bluuebunny/crossref_metadata_2025 huggingface dataset:
The surgical treatment of enteritis necroticans
Authors: Millar John S
Published: March 2007

The optimum timing of surgery in acute cases of enteritis necroticans with bowel obstruction has not been established. Two similar groups of patients with this condition were sequentially compared to determine if early surgical intervention reduces mortality. In the first group 42 per cent of the 79 patients received medical treatment only and 58 per cent had an operation at a median time of 4 days following the onset of obstruction. In the second group 96 per cent of the 50 patients received surgery at a median time of 2 days following the onset of obstruction and 4 per cent received medical treatment only. The mortality in the second group (21 per cent) was half that of the first group (43 per cent). Surgery after a short period of resuscitation is advocated for all cases of enteritis necroticans with bowel obstruction.
The surgical treatment of the radiation-damaged rectum
Authors: Cooke S A R , De Moor N G
Published: March 2007

Details are given of 37 consecutive patients with radiation damage to the rectum. Twenty-eight presented with rectovaginal fistulas, 3 with haemorrhage from ulcerative proctitis, 3 with low rectal strictures, 2 with a painful rectal ulcer and 1 with a rectal carcinoma. Thirty-five of the 37 had been treated for carcinoma of the cervix, and of these, 30 were Black South African women in whom this disease forms approximately 70 per cent of all malignancies. Associated pathology in these patients included urinary fistulas, small bowel fistulas or stenoses and a variable degree of fibrosis of the pelvic cellular tissue.

Treatment involved subtotal rectal resection with restoration of continuity by means of a peranal sleeve anastomosis between healthy colon and the rectal stump denuded of its mucosa. Technical success was achieved in 35 of the 37 patients, with no mortality. The functional results were assessed both subjectively and objectively in 31 patients followed up for more than 6 months. Full continence was achieved in 54 per cent initially, improving to 75 per cent (21 of 28) at 1 year postoperatively. At 1 year, variable degrees of incontinence for a liquid stool persisted in 7 of 9 patients who had low fistulas with a low anastomosis at dentate line level. Where anastomosis was possible at a higher level, all 19 patients cured of fistula, ulcer, stenosis or haemorrhagic proctitis were fully continent at 1 year.
Kimura's disease with salivary gland involvement
Authors: Tham Kyi-Toe , Leung Ping-Chung , Saw Daisy , Gwi Elaine
Published: March 2007

Fourteen cases of Kimura's disease involving parotid and submandibular glands in Chinese patients are described to draw attention to this unique lesion which has been reported mainly in the Chinese and Japanese literature. Blood eosinophilia is almost always present, there is a male preponderance and the aetiology is unknown. Surgical excision is recommended though irradiation and steroid therapy have also been used.
High colloidal uptake in axillary nodes with metastatic disease
Authors: Peyton J W R , Crosbie J , Bell T K , Roy A D , Odling-Smee William
Published: March 2007

Axillary lymphoscintigraphy using 99Tcm antimony sulphide colloid has been carried out in 29 patients with suspected breast cancer and was correlated with histology. Of the 23 with proved tumour, axillary node metastases were found in 19 and, although 10 did have diminished uptake on the side of the lesion, 5 had an equal uptake in both sides and 4 had an increased uptake on the side of the lesion. Further, some of the nodes in which the high uptake had occurred were those heavily infiltrated by tumour. It is concluded that: a, lymphoscintigraphy with antimony sulphide colloid is not a reliable technique for the detection of metastatic disease in the regional nodes; b, any lymphoscintigraphy with this or any other agent requires more meticulous histological correlation than hitherto before it can be assumed to have any proved clinical value.
Anal fistulas in Crohn's disease
Authors: Marks C G , Ritchie Jean K , Lockhart-Mummery H E
Published: March 2007

Anal fistulas were recorded in 112 patients out of a series of 329 patients with Crohn's disease admitted to St Mark's Hospital for the first time between 1965 and 1974. Only 13 of the 112 patients had small bowel disease alone. The remainder all had involvement of some part of the large bowel. There were 125 fistulas in the 112 patients. No treatment was attempted for 47 fistulas (38 per cent). Most patients had low fistulas which were treated by conventional techniques and healed successfully. Limited surgery was often successful in curing the symptoms of patients with more difficult fistulas. Anal lesions were the major reason for surgery in only a third of the patients who finally underwent excision of the rectum.
Physiological studies of the anal sphincter musculature in faecal incontinence and rectal prolapse
Authors: Neill Mischel E , Parks Alan G , Swash Michael
Published: March 2007

The clinical, anorectal manometric and electrophysiological findings in 24 patients with faecal incontinence, 10 of whom also had rectal prolapse, and in 8 patients with rectal prolapse without incontinence, are reported. Single fibre electromyographic studies and anal reflex latencies were abnormal, indicating damage to the innervation of the pelvic floor musculature, in all the patients with faecal incontinence, with or without rectal prolapse. These studies were normal in 7 of the 8 patients in whom rectal prolapse occurred without incontinence. These investigations imply that denervation of the sphincter musculature can be recognized by electrophysiological tests in most patients with primary faecal incontinence and that the pathogenesis of rectal prolapse differed in the two groups of patients.
Integrity of low colorectal EEA-stapled anastomosis
Authors: Kirwan W O
Published: March 2007

