bluuebunny/crossref_metadata_2025 huggingface dataset:
Factors determining outcome of reversed saphenous vein femoropopliteal bypass grafts
Authors: Sonnenfeld Tomas , Cronestrand Ruben
Published: March 2007

This investigation was designed to study factors that might be of predictive value in femoropopliteal vein bypass grafting. A series of 146 grafts had a cumulative 5-year graft patency of 82·5 per cent. Five-year limb survival rate in salvage cases was 77·9 per cent. These results are encouraging. However, taking certain factors into account, the patency rates varied. In limbs with claudication, the 5-year graft patency rate was significantly higher than in salvage procedures (P < 0·05). Basal and maximal (during pharmacological vasodilalation) intraoperative graft flow rates were also significantly higher in claudicating limbs (P < 0·01). Reconstructions in limbs with a good run-off had better patency and flow rates than in limbs with a poor run-off (P < 0·001). This suggests that progression of distal atherosclerosis is a major factor for late graft thrombosis. The incidence of graft thrombosis was correlated with the flow rates (P < 0·01). Age, the presence of diabetes, graft diameter and the site of the distal anastomosis did not affect patency.
Aorto-duodenal and subsequent aorto-colonic fistula following operation for ruptured aortic aneurysm
Authors: Cranston D , Vowles K D J
Published: March 2007

Direct communication between aorta and intestinal lumen. whether spontaneous (primary) or postoperative (secondary), is a rare and frequently lethal cause of gastrointestinal haemorrhage. This paper records what is believed to be a unique occurrence in the survival of a patient who, following surgery for ruptured aortic aneurysm, not only developed an aorto-duodenal but subsequently an aorto-colonic fistula over a span of 5 years.
Is continued anal dilatation necessary after a Lord's procedure for haemorrhoids?
Authors: Vellacott K D , Hardcastle J D
Published: March 2007

Forty patients with symptomatic haemorrhoids had a Lord's procedure performed under general anaesthetic. Anal pressures were recorded before and after the dilatation. The patients were then randomly allocated to one of two regimens. Group I was given only a bulk laxative and group 2 was given a bulk laxative and a large anal dilator to use over the next few months according to Lord's regimen. When reviewed at 3 months and 12 months there was no difference in the results between the two groups. We conclude that the use of an anal dilator does not improve the results after a Lord's procedure.
Isolated limb perfusion with melphalan in the treatment of malignant melanoma
Authors: Bulman Andrew S , Jamieson Crawford W
Published: March 2007

Seventy patients with invasive malignant melanoma confined to one limb were treated by isolated perfusion with 1-phenylalanine-dihydrochloride (melphalan) and regional lymphadenectomy between 1959 and 1979. Five patients were perfused twice.

This treatment did not modify the results of appropriate local excision in early melanoma. Twenty-one patients with stage I disease have had 76 per cent 5-year survival.

Forty-eight per cent of 29 patients with extensive local recurrent tumour showed marked tumour regression. Nine of these had subsequent local recurrence with a mean remission of 7 months. Survival in those who responded was 2 years longer than in those who did not. In 6 patients with slight local recurrence, and 19 patients with regional node metastases, response could not be assessed directly. Their 5-year survival was 52 per cent.

There have been no deaths as a result of the procedure and no amputations. Mean postoperative hospital stay was 25 days. We conclude that this technique has a useful place in the palliation of extensive local recurrent melanoma.
The presentation and progress of macroscopic breast cysts
Authors: Jones B M , Bradbeer J W
Published: March 2007

A total of 322 cases of macroscopic breast cysts presenting at a district general hospital has been studied with a minimum follow-up period of 5 years. In almost half the patients (44·18 per cent) a further cyst occurred following aspiration, and in two-thirds of these, more than one subsequent cyst developed. There was a 50-year age span from the youngest to the oldest patient at presentation; however, the majority of cysts (61·80 per cent) occurred in the perimenopausal age group (40–50 years). The subsequent incidence of carcinoma was more than twice that which would be expected in the population at large, but no case of carcinoma that was not suspected clinically was revealed by cytology.
Intestinal complications of endometriosis
Authors: Pillay S P , Hardie I R
Published: March 2007

Five patients with intestinal endometriosis are presented. Two patients had appendiceal involvement, and 3 with sigmoid colon involvement presented with clinical features indistinguishable from carcinoma of the colon. It is important for surgeons to be aware of the possibility of intestinal endometriosis when treating patients with polypoidal colonic masses, strictures of the pelvic colon and atypical rectal bleeding.
Association of Surgeons of Great Britain and Ireland
Authors: Lawrence D , Kakkar V V
Published: March 2007

Foot volumetry is a simple, non-invasive technique for functional assessment of the venous system of the lower limb. The results of foot volumetry and venous pressure measurements were compared in 28 patients who were allocated to one of three groups—normal, uncomplicated superficial venous incompetence and deep venous incompetence—on the basis of clinical examination and ascending phlebography. Volumetry was found to differentiate more accurately between the three groups. Volumetry was also used in 113 patients who had suffered from phlebographically proved deep vein thrombosis (DVT). Seventy-seven per cent of 34 patients who sustained a major DVT and 16 per cent of 79 patients with calf vein thrombosis had evidence of severe haemodynamic impairment equivalent to that seen in the established post-phlebitic syndrome. The clinical significance of these findings is discussed.
The recovery of intestine after ischaemic injury
Authors: Gorey Thomas F
Published: March 2007

A reproducible model of reversible segmental ischaemia was used to evaluate methods of predicting intestinal viability after the release of strangulation. Visual assessment in the immediate period after reperfusion and at ‘second-look’ 24 hours later was inaccurate in identifying recoverable bowel. A Doppler probe used to detect the return of pulsatile blood flow was overpredictive of necrosis. The pattern of surface fluorescence after injection of the supravital dye fluorescein increased the accuracy of predicting intestinal recovery.

