bluuebunny/crossref_metadata_2025 huggingface dataset:
Morbidity and mortality of common bile duct exploration
Authors: Sheridan W G , Williams H O L , Lewis M H
Published: March 2007

This retrospective study reviews the complications which occurred in 257 patients who had supraduodenal exploration of the common bile duct in one hospital during a 15-year period. One hundred and eighteen patients (46 per cent) developed complications: septic and cardiorespiratory complications were most common, occurring in 19·5 per cent and 16·7 per cent of patients respectively. Postoperative retained stones were detected in 37 patients (14 percent), causing complications in 54 per cent. Peroperative postexploratory cholangiography did not significantly reduce the incidence of this problem. None of the 12 patients who had postexploratory choledochoscopy had retained stones. Five patients (1·9 per cent) died, three of whom had duct procedures in addition to supraduodenal exploration and two of whom had retained stones. It is concluded that common bile duct exploration has a high associated morbidity, particularly due to sepsis and retained stones.
Acute cholangitis in association with acute pancreatitis: Incidence, clinical features and outcome in relation to ERCP and endoscopic sphincterotomy
Authors: Neoptolemos J P , Carr-Locke D L , Leese T , James D
Published: March 2007

Although endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) have been shown to be valuable in managing patients with acute cholangitis, their role in patients who have simultaneous acute cholangitis and acute pancreatitis is not known. We have reviewed 32 consecutive patients presenting with both conditions over ten years which represents 23·0 per cent of all cases of gallstone-related acute cholangitis and 14·4 per cent of all cases of biliary acute pancreatitis admitted during the same period. The majority of patients were elderly (median 76 years) and female (75 per cent). Five patients had previously undergone cholecystectomy. Eleven patients were clinically shocked (34 per cent) and blood cultures were positive in 9/14 cases (64 per cent). Twenty patients (63 per cent) had a predicted severe attack of acute pancreatitis (modified Glasgow criteria). Common bile duct (CBD) stones were identified in 15 of 23 patients with successful ERCP. Of these 23 patients, 9 were treated by endoscopic sphincterotomy (ES) alone, 5 by ES and surgery, 4 by surgery alone and 5 were treated conservatively. There was one death (4·3 per cent). Nine patients were managed without cholangiography; four had surgery and five were treated conservatively. There were three deaths (33 percent; P = 0·10). Evidence of recent CBD stone passage was apparent in eight patients (25 per cent) compared with five out of eighty-seven patients (5·7 per cent) with acute cholangitis alone (P<0·05). The results indicate that ERCP and ES may have an important role in the management of these patients.
Ureteric re-implantation in the neuropathic bladder
Authors: Brereton R J , Narayanan R , Ratnatunga C
Published: March 2007

During the last 5 years 174 children with neuropathic bladder were studied, and only 7 required urinary diversions. A total of 31 ureteroneocystostomies were performed in 17 patients, 16 of whom had gross vesico-ureteric reflux. Revisionary surgery was required in four children and two underwent pyeloplasty. Deterioration followed ureteroneocystostomy in two patients, but 13 (76 per cent) of the children were significantly improved.
Periodic gallbladder contraction maintains bile acid circulation during the fasting period: A canine study
Authors: Nally C V , McMullin L J , Clanachan A S , Scott G W
Published: March 2007

Using a canine model we have studied the relationship between the interdigestive cycle in the small intestine, motility changes in the biliary tract and bile acid output into the duodenum from direct hepatic secretion and gallbladder emptying. Under anaesthesia catheters were inserted into the gallbladder, common bile duct and duodenum, and electrodes were attached to the small intestine in five dogs. These animals were subsequently studied conscious and fasting. A double marker technique was used to measure bile acid output from the gallbladder and liver while pressure in the gallbladder and common bile duct and electrical activity in the small intestine were monitored. Four complete interdigestive cycles were recorded in each dog. Output of bile acids from the gallbladder fluctuated with the phases of the cycle: being lowest in phase I (3·9 ± 0·7 μmol/min); increasing significantly (P<0·005) in phase II (9·8 ± 1·0 μmol/min); remaining elevated in phase III (13·9 ± 1·7 μmol/min); and falling significantly (P<0·05) in phase IV (8·4 ± 1·8 μmol/min). In contrast, hepatic secretion of bile acids directly into the duodenum remained fairly constant. Intraluminal pressure in the biliary tract paralleled the fluctuation in gallbladder bile acid output, being significantly increased (P<0·05) in phases II and III. Periodic contraction of the gallbladder would, therefore, appear to be the principal mechanism for the phasic output of bile during fasting.
Raised serum thyrotrophin in women with peripheral arterial disease
Authors: Powell Janet , Zadeh J Alaghband , Carter G , Greenhalgh R M , Fowler P B S
Published: March 2007

