bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment of ‘inoperable’ neck nodes using surgical clearance and postoperative interstitial irradiation
Authors: Stafford N , Dearnaley D
Published: March 2007

The inability to remove all disease at the time of a radical neck dissection, or inoperable recurrent disease after a neck dissection, are both familiar problems for the head and neck surgeon. All too frequently the conventional treatment options have already been used, the patient having received external beam radiotherapy and possibly cytotoxic chemotherapy. In such circumstances, and provided that the primary tumour remains under control, a positive approach to the further management of the neck metastases should be adopted, given that the patient is in otherwise reasonable health and does not have gross distant metastatic disease. We describe our experience with postoperative interstitial irradiation (brachytherapy) using after-loaded iridium-192 (192Ir) wires positioned at the site of the tumour after its surgical exposure and debulking or clearance. All the treated patients had previously received external beam irradiation to the neck and in the first three cases local skin necrosis occurred as a sequel to interstitial implantation. Therefore, in the other five patients, cutaneous or myocutaneous flaps were used to resurface the area at the time of implant placement. This combination of technqiues, which has not been described previously, provided local tumour control in four out of the five cases without irradiation necrosis occurring in any of them.
Effect of epidural anaesthesia on intestinal blood flow
Authors: Johansson K , Ahn H , Lindhagen J , Tryselius U
Published: March 2007

The effect of epidural bupivacaine (5 mg/ml) on intestinal blood flow was studied with laser Doppler flowmetry in 15 patients during operations including various types of large bowel resection. In the colon, blood flow increased in 13 out of 15 patients, which was significant at the 1 per cent level. The average increase was 41 per cent. In the ileum an increase was found in eight out of eleven patients who could be studied, which was significant at the 5 per cent level. Bowel function was restored satisfactorily in all patients. It is concluded that epidural bupivacaine has a favourable effect on intestinal blood flow during colorectal surgery.
Prospective study of conservative and operative treatment for faecal incontinence
Authors: Miller R , Bartolo D C C , Locke-Edmunds J C , Mortensen N J McC
Published: March 2007

To assess the functional results of treatment of faecal incontinence we carried out physiological and radiological measurements in 46 patients and 20 controls. Twenty patients were selected for conservative treatment and 26 for surgery (including 17 postanal repairs and 6 anterior sphincter repairs). The degree of incontinence was scored before and after treatment and postoperative investigations carried out on 17 patients (11 postanal repairs). Forty per cent of the conservative treatment group had a successful result compared with sixty-five per cent of the operative group as a whole and fifty-nine per cent of the postanal repair patients. Resting and ‘squeeze’ anal canal pressures were improved following postanal repair as was upper anal canal sensation but there was no change in the anorectal angle. We conclude that the anorectal angle is not crucial in maintaining continence.
Gastric cancer: An audit of 122 consecutive cases and the results of R1 gastrectomy
Authors: Irvin T T , Bridger J E
Published: March 2007

In a consecutive series of 122 patients with gastric carcinoma, 9 per cent had no operation, 27 per cent had incurable disease at laparotomy, and 64 per cent underwent gastric resection. R1 gastrectomy was performed in 73 of the 78 resections. The operative mortality after gastric resection was 4 per cent, but there were no deaths after potentially curative resections. The actuarial 5-year survival was 20 per cent overall, 60 per cent in patients undergoing a ‘curative’ resection with N0 disease, and 18 per cent in patients with N1 disease. Local or regional recurrence without evidence of distant metastases was identified in 11 per cent of cases after ‘curative’ resections. The probability of survival was adversely affected by N1 nodal involvement (P<0.005) and by the presence of poorly differentiated or anaplastic tumours (P<0.001). Only 6 per cent of patients had early gastric cancer, and absolute curative resections by Japanese criteria were possible in only 5 per cent of cases. The results suggest that the unfavourable presenting pathology is the principal determinant of the poor prognosis of gastric cancer. A more radical or extended lymphadenectomy (R2/3 gastrectomy) might have cured more patients with N1 metastases, but only 12 per cent of potentially curable patients had N1 disease in this study, and it appears that more radical surgery may have little effect on the overall survival rates for gastric cancer.
Experimental columnar metaplasia in the canine oesophagus
Authors: Gillen P , Keeling P , Byrne P J , West A B , Hennessy T P J
Published: March 2007