Anastomotic integrity after a low colorectal EEA-stapled anastomosis performed for cancer was assessed by a contrast enema in 30 patients. There was an overall 20 per cent radiological anastomotic leakage rate. The leakage rate in the last 10 cases, however, was zero. This indicates that increased familiarity with the technique results in fewer complications.
Colonic mucosal—submucosal blood flow and the incidence of faecal fistula formation following colostomy closure
Authors: Forrester Donald W , Spence Vance A , Walker William F
Published: March 2007

Fistula formation following closure of a colostomy occurs most frequently when closure is carried out within the first few weeks of construction and may be related to an impaired local microcirculation. Using a recently described method for measuring colonic mucosal—submucosal blood flow, the variations in local flow which occur during the first month after colostomy construction were determined in 8 patients. Mean blood flow increased from 6·9±1·8ml min−1 100g−1 (s.d.) at 7 days to 31·1±12·5ml min−1 100g−1 (s.d.) at 28 days. In a further 40 consecutive patients undergoing colostomy closure, blood flow measurements were made before operation. Eight patients developed a faecal fistula, and in 5 of these patients mucosal—submucosal blood flow was found to be less than 15ml min−1 100g−1. In every successful colostomy closure blood flow was greater than 15ml mi−1 100g−1. This study provides evidence that a subnormal blood flow is one of the factors associated with fistula formation following the operation of colostomy closure.
The Kock ileostomy reservoir: An experimental study of methods of improving valve stability and competence
Authors: Cranley Brian , McKelvey S T D
Published: March 2007

The performances of four valve designs which have been used in clinical practice in the Kock continent ileostomy reservoir were examined and compared to four further modifications in an experimental study on dogs. It was found that a stable valve could be consistently produced by subjecting the gut, which forms the valve, to deep seromuscular diathermy and by excluding the mesentery completely from the intussusception. Construction of the valve with the autosuture GIA Stapling device shortened the operating time considerably but did not improve on valvular stability.
A trial of total gastrectomy, combined with total thoracic oesophagectomy without formal thoracotomy, for carcinoma at or near the cardia of the stomach
Authors: Kirk R M
Published: March 2007

There is a high incidence of residual tumour in the cut ends following orthodox resections for gastric adenocarcinoma and oesophageal squamous carcinoma at or near the cardia. In the hope of preventing the tragic recurrence of malignant dysphagia in patients who have survived a high-risk operation for its relief, the whole stomach and thoracic oesophagus were resected in 6 patients, establishing continuity using jejunum or colon, with anastomosis in the neck. Of 6 patients, 5 survived the operation. Of 2 followed up for more than 1 year, 1 has survived 5·5 years without recurrence, 1 died after 1 year with no post-mortem evidence of recurrence. This radical operation merits an extended trial in suitable patients.
Ventilatory capacity after three methods of anaesthesia for inguinal hernia repair: A randomized controlled trial
Authors: Godfrey P J , Greenan J , Ranasinghe D D , Shabestary S M , Pollock A V
Published: March 2007

One hundred consecutive male patients undergoing elective inguinal herniorrhaphy were randomized to receive general, epidural or local anaesthesia, and the patterns of ventilation were studied before and after operation. General anaesthesia caused more depression of FEV1 and FVC than the other two methods, but no important arterial hypoxia or clinical chest complications ensued. One patient suffered minor staphylococcal wound infection, and one died of massive pulmonary embolism on the eleventh day.
A randomized trial to assess childhood circumcision with the Plastibell device compared to a conventional dissection technique
Authors: Fraser Ian A , Allen Michael J , Bagshaw Philip F , Johnstone Michael
Published: March 2007

A randomized trial of routine circumcision in children using the Plastibell device is described and compared to a dissection suturing technique. One hundred children were studied with a mean age of 4·7 years. The device was applicable to all boys up to the age of 8, and a few older. General discomfort was carefully assessed and slightly less common after Plastibell circumcision, but dysuria more so. No serious complication was encountered with either method; infection was slightly more common after the conventional procedure. Cosmetic results were similar for both methods. It is concluded that the Plastibell device is a satisfactory method for circumcising children of this age.
Subclavian arteriopathy in the young patient
Authors: Drury J K , Pollock J G
Published: March 2007

Non-atheromatous stenosis of the subclavian artery is rare. A 10-year experience, comprising 5 cases of non-infective arteritis and 1 of fibromuscular dysplasia, in patients of average age 29 years, is described. The literature is reviewed and the possible aetiology discussed. Acceptable functional results were obtained using extra-anatomical procedures such as carotid subclavian and carotid axillary bypass. There was no appreciable morbidity.
Genito-urinary tract injuries of civil hostilities
Authors: Archbold James A A , D'sa Aires A B Barros , Morrison Ernest
Published: March 2007

During 10 years of civil violence, 76 patients whose injuries included damage to the genito-urinary tract were admitted to the Royal Victoria Hospital, Belfast. This paper reviews these injuries, their management and, where possible, eventual outcome.
Delayed primary wound closure in gangrenous and perforated appendicitis
Authors: Pettigrew Ross A
Published: March 2007

