. H. , Rofe S. B. , Butler R. N.
Published: January 2008

Post‐prandial serum levels of gastrin, the main hormonal stimulator of acid secretion, have been shown to be significantly elevated after HSV compared with controls. The mechanism for this elevation is not known but could be secondary to an increased antral gastrin concentration (AGC). In this study AGCs were measured in endoscopic biopsies before and at intervals of 6 and 32 weeks after HSV in 12 patients with duodenal ulcer. Results were compared with 13 normal controls and 12 duodenal ulcer patients treated with cimetidine for 6 weeks. Blood was taken for fasting serum gastrin concentration at each endoscopy. In the HSV group AGC significantly increased on both postoperative occasions when compared with pre‐operative values (P < 0.01). AGC also showed a significant correlation with time after HSV (r= 0.71; P < 0.01). Only one patient, who had a persistent duodenal ulcer, failed to show an increase in AGC. Cimetidine failed to increase AGCs in duodenal ulcer patients after 6 weeks of treatment. However, a subgroup (n= 7) of cimetidine‐treated patients with low pretreatment AGCs, below 10 ng/mg, did show a significant rise at 6 weeks (P < 0.05). Fasting serum gastrin levels did not change significantly in any of the three groups. It is concluded that HSV causes a significant increase in AGC with time.
THE EFFECT OF STAPLER DIAMETER AND PROXIMAL COLOSTOMY ON NARROWING AT EXPERIMENTAL CIRCULAR STAPLED LARGE BOWEL ANASTOMOSES
Authors: Waxman Bruce P. , Ramsay Andrew H.
Published: January 2008

The effect of stapler diameter and proximal colostomy on large bowel anastomotic narrowing was studied in 23 ewes, to test the hypotheses that stapler diameter is inversely proportional to narrowing and that a colostomy increases narrowing. Large bowel anastomoses were performed with ILS Proximate circular staplers of 25, 29 and 33 mm diameter (six in each group), and assessed at 12 weeks for anastomotic narrowing, hydroxyproline content and histology. In five animals a proximal loop colostomy was added after anastomosis with the 29 mm stapler and similarly assessed at 6 weeks. Neither radiological nor clinical anastomotic leaks occurred and there were no deaths. Comparison of narrowing indices showed no statistically significant difference between the three stapler diameters. Colostomy significantly increased narrowing. Hydroxyproline content was greater at all anastomoses compared with controls. Anastomoses with the 25 mm staplers had a significantly reduced hydroxyproline content compared to the 29 and 33 mm staplers, which may be explained by anastomotic dilatation. The tendency for stapled anastomoses to develop narrowing should not necessarily influence the surgeon's choice of stapler diameter when performing large bowel anastomoses. Moreover, dilatation by faeces may be a factor in reducing staple anastomotic narrowing and, when safe, a proximal colostomy is best avoided.
COLORECTAL CANCER: KNOWLEDGE AND ATTITUDE OF SURGEONS IN NEW ZEALAND
Authors: Isbister William H. , Dent Owen
Published: January 2008

In order to determine surgeons' knowledge of colorectal cancer (CRC) in New Zealand, a questionnaire was sent to all general surgeons on the New Zealand Medical register. One hundred and thirty‐three responses were received and 123 were analysed. In general, respondents seemed to have a better detailed knowledge of CRC than Australian physicians and surgeons, although trends were similar and knowledge was patchy and in some areas poor. The value of rectal examination and sigmoidoscopy in relation to the detection of colorectal neoplasia was overestimated. Knowledge of faecal occult blood testing was such as to preclude usefful evaluation of test results. The findings have serious implications for medical education.
THE USE OF REGIONAL, LOW DOSE STREPTOKINASE IN RECENTLY THROMBOSED ARTERIAL GRAFTS*
Authors: Miles C. R. , Blombery P. A. , Sacharias N. , Stubbe J. W. , Bass C. J. , Ferguson I. A. , Rosengarten D. S. , Stuchbery K. E.
Published: January 2008

Between August 1983 and January 1985, 20 patients aged33–77 years, with occluded lower limb bypass grafts, were on 23 occasions treated with streptokinase via intra‐arterial infusion. Streptokinase (5000 units/h) was effective in clearing occluded grafts in 15 patients on 16 occasions. The median duration of occlusion in these patients was 5 days and the median duration of streptokinase infusions was 24 h. Completion angiography following streptokinase thrombolysis revealed five graft stenoses and 12 outflow stenoses or occlusions. In two grafts no cause for graft failure could be identified. These results permitted the surgeon to make an accurate pre‐operative assessment of the definitive therapy required to ensure graft patency.
USE OF HYDROGEN PEROXIDE TO IDENTIFY INTERNAL OPENING OF ANAL FISTULA AND PERIANAL ABSCESS
Authors: Glen Donald L.
Published: January 2008

