bluuebunny/crossref_metadata_2025 huggingface dataset:
Erythrocyte and plasma circulation times in haemorrhagic shock
Authors: Watkin D F L , Hudson Jennifer
Published: March 2007

A method has been developed in which the simultaneous administration of 51Cr-labelled red bloodcells and 125I-labelled albumin in the dog has been used to compare the flow rates and transit times of erythrocytes and of plasma in three circulatory beds–the hindlimb, the kidney, and the small intestine. Blood-flow rates calculated from either isotope agreed well and were significantly greater than simultaneous direct measurements and electromagnetic flowmeter readings. This difference was due to in complete recovery of the isotope from the venous cannula, recovery ranging from 23 to 96 per cent. When the isotope-flow results were corrected for these losses they did not differ significantly from direct measurements though they were still greater than the electromagnetic flowmeter readings.

The mean transit time for erythrocytes was, on average, 6–8 per cent shorter than that for plasma. There was no significant difference in this percentage for the three vascular beds studied or between a control period and haemorrhagic shock. Thus, in this shock preparation red-cell ‘sludging’ cannot have been extensive. The rationale for the use of low-molecular-weight dextran as a specific ‘antisludging’ agent in shock is, therefore, not supported.
Thoracic enteric cysts and diverticulae
Authors: Ahmed Saeed , Jolleys Ambrose , Dark John F
Published: March 2007

Six cases of thoracic enteric cysts and diverticulae are described to illustrate a manifestation of the split notochord syndrome. The varied clinical, radiological, and operative picture in these cases is emphasized, the common triad being respiratory symptoms, a posterior mediastinal mass, and a vertebral anomaly. The symptoms may, however, be entirely gastrointestinal in the form of abdominal enlargement or gastro-intestinal haemorrhage. Because of the diversity of presentation these patients may come under the domain of the paediatric surgeon, the thoracic surgeon, or the neurosurgeon, and occasionally a combined team approach may be required to obtain satisfactory results in surgical treatment, which is mandatory.
Multiple organ grafts in the pig techniques and results of pancreatic, hepatic, cardiac, and renal allografts
Authors: Calne R Y , Sells R A , Marshall V C , Millard P R , Herbertson B M , Hadjiyannakis E J , Dunn D C , Robson A J , Davis D R
Published: March 2007

Technical descriptions of organ grafting in the pig are given for the liver, heart, and pancreas heterotopically, the kidney and pancreas orthotopically, and simultaneous orthotopic transplantation of the liver and pancreas and the liver, pancreas, and kidney. Recipient animals can withstand these procedures and they and their grafts can be studied from the point of view of immune reactions and organ function.
Prediction of 1-year survival after resection of lung tumours from the preoperative steroid excretion pattern
Authors: Rao L G S
Published: March 2007

A prospective study of 50 patients with lung cancer who were treated by surgical resection of their tumour has shown that most of those who died within 1 year after resection had abnormalities in preoperative steroid excretion whereas most of those who are alive had normal steroid excretion. Of the 21 patients who died within 1 year, 5 died in hospital, mainly as a result of surgical complications, and were found to have an abnormally low androsterone to aetiocholanone ratio and a high total 17-oxosteroid excretion. Those who were discharged alive and well from hospital but who died within 1 year as a result of metastasis to other organs had a low androsterone level in relation to aetiocholanolone and to total 17-hydroxycorticosteroids. Thus, it has been possible to identify by their preoperative steroid excretion 12 out of 14 patients who died within 1 year although they had had a successful resection.
Massive haemorrhage in elephantiasis neurofibroma
Authors: McMaster P
Published: March 2007

An unusual case of elephantiasis neurofibroma associated with massice haemorrhage occurring in an elderly man is reported.
Open skin-grafting in developing countries
Authors: Gibraiel Ezzat A
Published: March 2007

Because of the poor condition of most granulating wounds and the unpredictable and frequently unsatisfactory results of closed skin-grafting, 160 open skin-grafting operations were performed and studied in Egypt and Jordan in order to develop a reliable procedure for use in developing countries. A simple, economical, and successful open grafting method was established. The results are given together with the details of 4 illustrative cases. Important technical points are mentioned. The necessity of the application of open grafts on patients in developing countries is stressed and the advantages of the author's method are discussed.
Vein-graft by-pass in axillary and brachial artery occlusions causing claudication
Authors: Wood P B
Published: March 2007

Four cases of axillary and brachial artery occlusions which caused claudication in the arm and hand are presented. They demonstrate that the effects of reduced arterial supply are equally disabling in the hand as in the leg. Axillary and brachial artery occlusions can be treated by vein-graft by-pass, in a similar way to arterial disease in the leg, with excellent results.
Local recurrence in primary osteosarcoma of the femur
Authors: Hill Peter
Published: March 2007

Cases of primary osteosarcoma of the lower femur treated by through-femur amputation and reported to the Bristol Bone Tumour Registry have been reviewed from the viewpoint of local recurrence.

There were 2 recurrences within the stump and 4 cases with metastases in the ilio-inguinal region.