A prospective randomized trial was performed on 122 patients with perforated or gangrenous appendicitis to determine whether delayed primary wound closure lowered morbidity from wound infection. The 54 per cent wound infection rate with delayed primary closure was significantly inferior to the 18 per cent infection rate for primary closure with topical ampicillin powder (P = 0.0082), but not significantly different from the 37 per cent infection rate for primary closure alone. Furthermore, patients disliked delayed primary closure, their hospital stay was prolonged and 17 per cent of their wounds became contaminated with Staphylococci before being closed. Delayed primary wound closure should not be used in treating perforated and gangrenous appendicitis wounds.
Intussusception: Analysis of 98 cases
Authors: Raudkivi Peter J , Smith H Lawrence M
Published: March 2007

A retrospective study of the clinical features and surgical management of 98 cases of paediatric intussusception treated in New Zealand during the past 16 years is presented. The classic triad of vomiting, rectal bleeding and abdominal pain occurred in only 20 per cent of patients. Barium enema examination was used in 67 patients but successful reduction was achieved in only 13. Laparotomy was performed in 85 patients with 1 operative death. Gangrenous bowel was found in 17 patients and 24 required bowel resection with no associated mortality. This high rate of bowel resection appears to be related to the long duration of symptoms before the diagnosis was established. It is concluded that earlier diagnosis is the single factor most likely to reduce morbidity.
Long term effects of arterialization of the portal vein stump in dogs with Eck's fistula
Authors: Aldrete Joaquin S , Soyer M Tanju , Han Sang Y
Published: March 2007

This study investigates the possibility of avoiding the sequelae of Eck's fistula in dogs by preserving the hepatic blood flow with an autologous vein graft inserted between the infrarenal aorta and the transected stump of the portal vein at its entrance into the liver. Ten dogs with such experimental preparation were observed for signs of encephalopathy; the patency of the grafts was assessed by periodic arteriograms.

The signs of encephalopathy and general deterioration usually observed in dogs with Eck's fistula were prevented; however, marked dilatation of the intrahepatic branches of the portal vein leading sometimes to spontaneous rupture of the liver or to thrombosis of the venous graft was observed. Thus, this technique does not appear to be a satisfactory long term solution for preventing the deleterious effects of Eck's fistula in dogs.
A scanning electron microscopy study of ultrastructural changes in the colonic mucosa of patients with large bowel tumours
Authors: Traynor O J , Costa N L , Blumgart L H , Wood C B
Published: March 2007

Scanning electron microscopy (SEM) has been used to compare the appearances of the colonic mucosal surface and overlying mucus layer of patients with normal colons, adenomatous polyps and colorectal carcinoma. The normal colonic mucosa had a characteristic orderly arrangement of crypts and was completely covered by an intact mucus layer. Epithelial and cryptal irregularities were seen on the surface of both polyps and carcinomas, and, in addition, the mucus layer was fragmented, leaving areas of the underlying epithelium exposed. These changes were more marked in colorectal cancers than in polyps and were present to a lesser degree in the apparently normal mucosa adjacent to tumours. The findings indicate that SEM can detect minor subtle irregularities on the surface of the colon and so may be useful in detecting pre-neoplastic and early neoplastic changes.
The acute treatment of haemorrhage from oesophageal varices: A comparison of oesophageal transection and staple gun anastomosis with mesocaval shunt
Authors: Osborne D R , Hobbs K E F
Published: March 2007

Two matched groups of 20 patients with bleeding oesophageal varices were treated by the same surgical team by either oesophagogastric transection and anastomosis using a mechanical stapling instrument or by mesocaval portosystemic shunt operation. Five of the patients treated by transection died postoperatively, 2 of the survivors developed portosystemic encephalopathy (PSE). 2 died later and 5 rebled. Seven of the patients who had a mesocaval shunt died postoperatively, 8 developed PSE, 3 died later and 4 rebled. It is concluded that oesophagogastric transection and anastomosis using a mechanical instrument is preferable to portal decompression for managing bleeding oesophageal varices in the urgent situation.
Biliary surgery in the same admission for gallstone-associated acute pancreatitis
Authors: Osborne D H , Imrie C W , Carter D C
Published: March 2007

The clinical course of 47 patients with gallstone-associated acute pancreatitis who had surgery during the same admission has been reviewed. In 37 patients, when the signs and symptoms of pancreatitis settled on conservative management, biliary tract surgery was safely performed during that admission without mortality. The 10 patients whose clinical condition failed to settle prior to surgery had a complicated hospital stay and a 50 per cent mortality. A revised prognostic factor grading system has been outlined in which the age factor is removed and serum transaminase levels are considered of prognostic significance only if greater than 200 u/l within 48 h of admission. This revised system gives a more accurate assessment of the severity of individual attacks of gallstone-associated acute pancreatitis.
Radionuclide biliary scanning in acute pancreatitis
Authors: Glazer Geoffrey , Murphy Frank , Clayden Gerald S , Lawrence Rosemary G , Craig Oscar
Published: March 2007

Radionuclide biliary scanning with 99Tcm-labelled HIDA was performed in 36 patients with acute pancreatitis within 3 days of admission. Twenty had a non-visualized gallbladder on scanning and all were subsequently shown by cholecystography (n = 16) andlor operation (n = 16) to have underlying gallstones; 5 of the 16 cholecystograms revealed a ‘functioning’ gallbladder. Sixteen patients had normal HIDA scans with gallbladder visualization, and subsequently all were shown by cholecystography (n = 15) or operation (n = 1) to have a normal biliary tree; 15 of these had an alcoholic background. In the differentiation of gallstone from non-gallstone pancreatitis, biliary scanning was completely accurate and a better discriminant than the liver function profile or the clinical features, the latter being valueless.

