bluuebunny/crossref_metadata_2025 huggingface dataset:
Prolonged survival in a patient with multiple plasma-cell tumours
Authors: Mills K L G , Dawson Audrey A
Published: March 2007

A case is reported of unusually long survival in a patient with histological evidence of recurrent plasmacell infiltration in both soft tissues and many bones.
Deep-vein thrombosis in two district hospitals in Essex
Authors: Sripad Sushila , Antcliff A C , Martin Peter
Published: March 2007

Two groups, each of 50 patients over the age of 40 years, underwent elective operation at two district general hospitals in Essex. The incidences of calfvein thrombosis on routine 125I-fibrinogen scans after operation were 16 and 18 per cent respectively. The incidence in comparable samples of patients from three metropolitan teaching hospitals was about 33 per cent.
Femoral and sciatic compression neuropathy
Authors: Kubacz G J
Published: March 2007

A case of a femoral neuropathy following anticoagulant therapy is presented. A combined femoral, obturator, and sciatic nerve palsy resulting from complications of atherosclerotic disease of the aorta and iliac arteries is also described. The pathogenicity of the neuropathies is discussed and it is suggested that conservative management ought to be employed where such neuropathy has occurred spontaneously in a haemophiliac or during the course of anticoagulant therapy. Early surgery offers the only satisfactory outcome in those neuropathies associated with atherosclerotic disease of the major vessels.
Oedema at the site of small-bowel anastomoses
Authors: Shields M A , Dudley H A F
Published: March 2007

The change in water content of bowel tissue in the area of an end-to-end anastomosis was estimated by a desiccation technique. Significant oedema, sufficient to cause 5-10 per cent increase in tissue weight, could be demonstrated at the anastomotic site up to 96 hours after operation, when compared with control tissue. However, up to 48 hours the anastomoses were neither more nor less oedematous than the remainder of the bowel. After that time the oedema of the unanastomosed bowel began to decrease. It is concluded that the degree of oedema demonstrated, if applied to the human case, could only provok obstruction of a stoma already of critical size.
Mammary infarction
Authors: Pambakian H , Tighe J R
Published: March 2007

Three cases of mammary infarction are reported. One showed infarction of a fibro-adenoma in a nonlactating breast. In the second there were two lesions in lactating breasts, one an infarcted fibro-adenoma and the other an infarction of hyperplastic breast tissue, also probably a fibro-adenoma. The third case showed infarction of hyperplastic lactating breast tissue. The possibility of confusion with carcinoma of the breast is discussed.
Superior mesenteric embolectomy
Authors: Jago R H
Published: March 2007

A 57-year-old woman with embolic occlusion of the superior mesenteric artery was treated by embolectomy. It is remarkable that it has been possible to trace only 4 previous reports of successful embolectomy in the British literature. In view of the simplicity of the techniques involved this must be due to a failure of early diagnosis, resulting principally from the lack of abdominal signs characteristic of the condition. The common clinical findings are reviewed.
Ulnar arteriovenous fistula for maintenance haemodialysis
Authors: Kinnaert P , Vereerstraeten P , Geens M , Toussaint C
Published: March 2007

Sixteen ulnar arteriovenous fistulae have been performed in 11 patients. Three immediate thromboses occurred in the same patient. Six late thromboses were observed: 2 after kidney transplantation and 4 after haemodialysis. Seven out of the 10 patients in whom the fistula was used were dialysed adequately from 5 weeks to 15 months. No adverse effect owing to the fistula was noted.
The response of chronic gastritis to conservative treatment
Authors: Lawson H H
Published: March 2007

Gastroscopy and gastric biopsy have been carried out in human subjects before and after a course of conservative treatment for gastric ulceration or postgastrectomy dyspepsia due to gastritis. In the healing gastric ulcer the surrounding mucosa returns to histological normality, but in the postgastrectomy patient there is a persistent chronic gastritis around the stoma. In the gastric ulcer patient the cause of the gastritis may be the action of acid-pepsin on mucosa sensitized by bile reflux. In the postgastrectomy cases persistent gastritis may be due to the refluxing fluid itself causing the irritation, or to the absence of a protective effect exerted by the pyloric gland area.
The aetiology of appendicitis
Authors: Burkitt Denis P
Published: March 2007

Extensive evidence from the geographical distribution of appendicitis and its rise in prevalence in economically developed countries in the early part of this century suggest that the change from a high- to a low-residue diet is largely responsible for this disease.
Case report of a vesicovaginal fistula of unusual presentation
Authors: Foley John Joyce , McGrath James
Published: March 2007

A case of vesicovaginal fistula presenting 18 months after operation for rectal carcinoma is reported and a simple technique for closing the fistula is described.
Unusual presentation of seminoma of the testis
Authors: Evans C C , Kaufman H D
Published: March 2007

A case of peripheral sensorimotor neuropathy associated with seminoma of the testis is described. The literature on the subject is reviewed including a classification of the neuropathies. Finally, because the neurological symptoms may well be transitory they should not be regarded as a contra-indication to treating the primary neoplastic process.
Depressed lymphocyte function in carcinoma of the breast
Authors: Whittaker M G , Clark C G
Published: March 2007

The reduced ability of lymphocytes from patients with carcinoma of the breast to transform in response to phytohaemagglution (PHA) is shown. The greatest depression of response was found in advanced or recurrent disease and is due, at least in part, to an abnormality in the patient's serum. Those patients who were clinically free from recurrence had no depression of response.

