bluuebunny/crossref_metadata_2025 huggingface dataset:
Incisional hernia: A 10 year prospective study of incidence and attitudes
Authors: Mudge Marjorie , Hughes L E
Published: March 2007

Five hundred and sixty-four patients reviewed 1 year after major abdominal surgery have been studied prospectively by a single observer for 10 years to determine the incidence and significance of incisional hernia. Of 337 (60 per cent) patients completing the 10 year follow-up 37 (11 per cent) developed an incisional hernia and 13 (35 per cent) of these first appeared at 5 years or later. One in three hernias caused symptoms. The late appearing hernias were smaller than the early ones, and caused little trouble. Of the 18 patients who consulted their general practitioner, 11 had symptoms and of these six (55 per cent) were referred for surgical opinion. Many hernias were diagnosed at routine outpatient follow-up and were likely to receive treatment from the surgeon. Most symptomatic patients were offered surgery with the remainder usually being offered a corset. In about half our patients (mainly those without symptoms) surgery was refused or advised against although the patients would have accepted it. Recurrence is common after surgical repair (40 per cent) but seems to be related to surgical technique. The possibility of complications occurring from an incisional hernia does not appear to be discussed with patients although obstruction occurred in 14 per cent of our patients with troublesome hernia.
Prediction of outcome following acute variceal haemorrhage
Authors: Garden O J , Motyl H , Gilmour W H , Utley R J , Carter D C
Published: March 2007

In order to identify factors predicting survival following acute variceal haemorrhage, data were collected prospectively from 100 admissions in 70 patients managed by a standard policy employing oesophageal tamponade, injection sclerotherapy and, if necessary, oesophageal transection. Of the ten predictive factors identified by univariate analysis, only prothrombin ratio, serum creatinine and the presence of encephalopathy on admission were shown by stepwise logistic regression to have independent significance. The derived regression equation allowed clearer identification than conventional scoring systems of high and low risk groups and successfully predicted outcome in 90 per cent of admissions.
Oesophageal manometry in patients with varices and following oesophageal transection
Authors: Spence R A J , Johnston G W , Parks T G
Published: March 2007

Thirteen patients who had recently bled from varices underwent oesophageal manometry. A control group of 13 asymptomatic subjects were also studied. Seven of the thirteen variceal patients had manometry before oesophageal transection and repeat manometry at least 1 month following operation. A further group of 17 post-transection patients also underwent manometry at a mean 27.6 months following operation. Comparison between variceal (13) and control subjects (13) showed that the lower oesophageal sphincter pressure, total length and length of the abdominal and proximal portions of the sphincter were similar in the two groups. Pre- and postoperative manometry (7) revealed a significant reduction in lower oesophageal sphincter pressure following transection. The total length of the lower sphincter was shorter postoperatively compared to the pre-operative length. Both the abdominal and the proximal portion of the sphincter were significantly shorter postoperatively. Comparison between post-transection group (24) and control subjects (13) showed that lower oesophageal sphincter pressure was significantly less following transection. Both total length and the length of the abdominal portion of the sphincter were significantly lower in the post-transection group.
Increased efficiency of transfusion practice in routine surgery using pre-operative antibody screening and selective ordering with an abbreviated crossmatch
Authors: Dodsworth Helen , Dudley H A F
Published: March 2007

In an effort to meet the increasing demands for blood to cover routine surgery and in order to reduce the amount of time-expired blood, we have adopted a system of grouping and screening patients' blood pre-operatively but not crossmatching blood unless there is more than a 30 per cent chance that it will be used. This approach is based on schemes developed in the USA over the past three decades. If there is unexpected haemorrhage at operation and the patient's serum is known to be free of irregular antibodies, blood of the same ABO group is provided, with only an abbreviated crossmatch to check ABO compatibility. During the first 6 months in which the new scheme was in operation it is estimated that the laboratory crossmatched at least 3000 units of blood (44 per cent) less than it would otherwise have done. 336 units were transfused after an abbreviated crossmatch and, as expected, there were no haemolytic transfusion reactions.
Abdominal aortic aneurysms in Western Australia: Descriptive epidemiology and patterns of rupture
Authors:   The Members of the West Australian Vascular Service, Castleden W M , Mercer J C
Published: March 2007

All abdominal aortic aneurysms presenting to hospitals and coroners in Western Australia over an 11-year period (January 1971 to December 1981) have been reviewed. A total of 1237 abdominal aortic aneurysms were found. After age and sex standardization it was apparent that the prevalence of diagnosis of abdominal aortic aneurysms had increased from 74.8 per 100 000 to 117.2 per 100 000 for men over 55 years of age (increase of 56.7 per cent) and from 17.5 per 100 000 to 33.9 per 100 000 for women over 55 years of age (increase of 93-7 per cent) during this period. One hundred and twenty-three patients were identified by coroner's autopsy after sudden death from ruptured abdominal aortic aneurysms in whom there had been no previous diagnosis of abdominal aortic aneurysm. Between 1971 to 1981, 478 patients underwent surgery; 225 had elective resection of their aneurysm with a 4.0 per cent fatality rate, and 253 had emergency operations with a 31.2 per cent fatality rate. Seasonal variations contributing to the date of emergency presentation or death from rupture of abdominal aortic aneurysms indicated a possible influence of colder weather upon rupture. It is hoped that the information provided in this paper will be of use to surgeons and physicians involved in health care planning for similar populations.
Vascular occlusion in the pathogenesis of complicated amoebic colitis: Evidence for an hypothesis
Authors: Luvuno F M , Mtshali Z , Baker L W
Published: March 2007

