bluuebunny/crossref_metadata_2025 huggingface dataset:
An isotope clearance method for measurement of liver blood flow during portasystemic shunt in man
Authors: Leiberman D P , Mathie R T , Harper A M , Blumgart L H
Published: March 2007

The clearance from the surface of the liver of krypton 85 following its injection into the portal vein was measured in 10 patients. Six control patients (i.e. those not suffering from portal hypertension) averaged flow values of 142 ml per 100 g liver weight per min. A repeat flow estimation in these patients was not significantly different.

Four patients with portal hypertension were studied. In 2 with congenital hepatic fibrosis the portal vein was temporarily occluded to allow prediction of the degree of hepatic perfusion likely to be achieved by the hepatic artery alone after portal deviation. The flow after portal venous clamping was unaffected in one of these cases but reduced by 45 per cent in the other. In a patient undergoing a Warren distal splenorenal shunt there was no change in flow after the procedure.

If measurements are performed before and during temporary portal vein occlusion, an assessment of the flow reduction to be expected after a shunt procedure can be made. We suggest that a knowledge of liver tissue perfusion might influence the choice of operative procedure.
Post-amputation pneumatic walking aid
Authors: Redhead R G , Davis B C , Robinson K P , Vitali M
Published: March 2007

A pneumatic walking training aid is described that has been developed by the Biomechanical Research and Development Unit, Roehampton, from the original design by Little. The new design has been used in the management of 87 amputations, including 44 patients over the age of 70. Ninety-four per cent of these patients were rehabilitated to walking independently on a pylon or prosthesis.
Acute abdominal complications of systemic lupus erythematosus
Authors: Stoddard C J , Kay P H , Simms J M , Kennedy A , Hughes P
Published: March 2007

Four patients with acute abdominal complications of systemic lupus erythematosus requiring laparotomy are presented. The complications consisted of intestinal ischaemia, without perforation, in 3 patients and omental infarction in the fourth. In 2 patients the abdominal emergency was the first manifestation of the collagen disease. Tissue removed from 3 patients showed a marked vasculitis on histological examination. The pathogenesis and management of acute obdominal complications of systemic lupus erythematosus are discussed and the literature reviewed.
Kock's continent ileostomy: Results of 51 operations and experiences with correction of nipple-valve insufficiency
Authors: Palmu A , Sivula A
Published: March 2007

Fifty-one Kock's continent reservoir ileostomies were performed over a 4-year period. Immediate postoperative complications included 2 perforations of the reservoir, causing the death of 1 patient, 4 faecal fistulas and 8 intestinal obstructions. After a follow-up of more than 3 years in 22 cases, of 1-3 years in 21 cases and of less than 1 year in 8 cases an excellent functional result was attained after the first operation in 31 cases. Fifteen patients had to undergo reoperation owing to leakage of gas and bowel contents and difficulties in catheterization. Reoperation revealed three different causes of nipple insufficiency: total or partial sliding of the invaginate in 6 cases, dislocation of the nipple out of the reservoir in 6 cases and a fistula at the base of the nipple in 3 cases. Correction of the nipple-valve was performed using a modified invagination technique. After reoperation an excellent functional result was attained in 12 out of 15 cases. Thus, the functional result in the whole series was excellent in 43 patients.

The symptoms of nipple-valve insufficiency appeared in most of the cases during the first 3-6 months post-operatively. Since there is a good chance that reoperation will correct the failure, the procedure should be carried out without delay after the appearance of disturbance in nipple-valve function.
The prognostic and therapeutic implications of the positive radionuclide bone scan in clinically early breast cancer
Authors: McKillop J H , Blumgart L H , Wood C B , Fogelman I , Furnival C M , Greig W R , Citrin D L
Published: March 2007

Seventy-five women with clinical stage I or stage II carcinoma of the breast have had radionuclide bone scans at the time of presentation and at 6-monthly intervals during a mean follow-up period of 39 months. Patients with evidence of metastases on bone scan, either at the time of presentation or during follow-up, had significantly higher mortality and morbidity rates than those with persistently negative scans.

Whatever the clinical stage, breast cancer patients with a positive bone scan have a very poor short term prognosis and local therapy to the breast is inadequate. A plan is outlined which incorporates the patient's bone scan status into the decision to introduce endocrine therapy or chemotherapy.
The plasma clearance of fructose and glucose during and after surgical operation
Authors: McCarthy D O B , Wright P D , Johnston I D A
Published: March 2007

Fasting blood glucose is elevated and the rate of disappearance of a glucose load is reduced after major surgery. Resistance to insulin is considered to play a part in post-traumatic glucose intolerance. Fructose metabolism is partly independent of insulin.

Glucose and fructose clearance were compared in two groups of 6 matched male patients with normal glucose tolerance who were studied before and after major vascular surgical operations of the same severity. Fructose or glucose (25 g) was given intravenously over a 2-min period before, during and at intervals for 8 days after surgery.

The rate of clearance of fructose increased significantly during operation (P<0.01), but returned to the preoperative level by the first postoperative day. Glucose clearance, in contrast, was reduced during and throughout the 8 days of the study.