It is postulated that the reduced immunological reactivity in these patients is a secondary rather than a primary event and is possibly related to the extent and aggression of the disease. The practical usefulness of the test as an index of prognosis is being evaluated together with more conventional data.
Vagotomy for gastric ulcer combined with duodenal ulcer
Authors: Douglas M C , Duthie H L
Published: March 2007

Many of the favourable reports on the conservative treatment of gastric ulcers do not clearly define what proportion of the cases had associated duodenal disease. During the past 6 years we have treated 39 patients with gastric ulcers combined with duodenal ulcer or scarring by vagotomy and pyloroplasty. Over the same period 44 cases with gastric ulcer have been similarly treated.

At an average follow-up of just under 3 years the functional results were good for 83 per cent, satisfactory for 14 per cent, and poor for 3 per cent for combined ulcers, compared with 54 per cent, 25 per cent, and 21 per cent respectively for gastric ulcers. These differences are just statistically significant. Thus, vagotomy with pyloroplasty has been shown to give better results when used in the treatment of combined ulcers than when solitary gastric ulcers are treated by this operation.
Prognosis after ileal resection for Crohn's disease
Authors: Kyle James
Published: March 2007

The recurrence rate in a series of 62 patients who underwent first resections for Crohn's disease of the ileum was determined by an actuarial method. After 5 years the recurrence rate was 18 per cent, and at 10 years it was 33 per cent. The prognosis was least favourable in young females with short clinical histories. The E.S.R., the length of intestine resected, and the histology of the bowel were of little value in prognosis. Extensive resections should be avoided. Recurrence more than 10 years after resection was not uncommon.
The incidence and pathogenesis of tracheal injury following tracheostomy with cuffed tube and assisted ventilation analysis of a 3-year prospective study
Authors: Andrews M J
Published: March 2007

Observations are reported from a 3-year prospective study of tracheal injury occurring in patients managed by cuffed-tube tracheostomy and assisted ventilation in the Respiratory Failure Unit at Toronto General Hospital. When the cuffed tracheostomy tube was finally removed an initial bronchoscopic examination of the trachea was performed. Further clinical and radiological assessments were made 3 weeks and 3 months later, using bronchoscopy when indicated.

The incidence of symptomatic tracheal stenosis in 153 patients studied was 21 per cent. Of these strictures, 18 occurred at the level of the tracheostome and 14 at the level of the inflatable cuff. Disability due to airway obstruction was severe in 18 and mild in 14 patients. These mild lesions might easily have remained undetected. Two patients with severe strictures died of airway obstruction before treatment could be instituted, a mortality of 6·2 per cent in patients developing strictures. The remaining 30 strictures required treatment either by dialtation alone or by dilatation and resection of the stricture with tracheal reanastomosis. Two of the 153 patients studied developed chronic tracheo-oesophageal fistulas.

The observations indicate that stenosis can be anticipated before the lesion has developed by the finding of circumferential mucosal ulceration or segmental collapse at the initial per stomal bronchoscopy.

Observations from the study prompted the following changes in technique:- A modification of the connexions between the tracheostomy tube and the respirator, with a subsequent reduction in symptomatic stenosis at the stomal level.A reduction in the diameter of tracheostomy tubes.A search for a less injurious inflatable cuff.

The conclusions reached by this study were as follows:– Tracheostomy tubes of large diameter predispose to the development of strictures at the level of the tracheostome in male patients.The presence of airway infection predisposes to stomal stenosis, and probably to cuff stenosis.Cuff strictures are commoner in female patients than in male patients.Age and pre-existing lung disease may be important in the production of stomal stenosis.The use of a deliberate routine follow-up examination to evaluate tracheal injury following tracheostomy and assisted ventilation is a necessary undertaking.
The delayed insulin test and recurrent duodenal ulceration
Authors: Watkin D F L
Published: March 2007

It has previously been shown that insulin tests of gastric secretion carried out within 2 weeks of vagotomy and pyloroplasty give no indication of the patient's liability to recurrent duodenal ulceration. Delayed insulin tests (done 6 or more months postoperatively) have been compared in 100 patients without and 50 patients with recurrence after operation for duodenal ulceration. Complete discrimination between the groups was not achieved but the incidence of recurrence was related to the magnitude of the acid response. As no dividing line could be established to separate tests into positive and negative results, it is preferable that the actual figures for the gastric acid response to insulin be quoted. It is suggested that the peak acid concentration should be selected for this purpose. Separate estimates of the probability of recurrence associated with various levels of peak acid concentration have been made for routine insulin tests and for tests performed in patients with clinical evidence suggestive of recurrent ulceration.
Diagnosis and diagnostic patterns
Authors: Fraser Patricia M
Published: March 2007

A multivariate statistical analysis of biochemical data from patients with hypercalcaemia is presented as an example of the use of the computer as an aid to diagnosis.
On the importance of intracranial air
Authors: North J B
Published: March 2007

1. The presence of air within the skull (aerocele, pneumocephalus) indicates that a fistula communicates to the exterior. Without operative repair 25 per cent of patients will develop meningitis as dural tears heal poorly.