It is argued that these figures do not justify the routine use of hip disarticulation with its necessarily cumbersome prosthesis in the primary treatment of these tumours.
Pseudocyst of the pancreas
Authors: Simpson Alan , Srivastava V K
Published: March 2007

An account of pseudocyst of the pancreas, which is a less common cause of abdominal swelling, is given. Various methods of treatment are described. A series of 8 patients with pseudocyst of the pancreas is reported. The treatment in each case is described.
Intracranial subdural abscess
Authors: Anagnostopoulos D I , Gortvai Peter
Published: March 2007

Thirty-two cases of intracranial subdural abscess were treated between 1947 and 1969 in two neurosurgical centres. Five patients (15.6 per cent) died. When an E.N.T. focus is detected clinically or radiologically the abscess is always related to it. Four of the 5 fatalities harboured pus along the falx cerebri. Angiography is used to aid localization and to detect further collection of pus. Limited experience in the use of gamma scanning for localization is encouraging. Pus in the subdural space is drained through bur-holes and antibiotics are administered locally. Broadspectrum bactericidal antibiotics are used in high dosage as the initial treatment and cerebral oedema is controlled by mannitol and dexamethasone in the drowsy or unconscious patient. Surgical decompression should be considered when comatose patients do not respond to bur-hole drainage of the pus and medical measures.
Splenosis. A case report and some considerations on the function of splenotic tissue
Authors: Mackie W J , Miller D F
Published: March 2007

A further case of intra-abdominal autotransplantation of splenic tissue is presented. The main importance of the condition probably lies in its recognition at laparotomy.

In the present case although the autotransplanted tissue was histologically similar to normal splenic tissue no normal splenic function could be ascribed to it.
Isotope venography
Authors: Highman J H , O'Sullivan E , Thomas E
Published: March 2007

An isotope method of venography using 99mTc as pertechnetate (or MAA technetium) and a gamma camera is described. Initial results are encouraging. Good visualization of the major venous channels in the lower limbs and pelvis can easily be obtained. Venous occlusion and the formation of collaterals, particularly in the pelvis, are well shown. It appears to be possible to infer the presence of deep venous occlusion in the calf when delayed filling is seen through normal popliteal and femoral veins. The procedure is entirely painless and can easily be performed in the out-patients' department. It avoids the pain consequent on injection of the usual radiographic contrast media and the phlebitis which may also follow their injection. It does not afford the same degree of anatomical detail but this is of minor importance if operative intervention is unlikely.
Fundoplication for hiatus hernia
Authors: Franklin R H , Iweze F I , Owen-Smith M S
Published: March 2007

Eighty-eight patients who had symptomatic hiatus hernia were treated by fundoplication during 1967-70. Worth-while symptomatic benefit was achieved in 88 per cent of the patients who had reflux only and in 80 per cent of those who had radiologically demonstrable strictures as well as reflux.

Both as a primary and ‘salvage’ operation fundopliction gave equally good results, relieving 86 per cent of patients of their symptoms.
Adult hypertrophic pyloric stenosis
Authors: MacDonald John A E
Published: March 2007

Adult hypertrophic pyloric stenosis is an uncommon condition which when encountered is usually mistakenly diagnosed as carcinoma of the antrum. It is a benign disease resulting from hypertrophy of the circular fibres of the pyloric canal and is recognizable radiologically by narrowing and elongation of the pyloric canal. The aetiology is in doubt but the condition is probably congenital. The treatment of choice is partial gastrectomy.
Intraluminal diverticulum of the duodenum
Authors: Papalexandris N M , Lewis D Lincoln
Published: March 2007

In contrast with primary and secondary diverticuli of the duodenum, which are fairly common, the intraluminal diverticulum of the duodenum is a very rare entity.
Experimental investigation of the use of cyano-acrylate adhesive to prevent biliary leakage in percutaneous transhepatic cholangiography
Authors: Georgakakis A
Published: March 2007

A simple modification of the technique of percutaneous transhepatic cholangiography to prevent leakage of bile or blood has been investigated.

Isobutyl 2-cyano-acrylate monomer has been used to obliterate and seal the tract left when the needle and polythene tube are withdrawn, thus effectively preventing leakage.
Intramuscular myxomas
Authors: Rosin R D
Published: March 2007

Seven cases of intramuscular myxoma are presented. Although these lesions appear to be malignant macroscopically they are in fact benign tumours. They are well recognized and described in the pathology literature, but are not so readily recognized by surgeons.
The diagnosis and prophylaxis of pulmonary complications of surgical operation
Authors: Laszlo G , Archer G G , Darrell J H , Dawson J M , Fletcher C M
Published: March 2007

Eighty-eight non-bronchitic and 52 bronchitic patients undergoing elective general and plastic surgical operations in two wards were studied for postoperative chest complications, which were diagnosed by increased purulence of sputum and radiological changes at 24 or 48 hours. Eighty per cent of the patients undergoing upper abdominal surgery and 30 per cent of the other patients had chest complications. Postoperative bronchitis or pneumonia severe enough to delay discharge was found in 14 patients (10 per cent). Twice-daily physiotherapy to the chest did not affect the outcome in 86 patients without chronic bronchopulmonary disease. Routine administration of ampicillin to ‘cover’ chronic bronchitics undergoing general anaesthesia was found to be of no value in a controlled trial of the 52 bronchitic patients. However, bacteriological and radiological studies lend some support to the suggestion that prophylaxis with a bactericidal antibiotic may reduce the incidence and morbidity of postoperative pulmonary infections in patients having upper abdominal operations.
Pneumomediastinum and subcutaneous emphysema after perforation of the duodenum during gastroscopy
Authors: Allan R N , Smallwood C J
Published: March 2007

The first case of duodenal perforation during gastroscopy is reported. The patient's symptoms were mild in contrast to the dramatic picture of perforated peptic ulcer. He developed a pneumoperitoneum, pneumomediastinum, and, in addition, subcutaneous emphysema of the neck—signs more commonly associated with oesophageal rupture than perforation of the duodenum.