Amoebic perforation of bowel, the final and most serious manifestation of transmural amoebic colitis, is due to thrombotic occlusion of vessels supplying the segment of bowel with subsequent infarction and ischaemic necrosis. The ischaemic nature of the necrosis is confirmed by its shape and the demonstration of vascular thrombosis in the resected specimens of perforated amoebic colitis. Specimen angiography confirms the avascular area confined to the macroscopic lesions. Thrombotic occlusion and amoebic invasion of blood vessels have been demonstrated histologically. This new information suggests that amoebic perforation of the bowel is due to vascular compromise.
Electrophysiological and manometric assessment of the pelvic floor in the solitary rectal ulcer syndrome
Authors: Snooks S J , Nicholls R J , Henry M M , Swash M
Published: March 2007

Fifteen of twenty patients with the solitary rectal ulcer syndrome, eighteen of whom were women, had evidence of reinnervation in the external anal sphincter muscle as demonstrated by single fibre EMG and nine of these patients had an increased pudendal nerve terminal motor latency. In ten patients there was paradoxical puborectalis muscle activity on straining, but damage to the innervation of the external anal sphincter muscle was correlated with a history of straining, and with excessive perineal descent, rather than with paradoxical puborectalis activity. We suggest that this syndrome does not have a single cause.
R2/3 gastrectomy for gastric carcinoma: An audited experience of a consecutive series
Authors: Diggory R T , Cuschieri A
Published: March 2007

A consecutive series of 27 patients with gastric neoplasm (24 carcinoma, 3 lymphoma) have been staged at laparotomy using the Japanese criteria for macroscopic staging. In 20 patients the radical R2/3 resection was considered potentially curative as defined by the Japanese Society for Research in Gastric Cancer. The operative mortality in this subgroup was 1/20 (5 per cent) and 3/27 (11 per cent) in the entire series. Locoregional recurrence was not observed in the potentially curative group. Follow-up has varied from 6 months to 7 years. An overall survival of 12/27 (48 per cent) has been observed to date. Death from cancer dissemination is maximal in the first and second year after resection. The R2/3 resection was considered non-curative in seven patients. In this subgroup there were two postoperative deaths and four have died of metastatic disease within 12 months of the resection. The only 5 year survivor in this group had a gastric lymphoma.
Lesser curve disconnection using a stapling device: Highly selective vagotomy made quicker and easier
Authors: Hooper T L , Macfoy D , Magell J
Published: March 2007

A stapling device has been used to disconnect the lesser curve of the stomach during highly selective vagotomy in a consecutive series of ten patients. This modification renders the operation technically easier and quicker to perform. Postoperative recovery was uneventful in all patients, and in the subsequent follow-up period of 7–15 months, no problems relating to the technique were encountered.
Twenty-five years of injection sclerotherapy for bleeding varices
Authors: Spence R A J , Anderson J R , Johnston G W
Published: March 2007

Acute injection sclerotherapy has been used in Belfast for 25 years and the results are reviewed. During this period 264 patients had injection sclerotherapy for acute bleeding from oesophageal varices during 396 admissions; a rigid oesophagoscope was used and 447 injections were performed. The series includes 19 children who received 69 injections. Thirty-eight had extrahepatic portal venous hypertension and the remainder had intrahepatic disease. Overall, 81 were Child's grade A (including the 38 extrahepatics), 82 were grade B and 101 were grade C. Of the 396 admissions, acute injection sclerotherapy controlled bleeding in 362 instances (control rate 91.4 per cent); control rate in the children's group was 97.1 per cent and in the adults 90.2 per cent. The hospital mortality was 14.9 per cent (57 adults and 2 children). Nineteen deaths were due directly to bleeding oesophageal varices, two from bleeding gastric varices and seven directly or indirectly from oesophageal leaks. Most of the remaining deaths were due to liver failure. We consider that sclerotherapy is valuable in the control of variceal haemorrhage where bleeding is uncontrolled or recurs after vasopressin or tamponade in any admission.
Allergic contact dermatitis to epoxy resin in ostomy bags
Authors: Beck M H , Burrows D , Fregert S , Mendelsohn S
Published: March 2007

Six ostomy patients presenting with peristomal rashes have been shown to be allergic to their ostomy bags and to epoxy resin. Subsequent investigation confirmed the presence in the bags of low molecular weight epoxy resin oligomers, which are known as potent contact sensitizers.
Diagnosis and management of spontaneous transmural rupture of the oesophagus (Boerhaave's syndrome)
Authors: Walker W S , Cameron E W J , Walbaum P R
Published: March 2007

