bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of venous hypertension on canine hind limb lymph
Authors: Leach R D , Browse N L
Published: March 2007

The effect of acute and chronic venous hypertension on the lymph draining from the hind limb has been studied in 10 dogs. Acute venous hypertension was produced by venous occlusion, and chronic venous hypertension by fashioning an arteriovenous fistula in the groin. Acute venous hypertension trebled the lymph flow and doubled its fibrinogen concentration thus increasing the net transport of fibrinogen across the interstitial space by 600 per cent. Chronic venous hypertension had a similar effect and caused the appearance of α-2-antiplasmin in the lymph. The fibrinolytic activity of the lymph did not change significantly in either group of experiments. These results suggest that the deposition of interstitial fibrin seen in the skin of the postphlebitic limb is related to an increased concentration of interstitial fluid fibrin, and to the appearance of the fibrinolytic inhibitor, α-2-antiplasmin, without a concomitant increase of fibrinolytic activator.
Platelet count in radiation bowel disease: An aid to diagnosis
Authors: Carr N D , Holden D , Hasleton P S , Schofield P F
Published: March 2007

This study reports the results of serial observations of simple haematological indices (haemoglobin concentration, white cell count and platelet count) in 25 patients who developed radiation bowel disease as a late complication of pelvic radiotherapy for malignancy. It is compared with a control group of 25 women patients who received pelvic radiotherapy but did not develop radiation bowel disease. There is a highly significant elevation in the platelet count (P<0·0001) at a time when the patients develop radiation bowel disease. The platelet count returns to normal after successful excision of the disease but the elevation recurs if further radiation disease develops in the urinary or gastrointestinal tracts. It is suggested that the platelet count may have a useful role in the diagnosis of radiation bowel disease.
Hepatic resection in the treatment of hepatocellular carcinoma: Report of 60 cases
Authors: Nagasue N , Yukaya H , Ogawa Y , Sasaki Y , Akamizu H , Hamada T
Published: March 2007

During the last 3 years and 9 months, hepatic resections were carried out on 60 patients with hepatocellular carcinoma (HCC). The resections were radical in 44 and palliative in 16 cases. Simultaneous operations were performed for oesophageal varices in 11 (9 prophylactic and 2 therapeutic) and for cholelithiasis in 9 patients. Fifty-nine patients had underlying hepatic disease; 52 had cirrhosis and 7 chronic hepatitis. Operative mortality rate within 1 month was 10 per cent and overall hospital mortality rate was 16·7 per cent. Excluding operative and hospital deaths, 76·8 per cent of patients who had radical excision and 18±8 per cent with palliative resections are alive. The result indicates that HCCs are frequently resectable even in the presence of liver cirrhosis provided that they are discovered at a relatively early stage.
The efficacy of lower axillary sampling in obtaining lymph node status in breast cancer: A controlled randomized trial
Authors: Steele R J C , Forrest A P M , Gibson T , Stewart H J , Chetty U
Published: March 2007

Four hundred and seventeen patients with operable breast cancer treated by simple mastectomy were randomly allocated to have node sampling or total axillary clearance. There was no significant difference in the incidence of node positivity. One hundred and thirty-five patients had node sampling and were randomized at the completion of this procedure to have axillary clearance or to have no further surgery. All node positive patients who went on to have a clearance had positive samples, confirming the accuracy of the sampling technique.
Proteinase-like peptidase activities in malignant and non-malignant gastric tissue
Authors: Vasishta A , Baker P R , Hopwood D , Marguerite Holley P , Cuschieri A
Published: March 2007

Activities of several proteinase-like peptidases have been determined in homogenates of malignant tissue, non-malignant tissue adjacent to the tumour (A-NM) and non-malignant tissue distant to the tumour (D-NM) from 17 patients undergoing surgery for histologically confirmed gastric malignancies. In homogenates of malignant tissues the activities of collagenase, cathepsin B, cathepsin (B+L), cathepsin H and cathepsin D were significantly higher than in D-NM tissues. By contrast, the levels of plasminogen activator were significantly lower in malignant tissues than in the D-NM tissues. Furthermore, the activities of collagenase-like and the cysteine-proteinase-like peptidases in the A-NM tissues were lower than in malignant tissues but higher than in the D-NM tissues. Separation of full-thickness non-malignant tissues into mucosal and seromuscular layers revealed significantly higher activities in the former. The elevated levels of these proteinase-like peptidases in homogenates of gastric cancer tissue suggests an important role for these enzymes in tumour invasion.
Dynamic liver scanning in cirrhosis
Authors: McLaren M I , Fleming J S , Walmsley B H , Ackery D M , Taylor I , Karran S J
Published: March 2007

Dynamic liver scanning using 99mTc sulphur colloid has been used in assessing 41 patients with cirrhosis and the data compared with 33 control subjects. The mesenteric fraction (MF) was significantly reduced in cirrhotics (0.30 ± 0.17) compared with controls (0.58 ± 0.09), P < 0.001. The liver:spleen ratio (L:S) was also significantly different (1.6 ± 0.95 compared with 4.9 ± 1.4), P < 0.001. Those patients who had undergone a recent variceal bleed had values less than patients who had not bled. Dynamic scintigraphy may be of value in monitoring the progress of disease and response to treatment.
Laparoscopy or scanning in oesophageal and gastric carcinoma?
Authors: Shandall A , Johnson C
Published: March 2007