Women with symptomatic peripheral arterial disease were screened for impaired thyroid function using a sensitive immunoradiometric assay for thyrotrophin (TSH). The arterial disease in the aortotibial segment was documented by an abnormal brachial/ankle pressure index in 80 patients. An age-matched control group of elderly women (n = 30) with a normal pressure index was established. In the control group the mean serum TSH was 1·6 × 1·1 milliunits/l, median 1·5 milliunits/l and this established a normal range of 0·2–3·9 milliunits/l. Seven patients (8·8 per cent) were already receiving treatment for myxoedema. In the remaining patients, the overall distribution of serum TSH was skewed to higher levels; the mean was 3·7 milliunits/l, median 2·4 milliunits/l, P<0·001 compared with controls and 15 (19 per cent) had a serum TSH > 4 milliunits/l, compared with only one (3·3 per cent) of the controls. Therefore 22 patients (28 per cent) had myxoedema or a raised serum TSH. For all subjects with a normal TSH, there was a positive correlation of serum TSH with serum cholesterol, r = 0·68, P<0·001. For patients with a raised TSH, there was a continuing, but non-linear, increase of serum cholesterol with TSH. These results suggest that a raised serum TSH may be one of the risk factors for the development of peripheral arterial disease in women, possibly by increasing cholesterol levels.
Triple therapy in cadaver renal transplantation
Authors: Jones R M , Murie J A , Allen R D , Ting A , Morris P J
Published: March 2007

One hundred consecutive first (n = 72) and regrafted (n = 28) cadaver renal allograft recipients were immunosuppressed with cyclosporin, azathioprine and prednisolone (triple therapy) and followed for a median of 17.3 months (range, 7-26 months). Actuarial patient survival at 12 and 24 months was 97.7 per cent. Actuarial graft survival at 12 and 24 months was 79.5 per cent (first graft recipients 81.3 per cent and regrafted recipients 75 per cent). HLA-DR matching significantly improved graft survival which was 93 per cent at 1 year in patients given HLA-DR compatible kidneys, compared with 83 and 54 per cent, respectively, in patients who received kidneys mismatched for one or two HLA-DR antigens. There were 0.8 (s.d. = 0.7) episodes of acute rejection per patient during the first 3 months after transplantation. Triple therapy provides effective immunosuppression without evidence of over immunosuppression and reduces the incidence of cyclosporin side-effects. Although acute nephrotoxicity was uncommon, serum creatinine remained elevated 6 and 12 months after transplantation.
Results of resection of gastric cancer extending to adjacent organs
Authors: Korenaga D , Okamura T , Baba H , Saito A , Sugimachi K
Published: March 2007

We report the late results of resection in 281 patients with gastric carcinoma extending to adjacent organs. In 92 without incurable factors (peritoneal dissemination, liver metastasis and widespread nodal involvement) the 5-year survival rate was 36.7 per cent in those treated by gastrectomy and complete removal of the invaded organ. This value is significantly higher than the 17.4 per cent recorded in those undergoing gastrectomy alone or with incomplete removal of the invaded organs (P < 0.05). In 189 patients with incurable factors, the 5-year survival rates were 5.4 and 2.8 per cent respectively in cases of complete and incomplete excisions. This tendency was similar in patients with a single invaded organ and also in those with plural organ involvement. In potentially curable patients treated by complete excision, the probability of long-term survival was statistically better than that following incomplete excision only when the pancreas was involved (P <0.05). We recommend complete excision of invaded organs, irrespective of the number or site of organs involved, provided that there is no evidence of incurable factors.
Improvements in the treatment and prognosis of colorectal carcinoma
Authors: Järvinen H J , Ovaska J , Mecklin J-P
Published: March 2007

In a survey of the surgical results in 709 patients with colorectal carcinoma (CRC) treated between 1976 and 1985 a favourable shift of stage distribution was observed. The tumour was localized (Dukes' classification A or B) in 61 per cent of patients, as compared with 47 per cent in the previous 10-year period. This change was, in part, due to different interpretation of stage definitions. Clear improvements of the results were, however, also noted. Radical surgery was possible in 76 per cent of patients and the primary tumour was removed in 93 per cent. Surgical mortality was 4·4 per cent and complication rate 15 per cent, significantly less than earlier (6·5 and 38 per cent, respectively). Increasing numbers of sphincter-saving operations were performed in rectal cancers (47 per cent as compared with 24 per cent in the previous 10-year period). The overall 5-year survival rate improved from 40·5 to 52·5 per cent. Premalignant conditions were identified in 12.6 per cent of patients: previous CRC 4.8 per cent, cancer family syndrome 4·1 per cent, ulcerative colitis 1·7 per cent and familial adenomatosis 0·6 per cent. In order to sustain the favourable trend of improving survival prospects, more emphasis must be directed to the detection of early stage cancers.
Penile incarceration by a metallic object
Authors: Sinha B B
Published: March 2007

Incarceration or strangulation of the penis by an encircling object is an uncommon clinical presentation. This paper describes a simple method to deal with such an emergency in which no special skill is required and no immediate or long-term morbidity related to the treatment occurs.
Complete rectal prolapse: The anatomical and functional results of treatment by an extended abdominal rectopexy
Authors: Mann C V , Hoffman C
Published: March 2007

Between 1970 and 1985 (inclusive), 66 patients presented with complete rectal prolapse; 59 (89 per cent) were treated by extended abdominal rectopexy. Forty-four patients (75 per cent) have been followed for more than 2 years: all cases were cured of their complete prolapse, no patients died, and major complications were few. Constipation (47 per cent) and incontinence (19 per cent) caused serious problems for many patients postoperatively.
Tubercular fistula in ano
Authors: Shukla H S , Gupta S C , Singh G , Singh P A
Published: March 2007