A series of silicone rubber injections was carried out to investigate whether the patency of the microvessels influenced the outcome. It was shown that as the ischaemic period increased there was progressive failure of the microcirculation.

It was concluded that the fluorescein injection test correctly identifies recoverable bowel and that the outcome after ischaemic injury is related to microvascular patency.
The effect of vibration on digital blood flow
Authors: Welsh C L
Published: March 2007

The effect on digital blood flow of an acute exposure to vibration has been assessed. Vibration in the frequency range 40–200 Hz reduces digital blood flow, the effect being maximal at 120 Hz. Increasing the amplitude of vibration reduces digital blood flow. The results have implications in the formulation of industrial vibration standards and in the pathophysiology of vibration-induced white finger.
The value of laparoscopy under local anaesthesia in 250 medical and surgical patients
Authors: Hall T J , Donaldson D R , Brennan T G
Published: March 2007

This study reports our experience of laparoscopy under local anaesthesia in 250 patients; the procedure was safe, quick and easy to perform with minimal inconvenience to the patient. We advocate the early use of laparoscopy in patients with ascites and when there is difficulty in the diagnosis of patients with jaundice and hepatomegaly, an accurate histological diagnosis being obtained in the majority. In patients with intra-abdominal malignancy, in whom surgery is planned, laparoscopy can detect disseminated disease and so avoid an unnecessary laparotomy. Laparoscopy may also provide a diagnosis in patients presenting with a variety of vague symptoms such as abdominal pain, weight loss, lethargy etc. We have found laparoscopy an excellent investigation if positive but, as it only allows the surface inspection of viscera, when negative, we recommend caution in its interpretation.
A prospective study of sexual function after major colorectal surgery
Authors: Williams J T , Slack W W
Published: March 2007

Excision of the recto-sigmoid and rectum for cancer or inflammatory disease frequently damages the autonomic nerve supply. The anatomy and function of the autonomic nervous system in the pelvis is reviewed.

Thirty-two patients who underwent excision of the rectum have been studied: 28 operations were for carcinoma, 4 for ulcerative colitis. A detailed history of sexual function was obtained preoperatively together with a neurological examination of the genitalia and perineum. Biopsies were taken from the surgical specimens and examined for the presence of nerve tissue. A further sexual history was taken 3 months postoperatively.

Ten sexually active men (ages 46–74) who had anterior resections or abdominoperineal excisions for carcinoma tended to show impaired sexual activity if there was excessive nerve tissue in the specimen. Two out of 3 sexually active women (ages 53–68) who had cancer operations had satisfactory sexual function postoperatively.

Four patients (ages 28–66) all had satisfactory sexual function after panproctocolectomy for ulcerative colitis.

The advantages of avoiding damage to the pelvic autonomic nerves at operation are discussed.
The anal reflex in idiopathic faecal incontinence; an electrophysiological study
Authors: Henry M M , Parks A G , Swash M
Published: March 2007

We have recorded the latency of the anal reflex, using a simple electrophysiological method, in 22 patients with anorectal incontinence and in 33 control subjects without anorectal disease. The mean latency in the control subjects was 8·3 ms (range 5–11·3 ms). In the patients with faecal incontinence the mean latency of the anal reflex was 13·0 ms (range 6·5–22·0 ms). The reflex latency was within the normal range in only three incontinent patients. These findings support our concept, based on histological examination of the external anal sphincter musculature, that a major cause of this syndrome is denervation of these muscles due to damage to the innervation of the external anal sphincter and puborectalis muscles.
Cancer of the oesophagus—how should tumour biology affect treatment?
Authors: Roberts John G
Published: March 2007

An analysis of the biology of cancer of the oesophagus suggests that significant dissemination may not have taken place at the time of diagnosis in approximately one-third of cases. Positive nodal histology in the mediastinum or abdomen is the best available evidence of disseminated disease. Patients without such nodal involvement there-fore represent a group in whom the disease is most likely to be localized. It is suggested that only these patients be subjected to aggressive local therapy. The effects of no treatment, ortho- and megavoltage radiotherapy, surgery and combinations of surgery and radiotherapy are reviewed. The need for cooperative randomized clinical trials to test the biological hypothesis outlined is discussed. Megavoltage radiotherapy as a primary treatment for oesophageal cancer followed by radical surgery in those patients without evidence of dissemination from nodal histology is proposed as a basis for such clinical trials.
Single dose intra-rectal metronidazole as prophylaxis against wound infection following emergency appendicectomy
Authors: Tanner W A , Ali A E , Collins P G , Fahy Ann M , Lane B E , McCormack T
Published: March 2007

A prospective placebo controlled randomized trial was carried out in 104 patients with a presumptive diagnosis of acute appendicitis. A single dose of 1 g of metronidazole was given intra-rectally 1 h preoperatively. There were 16 wound infections, 15 (out of 50) in the placebo group, 1 (out of 54) in the metronidazole group. This study supports the already accepted value of metronidazole but suggests that a single intra-rectal dose regimen is adequate for prophylaxis.
Incidence of postoperative venous thromboembolism in South India
Authors: Shead G V , Narayanan Ramji
Published: March 2007

The development of postoperative deep vein thrombosis (DVT) was determined in 50 South Indian patients aged 50 years or more using the 125I-fibrinogen uptake technique. The overall incidence was 28 per cent. In patients with malignancy the incidence was 47·6 per cent. Predisposing factors such as varicose veins, oral contraceptives and obesity did not appear important.