A prospective study was undertaken of the accuracy in diagnosing intra-abdominal metastatic disease of the liver by scintigraphy, ultrasound scanning and laparoscopy. The effect of laparoscopy on management was also studied. Fifty patients were studied: 23 oesophageal carcinoma, 14 gastric carcinoma and 13 with suspected intra-abdominal metastatic spread. Accuracy was determined by laparoscopic biopsy, laparotomy and autopsy. The accuracy was 72 per cent for scintigraphy, 75 per cent for ultrasound and 96 per cent for laparoscopy (with 10 per cent failed ultrasound due to intra-abdominal gas). There was no morbidity or mortality associated with laparoscopy, with one failure due to adhesions. Thirteen patients without hepatic metastases had nodal and/or peritoneal spread diagnosed only by laparoscopy. Laparotomy was avoided in 58 per cent, and 74 per cent died in the 18 month follow-up period. Laparoscopy can obviate the need for laparotomy in inoperable cases of oesophageal carcinoma and allow better planning for potentially curable surgery. In gastric carcinoma the value of laparoscopy is doubtful as a high percentage require at least palliative surgery.
Vasopressin effects on the small intestine: A possible factor in paralytic ileus?
Authors: Mitchell A , Collin J
Published: March 2007

Experiments were performed on luminally perfused, isolated, canine, jejunal segments in vivo to determine the effects of vasopressin on intestinal motility, myoelectrical activity and absorption. Intravenous vasopressin abolished spike activity and sometimes disrupted slow wave activity. The jejunum became atonic with intraluminal pooling of perfusate. Transit time was prolonged and intestinal absorption of water was decreased. Radionuclide imaging of the intestinal contents showed a doubling of intraluminal volume with vasopressin and confirmed the loss of intestinal motility. It is suggested that the high plasma levels of vasopressin which are known to follow laparotomy may be a factor in the development of postoperative ileus.
Use of a single layer extramucosal suture for intestinal anastomosis in children
Authors: Brain A J L , Kiely E M
Published: March 2007

We report our experience using an interrupted single layer extramucosal suture technique to construct both large and small bowel anastomoses in children. There were 75 anastomoses constructed in 68 children without any clinical evidence of a leak or any complications attributable to the anastomosis. Function after completion of the anastomosis was rapid. The median time for the passage of the first stool after operation was 46 h. This technique allowed construction of an end to end anastomosis with minimal reduction of the lumen even when there was great disproportion between the ends of intestine. It was therefore particularly suitable for the anastomosis of bowel of very small calibre.
Small bowel tumours causing intussusception in childhood
Authors: Puri P , Guiney E J
Published: March 2007

In a series of 292 children with intussusception ten (3.5 per cent) were caused by small bowel tumours. The average age of these patients was greater than in idiopathic cases; seven of the ten being older than 2 years. Intussusception due to Peutz-Jeghers hamartomas was jejunojejunal whereas other small bowel tumours causing intussusception were in the terminal ileum. The majority of these intussusceptions were either irreducible or gangrenous and all required resection of bowel. There was only one death in the entire series of 292 patients, and this was a child with lymphosarcoma.
The Angelchik anti-reflux prosthesis — some reservations
Authors: Durrans D , Armstrong C P , Taylor T V
Published: March 2007

A prospective study has been made of the use of the Angelchik prosthesis in the treatment of hiatus hernia and gastro-oesophageal reflux. Forty-one patients under the care of one surgeon were studied over a 3-year period. The operation is simple and safe to perform. Twelve patients suffered transient dysphagia which spontaneously resolved within 3 months. Satisfactory results were obtained thereafter in 80·9 per cent. Seven of the prostheses have been removed (17·1 per cent), all within 18 months of performing the operation. Dysphagia and recurrent symptoms were the main reasons for removal and in two of these stricturing was present pre-operatively. We feel the presence of an established stricture is a contraindication to the use of the device. We have, however, been impressed by its use as a second procedure when previous surgery has failed and when revisional surgery for recurrent hiatus hernia is difficult due to dense adhesion formation. While it is still early to assess the legacy that the use of this prosthesis might incur, we would recommend conservatism if not abandonment of its use until longer-term evaluation is available.
Ultrasound examination in the diagnosis of popliteal artery aneurysms
Authors: MacGowan S W , Saif Mai F , O'Neill Geraldine , Fitzsimons Patricia , Bouchier-Hayes D
Published: March 2007

Popliteal artery aneurysm is a potentially limb-threating lesion which is frequently difficult to diagnose by clinical examination or angiography. The risk of limb loss can best be reduced by early diagnosis. Over the past 5 years we have prospectively evaluated ultrasound examination of the popliteal space in screening patients with clinically suspected popliteal artery aneurysms. One hundred patients who were suspected clinically of having a popliteal artery aneurysm underwent bilateral ultrasound examination of their popliteal fossae. There were 21 patients who had abnormal scans. The problems identified were popliteal artery aneurysm in thirteen patients, popliteal artery ectasia in four patients, Baker's cyst in two patients, thrombosis in one patient and popliteal stenosis in one patient. Eight patients with eleven popliteal artery aneurysms by ultrasound also underwent angiography. Seven of the aneurysms were confirmed, four were missed. All eleven aneurysms were confirmed at operation. In addition, angiography did not demonstrate an aneurysm in any patient with a normal ultrasound. This study confirms that ultrasound examination is a quick, accurate, and non-invasive method of screening for popliteal artery aneurysms.
Growth rate of abdominal aortic aneurysms as measured by computed tomography
Authors: Delin A , Ohlsén H , Swedenborg J
Published: March 2007