Of 122 patients with fistulae in ano operated upon in a 5-year period, 19 (15.6 per cent) were found to have tubercular fistulae on histopathological examination. There was no characteristic clinical picture and concomitant pulmonary tuberculosis was present in only three patients. Histological examination of the excised fistula is mandatory for the diagnosis of anal tuberculosis. There were no cases of Crohn's disease of the anal region.
Anal fissure in Crohn's disease
Authors: Sweeney J L , Ritchie Jean K , Nicholls R J
Published: March 2007

There is little information on the natural history of anal fissure in Crohn's disease. The case notes of all new patients with Crohn's disease attending one hospital between 1977 and 1983 were reviewed: there were 61 patients with this diagnosis and an unhealed anal fissure as the only anal lesion. of these 61 patients the fissure healed in 42 (69 per cent) during medical treatment of the intestinal disease. Ten patients (16 per cent) developed other anal lesions and in the remaining nine patients the fissure remained unhealed at the time of rectal excision (six) or last out-patient attendance (three). Activity of the fissure did not reflect disease activity elsewhere in 11 cases in whom healing of the fissure occurred despite progressive intestinal disease subsequently requiring resection. This study validates the policy of conservative management of anal fissure in Crohn's disease with anal surgery (required in 9.8 per cent of patients in this series) being reserved for the development of other anal disease.
Appendicitis and schistosomiasis
Authors: Al-Kraida A , Giangreco A , Shaikh M U , Al-Shehri A
Published: March 2007

A retrospective clinical and pathological study of 15 cases associated with schistosomiasis drawn from 1920 patients undergoing appendicectomy is discussed. The average age of the patients was 31.6 years with a 12:3 male predominance. Hepatomegaly, past or present jaundice, or splenomegaly were not observed. One patient had a previous history of similar right lower quadrant pain for several days. Eighty per cent of the cases showed an inflammatory reaction on pathological examination. In the remaining 20 per cent no inflammation was seen, but there was severe congestion mainly involving the subserosal blood vessels. Schistosoma haematobiurn was present in 80 per cent of the cases.
Prognosis after simple incision and drainage for a first-episode acute pilonidal abscess
Authors: Jensen S L , Harling H
Published: March 2007

During a 3-year period 73 patients were treated consecutively for a first-episode acute pilonidal abscess with simple incision and drainage under local anaesthesia. In all cases the treatment relieved symptoms and all patients returned to work immediately after treatment. Healing per primam occurred in 42 patients (58 per cent; 95 per cent confidence limits: 45–69) within 10 weeks after treatment. These patients had significantly fewer pits and lateral tracts compared with patients who developed excessive granulation tissue after incision and who required definitive surgical treatment later. Nine patients (21 per cent; 95 per cent confidence limits: 10–37) with healing per primam developed recurrence of their pilonidal disease during the prospective follow-up period (median follow-up period was 60 months, range 36–84 months). Actuarial analysis of the data revealed a constant cure rate of 76 per cent (95 per cent confidence limits: 57–95) after 18 months.
Acral (volar-subungual) melanoma in Auckland, New Zealand
Authors: Shaw J H F , Koea J B
Published: March 2007

We have retrospectively reviewed the charts of 34 acral melanoma patients (melanoma arising from the volar skin of the hands, feet or a subungual site) seen in the Auckland area between 1970 and 1985. These 34 patients constituted 3.5 per cent of the total number of patients (972) reviewed over this period. Six of the thirty-four patients were either Polynesian or Maori. There were 19 men and 15 women, and the mean age of the group was 59 years. The primary lesion arose from the plantar or palmar skin in 25 patients and 9 patients had subungual lesions. All lesions but one were pigmented. Most patients with plantar or palmar lesions presented with clinical stage 1, Clark's level 4 disease, while those with subungual lesions presented most commonly with stage 2, Clark's level 5 disease. Treatment was wide local resection for plantar and palmar lesions and amputation for subungual lesions. Regional lymph node dissection was performed in 10 patients with positive nodes at presentation and in 6 patients who developed metachronous nodal disease. Patients were followed for between 1 and 16 years, and 18 patients died in this period, 15 of metastatic melanoma (mean time 34 months). Subungual melanoma carried a worse prognosis than melanoma arising in palmar or plantar skin.
Platelet aggregation on peritoneal tube grafts and double velour grafts in the inferior vena cava of the pig
Authors: Ribbe Else B , Jönsson B-A , Norgren L E H , Strand S-E , Thörne J L
Published: March 2007

In 14 pigs the infrarenal vena cava was replaced with a peritoneal tube graft or a collagen-coated double velour graft. With 111In-labelled platelets dynamic in vivo imaging of platelet aggregation over the graft was carried out using a scintillation camera. After removal, the grafts were examined by autoradiography for an evaluation of the platelet aggregation pattern. Measurements of activity in different regions of the grafts were also performed. The results indicated low activity uptakes both in vivo and in vitro. The dynamic study did not show any uniform increase of activity content 1–3 h postoperatively, in any of the groups. During the period 2–3 h postoperatively no increasing activity accumulation was found. Hemashield® Microvel® grafts had an uptake of 0.19 per cent of the total activity while the corresponding figure for peritoneal tube grafts was 0.17 per cent. The activity distribution on different parts of the grafts indicated lower accumulation on the Hemashield graft surfaces than in the anastomoses, while the accumulation was higher on the graft surface of peritoneal tube grafts. The autoradiographical findings supported this indication. In conclusion, low platelet aggregation was found with both dynamic in vivo imaging and in vitro activity measurements on both peritoneal tube grafts and collagen-coated double velour grafts.
Pancreatic abscess: Results of prolonged irrigation of the pancreatic bed after surgery
Authors: Nicholson M L , McC Mortensen N J , Espiner H J
Published: March 2007