The fructose load produced a brisk insulin response before operation which was diminished and delayed during surgery. These findings suggest that administered fructose may be removed more rapidly than glucose during and immediately after surgical operation.
Laparoscopic assessment of the jaundiced patient: A review of 53 patients
Authors: Irving A D , Cuschieri A
Published: March 2007

Laparoscopy in the investigation of patients with jaundice allows visualization of intra-abdominal pathology, target biopsy of intra-abdominal lesions and percutaneous fine-needle cholangiography, all to be carried out at the one procedure. Formal laparotomy can then be planned electively or avoided completely in appropriate cases.

In our experience we have found laparoscopy with percutaneous fine-needle cholangiography and biopsy to be a useful procedure in the diagnosis and management of jaundiced patients.
The role of ultrasound scanning in the diagnosis of thyroid swellings
Authors: Lees W R , Vahl S P , Watson L R , Russell R C G
Published: March 2007

This study has determined the ability of grey scale ultrasound to assess if a thyroid is normal or abnormal, if the appearances of the gland are specific for one disease and if the probability of malignancy can be determined. One hundred patients were studied, 65 with histologically confirmed diagnoses. It was found that the normal gland was distinguished from the abnormal with 99 per cent accuracy, simple cysts were diagnosed with 100 per cent accuracy and a specific disease diagnosis was given with 84 per cent accuracy. It was correctly stated in 87 patients that the disease was definitely benign, but in the remaining 12 patients (3 with cancer) it was stated that malignancy could not be excluded.
The clinical scope and potential of isotope angiology
Authors: Hurlow R A , Strachan C J L
Published: March 2007

Arterial imaging using a gamma-camera to follow an intravenously injected bolus of 99Tcm has been performed in over 200 patients. The technique has been found useful in the evaluation of emergency vascular problems, in routine cases where arteriography cannot be performed or is inadvisable and in the assessment and follow-up of patients with intermittent claudication and digital vessel disease.
The indications for simple closure of perforated duodenal ulcers
Authors: Playforth M J , McMahon M J
Published: March 2007

One hundred and sixty-one patients undergoing simple suture of a perforated duodenal ulcer are reviewed retrospectively. Nine patients (6 per cent) suffered a complication of their ulcer during the postoperative period and 3 (2 per cent) of them died.

The mean length of follow-up was 26 months and during this period a total of 14 complications was seen in 12 patients. Five of these patients died after a complication of their ulcer.

Analysis of the data from patients who had complications of their ulcers indicates that the operation of simple suture of a duodenal ulcer is indicated only in young and middle-aged women.
A double blind trial of the prolactin inhibitor bromocriptine in painful benign breast disease
Authors: Mansel R E , Preece P E , Hughes L E
Published: March 2007

A double blind crossover trial of the prolactin inhibitor bromocriptine in painful benign breast disease is reported. Twenty-nine women with cyclical mastalgia and 11 with non-cyclical pain were treated with bromocriptine, 5 mg daily, and placebo over six menstrual cycles. Assessment of response to treatment was made by a linear analogue system and clinical examination together with plasma prolactin estimations. Bromocriptine produced a significant improvement in breast symptoms and a significant improvement in breast symptoms and a significant fall in prolactin levels in the cyclical pain group, but had no effect in the non-cyclical group. These results suggest that bromocriptine offers a new and effective approach in the management of cyclical breast pain.
A new method for the rapid measurement of body composition in critically ill surgical patients
Authors: Hill G L , McCarthy I D , Collins J P , Smith A H
Published: March 2007

A rapid, non-invasive method for the measurement of obsolute amounts of fat, protein, minerals and water in the body has been developed which is applicable to very ill patients. The patients is weighed and skinfold thickness is measured with calipers. The body contents of potassium, nitrogen, sodium, chlorine, calcium and phosphorus are measured in a whole-body radiation counter after irradiation with fast neutrons. From these values absolute amounts of body fat, protein, minerals and water are calculated. The procedure, which takes about 40 min, is carried out with the patient lying supine on a couch. The errors in the absolute measurement of the components expressed as percentages of body weight are: for fat, 4·5 per cent; for protein, 1·6 per cent; for minerals, 0·8 per cent; and for water, 4·9 per cent. The radiation dose is equivalent to that of a chest radiograph (50 mrem).

We have used this technique (a) to determine the tissue composition of the weight lost in 16 patients after excision of the rectum: (b) to establish that the weight gained by 16 patients receiveing intravenous nutrition was mainly water; and (c) to show that in 10 patients who received a simple solution of amino acids for 2 weeks after rectal excision body protein was preserved as efficiently as in 10 similar patients who received a full course of intravenous nutrition.

This is the first time body weights of living persons have been broken down into terms of fat, protein, minerals and water, and the method should help to solve a number of metabolic and nutritional problems in clinical surgery.
The aldosterone response to surgery and the relationship of this response to postoperative sodium retention
Authors: Cochrane J P S
Published: March 2007

To investigate whether the aldosterone response to surgery is ‘inevitable’ and whether it is the prime cause of postoperative sodium retention, 30 patients undergoing uncomplicated cholecystectomy were givaen four different postoperative intravenous intakes (either ‘low’ or ‘high’ sodium, with and without dextran). Patients on the low sodium intake–a conventional intake of approximately 75 mmol of sodium daily – had a sixfold increase in their plasma aldosterone levels on the day of operation, which slowly declined to the preoperative level by the fifth day after operation, Patients on a high sodium intake, which was between two and three times the low sodium intake, showed only a modest rise (two-fold), which returned to the preoperative level within 8 h of operation. These aldosterone responses appeared to be caused by at least two stimuli, with the evidence suggesting that ACTH and renin were both involved.