The risk of rupture of an abdominal aortic aneurysm increases with size. It has thus been recommended that small aneurysms be continuously followed with some type of imaging technique to detect when aneurysm size constitutes an indication for surgery. The present study focuses on the growth rate of abdominal aortic aneurysms in 35 patients who were subjected to repeated computerized tomographic examinations of their abdominal aortic aneurysms. Several aneurysms were measured more than twice resulting in 57 different examinations. The mean growth rate of the transverse diameter was 0·52 cm/year. The individual growth rates were, however, variable. Aneurysms with an initial transverse diameter exceeding 6 cm showed a slightly but not significantly faster increase in size compared with smaller aneurysms. No correlation between initial size and growth rate could be established. Six patients died during the study period, two from myocardial infarction, three after elective aneurysm operations and one, refused for elective operation, died after rupture. It is concluded that the growth rate measured with computed tomography agrees well with previously reported estimates obtained with ultrasonography. It is recommended that small aneurysms particularly in patients with relative contraindications to surgery be followed with repeated examinations of size.
Chemical composition of biliary calculi in relation to the pattern of biliary disease in Singapore
Authors: Ti T K , Yuen R
Published: March 2007

The chemical composition of biliary calculi from 25 Singapore patients operated upon over a three month period was determined by a microanalytical technique and equilibrium swelling tests. Twelve patients had biliary calculi confined to the gallbladder and the main component of six calculi was cholesterol. In the other 6 patients, the dark brown to black pigment calculi contained bilirubin and calcium and a small quantity of cholesterol, but the chief component was an insoluble pigment with the swelling characteristics of a bilirubin polymer. These cholesterol and pigment calculi have similarities in composition to gallstones of Western patients. In 13 patients with cholangitis, the brown, soft pigment calculi found in the dilated bile ducts (and also concurrently in the gallbladder in 5 patients) had bilirubin as the main component. Fatty acid was frequently present. The insoluble pigment component was considerably less but the lower swelling ratio suggested more cross linkage compared with black gallbladder stones. Differences in chemical composition between pigment gallbladder and bile duct calculi support the concept that Western type cholelithiasis and Oriental cholangitis occur as separate disease entities in Singapore patients.
Segmental and subsegmental resections of the cirrhotic liver under hepatic inflow and outflow occlusion
Authors: Nagasue N , Yukaya H , Ogawa Y , Hirose S , Okita M
Published: March 2007

Segmental and subsegmental resections of the cirrhotic liver were carried out on 44 patients with hepatocellular carcinoma (HCC) and three cases with regenerating liver nodules. Seventeen patients underwent hepatectomies without hepatic vascular arrest (Group 1). In Group 2 (19 occasions), the Pringle manoeuvre was used for 8–46 min during parenchymal dissection. Hepatic resections were performed during simultaneous occlusion of hepatic inflow and outflow for 20–47 min in 11 patients (Group 3). The estimated blood loss during surgery was 2924 ml in Group 1,1239 in Group 2, and 765 in Group 3 (Group 1 versus Group 2; P < 0·02, Group 1 versus Group 3; P < 0·02). Haemorrhagic shock occurred in three patients of Group 1, one of Group 2, and none of Group 3. Life-threatening postoperative complications occurred in four patients in Group 1, two in Group 2, and none in Group 3. Hospital death rate was 23·5 per cent in Group 1, 10·5 per cent in Group 2, and nil in Group 3. The present results may indicate that in performing nonanatomical resection of cirrhotic livers temporary occlusion of both hepatic inflow and outflow can be achieved for at least 30 min and is useful in reducing postoperative morbidity and mortality.
Carbon-fibre versus Marlex mesh in the repair of experimental abdominal wall defects in rats
Authors: Cameron A E P , Taylor D E M
Published: March 2007

Large abdominal wall defects were created in Porton—Wistar rats and either left unrepaired (9 rats), or repaired with polypropylene (Marlex) mesh (11 rats), or with an open darn of filamentous carbon (11 rats). A further ten animals had a simple midline skin incision. At 5 months there were gross hernias in the unrepaired animals. Neither repair had resulted in gross recurrence although four of the carbon-repaired animals had bulges through the open weave. Tensiometry of the excised abdominal wall showed no difference in the strength of the two repairs. However, microscopy showed a striking difference—the Marlex had induced a chronic inflammatory response with disorganized collagen, whereas the carbon was not only well-tolerated but acted as a scaffold for well-organized and orientated collagen.
Aganglionosis of the entire bowel: Four new cases and review of the literature
Authors: Di Lorenzo Maria , Yazbeck S , Brochu P
Published: March 2007

Four cases of aganglionosis of the entire bowel are presented, each with their histological characteristics, all invariably lethal.
Vitamin K requirements in patients receiving total parenteral nutrition
Authors: Hands Linda J , Royle G T , Kettlewell M G W
Published: March 2007