2. Coexisting cerebrospinal fluid leakage occurs in only half of the patients with aerocele.

3. The appearance of an aerocele may be delayed for days, weeks, or even years after head injury.

4. Patients who after head injury complain of severe headache, have a fracture involving the paranasal sinuses, or who have a nasal discharge should have at least a brow-up lateral skull radiograph with a horizontal beam.

5. While awaiting a neurosurgical opinion penicillin and sulphadiazine should be given.

6. A Series of 41 cases of traumatic intracranial aerocele is presented.
Internal sphincterotomy and haemorrhoidectomy in acute haemorrhoids its value in reduction of postoperative pain
Authors: Smyrnis S A , Katsas A G , Georgiadis N J
Published: March 2007

Two groups of 16 patients each were studied. All were operated on for prolapsed and thrombosed haemorrhoids. One group was subjected to the typical Milligan-Morgan haemorrhoidectomy, while in the other an internal sphincterotomy was carried out in addition to haemorrhoidectomy. This was done in an effort to determine the effect of internal sphincterotomy on the reduction of postoperative pain.

We were pleased to note a definite beneficial effect from the addition of sphincterotomy in patients aged under 40 years, although we found no significant difference in older patients.
Complete transection of the stomach and pancreas as a result of blunt trauma
Authors: Welch Theodore P , Prathnadi Pongsiri , Narco Supat
Published: March 2007

A case is reported of complete transection of the stomach and pancreas as a results of blunt trauma. The occurrence of transection of the stomach and transection of the pancreas and their management are reviewed. From a search of the medical literature this is the first recorded case in which both these injuries have occurred together.
Aneurysm of an anomalous hepatic artery
Authors: Little J M , Spence J W
Published: March 2007

The third case of hepatic artery aneurysm successfully treated by prosthetic grafting is reported. This appears to be the forty-third patient to survive surgical treatment for this condition. Hepatic artery aneurysms has a poor prognosis and operative treatment is justified when the diagnosis is made. While ligation will be required in some instances, excision of the aneurysm with restoration of arterial blood-flow to the liver is to be preferred.
Right-sided diverticulosis of the colon
Authors: Perry P M , Morson B C
Published: March 2007

The clinical and pathological features of 2 patients with diverticulosis confined to the right side of the colon are described. This is extremely rare in persons of Caucasian origin but seems to be the most common type of diverticulosis in certain Oriental races. More information about the epidemiology of the different varieties of diverticular disease of the colon is required in order to clarify the environmental factors involved.
Surgical survey of peptic ulcer in South India
Authors: Garlick F H , Rao P S S Sundar
Published: March 2007

Between 1944 and 1960, 1138 consecutive patients operated on in the Christian Medical College Hospital, Vellore, for peptic ulcer were documented. Deaths within 1 month of operation gave an overall mortality of 3.3 per cent. Six hundred and seventy-eight patients with duodenal or gastric ulcer were operated on by one of three standard procedures, and were followed up for 5 to 15 years after operation. Relief of symptoms was obtained in 80 per cent of patients. Vagotomy and gastrojejunostomy was found to be the best standard operation.
The lateral view in the radiology of the rectum and rectosigmoid
Authors: Craig J O M C , Highman J H , Palmer F J
Published: March 2007

Twenty-seven cases of rectal and rectosigmoid abnormality which had been demonstrated radiologically were reviewed in order to assess the value of the lateral projection. Twenty-one of these cases were derived from a consecutive series of 2500 bariumenema examinations in symptomatic patients. The value of the projection is emphasized as part of a routine barium-enema examination, but it is appreciated that other views may also be necessary and should be included whenever indicated. It is felt that examination of this area not only is a clinical responsibility but also merits meticulous radiological attention.
Paraplegia following resection of abdominal aortic aneurysm a report of 3 cases
Authors: Bates T
Published: March 2007

Three cases of paraplegia following elective resection of an abdominal aortic aneurysm are presented. In each case the aorta was clamped below the renal arteries, but infarction of the spinal cord resulted from occlusion of the upper lumbar or lower intercostal and upper lumbar arteries by thrombosis or from dissection of the aortic wall proximal to the graft.

In 2 cases the onset of paraplegia was in the early postoperative period, but in the third case, paralysis followed an aortic dissection occurring after a long interval.

The blood-supply of the spinal cord and the aetiology of the paraplegia are discussed.
A clinical evaluation of ‘reinforced’ split-skin grafts
Authors: Monty Cyril P
Published: March 2007

A method is described which facilitates the removal and application of split-skin grafts.
Benign non-traumatic stricture of the common bile-duct owing to penetrating duodenal ulcer
Authors: Glick Selwyn
Published: March 2007

A case of stricture of the common bile-duct owing to fibrous encasement by the chronic inflammatory changes caused by an adjacent penetrating posterior duodenal ulcer is presented. The relative rarity of the condition is noted and a rational line of treatment suggested.
The normal anatomy of the lymphatic system in the human leg
Authors: Pflug J J , Calnan J S
Published: March 2007

The normal anatomy of the lymphatic system of the lower extremity of man has been described from 34 specimens. The investigation has shown that the lymphovascular network displays the following features:– A strictly regional pattern of drainage.No anastomoses between the subfascial and epifascial lymphatic trunks.No direct communications between the veins and lymphatics both in the epifascial and subfascial systems.