Whether or not the gallbladder is visualized on biliary scanning depends on the presence or absence of cystic duct obstruction, a fact confirmed in two other groups: in 53 patients with acute cholecystitis and non-visualized gallbladders on scanning, 52 were subsequently shown to have ‘non-functioning’ gallbladders by oral cholecystography (1 having stones in a functioning gallbladder), whereas 9 other patients with normal biliary scans, all had ‘functioning’ gallbladders on oral cholecystography.

Thus, acute gallstone pancreatitis appears to be accompanied in the early stages by occlusion of the cystic duct, though this is a transient phenomenon in about one-third of the patients. The cause of this occlusion may be oedema in some cases but its relationship to the pathogenesis of acute pancreatitis is unclear.
Surgical decision making
Authors: Ruckley C V , Ferguson J B P , Cuthbertson C
Published: March 2007

The decision-making process in a general surgical outpatient clinic has been studied by following the course of 2000 consecutive newly referred patients of whom 1045 were put on surgical waiting lists. Surgeons were asked to record their reasons for selection for each of four levels of care: main ward, 5-day ward, day bed unit or minor outpatient surgery. Selections were influenced by social and psychological factors in 12 per cent of patients, the remaining 88 per cent were determined by the medical history or physical condition.

The decision was assessed by monitoring the progress in hospital and the outcome at a follow-up clinic. In 84 per cent of patients arrangements had gone according to plan. Eleven (1·75 per cent) of 5-day or day care patients were transferred to a higher level of care and 13 (1·4 per cent) of the total series were re-admitted.

Surgeons were asked to forecast the duration of postoperative stay. Thirty-six per cent were discharged on the day forecast, 63 per cent within 24 h and 75 per cent within 48 h. Forrecasts of length of stay for hernias and varicose veins were accurate but were usually underestimated for major surgery.

It is concluded that for the majority of general surgical patients the selection of the level of care and the forecast of postoperative stay were sufficiently reliable to allow confident and definite advice to be given to the patient and to allow resources to be efficiently used.
Haemodynamic assessment following iliac artery dilatation
Authors: Gunn I G , Cowie T N , Forrest H , Quin R O , Sheldon C , Vallance R
Published: March 2007

Fourteen patients with symptomatic atheromatous stenoses of common or external iliac arteries underwent percutaneous arterial dilatation. Twelve procedures were considered successful in terms of arteriographic and symptomatic improvement but the application of three haemodynamic indices (pressure index, pulsatility index and the papavarine test) indicated that only 8 patients had gained a significant improvement in blood flow. These results illustrate the need for quantitative measurements in the assessment of this new technique.
Propranolol in the surgical treatment of hyperthyroidism, including severely thyrotoxic patients
Authors: Feely John , Crooks J , Forrest A L , Hamilton W F , Gunn Andrew
Published: March 2007

The perioperative course of 44 hyperthyroid patients prepared for surgery with propranolol alone, including 11 with severe thyrotoxicosis was compared to that of 20 euthyroid patients prepared for surgery with carbimazole. Conventional propranolol at a dosage of 160 mg/day was frequently insufficient to produce a high degree of beta-adrenergic blockade, particularly in severely thyrotoxic patients. A greater than 25 per cent reduction in sitting pulse rate was associated with a high degree of beta-blockade. The clinical course of patients with mild or moderate thyrotoxicosis was similar to that of the patients prepared with carbimazole. In contrast, the course of severely thyrotoxic patients was complicated and, in addition to a higher preoperative propranolol dosage, these patients commonly required supplemental propranolol after operation. Although thyroid crisis did not occur in any patient, we cannot recommend the use of propranolol alone for the severely thyrotoxic patient.
The value of preserving the anal sphincter in operations for ulcerative colitis and polyposis: A review of 22 mucosal proctectomies
Authors: Johnston David , Williams Norman S , Neal David E , Axon Anthony T R
Published: March 2007

Ulcerative colitis and polyposis are both diseases of the mucosa. They can be cured by colectomy combined with selective mucosal proctectomy, without sacrifice of the anal sphincters or damage to bladder or sexual function. Terminal ileum, either as a straight tube or in the form of a pouch, is drawn down through the denuded tube of anorectal muscle and anastomosed to the mid-anal canal. A temporary defunctioning ileostomy is always used. Caecum has also been used as a neorectum after mucosal proctectomy, but without long term success.