The vitamin K requirements of 47 adult patients on total parenteral nutrition (TPN) were investigated by randomly allocating them to receive either 0·15 mg vitamin K1 (1 ampoule of ‘Vitlipid’) per week or 20·15 mg vitamin K1 (1 ampoule of ‘Vitlipid’ plus 10 mg vitamin K × 2) per week. Vitamin K1 in a dose of 0·15 mg was as effective as a dose of 20·15 mg per week in maintaining a normal BCR (British Corrected Ratio) in most TPN patients. Seven patients in each group developed a BCR greater than 1·3; this was significantly associated with the use of cephalosporin antibiotics and responded to 10 mg vitamin K1 per day. Most patients receiving parenteral feeding require no more vitamin K than that provided by 1 ampoule of ‘Vitlipid’ per week. Regular monitoring of the BCR, especially in patients on antibiotics, will reveal those who need more. Such patients need 10 mg vitamin K1 per day.
Long-term results after pancreas resection for acute necrotizing pancreatitis
Authors: Nordback I H , Auvinen O A
Published: March 2007

This study was designed to investigate the long-term effects of early pancreatic resection for acute necrotizing pancreatitis. During 1973–1978 40 resections were performed in our clinic. Eleven patients died initially (28 per cent). None of the four further deaths was due to pancreatitis or associated disorders. Twenty-four patients were reexamined 5–11 years after resection — one patient refused to participate. Five had not been able to return to work because of severe polyneuropathy; one more had retired because of chronic pancreatitis in the pancreatic remnant. Polyneuropathy was found in five further patients. The reason for this high incidence of polyneuropathy (42 per cent) remains unknown. Eight patients still drank excessive alcohol; three of them had had recurrent pancreatitis and dyspepsia, and insulin requiring diabetes. All but 2(92 per cent) had diabetes, 14 needing insulin - half of them at 6 months to 6 years after the resection. Moreover, 11 patients (46 per cent) suffered from dyspeptic symptoms. The results suggest that because of the high frequency of late complications, in addition to the early complications, early resection of pancreas should be critically re-evaluated as the treatment for acute necrotizing pancreatitis. If resection is used in patients with extreme pancreatic necrosis, careful and continuous postoperative follow-up will be needed.
Immediate resection in emergency large bowel surgery: a 7 year audit
Authors: Koruth N M , Hunter D C , Krukowski Z H , Matheson N A
Published: March 2007

In a consecutive series of 153 emergency admissions with large bowel disease during a 7 year period, 49 per cent were for colonic obstruction, 46 per cent for peritonitis and 5 per cent for miscellaneous conditions. Urgent operation was performed on 104 (68 per cent) patients. Of those operated upon, 82 (79 per cent) had a primary resection with a mortality rate of 12·2 per cent, intraperitoneal sepsis rate of 2·4 per cent and wound sepsis rate of 7·3 per cent. The median postoperative hospital stay was 21 days. An immediate anastomosis was performed in 46 (56 per cent) patients with a mortality rate of 8·7 per cent, anastomotic leak rate of 2·2 per cent, and wound sepsis rate of 8·7 per cent. The median postoperative hospital stay was 19 days.

The mortality in patients presenting with large bowel emergencies is related to age and advanced malignant disease. Immediate resection is applicable in over 80 per cent of patients requiring urgent operation and morbidity can be low and treatment economical. Immediate anastomosis after proximal colonic resection is safe and the use of intra-operative colonic irrigation permits a primary anastomosis in selected patients after emergency resection of the distal colon.
Congenital diaphragmatic hernia: a 20 year experience
Authors: Simson J N L , Eckstein H B
Published: March 2007

The records of 253 children with congenital diaphragmatic hernia admitted to The Hospital for Sick Children, Great Ormond Street, between 1961 and 1980 were analysed. The overall mortality of 37 per cent is greater than that reported in the preceding 13 years from the same institution, and showed no improvement over the 20 years. While there was no significant increase in the number of admissions over the study period, the proportion of children who underwent surgery within the first 6 h of life steadily increased from 13 per cent in the first five years to 39 per cent in the last five years. The mortality of this group (65 per cent) did not improve over the study period and this would account for the lack of improvement in the overall survival figures. However, analysis of birth weights, onset and severity of signs and lung weights indicates that the increasing number of early admissions was due to speedier transfer rather than to referral of more severely affected children in the later years.
A randomized trial to compare single with multiple phenol injection treatment for haemorrhoids
Authors: Khoury G A , Lake S P , Lewis Margaret C A , Lewis A A M
Published: March 2007

One hundred and twenty consecutive patients were entered into a randomized trial of single versus multiple phenol injection for the treatment of haemorrhoids. Follow-up at 3 and 12 months was available in 105 patients (56 in the single group and 49 in the multiple group). The results have shown that injection therapy, whether this be single or multiple, is an extremely effective form of therapy for patients with first or second degree haemorrhoids.
Intramuscular haemangioma of the extremities: is computerized tomography useful?
Authors: Christenson J T , Gunterberg B
Published: March 2007

Fourteen patients with intramuscular haemangiomas of the extremities were included in the study. All had computerized tomography (CT) and thirteen had angiography. Twelve of the thirteen were operated upon. CT scan proved to be an extremely valuable tool in the pre-operative planning as the extent of the lesion could be assessed accurately by this method; in most cases this was not possible with angiography.
Cystic adventitial disease of the common femoral and popliteal arteries
Authors: Hall R I , Proud G , Chamberlain J , McNeil I F
Published: March 2007