A retrospective analysis of post-mortem examination performed on 432 patients dying after operation showed major pulmonary embolism to have occurred in only 1·9 per cent. The disproportion between the frequent ocurrence of postoperative DVT and the infrequence of fatal pulmonary embolism warrants further study.
Use of an extracorporeal glucose monitor for the diagnosis and surgical treatment of an insulinoma
Authors: Buysschaert M , Lambotte L , Reynaert M , Kestens P J , Ketelslegers J M , Lambert A E
Published: March 2007

An extracorporeal glucose monitor (EGM) has been used in a patient with an insulinoma. This system, which continuously measures blood glucose, can be used in combination with a feedback-controlled glucose infusion to maintain glycaemia at any preselected level. It prevents the risk of severe hypoglycaemia during diagnostic tests (total fast, tolbutamide and insulin tolerance tests) as well as during surgery. It also helps in determining whether all the insulin-secreting tumour tissue has been removed. The EGM is thus helpful in the diagnosis and surgical treatment of insulinomas.
The management of pancreatic and pancreaticoduodenal injuries
Authors: Campbell Robert , Kennedy Terence
Published: March 2007

From 1969 to 1979 39 injuries of the pancreas and duodenum were treated at the Royal Victoria Hospital, Belfast. The mortality was 31 per cent. Twenty-six injuries were due to stab, bomb or bullet. Two of the 17 with low velocity gunshot wounds died, whereas all 5 cases of high velocity missile injury died (P < 0·001). Ten of the 13 cases of blunt trauma were due to road traffic accidents. In 21 cases the body and tail of the gland were injured, and in 13 the head and neck. There were 5 isolated duodenal injuries and in 7 a combined pancreaticoduodenal injury. The mortality was directly related to the number of other organs damaged.

Three main methods of treatment were used—simple drainage, suture and drainage, and primary distal pancreatic resection. Serious complications, pancreatitis, fistula, secondary haemorrhage and sepsis were frequent after the first two methods but rare after distal resection.

Diagnosis was delayed in 4 cases of closed injury and 1 of these patients died. Pancreatic injury was missed 6 times at operation; in 4 cases retroperitoneal haematoma was not explored and 2 of these patients died.

Five of the 12 deaths were due to overwhelming bomb and bullet injury. In one case resuscitation was inadequate. The remaining 6 died of the complications of the original pancreatic injury, either because operation was delayed or because the injury was missed.

Our management was deficient in three areas: awareness of the need for laparotomy, recognition of the injury at operation and inadequate surgery. All open abdominal injuries must be explored; suspicion and careful assessment are essential in closed trauma. At operation the pancreas must be carefully examined; an upper retroperitoneal haematoma is an absolute indication for this. Simple drainage is only sufficient for trivial injury; for major injury of the body and tail we prefer distal resection. Roux loop drainage is suggested for injury to the head and neck, especially when associated with duodenal injury.
Exploration of the common bile duct—the relevance of the clinical picture and the importance of peroperative cholangiography
Authors: Cranley Brian , Logan Hume
Published: March 2007

A series of 500 cholecystectomies performed over a 7-year period was reviewed retrospectively. The reliability of preoperative clinical features such as jaundice and pancreatitis was assessed in determining the presence of choledocholithiasis, and was found to be of limited value. Investigations such as intravenous cholangiography and liver function tests were found also to be inaccurate in the detection of common duct stones as was the appearance of the duct at operation. The usefulness of the peroperative cholangiogram in the detection of common duct stones that would otherwise have been overlooked is emphasized. Common duct stones would have remained undetected in 25 per cent of patients with choledocholithiasis. Despite the use of routine peroperative cholangiography common duct stones were overlooked in 11·25 per cent of patients who underwent exploration.
Radiological demonstration of Meckel's diverticulum
Authors: Craig Oscar , Murfitt Janet
Published: March 2007

Three cases of Meckel's diverticulum are described. All were investigated by the conventional barium meal and follow-through examination. The methods of radiological investigation are considered and, contrary to the opinion of many authors, the value of the conventional barium examination is stressed.
Carcinoma of the hepatic duct junction
Authors: George Phyllis A , Brown Colin , Foley Robert T E
Published: March 2007

A series of 54 patients with carcinoma of the hepatic duct junction is reviewed. The condition is probably less rare than previous publications would suggest as the condition is frequently missed at operation. An account of the presentation, investigation and treatment of these patients is given, as well as the results obtained. In the discussion that follows, it is pointed out that if systematic investigation is carried out, with particular regard to adequate radiological investigations, both prior to and during surgery, the correct diagnosis can be made, although histological proof may be difficult to obtain. These tumours are seldom resectable, but good and worthwhile palliation may be obtained.
Traumatic renal artery occlusion producing hypertension
Authors: Ernst David , Windsor Colin W O
Published: March 2007