The mortality from pancreatic abscess may approach 70 per cent and the survivors often require repeated operations to debride the pancreas and to drain recurrent abscesses. We report the results of prolonged irrigation of the pancreatic bed after surgical débridement in 11 patients. Surgery was performed at an average of 17 days (range 8–25 days) after the onset of symptoms. The pancreatic slough was thoroughly debrided and 2–6 large drains were placed in the pancreatic bed. Irrigation with saline or Diaflex® solution (2–6 l/day) was started after 2 days and continued for a mean of 25 days (range 5–54 days). There were three deaths (27·3 percent) after surgery: one of these patients required re-operation and packing for massive postoperative haemorrhage and all three had some evidence of persisting sepsis at autopsy. Prolonged irrigation of the pancreatic bed after surgical débridement may reduce mortality and the need for repeated drainage procedures in patients with pancreatic abscess, but the detection and treatment of persisting sepsis remains the major problem.
Anterior lesser curve seromyotomy with posterior truncal vagotomy versus proximal gastric vagotomy
Authors: Oostvogel H J M , Van Vroonhoven Th J M V
Published: March 2007

In a prospective randomized trial anterior lesser curve seromyotomy with posterior truncal vagotomy (ASPTV, n=48) has been compared with proximal gastric vagotomy (PGV, n=43). Eighty-eight and eighty-three patients were available for follow-up studies at 1 year and 2 years, respectively. Six months postoperatively the mean reduction in pentagastrin-stimulated peak acid output (PAO) was 48.5 per cent (s.d. 26.3) after PGV and 50.5 per cent (s.d. 23.3) after ASPTV. Two years after the operation satisfactory clinical results (Visick I + II) were found in 84.2 per cent of the patients after PGV and in 88.9 per cent after ASPTV. There was a significant difference in the duration of surgery. No serious postoperative gastric sequelae were encountered after either operation. Up till January 1987, eight endoscopically proven, symptomatic recurrent ulcers have been diagnosed: four in the PGV group (9.3 per cent) and four in the ASPTV group (8.7 per cent). The results of this randomized study suggest that ASPTV is as good as PGV in the surgical treatment of chronic duodenal ulcers.
Stimulation of the healing of experimental colon anastomoses by low-power lasers
Authors: Asencio-Arana F , Martinez-Soriano F
Published: March 2007

Anastomotic leakage following colorectal surgery remains a complication with high mortality and morbidity. Recent studies suggest that helium-neon (He-Ne) lasers at specific energy densities can be used to enhance wound healing in different tissues. In this experimental study we have tested the strength of end-to-end anastomosis of the rat colon irradiated by He-Ne laser by measuring bursting pressures and bursting wall tensions at 2, 4 and 7 days after operation. The study shows that He-Ne laser radiation induces a significant increase in colonic strength at the anastomosis. The laser does not cause the luminal narrowing observed in non-irradiated specimens.
Low molecular weight heparin compared with unfractionated heparin in prevention of postoperative thrombosis
Authors: Samama M , Bernard P , Bonnardot J P , Combe-Tamzali Sophie , Lanson Y , Tissot E
Published: March 2007

Three consecutive randomized open studies have been carried out to determine the optimal dosage of low molecular weight heparin (LMWH) in the prevention of postoperative thrombosis in general surgery (892 patients). All patients undergoing abdominal, gynaecological, thoracic or urological surgery were over 40 years old and presented at least one of the following risk factors for thrombosis: previous thromboembolism, obesity, varicose veins, malignancy (30 per cent), pre-operative hospitalization over 5 days, oestrogen therapy, chronic cardiac disease or bronchitis. Isotopic venous thrombosis and bleeding complications were assessed after subcutaneous administration of a LMWH fragment (LMWH, Enoxaparine) or unfractionated heparin (UH). The three studies compared 3 × 5000 units UH daily with 1 × 60 mg, 1 × 40 mg, 1 × 20 mg LMWH daily. Thromboembolic events rates were not significantly different from group to group (UH: 3.8 per cent, 2.7 per cent, 7.6 per cent respectively compared with LMWH: 2.9 per cent, 2.8 per cent, 3.8 per cent). Bleeding episodes including wound haematoma formation, perioperative blood losses and systemic haemorrhage were not significantly different in patients receiving LMWH or UH. Significant decreases in haematocrit and haemoglobin were only observed in patients receiving 60 mg Enoxaparine (as compared to UH). An analysis using the ‘intention to treat’ approach gave results consistent with those of an analysis of good compliers. An overview of isotopic thromboses in the three studies gave no evidence of differences amongst the effects of the three doses of LMWH (P = 0.20), and pooling the results of the three studies using the Mantel-Haenszel procedure gave no evidence of a global difference between Enoxaparine and UH (P = 0.54). These results suggest that an optimal dosage of 20 mg/day of Enoxaparine is safe and effective in the prevention of postoperative thrombosis in this population.
Cytotoxic-loaded albumin microspheres: A novel approach to regional chemotherapy
Authors: McArdle C S , Hansell D , Lewi H , Kerr D J , McKillop J , Willmott N
Published: March 2007