The lymphoid system consists in man of popliteal and inguinal lymph-nodes. In both the lymph-node is neither an obligatory junction between the regional deep or superficial trunks nor does it represent an obligatory terminus for the relevant lymph-trunks.
Rupture of the ureter due to crushing injury in a boy with severe haemophilia
Authors: Forbes Charles D , Craig James A , Prentice Colin R M , McNicol George P , Levack James H , Ireland John T , Adams James F , Sutherland G Roy
Published: March 2007

A haemophilic boy, aged 14 years, presented with rupture of the upper end of the ureter as a result of a crushing injury. Primary ureteral anastomosis was successfully carried out under cover of cryoglobulin precipitate therapy. Renal function tests carried out at 2 months were normal, although the isotope renogram showed slight diminution of function on the injured side and an intravenous pyelogram showed some narrowing of the site of the anastomosis.
Operative treatment of high gastric ulcer with special reference to Pauchet's method
Authors: Lewis Adam , Qvist George
Published: March 2007

A high gastric ulcer may be treated by excision, or the ulcer may be retained and healing encouraged by other means. If the ulcer is retained there is a small but definite risk of malignancy. Neither gastric drainage, nor the Kelling–Madlener operation, nor vagotomy and pyloroplasty ensures healing in a high gastric ulcer. Local wedge resection of the ulcer is attended by very poor results, and a high mortality and morbidity preclude the use of subtotal or total gastrectomy. Pauchet's procedure combines the advantages of limited gastrectomy and gastroduodenal anastomosis with complete removal of the ulcer. It is the recommended operation for high gastric ulcers.
Perimuscular excision of the rectum for Crohn's disease and ulcerative colitis. A Conservation technique
Authors: Lee E C G , Dowling B L
Published: March 2007

The incidence of abnormalities of micturition and sexual function after removal of the rectum is discussed. It is thought that surgical damage to the autonomic nerves in the pelvis is the main cause of disability in young patients with benign disease. The various modifications of the standard abdominoperineal dissection of the rectum which have been introduced to prevent injury during the operation are described. None has proved entirely successful.

A new technique of rectal dissection, in which two surgeons concentrate on opposite sides of the bowel and carry out the dissection under direct vision in a bloodless field, is described. The results of its use in 24 patients are recorded.
The effect of environmental temperature and nutritional intake on the metabolic response to abdominal surgery
Authors: Spivey John , Johnston Ivan D A
Published: March 2007

Ambient temperatures of 29°C. had no effect on the nitrogen balance after elective abdominal surgery in 15 well-nourished men compared with 29 similar patients nursed at 24°C. The catabolic response as measured by nitrogen balance is small following operation of moderate severity and can be abolished by an increased intake of nitrogen and calories.
The local effects of intra-arterial injections of sodium tetradecyl sulphate (s.t.d.) 3 per cent. An experimental study
Authors: Mac Gowan W A L , Holland P D J , Browne Hyacinth I , Byrnes Dermot P
Published: March 2007

The accidental intra-arterial injection of the commonly used sclerosant sodium tetradecyl sulphate (S.T.D.) 3 per cent during the treatment of varicose veins can affect seriously the blood-supply to the limb, and gangrene may follow.

Intra-arterial injection of S.T.D. into the limb arteries of dogs chemically disintegrates the blood in the slow-moving stream of the capillaries and converts it into a thick sludge which obstructs the circulation locally, resulting in necrosis of the extremity.
Perianal gas-producing infection of non-clostridial origin
Authors: Brightmore Terence
Published: March 2007

Five cases of perianal infection caused by nonclostridial gas-producing organisms are reported. Four were males in their sixth decade, 2 of whom were diabetics, and the fifth was a female in her third decade. Two cases died, and the severity of these infections is emphasized. The diagnosis and treatment of non-clostridial gas-producing infections are discussed.
Prolapse of the ileum through the rectum and anal canal
Authors: Hall J H , Bradfield W J D
Published: March 2007

A case of prolapse of the ileum through a tear in the rectal wall and the anus is presented and 11 previous cases found in the literature are reviewed. The aetiology and the management of the condition are discussed.
Bowel herniation through a defect of the broad ligament
Authors: Cleator I G M , Bowden W M
Published: March 2007

This is the fifty-fourth reported case of a defect in the broad ligament and the forty-ninth associated with intestinal obstruction.
Perforation of a peptic ulcer in duplicated ileum
Authors: Collins C D
Published: March 2007

A case of perforation of a peptic ulcer in a tubular duplication of the ileum is presented with a brief review of the relevant literature.
Mortality in missile wounds of the head
Authors: Adeloye Adelola
Published: March 2007