Twenty-two patients, 20 with ulcerative colitis and 2 with polyposis, have been treated by mucosal proctectomy in the past 4 years, with no mortality. The caeco-anal procedure proved a failure because of recurrence of colitis, although the early functional results were good. After ileo-anal anastomosis, continence was perfect by day, but 2 patients had occasional lapses at night. The disadvantage of straight ileo-anal anastomosis is frequency of bowel action (6–9 times a day), even with codeine medication, although the patients considered the operation a success. Some form of pelvic reservoir is therefore desirable and our early experience with the triplicated ileal pouch is encouraging.
Surgical approach to corrosive injuries of the stomach
Authors: Di-Costanzo J , Cano N , Martin J , Noirclerc M
Published: March 2007

The surgical management of corrosive injuries of the stomach has not yet been clearly defined. This work analyses the results achieved with a surgical protocol included in a new therapeutic approach. This approach applied to 111 consecutive patients was based upon three points: (a) early fibroscopic examination, (b) protection of severe burns by total parenteral nutrition and (c) reparative surgery in the complete healing phase. The stomach was involved in 89 per cent of the 93 cases with proved gastrointestinal lesions; gastric lesions were isolated in 42 per cent of cases. The frequency of gastric involvement is partly related to the type of product ingested; the intensity of lesions is correlated with the quantity and the concentration of corrosive products. After a 3-month total parenteral nutrition period, reparative surgery can be performed without local complications in severe cases. Limited resections of the stomach must then be preferred when possible. In cases with total involvement bypass techniques can be carried out. Indications for early surgery are not yet well defined.
The treatment of pleomorphic adenomas by formal parotidectomy
Authors: Stevens K Lindsey , Hobsley M
Published: March 2007

We reviewed 100 patients who underwent formal parotidectomy. Seventy-two were new patients in whom a parotid lump proved to be a pleomorphic adenoma. Twenty-eight were patients in whom a tumour had recurred after treatment for pleomorphic adenoma by local excision (with or without irradiation) elsewhere. After a follow-up of 1–15 years (median 4 years), there were no recurrences in the primary group but 5 recurrences among the secondary cases. Permanent facial nerve damage was not seen in the primary group, but 11 patients undergoing secondary parotidectomy were left with some permanent facial weakness. Malignant change occurred in 4 patients in the secondary group.
The role of abdominal surgery in the treatment of advanced testicular germ cell tumours
Authors: Jones B M , Newlands E S , Begent R H J , Rustin G J S , Bagshawe K D , Johnson A G , Reynolds K W
Published: March 2007

Twenty patients with advanced testicular teratoma and 1 with advanced seminoma have undergone abdominal surgery for the removal of residual disease following treatment by sequential chemotherapy (1). Fourteen out of the 21 patients (66 per cent) have achieved complete remission with a follow-up period of 6–41 months. In 12 patients (57 per cent) the tumour had undergone histological maturation or necrosis following chemotherapy, those patients in whom the tumour remained histologically active having a worse prognosis. Raised preoperative serum levels of the tumour markers human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP) indicating active disease, forecast a particularly poor prognosis, 5 out of 9 such patients (55 per cent) having died. Computerized tomography gave false negative results in 3 patients (14 per cent). Postoperative complications were few, and only 2 patients (9 per cent) suffered with failure of ejaculation. At present our policy is surgical removal of any residual mass after chemotherapy to determine the histology, and, wherever possible, to achieve complete clinical and biochemical remission. Six patients with an apparently poor prognosis have benefited directly from surgery and remain in long term remission. The selection of patients who benefit most from surgery can only be determined by more experience and longer follow up.
Late results of proximal gastric vagotomy without drainage for duodenal ulcer: 5–9-year follow-up
Authors: De Miguel Jacinto
Published: March 2007

From 1970 to 1974 proximal gastric vagotomy without drainage was performed in 158 patients for duodenal ulcer. One patient died, giving an operative mortality of 0·6 per cent. Nine unrelated deaths occurred during the period of survey and 5 other patients were lost to follow-up. The remaining 143 patients were followed-up for a minimum of 5 years and a maximum of 9 years.

The most frequent symptoms were epigastric fullness and intolerance to milk. Early dumping, detected in 6·7 per cent of the patients, was always mild. Diarrhoea, also very slight and often only related to the ingestion of milk, was seen in 9·6 per cent. Recurrent duodenal ulcer was proved in 7·7 per cent and strongly suspected in 0·7 per cent and the presence of a new gastric ulcer was also proved in 1·4 per cent of patients, making a total incidence of recurrence of 9·8 per cent. Approximately 89 per cent of the patients were classed as having a satisfactory result and 11 per cent were classed as unsatisfactory.

Proximal gastric vagotomy is clearly effective in reducing the side-effects of gastric surgery, while the incidence of recurrent ulceration in the long term is similar to the incidence of recurrence after truncal or selective vagotomy with a drainage procedure. For these reasons, consideration should be given to the wider use of proximal gastric vagotomy in the elective surgical treatment of duodenal ulcer.
Hospital admissions for acute cholecystitis: Changes in the age and sex distribution in Oxford in the post-war period
Authors: Mitchell Andrew , Morris Peter J
Published: March 2007

Admissions for acute cholecystitis to the Radcliffe Infirmary, Oxford, during the period 1974–1978 have been reviewed and compared with figures previously published for the period 1953–1962 (I).

There was a small overall increase in the annual rate of female admissions for acute cholecystitis between the two periods and this increase can be accounted for by population changes in all age groups above the age of 40 years. However, there was a significant increase in the admission rate of women under the age of 40 which could not be accounted for by changes in population alone. This apparent increase in acute gallbladder disease in young women coincides with the growth between 1960 and 1970 of the number of women taking oral contraceptives, and is further evidence of a causal relationship between the use of the contraceptive pill and the development of gallstones. Women taking oral contraceptive steroids had a higher rate of common bile duct exploration and of sphincteroplasty than did those not taking oral contraceptives.