The aetiology of these signs and the prevention of this complication are discussed.
An unusual case of swallowed dental plate and perforation of the sigmoid colon
Authors: Cleator I G M , Christie J
Published: March 2007

A case of swallowed dental plate is described in which impaction and perforation occurred in the sigmoid colon. This was treated by resection and end-to-end anastomosis combined with transverse colostomy.
Adenocarcinoma and crohn's disease a report of 2 cases and analysis of the literature
Authors: Darke S G , Parks A G , Grogono J L , Pollock D J
Published: March 2007

Two cases of carcinoma developing in a segment of Crohn's disease are described, one in the large intestine and one in the small intestine. From an analysis of the literature, evidence is advanced with regard to age at the time of developing carcinoma, duration of symptoms attributable to Crohn's disease, anatomical distribution, and observed incidence compared with chance incidence. It is concluded that there is a small but significant risk of carcinoma developing, both in the small and large intestines, in Crohn's disease.
The use of immunized pig lymph-node cells in the treatment of patients with advanced malignant disease
Authors: Symes M O , Riddell A G
Published: March 2007

The treatment of 14 patients with advanced malignant disease by the infusion of pig lymph-node cells pre-immunized against the appropriate tumour is described.

Marked tumour necrosis was seen in 7 cases and 4 of the patients obtained definite clinical benefit.

It is suggested that the therapy may be of most value when used in conjunction with other forms of treatment.
High blood viscosity: An aetiological factor in venous thrombosis
Authors: Dormandy John A , Edelman Joy B
Published: March 2007

This is a preliminary report on a prospective study of 52 general surgical and gynaecological patients designed to investigate a possible relationship between a high blood viscosity and the development of deep venous, thrombosis (D. V. T.). The blood viscosity of the patients was measured immediately before operation and the development of venous thrombosis was monitored with the radioactive fibrinogen technique. The 11 patients who developed a D.V.T. had a blood viscosity, prior to operaton, 21 per cent higher than the patients who did not develop venous throbosis. The difference was 29 per cent if correction was made for variation in the heamatocrit. It was found that a general surgical patient, over 40 years of age, with a preoperatife blood viscosity above 4.3 cP (corrected to a heamatocrit of 45 per cent) will have a 73 per cent chance of deveiopin a D.V.T. after operation.
The effect of antral acidification on acid secretion stimulated by pentagastrin
Authors: Wheeler M H , Prescott R J , Forrest A P M
Published: March 2007

In 6 dogs with innervated antral pouches (4 with vagally innervated fundic pouches and 2 with vagally denervated fundic pouches) the effect of irrigating the antral pouches with acid on the pentagastrin-induced secretion from the fundic pouches was assessed. A range of doses of pentagastrin (0.25–8.0 μg. per kg. body-weight per hour) was given by intravenous infusion for 3 hours at a constant rate, each dose being given on six occasions in separate experiments carried out on separate days. No consistent inhibition of secretion was observed in either preparation. The results do not support the concept of either an inhibitory hormone or an inhibitory neural reflex of antral origin active against pentagastrin-stimulated acid secretion.
An analysis of 59 cases of tracheal stenosis following tracheostomy with cuffed tube and assisted ventilation, with special reference to diagnosis and treatment
Authors: Andrews M J , Pearson F G
Published: March 2007

An analysis of 59 cases of tracheal stenosis after tracheostomy with cuffed tube and assisted ventilation is reported. Special emphasis is placed upon diagnosis and treatment. The detection of severe strictures is usually easily achieved, but mild to moderate degrees of stenosis may present difficulties in diagnosis and may remain undetected for some time.

Management of the strictures included dilatation (14 cases), segmental tracheal resection with primary end-to-end anastomosis (34 cases), staged plastic reconstruction (2 cases), and permanent tracheostomy (4 cases). No treatment was given in 5 cases.

Dilatation achieved a good result in 6 cases and a satisfactory one in 8. Of 34 strictures treated by segmental resection, a good result was obtained in 29 cases, although 7 required a second operation for restenosis. Three cases had an unsatisfactory result and there were 2 operative deaths. Postoperative complications are discussed.