Traumatic renal artery occlusion is relatively rare. Prior to 1974 there were only 38 cases reported in the literature (1). The true incidence, however, is greater and the diagnosis is frequently missed at the time of the original injury. Less than 50 per cent of cases will develop hypertension. Early diagnosis is essential if this complication is to be avoided. Two cases of traumatic renal artery occlusion producing hypertension are described.
Solitary ulcer of the rectum—or is it? A report of 6 cases
Authors: Thomson G , Clark A , Handyside J , Gillespie G
Published: March 2007

Solitary ulcer of the rectum is an unusual disorder which presents only occasionally to the individual clinician. While the histopathological features are characteristic, the wide variety of naked eye appearances of lesions which the syndrome produces may make for clinical confusion, particularly since the lesions may be neither solitary nor ulcerated. We present here an experience of six cases which presented to the Victoria Infirmary, Glasgow, over the period 1969–79 which illustrate the diagnostic dilemma and variety of lesions encountered.
The surgical treatment of radiation injuries after radiotherapy for uterine carcinoma
Authors: Cochrane John P S , Yarnold John R , Slack William W
Published: March 2007

The outcome of serious radiation injuries to the pelvic viscera in 400 patients treated by radiotherapy for carcinoma of the uterus between January 1974 and December 1978 has been reviewed. Twenty-eight instances of serious radiation damage have been found, 13 of predominantly small bowel damage, 11 of predominantly large bowel damage and 4 of bladder damage. Many patients had involvement at multiple sites. Fourteen patients have died, and 9 survivors have artificial abdominal stomas. Leaking anastomoses and progressive sepsis were major problems in the postoperative period and could be related either to inadequate resection of irradiated bowel or to damage to other organs at operation. The possibilities of earlier diagnosis and better surgical procedures are discussed.
Gas gangrene in intestinal angina
Authors: McLenachan J , McLatchie G R , Browne M K
Published: March 2007

A patient with Clostridium welchii infection complicating intestinal angina is reported. Surgical resection of bowel of dubious viability is important to avoid this unusual complication.
Tuberculous pyloric stenosis
Authors: Keenan Daniel J M
Published: March 2007

A case of pyloric stenosis, caused by abdominal tuberculosis and presenting as an inoperable neoplasm in a member of the indigenous population of the British Isles, is reported. The need for histological confirmation of suspected inoperable malignant tumours is stressed. The pathogenesis and management of the condition are discussed.
Reoperation for recurrent peptic ulceration
Authors: Muscroft T J , Taylor E W , Deane S A , Alexander-Williams J
Published: March 2007

Thirty-eight patients undergoing reoperation for recurrent peptic ulceration have been reviewed after at least 3 years. All were considered to be in Visick grade IV before reoperation. There were no operative deaths. Thirty-three of the patients ended with both a vagotomy and antral resection. After reoperation 17 patients (45 per cent) remained in Visick grades III and IV. Eight patients have had further operations and, after 47 procedures in 38 patients, 14 (37 per cent) were still in Visick grades III and IV. Vagotomy and antrectomy has a high non-ulcer mobidity rate and we conclude that other methods of treatment for recurrent ulceration require evaluation.
The clinical relevance of isolated ventral pancreas
Authors: Thompson M H , Williamson R C N , Salmon P R
Published: March 2007

An isolated ventral pancreas results from failure of fusion of the dorsal and ventral pancreatic ducts. Until the advent of endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of this abnormality was not known. A series of 11 such patients in 850 consecutive ERCP examinations is described. No other cause for their symptoms was discovered. Secretory studies showed a low volume of pancreatic juice with normal concentration of bicarbonate and trypsin. In 5 cases operative dorsal pancreatography was performed: it was normal in all cases. In 3 cases the pancreatic tail was amputated and found unexpectedly to be the seat of pancreatitis in 2. Isolated ventral pancreas may be associated with pancreatitis, but this is not proved.
Surgical treatment for Graves' disease: A long term follow-up of 325 patients
Authors: Noguchi Shiro , Murakami N , Noguchi A
Published: March 2007

Postoperative thyroid status was classified into 6 categories on the basis of serum free thyroxine index (FTI), serum triiodothyronine (T-3) and serum TSH concentration. Review of 325 patients who underwent thyroidectomy for Graves' disease more than 4 years previously showed that 25 patients (7·7 per cent) had recurrent hyperthyroidism. Six patients (1·8 per cent) were classified as equivocal hyperthyroid since either FTI or T-3 was above the normal range. Two hundred and twenty-two patients (68·3 per cent) were unequivocally euthyroid and 33 patients (10·3 per cent) were euthyroid with elevated TSH levels. Twenty patients (6·2 per cent) were equivocal hypothyroid since either their FTI or T-3 values were below the normal range and TSH were increased. Hypothyroidism was present in 19 patients (5·8 per cent), of whom 11 had no clinical manifestation of thyroid dysfunction. The incidence of hypothyroidism did not correlate with the intervals between operation and review.

The second review, performed in 189 patients 18 months after the first, showed that there was a change in thyroid functional status in 46 patients, of whom 32 had an increased level of function, including one hypothyroid and 7 equivocal hypothyroid patients who became euthyroid spontaneously.