The presentation, diagnosis and management of 14 cases of spontaneous transmural oesophageal rupture have been reviewed. Analysis suggested that the classical triad of vomiting, chest pain and subcutaneous emphysema was rare (1/14) and therefore misleading. Abdominal pain and tenderness obscured the clinical picture; the temporal relationship of pain to vomiting varied and subcutaneous emphysema was uncommon (4/14). Consequently, only two cases were correctly diagnosed on presentation and diagnosis in the others was markedly delayed (average 4 days). Contrast swallow examination, when eventually performed, was diagnostic. Twelve patients underwent repair: four under 24 h, who all survived and eight over 24 h, amongst whom there were one (12·5 per cent) operative and two (25 per cent) late deaths. Conservative management was successful in the remaining two cases. Oesophageal fistula, empyema and incorrect initial surgery were common and serious complications. Management options are reviewed and their relative merits considered.
Reimplantation of the papilla of Vater
Authors: Williamson B W A , McArdle C S , Carter D C
Published: March 2007

Detachment of the papilla of Vater from the duodenum may happen (a) deliberately, during duodenal resection for tumour without concomitant resection of the pancreatic head, and (b) accidentally in the course of gastrectomy for duodenal ulcer, when attempts to exteriorize the ulcer are made. In this report two case histories are cited encompassing both of these circumstances, in which the ampulla was successfully reimplanted into a Roux loop.
111-Indium platelets in monitoring pancreatic allografts in man
Authors: Jurewicz W A , Buckels J A C , Dykes J G A , Chandler S T , Gunson B K , Hawker R J , McCollum C N , McMaster P
Published: March 2007

A technique for monitoring pancreatic allografts in man is presented. The method utilizes 111-indium labelled autologous platelets and provides quantitative and qualitative analysis of uptake of the tracer by the graft. Five patients without any significant accumulation of radiolabelled platelets in their transplants had an uneventful recovery and left hospital with satisfactory graft function. The three patients who suffered graft failure showed abnormal uptake of the tracer. This presented as a diffuse platelet accumulation within the transplanted pancreas in the case of acute rejection, or as a focal accumulation in two cases of venous thrombosis. Minor complications such as perigraft haematoma can also be diagnosed using this technique. We suggest that 111-indium labelled platelets provide a valuable diagnostic aid in the management of pancreatic transplant recipients.
The Klippel–Trenaunay syndrome: Clinical, radiological and haemodynamic features and management
Authors: Baskerville P A , Ackroyd J S , Thomas M Lea , Browse N L
Published: March 2007

Forty-nine patients with the Klippel-Trenaunay syndrome have been studied. Sixty-eight per cent have a superficial, embryological venous channel on the lateral aspect of the limb, 25 per cent have had one or more severe spontaneous haemorrhages from dilated varices and 22 per cent have suffered a venous thrombo-embolism. Twenty-nine per cent have had episodes of rectal bleeding or haematuria associated with pelvic angiomas. Foot volumetry (n = 31) showed that calf emptying was decreased in only five patients and only one of these had phlebographic evidence of deep venous obstruction, which conflicts with previous findings. The rate of calf refilling was increased in 81 per cent and phlebography demonstrated incompetent communicating veins in 45 per cent of patients. No patient had clinical evidence of an arteriovenous fistula, and arteriography (n = 22) and calf blood flow (n = 33) were normal, but lymphangiography (n = 14) showed lymphatic hypoplasia in 55 per cent of limbs. Eighty-eight operations have been performed on 38 patients but symptoms persist in 90 per cent. We suggest that surgery should be limited to the excision of localized symptomatic abnormalities and that the best form of control is provided by graduated compression stockings.
Ultrasonography, HIDA scintigraphy or both in the diagnosis of acute cholecystitis?
Authors: Gill P T , Dillon E , Leahy A L , Reeder A , Peel A L G
Published: March 2007

The benefit of early surgery for patients with acute cholecystitis is now accepted but rapid accurate pre-operative diagnosis is important and the single best investigation has not yet been clearly established. All 47 patients with suspected acute cholecystitis admitted to a district general hospital during a 6 month period underwent ultrasonic examination and scintigraphy with HIDA within 48 h of admission. In 23 patients acute cholecystitis was proven. Ultrasound correctly diagnosed this in 21 patients but in 2, changes attributed to chronic cholecystitis only were detected. Two false positive ultrasound results also occurred, one in a patient with adenomyomatosis and acute pancreatitis, the other in a case of duodenitis. HIDA scan was diagnostic in 19 patients but in the remaining 4 the presence of abnormal liver function tests accounted for non-visualization of the biliary tree (a non-diagnostic result). In the absence of jaundice a HIDA scan is the more specific test for confirming acute cholecystitis.
Suction drainage of the gallbladder bed does not prevent complications after cholecystectomy: A random control clinical trial
Authors: Playforth M J , Sauven P , Evans Mary , Pollock A V
Published: March 2007

Some surgeons drain the gallbladder bed routinely, some selectively and some not at all. We aimed to clarify this confusion by entering 155 consecutive patients undergoing emergency and elective cholecystectomy without exploration of the common bile duct into a random control clinical trial. In 78 patients a 3 mm suction drain was left in the gallbladder bed and in 77 the abdomen was closed without drainage. There were no withdrawals, one death (in the drainage group) from myocardial infarction and one intraperitoneal abscess complicating postoperative pancreatitis (in the no-drainage group). Other events studied were postoperative pyrexia, wound infection, respiratory tract infection and duration of hospital stay. In none of these did the two groups differ either clinically or statistically. We conclude that drainage or non-drainage of the gallbladder bed must remain a matter of individual preference.
Local radiotherapy in the management of squamous carcinoma of the anus
Authors: James R D , Pointon R S , Martin S
Published: March 2007