In a series of 250 patients with missile wounds of the head treated at the University College Hospital, Ibadan, Nigeria, 35 died after admission, a mortality of 14 per cent. Forty-three per cent of the deaths occurred within a week of wounding and were predominantly due to severe anatomical damage; among the 34 per cent who died at least 4 weeks after wounding there was evidence of intracranial infection. Surgical operation did not improve the outcome in the group with severe anatomical damage. A serious disturbance of the level of consciousness on admission, namely coma, was a bad prognostic sign.
The effects of intermittently applied external pressure on the haemodynamics of the hind-limb in greyhound dogs
Authors: Sabri S , Roberts V C , Cotton L T
Published: March 2007

The application of intermittent compression of 30 mm. Hg to the hind-limb of a greyhound results in an increase of about 400 per cent in the pulsatility of femoral vein flow and of 250 per cent in the peak femoral vein flow. This effect may result in adequate filling and emptying of the deep venous channels and sinuses of the lower limb of man, thereby preventing stasis in them. Intermittent compression of the calf seems, therefore, to have an obvious place in the prophylaxis of deep-vein thrombosis.
Leiomyoma of the oesophagus with calcification
Authors: Huddy Phillip , Griffiths Gordon
Published: March 2007

The successful removal of a leiomyoma of the oesophagus in a man aged 64 years is described. The exceptional feature was the presence of calcification within the tumour which is almost unknown. The differential diagnosis from extrinsic causes which produce a similar appearance is discussed in view of this misleading feature. A brief general description of the clinical, radiological, and surgical aspects of leiomyomata of the oesophagus is given.
A case of intraluminal diverticulum of the duodenum
Authors: Guerrier Hugh P , Turner Maurice J
Published: March 2007

The rare anomaly of intraluminal duodenal diverticulum is illustrated by a case history. Twenty-three earlier cases are quoted. In the discussion attention is drawn to the varied clinical presentation which may occur, including the possibilities of intestinal haemorrhage and subacute obstruction. The importance of radiology in making a preoperative diagnosis is stressed. Theories of possible causation are briefly reviewed.
The scope and safety of short-stay surgery in the treatment of groin herniae and varicose veins a report on 705 cases
Authors: Doran F S A , White Mary , Drury M
Published: March 2007

Between 1948 and 1968 the number of surgical patients treated in England and Wales increased by 38·6 per cent. In 1968, 267, 300 more surgical patients were admitted to hospital than in 1948. During the same period of time the increase in the number of beds was less than 1 per cent.

Faced with a steadily growing demand to treat patients suffering from cancer and other serious diseases it is difficult to find the beds and the operating time to treat patients with hernia and varicosa veins. Even so the operating performed on patients suffering from these two complaints amount to nearly one-third of all the operatons performed annually. There are 231 other operations in general surgery.

As a result the average time patients with ruptures and variocse veins languish on hospital waiting lists is up to 2 years, and ofter for longer than that.

At the present time in England and Wales the average time a patient stays in hospital after a herniorrhaphy or an operation for varicose veins is 10·5 days. This is an expensive waste of beds; 75 per cent of all patients can safely be sent home 48 hours after both these types of operatun. The number of patients who develop an acute postoperative comlication and cannote go home is only 5·4 per cent and the number who need readmission for a delayed complication is less than 1 per cent.

Being discharged home 48 hours after having their hernia reparied or thier varicose veins operated on is popular both with the great majority of patients and also with their relatives. Moreover it is accepted by the general practitioners concerned. Proceeding in this way the time such patients have to wait for their operation is reduced to an average of 3–6 months.

It is important to realize, however, that short-stay surgery will increase the total number of operations performed each year. They are additional operations and, as such, need extra theartre time and extra theatre staff, otherwise they cancnote be done.

The present series of 705 cases could note have been operated on if an additional theartre and staff had not been provided.
Tuberculous Peripheral Lymphadenitis
Authors: Hooper A A
Published: March 2007

Tuberculous peripheral lymphadenitis is still a common and often poorly treated manifestation of tuberculosis. One hundred and eighteen cases are reviewed, and the problems of diagnosis and management are considered together with the causes of failure of treatment.
The Lithogenic Effect of Vagotomy
Authors: Cowie A G A , Clark C G
Published: March 2007

The composition and the rate fo flow of bile produced in response to a standard fatty meal in cholecystectomized dogs have been determined before and after vagotomy and pyloroplasty. The results presented support the view that vagotomy is potentially lithogenic, particularly after cholecystectomy.
Non-Recurrent Laryngeal Nerve
Authors: Stewart George R , Mountain John C , Colcock Bentley P
Published: March 2007

During the performance of 2101 thyroid operations, 3496 recurrent laryngeal nerves were identified and exposed. Of the 1776 visualized nerves on the right side, 6 were found to be non-recurrent. A brief survey of the literature relevant to this anatomical abnormality is included, and its importance in the performance of thyroid surgery is emphasized.
Bacterial Content of the Gastric Juice
Authors: MacGregor A B , Ross P W
Published: March 2007

A survey has been made of the bacteria present in the gastric aspirate obtained from 280 preoperative and postoperative secretion studies. In the preoperative group viable bacteria were isolated from 41 per cent of patients, whereas in the postoperative group they were isolated from 73 per cent. The nature of the bacterial flora also differed in the two groups.