Hydrogen peroxide injected into a fistula or perianal abscess produces a jet of white bubbles from the internal orifice on the dentate line. This technique has been helpful in locating this often elusive ostium. Failure to produce such an efflux warns one that the pathology was different from what was expected. Confidence to abandon the search in the absence of an efflux is developing, provided the dictates of gravity are respected in positioning the patient so that the anus lies above the abscess.
INTRAVENOUS RUPTURE OF ABDOMINAL ANEURYSMS: DIAGNOSTIC AND PATHOLOGICAL CONSIDERATIONS
Authors: Falk G. L. , Weale A. C. Gray , Lippey E. R. , Burgh M. M. de
Published: January 2008

Saven cases of abdominal arteriovenous fistla secondary to aneursysm are reported. There were five arotocaval fistulae, on aortolumbar vein fistula, and one iliac artery to vein fistula. Three of five aortocaval fistulae were diagnosed pre‐operatively. One in‐hospital death occurred, and one post‐hospital death. An analysis of the diagnostic patterns is made in an attempt to increase pre‐operative diagnosis.
PROCTOCOLECTOMY AND ILEO‐ANAL ANASTOMOSIS WITH A J‐POUCH
Authors: Jr Robert W. Beart
Published: January 2008

Of 188 Patients having a total proctocolectomy and ileo‐anal anastomosis, 95|X% had a successful procedure and are sarisfied with their quality of life. Mortality was zero, and mean hospital stay was 14 days after colectomy and 10 days after closure of the stoma. Pelvic spsis and small bowel obstruction remained clinical problems in the postoperative period. No male patients were impotent.
THE VALIDITY OF INTERNAL CAROTID BACK PRESSURE MEASUREMENTS DURING CAROTID ENDARTERECTOMY FOR UNILATERAL CAROTID STENOSIS
Authors: Lord Reginald S. A. , Graham Antony R.
Published: January 2008

Peri‐operative neurological deficits in 212 patients undergoing carotid endarterectomy for unilateral carotid stenosis were examined to determine whether the internal carotid back pressure (ICBP) correctly predicted the need for a protective shunt during temporary carotid occlusion. Three strokes occurred in 149 patients who were not shunted. In one of these the ICBP indicated the need for a shunt, but shunting was not possible for technical reasons and a stroke due to hypoperfusion occurred. In another patient a stroke occurred as a result of embolism. There was only one patient where the ICBP possibly incorrectly predicted that a shunt would not be necessary. Four strokes due to various causes occurred in the 63 shunted patients. Shunting was not withheld from these patients in order to prove that ICBP would correctly predict their vulnerability to hypoperfusion since to have done so would be unethical. The results indicate that in patients with unilateral carotid stenosis the ICBP is an accurate indicator of which patients can undergo carotid endarterectomy without the need for shunting.
PROFILE OF GASTRIC STRESS ULCERATION FOLLOWING ACUTE CERVICAL CORD INJURY: AN ANIMAL MODEL
Authors: MacLellan Donald G. , Shulkes Arthur , Hardy Kenneth J.
Published: January 2008

A reproducible model of acute gastric stress ulceration has been described in the tetraplegic rat. The characteristics of the development of acute gastric ulceration and the concentrations of plasma gastrin have been examined. There was a significant increase in gastric stress ulceration within 4 h of producing the tetraplegia. The ulceration was confined to the glandular portion of the stomach and occurred equally on crests and rugal throughs. Plasma gastrin concentrations were not changed by spinal cord section. This characterized model can serve as a basis for further investigation of the aetiology and prophylaxis of acute gastric ulceration in quadriplegia.
AN ALTERNATIVE APPROACH TO SKIN GRAFT DONOR SITE DRESSING
Authors: Dewan P. A. , Packer S. G. K. , Robinson R. G.
Published: January 2008

A simple closed suction drainage dressing for skin graft donor sites, prepared from readily available items, is described.
HIGH CALORIE AND PROTEIN CLEAR FLUID REGIME FOR PRE‐OPERATIVE BOWEL PREPARATION
Authors: Fletcher J. P. , Little J. M.
Published: January 2008

The effect of high calorie and protein clear fluid regime for pre‐operative bowel preparation was assessed in 16 patients requiring aortic grafting for aneurysm or occlusive disease. Patients were randomized to receive either standard clear fluids or special high calorie and protein clear fluid regime for 48 h pre‐operatively. Nitrogen balance was calculated for the first 5 postoperative days. The group receiving the special high calorie and protein clear fluid regime had consistent reduction in negative nitrogen balance on each day of the study with mean daily negative nitrogen balance of 9.00 g compared to 12.33 g, this difference being highly significant (P= 0.004).
GASTRIC RUPTURE FOLLOWING CARDIOPULMONARY RESUSCITATION
Authors: Woods S. D. S. , Hutchinson G. , Johnson W. R. , Masterton J. P.
Published: January 2008

Three cases are reported in which gastric rupture occurred during cardiopulmonary resuscitation. Precipitating factors are considered and discussed with reference to the literature. This condition has been considered to be rare. Its occurrence gready adds to the morbidity and mortality of the underlying disease. Possible precautions to limit its occurrence are discussed.
EVALUATION OF A NEW OESTROGEN RECEPTOR ASSAY
Authors: Alexander A. I. , Mercer R. J. , Lie T. H. , Letchford D. , Bennett R. C.
Published: January 2008