This paper describes the results of treating 74 patients with squamous cell carcinoma of the anal canal and perianal skin using interstitial radio-therapy as primary treatment. This technique does not involve irradiation of regional lymph nodes. The local control rate for patients with tumours smaller than 5 cm and with negative inguinal nodes was significantly better than for the remaining patients (64 versus 23 per cent). Only 3 of 41 patients with tumours less than 5 cm diameter had clinically significant nodes at presentation, while in 33 patients with tumours larger than 5 cm there were 6 with involved nodes at presentation. Local treatment using interstitial radiotherapy is suggested as useful primary treatment for small, node-negative carcinomas, with surgery held in reserve for failures.
Early gastric carcinoma in Japanese patients under 30 years of age
Authors: Mori M , Sugimachi K , Ohiwa T , Okamura T , Tamura S , Inokuchi K
Published: March 2007

The clinicopathological characteristics of early gastric carcinoma (EGC) in 23 Japanese under 30 years of age were reviewed and the findings compared with data on 53 patients over age 70. In the young patients, there was a female preponderance, a macroscopic solitary lesion and the cancer was of the poorly differentiated type without intestinal metaplasia in the surrounding mucosa. In the old patients, there was a male preponderance; about half the number of patients had macro-scopically elevated lesions and 10 of the 53 had a multifocal gastric carcinoma. Here, most lesions were well to moderately differentiated types with intestinal metaplasia in the surrounding area. Growth patterns of EGC in the young patients were analysed. Curative operations with dissection of regional lymph nodes were done in all the young patients. Metastases to the regional lymph nodes were present in only 2 of 23. Twenty of twenty-three followed for 5 years or longer are well.
Circumferential skin blood flow measurements in the ischaemic limb
Authors: McCollum P T , Spence V A , Walker W F
Published: March 2007

Skin blood flow (SBF) values were estimated on the posterior, medial and lateral aspects of the lower leg in 47 patients presenting for assessment of amputation level. Measurement was made using a radioisotope (iodo-antipyrine) clearance technique. Medial SBF was 9±0±5±2 ml 100 g−1 min−1; posterior SBF was 8±3±5±0 ml 100 g−1 min−1 and lateral SBF was 6±5±4.1 ml 100 g−1 min−1. The results gave significantly higher SBFs on the medial and posterior aspects of the ischaemic leg. The finding of an uneven distribution of blood flow at the below knee amputation level has important implications in the planning of amputation flaps.
Asymptomatic carotid stenosis: Is prophylactic endarterectomy justifiable?
Authors: Colgan Mary P , Kingston Wiley , Shanik D G
Published: March 2007

Carotid endarterectomy is well established in the treatment of selected cases of atherosclerosis of the carotid bifurcation; however, its role in the management of asymptomatic stenosis of the internal carotid artery remains controversial. Over a 4 year period 190 patients with 209 asymptomatic stenoses of the internal carotid artery were prospectively studied by means of Doppler ultrasound in combination with real time spectral analysis to determine the natural history of asymptomatic carotid stenosis. We report a cumulative stroke-free survival of 97 per cent at 3 years and we therefore question the merit of prophylactic endarterectomy in the management of asymptomatic carotid disease.
Aortofemoral bypass and the role of concomitant femorodistal reconstruction
Authors: Harris P L , Bigley D J Cave , McSweeney L
Published: March 2007

A consecutive series of 200 patients having aortofemoral bypass grafts were studied in order to determine the effect of femoropopliteal occlusive disease on the results and the role of concomitant femorodistal bypass. Bifurcated aortic grafts were used in 177 patients and unilateral aortofemoral grafts in 23 giving 377 limbs for study. Of the 377 limbs, 184 (49 per cent) had minimal femoropopliteal disease (Group 1), 24 (6·4 per cent) had a femoropopliteal stenosis (Group 2) and 169 (44·6 per cent) had complete femoropopliteal occlusion (Group 3). In Group 3 aortofemoral bypass was carried out alone in 106 cases (Group 3a): in the other 63 cases femorodistal bypass was carried out at the same time as aortoiliac reconstruction (Group 3b). The cumulative patency at 5 years for all aortofemoral grafts together was 91 per cent. However, that for grafts in Group 3a was only 65 per cent compared with 98 per cent for Groups 1 and 3b and 94 per cent for Group 2. The cumulative patency rate for grafts in Group 3a was significantly lower than for all other groups (P<0·001). The operative mortality for those patients who had concomitant aortofemoral and femorodistal grafts (Group 3b) did not differ significantly from that of any of the other groups (P > 0·1). Of the cases in Group 3a, 21 (26 per cent) required femoropopliteal reconstruction at a later date. The results indicate that in the presence of combined aortoiliac and femoropopliteal occlusive disease concomitant reconstruction of both arterial segments yields significantly better results than aortoiliac bypass alone.
Solid and liquid gastric emptying in patients with gastro-oesophageal reflux
Authors: Maddern G J , Chatterton B E , Collins P J , Horowitz M , Shearman D J C , Jamieson G G
Published: March 2007