Cystic adventitial arterial disease (CAAD) is usually situated in the popliteal artery and is a well recognized cause of intermittent claudication in otherwise healthy, young, non-smokers. Three cases of CAAD have recently been encountered, involving the popliteal artery in two patients and the common femoral in one. Two of these patients were hypertensive smokers in their sixth decades and only one was an otherwise healthy nonsmoker, but all three had a characteristically rapid onset of symptoms. All had angiographic appearances suggestive of CAAD, confirmed by ultrasound and CAT scanning in one patient. Two were treated by resection of the affected artery and a replacement graft, both with excellent results. One popliteal lesion was bypassed with a vein graft which occluded after 3 months. CAAD may occur more commonly than generally realized. It can present in patients whose condition suggests an atheromatous cause for their symptoms. Since good results can be expected from appropriate surgical treatment in most cases, CAAD should be considered in the diagnosis of all patients with claudication, particularly when the onset has been rapid.
Secondary carcinomatous infiltration of the penis: palliation with radiotherapy
Authors: Gillatt D A
Published: March 2007

Secondary carcinomatous involvement of the penis is surprisingly uncommon considering its proximity to the site of many common primary malignancies. Management of this unpleasant condition is difficult and should be primarily aimed at palliative relief of symptoms. Four cases are presented, two with primary prostatic adenocarcinoma, one rectal carcinoma and one carcinoma of the caecum. Three of these patients, on developing penile involvement, were subjected to a single course of radiotherapy. This resulted in marked relief of pain and reduction in tumour bulk allowing an improvement in micturition, where obstructive symptoms were present. Due to the small number of cases available treatment cannot be prospectively evaluated. A logical palliative treatment for metastatic penile disease is suggested.
Pancreatic resection for severe acute pancreatitis
Authors: Aldridge M C , Ornstein M , Glazer G , Dudley H A F
Published: March 2007

Non-operative management of acute necrotizing pancreatitis carries a mortality of up to 80 per cent. Over the last 6 years we have pursued an aggressive policy of intensive supportive therapy followed by pancreatic resection in those patients with this severe form of the disease. We have managed 15 patients in this way, 14 by subtotal pancreatic resection (usually body and tail of the gland) and one by total pancreatectomy; 7 had early overwhelming multi-system failure with a median of 4 positive prognostic factors whilst 8 were operated on later between 3 and 8 weeks (plus one at 32 weeks) and had varying clinical pictures. Eight patients had ischaemia of the transverse colon which was noted at operation in four, and presented postoperatively in the remainder. Re-operation was necessary in 13 patients to remove further slough or resect ischaemic bowel. Five patients (33 per cent) died between 10 days and 4 weeks postoperatively, death being due to sepsis and multi-system failure in four and a massive retroperitoneal haemorrhage in one. of the ten survivors, four require insulin. Timely excision of necrotic pancreatic tissue combined with intensive supportive therapy may help reduce the high mortality in this condition.
Endoscopic management of upper urinary tract stones
Authors: Payne S R , Ford T F , Wickham J E A
Published: March 2007

Since 1981, 525 renal and ureteric calculi have been removed with percutaneous nephrolithotomy (PCN) or transurethral ureteroscopy as the primary modalities of therapy. Successful extraction of the stone at the first attempt was achieved in 92 per cent of cases by PCN and 70 per cent of cases by ureteroscopy, whilst further endoscopic surgery improved the overall success rates to 98 per cent and to 80 per cent respectively. Complication rates from these procedures have both been low as has the morbidity, with most patients leaving hospital within 4 days and returning to work within 2 weeks. The successful development of endoscopic lithotomy and the use of in situ destruction techniques has meant that we now reserve open surgery for difficult multibranched staghorn calculi and ureteric stones embedded in the urothelium. With the advent of extracorporeally generated shockwave lithotripsy it is likely that even these types of stone will be amenable to minimally invasive procedures.
The effects of a somatostatin analogue SMS 201-995 on hepatic haemodynamics in the cirrhotic rat
Authors: Jenkins S A , Baxter J N , Corbett W A , Shields R
Published: March 2007

The effects of a somatostatin analogue, SMS 201-995 on hepatic haemodynamics were studied in rats with dimethylnitrosamine-induced cirrhosis. An intravenous infusion of 1, 2 or 4μg kg−1 body wth−1 SMS 201-995 produced a rapid and sustained decrease in portal pressure, portal venous flow and liver blood flow without significantly altering arterial blood pressure or pulse. The reductions in portal pressure, portal venous flow and liver blood were accompanied by an increase in splanchnic vascular resistance. Portal venous resistance was not affected. Subcutaneous injection of 2μg kg−1 body wt SMS 201-995 produced a gradual decrease in portal pressure, the maximum reduction occurring 18 min after administration. This reduction in portal pressure was sustained for a further 20 min. The results suggest that SMS 201-995 may be of value in the control of bleeding oesophageal varices. Furthermore, the prolonged duration of action of SMS 201-995 following its subcutaneous administration suggests that the analogue may be useful in the long-term management of portal hypertension in patients with cirrhosis.
Chemodectomas of the neck: the response to radiotherapy
Authors: Mitchell D C , Clyne C A C
Published: March 2007