Patients on the high sodium intake had the highest positive sodium balance, amounting to approximately 400 mmol of sodium retained by day 4 after operation, despite the fact that the plasma aldosterone level had returned to the preoperative level within 8 h of operation, and thereafter remained below it. No clear evidence was found to show that the plasma aldosterone level had any significant relationship to the amount of sodium each patient retained. The sodium retained was found to be a similar proportion of the sodium intake whether the intake was low or high, the addition of dextran making no consistent difference.

Analysis of the data produced the incidental finding of an increasingly significant correlation, over the 5 postoperative days studied, between the proportion of sodium retained and the patient's preoperative systolic blood pressure. It has long been known that patients with a raised blood pressure excrete a sodium load more rapidly than normotensive patients, but this effect on sodium balance after operation has not previously been recorded.
Amoebic perforation of the bowel: Experiences with 26 cases
Authors: Eggleston F C , Verghese M , Handa A K
Published: March 2007

Over a period of 14½ years, 26 instances of amoebic perfoation of the bowel occurring in 25 patients were treated surgically. Nineteen perforations occurred in males and 7 in females, whose ages ranged from 3 to 74 years. The duration of symptoms varied from 12 h up to 5 months (average 15 days). All patients were toxic and a right lower quadrant mass was present in 14. The correct diagnosis was made or suspected in 14 (54 per cent).

Amoebic perforation of the bowel should be suspected in patients presenting with an acute abdomen if a past history of fever, pain and diarrhoea is obtained, particularly if a large tender mass is present in the right iliac fossa.

Resctional surgery was performed in 7 patients, with a mortality of 71 per cent, whereas procedures designed to divert the faecal stream were carried out in 19, with a mortality of 43 per cent. All 6 patients with concomitant liver absesses died. If these patients are excluded, the mortality from resections was 60 per cent and from faecal diversion 27 per cent.

Faecal diversion with wide drainage is the treatment of choice for amoebic perforation of the colon.
Postoperative external small bowel fistulas: A study of a consecutive series of patients treated with intravenous hyperalimentation
Authors: Blackett R L , Hill G L
Published: March 2007

A consecutive series of 25 patients who developed external small bowel fistula within 2 weeks of abdominal surgery is described. Half the patients had a primary diagnosis of inflammatory bowel disease and the fistula arose usually as a result of direct trauma to the bowel or the breakdown of an anastomosis.

All the patients were treated conservatively with total bowel rest and intravenous hyperalimentation. In 15 (60 per cent) spontaneous fistula closure occurred, in an average period of 32 days. In 8 patients the fistula failed to close and surgery was performed, but was effective in only 3 cases. Thus the fistula eventually closed in 18 patients. Five patients died, all from intra-abdominal sepsis. of the 8 patients with a primary diagnosis of Crohn's disease, 3 died, 2 have a persistent fistula, 1 has a permanent ileostomy and spontaneous closure occurred in only 2.
Fasting and postprandial serum gastrin levels before and after highly selective gastric vagotomy, truncal vagotomy with pyloroplasty and truncal vagotomy with antrectomy: Is there a cholinergic antral gastrin inhibitory and releasing mechanism?
Authors: Lam Shiu Kum , Chan Patrick K W , Wong John , Ong G B
Published: March 2007

Fasting serum gastrin levels and postprandial gastrin response were measured before and 1 month after highly selective vagotomy, truncal vagotomy with pyloroplasty and truncal vagotomy with antrectomy. The three groups of patients, 12 in each group, were closely matched for age, sex, maximum acid output and completeness of vagotomy. After highly selective and truncal vagotomy an identical and significant increase in fasting gastrin was observed, whereas after truncal vagotomy with antrectomy the pre- and postoperative fasting gastrin levels were not different. The net postprandial gastrin output over basal value was significantly increased after highly selective vagotomy, unchanged after truncal vagotomy and significantly lowered after truncal vagotomy with antrectomy. These results suggest the presence in the intact subject of a cholinergic inhibitory mechanism in the gastric body and fundus for the release of antral gastrin in the fasting and postprandial states and a possible cholinergic facilitatory mechanism for the release of antral gastrin after meals.
Management of abdominal aortic aneurysm
Authors: Gordon-Smith I C , Taylor E W , Nicolaides A N , Golcman L , Kenyon J R , Eastcott H H G
Published: March 2007