Thus postoperative hypothyroidism in some patients can recover without medication. Also thyroid function in some postoperative patients is not maintained at a fixed level but may fluctuate.
The wound fibroblast and macrophage. I: Wound cell population changes observed in tissue culture
Authors: Stewart Richard J , Duley John A , Rosman Ingrid , Fraser Robin , Allardyce Randall A
Published: March 2007

The number and type of cells which migrated from sequential explants of wounded fascia in rats reflected the dense and changing cell populations observed in healing wounds. Macrophages appeared in large numbers from explants taken in the 5 days following injury, thereafter fibroblast-like cells predominated. The results support the hypothesis that the fibroblast-like cell of tissue culture is the same as the wound fibroblast. The technique can be used to obtain wound cells and provides a useful bridge between in vivo and in vitro means of investigating wound repair.
Spontaneous common bile duct stricture: An illustrated case report
Authors: Muscroft T J , Middleton M D
Published: March 2007

An illustrated case of spontaneous extrahepatic biliary stricture is presented and the differential diagnosis is considered. A lesion of this sort does not appear to have been described previously.
Lymphoscintigraphy cannot diagnose breast cancer
Authors: Black R B , Merrick M V , Taylor T V , Forrest A P M
Published: March 2007

Axillary lymphoscintigraphy was performed by the technique of Agwunobi and Boak (1) in 68 patients with operable cancer of the breast and 11 patients with benign disease. Contrary to their previous report, scans were found to be indistinguishable from normal in the majority of breast cancer patients with interpretable scans, and no pattern of uptake was found which was typical of carcinoma in the corresponding breast.
Scintiscanning of the breast with 99Tcm−diethylene triamine penta-acetic acid—a prospective blind evaluation
Authors: Cuschieri A , Hutchinson F , Neill G D S , Wisbey M L , Wood R A B , Preece P , Clark J
Published: March 2007

In this blind prospective study of breast scintiscanning with 99Tcm−diethylene triamine penta-cetic acid (DTPA) in 67 female patients presenting at a primary breast referral clinic, we have observed that this investigation has a high diagnostic accuracy in distinguishing benign from malignant lesions of the breast. The predictive value of the test when positive in establishing the presence of cancer is 94 per cent with a false negative rate of 6 per cent. The predictive value of the test when negative in excluding cancer is 97 per cent with a false positive rate of 3 per cent. Initial studies also indicate the potential value of DTPA breast scintiscanning in delineatingthe activityof painful benign lesions of the breast.
The effects of caerulein and a meal stimulus on gallbladder intraluminal pressure and bile flow in the pig
Authors: Mitchenere P , Adrian T E , Hobbs K E F , Bloom S R
Published: March 2007

The intraluminal gallbladder pressure has been measured in a conscious unsedated pig model by the use of a radiotelemetry pressure capsule. A loop fistula was incorporated to measure bile output simultaneously. Mean fasting intraluminal gallbladder pressure was found to be 15±4 mmHg above atmospheric pressure, and mean fasting bile output 7·5±0·8 ml/10 min.

Following intravenous caerulein pressure peaked at 2 min with a mean rise of 17±3 mmHg above basal (P<0·005). Bile output was increased for 30 min following caerulein with a total mean increase for this period of 13·5±2·2 ml (P<0·005).

Gallbladder pressure rose significantly 5 min after commencing a meal by 6·0±1·9 mmHg (P<0·025) reaching a peak pressure 65 min after the meal with a mean rise of 14·8±2·3 mmHg (P<0·005). Bile output was significantly increased for 50 min following the ingestion of food. The total increments above basal values for bile output being 15·9±2·7 ml (P<0·005) in the first 30 min post-randially and 11·6±2·4 ml (P<0·005) in the 30–60 min period.

This model re-emphasizes the rapidity of the hormonal response and may be valuable for further studies on the physiology of post-randial gallbladder emptying.
Carcinoma of the gallbladder
Authors: Koo Jarley , Wong John , Cheng Frank C Y , Ong G B
Published: March 2007

A retrospective study of 100 proved cases of primary carcinoma of the gallbladder admitted to the University Surgical Unit, University of Hong Kong, over a 20-year period was undertaken. The female to male ratio was 1·4 to 1. The peak incidence was in the seventh decade for the females and the sixth decade for the males. Preoperative diagnosis was made in 10 patients. ‘Curative’ cholecystectomy was performed in 20 patients with a 5-year survival rate of 10 per cent. Palliative procedures were performed in 44 patients with a median survival of 8 weeks, which was notsignificantly different from that in the 30 patients who were not operated upon or had laparotomy and biopsy only. Radical resection was carried out in 6 patients, all of whom died in hospital. Gallstones were found in only 26 patients. The gallbladders of 3 patients had associated benign tumours, one of which had malignant transformation at multiple sites. One patient had chronic typhoid infection. The incidence of clonorchis infestation and primary pyogenic cholangitis in these 100 patients was not different from that of our general hospital population.
Management of diabetes during open heart surgery
Authors: Gill G V , Sherif I H , Alberti K G M M
Published: March 2007