Adriamycin®-loaded albumin microspheres (15–40 μm diameter) incorporating 1 per cent by weight of Adriamycin were prepared by cross linking albumin with glutaraldehyde. After systemic administration in rats, the microspheres were trapped in the pulmonary capillary bed, biodegradation occurring over 48 h. After selective intrarenal arterial injection of 99mTc-labelled albumin microspheres in rabbits, 97 per cent of the injected microspheres were trapped within the kidney; less than 1 per cent were found in the contralateral kidney, lungs and liver. Similar results were obtained after selective intrahepatic arterial injection. The selective injection of cytotoxic-loaded microspheres may provide a reliable method of administering high concentrations of cytotoxic drug to a target organ without producing high serum levels; this technique may have a role in the management of solid tumours.
Prediction of choledocholithiasis using a pocket microcomputer
Authors: Taylor T V , Armstrong C P , Rimmer S , Lucas S B , Jeacock J , Gunn A A
Published: March 2007

A computerized method, using a small pocket computer, has been used to predict the presence of choledocholithiasis in a prospective series of 239 patients undergoing cholecystectomy. From an initial data base of 424 patients 36 factors were evaluated and the most important 2 of these were determined by multivariate analysis for use in the prospective analysis. Satisfactory operative cholangiograms were a prerequisite to evaluation of the statistical method and were obtained in 90.4 per cent of cases. Using the computerized method a common bile duct stone would have been overlooked in only 1 patient but 17 unnecessary explorations would have been carried out. The overall accuracy of the computerized method was 92.5 per cent. When the method was applied to a further study of 97 patients from a separate centre the overall accuracy was 85.6 per cent. If the method was used to aid selective use of operative cholangiography, cholangiograms would be performed in 20 per cent and stones would be overlooked in less than 1 per cent.
Anergy in jaundiced patients
Authors: Cainzos M , Potel J , Puente J L
Published: March 2007

A prospective study of delayed hypersensitivity was carried out in jaundiced patients. One hundred and nineteen subjects were studied. Fifty-nine were controls and sixty were patients with pancreatobiliary pathology and biliary tract obstruction. A Multitest technique was used to evaluate the delayed hypersensitivity response, classifying the subject into one of three groups: immunocompetent, relatively anergic and anergic. In the control group, 76 per cent of the subjects were immunocompetent as opposed to 17 per cent of the patients (P<0.001). Ten per cent of the control subjects and fifty-five per cent of the patients presented anergy (P<0.001). Amongst the patients no difference could be found in the index of anergy between malignant or benign pathology. A greater incidence of postoperative septic complications in anergic and relatively anergic patients was found. Our study indicates a relationship between jaundice and anergy.
Total pancreatectomy in the MEN-1 syndrome
Authors: Tisell L E , Ahlman H , Jansson S , Grimelius L
Published: March 2007

A family with the multiple endocrine neoplasia Type 1 (MEN-1) syndrome, followed over three generations, is presented. In the first generation, one family member died after a history indicating Zollinger-Ellison syndrome. In the second generation endocrine pancreatic tumours were diagnosed or suspected in three out of five members. In the third generation, five out of seven members were investigated and four of these had positive tests at hormonal screening. of particular diagnostic value in this family was the determination of peripheral serum levels of proinsulin and C-peptide, which were used as tumour markers both for diagnosis and in the postoperative follow-up. Two members in the third generation have been successfully managed by total pancreatectomy. A MEN-1 patien with malignant pancreatic tumours should be considered for total pancreatectomy if the pancreatic disease has caused high morbidity and mortality within the family. This is especially pertinent if the patient has multiple malignant tumours.
Surgery in tropical pancreatitis
Authors: Thomas P G , Augustine P
Published: March 2007

Nineteen consecutive patients with tropical pancreatitis and chronic pancreatic pain operated upon over a 3-year period in Kerala, India, are reported. The pancreatic ductal morphology was studied by ultrasound scan, endoscopic retrograde cholangiopancreatography and/or operative pancreatography. In 17 patients, duct drainage by lateral pancreatojejunostomy and/or transduodenal pancreatic sphincteroplasty constituted the main surgical procedure. Caudal pancreatic resection was required in six of these patients. Unresectable pancreatic masses were found in two patients. Three patients died. of the 16 survivors, 14 had good relief of pain within the limits of the available follow-up. In analysing the results, patients with ‘obstructive pancreatitis’ were found to have increased morbidity and mortality. The need to diagnose this subgroup of chronic pancreatitis pre-operatively is discussed.
Staphylococcus epidermidis as a cause of postoperative wound infection after cardiac surgery: Assessment of pathogenicity by a wound-scoring method
Authors: Wilson A P R , Grüneberg R N , Treasure T , Sturridge M F
Published: March 2007