A series of 245 patients was operated upon for abdominal aortic aneurysm during the years 1969–77, of whom 162 were elective cases while in 83 the aneurysm was leaking or had ruptrued. The hospital mortality for the latter group fell from 77 per cent at the beginning of the study period to 30 per cent at the end. For elective operations, hospital mortality averaged 9·3 per cent, though during the last 2 years there were no deaths in the 51 consecutive cases. Operative methods and post operative treatment changed during the years of the study, with fewere excision-replacement grafts and greater use of the inlay technique, most of the latter being simple unbrached Dacron tubes. Early graft infection, the most important and serious surgical complication, caused 9 deaths, an overall incidence of 3·7 per cent, of which 8 were in patients who received no perioperative antibiotics and only I among the patients who did receive them. All deaths were in the inlay group. The reasons for this are discussed. Since July 1976 Perioperative antibiotic treatment has been routine for all arterial prosthetic graft patients in our hospital.
Ruptured abdominal aortic aneurysms
Authors: Butler M J , Chant A D B , Webster J H H
Published: March 2007

The results of operation in 76 patients with a ruptured abdominal aortic aneurysm are presented with an analysis of the cause of operative death. Overall mortality was 58 per cent and preoperative hypotension significantly increased mortality; deterioration while awaiting operation made a successful outcome particularly unlikely. No group could be identified, however, in which operation was without hope of saving life, and age alone should not contrairdicate surgery.
An androgen-associated hepatic adenoma in a trans-sexual
Authors: Coombes G B , Reiser J , Paradinas F J , Burn Ian
Published: March 2007

A case is reported of an hepatic adenoma developing in a patient who had been taking testosterone for 3 years. There appears to be an association between various steroid preparations and hepatic neoplasia. Reports of such cases with all relevant data will allow a balanced assessment of the problem to be made.
Should you drain a perforated appendix?
Authors: Greenall M J , Evans Mary , Pollock A V
Published: March 2007

One hundred and three consecutive patients undergoing appendicectomy for perforated appendicitis were randomly allocated either to have an intraperitoneal drain inserted or not. The results of this trial lend no support to the advocates of drainage.
An abdominal extraperitoneal approach for the difficult orchidopexy
Authors: Jones Peter F , Bagley Frederick H
Published: March 2007

An abdominal extraperitoneal approach is described for use in patients who have a severe degree of incomplete descent of the testicle. In 86 such operations, the testicle was placed in the scrotum in 85. The approach allows certainty of diagnosis in cases of anorchia and it is helpful when orchidopexy has to be combined with a herniotomy in infancy.
Neurofibrosarcoma of the duodenum in von Recklinghausen's disease
Authors: Thomson W O , Carachi R , Wood C B , Short D W
Published: March 2007

The clinical features and surgical management of 2 patients with neurofibrosarcoma of the duodenum in association with von Recklinghausen's disease are described. The tumours were excised and the resulting duodenal defects closed satisfactorily using the jejunal serosal patch technique. Three such neurofibrosarcomas reported previously in English are reviewed.
Highly selective vagotomy with excision of the ulcer compared with gastrectomy for gastric ulcer in a randomized trial
Authors: Duthie H L , Bransom C J
Published: March 2007

Fifty-six patients with benign gastric ulcer of the body of the stomach have been entered into a randomized trial of highly selective vagotomy with excision of the ulcer (HSVE) (26 cases) against standard Billroth I partial gastrectomy (BI) (30 cases). The operations were carried out by all grades of surgical staff. No patient died within 1 month of operation. Postoperative morbidity was greater after gastrectomy than after HSVE. At an average follow-up of about 4 years, functional results according to a modified Visick classification were similar in both groups, with about 75 per cent good results. Two recurrent ulcers occurred after gastrectomy (7 per cent) and 4 after HSVE (15 per cent). Neither operation has a distinct advantage at this stage.
Pylorectomy and prepyloric antrectomy for gastric ulcer
Authors: De Miguel Jacinto
Published: March 2007

From July 1970 to May 1977 79 patients with chronic gastric ulcer were submitted to a pylorectomy and prepyloric antrectomy (only 4–5 cm of the distal stomach being removed). In most, the excision extended in the form of a narrow tongue along the lesser curvature to include the ulcer. Vagotomy was added when signs of a healed or active duodenal ulcer were seen (19 cases). Associated lesions in the distal stomach were detected in 38 more patients.

Up to the present no recurrence has been observed and functional results have been satisfactory in 90 per cent of patients.

Preliminary results show that this operation produces a satisfactory cure for gastric ulcer, thus making more extensive resections unnecessary.
The stripping of varicose veins: A clinical trial of intermittent compression dressings
Authors: Melrose D G , Knight M T N , Simandl E
Published: March 2007

This study compares a standard method of care for patients following excision and ligation of varicose veins with a new regimen which involves intermittent compression dressings. In a fully randomized between-patient prospective trial it has been found that the use of such dressings results in a significant reduction in postoperative pain and in the length of hospitalization and indicates that such dressings may improve the healing of surgical wounds.
Splenectomy for undiagnosed splenomegaly
Authors: Goonewardene A , Bourke J B , Ferguson R , Toghill P J
Published: March 2007

During the 9-year period 1968–76 116 splenectomies were performed at the General Hospital, Nottingham. Of these, 13 (11 per cent) were undertaken for unexplained splenomegaly. In 6 patients a diagnosis was established by the operative procedure (2 with sarcoidosis, 2 splenic cysts, 1 Gaucher's disease and 1 haemangiosarcoma). Histological examination of the excised spleens in the remaining 7 patients showed no specific features. Two of these patients benefited considerably from removal of very large spleens. Another patient died from lymphosarcoma which was diagnosed 21 months after splenectomy. In the remaining 4 patients with mild to moderate splenomegaly, there were no real diagnostic or therapeutic advantages. It is concluded that splenectomy should always be considered in patients with unexplained moderate or gross splenomegaly but it may not be helpful in the patient whose spleen is only mildly enlarged.
The surgical management of malignant tumours of the oesophagus and cardia: A review of the results in 292 patients treated over a 15-year period (1961–75)
Authors: Jackson J W , Cooper D K C , Guvendik L , Reece-Smith H
Published: March 2007

Of 292 patients, excision of the tumour with replacement by stomach or jejunum was carried out in 216 in whom the lesion was considered operable on both technical and general grounds, intubation was performed in 45 and the remaining 31 were managed without operation.