The management of 5 insulin-dependent diabetics following open heart surgery was studied and compared with a group of 5 similar diabetics who had undergone urological or orthopaedic operations. The patients were all treated with a glucose/insulin/potassium infusion regimen, but the cardiac group needed much greater amounts of insulin (1·0 unit/g of glucose) than the non-cardiac group (0·3 units/g) to achieve a similar level of control. The high requirements of the cardiac patients are probably related to trauma, hypothermia and glucose loading when cardiopulmonary bypass begins. Diabetics undergoing such surgery need suitably modified insulin regimens from the outset.
The influence of an intact pylorus on postprandial enteroglucagon and neurotensin release after upper gastric surgery
Authors: Sagor G R , Ghatei M A , McGregor G P , Mitchenere P , Kirk R M , Bloom S R
Published: March 2007

Upper partial gastrectomy for carcinoma of the gastric cardia or fundus is unavoidably accompanied by truncal vagotomy, so it is orthodox practice to carry out pyloroplasty with this procedure. In order to assess the effect of leaving an intact pylorus in this operation, 21 patients were investigated with an oral hypertonic load (200 ml 50 per cent glucose solution), and blood was taken at intervals during the test, for the ileal gut hormones, enteroglucagon and neurotensin, as well as for measurements of haematocrit and blood glucose. Clinical features of dumping during the test were sought. There were 7 patients with upper partial gastrectomy, truncal vagotomy and an intact pylorus, 7 patients without a pylorus(total or near total gastrectomy) and 7 patients not subjected to gastric surgery.

No significant difference was found in any of the measurements between gastrectomy patients with an intact pylorus andthose draining through an enterostomy. However, both these groups differed significantly from normal controls in havinggreater rates of rise and higher peak values of enteroglucagon, neurotensin, haematocrit and blood glucose, together witha more frequent occurrence of dumping symptoms during the test.

As the above measurements probably reflect transit of glucose into the small intestine, the findings in this study suggest that leaving an intact unstenosed pylorus is unlikely to lead to gastric stasis following upper partial gastrectomy.
Gallstone ileus complicating terminal ileal Crohn's disease
Authors: Highman L , Jagelman D G
Published: March 2007

Two cases are reported of gallstone ileus complicating terminal ileal Crohn's disease. Both patients had a prolonged history of Crohn's disease without the need for surgical intervention. They were admitted with small bowel obstruction which failed to resolve on conservative management as is usually the case. The features of these two cases that may lead to the development of this complication and the pointers in diagnosis are discussed.
Body temperature after accidental injury
Authors: Little R A , Stoner H B
Published: March 2007

Core and mean skin temperatures have been measured in 82 patients shortly after accidental injuries of different severity in order to study the effects of injury on thermoregulation. Skin temperature fell after injury and core temperaturealso when the injury was severe. After severe injuries both core and mean body temperatures were negatively related to theseverity of the injury, measured by the Injury Severity Score. The fall in skin temperature was attributed to vasoconstriction and that in core temperature to decreased heat production due to reduced oxygen transport to the tissues. These changes in temperature should have stimulated shivering which was not observed in the severely injured. This suggests thatthermoregulation is affected after injury, and possible mechanisms are discussed.
Postoperative changes in coagulation and fibrinolysis independent of neurogenic stimuli and adrenal hormones
Authors: Rem J , Feddersen C , Brandt M R , Kehlet H
Published: March 2007

Postoperative changes in various haemostatic parameters (capillary bleeding time, platelet count, fibrinogen, fibrinmonomers, prothrombin, antithrombin III, factor VIII procoagulant, factor VIII antigen, euglobulin clot lysis time, streptokinase lysis time, fibrinogen related antigens, α1−antitrypsin and α2−macroglobulin) plasma glucose and cortisol were studied in 12 female patients undergoing elective abdominal hysterectomy during either general anaesthesia or epidural analgesia (T4−S5). General anaesthesia and epidural analgesia on their own had only negligible influence on haemostatic parameters. Hysterectomy during general anaesthesia caused activation of coagulation and fibrinolysis, followed by depression of fibrinolysis. Epidural analgesia prevented the cortisol and glucose response to surgery, but did not influence the coagulation and fibrinolytic response to surgery, except for an inhibition of the postoperative increase in factor VIII antigen. It is concluded that postoperative changes in the coagulation and fibrinolytic systems are mediated by factors other than neurogenic stimuli and adrenal hormones.
Ionized calcium in acute pancreatitis and its relationships with total calcium and serum lipase
Authors: Croton Roger S , Warren Richard A , Stott Anthony , Roberts Norman B
Published: March 2007

Serial measurements of serum amylase, lipase and ionized calcium were made in a prospective study of 17 patients withacute pancreatitis. The mean serum ionized calcium was significantly below the normal range for the first 24 h and had returned to normal after 48 h. There was no correlation between serum ionized calcium and paired calcium corrected for albumin during the first 36 h of the study, but they were correlated for the remainder of the investigation. Serum lipase andionized calcium levels were just significantly correlated over the first 3 days (r= −0·44;t = 2·3; P<0·05; d.f. 22), but failed to reach correlation over the whole period of study (r= −0·34; t= 2·0; d.f. 31). These data establish a significant drop in directly measured ionized calcium early in an attack of pancreatitis, which is not seen in the paired corrected calcium values. Furthermore, the drop is correlated with serum lipase, although this is weak and other factors must be involved in the hypocalcaemia.
Diagnostic peritoneal lavage in acute pancreatitis—the value of microscopy of the lavage fluid
Authors: Bradley J Andrew , Bradley Paul , McMahon Michael J
Published: March 2007