Mild strictures may be satisfactorily managed by dilatation, but some mild strictures and all severe strictures are best treated by segmental resection with primary end-to-end anastomosis. Segmental defects ranging from 0.5 to 5.5 cm. in length can be satisfactorily resected.
The Kirschner operation—a forgotten procedure
Authors: Ong G B
Published: March 2007

Kirschner, in 1920, described an operation for benign stricture of the oesophagus. This entails division of the cervical oesophagus, closing the distal portion, bringing the stomach to the neck, and anastomosing the fundus to the proximal divided portion of the oesophagus. This operation has not been performed since, because of the tedious anastomosis between the divided abdominal oesophagus and the jejunum. However, it may be applied in the treatment of malignant oesophagobronchial fistula when it is desirable to isolate the fistula from the upper alimentary tract. This paper describes the operation as carried out in the treatment of 18 cases of advanced oesophageal carcinoma, 6 of whom had a oesophagobronchial fistula. When the operation was successful the patients could eat a normal diet without spasms of cough.
Glove-powder granuloma of the testis after surgery
Authors: Pugh J I , Stringer Paul
Published: March 2007

A case of epididymitis and periorchitis due to talc granulomatosis 11 years after operation for hydrocele is reported. The pathology of the lesions caused by the inadvertent contamination of tissues during surgical operations is reviewed with particular reference to the testis.
Neurilemmoma presenting as a lump in the breast
Authors: Collins Richard , Gau Gillian
Published: March 2007

As far as is known a neurilemmoma growing in the breast tissue has not previously been reported. Such a case is described here.
The effects of early experimental cryptorchidism and subsequent orchidopexy on the maturation of the guinea-pig testicle
Authors: Atkinson P M
Published: March 2007

A histological study of experimental cryptorchidism in the immature guinea-pig and the results of subsequent orchidopexy are described.

Arrest of development of a testis was produced by delaying its descent into the scrotum. Subsequent orchidopexy at ages up to and beyond puberty allowed development to continue to active spermatogenesis.

The poor results following orchidopexy for natural cryptorchidism in man are discussed in relation to this experimental work and the existence of a primary testicular abnormality is suggested. The superficial inguinal pouch ectopic testicle and the retractile testicle are also discussed.
The effect of unilateral experimental cryptorchidism and subsequent orchidopexy upon maturation of the contralateral scrotal testicle of the guinea-pig
Authors: Atkinson P M
Published: March 2007

A study of the contralateral scrotal testicle of the guinea-pig before and after the surgical treatment of unilateral experimental cryptorchidism is described.

The contralateral scrotal testicle of the guinea-pig has been found to mature quite normally without any evidence of incomplete development. In man, however, the contralateral scrotal testicle of unilaterally cryptorchid patients often shows incomplete development. The difference in results suggests that in man the unilateral cryptorchid state may be associated with a bilateral testicular abnormality. This bilateral abnormality might be the cause of poor fertility and, if severe, might also be the cause of failure of descent of the cryptorchid testicle.
Sincipital encephalomeningoceles
Authors: Whatmore W J
Published: March 2007

A definition of cranial encephalomeningocele is presented together with a classification of the types of sincipital encephalomeningocele and a review of their frequency throughout the world. A series of 30 cases encountered in Burma is described, including the personal details, clinical presentation, diagnostic procedures, general management, operative treatment, and the observations at operation. The aetiology and pathogenesis of sincipital encephalomeningocele are discussed with reference to the literature, to the embryogenesis of the skull and brain, and consideration of the observations made in this series of cases.
The value of plasma gamma-glutamyl transpeptidase in the detection of hepatic metastases
Authors: Irvin T T , Edwards J P , Goligher J C
Published: March 2007

It has been suggested that measurement of the plasma enzyme gamma-glutamyl transpeptidase (GGTP) may be useful in the detection of hepatic metastases.

To assess the value of GGTP as a screening test for hepatic metastases, 40 cases of gastro-intestinal carcinoma were studied prior to surgery.

Ten patients had hepatic metastases, and in 5 of these the plasma GGTP was within normal limits. Abnormal GGTP results were always associated with elevation of the plasma alkaline phosphatase, and preoperative clinical examination of the liver proved to be the most accurate method for the detection of hepatic metastases.
A controlled trial of closed wound suction drainage in radical mastectomy
Authors: Morris A M
Published: March 2007

A controlled clinical trial has been performed to compare the effectiveness of suction drainage with that of static drainage. The trial has shown that in 53 radical mastectomy wounds the rate of wound healing was faster in those cases in which suction drainage was used, with a reduction in incidence of wound infection, breakdown, and necrosis.
Postoperative wound infection in colonic and rectal surgery
Authors: Burton R C
Published: March 2007

There was a statistically significant association between the species of bacteria isolated from the bowel at operation, and the species subsequently isolated from a postoperative wound infection in 100 patients who underwent colonic or rectal surgery. There was also a statistically significant increase in the incidence of Gram-negative bacteriaemia in patients who developed a wound infection following such surgery. This bacteriaemia was most commonly detected before and during the operation. Its role in the aetiology of postoperative wound infection has not yet been established.
Cytotoxic perfusion of the liver via the umbilical vein for liver metastases in carcinoma of the colon
Authors: Bevan P G
Published: March 2007

Four patients with carcinoma of the large bowel and liver metastases have been treated by primary resection and perfusion of the liver with 5-fluorouracil via an umbilical vein cannula.