In the 16 year period 1965–81, 12 patients with head and neck chemodectomas received radiotherapy. In only 1 patient did the tumour fail to respond, due to metastases, and 9 showed complete resolution of the tumour. As this form of treatment is associated with few complications, we conclude that it is the treatment of choice in those patients who are unfit for surgery and those whose tumours are technically unresectable.
Operation for recurrent saphenofemoral incompetence using a medial approach to the saphenofemoral junction
Authors: Greaney M G , Makin G S
Published: March 2007

Forty-seven patients (53 limbs) with recurrent saphenofemoral incompetence and varicose veins underwent re-ligation of the saphenofemoral junction using a medial approach to the femoral vein. Twenty-seven patients (31 re-ligation procedures) were available for assessment at long-term follow-up (mean 30.4 months). Saphenofemoral incompetence was demonstrated in five limbs (16.1 per cent) The operative procedure is described and the alternatives discussed. This is a valuable procedure in the repertoire of the surgeon who has to treat recurrent varicose veins.
Pulmonary embolism in acute iliofemoral venous thrombosis
Authors: Plate G , Ohlin P , Eklöf B
Published: March 2007

Serial perfusion lung scanning and chest radiography were used to study the incidence of pulmonary embolism in patients with acute iliofemoral venous thrombosis. The efficacy of conventional anticoagulation and surgical thrombectomy in controlling embolism and the risk of creating emboli during thrombectomy were also evaluated. Lung scans obtained on admission in 49 patients were normal in 37 per cent, inconclusive in 18 per cent and positive for embolism in 45 per cent of the patients. Symptoms suggestive of embolism were present in only 24 per cent of the patients and correlated poorly with lung scans. Massive embolism was present in only two patients. Additional, usually asymptomatic, emboli developed within one month in 21 per cent of 29 patients treated conservatively with anticoagulation alone and in 20 per cent of 20 patients having acute thrombectomy combined with a temporary arteriovenous fistula and systemic anticoagulation. Only one conservatively treated patient required caval interruption. Pulmonary embolism, usually of minor degree, is thus present in nearly every other patient with acute iliofemoral venous thrombosis. Anticoagulation alone or in conjunction with thrombectomy and arteriovenous fistula in most cases effectively prevents further embolization and the risk of creating additional emboli by the surgical procedure is insignificant.
Out-patient diagnosis of breast cancer
Authors: Bradbeer J W
Published: March 2007

A method of diagnosis of the solid discrete breast lump using frozen section examination of a Tru-cut needle biopsy is described. In 194 patients, the Tru-cut biopsy report is compared to the histological report of the excised lesion. Overall accuracy is 90 per cent, sensitivity 89 per cent, specificity 96 per cent, predictive value of a positive report 99 per cent, and predictive value of a negative report 56 per cent. The advantage of the technique is that many patients with breast cancer can be informed of the diagnosis at their first attendance.
The mycotic flora in proctological patients with and without pruritus ani
Authors: Dodi G , Pirone E , Bettin A , Veller C , Infantino A , Pianon P , Mortellaro L M , Lise M
Published: March 2007

The perianal mycotic flora was studied in proctological patients with and without pruritus ani, as well as in control subjects. Four groups of patients underwent perianal mycoculture. In Group 1, 53 patients with anal pruritus were treated for benign anorectal disease. In Group 2, 24 patients with no underlying disease presented with anal pruritus. Both of these groups underwent concomitant chemical and parasitical examination of the faeces and an oral glucose tolerance test. In Group 3, 50 patients without pruritus ani at present or in the past were treated for benign anorectal diseases. In Group 4, 47 surgical patients without pruritus ani were treated for benign (9) and malignant (38) non-proctological diseases. In Group 1 the mycoculture was positive in 24/53 patients (Candida albicans 14, dermatophytes 10). In Group 2 fungal infections were seen in 16/24 patients (C. albicans 7, dermatophytes 9). No parasites or diabetes were found in either group. In Group 3 C. albicans was isolated in 14/50 patients. In Group 4 C. albicans was found in 11/47 cases (2 in benign, 9 in malignant diseases). Infection by C. albicans was observed in all groups studied, independent of the presence of disease or anal pruritus. The presence of dermatophytes was always associated with pruritus ani.
Stimulus for vasopressin release during elective intra-abdominal operations
Authors: Melville R J , Forsling M L , Frizis H I , LeQuesne L P
Published: March 2007

In 12 patients undergoing an upper abdominal operation, blood pressure and peripheral venous blood samples were taken at intervals throughout the procedure. There was no significant increase in plasma vasopressin concentration after induction of anaesthesia or skin incision; within 3 min of opening the peritoneum and commencing intraperitoneal manipulation there was a highly significant rise (P < 0.07), maintained with fluctuations until closure of the abdomen. There was no correlation between the changes of blood pressure and those in plasma vasopressin level. In 16 patients undergoing elective cholecystectomy similar observations were made to coincide with events believed, on the basis of the first study, to be related to changes in the concentration of vasopressin. There was a significant rise in vasopressin concentration (P < 0.01) after incision of the peritoneum, 1 min after the start of intraperitoneal manipulation (P < 0.01) and after deliberate traction on the stomach (P < 0.01). During operative cholangiography, when there was no intraperitoneal manipulation, there was a significant fall in the vasopressin level. There was no correlation between changes in vasopressin concentration and blood pressure. These findings indicate that during an abdominal operation nervous stimuli, arising from within the peritoneal cavity and probably mediated via the autonomic system, are an important factor responsible for the increased secretion of vasopressin, and, at least in the absence of major changes in blood pressure and osmolality, the determinant factor.
Comparison of clinical scores and acute phase proteins in the assessment of acute Crohn's disease
Authors: Pettit S H , Holbrook I B , Irving M H
Published: March 2007