Wound infection after clean surgery prolongs hospital stay but the organism most commonly isolated from wound discharge, Staphylococcus epidermidis, is often dismissed as a contaminant or commensal. The wounds of 517 patients were assessed, after cardiac surgery, by a wound-scoring method (‘ASEPSIS’) and a close comparison was made of the appearance and clinical outcome of 89 wounds, from which bacteria were isolated. There was no significant difference in the scores of 49 wounds, where S. epidermidis was the sole isolate (9.5 per cent of all wounds, 95 per cent CI 6.9-12.0 per cent), and 13 wounds infected with Staphylococcus aureus (2.5 per cent, 95 per cent CI 1.2-3.9 per cent). Repeat cultures were obtained from 21 of the 49 wounds and, in 16 of these, the second isolate showed the same biochemical reactions and antibiotic resistance pattern as the first. Infection of sternal wounds is commoner with coagulase-negative staphylococci than with S. aureus and, clinically, is just as severe.
Surgical gloves as a mechanical barrier against human immunodeficiency viruses
Authors: Dalgleish A G , Malkovsky M
Published: March 2007

A wide variety of surgical gloves are presently available. Seven different types of gloves were investigated for the ability to prevent transmission of the human immunodeficiency virus (HIV), the causative agent of AIDS. Six types of gloves withstood severe compression tests and also exhibited direct antiviral properties. No penetration of HIV through the intact glove was detected.
Biochemical prediction of gallstones in acute pancreatitis: A prospective study of three systems
Authors: Davidson B R , Neoptolemos J P , Leese T , Carr-Locke D L
Published: March 2007

Three clinicobiochemical systems have been proposed for predicting gallstones in acute pancreatitis based on one, three and five factors respectively, but have not been compared in a single prospective study. System I is based on the serum transaminase alone: system 2 uses alkaline phosphatase and bilirubin in addition to transaminase; and system 3 involves female gender, age, amylase and alkaline phosphatase in addition to transaminase. Over the 4-year period 1983-86, 368 patients with 391 episodes of acute pancreatitis had clinicobiochemical analysis within 48 h. Of these episodes, 220 were related to gallstones (56 per cent), 62 to alcohol (16 per cent) and 109 to other aetiologies or were idiopathic (28 per cent). Significant differences were found between the biliary and non-biliary groups with respect to sex (139 versus 59 women, P<0·002), age (65±17 versus 52±19 years, P<0·0001) and serum amylase (6041±6335 versus 4546±3990 units/l, P<0·0001), alkaline phosphatase (257±225 versus 141±137 units/l, P<0·0001), alanine transaminase (221±227 versus 72±119 units/l, P<0·0001) and bilirubin (40±39 versus 24±30 μmol/l, P = 0·0001). The sensitivity and specificity was 75 per cent and 74 per cent for the one-factor system, 74 per cent and 78 per cent for the three-factor system and 62 per cent and 80 per cent for the five-factor system. The predictive value of a positive result was 78±8 per cent, 81±5 per cent and 80·1 per cent and of a negative result 69·4 per cent, 70·1 per cent and 62·3 per cent for the three systems respectively. The performances of the one- and three-factor systems were marginally better than that of the five-factor system; the one-factor system, however, had the advantage of simplicity.
Surgical morbidity and mortality in one hundred and twenty-nine patients with obstructive jaundice
Authors: Greig J D , Krukowski Z H , Matheson N A
Published: March 2007

One hundred and twenty-nine jaundiced patients were operated upon for the relief of benign and malignant bile duct obstruction during a 10-year period, 1977–86. The overall mortality was 4·7 per cent but increased to 9·1 per cent in patients with a serum bilirubin > 300 μmol/l. In all, 46·5 per cent of patients had a rise in postoperative creatinine but renal dysfunction occurred in only 4·7 per cent. Wound infection developed in 3·1 per cent of patients and appeared unrelated to infected bile; 3·9 per cent of patients were treated for postoperative septicaemic episodes. The low morbidity and mortality observed suggests that pre-operative biliary drainage need not be considered in routine surgical practice if simple measures to maintain urine flow and prevent postoperative sepsis are used.
Management of penetrating abdominal stab wounds
Authors: de Lacy A M , Pera M , Garcia-Valdecasas J C , Grande L , Fuster J , Cugat E , Lopez-Boado M A , Visa J , Pera C
Published: March 2007

The authors present the results of a therapeutic trial of the conservative or surgical management of penetrating abdominal stab wounds (PASW) based on clinical criteria. In a prospective series of 100 patients, 70 were treated non-operatively. Thirty patients were operated upon, twenty-one immediately and nine during the 48 h observation period. In five laparotomies no significant injuries were found. Morbidity was similar in both immediate and delayed laparotomy groups (3/21 versus 1/9). Acute alcoholic intoxication identifies a subgroup of patients that are difficult to evaluate and hence are more likely to be managed by laparotomy (χ2 = 4·056, P<0·05). The authors conclude that selective surgical management of PASW based on clinical criteria is an accurate and safe procedure.
Doppler ultrasonography in the diagnosis of acute scrotal pain
Authors: Bickerstaff K I , Sethia K , Murie J A
Published: March 2007

Pre-operative Doppler ultrasonography was performed on 41 patients who underwent an emergency scrotal exploration because of the clinical suspicion of a testicular torsion. The final diagnoses were testicular torsion in 18 patients, epididymitis in 15 patients and torsion of a testicular appendage in 8 patients. An unequivocal indication as to the presence or absence of a testicular torsion was obtained in 31 patients (76 per cent), an equivocal result was obtained in 5 patients and in 5 patients the examination was unsatisfactory. The sensitivity and specificity of the investigation for the diagnosis of testicular torsion were 67 per cent and 83 per cent respectively, and the predictive value of either a positive or negative result was 100 per cent. Our results suggest that the use of Doppler ultrasonography could reduce the incidence of unnecessary operations without incurring the risk of reduced testicular salvage.
High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: Screening by ultrasonography
Authors: Allardice J T , Allwright G J , Wafula J M C , Wyatt A P
Published: March 2007