A dual isotope radionuclide technique has been used to assess solid and liquid gastric emptying simultaneously in 72 patients with symptomatic gastro-oesophageal reflux and 22 normal controls. Objective evidence of gastro-oesophageal reflux was obtained from standard acid reflux testing and/or endoscopy in all patients. Solid emptying was delayed in 32 patients (44 per cent), liquid emptying was delayed in 27 patients (37 per cent) and 16 of those two groups had delayed solid and liquid emptying. Thus 29 patients (40 per cent) had normal solid and liquid emptying. The solid lag period was significantly delayed in the patient group (P<0.01). There was a significant correlation (P<0.01) between the solid and liquid gastric emptying values obtained in patients. No significant correlation was found between gastric emptying and the resting lower oesophageal sphincter pressure or the presence of symptoms of regurgitation and epigastric fullness. In the patients with delayed solid emptying there was a higher incidence of oesophagitis than in patients with normal emptying (P<0.05).
Cerebral blood flow and CO2 responsiveness as an indicator of collateral reserve capacity in patients with carotid arterial disease
Authors: Bullock R , Mendelow A D , Bone I , Patterson J , Macleod W N , Allardice G
Published: March 2007

Resting cerebral blood flow (CBF) and the response to inhalation of 7 per cent CO2 was measured in 74 patients with symptoms of cerebrovascular disease. In order to evaluate their role in the identification of patients with significant arterial lesions, these measurements were correlated with the angiographic appearances, the clinical picture and the presence or absence of infarction on CT scan. Patients with carotid stenosis of 60 per cent or more had normal resting flows, but reduced responsiveness to CO2 inhalation. Patients with carotid occlusion had both reduced resting flow and reduced CO2 responsiveness. Infarcts were visible in 25 per cent of the hemispheres studied, and were more common in patients with fixed neurological deficits, but were also present in 17 per cent of patients with transient ischaemic attacks (TIAs). Reduction in the collateral supply from the contralateral carotid artery via the Circle of Willis further reduced CO2 responsiveness with ipsilateral internal carotid occlusion. The normal increase in CBF which occurs with the inhalation of carbon dioxide is diminished with increasingly severe bilateral disease, with infarction and with a fixed neurological deficit.
A randomized controlled trial of adjuvant portal vein cytotoxic perfusion in colorectal cancer
Authors: Taylor I , Machin D , Mullee M , Trotter G , Cooke T , West C
Published: March 2007

In this randomized trial adjuvant cytotoxic portal vein perfusion in patients undergoing surgery for colorectal cancer without liver metastases was assessed to determine whether the incidence of meta-chronous liver metastases could be reduced and survival thereby improved. There were 127 control patients and 117 patients who received adjuvant perfusion. A further 13 patients were excluded following randomization because of cirrhosis in 1, liver metastases at laparotomy in 3 and technical problems with cannulation in 9. Dukes' staging and degree of differentiation were similar in the two groups. There were fewer liver metastases in the perfusion patients and overall survival was improved. However, the benefit appears to be greatest in patients with Dukes' B colon cancer.
Probability of false negative nodal staging in conjunction with partial axillary dissection in breast cancer
Authors: Kjærgaard J , Blichert-Toft M , Andersen J A , Rank F , Pedersen B V
Published: March 2007

There is a risk of overlooking lymph node metastases and thereby contributing to inaccurate nodal staging when performing partial axillary dissection in conjunction with total mastectomy in female breast cancer. The Danish Breast Cancer Cooperative Group (DBCG) analysed this risk in a prospective nation-wide adjuvant trial dealing with primary operable breast carcinoma. The series comprised 3114 patients, initially found to have lymph node negative axillae, followed for a median of 24 months (quartiles 12-40). It was found that the probability of early ipsilateral axillary relapse of cancer, estimated by means of the life table method, decreased with the number of nodes removed. After 2 years the recurrence rate was 12 per cent for patients with no lymph nodes removed, 7 per cent with one or two nodes removed and 2 per cent with three or more nodes removed. It is concluded that the risk of false negative nodal staging in conjunction with partial axillary dissection is modest, provided at least three lymph nodes are removed and found to be negative on histological examination.
Factors affecting survival in patients presenting with synchronous hepatic metastases from colorectal cancer: A clinical and computer analysis
Authors: Finan P J , Marshall R J , Cooper E H , Giles G R
Published: March 2007

A review of 90 patients presenting in Leeds over the period 1976-80 with synchronous hepatic metastases from colorectal cancer has been undertaken. The median survival for the group was 10.3 months (range 1–48 months). A multivariate analysis identified factors in the history and examination of the patient, results of biochemical and haematological investigations and characteristics of both the primary and secondary tumour, which influenced survival. Recognition of these factors allowed both a clinical scoring index and computer survival model to be constructed. When applied to the group as a whole both were reasonably accurate at predicting survival (62 per cent for the survival model and 66 per cent for the scoring index). However, the computer model correctly identified 80 per cent of the long-term survivors (> 12 months from the time of diagnosis). It is concluded that many trials of therapy for hepatic metastases from colorectal cancer have failed to consider the natural history of the disease and the identification of prognostic indices should allow for adequate stratification within the treatment arms of any future study.
The role of peptidases in cancer of the rectum and sigmoid colon
Authors: Durdey P , Cooper J C , Switala S , King R F G J , Williams N S
Published: March 2007