Two patients survived for 14 and 17 months respectively, 1 is still alive after 17 months, and 1 was relieved of deep obstructive jaundice but died 4 months after treatment. The patients were studied clinically, by serial haematological and liver-function tests, and by hepatography and liver scanning. The only severe toxic effect was diarrhoea in 1 patient. The rationale of this method of treatment is discussed along with other applications. It is considered justifiable to use this technique in this group of patients in an attempt to improve the poor prognosis.
A circulating depressant effect following canine haemorrhagic shock
Authors: Fisher W D , Heimbach D W , McArdle C S , Maddern M , Hutcheson Maureen M , Ledingham I McA
Published: March 2007

Following periods of 1 or 3 1/2 hours of haemorrhagic shock in 12 anaesthetized ventilated greyhounds, ultrafiltrates of plasma taken 4 hours after retransfusion exibited significantly increased depressant activity on guinea-pig atrium in vitro. This effect was significantly greater following prolonged hypotension and could not be accounted for by changes in electrolyte composition. It is suggested that this effect may be related to defective myocardial function following haemorrhagic shock.
Hyperbaric oxygen and wound healing in post-irradiation head and neck surgery
Authors: Greenwood T W , Gilchrist A G
Published: March 2007

Irradiation impairs wound healing owing to reduced vascularity with an increased susceptibility to infection. The case histories of 4 patients with carcinoma of the larynx who have had irradiation and subsequent laryngectomies followed by hyperbaric oxygen therapy are described. It is the authors' clinical impression that skin healing in these patients has been improved by hyperbaric oxygen therapy. The skin changes following ionizing radiation, the rationale of hyperbaric oxygen, and its method of use are described.
Oesophageal intubation in obstructive lesions of the oesophagus
Authors: Das Suman Kumar , John H T
Published: March 2007

In a study of the relative merits of the Mousseau-Barbin and Celestin tubes used for palliation in 60 patients with dysphagia due to mechanical obstruction of the oesophagus by cancer or stricture, the Celestin tube emerged as a better palliative measure than the Mousseau-Barbin tube in so far as operative morbidity and mortality are concerned. In the assessment of the quality of life after intubation the Celestin tube again appears to be the better tube in the early postoperative period but in the later stages there appears to be no significant difference in the quality of life between the two tubes.

The quality of life as defined in this paper appears to have little relation to the duration of survival.
Diaphragmatic rupture due to blunt trauma
Authors: Salleh Hussein Bin Mohamed
Published: March 2007

With the increasing number of abdominal, pelvic, and thoracic injuries due to trauma as a result of roadtraffic accidents rupture of the diaphragm is becoming more frequent. Two personal cases are presented and the literature as regards symptomatology, mechanism of rupture, site of rupture, and treatment is reviewed. Early operative treatment is recommended.
Deep-vein thrombosis in patients with fracture of the upper part of the femur: A phlebographic study
Authors: Smyrnis S A , Kolios A S , Agnantis J K
Published: March 2007

Deep-vein thrombosis was found by phlebography in 60.3 per cent of 58 patients with fracture of the upper end of the femur. The incidence was higher on the left side. Thrombus was detected in the uninjured leg in many cases, and therefore the need for bilateral investigation is emphasized.

The convenience of the radioactive fibrinogen test and ultrasound technique for detecting thrombosis in patients has been widely accepted, but we also consider that phlebography, using a portable radiograph machine, is a valuable and easy method for the detection of deep-vein thrombosis in seriously ill patients.
A randomized prospective clinical trial of single-layer and two-layer inverting intestinal anastomoses
Authors: Irvin T T , Goligher J C , Johnston D
Published: March 2007

Most surgeons recommend an inverting technique for anastomosis of the intestine using two layers of sutures, but it has been suggested that greater safety would be achieved by using an inverting method which involves only a single layer of sutures.

Single-layer inverting and standard two-layer inverting intestinal anastomoses were compared in a randomized prospective clinical study of 60 patients. A similar incidence of anastomotic dehiscence and obstructive complications occurred after both types of anastomosis and it was concluded that single-layer methods of anastomosis do not possess qualities which surpass the standard two-layer method.
Non-malignant breast masses in an african population
Authors: Ajayi O O , Adekunle O
Published: March 2007

The clinical manifestation of non-malignant breast masses in an African population is presented. The pattern of disease is affected by many factors, among which are social habits, poverty, and ignorance. The problems of diagnosis and treatment are discussed. Ulcerating benign masses simulate advanced malignancies and no hasty conclusion should be made on the latter without histological proof or evidence of distant metastases. There may be an indication for mammary amputation in some diseased pendulous breasts.
Demonstration of simple ureterocele prolapsing into the urethra of an adult male
Authors: Parsons C A , Malpass C P
Published: March 2007

A case is reported of a simple ureterocele descending into and obstructing the urethra during micturition in a 30-year-old male who had symptoms for only 6 months. This was demonstrated and recorded by a simple technique using conventional radiographic apparatus.
Arterial embolus to the upper limb
Authors: Champion H R , Gill W
Published: March 2007

Seven cases of arterial embolus to the upper limb are presented. The cases support the current trend to management by embolectomy and the restoration of normal hand function as an important feature.
Glucagon therapy in acute pancreatitis
Authors: Condon John R , Knight Michael , Day John L
Published: March 2007

Thirty patients with acute pancreatitis (10 classified as severe) were treated with glucagon at an initial dose of 1 mg. intravenously followed by 1-1-5 mg. every 4 hours.