Regeneration of canine oesophageal mucosa was studied under basal conditions and in the presence of gastro-oesophageal reflux. In normal circumstances mucosal defects in the oesophagus regenerate by squamous epithelium. In the presence of gastro-oesophageal reflux of either acid or a combination of acid and bile, regeneration was frequently by columnar epithelium (Barrett's oesophagus). This columnar regeneration was not seen with bile reflux alone. By the use of squamous barriers to proximal migration of columnar epithelium in the stomach, it was demonstrated that columnar re-epithelialization may occur from cells intrinsic to the oesophagus and is not dependent on proximal migration of cardiac columnar epithelium. The cell of origin of this epithelium may be located in oesophageal gland ducts and is likely to be a multipotential stem cell since the regenerated columnar epithelium may contain goblet and parietal cells not normally found in the oesophagus. This epithelium is morphologically distinct on mucin histochemistry from cardiac columnar epithelium. These findings support the concept that Barrett's epithelium is metaplastic.
Operative management of tubulovillous neoplasms of the duodenum and ampulla
Authors: Krukowski Z H , Ewen S W B , Davidson A I , Matheson N A
Published: March 2007

Six patients are described to illustrate the operative management of tubulovillous neoplasms of the duodenum. Pancreaticoduodenectomy is appropriate for associated invasive carcinoma. Transduodenal submucosal excision of tubulovillous neoplasms with resection and reconstruction of the distal bile and pancreatic ducts if necessary is a satisfactory alternative when the neoplasm has not penetrated the muscularis mucosae.
Clinical management of recurrent hepatocellular carcinoma after primary resection
Authors: Kanematsu T , Matsumata T , Takenaka K , Yoshida Y , Higashi H , Sugimachi K
Published: March 2007

Curative resections were performed on 121 patients with primary hepatocellular carcinoma from 1975 to 1986 at Kyushu University Hospital, Japan. Up to August 1987 there was a recurrence in 41, detected between 4 and 86 (mean 20) months after surgery. Intrahepatic recurrences were the most common (82 per cent). There was no statistically significant correlation between size of the primary tumour and interval from surgery to detection of recurrence (r = −0·09). Serial measurement of serum α-fetoprotein (AFP) was useful for the detection of recurrences. However, the levels of AFP seem to be a non-specific, unreliable test for such patients since this tumour marker showed different ranges before the primary surgery and at the time of recurrence in 5 of the 41 patients (12 per cent). Postoperative chemotherapy with oral 5-fluorouracil had no apparent preventative effect on the recurrence. A second curative resection was effective in four patients, and three survived for over 2 years; the longest survival time is 9 years after the second procedure.
Necrosectomy and postoperative local lavage in necrotizing pancreatitis
Authors: Beger H G , Büchler M , Bittner R , Block S , Nevalainen T , Roscher R
Published: March 2007

Necrosectomy with postoperative continuous local lavage was performed in a prospective study involving 95 patients with necrotizing pancreatitis. In the same period 567 patients with oedematous-interstitial pancreatitis were treated non-operatively with a hospital mortality rate of 0·7 per cent. In patients with necrotizing pancreatitis the median Ranson criteria score was 4·5 points; operation was required at a median of 7 days after the onset of symptoms because of non-response to conservative treatment. In all, 59 per cent of the patients (56 out of 95) developed extended intrapancreatic parenchymal necrosis, 70 per cent had ascites, and 66 per cent had intra- and extrapancreatic necrosis; 42 per cent of the patients had bacterial infection of the necrotic tissue. For lavage a median of 8l/24 h of fluid were instilled postoperatively for 25 days (median). The lavage fluid showed high levels of immunoreactive trypsin, phospholipase A2, and endotoxin in the early postoperative period. Hospital mortality rate was 8·4 per cent. Necrosectomy and continuous postoperative lavage can achieve high survival rates in patients with necrotizing pancreatitis. Postoperative local lavage allows the continuous non-operative evacuation of biologically active compounds and devitalized tissue, and avoids damage to remaining vital exocrine and endocrine pancreatic tissue.
Blunt injuries of the diaphragm
Authors: Johnson C D
Published: March 2007

Rupture of the diaphragm is a potentially serious complication of blunt trauma which can easily be overlooked at the time of presentation. This review examines the incidence and pathogenesis of the injury and discusses diagnosis and management.
Relative merits of ultrasound and intravenous urography in the investigation of the urinary tract
Authors: Jagjivan B , Moore D J , Naik D R
Published: March 2007