Fifty-two patients with Crohn's disease have been assessed using acute phase proteins and a scoring system. Thirty-nine underwent operation and intra-abdominal abscesses were found in seventeen. Both scores and acute phase proteins have been shown to reflect inflammation due to secondary sepsis in addition to that from active Crohn's disease. The scores were higher, and acute phase changes greater, in patients with sepsis than those without. By choosing a threshold for each variable that excludes patients without sepsis it has been found that a score > 181, ESR >45 mm/h, CRP >33 mg/l, orosomucoid >1.8g/l and albumin < 26.7 g/l identify sepsis with a specificity >95 per cent and sensitivity > 35 per cent. Over 70 per cent of patients with abscesses exceeded one or more of these thresholds. We believe that operative management should be strongly considered if one or more of these criteria are positive as such patients have a greater than 90 per cent chance of having an intra-abdominal abscess. This will prevent these abscesses eroding into adjacent viscera or to the surface with resulting fistula formation.
Continuing experience with single layer appositional anastomosis in the large bowel
Authors: Matheson N A , McIntosh Carol A , Krukowski Z H
Published: March 2007

Results of continuing experience with single layer appositional anastomosis of the large bowel during 8 years (1977–84) were extracted from a prospective computerized audit of all abdominal operations under one consultant. After 204 elective operations mortality rate was 1.5 per cent: there were no deaths from anastomotic leakage. The total incidence of wound infection (including late infections) was 2.0 per cent. The median duration of postoperative stay was 9.7 days and the mode 8 days. Three clinical anastomotic leaks (total incidence 1.5 per cent) occurred in 140 patients (2.1 per cent) after elective colorectal anastomoses. A restorative anastomosis was made in 86 per cent of patients with rectal carcinoma 6–12 cm from the anus and in 29 per cent with tumours below 6 cm. The overall incidence of a permanent stoma for rectosigmoid carcinoma was 19 per cent. ‘Protective colostomy’ and anastomotic drains were not used. The safety and applicability of single layer anastomosis in the rectum are compared with those of stapling.
Evacuation proctography in obstructed defaecation and rectal intussusception
Authors: Bartolo D C C , Roe A M , Virjee J , McC. Mortensen N J
Published: March 2007

The symptoms of obstructed defaecation may present as a number of different syndromes including descending perineum, solitary rectal ulcer, irritable bowel and mucosal or complete rectal prolapse. In order to clarify the pathophysiology of obstructed defaecation we carried out dynamic and static radiological investigations together with manometric and electrophysiological measurements in ten patients with severe, intractable obstructed defaecation. Results were compared with a total of 35 control subjects. There were no significant differences in sphincter pressures or the recto-anal inhibitory reflex between patients and controls. Mean motor unit potential duration was prolonged in patients compared with controls (P<0.02) in the puborectalis and external sphincter indicative of neuropathic changes. X-ray measurements of the anorectal angle and perineal descent at rest showed no differences. However, obstructed defaecation patients had a greater increase in anorectal angle on straining (P<0.02) and significantly more descent on straining (P<0.002). Fast film sequence evacuation proctography showed that the anal canal was occluded by anterior rectal wall in four patients and five patients had variants of recto-rectal intussusception without overt rectal prolapse, which explained the obstructive symptoms. This information should allow the surgeon to follow a rational treatment programme based on the anatomical abnormality.
Intussusception and intestinal malrotation in infants: Waugh's syndrome
Authors: Brereton R J , Taylor B , Hall Christine M
Published: March 2007

The position of the duodenojejunal flexure was determined in 37 out of a group of 49 consecutive infants presenting with intussusception. The flexure was in a normal position in 19, at the midline in 3, and in an abnormal position in 15. The caecum was unfixed in all of the 41 infants subjected to operation. It is concluded that lack of normal rotation and fixation of the intestine is an important factor in the aetiology of idiopathic intussusception of infants.
Restorative rectal resection: An audit of 220 cases
Authors: Tagart R E B
Published: March 2007

Two hundred and twenty consecutive, unselected cases of restorative rectal resection are reported. The operative mortality was 8.3 per cent; 3.5 per cent in patients less than 70 years old and 13 per cent over that age. Leakage at the colorectal suture line was an intractable problem, uninfluenced by anastomotic technique, but the introduction of antimicrobial prophylaxis as a routine was followed by a statistically significant reduction in the leak rate. Postoperative rectal function was satisfactory but temporary stenosis at the suture line was not uncommon. In only one case was it permanent, requiring regular dilatation. Recurrence of malignant disease occurred in 50 per cent of cases followed for at least 2 years; 35 per cent general disease, 15 per cent localized to the pelvis. These figures do not differ significantly from those following total rectal excision, which is now necessary in only 1 in 10 cases where the growth lies within 10 cm of the anus.
Influence of local surgery and radiotherapy on the natural history of pleomorphic adenomas
Authors: Watkin G T , Hobsley M
Published: March 2007