In only 2 of 98 cases with a clinical diagnosis of acute pancreatitis submitted to peritoneal lavage in order to assess severity was the diagnosis found to be wrong. These two cases (one was biliary peritonitis and the other mesenteric infarction) were not differentiated from severe pancreatitis by clinical examination, measurement of plasma amylase, the appearance of the lavage fluid or its amylase or white cell count. One case was exceptional in that the lavage fluid had a faecal odour, and both cases were found to have large numbers of intestinal organisms which were clearly visible on routine microscopy. Scanty commensals (? contaminants) were seen in the lavage fluid of 2 of the 96 patients with acute pancreatitis but no intestinal organisms were found. If peritoneal lavage is used in the management of acutepancreatitis, microscopy of the lavage fluid, carried out as an emergency investigation, might help to detect the occasional case with a false diagnosis.
The effect of increased motility on absorption from the canine colon
Authors: Grandison A S , Hyland J , Darby C , Shields R , Taylor I
Published: March 2007

The absorption of water and electrolytes and intraluminal pressure were measured from Thiry-Vella loops in 4 dogs under basal conditions and during electrical stimulation of the colonic smooth muscle. Pulse wave electrical stimulation via serosal silver | silver chloride electrodes gave rise to significant increases in both intraluminal pressure and percentage motility. Absorption of water, sodium and chloride was significantly increased during stimulation but the transport of ammonia, bicarbonate and potassium was not significantly affected. It is suggested that motility changes result in altered absorption irrespective of transit time.
The effect of surgical operation upon monocytes
Authors: Everson N W , Neoptolemos J P , Scott D J A , Wood R F M , Bell P R F
Published: March 2007

The effect of surgical operation upon monocyte numbers and function was studied in patients with both benign and malignant disease. In patients with benign disease a significant increase in the phagocytosis of 99Tc latexlabelled particles by monocytes was observed at 24 h postoperatively (P<0·01 compared with preoperatively) and also a significant increase in monocyte numbers (P<0·001 compared with preoperatively). In patients undergoing surgery for malignant disease no significant increase in phagocytic activity of monocytes was found postoperatively. A significantdecrease in monocyte numbers was shown to follow surgery in this group (P<0·001). The implications of these findings are discussed.
The social, emotional and financial implications of adjuvant chemotherapy in breast cancer
Authors: McArdle C S , Calman K C , Cooper A F , Hughson A V M , Russell A R , Smith D C
Published: March 2007

The incidence and severity of toxicity, the extent of emotional disturbance and cost of adjuvant chemotherapy were assessed in patients with early breast cancer randomized to receive either radiotherapy, chemotherapy (CMF) or radiotherapyfollowed by chemotherapy. Nausea and vomiting occurred in 85 per cent of patients receiving chemotherapy and contributed significantly to distress. Over one-third of patients required a wig or developed mucosal ulceration. Nevertheless, most patients were able to return to work during treatment. Leucopoenia was more commonly encountered in those patientswho received radiotherapy prior to chemotherapy. Twelve months after mastectomy, psychiatric morbidity was present in 13 of 34 patients receiving chemotherapy with or without radiotherapy, compared with only 1 of 18 receiving radiotherapy alone. Anxiety was common in both groups. This trend was still present 6 months after the completion of chemotherapy. The cost of chemotherapy is discussed.
Naftidrofuryl for ischaemic rest pain: A controlled trial
Authors: Greenhalgh R M
Published: March 2007

A preliminary study suggested that some patients with ischaemic rest pain improved during treatment with naftidrofuryl (Praxilene). Therefore, a controlled trial was performed in which 16 patients were treated for 7 days with placebo (given intravenously and in tablet form), and were then given Praxilene for a further 10 days and assessed subjectively and objectively. The drug regimen used was Praxilene 200 mg 8-hourly by mouth and 200 mg twice-daily intravenously. Although no objective improvement could be attributed to the drug, 7 of the 16 patients showed subjective improvementduring the placebo period, but reported no further improvement during the Praxilene period (placebo responders). Five patients did not respond to the placebo but reported an improvement whilst taking the drug. In 4 patients there was no improvement at all. Praxilene produced subjective improvement in the symptoms of rest pain in 5 patients out of 16 in this small study.
Recurrent inguinal hernia after local anaesthetic repair
Authors: Kingsnorth A N , Britton B J , Morris P J
Published: March 2007

A consecutive series of 227 inguinal hernias were repaired under local anaesthetic between 1976 and 1978 in the Oxford hospitals. A total of 187 of these operations was performed on a day-case basis.

Data were available for analysis from 183 cases in whom there were 13 recurrences. The factor most strongly influencing the recurrence rate was the experience of a particular surgeon with the local anaesthetic technique. It was found thatonce 6 hernias had been repaired under local anaesthetic the chance of recurrence fell to a level of 2·5 per cent (which projects to 7·5 per cent at the end of 25 years).

The recurrence rate for beginners (those who have repaired less than 6 hernias under local anaesthetic) was unacceptably high at 9·4 per cent (which projects to 28 per cent at the end of 25 years).