Three hundred and fifty adult patients referred for intravenous urography were entered into a prospective double blind trial comparing intravenous urography with real time ultrasound. The study was performed to clarify the relative merits of the two techniques. Our results show that ultrasound and a plain abdominal radiograph should be the examination of first choice in most circumstances. This is particularly so in vague abdominal pain and in recurrent urinary tract infections where intravenous urography can usually be omitted or used only as a secondary investigation for further evaluation of abnormal ultrasound findings. In acute renal colic, intravenous urography should be the primary investigation. In macroscopic haematuria, initial examination by ultrasound would reliably diagnose mass lesions, show whether the lesion is cystic or solid and assess possible spread. Normal ultrasound does not exclude haematuria due to ureteric lesions or bladder lesions and intravenous urography is recommended.
Venous mesenteric infarction: A particular entity
Authors: Clavien P-A , Dürig M , Harder F
Published: March 2007

Ninety-eight patients with documented mesenteric infarction during a 19-year period were reviewed. In 13 patients infarction was due to a mesenteric venous thrombosis (MVT). Patients with MVT distinguished themselves from those having another aetiology by: (1) longer history of pain before admission (median 8 days, P<0·0001); (2) typical appearance of the bowel at laparotomy (10/13); (3) a localized segment of ischaemic jejunum or ileum of less than 120 cm in length (12/13) allowing better operability at the first laparotomy (P = 0·006). In hospital the mortality was lower for venous mesenteric infarction (5/13, 38 per cent) than for mesenteric infarction of other aetiologies (70/85, 82 per cent) (P = 0·002). Patients with primary venous mesenteric infarction showed a better survival rate (one death in eight patients) than patients with associated diseases such as liver cirrhosis, sepsis or previous operation who had a poor prognosis with a mortality comparable to other aetiologies of acute bowel ischaemia (four deaths in five patients). Since the high recurrence rate of this disease in the early postoperative period was due to residual venous thrombosis and to a hypercoagulable state, a wide bowel resection is recommended followed by early and long-term anticoagulation. Thrombectomy is probably inefficient since it removes only centrally located thrombi and leaves peripheral occlusion, which is responsible for the recurrence.
Management of pleomorphic adenoma of the parotid
Authors: Maynard J D
Published: March 2007

A series of 336 parotidectomies, carried out for benign disease has been followed for up to 20 years. One hundred and thirty primary pleomorphic adenomas were treated by wide excision of the tumour after identification of the facial nerve. Recurrence occurred in only one patient and, although 20 patients (15 per cent) experienced some degree of facial nerve weakness postoperatively, there was only one case of permanent weakness.
Assessment of injection sclerotherapy in the management of 152 children with oesophageal varices
Authors: Howard E R , Stringer M D , Mowat A P
Published: March 2007

A total of 152 consecutive children with oesophageal varices have been endoscopically reviewed since 1979. In all, 108 of these children presented with variceal bleeding which was managed by injection sclerotherapy. Variceal obliteration was achieved in 33 (92 per cent) children with extrahepatic portal hypertension and 54 (75 per cent) with intrahepatic portal hypertension. Prophylactic injection sclerotherapy was used to obliterate large varices in 11 children with no history of haemorrhage. Bleeding episodes occurred in 38 (39 per cent) children before variceal obliteration was complete. However, the mortality rate from variceal bleeding was only 1 per cent. Complications were oesophageal ulceration (29 per cent) and stricture (16 per cent) which both resolved with conservative management. During a mean follow-up period of 2.9 years after sclerotherapy, recurrent oesophageal or gastric varices developed in 12 (12 per cent) cases, with rebleeding in 9 (9 per cent), but all responded successfully to a second course of treatment. These results are superior to contemporary surgical management and injection sclerotherapy should therefore currently be the primary treatment of choice for bleeding oesophageal varices in children.
Cerebral angiography for cerebrovascular disease: The risks
Authors: Leow K , Murie J A
Published: March 2007

Cerebral angiography is still suggested as a first line investigation for patients with putative transient ischaemic attacks (TIA) and it is considered by most surgeons as a necessary prelude to carotid endarterectomy. That conventional cerebral angiography involves risk is well known, although the magnitude of this risk is not. Prospective studies of cerebral complications from this technique, published over the last decade, have been analysed to show that the major stroke rate after conventional cerebral angiography for patients with TI As is likely to be about 2.4 per cent. This must be taken into account if the true morbidity of carotid endarterectomy is to be appreciated (assuming conventional angiograms have been used). Furthermore, since many sufferers are assessed by angiography but not submitted to surgery, a policy of conventional angiography for patients with TI As puts a far greater number at risk than that actually having carotid endarterectomy.
Results of excision of a cervical rib in patients with the thoracic outlet syndrome
Authors: Brown S C W , Charlesworth D
Published: March 2007