Of the 216 in whom resection was performed, only 20 per cent were free from local spread, lymph node involvement or secondary deposits at the time of operation. Hospital mortality was 18 per cent and did not significantly differ between one 5-year period and another. Survival at 1 year was 54 per cent, at 2 years 25 per cent and at 5 years 14 per cent. The average length of survival following intubation was 2.6 months and following non-operative management 2.8 months. The poor average survival of between 3.5 and 5 months obtained in those patients with secondary deposits at the time of resection suggests that resection is of questionable value in this group.

There was a marked difference in survival following Roux loop procedures compared with upper partial gastrectomy for tumours of the lower third and cardia in patients without lymph node involvement or secondary deposits, strongly suggesting that upper partial gastrecsomy, although a rather simpler and quicker operation, is not the operation of choice in these patients.

On 31 December 1976, after a minimum follow-up of 1 year, there were only 22 patients still alive of the original 292 (7.5 per cent).
A reappraisal of the value of carcinoembryonic antigen in the management of patients with various neoplasms
Authors: Cooper M J , Mackie C R , Skinner D B , Moossa A R
Published: March 2007

Eight hundred and eight patients with histologically proved malignant disease had carcinoembryonic antigen (CEA) estimations performed at the time of tissue diagnosis. An elevated level was found in 384 of 518 patients with gastrointestinal neoplasms (74 per cent) and in 162 of 290 patients with other neoplasms (56 per cent). No correlation was found between CEA elevations and tumour differentiation. There was a good correlation between tumour staging and CEA levels for patients with colorectal cancer; the more advanced the tumour, the higher the CEA.

Several illustrative cases are presented and the role of CEA assay in the diagnosis and management of neoplasia is discussed. CEA assay is a poor screening test for neoplastic disease, but serial CEA monitoring is valuable in the detection of residual or recurrent cancer.
Arterial obstruction of the upper limb in Buerger's disease: Its incidence and primary lesion
Authors: Hirai Masafumi , Shionoya Shigehiko
Published: March 2007

In the present study, the incidence of upper extremity involvement and the primary lesion of the arm in Buerger's disease were investigated with special regard to arteriographic findings in the upper limb. Of 34 patients with Buerger's disease admitted to our hospital during the 12-month period from March 1977 to February 1978, in 31 cases (91 per cent) the existence of arterial obstruction of the upper limb was confirmed. From the results of arteriographic study in 78 arms, the primary lesion of Buerger's disease appears to develop most frequently in the digital arteries. However, it is possible for the disease to develop independently in the arteries of the hand, or in the radial or ulnar artery. Although the aetiology of Buerger's disease is not definitely known, it is suggested that repeated blunt injury to the hand or fingers is involved in the evolution of the disease as well as in the appearance of symptoms.
Surgical aspects of radiation injury to the intestine
Authors: Galland R B , Spencer J
Published: March 2007

The clinical features are described of 37 patients requiring surgical management for radiation injury to the intestine sustained as a result of treatment of abdominal or pelvic malignancy. Twenty-nine of the patients underwent operation and only 4 remained symptom-free after the procedure. Thirteen patients died in the postoperative period, and of these, 5 were free of the original disease. Possible predisposing factors in the production of intestinal injury are discussed, as are various means of dealing with the established condition.
A prospective randomized trial of vagotomy in chronic duodenal ulceration
Authors: Koffman C G , Elder J B , Gillespie I E , Ganguli P C , Ostick D G , Cowley D J , Dymock I W , Tweedle D E F , Schofield P F , Pengelly C D R , Shafiq M , Shreeve D R , Palmer M
Published: March 2007

In a prospective, randomized trial, 76 patients with duodenal ulceration treated by truncal vagotomy and pyloroplasty were compared with 77 patients who underwent highly selective vagotomy. A total of 149 patients was followed up for from 1 to 4 years, the average follow-up period being 2.6 years. There was no operative mortality and no significant difference in postoperative morbidity between the two groups. The incidence of recurrent ulceration was greater after highly selective vagotomy, but this difference was not statistically significant. The clinical results were comparable in each group, and although the incidence of diarrhoea and dumping was greater after vagotomy and pyloroplasty, this difference was not statistically significant.
Interrelations between serum gastrin levels, gastric emptying and acid output before and after proximal gastric vagotomy and truncal vagotomy and antrectomy
Authors: Donovan I A , Owens Caroline , Clendinnen B G , Griffin D W , Harding L K , Alexander-Williams J
Published: March 2007