A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 percent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.
Ultrasound mammography in the management of breast cancer
Authors: Warwick D J , Smallwood J A , Guyer P B , Dewbury K C , Taylor I
Published: March 2007

In this centre, ultrasound mammography has been shown to be more accurate in elucidating the nature of palpable breast lesions than X-ray mammography. A prospective study was devised to determine whether this accuracy could be translated into improved management of patients with breast carcinoma. A total of 223 patients with palpable breast masses were assessed by clinical examination, imaging (X-ray and ultrasound mammography) and aspiration cytology. Each was scored on a five-point scale and treatment was planned according to the total score. According to the protocol, an adequate total score would permit definitive surgery avoiding frozen section. By using sonography rather than radiology, the number of correct diagnoses could be improved by 25 per cent. This was because the greater sensitivity of ultrasound (92·8 per cent) compared to X-ray mammography (82·5 per cent) was reflected in a higher total score, which was sufficient to allow definitive surgical treatment without prior histological confirmation of diagnosis.
Fate of the ischaemic limb in Buerger's disease
Authors: Ohta T , Shionoya S
Published: March 2007

The clinical course of 328 patients with Buerger's disease (thrombo-angiitis obliterans: TAO) was followed. Neither ischaemic ulcers nor gangrene occurred in 26 per cent of the patients. Almost all of the ulcers occurred in patients between 20 and 50 years of age, with a peak incidence between 40 and 45 years. The younger the patient at the onset of the disease, the later the first ulcer occurred, and the later the first ulcer occurred, the shorter the period in which ulceration may recur. Recurrent ulcers were observed in 45 per cent of the patients. The progression of symptoms was influenced by smoking, but this was not the only deleterious factor as there were patients with stable TAO unaffected by smoking. In the 30 patients over the age of 60 years, ulceration and gangrene were not observed. In all patients, the progression of symptoms was self-limited and recurrent ulcers occurred less frequently with ageing. The rate of major amputation was low (3·9 per cent) although minor digital amputations were sometimes required. The survival rate of patients with TAO was higher than that of patients with arteriosclerosis obliterans. The aim of treatment in patients with TAO is to make patients abstain from smoking to prevent ulceration and to shorten the period of healing of trophic lesions without major amputation, as ulceration and gangrene in TAO are limited to the most distal part of the limbs, and seems to have healing potential.
Diagnosis of Meleney's synergistic gangrene
Authors: Davson J , Jones D M , Turner L
Published: March 2007

A retrospective and comparative study of 127 case reports of Meleney's postoperative progressive synergistic gangrene and of 62 examples of postoperative amoebic skin gangrene, showed that these two entities were clinically indistinguishable and that therefore a purely clinical diagnosis of Meleney's gangrene could not be made. Furthermore, a critical appraisal of the bacteriological data indicated that a certain diagnosis of Meleney's gangrene cannot be provided by the clinical bacteriologist. Finally, the histological features were entirely non-specific thus precluding a definitive diagnosis by the histopathologist. If Meleney's entity cannot be diagnosed its existence becomes debatable. The alternative diagnosis of cutaneous amoebiasis is advanced for consideration. Several of the outstanding features of Meleney's progressive gangrene, hitherto unexplained, are better understood if Entamoeba histolytica is accepted as the prime cause rather than bacteria.
Relationship between gastric emptying of liquid and postvagotomy diarrhoea
Authors: Parr N J , Grime S , Brownless S , Critchley M , Baxter J N , Mackie C R
Published: March 2007

Gastric emptying of liquid was studied in 10 normal volunteers and in 27 patients previously treated with truncal vagotomy and drainage. Thirteen of the twenty-seven patients complained of persistent postvagotomy diarrhoea. For each study 300 ml 15 per cent dextrose, labelled with 99mTc-diethylene triamine penta-acetic acid (DTPA), was ingested at a standard rate by subjects who sat facing a gamma camera. Imaging proceeded for 30 min. Gastric area activity curves were corrected for emptying of the test meal during ingestion, and for movement using a new image alignment technique. Gastric emptying at 15 min was 10±2·6 per cent (mean ± s.e.m.) in healthy volunteers, 48±7·3 per cent in patients without diarrhoea, and 84±2·3 per cent in those with diarrhoea (P < 0·001, ANOVA). Gastric emptying from 15 min onwards was slower than normal in both patient groups (P < 0·001). These results show that initial gastric emptying is rapid following truncal vagotomy and drainage, and this change is greater in patients with postvagotomy diarrhoea. No patient with diarrhoea had normal initial gastric emptying.
Bypass surgery for unresectable oesophageal cancer: Early and late results in 124 cases
Authors: Mannell Aylwyn , Becker P J , Nissenbaum M
Published: March 2007