It is suggested that infected stomach contents may cause local sepsis following gastric surgery and that loss of the acid barrier may allow infection by pathogenic bacteria of the gut, producing postoperative diarrhoea.
Aorto-Caval Fistulae: An Uncommon Complication of Abdominal Aortic Aneurysms
Authors: Reckless J P D , McColl I , Taylor G W
Published: March 2007

Two cases of successfully treated aorto-caval fistula are described, brining the total number of reported cases to 71. Forty-one cases which were treated surgically are reviewed. The aetiology of the leg oedema is discussed.
Two Unusual Leg Ulcers
Authors: Fawcett A N , Harrison D A
Published: March 2007

Two unusual leg “ulcers” are reported. The first represents an uncommon site for a basal-cell epithelioma, the atypicality of which is emphasized by its lymph-borne metastasis. The second, a fibrosarcoma, is an example of a rare type of malignant transformation occurring in a long-standing varicose ulcer.
Carcinoma of Colon Simulating Crohn's Disease
Authors: Stoodley B J , Mann C V
Published: March 2007

Three cases are described where carcinomatous involvement of the colon was mistaken for Crohn's disease of the large bowel. The need to obtain histological proof is emphasized. Ascitc fluid should be examined histologically in patient dianosed as having Crohn's disease. Selective mesenteric angiography was used and is considered a valuable tool in diagnosis.
Surgical objectives in unresected cancer of the head of the pancreas
Authors: Elmslie R G , Slavotinek A H
Published: March 2007

Twenty-seven patients with obstructive jaundice due to unresected cancer of the pancreas have been reviewed. The surgical objectives in treating this sort of patient were taken as the need to make a positive diagnosis and to palliate until death. There was failure to establish the diagnosis of cancer at operation (17 patients), failure to attain permanent biliary decompression (1 patient), failure to anticipate duodenal obstruction (3 patients), and failure to relieve pancreatic pain (8 patients). As a result of this review we have evolved a set of guide-lines which should be considered when treating patients with irresectable cancer of the pancreas.
The effect of the fibrinolytic inhibitor epsilonaminocaproic acid on the incidence of deep-vein thrombosis after prostatectomy
Authors: Gordon-Smith I C , Hickman J A , Masri S H El
Published: March 2007

Sixty-two patients undergoing retropubic prostatectomy were examined for evidence of deep-vein thrombosis using the 125I-fibrinogen technique. Patients were allocated randomly into two groups. The first grops was given the fibrinolytic inhibitor epsilonminocaproic acid (EACA) during the perioperative period, while the second group of patients acted as a control. The administration of EACA did not increase the incidence of deep-vein thrombosis after prostatectomy. This finding is discussed together with the possible role of the fibrinolytic system i postoperative venous thrombo-embolic disease.
Abdominal tuberculosis
Authors: Gunn A , Keddie N C
Published: March 2007

Twelve cases of abdominal tuberculosis are presented. They illustrate the great variability in the clinical features of this condition, making diagnosis extremely difficult. In particular, we draw attention to the problem of tuberculosis of the reticuloendothelial system in the abdomen. Biopsy and culture are essential at laparotomy if a correct diagnosis is to be made.
The incidence of right inguinal hernia following appendicectomy
Authors: Leech Peter , Waddell Gordon , Main Robert G
Published: March 2007

A retrospective study of 549 patients who had undergone repair of an inguinal hernia is presented. It is noted that appendicectomy does not predispose to the development of a right inguinal hernia.
Dietary fat, dyspepsia, diarrhoea, and diabetes
Authors: Childs Peter
Published: March 2007

This paper postulates that fat intolerance is a widespread metabolic disorder characterized by impairment of glucose tolerance caused by excess dietary fat intake, and cured in most cases by the fat-free diet as defined in this paper.

Fat intolerance may present as flatulent dyspepsia, surgical disease or disorder in the biliary tract, peptic ulcertion, diarrhoea associated with spasm or diverticular disease of the colon or colitis, or as maturity-onset diabetes mellitus; one, two, or more of these syndromes may occur at the same or different times in the same patient. The dietary fat intake and the effect of the fat-free diet in each of these syndromes have been investigated, and the findings and their implications are discussed.

Treatment of disease and disorder in the biliary tract by sphincterotomy of the sphincter of Oddi in a series of 57 cases and of duodenal ulcer by pyloroplasty alone in 50 cases is reported. The results of treatment of duodenal ulcer by pyloroplasty alone in a series of 38 cases are compared with those after vagotomy and pyloroplasty in a similar series of 38 cases. Cure of peptic ulceration by pyloroplasty alone is reported, and vagotomy is considered to be unnecessary. The normal pylorus is defined, and the naked-eye appearances of the pylorus observed during 87 cholecystectomies are reported. The significance of these observations and of radiological abnormalities seen in routine barium-meal examinations of cases of disease or disorder in the biliary tract is discussed. Evidence is presented that the function of and pathological changes in the sphincter of Oddi and the pylorus are affected by the dietary fat intake and determine the absence or presence of abnormality in the biliary tract or of peptic ulceration respectively.