In a prospective study of proximal gastric vagotomy and truncal vagotomy and antrectomy measurements were made, before and after operation, of acid output, gastrin output and gastric emptying of a solid and a liquid meat extract meal. No relationships were demonstrable between acid output and gastrin output. Truncal vagotomy and antrectomy (TVA) produced rapid early emptying of both meals combined with gross prolongation of the overall emptying of the solid meal. Truncal vagotomy and antrectomy reduced the integrated gastrin output after either meal. Proximal gastric vagotomy (PGV) produced rapid early emptying of the liquid meal with no alteration in the early emptying of the solid meal; however, overall solid meal emptying was delayed. Proximal gastric vagotomy increased basal, peak and integrated gastrin output. In preoperative patients slow solid meal emptying was associated with higher gastrin output but after PGV the reverse was found, the slowest emptiers having the lowest gastrin output. These findings do not support the contention that a pyloroplasty should be added to PGV to reduce the hypergastrinaemia produced by the operation.
Scalp and cranial substitution with autotransplanted greater omentum using microvascular anastomosis
Authors: Browning F S C , Eastwood D S , Price D J E , Kester R C
Published: March 2007

A case is described whereby a large defect of scalp and cranium was successfully covered using autotransplanted greater omentum, revascularized by microsurgical techniques.
One-dose antibiotic prophylaxis against wound infection after appendicectomy: A randomized trial of clindamycin, cefazolin sodium and a placebo
Authors: Donovan I A , Ellis D , Gatehouse D , Little G , Grimley R , Armistead S , Keighley M R B , Strachan C J L
Published: March 2007

Two hundred and fifty patients were admitted to a prospective randomized trial of single dosage prophylaxis against wound infection after appendicectomy. There were 12 exclusions, 72 patients received placebo, 81 received 600 mg i.m. clindamycin phosphate and 85 received 1 g i.m. cefazolin sodium, the agent being given in the anaesthetic room. Clindamycin produced a significant reduction in the overall rate of wound infection from 33 per cent in the controls to 17 per cent. In cases with a gangrenous or perforated appendix the infection rate in controls was 78 per cent; this was reduced to 44 per cent by a single dose of clindamycin.

Cefazolin significantly reduced the number of aerobic organisms isolated from wound infections, but did not significantly reduce the incidence of wound infection. We conclude that anaerobic organisms are more important than faecal aerobic organisms in the pathogenesis of wound infection after appendicectomy.
Mercury nephrotoxicity from peritoneal lavage
Authors: Pusey C D , Kennedy N D , Rainford D J
Published: March 2007

Two cases of acute renal failure following intraperitoneal administration of mercury are described.
Whole gut irrigation: A survey of patient opinion
Authors: Downing R , Dorricott N J , Keighley M R B , Oates G D , Alexander-Williams J
Published: March 2007

Patients' assessment of whole gut irrigation via a nasogastric tube has been obtained by a questionnaire answered by 79 of 99 patients who received this method of bowel preparation before operation on the large bowel or colonoscopy. Abdominal pain during the irrigation was experienced by 13 patients (17 per cent) and nausea and vomiting occurred in 24 (30 per cent). Intubation with a nasogastric tube and the discomfort of prolonged sitting on a commode were considered the most disagreeable aspects of the procedure. Fifty-six patients (71 per cent) would have agreed to the irrigation being repeated if necessary and many patients preferred whole gut irrigation to previous ‘orthodox’ bowel preparations that they had experienced.
A new appliance for collecting ileostomy and jejunostomy fluid in the postoperative period
Authors: Hill G L , Pickford I R
Published: March 2007

A new lightweight two-piece ileostomy appliance was tested in 11 patients with newly established ileostomies and jejunostomies. Seven of the patients presented difficult stoma care problems. The appliance was fitted in theatre on completion of the operation and the patient was followed until discharge from hospital.

The appliance remained in place for an average of 4.8 ± 1.2 days. In a total of 204 patient-days the pouch became dislodged from the flange on 10 occasions and there was leakage under the body flange on 7 occasions. All but one of the patients continued to use the appliance on discharge. No patient was allergic to the appliance nor complained of odour.

It is concluded that this new appliance represents an important advance in postoperative stoma care.
Hyperosmolar diabetes presenting as acute urinary retention: Report of three cases
Authors: Salem H H , Ramsay Ian
Published: March 2007

Three elderly patients presented at one hospital in a 2-week period with acute urinary retention precipitated by the hyperosmolar non-ketotic diabetic state. In each case routine urine testing was reported as showing 1 per cent glycosuria. The first two patients were admitted at night and blood glucose estimations were not done. This led to a delay of 16 and 12 h respectively before the appropriate therapy was instituted. It is suggested that this clinical presentation, previously unreported, may not be a rarity and represents an avoidable cause of death in patients with acute urinary retention.
Spontaneous rupture of a liver cell adenoma after long term Methyltestosterone: Report of a case successfully treated by emergency right hepatic lobectomy
Authors: Bird David , Vowles Keith , Anthony P P
Published: March 2007

A case of spontaneous rupture of a liver cell adenoma is reported in a female transexual treated with methyl-testosterone 150 mg daily for 7 years. Emergency right hepatic lobectomy was performed successfully. Histology showed peliosis hepatis also.