The early and late results of bypass surgery in 124 patients with unresectable oesophageal cancer are reported. Patients were grouped according to the extent of disease: group A, tumour localized to the oesophagus where severe pulmonary disease contra-indicated oesophagectomy (n = 9); group B, tumour ⩽ 10 cm in length with mediastinal invasion (n = 81); group C, tumour > 10 cm in length with mediastinal invasion and/or fixed malignant lymph nodes (n = 33). Extent of disease was not recorded in one patient. The operative mortality was 4 per cent but 9 other patients died in hospital (hospital mortality, 11 per cent). Mortality was increased in patients undergoing colon bypass and in those with a large tumour load but these differences failed to reach statistical significance. The most frequent complication was neck sepsis, secondary to leakage from the proximal end of the excluded oesophagus. Eighty-nine per cent of the survivors could eat a normal, unrestricted diet on discharge and eighty-two per cent of survivors had complete and lasting relief from dysphagia. Median survival after bypass was 5 months but survival was significantly improved by radiotherapy to the tumour (P < 0·001). Gastric bypass with radiotherapy is indicated in patients with extra-oesophageal spread of malignancy and in patients with tumours localized to the oesophagus who are unfit for resection. Bypass surgery may be contra-indicated in patients with a primary tumour > 10 cm in length and/or fixed lymph node metastases because mortality is increased and survival after operation is short.
Role of collagenase in colonic anastomoses: a reappraisal
Authors: Chowcat N L , Savage F J , Hembry R M , Boulos P B
Published: March 2007

Increased collagenolysis, with reduction in collagen concentration, has been incriminated in the breakdown of colonic anastomoses but previous studies have measured only collagen levels and non-specific collagenolytic activity. Collagenase, the initiating enzyme in collagen degradation, is synthesized on demand and controlled by tissue inhibitor of metalloproteinases (TIMP). Antibodies to collagenase and TIMP were applied to colonic anastomoses in rabbits to investigate the role of the enzyme during healing. Within 12 h of operation, secreting cells and extracellular collagenase were identified at the everted edges of the bowel wall. After 24 h, collagenase activity was accompanied by TIMP secretion in the same localized regions, and by the third postoperative day very few cells were still synthesizing enzyme in these areas, although extracellular activity remained visible. TIMP-secreting cells, however, were seen in a layer of connective tissue sealing the serosal surface of the anastomosis. At 7 days, both enzyme and inhibitor were found only in small aggregates of secreting cells in the deeper layers. The localization and extent of collagenase and TIMP activity accorded well with a normal healing response as, at all times, the enzyme was confined to the immediate vicinity of the suture line.
Resectability rate of hepatocellular carcinoma in rural southern Africans
Authors: Maraj Rinah , Kew M C , Hyslop R J
Published: March 2007

The purpose of this analysis was to ascertain the resectability rate of symptomatic hepatocellular carcinoma in rural southern African black males. All 224 such patients proven to have hepatocellular carcinoma in a single hospital were included in the study. Of 205 patients undergoing a complete diagnostic work-up, 134 (65·3 per cent) were judged on clinical criteria to be inoperable, 23 (11·2 per cent) had pulmonary or osseous metastases, and 38 (18·5 per cent) proved on hepatic imaging and 5 (2·4 per cent) on hepatic arteriography to have an irresectable tumour. Thus, only five (2·4 per cent) of these patients proceeded to laparotomy. Another 7 patients who did not have an arteriogram, 9 with surgical emergencies, and 2 mistakenly believed to have an amoebic hepatic abscess also underwent laparotomy. Only 2 patients (0·9 per cent of 223) proved to have a resectable tumour. The extremely low resectability rate reinforces the urgent need for a surveillance programme to detect early tumours in high-risk members of this population.
Parastomal hernia in relation to site of the abdominal stoma
Authors: Sjödahl R , Anderberg B , Bolin T
Published: March 2007

Parastomal hernia is a common late complication of enterostomy, especially colostomy, and sometimes requires surgical treatment. A possible contributory factor, location of the stoma in relation to the rectus abdominis muscle, was studied by examination of 130 patients with permanent intestinal stoma. The bowel had been brought out through the rectus abdominis muscle in 107 patients and lateral to it in 23 patients. The respective prevalence of parastomal hernia in these groups was 2·8 per cent and 21·6 per cent. The highly significant difference indicates that enterostomy should be constructed through the rectus abdominis muscle, not lateral to it.
Bacterial short-chain fatty acids and mucosal diseases of the colon
Authors: Roediger W E W
Published: March 2007

This review examines the potential association between short-chain fatty acids and mucosal diseases of the colon, and discusses the implication of these relationships and the surgical management of large bowel disorders.
The pulsed dye laser and atherosclerotic vascular disease
Authors: Murray A , Crocker P R , Wood R F M
Published: March 2007

The use of a pulsed dye laser to ablate atheromatous tissue obtained from post-mortem human aortic specimens is reported. Laser energy was delivered with a 600 μm quartz fibre, at a wavelength of 504 nm and a pulse length of 1 μs. Pulse energy was varied from 30–140 mJ, producing peak pulse powers of the order of 100 kW. With these parameters the laser ablated fatty, fibrous and calcified plaques. At this wavelength atheroma is vaporized but there is minimal damage to normal vessel wall, due to preferential absorption of the laser light. Light microscopy shows that by microsecond pulsing, thermal damage to surrounding tissues associated with continuous wave lasers is avoided. Transmission electron micrographs reveal a sharp demarcation between a laser crater and the adjacent vessel wall with little ultrastructural disruption. Scanning electron micrographs show the crater walls to be smooth. The pulsed dye laser may therefore be effective in the treatment of occlusive peripheral vascular disease without undue risk of vessel perforation.