The annual rate of male admissions almost doubled between the two periods and this increase cannot be accounted for by population changes. There has also been a virtual disappearance of acute cholecystitis in children over the same time.
Report of a prospective trial of dextranomer beads (Debrisan) and silicone foam elastomer (Silastic) dressings in surgical wounds
Authors: Young Howard L , Wheeler Malcolm H
Published: March 2007

A prospective randomized controlled trial of dextranomer beads (Debrisan) and silicone foam elastomer (Silastic) dressings in open infected surgical wounds has been performed. The results indicate that the healing time for wounds treated by Debrisan (n = 25) and elastomer (n = 25) is similar, being 40·92 ± 3·98 and 36·90 ± 3·18 days respectively. The time taken for wounds to become pain-free was similar in both treatment groups, as was the persistence of signs in the wounds of erythema, oedema and slough. Comparison of cost reveals the elastomer dressing to be considerably cheaper than Debrisan.
Difficulties in the diagnosis and management of pyogenic liver abscess
Authors: Northover J M A , Jones B J M , Dawson J L , Williams Roger
Published: March 2007

Thirty patients with pyogenic liver abscess were admitted to King's College Hospital between 1967 and 1978. The overall mortality was 43 per cent (13 patients). The diagnosis was often difficult and in 10 patients the correct diagnosis was not made until post-mortem. Of the 20 patients diagnosed and treated, 17 had a unilocular abscess, of whom 16 survived. The remaining 3 had a multicentric abscess, and only 1 of them survived. Difficulty in diagnosis was sometimes increased by misleading results from special investigations. Clinical awareness leading to early diagnosis, drainage and broad spectrum antibiotic treatment remain the prerequisites for cure.
Injection sclerotherapy for oesophageal varices in children
Authors: Stamatakis J D , Howard E R , Psacharopoulos H T , Mowat A P
Published: March 2007

Oesophageal varices in 21 children with portal hypertension (intrahepatic 13, extrahepatic 8) were treated with sclerotherapy using ethanolamine oleate injected via a fibreoptic endoscope. Repeat endoscopy confirmed variceal obliteration in 18 children with a mean of 3·5 (range 1–8) injections. No patient has bled since obliteration of varices. Complications were oesophageal stricture (2 patients), oesophageal ulcer (5 patients) and haemorrhage within 30 days of injection (5 patients). The early results suggest that this is a satisfactory method for the treatment of oesophageal varices in children.
Parathyroid function during acute pancreatitis
Authors: McMahon M J , Heyburn P J , Playforth M J , Woodhead J S
Published: March 2007

The renal handling of calcium and phosphate, which normally reflects parathyroid hormone (PTH) activity, was studied during the first 5 days after admission to hospital in 18 patients with acute pancreatitis. The ionized calcium level in plasma was calculated from the total calcium, albumin, total protein and pH. Hypocalcaemia (Ca < 1·08) was found in 6 patients and was associated with low urine calcium concentrations, hypophosphataemia and lower renal tubular reabsorptions of phosphate. Although these changes were all consistent with an appropriate renal response to increased PTH production in the hypocalcaemic patients, measured levels of PTH were very variable. In one patient who developed tetany, calcium infusion resulted in a rise in plasma calcium and a reversal of renal changes, but had little influence upon PTH levels. We found no evidence that hypomagnesaemia or proteolytic degradation of PTH were factors in the aetiology of hypocalcaemia.

The discrepancy between evidence of PTH activity from renal function and immunoassayable levels of PTH in plasma might indicate that the parathyroid response, although present, was inadequate to mobilize enough skeletal calcium to prevent hypocalcaemia; it underlines the need for caution in the interpretation of data from radioimmunoassay techniques when taken in isolation in situations where they have not been fully evaluated.
Cholecystoduodenocolic fistula following abdominal trauma
Authors: Griffith C D M , Saunders J H
Published: March 2007

A case of cholecystoduodenocolic fistula following trauma is reported. It is unusual in that the majority of such fistulas are seen in relation to gallstones. The patient was managed initially by total parenteral nutrition and drainage followed by successful operation.
HLA antigens in relationship to duodenal ulceration, gastric acid secretion and the clinical result following vagotomy
Authors: Gough M J , Rajah S M , Giles G R
Published: March 2007

The distribution of 20 HLA antigens was measured in 100 patients with a duodenal ulcer. An increase (P < 0·05) in the incidence of the HLA-BW35 antigen was identified which conferred an increased risk factor of developing a duodenal ulcer of 2·7. The preoperative acid output in patients who had the BW35 antigen was significantly lower than that found in all other patients prior to surgery. The clinical outcome from definitive surgical treatment did not appear to be influenced by the HLA status of the patients.
Adjuvant tamoxifen therapy for early breast cancer: An experimental study with reference to oestrogen and progesterone receptors
Authors: Wilson Alan J , Tehrani F , Baum M
Published: March 2007