Glucagon therapy was associated with the relief of pain and clinical improvement in all the patients including 2 subjects who eventually died. In all but 1 of the patients the plasma amylase fell during glucagon infusion. Two patients died, giving a mortality-rate of 7 per cent compared with 22 per cent and 26 per cent of most published series in Britain.
Ten years' experience in the surgical treatment of basal-cell carcinoma. A study of factors associated with recurrence
Authors: Taylor G Allan , Barisoni Dino
Published: March 2007

A retrospective review of 817 basal-cell carcinomas Which were treated surgically and confirmed by histological examination is presented.

Slightly more than half of the 590 patients were men. Eighty per cent of the lesions occurred in patients over the age of 50 years.

Ninety-four per cent of the lesions occurred in the head and neck with the highest density in the nasal and periorbital regions.

One lesion in 4 had been unsuccessfully irradiated prior to referral.

Less than one-half of the pathology reports gave any indication of completeness of removal. Nineteen per cent of these reported tumour in the margin of resection, indicating incomplete removal.

Over half of the lesions were kept under observation for more than 2 years.

The overall recurrence rate for the series was 9.8 per cent, but for the 535 lesions treated primarily by us the recurrence rate was 5.2 per cent.

Factors producing an increased risk of recurrence probably operate in combination making it difficult to evaluate them individually. Such factors are: (a) the anatomical site, the nasal and periorbital regions carrying the highest risk; (b) previous treatment before referral, including irradiation; (c) free skingrafting as a method of repairing the defect; (d) the presence of tumour histologically in the margin of resection.

Fifty-nine lesions did not recur in spite of pathology reports which indicated incomplete removal. This was not related to either a shorter length of follow-up or the type of repair used in these cases.
Obstructive uropathy in granulomatous bowel disease
Authors: Mooney R A H , Sant G R
Published: March 2007

Ureteral obstruction is a seldom recognized complication of Crohn's disease and its incidence and natural history are unknown. The intravenous pyelogram findings in 5 cases of Crohn's disease are discussed and it is suggested that ureteral involvement signifies severe disease necessitating operation. The operative treatment of 1 of the cases by ureterolysis plus bowel excision is presented and discussed. Routine intravenous urography is recommended as part of the assessment of cases of Crohn's disease.
The effect of vagotomy on the inhibition of gastric secretion by intraduodenal fat
Authors: Ward A S
Published: March 2007

It has been suggested that the inhibition of gastric secretion by intraduodenal fat is a vagal phenomenon in man. Selective and highly selective vagotomy, by preserving this reflex, could offer advantages over truncal vagal section. This paper reports the effect of intraduodenal fat on pentagastrin-stimulated gastric secretion in duodenal ulcer patients before and after truncal vagotomy.

Marked inhibition of gastric secretion occurred in all the patients. In the postoperative group gastric secretion was almost totally abolished following fat infusion despite the absence of an abdominal vagal supply. The results suggest that inhibition of gastric secretion by intraduodenal fat is mediated by a nonvagal mechanism in man; from this point of view, therefore, there is little advantage in attempting to preserve the nerve-supply to the duodenum at vagotomy.
Evaluation of oral thymoxamine in patients with peripheral vascular occlusion of the lower limbs
Authors: Thomas Margaret , Campbell H , Heard G E
Published: March 2007

To determine the effectiveness of oral thymoxamine (Opilon) as a cutaneous vasodilator in patients with peripheral vascular occlusion of the lower limb, double-blind trials of a placebo, of tolazoline in a dose of 50 mg., and of thymoxamine in single doses of 20, 40, 60, 80, and 100 mg. have been undertaken using skin temperature and skin blood-flow as measures of response. Thymoxamine produced no significant increases in skin temperature and blood-flow at any dose level, whereas in the same patients tolazoline produced highly significant increases.
Non-pulmonary surgical tuberculosis
Authors: Faber R G
Published: March 2007

Fifty-one cases of non-pulmonary surgical tuberculosis are reviewed, 29 of the cases being immigrants. Of the 44 ‘new’ cases, tuberculosis was not among the preoperative differential diagnoses in 15. Lymphnodes were the site of the disease in more than half the cases. In only 29 cases was an operative specimen sent for bacteriological culture, and the necessity for culturing operative specimens and the reasons for the failure of isolation of tubercle bacilli in 50 per cent of the cultures are discussed. The impression that tuberculosis is not sufficiently considered by doctors in the preoperative differential diagnosis of several surgical presentations, especially in English patients, is confirmed.
Renovascular hypertension: The place of renal autotransplantation
Authors: Clunie G J A , Hartley L C J , Collins G M , Gordon R D
Published: March 2007

Six cases of hypertension due to renal artery stenosis were treated by renal autotransplantation, with cure in 4 cases and significant improvement in the other 2 cases. The procedure allows reconstruction of complex arterial lesions before revascularization, and should be preferred to nephrectomy whenever technically possible.
The management of carcinoma of the breast by radical supervoltage radiation
Authors: Strickland Paul
Published: March 2007

A high-dose radiation technique for the management of inoperable carcinoma of breast is described, and the results of the treatment of 385 consecutive cases are outlined. The morbidity is considerable. Supervoltage radiotherapy can usually arrest the primary disease and cure a substantial number of cases. The quality of life enjoyed by the survivors is good.
The effects of intravenous and intraduodenal feeding on nitrogen balance after surgery
Authors: Hindmarsh J T , Clark R G
Published: March 2007

To assess the value of nutrition in the first week after surgery, total nitrogen balance was determined in three groups of patients (two experimental, one control) undergoing vagotomy and pyloroplasty from 1 day before to 8 days after operation. In the experimental groups nutrition was maintained postoperatively by the intravenous route in one and intraduodenally in the other at a level adequate for normal non-postoperative subjects. Water and electrolyte intakes were similar in the three groups, but patients in the control group received no calories or nitrogen in the immediate postoperative period.