The clinical syndromes of fat-intolerant diarrhoea and its association with spasm of the colon, colitis, and diverticulitis, and of abdominal pain due to fat intolerance seen in a series of 17 children, are described as clinical entities.

The effect of the fat-free diet on glucose tolerance has been investigated in a series of 65 patients, and the significance of the increased tolerance observed has been assessed statistically. Four hundred and thirty-three glucose-tolerance tests have been performed to assess the change in glucose tolerance in 134 patients who had been on the fat-free diet for periods of 3 months to 2 years as treatment for dyspepsia due to disease or disorder of the biliary tract, peptic ulceration, diarrhoea associated with spasm of the colon, diverticulitis or colitis, obesity, and migraine. Among these patients were 23 who also suffered from diabetes mellitus. Cure of maturityonset diabetes mellitus by the fat-free diet is reported, and evidence is produced to show that it is an acquired abnormality of the metabolism caused by excess dietary fat intake.
The origin of phleboliths
Authors: Shemilt Philip
Published: March 2007

Phleboliths originate as thrombi in the pelvic veins and are the result of injury to the vein wall.

Although in children the pelvic veins and venous plexuses may be protected by valves, these have disappeared in adult life. In 20 dissections in adult cadavers remnants of osteal valves were sometimes seen, but a functioning bicuspid valve was noted only once.

These unprotected veins are subjected to large and abrupt rises in pressure during normal acts of coughing and straining. Because of this the veins are distended and damage to the intima with the formation of a protective thrombus can occur.

A locally high concentration of phosphatase in the perivesical tissues would explain why these thrombi become calcified in the pelvis and why phleboliths are so rarely found elsewhere.
Mesenteric neurofibromatosis in childhood
Authors: Cywes S , Mayell Margaret J
Published: March 2007

A child is reported in whom severe malabsorptive symptoms were present from a short time after birth together with increasing pseudo-obstructive episodes. Total neurofibromatous involvement of the smallbowel mesentery was found at laparotomy at the age of 4½ years. The child survived a further 2¼ years. The relevant literature is discussed.
Nickel sensitivity to surgical skin clips
Authors: Tinckler Laurence F
Published: March 2007

A case of hitherto unrecorded skin sensitivity to surgical skin clips is reported. A sensitivity test revealed that the sensitivity was to the nickel constituent of the copper/nickel alloy of which surgical clips are manufactured. It is suggested that when the use of skin clips is anticipated inquiry should be made of the patient as to the previous experience of sensitivity to metal articles of attire and the use of skin clips consequently avoided if the reply is affirmative.
Experimental organ preservation
Authors: Calman K C , Bell P R F
Published: March 2007

An experimental model for the study of organ preservation based on the isolated, biologically perfused rat heart is described. Using this model a standard storage solution has been evolved for use with initial perfusion and hypothermic storage. This solution contains Dextran 40 and insulin. Various perfusion characteristics including pH and infusion volume have also been studied. This solution has been modified and compared with two currently available storage solutions–Collins's C4 solution and the Gelin technique–and found to be superior to both. The technique consists of two parts; first, the organ is flushed with 0.5 per cent lignocaine in a buffered solution and is then perfused with the Dextran-40-based solution containing insulin and lignocaine. Further modification of the solution to contain a high magnesium concentration has resulted in a further improvement in survival after storage. These results are now being confirmed in the dog kidney.
Ivalon (polyvinyl alcohol) sponge in the repair of complete rectal prolapse
Authors: Morgan Clifford Naunton , Porter Nigel H , Klugman David J
Published: March 2007

One hundred and fifty cases of complete rectal prolapse have been operated on using an Ivalonspong implant, the first case being over 13 years ago. Seventy per cent of the patients were over the age oof 60 years. The operation has a low mortality- and morbidity-rate. Repair using Ivalon sponge was 96 per cent successful in the cure of complete prolapse and the methood apears to stand the test of time well.
The effect of obstructive jaundice on the migration of reticulo-endothelial cells and fibroblasts into early experimental granulomata
Authors: Lee Emanoel
Published: March 2007

Clinical and experimental evidence indicates that obstructive jaundice inhibits the healing of wounds. Experiments in the rat designed to investigate the migration of reticulo-endothelial and fibroblasts into experimental granulomata are described. Standard preparations of obstructive jaundice and controls were devised using Wistar rats. The effects of bile-duct obstruction and sham ligation are described. In another group of animals which was similarly prepared granuloma-pouch experiments were carried out by burying sterile cotton-wool pledgets of a known weight. These peledgets were removed from the jaundiced and control animals on the third, fifth, seventh, and ninth days after implantation, dried to remove the fluid component of the inflammatory process, and weighed on a microbalance. The weights were compared and it was found that a significant inhibition of weight increase occurred in the jaundiced animals during the first week, suggesting a delay in the migratory activity of reticuloendothelial cells and fibroblasts.
Ectopic thymic tissue presenting as a lateral cervical swelling
Authors: Finch D R A , Gough M H
Published: March 2007