There is very little known about the subsequent behaviour of breast cancer following adjuvant endocrine therapy or the effect of this therapy on the oestrogen and progesterone receptor content of recurrent disease. Mammary tumours were induced in Sprague–Dawley rats using n-nitrosomethylurea. In two experiments animals were treated with tamoxifen at different doses prior to the appearance of tumours. Tamoxifen prolonged the induction time and reduced the total number of tumours. Subsequent treatment of established tumours exposed to tamoxifen in the induction period demonstrated a reduced response to further tamoxifen therapy. There was no difference in the oestrogen receptor content of the tumours previously exposed to tamoxifen, but there was a significant reduction in the progesterone receptor content. The results suggest that: (a) patients treated with adjuvant tamoxifen therapy will show a delay in the appearance of recurrent disease with a reduced response to further tamoxifen therapy; (b) the model may provide an in vivo method to examine the relationships between oestrogen and progesterone receptors and response to endocrine therapy.
Randomized controlled trial of colestipol in antibiotic-associated colitis
Authors: Mogg G A G , George R H , Youngs Denise , Johnson Margaret , Thompson H , Burdon D W , Keighley M R B
Published: March 2007

Thirty-eight patients with severe antibiotic-associated postoperative diarrhoea were entered into a randomized controlled trial to compare colestipol (an ion exchange resin) in 17 patients with placebo (sherbet) in 21 patients. Clostridium difficile or its toxin was present before treatment in 12 of the colestipol group, compared with only 5 in the placebo group. Because of the low incidence of Cl. difficile or its toxin, the placebo group data from 22 patients receiving placebo in a previous trial (9 of whom had Cl. difficile or toxin) were included for comparison. Neither colestipol nor placebo had any influence on the faecal excretion of Cl. difficile or its toxin. Colestipol was clinically no better than placebo. In view of the persistent faecal excretion of Cl. difficile toxin, ion exchange resins cannot be recommended for the treatment of antibiotic-associated colitis.
Effect of surgery on monocyte function
Authors: Oladimeji M , Grimshaw A D , Baum M , Patterson K G , Goldstone A H
Published: March 2007

In vitro monocyte lysozyme production (IVMLP) was assessed in 10 male patients preoperatively and at intervals postoperatively. A similar procedure was carried out in 6 sex- and age-matched controls. In contrast to the control group where the IVMLP was constant, the IVLMP levels in the surgical group showed a marked increase at 6–10 h postoperatively, falling to control levels after 10 days. In addition, peripheral monocyte counts were carried out using a Technicon Hemalog D counter which produces accurate reproducible counts for cells such as monocytes which occur at low frequency. The peripheral monocyte counts were stable in the control group, whilst in the surgical patients there were significantly higher readings at 36–48 h, which persisted for up to 10 days compared with preoperative counts. This study suggests that surgery has both a qualitative (IVMLP) and quantitative (monocyte counts) effect on the mononuclear phagocytes. These data may be relevant when considering factors that influence the early stages of wound healing.
Traumatic lumbar hernia
Authors: Quick C R G
Published: March 2007

A case of lumbar hernia through Petit's triangle that appeared following a serious road traffic accident is reported. Compression injury of the abdomen is likely to have caused the condition and made it necessary to use a polyester mesh implant for repair.
Typhoid enteric perforation
Authors: Chouhan M K , Pande S K
Published: March 2007

A review of 344 patients with typhoid perforation of the intestine is presented. Patients with enteric perforations should be treated with antibiotics, by fluid and electrolyte replacement and blood transfusion. Surgery is necessary to close the perforated gut and drain the contaminated peritoneum with the minimum surgical interference which will achieve these objectives. Although better conservative management has significantly reduced the mortality of typhoid perforation, early limited surgery is most important if good results are to be obtained.
A study of cytoplasmic oestrogen receptors in patients with breast cancer in a district general hospital
Authors: Spencer G R , Prothero D L , Dawkins P D , Akehurst A C , Turner D R
Published: March 2007

The tumours of 61 patients suffering from primary adenocarcinoma of the breast were assayed for oestrogen receptors (ER), using the dextran-coated charcoal method. A statistically significant relationship (P < 0.05) was found to exist between ER status and the histological grade of the tumour. No relationship was found between ER status and either tumour size or the pathological state of the axillary lymph nodes. It is concluded that it is a practical proposition to establish an ER assay service in a district general hospital, with subsequent benefits for the individual patient.
Primary hyperparathyroidism due to overactive intrathyroid parathyroid glands: A potential cause of failed exploration
Authors: Bainbridge E T , Barnes A D
Published: March 2007

The variable location of the parathyroid glands is a significant factor in unsuccessful cervical exploration for hyperparathyroidism. Particular difficulty may be experienced when an overactive parathyroid is concealed within the substance of the thyroid. Currently available methods of localizing abnormal parathyroid tissue may well fail to indicate an intrathyroid location. The latter possibility should always be considered whenever thorough cervical exploration has failed to reveal a parathyroid tumour as such awareness may obviate re-exploration or an unnecessary sternotomy. This report details the clinical features and operative findings in 6 patients whose primary hyperparathyroidism was due to an overactive intrathyroid parathyroid gland. Successful parathyroid surgery demands a strict routine exploration of the possible sites of overactive glands, virtually all of which are easily accessible through a standard collar incision.
Acute portal vein thrombosis after right hepatic lobectomy: Successful treatment by thrombectomy
Authors: Jaffe V , Lygidakis N J , Blumgart L H
Published: March 2007