With respect to nitrogen economy, the group fed largely by the intraduodenal route fared best. Nevertheless, nitrogen balance did not reach equilibrium until day 5 in any group, probably indicating a relative increase in protein catabolism in the early postoperative period.
Surgical treatment of aneurysm of the thoracic aorta under a temporary external by-pass shunt
Authors: Inoue Tadashi , Shohtsu Akira , Kawada Kozo , Nagai Izumi , Tanaka Susumu , Takeuchi Shigeyuki , Sohma Yasuhiro
Published: March 2007

Twenty-eight patients were operated upon for aneurysm of the thoracic aorta using a temporary external by-pass shunt. Four early deaths occurred, the cause of which could not be related to the by-pass procedure itself. The temporary long external by-pass from the left subclavian artery or from the ascending aorta to the femoral artery was preferable for resection of an aneurysm of the descending aorta or the distal aortic arch which required cross-clamping of the aorta.
Selection of operation for duodenal ulcer based on acid secretory studies—A reappraisal
Authors: Robbs J V , Bank S , Marks I N , Louw J H
Published: March 2007

The incidence of recurrent duodenal or jejunal ulceration was assessed 5–10 years after selective surgery for duodenal ulceration in 253 patients after vagotomy and drainage and in 55 patients after vagotomy and antrectomy.

In the vagotomy and drainage group 8.6 per cent of the patients developed proven or highly suspected recurrent duodenal or jejunal ulcer. None of these patients had preoperative maximal acid output (M.A.O.) values less than 25 mEq. per hour. No recurrent jejunal ulcers occurred in the vagotomy and antrectomy group despite the fact that they had the same incidence of incomplete vagotomy by Hollander's criteria as the vagotomy and drainage group.

It is suggested that a policy of selection of patients for vagotomy and drainage based on a preoperative M.A.O. of 25 mEq. per hour seems more justified and realistic than the previously used level of 40–50 mEq. per hour. Vagotomy and antrectomy should probably be employed if the M.A.O. is greater than 25 mEq. per hour.
The buerger syndrome in java. A description of the clinical syndrome and some aspects of its aetiology
Authors: Hill G L , Moeliono J , Tumewu F , Brataamadja D , Tohardi A
Published: March 2007

A case control field survey was carried out on 106 Indonesian patients with spontaneous peripheral gangrene. In 101 patients the disease was a four-limb youthful type of peripheral vascular disease occurring in young male smokers. Migratory superficial thrombophlebitis was present in 38 patients. This constellation of signs and symptoms was similar to that described for the Buerger syndrome.

Of the aetiological factors studied, tobacco, cold injury, familial aggregation, and a past history of mycotic infection may be of significance.
Metabolic changes following varying degrees of partial hepatectomy in the rat
Authors: Wood C B , Karran S J , Blumgart L H
Published: March 2007

The metabolic and functional changes that follow hepatectomy in the rat are related to the extent of liver resection. Regenerating liver cells show an impaired ability to excrete bilirubin, bromsulphophthalein, and 125I Rose Bengal during the early postoperative period.
The leucocyte count in acute appendicitis
Authors: Lee P W R
Published: March 2007

The leucocyte count was estimated in 100 consecutive cases of pathologically proved appendicitis. It is concluded that although a white-cell count below 10,000 per c.mm. does not exclude the diagnosis of acute appendicitis, such a result should prompt further review and consideration of the diagnosis.
Intussusception of the appendix
Authors: Down R H L , Bates T
Published: March 2007

Two cases of intussusception of the appendix are reported. In both cases there was a palpable tumour within the caecum and a short thickened appendix. Both intussuceptions were predominantly mucosal and of a type not previously described.
An unusual presentation of gas gangrene
Authors: Fraser-Moodie Alistair
Published: March 2007

Gas gangrene is now uncommon in this country, particularly as a postoperative complication of elective abdominal surgery. A case of a patient who developed gas gangrene of the scrotum after a sigmoid colectomy for diverticulitis is described. A search through the relevant literature failed to reveal any similar cases.
The surgical management of amoebiasis in children
Authors: Spitz Lewis
Published: March 2007

Five children with severe complications of acute amoebic dysentery are described. The results of a simple defunctioning proximal ileostomy are encouraging. Prior administration of anti-amoebic therapy and postoperative intensive medical care are mandatory for a successful outcome.
Choledochoscopy in choledocholithiasis
Authors: Longland C J
Published: March 2007

Stones are overlooked in the bile-ducts during operations for gall-stones sufficiently often to pose a continuing problem. The choledochoscope, first described 50 years ago, has recently been developed to a degree which makes it valuable in locating common-duct stones, besides permitting observation of changes in the ducts which are not otherwise demonstrable.