Increased levels of peptidases are found in some human carcinomas and may be related to invasive potential. We therefore measured the activity of four peptidases in 50 specimens of tumour and normal colonic wall from patients with a rectal or sigmoid carcinoma, and correlated this with the stage, differentiation, fixity of the tumour and presence of venous invasion, determined histologically. Since acute phase reactant proteins (APRP) may inhibit these proteolytic enzymes we have also measured serum levels of two relevant APRPs, α1 acid glycoprotein (AGP) and C-reactive protein (CRP) pre-operatively. Activity of cathepsin B, cathepsin H and collagenase-like peptidase (CLP) was determined fluorimetrically and collagenase photometrically. Significantly elevated activity of cathepsin B, CLP and collagenase was found in tumour compared with normal colonic wall (median values: (nmol (mg protein)−1 min−1) Cat B 0.71 and 0.42 (P<0.001), CLP 25.24 and 12.25 (P<0.001) and collagenase 0.49 and 0.31 (P<0.001)). There was no correlation between the activity of these enzymes expressed as a ratio of tumour/colonic wall, and differentiation or Dukes' stage of the tumour. However, there was significant elevation of activity of cathepsin B in tumours with local spread (n = 13) compared with those with no spread (n = 37) (median values 2.76 and 1.36 respectively (P<0.001)) and also in tumour with venous invasion (n = 24) compared with tumours without (n = 26) (median values 1.82 and 1.18 respectively (P<0.01)). Pre-operative serum levels of CRP were inversely correlated with the activity of CLP and cathepsin H and collagenase in the tumours (rs = 0.332, 0.359 (P<0.05) and 0.302 (P = 0.05) respectively). Thus certain peptidases are raised in rectal and sigmoid tumours. Activity of cathepsin B appears related to local tumour invasion. APRP may have a role in inhibiting the activity of these enzymes. These findings may have therapeutic implications.
Effects of somatostatin and a long-acting somatostatin analogue on the prevention and treatment of experimentally induced acute pancreatitis in the rat
Authors: Baxter J N , Jenkins S A , Day D W , Roberts N B , Cowell D C , Mackie C R , Shields R
Published: March 2007

The effects of somatostatin (SRIF) and its long-acting analogue, SMS 201-995 on the prevention and treatment of acute pancreatitis were studied in rats. Acute pancreatitis was established by ligating the bile duct at the point of entry into the duodenum, thereby allowing reflux of bile into the pancreas. Administration of SRIF (4 μg kg−1 body wt IV followed by a 12 h infusion of 4 μg kg−1 body wt h−1) or SMS 201-995 (2 μgkg−1 body wt SC) at the time of bile duct ligation prevented the increase in the serum concentrations of amylase and lipase observed in control rats 12 h after bile duct ligation. Moreover, SRIF and SMS 201-995 administration prevented development of the histological changes consistent with acute pancreatitis observed in control animals. These results suggest that SRIF or SMS 201-995 may be of value in preventing acute pancreatitis following ERCP or after surgery on the pancreas. In rats with established pancreatitis, SRIF (IV bolus of 4μg kg−1 body wt followed by a 24h continuous infusion of 4μgkg−1 body wt h−1) or SMS 201-995 (2μgkg−1 body wt SC followed by a similar dose 12h later): (1) significantly improved survival; (2) produced histological changes in the pancreas consistent with organization and healing; (3) prevented the accumulation of ascitic fluid; (4) reduced the serum levels of amylase and lipase. These results suggest that SRIF and SMS 201-995 may prove valuable in the treatment of established acute pancreatitis in man.
Management of gallstones in a district general hospital
Authors: Crumplin M K H , Jenkinson L R , Kassab J Y , Whitaker C M , Al-Boutiahi F H
Published: March 2007

This survey reviews 815 consecutive patients undergoing surgery for benign biliary disease. There were no deaths following elective operations and the overall mortality was 0.7 per cent. One-third of patients had one or more complications. The mortality in patients having common bile duct exploration (n = 160) by one or more methods was 2.5 per cent (4 patients) with 46 per cent of these patients having complications. Of 95 patients undergoing duct exploration and postoperative T-tube cholangiography, 7 had unexpected residual calculi after initial cholecystectomy. Five have had further surgery to clear the duct. All patients having duct surgery alone for retained stones (n = 24) had previously had cholecystectomy with or without supraduodenal duct exploration. Of all patients undergoing choledochoduodenostomy or transduodenal sphincter exploration only one has returned with evidence of retained calculi. Patients with choledocholithiasis were examined in an attempt to identify a high risk group. These were found to be elderly patients, having emergency surgery for sepsis and on whom more than one duct procedure was performed (mortality 10 per cent).
Screening for acute pancreatitis: A rapid assay for plasma lipase
Authors: Mayer A D , McMahon M J , Holdsworth P J , Wilson D H , Flowers M W , Brown D A
Published: March 2007