Two infants presented with a swelling inferior to the angle of the mandible. At exploration both swellings were identified macroscopically and by frozen section as normal thymic tissue. In the light of present knowledge of the function of this gland in this age-group excision was not performed.
Congenital oesophago-bronchial fistula in an adult
Authors: Hill D G
Published: March 2007

A case of oesophago-bronchial fistula presenting in adult life and treated successfully by surgical excision is reported. Unusual features were severe halitosis and the downward direction of the fistula from the oesophagus to the lung.
Glomus jugulare tumours—radiotherapy or surgery?
Authors: Glover G W , Block J
Published: March 2007

Seven patients with glomus tumours are described. Many authors still advocate surgery for these tumours, despite the excellent results obtained with radiotherapy. The results obtained by irradiation in the present series strongly support the view that it is the treatment of choice in large petrosal tumours and those with intracranial extension.
Recurrent spontaneous rupture of the urinary bladder
Authors: Wheeler M H
Published: March 2007

Only 5 cases of recurrent spontaneous bladder rupture have been reported in the literature. The present report is of a patient who developed a spontaneous rupture on two occasions within 5 years. The first rupture was treated without bladder suture. A pelvic fracture 12 months before the first episode is considered to be a probable aetiological factor.
The calcium palmitate gall-stone
Authors: Cowie A G A , Sutor D June , Wooley Susan E , Clark C G
Published: March 2007

Crystallographic studies have recently shown that calcium palmitate is the fourth most abundant crystalline constituent of gall-stones. In a study of the gall-stones from 31 consecutive patients undergoing operation at University College Hospital, London, in 1970, 2 patients were found whose stones contained calcium palmitate as the sole crystalline constituent, and a stone from a third patient had this compound as the major component. Three other patients had small beads of calcium palmitate in stones consisting predominantly of cholesterol. Some points of interest concerning these stone-formers are reported.
Renal function and hypertension in primary hyperparathyroidism
Authors: Chowdhury S D , Gray J G
Published: March 2007

Fifteen patients with histologically proven primary hyperparathyroidism have been investigated with special reference to renal function and the occurrence of hypertension. The patients have been followed up clinically, biochemically, and radiographically for a period of 8 months to 5 years after surgery. In all cases the serum-calcium levels returned to normal immediately after parathyroid adenectomy.

Satisfactory renal function was maintained in all but I of the cases who had had normal preoperative renal function tests. However, renal damage once established persisted and even progressed after parathyroid adenectomy. Renal function, therefore, did not improve after operation.

At follow-up examination a decrease in the number of renal calculi was found in only 2 cases. None of the patients showed formation of new renal calculi or increase in size of those present preoperatively.

Hypertension was present in 6 patients preoperatively. Six months after operation 2 more patients became hypertensive. Both of these patients had shown evidence of renal damage preoperatively. In another case the patient became normotensive 3 months after operation. The severity of renal functional impairment did not bear any relationship to the degree of hypertension although it is possible that the hypertension is secondary to the renal lesion.
Intrapulmonary lipoma associated with multiple pulmonary hamartomas
Authors: Jones E L , Lucey J J , Taylor A Brian
Published: March 2007

A pulmonary lipoma is described in a 64-year-old male, involving the right middle lobe, associated with a separate area of intrapulmonary ossification and a central intrabronchial hamartoma.

It is postulated that the lipoma most probably arose from one of the multiple pulmonary hamartomas.
Computer-assisted statistical analysis of skeletal scintigrams
Authors: Galasko C S B
Published: March 2007

Forty-two consecutive skeletal scintigrams of the dorsal and lumbar spine have been statistically analysed using an Elliott 4120 Computer. Each patient had, in addition, anteroposterior and lateral radiographs of the dorsal and lumbar spine taken. All the patients have been followed up for a minimum of 18 months. In each patient the radiological, scintigraphic, and statistically analysed data have been compared and the accuracy of the results determined by the subsequent progress made by the patient. The results indicate that the computer analysis introduced both false positives and false negatives, and it is suggested that, at the moment, the computerassisted statistical analysis of the skeletal scintigram is not sufficiently reliable for clinical use.
A ‘corrugated’ extrahepatic bile-duct: A new cholangiographic picture
Authors: Dickson G H
Published: March 2007

A patient with an operative cholangiogram showing appearances suggestive of multiple diverticula is recorded; these appearances are apparently unique.
The controlled use of vasodilator drugs in the management of hypovolaemia complicated by diminished cardiac function
Authors: Pagliero K M , Yates A K , Hill D G
Published: March 2007

The fundamental importance of precise measurement of cutaneous temperature rather than the cursory assessment with the back of the hand in cases of shock or diminished tissue perfusion has been well described by Ross, Brock, and Aynsley-Green (1969). They showed examples where core/toe temperature gradients reflected hypovolaemia in postoperative cardiac surgical patients and further showed how this information could be used to guide α-blockade therapy to overcome peripheral vasoconstriction, thus allowing rapid correction of hypovolaemia by transfusion.

One criticism levelled by antagonists to this form of treatment is that α-blockade drugs cause hypotension. This article shows that with careful control α-blockade should not cause significant hypotension. Furthermore, in patients with hypotension of cardiogenic origin, α-blockade may be safely used in the treatment of coincidental hypovolaemia.