Replicate assays of oestrogen receptor (ER) concentration on 81 specimens of human breast carcinoma were performed to compare the ligand binding Sephadex separation method with a polystyrene bead linked antioestrogen receptor monoclonal antibody technique (enzyme immunoassay [EIA], Abbott Laboratories). Each specimen was homogenized and the cytosol divided into four fractions. Replicate assays by each method gave an estimate of reproducibility. The mean CV (coefficient of variation = standard deviatiodmean) for the ligand binding method was 9.73% compared with a mean CV of 17.9% for the ElA method. In the clinically significant range of ER values, around the cut‐off point between negative and positive assays, there was no difference in the precision of the two assays (Mann Whitney U‐test). The correlation between methods gave a Pearson'Product Moment Correlation Coefficient (r value) of 0.822, significant at the P < 0.001 level, indicating a close correlation between the two methods. The highest CVs for both methods were in the range of oestrogen receptor concentrations, below 10 fmolhg cytosol protein. Using 10 fmol/mg cytosol protein as a cut‐off between negative and positive assays, 9.87% of the specimens would be reclassified as either positive or negative by the new assay method. The new assay method is, therefore, acceptabel for clinical use.
CLINICAL TRIAL OF PROPHYLAXIS OF WOUND SEPSIS IN ELECTIVE COLORECTAL SURGERY COMPARING TICARCILLIN WITH TINIDAZOLE
Authors: Ryan Mr. P. J. , Fink R. L. W. , Co‐ordinator) Mr. H. Ross(Trial , Allsop Mr. J. R. , Andrew Dr. J. H. , Bennettt Professor R. C. , Braithwaitte Mr. P. A. , Carson Mr. P. , Collins Mr. J. P. , Collopy Mr. B. T. , Cuthberston Mr. A.M. , Ewing Mr. H. , Forbes Mr J. F. , Francis Mr. D. M. , Gray Mr. B. N. , Hardy Professor K. J. , Harvey Dr. K. , Jones Mr. T. , Judson Mr. R. T. , Kune Professor G. A. , Mackay Mr. J. R. , McLeish Mr. A. R. , Martin Mr. C. J. , Millar Mr. K. J. , Pavillard Dr. E. R. , Penfold Mr. J. C. B. , Read Mr. A. E. , Sali Mr. A. , Tosolini Dr. F. A.
Published: January 2008

A prospective randomized single blind controlled clinical trial was undertaken to compare prophylactic therapy using a systemic antibiotic active against both aerobic and anaerobic bacteria with an oral antibiotic agent active only against anaerobic bacteria in elective colorectal surgery. One hundred and thirty‐one patients received ticarcillin and 130 received tinidazole. The wound infection rate was 8% in those patients receiving ticarcillin prophylaxis and 20% in those receiving tinidazole (P < 0.05). Multivariate analysis of the factors affecting wound infection rate showed that there were three independent factors that reached statistical significance: the prophylactic antibiotic used; the type of hospital (public or private) in which the operation was performed, and the presence of a stoma at operation. The wound infection rate in those patients receiving tinidazole prophylaxis was more than twice that reported previously by the authors. The mortality in patients receiving ticarcillin prophylaxis was 1.5% compared to 9.2% in those receiving tinidazole prophylaxis (P < 0.05). The clinical anastomotic leakage rate was similar in each antibiotic prophylactic group, 8.6% in those receiving ticarcillin and 7.3% in those receiving tinidazole.
SUPERIOR MESENTERIC VEIN THROBOSIS
Authors: Ghaly Moheb , Frawley John E.
Published: January 2008

Superior mesenteric venous occlusion may be difficult to recognize, but is important as it carries a better prognosis than superior mesenteric arterial occlusion, and may be amenable to surgical treatment. Three successful cases treated by thrombectomy have appeared in the literature. A case of successful superior mesenteric vein thrombectomy with bowel resection is reported.
SPINAL INJURY AND COMPUTERIZED TOMOGRAPHY: A REVIEW OF FRACTURE PATHOLOGY AND A NEW APPROACH TO CANAL DECOMPRESSION
Authors: Grant J. M. F. , Sears W. R.
Published: January 2008

The plain X‐rays and CT scans of 23 cases of thoracolumbar and 18 cases of lower (below C2) spinal compression fractures were compared. A new picture of the fracture pathology has emerged as several features consistently appeared and are described: a midline or slightly oblique split of the vetebral body; posterolateral fractures of the body in the region of the developmental neurocentral joint; fragments of the body displaced backwards into the canal at the level of the pedicles; oblique laminal fractures; and separation of the zygapo‐physeal rim in thoracolumbar fractures. With this more complete picture of the bony injury, in particular canal encroachment, a new method of anterolateral canal decompression has been tried and is described.