A simple agglutination test for plasma immunoreactive lipase has been evaluated in 101 patients. A positive agglutination reaction was observed if, and only if, plasma lipase exceeded 300 μg/l. The test was positive in all 23 patients with acute pancreatitis who were tested on the day of admission to hospital, in one patient with a pancreatitic pseudocyst and in one patient with hyperamylasaemia and hyperlipasaemia due to a perforated duodenal ulcer. The simplicity and reliability of this test make it suitable as an urgent diagnostic investigation for acute pancreatitis.
Long-term survivors after breast cancer
Authors: Dixon J M , Page D L , Anderson T J , Lee D , Elton R A , Stewart H J , Forrest A P M
Published: March 2007

A retrospective analysis of two groups of patients, one surviving 16–20 years and the other dying within 10 years after diagnosis and treatment of primary breast cancer has been undertaken to determine whether there were particular clinical or histological features associated with long-term survival. The striking histological dijfference between the tumours of the two groups of patients was the prevalence of tumours of ‘special’ invasive types (cribriform, tubular, lobular and medullary) in the long-term survivors. M icro-invasive and non-invasive carcinomas were also more common in the survivors. The tumours of the surviving group which were not of a ‘special’ type more commonly had a better histological grade than those tumours of patients dying early from breast cancer. In the overall group elastosis was present in significantly more tumours of the survivors whereas tumour necrosis, vascular and lymphatic invasion were ail significantly more common in the short-term survival group. Although there was a significantly increased incidence of earlier stage tumours in the long-term survivors, the histological distinctions between the two groups were independent of the differences in clinical features.
First experimental results with the oxygen electrode as a local blood flow sensor in canine colon
Authors: Piasecki C
Published: March 2007

A modified oxygen electrode was tested against the electromagnetic flowmeter to see if its reading indicated blood flow to the canine colon. Although gross inflow was compared with local flow, the correlation was good in each of seven individuals (r ranged from 0.86 to 0.97). The closeness of the relative values gives the instrument potential for cheap, fast, repeatable and non-invasive estimation of regional blood flow, in colon and other exposed tissues.
Out-patient treatment of haemorrhoids: A randomized clinical trial to compare rubber band ligation with phenol injection
Authors: Gartell P C , Sheridan R J , McGinn F P
Published: March 2007

A prospective randomized clinical trial comparing rubber band ligation (RBL) with phenol injection in 269 patients with symptomatic haemorrhoids presenting to one surgical clinic over a 6 year period, has been carried out. Questionnaires were completed by 215 patients (106 RBL and 109 injection) with an average follow up of 2.75 years. A successful outcome was achieved in 89 per cent of those receiving RBL compared with 70 per cent for injection (P <0.001). All symptons tended to respond more favourably to RBL, the results achieving statistical significance in patients complaining of bleeding and prolapse (P <0.01 and P <0.05 respectively). Complications from either technique were minimal. It is concluded that RBL is superior to phenol injection in the out-patient treatment of haemorrhoids.
Postoperative pain and pulmonary complications: Comparison of three analgesic regimens
Authors: Cuschieri R J , Morran C G , Howie J C , McArdle C S
Published: March 2007

In a prospective study, patients undergoing cholecystectomy were randomly allocated to receive (a) intermittent intramuscular morphine (n = 25), (b) continuous intravenous morphine infusion (n = 25) or (c) epidural bupivacaine (n = 25) for postoperative pain relief. Morphine by intravenous infusion provided comparable pain relief to intermittent intramuscular morphine; there was no significant difference in the incidence of postoperative pulmonary complications. Patients receiving epidural bupivacaine for 12 h had better analgesia than patients receiving morphine (P <0.001). Arterial oxygen tensions were also significantly higher in the epidural group for the first three postoperative days (P <0.05). Epidural analgesia was associated with a significant reduction in the incidence of pulmonary complications (P <0.01) and chest infection (P <0.05).
Treatment of malignant melanoma by fast neutrons
Authors: Blake P R , Catterall Mary , Errington R D
Published: March 2007

Fast neutron therapy has been used to treat 87 tumours of primary, recurrent or metastatic melanoma in 48 patients. Complete regression has been obtained in 71 percent of tumours and 91 per cent of all tumours were controlled for the remainder of the patients, lives. Median survival was 14·5 months; 30 of the 34 deaths were due to metastases. Complications arose in 22 per cent of sites and were either fibrosis, which was related to large treated areas, previous surgery or a higher than standard dose, or necrosis which was related to sites with poor circulation, such as in the lower limb. It is suggested that for the treatment of advanced local disease fast neutron therapy is more effective than X-ray treatment and has a local control rate similar to that of surgery.
The value of perioperative Doppler ankle systolic pressure measurements in reconstructive arterial surgery
Authors: Wood D J , Bishara R , Darke S G
Published: March 2007

This study evaluates the use of ankle systolic Doppler indices for the detection of technical errors during reconstructive surgery. Measurements taken peroperatively, following declamping, are expressed as a ratio of brachial systolic pressure and compared with pre-operative and postoperative readings. A study has been made of 377 limbs in 272 patients, including patients undergoing surgery for aneurysm, claudication and limb salvage. In the majority of patients the peroperative ratios were similar to, or improved on, pre-operative levels. No technical errors or primary failures were apparent in those patients in which this was the case. In contrast, in the 27 limbs in which a pre-operative ratio had been measurable, but no peroperative signal obtained, 21 technical errors were identified and corrected immediately. There were 16 limbs with severe ischaemia, and neither pre-operative nor peroperative signals, in which the outcome was less certain. In ten, major amputation subsequently became necessary because of inadequate run-off which was demonstrated radiologically. Finally, there were four limbs in which failure occurred postoperatively in spite of a restored peroperative signal. It is concluded that this simple technique is useful and sensitive.
Carcinoid tumours of the appendix
Authors: Anderson J R , Wilson B G
Published: March 2007