We have analysed the interval between first treatment and tumour recurrence in 65 patients with parotid pleomorphic adenomas which had recurred following local excision. Our results indicate that 5 years is an inadequate period of follow-up and that 10–20 years may be more realistic. Radiotherapy given to 17 patients after local excision of their tumours was found to have had no significant advantageous effect in terms of recurrence-free interval either before or following formal parotidectomy or in limiting the ultimate surgery required. Major complications directly attributable to radiotherapy developed in at least 3 of these 17 patients. Malignant transformation of the pleomorphic adenoma has occurred in three patients, two of whom had been subjected to radiotherapy. We advise that caution is exercised in the interpretation of results of local excision and radiotherapy in this disease. In view of the fact that an alternative and apparently superior treatment is available in the form of formal parotidectomy, we urge that this should be universally adopted for the management of both primary and recurrent pleomorphic adenomas.
Monitoring middle cerebral artery blood velocity during carotid endarterectomy
Authors: Padayachee T S , Gosling R G , Bishop C C , Burnand K , Browse N L
Published: March 2007

Transcranial pulsed Doppler ultrasound and spectral analysis were used to monitor blood velocities in the middle cerebral artery of nineteen patients (mean age 61 ± 9 years) during carotid endarterectomy. A Javid shunt was used in all patients. The intensity weighted mean Doppler frequency for each spectral sweep (at 5 ms intervals) was time-averaged over the cardiac cycle to obtain a mean value for blood velocity in the middle cerebral artery. The range of such values found in the 19 patients was: 12–38 cm s−1 after anaesthesia (baseline); 12–69 cm s−1 during diathermy; 0–30 cm s−1 during carotid clamping; 16–32 cm s−1 during shunting and 18–60 cm s−1 in the recovery room. The average change in middle cerebral artery blood velocity from baseline values showed significant increases during diathermy (P<0.005), shunting (P<0.05) and in the recovery room (P<0.005). Clamping of the internal carotid artery showed a significant decrease in middle cerebral artery blood velocities of all patients (P<0.005), three of whom showed no flow in the middle cerebral artery during clamping. Abnormally high amplitude Doppler signals at the commencement of shunting were detected in 17 of the 19 patients. Such Doppler signals are consistent with turbulent blood flow or the introduction of micro-air bubbles by the shunt. Backbleeding in the internal carotid artery before insertion of the shunt was associated with diminished flow in the ipsilateral middle cerebral artery of ten patients, oscillatory forward/reverse flow in three patients and cessation of flow in the remaining six patients.
Seat belt injury to the female breast
Authors: Dawes R F H , Smallwood J A , Taylor I
Published: March 2007

Six women who sustained injury to a breast from seatbelt straps during road traffic accidents are presented. In three the breast contained a carcinoma. In view of the overlap of the appearance of fat necrosis and carcinoma by clinical and radiological examination all such lesions should be biopsied to exclude carcinoma as the history of the lesion can be dangerously misleading.
Drainage in uncomplicated thyroid and parathyroid surgery
Authors: Kristoffersson A , Sandzén B , Järhult J
Published: March 2007

A randomized study of the value of drainage in thyroid and parathyroid surgery is presented. Fifty patients were provided with surgical drains and another fifty patients were allocated to a control group without drainage. Complications were few in either group and the rate of subjective discomfort from the collar incision was equally low in both groups. The observations suggest that the provision of drainage is not necessary after uncomplicated neck surgery.
Effects of a long-acting somatostatin analogue in patients with severe ileostomy diarrhoea
Authors: Cooper J C , Williams N S , King R F G J , Barker M C J
Published: March 2007

Proctocolectomy (PC) with small bowel resection may lead to profuse ileostomy diarrhoea which can be difficult to treat. The effect of a recently developed long acting somatostatin analogue (SMS 201-995) on ileostomy output was investigated in 5 patients who had undergone PC and ileal resection (median 120 cm) and who suffered severe diarrhoea (4–7 litres/24 h). Gastric emptying, transit of a standard meal through the small bowel and the amounts of nutrients excreted were simultaneously determined during double blind infusion of SMS (25 fig/h) and placebo (isotonic saline 125 ml/h). SMS 201–995 significantly reduced ileostomy output (P < 0.05) and water excretion (P < 0.05) and prolonged small bowel transit time (P < 0.05). Whilst having little effect on gastric emptying, or on the excretion of glucose or nitrogen, fat excretion was significantly increased (P < 0–05). In two patients subcutaneous administration of SMS 201-995 (50 μg b.d.) has maintained a reduced ileostomy output for 4 and 6 months respectively.
Gastric secretory responses to modified sham feeding (MSF) and insulin after vagotomy
Authors: Athow Anna C , Lewin M R , Sewerniak Anna T , Clark C G
Published: March 2007

Modified sham feeding (MSF) and insulin tests were carried out in 28 patients after vagotomy. Basal and pentagastrin collections were also performed. Using the secretory data from 9 of the patients with endoscopically proven recurrent ulcer as a reference, 20 gastric secretory indices were studied and critical levels were chosen to provide the maximum sensitivity and specificity. The eleven most discriminating indices were then used to evaluate the remaining 19 patients. There was agreement between the responses to MSF and insulin as to the adequacy of vagotomy in 16 of the patients (84 per cent) and contradictory responses in 3 patients (16 per cent). Overall, MSF responses were as discriminating as the responses to insulin. A simplified ward test, based on crude volume measurements in response to MSF is proposed.