Emergency resection of a liver cell adenoma has been reported in a young woman taking oral contraceptives, and an elective resection in another female transexual treated with methyltestosterone. However, to the best of our knowledge this is the first case of emergency resection of a spontaneously ruptured liver cell adenoma in a transexual treated with long term methyltestosterone. Since there are numerous other patients similarly treated, it may be expected that this complication will he seen again.
Lipid metabolites and nitrogen balance after abdominal surgery in man
Authors: Foster K J , Alberti K G M M , Binder C , Hinks L , Karran S J , Ørskov H , Smythe P , Talbot S , Turnell D
Published: March 2007

The relation of lipid metabolism to nitrogen balance was studied in patients having undergone abdominal surgery and was compared with control subjects who had fasted for a similar period. The patients had lower circulating concentrations of glycerol, non-esterified fatty acids and ketone bodies. There were inverse correlations between blood alanine and ketone body concentrations in both patients (r = −064, P < 0.01) and controls (r = − 0.58, P < 0.01). Nitrogen excretion by patients (12.7 mmol/kg body weight/day ± 1.4 s.e. mean) was greater than by controls (9.2 mmol kg−1 d−1 ± 0.8, P < 0.05), but a more marked difference was noted for urinry methyl histidine excretion of 5.1 ± 0.5 μmol kg−1 d−1 by patients and only 2.5 ± 0.3 μmol kg−1 d−1 by controls (P < 0.01), a disparity indicative of more active protein turnover after surgery.
Spontaneous and traumatic rupture of hepatoma
Authors: Nagasue Naofumi , Inokuchi Kiyoshi
Published: March 2007

Hepatoma is a common cause of spontaneous rupture of the liver. During recent years, spontaneous rupture was found in 11 (7 per cent) of 157 patients with hepatoma. The rupture occurred spontaneously in 7 patients, traumatically in 1 while in 3 patients trivial trauma seemed to be the precipitating factor. A correct preoperative diagnosis was made in 7 patients, all of whom were known to have a hepatoma. Hepatic resection was performed in 4 patients, 2 of whom were long term survivors. Haemorrhage stopped in 2 of 3 patients who underwent hepatic artery ligation, but only 1 patient was discharged from hospital. The remaining patients, who were treated by packing, suture or laparotomy alone, died within a short time after admission. It is suggested that resection is the preferred management, but if this is not possible hepatic artery ligation should be performed.
Spontaneous liver rupture in polyarteritis nodosa
Authors: Li A K C , Rhodes J M , Valentine A R
Published: March 2007

An unusual case of spontaneous rupture of the liver associated with polyarteritis nodosa is reported.
Benign inflammatory tumour of the common bile duct
Authors: Stamatakis J D , Howard E R , Williams R
Published: March 2007

A rare cause of obstructive jaundice in childhood is presented. Ultrasound and subsequent percutaneous cholangiography demonstrated the site of obstruction. Histological examination of the resected tumour showed features consistent with a diagnosis of benign inflammatory tumour of the common bile duct.
Assessment of carotid artery stenosis using pulse wave transit time
Authors: Horrocks M , Roberts V C , Cotton L T
Published: March 2007

A prospective study has been undertaken on 24 patients to establish the relationship between the degree of internal carotid artery stenosis, as estimated by arteriography, and the pulse wave transit time in the carotid artery. The technique involves the simultaneous use of two continuous wave Doppler velocimeters, one on the carotid and one on the supraorbital artery, to measure the flow waves and hence deduce the pulse wave transit times. The measured transit times varied from 17 to 124 ms with a beat-to-beat variation of 11 per cent.

The absolute transit time in any segment correlated moderately well with the estimated degree of stenosis (r = 0.68, P < 0.001). However, normalization of the transit times, to correct for the effects of blood pressure and age, produced an improved correlation between the variables (r = 0.8, P < 0.001). Normalization was achieved by dividing the common carotid to supraorbital transit time by the shortest transit time found between the common carotid and either the superficial temporal or brachial arteries.

Significant differences in the normalized transit times were found between arteries that were diametrically stenosed by more than 50 per cent, by between 21 and 50 per cent and by 20 per cent or below. It is concluded that pulse wave transit time measurement can provide a simple and reproducible non-invasive technique for the diagnosis of varying degrees of carotid artery stenosis.
Radiological assessment of nipple–valve insufficiency in Kock's continent reservoir ileostomy
Authors: Standertskjöld-Nordenstam C-G , Palmu A , Sivula A
Published: March 2007

In a series of 51 continent reservoir ileostomies nipple–valve insufficiency developed in 15 patients who were examined radiographically to find the cause for the loss of continency. The radiological diagnosis was confirmed at reoperation. The causes for nipple–valve insufficiency were a total or partial disappearance of the nipple–valve by sliding of the invaginate (7 cases) and dislocation of an undamaged nipple out of the reservoir (8 cases). In these groups the radiological diagnosis was compatible with the operative findings in all but one case. At reoperation a fistula in the nipple–valve was found in 3 cases, but in no instance had this been diagnosed radiologically. A correct preoperative diagnosis is valuable, especially in cases of dislocation, where a danger exists that the real mechanism of valve insufficiency may remain obscure at operation.
Closure of colostomy in infants and children
Authors: Rickwood A M K , Hemalatha V , Brooman P
Published: March 2007