In this paper we report a case of an acute portal vein thrombosis which occurred following a right hepatic lobectomy for metastatic liver disease.
Clinical trials of the efficacy and duration of antibacterial cover for elective resection in inflammatory bowel disease
Authors: Hares M M , Bentley Sandra , Allan R N , Burdon D W , Keighley M R B
Published: March 2007

A prospective double-blind placebo controlled trial was performed to test the value of 24-h cover with metronidazole and gentamicin in 57 patients requiring elective resections for inflammatory bowel disease (phase 1). The short term antimicrobial cover was not associated with a reduction in the incidence of postoperative sepsis. A further group of 30 patients who received metronidazole and gentamicin cover for 5 days (phase 2) was therefore studied and the results were compared with phase 1. There was a significant reduction in the incidence of sepsis in the patients receiving 5-day postoperative antibiotic cover compared with the placebo group.
Detection of carotid bifurcation disease: Comparison of ultrasound tests with angiography
Authors: Padayachee T S , Lewis R R , Gosling R G
Published: March 2007

Doppler-shift ultrasound with spectral analysis permits the measurement of the relative heights of systolic peaks (the A/B ratio) in blood velocity sonograms from supra-orbital and common carotid arteries, the temporal artery occlusion test, the common carotid resistance index and transit times of flow-velocity waves in the internal carotid pathway. The results are compared with 201 carotid angiograms and expressed in terms of sensitivity (true positive) and specificity (true negative).

Supra-orbital and common carotid A/B ratios, in combination with the temporal artery occlusion test, detected all grades of carotid artery disease with a sensitivity of 72 per cent and a specificity of 93 per cent. The corrected transit time gave a sensitivity of 57 per cent and a specificity of 89 per cent, whilst the Resistance Index gave a sensitivity of 60 per cent and a specificity of 80 per cent.

The values of ultrasound parameters associated with severe disease, defined as reductions in lumen diameter of 75 per cent or more, of the internal carotid artery are examined. The temporal artery occlusion test gave a sensitivity of 91 per cent and a specificity of 94 per cent. These results were more accurate than those obtained for the corrected transit time (sensitivity 83 per cent, specificity 92 per cent) and for the Resistance Index (sensitivity 75 per cent and specificity 92 per cent).

The results show that of the tests described the supra-orbital and common carotid artery A/B ratios, together with the temporal artery occlusion test, gave the best sensitivity and specificity for detection of both severe and minor carotid bifurcation disease.
Inflammatory bowel disease in the older patient
Authors: Carr N , Schofield P F
Published: March 2007

This paper presents a review of 64 patients in whom the first symptoms of inflammatory bowel disease occurred after the age of 60 years. Inflammatory bowel disease in older patients affects the large bowel much more commonly than the small bowel. The commonest variant is disease localized in the rectum and distal colon, and many of these patients have Crohn's disease (14 out of 28 patients). In 19 patients with localized left-sided colitis it was difficult to distinguish ischaemic colitis, acute diverticulitis and Crohn's disease. Patients with left-sided colitis or total colitis (15 patients) had a high incidence of acute complications, particularly colonic perforation. There should be an awareness of the risks associated with all types of colitis in the older patient.
A comparison of intravenous and oral metronidazole as prophylactic in colorectal surgery
Authors: Beggs F D , Jobanputra R S , Holmes J T
Published: March 2007

In a prospective randomized double-blind trial we have compared oral (n = 46) and parenteral prophylaxis (n = 51) with metronidazole in elective colonic resection. All patients received oral or intravenous metronidazole, together with oral neomycin. The overall infection rate was 11·3 per cent. Six out of 46 patients in the oral group (13 per cent) had a wound infection postoperatively compared with 5 out of 51 patients who received intravenous metronidazole (9·8 per cent). These results suggest that there is no significant difference whether metronidazole is administered intravenously or orally as a prophylactic in elective colonic surgery.
Surgery for primary hyperparathyroidism: Experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient
Authors: Russell Colin F , Edis Anthony J
Published: March 2007

A group of 500 patients with a presumptive diagnosis of primary hyperparathyroidism (HPT) was operated upon at the Mayo Clinic between September 1974 and May 1980 using a standardized operative strategy. Clinical profiles, biochemical data, operative findings and pathological changes are reviewed. Of the 500 patients, 461 (92·2 per cent) were cured after primary cervical exploration. One patient died during the postoperative period, 1 had a permanent unilateral vocal cord paralysis and 10 (2 per cent) had protracted hypoparathyroidism. Owing to the continuing controversy regarding the appropriate therapeutic management of asymptomatic, uncomplicated and mild (‘biochemical’) primary HPT, we further evaluated this surgical experience by comparing the results of operation in two groups of patients: those with (‘biochemical’) HPT (serum calcium < 11 mg/dl) and those with ‘non-biochemical’ HPT (symptomatic or complicated disease or serum calcium > 11 mg/dl). The cure rate in each patient group was greater than 90 per cent. A statistically significant increase in the incidence of negative cervical exploration (4 normal parathyroid glands identified and biopsied) was noted in the ‘biochemical’ group. However, parathyroid disease was found at operation in 92 per cent of these patients. We conclude that cervical exploration in all patients with primary HPT, including those with ‘biochemical’ disease only, is safe and that such an aggressive management policy is justified.