At 37 duct explorations, among a total of 135 gallstone operations, endoscopy was found valuable in clarifying equivocal pre-exploratory cholangiograms, or on occasion taking their place, and in detecting stones not removed using the usual methods of detection. It is suggested that endoscopy is quicker and more readily repeatable than post-lithotomy cholangiography, is unaffected by bubbles entering the duct system, and avoids exposure of staff and patient to X-rays. However, it should be used in conjunction with pre-exploratory cholangiography.
Emergency oesophageal transection in uncontrolled variceal haemorrhage
Authors: George P , Brown C , Ridgway G , Crofts B , Sherlock S
Published: March 2007

The results of emergency oesophageal transection are described. The overall operative mortality-rate was 45 per cent. There were no operative deaths in the patients with extrahepatic obstruction and normal liver function. The operative mortality-rate for the patients with cirrhosis was 53 per cent, or a salvage rate of 47 per cent if one considers that this is a highly selected group of patients (albeit negatively)–patients with impaired liver function who had not responded to intensive medical treatment and who were still bleeding at the time of surgery.
Interposition teflon mesenteric caval shunt for bleeding oesophageal varices
Authors: Giles G R , Brennan T G , Losowsky M S
Published: March 2007

A modified mesenteric caval shunt using a Teflon ‘H’ prosthesis has been performed in 4 poor-risk patients with cirrhosis and exsanguinating haemorrhage from oesophageal varices and a fifth patient with portal vein thrombosis. Although 2 patients ultimately died, the procedure was effective in arresting the haemorrhage and is technically simple to perform.
Thermography in the diagnosis of occlusive vascular disease of the lower limb
Authors: McLoughlin G A , Rawsthorne G B
Published: March 2007

An assessment of the diagnostic accuracy of thermography in arterial disease of the lower limb is reported. By comparing the arteriographic and thermographic appearances of 52 patients, three independent observers had overall agreement of interpretation in approximately 50 per cent of cases. Factors found to limit accuracy were increasing subcutaneous fat thickness and localized disease with good collateral circulation.
Blunt abdominal injury: A review of 59 consecutive cases undergoing surgery
Authors: Bolton P M , Wood C B , Quartey-Papafio J B , Blumgart L H
Published: March 2007

A consecutive series of 59 patients undergoing laparotomy as a result of blunt abdominal trauma is reported. Road-traffic accidents were the most common cause of blunt abdominal trauma and frequently produced a complex pattern of associated injuries. There were 8 deaths, giving a mortality-rate of 14 per cent. The number of associated injuries was the most important single factor influencing the mortality-rate. Delay in diagnosis occurred in 14 patients, and this may contribute to the high mortality-rate of blunt abdominal injury. A high index of suspicion, thorough and repeated clinical assessment, and willingness to resort to laparotomy are the main principles in the diagnosis of blunt abdominal injury.
Closed injury of the external iliac and common femoral arteries
Authors: Brady M P , Keaveny T V , Fitzgerald P A
Published: March 2007

Two cases of traumatic closed injury of the iliofemoral arterial segment incurred while working at sea are reported. These cases share many similarities which are discussed together with general observations on the management of such injuries. The need for repair utilizing the by-pass principle rather than direct procedures on the involved segment is stressed.
A sterile ‘Use-Once’ clip applicator for skin closure
Authors: Annis David
Published: March 2007

A sterile disposable applicator for skin clips has been used for the closure of skin incisions in 117 consecutive operations. These have included most of the standard incisions in the head, neck, trunk, and limbs. The instrument has proved satisfactory in use, the skin incisions having healed satisfactorily with much time having been saved in their closure.
Vagotomy and pyloroplasty in the elective treatment of gastric ulcer
Authors: Lawson W R , Hutchison J S F
Published: March 2007

Vagotomy and pyloroplasty have been used in the elective treatment of gastric ulcer in 72 patients. In 33 patients there was associated duodenal ulcer (G.D.U.). In the other 39 patients (G.U.) there was no evidence of duodenal ulcer. Patients with prepyloric gastric ulcer were excluded. The operative mortality was nil.

At an average follow-up of 3 1/2 years the functional results in the G.U. group were good for 89 per cent of the cases, satisfactory for 5-5 per cent, and poor for 5-5 per cent compared with 73, 10, and 17 per cent respectively in the G.D.U. group. Two patients in each group showed recurrent ulcer, an incidence of 5-4 per cent in the G.U. group and 6-7 per cent in the G.D.U. group. There is no statistically significant difference in these results.

Vagotomy and pyloroplasty appear to comprise a satisfactory treatment for gastric ulcer whether or not the ulcer is associated with duodenal ulcer. The present findings do not support the view that the good results previously reported were due to the inclusion of patients with pre-pyloric gastric ulcer or with associated duodenal ulcer.

Three patients showed malignancy in the ulcer and a further case has been recorded in the total of 102 patients undergoing surgery during the period of the review (an incidence of 4 per cent), underlining the need for biopsy of the ulcer in all cases.