A retrospective survey of 100 consecutive colostomy closures in infants and children is presented: the operative technique consisted of bowel resection and anastomosis, usually as a single layer, with intraperitoneal closure. Faecal fistula occurred in 5 cases and there were other major complications in 8 instances. Wound infection occurred in 43 patients. The subsequent use of a more aggressive bowel preparation reduced the incidence of this complication.
The ingrowing toenail: A modified segmental matrix excision operation
Authors: Gabriel S S , Dallos V , Stevenson D Lang
Published: March 2007

A series of 528 patients with ingrowing toenails has been operated on under local anaesthetic by one surgeon using a simple technique in which a segment of germinal matrix is completely excised without cutting skin and with minimal interference with the nail wall. Normal footwear was worn by the fifth day in 79 per cent of patients. The recurrence rate was 1.7 per cent.
Melanoma of the nipple and areola
Authors: Papachristou D N , Kinne D , Ashikari R , Fortner J G
Published: March 2007

Fourteen primary melanomas arising in the nipple and areola of the breast were treated by mastectomy and axillary dissection. Four patients had axillary lymph node metastases and all were dead within 3 years of their operation, while the 10 patients with no axillary node involvement were free from recurrent disease 5 years after their operation. On the basis of clinical and anatomical studies, it is suggested that a wide local excision without mastectomy is adequate for the treatment of nipple and areola melanomas.
Sclerotherapy for hydrocoele and epididymal cysts
Authors: Nash J R
Published: March 2007

A prospective study was carried out on the efficacy of sclerotherapy for the treatment of hydrocoeles and epididymal cysts. Thirty-six hydrocoeles and 13 epididymal cysts were treated and followed up for between 1 and 2 years. Thirty-four hydrocoeles were cured, 1 failed to respond to treatment and 1 recurred after treatment. All 13 epididymal cysts were cured.
The effect of aspirin on the fibrinolytic activity of gastric juice
Authors: O'Brien T E , Hadley Helen , Irving M H
Published: March 2007

Fibrinolytic activity in the gastric juice of normal subjects has been studied by a double-blind cross-over technique comparing the effect of placebo and pentagastrin against aspirin and pentagastrin. Aspirin effectively produced a gastritis and pure fibrinolytic activity was detected in the gastric juice, but the number of samples showing pure fibrinolytic activity did not differ between the two groups. In both the placebo and the aspirin groups the presence of a protease active at neutral pH and capable of dissolving fibrin is confirmed. Aspirin is unlikely to cause gastric bleeding by increasing local fibrinolytic activity within the stomach. The model, so constructed, is not sensitive enough to be of value in investigating further the role of gastric fibrinolytic activity in gastric haemorrhage.
Chronic abdominal pain: A surgical or psychiatric symptom?
Authors: Woodhouse C R J , Bockner S
Published: March 2007

A prospective investigation of chronic, non-specific abdominal pain in 20 patients is reported. The cause was found to be psychiatric in 8 (40 per cent), while a surgical cause was found in only 3 (15 per cent). Four had irritable colon (20 per cent) and no diagnosis was made in 5 (25 per cent). It is suggested that such pain is more often a psychiatric than a surgical symptom and therefore a psychiatric consultation should be a routine part of the investigation.
Interstitial emphysema of the stomach
Authors: Turnbull A R , Michell R C
Published: March 2007

A case of interstitial emphysema of the stomach is reported and the possible aetiological factors involved are discussed.
The management of insulin tumours of the pancreas
Authors: Le Quesne L P , Nabarro J D N , Kurtz A , Zweig S
Published: March 2007

A series of 26 patients diagnosed as having an insulin-secreting, islet-cell tumour of the pancreas is described. Three patients were treated medically, but in the remaining 23 the tumour was found at operation; 1 patient had a carcinoma with hepatic metastases, but in the other 22 the tumour was apparently benign and the subsequent course of these patients has confirmed this conclusion.

The tumour was found at the initial operation in 19 of the 22 patients with a benign tumour treated surgically. Of the other 3, the tumour was removed at a second operation in 2 and at a third operation in 1. Two of the 22 patients died following the operation.

Diazoxide was administered to 21 patients, before and/or after operation. It was given preoperatively to 17 patients, in all of whom it prevented the development of hypoglycaemic symptoms, but in 2 it caused serious fluid retention and had to be discontinued. Seven patients have been successfully treated with long term diazoxide, either as an alternative to surgery or following an unsuccessful operation, 1 of these being the patient with an islet-cell carcinoma. In these patients diazoxide has been given for up to 12 years without apparent side effects.

Selective coeliac angiography was performed in 13 patients. In no patient did it provide critical information that significantly influenced the treatment of the patient.

Percutaneous, transhepatic portal venous catheterization was performed in 4 patients and indicated the site of the tumour in 3, 2 of whom had had 1 previous operation and 1 had had 2 previous operations, at none of which was a tumour found: in all 3 patients the tumour was removed at a subsequent operation.

The application of these findings to the management of patients with an insulinoma is discussed and a scheme of management is proposed.