Appendicular carcinoid tumours in 147 patients are presented. Two patients had evidence of metastatic spread at the time of presentation. Both patients had primary tumours < 2 cm in diameter. Size remains the most reliable guide to the malignant potential of these tumours. If, after simple appendicectomy, a carcinoid tumour is found with a post-formalin fixation diameter > 1·5 cm then a subsequent right hemicolectomy should be considered.
Influence of rectal washout on bacterial counts in the rectal stump
Authors: Scammell B E , Phillips R P , Brown R , Burdon D W , Keighley M R B
Published: March 2007

Forty-three patients undergoing a restorative colorectal resection were randomized to have their rectal stump washed out with either 0·9 per cent saline, 2·5 per cent povidone—iodine or 0·3 per cent sodium hypochlorite. The bacterial counts before and after washout for Escherichia coli and Bacteroides fragilis were compared using the Mann—Whitney U test. There was no significant difference in the counts for E. coli before and after washout with saline (log 9·7–log 9·7 organisms/ml) and saline had no influence on the counts of B. fragilis (log 7·9–log 6·5 organisms/ml). Hypochlorite was associated with a significant reduction in E. coli counts (log 6·1–log 1·1 organisms/ml, P < 0·005) and the counts of B. fragilis (log 8·1–log 0·0 organisms/ml, P < 0·005). The counts of B. fragilis were significantly reduced by povidone—iodine (log 8·1–log 1·1 organisms/ml, P < 0·005) but there was no significant reduction in counts of E. coli (log 5·6–log 5·3 organisms/ml). The data suggest that sodium hypochlorite is better than povidone—iodine or saline as a rectal washout for colorectal anastomosis.
Acral (volar—subungual) melanoma
Authors: Gutman M , Klausner J M , Inbar M , Skornick Y , Baratz M , Rozin R R
Published: March 2007

Acral melanoma occurs in the volar surface of the hands, feet, fingers, toes and subungual sites. Recently it has been recognized as a distinct entity with characteristic clinical and pathological features. Of our 340 patients with malignant melanoma, 24 (7 per cent) had acral melanoma. Sixteen were in the plantar skin, two in the palms and six in the nailbed. The delay in diagnosis was 6 months to 5 years and most of the patients presented with large neglected tumours. Fourteen lesions had histological features consistent with acral lentiginous melanoma — a unique pattern to this area. Fourteen patients were in clinical stage I at diagnosis, seven in stage II and three had distant metastases (stage III). The treatment was mainly surgical. Palmar—plantar lesions were widely excised. One patient underwent below-knee amputation. Lesions of the digits were treated by amputation of the affected toe. Fourteen of the patients underwent either prophylactic or therapeutic lymph node dissection. In 9 of them, regional metastases were found. In patients with advanced disease chemotherapy was added. Three patients had isolated limb perfusion. Fourteen patients died of metastatic disease within 1–5 years. Four are alive but have metastatic spread. Six patients are disease-free, one to 4·5 years following diagnosis.
Partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after Nissen fundoplication
Authors: Salo J A , Lempinen M , Kivilaakso E
Published: March 2007

The results of partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication in six patients were analysed. There were no postoperative deaths. Postoperative complications (pneumonia and atelectases, postoperative ileus) developed in three patients. The results were evaluated by clinical and endoscopic examination 1 to 3·5 years after the operation. Clear clinical and endoscopic improvement was observed in five of the six patients. In the remaining patient the procedure failed to prevent progression of the oesophagitis with development of a Barrett's oesophagus. The results suggest that a partial gastrectomy with Roux-en-Y reconstruction is an effective and safe procedure in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication.
Management of retroperitoneal haematoma following penetrating trauma
Authors: Costa M , Robbs J V
Published: March 2007

Experience with the management of 106 consecutive patients found to have a retroperitoneal haematoma (RH) at laparotomy for penetrating trauma over a 2-year period is reviewed. Three types of retroperitoneal haematoma are recognized: Type I (central), Type II (flank) and Type III (pelvic). Type I RH was present in 22 patients as a result of injuries to the inferior vena cava (9), the aorta (5), the pancreas and duodenum (5), the portal vein (2), and to both aorta and inferior vena cava (1). Fourteen patients died (63·8 per cent) representing 70 per cent of all deaths in the series. Type II RH was seen in 73 patients. Thirty-two were stable and the perinephric fascia was not opened with no morbidity or mortality. Forty-one were explored: 15 on pre-operative evidence of renal injury which was confirmed at laparotomy. In the remaining 26 a stable haematoma was explored and no significant lesion found. It is considered that in 45 of 73 Type II RH (61·0 per cent) exploration was unnecessary. Five patients died (6·8 per cent). Type III RH was found in 11 patients and was due to iliac vessel injuries. Two patients died. In conclusion Type I and III RH should be routinely explored. Stable Type II RH discovered at laparotomy should be explored selectively based on pre-operative clinical and radiological assessment of renal injury.