Our recurrence rate was high in patients with a direct hernia in whom there were associated risk factors known to predispose to recurrence.
A controlled trial to compare systemic and intra-incisional cefuroxime prophylaxis in high risk gastric surgery
Authors: Hares M M , Hegarty M A , Warlow J , Malins D , Youngs Denise , Bentley Sandra , Burdon D W , Keighley M R B
Published: March 2007

A prospective randomized controlled trial has compared single dose systemic cefuroxime (n = 27) or intra-incisional cefuroxime (n = 26) with a control group (n = 28) in 81 patients undergoing gastric resection, revision gastric surgery or operation for gastro-oesophageal malignancy. In the controls the incidence of sepsis was: 35 per cent wound infection, 29 per cent abscess, 21 per cent septicaemia. After intra-incisional cefuroxime the incidence was: 4 per cent wound sepsis, 19 per cent abscess and 4 per cent septicaemia. After systemic cefuroxime only 2 patients developed wound sepsis (7 per cent) with no cases of abscess or septicaemia. Excluded from this high risk group were 36 patients who had a vagotomy with or without drainage during the trial where antibiotics were not given, 4 of whom developed wound sepsis only (11 per cent). There was a poor correlation between the individual species isolated from the gastric aspirate and the organisms responsible for postoperative infection in the controls, but there was a good correlation between fasting gastric pH and the risk of sepsis in the controls.
Typhoid perforation: Choice of operation
Authors: Eggleston Forrest C , Santoshi Bannu
Published: March 2007

Over a 17-year period 93 patients have been treated for typhoid perforation of the bowel. Forty-three of these have been treated by closure of the perforation, and 42 by end-to-side ileotransverse colostomy. These two groups are compared. Although there was no difference in mortality, postoperative morbidity in survivors was less in those having an end-to-side ileotransverse colostomy. End-to-side ileotransverse colostomy is a logical operation based upon the pathological changes in the bowel produced by typhoid fever and is the operation of choice.
Superior mesenteric venous thrombosis
Authors: Carr Nick , Jamison Michael H
Published: March 2007

Superior mesenteric venous occlusion may be difficult to recognize, but is important as it carries a better prognosis than superior mesenteric arterial occlusion, and may be amenable to surgical treatment. Three cases of primary superior mesenteric venous occlusion are described. The diagnosis was unsuspected until discovered at laparotomy. Non-viable bowel was present in all cases and in two cases thrombosed veins were apparent in the mesentery. The lesion was localized in distribution, and generous bowel resection with primary anastomosis was performed. Recovery was uncomplicated in all cases. When the thrombosis appears well localized, generous resection with primary anastomosis seems a suitable alternative to resection and exteriorization or conservative treatment with a second-look procedure.
Circulating immune complexes in patients with benign and malignant colorectal tumours
Authors: Vellacott K D , Baldwin R W , Balfour T W , Hardcastle J D
Published: March 2007

Circulating immune complexes were measured using a modified C1q binding assay in 100 preoperative patients with colorectal cancer and in 52 patients with benign polyps. Sixty-one per cent of the patients with cancer and 49 per cent of the patients with benign polyps had elevated levels, as did 92 per cent of those with malignant polyps. There was no relation to a, the stage of the disease, with 10 out of 13 Dukes' A tumours (77 per cent) having increased levels; b, the degree of differentiation of the cancers; c, the tumour mass. However, cancers on the right side of the colon had significantly higher levels than rectal cancers.
Anaerobic paronychia
Authors: Whitehead Stephen M , Eykyn Susannah J , Phillips Ian
Published: March 2007

During 1 year 116 patients with paronychia had bacteriological cultures of the pus. Aerobic bacteria, predominantly Staphylococcus aureus were isolated from 81. Anaerobic bacteria were isolated from 35, and in 31 of these aerobes were also present. Anaerobic paronychias were less acute than those caused by aerobes but otherwise the clinical features and management were the same. The anaerobes isolated were those found as oro-pharyngeal commensals and did not include the colonic commensal Bacteroides fragilis. They were, with few exceptions, sensitive to penicillin.
High bile duct cancer: Incidence and pattern of investigation in the general hospital setting
Authors: Peel A L G , Dillon E , Dellipiani A W
Published: March 2007

Between 1 April 1977 and 30 November 1979, 16 cases of high bile duct carcinoma presented at North Tees District Hospital, giving an incidence of one per 40 000 population per annum for Teesside. Results of this prospective study emphasize the potential accuracy of preoperative assessment using techniques which should be available in a district general hospital. Ultrasound revealed the site of obstruction in every patient in whom it was used (n = 13), and often indicated a neoplastic aetiology (n = 10). Percutaneous transhepatic cholangiography (PTC) and endoscopic retrograde cholangiography (ERC) correctly demonstrated the site of obstruction in each patient and suggested a primary bile duct carcinoma in 12 patients. Although intraoperative cholangiography gave additional information in some patients, it was not sufficiently reliable to dispense with either PTC or ERC.

Histological proof of a primary bile duct carcinoma was obtained in 15 patients. In the 10 patients without obvious metastatic disease frozen section analysis was positive in 7, but was negative in 3 patients with multiple strictures where malignant cells were relatively infrequent and were found in the perineural lymphatics on paraffin sections.

In this difficult group of patients the approach described eliminates the possibility of a false negative laparotomy, enables careful planning of the necessary surgical technique and also the consideration of nonoperative management.