Excision of a cervical rib in patients with the thoracic outlet syndrome has been the subject of debate. One surgeon's experience of 23 cervical rib excisions is presented. Ten operations produced a complete cure, eleven improvement, and two no change in the patient's condition. Of 15 cases with neurological symptoms alone, 9 were cured, 5 improved and 1 was not helped; in contrast, of 8 patients with vascular symptoms, I was cured, 6 were improved and I was not helped. We conclude that cervical rib resection is the correct treatment for patients whose symptoms are predominantly neurological. Rib resection alone may not be sufficient in patients with vascular symptoms. The management of a cervical rib with vascular involvement is discussed.
Role of duodenal bile crystal analysis in the investigation of ‘idiopathic’ pancreatitis
Authors: Neoptolemos J P , Davidson B R , Winder A F , Vallance D
Published: March 2007

Duodenal bile crystal analysis for the detection of gallstones was assessed in 26 patients with acute pancreatitis of known aetiology (11 attributable to gallstones and 15 to alcohol) and in 37 patients without a history of acute pancreatitis (21 with gallstones and 16 without). The sensitivity was 64–67 per cent and the specificity was 94–100 per cent in these groups. Analysis of duodenal bile from 14 patients with ‘idiopathic’ pancreatitis revealed calcium bilirubinate crystals (but not cholesterol crystals) in 5 patients (36 per cent). Gallstones were confirmed at cholecystectomy in three of these patients and also in one other patient who had a gallstone on a ‘late’ ultrasound examination but was negative for crystals. Thus 29 per cent of the original ‘idiopathic’ group had gallstones confirmed. Gallstone analysis showed that pigment stones were present in 7 of 31 (23 per cent) non-pancreatitis controls compared with 9 of 13 (69 per cent) pancreatitis patients (P = 0·0048). These results suggest that duodenal bile crystal analysis (involving both calcium bilirubinate and cholesterol crystals) may be a useful technique for the investigation of patients with ‘idiopathic’ pancreatitis.
Surgical management of chronic pancreatitis: Long-term results in 141 patients
Authors: Mannell Aylwyn , Adson M A , McIlrath D C , Ilstrup D M
Published: March 2007

The management of pancreatic pain is a controversial subject and the treatment recommended varies from one extreme to the other. Some authorities advise simply waiting for chronic pancreatitis to ‘burn out’, while others practise removal of the entire gland. In this paper we present 141 patients who underwent surgery for chronic pancreatitis at the Mayo Clinic. The main indication for operation was pancreatic pain and the choice of operation was based on anatomical abnormalities in the gland. The long-term results of the policy are reviewed (mean follow-up 8·5 years). Length of history, aetiology of disease, pancreatic dysfunction and pathology, time after operation and continued alcohol abuse were computer analysed for a statistically significant influence on pain relief, ability to work, pancreatic function and survival. There was one operative death (mortality rate 0·7 per cent). Continued drinking was not shown to affect postoperative pain relief but 10-year survival was significantly less in alcoholics than in those with non-alcoholic pancreatitis (P < 0·02). Dilated ducts and duct calculi were associated with good results for pain relief although this association did not achieve statistical significance. Parenchymal calcification and time after operation did not influence the results of surgery. When the operation failed to relieve pain, spontaneous remission occurred in a few cases only. Seventy-seven per cent of patients had lasting relief of pain and operations selected on the basis of gross pathology were equally effective in relieving pain. Longitudinal pancreaticojejunostomy in those with dilated ducts and a Whipple operation for disease of the pancreatic head gave good results. However quality of life and pancreatic function were severely impaired by 80–95 per cent distal resections and by total pancreatectomy. An extended proximal resection is suggested for patients with diffuse disease and non-dilated ducts.
Tumour calcification following repeated hepatic de-arterialization in patients: a preliminary communication
Authors: Bengmark S , Jeppsson B , Lunderquist A , Tranberg K-G , Persson B
Published: March 2007

A novel method of repeated hepatic de-arterialization is presented. A vascular occluder is placed around the hepatic artery and connected to an injection port. The hepatic artery can thereafter be occluded repeatedly. Patients with irresectable liver metastases from colorectal cancers were treated with occlusions of the hepatic artery for 1 h twice daily, in combination with intraperitoneal cyclic administration of 5-fluorouracil. The first three patients treated are presented. They all exhibited massive tumour calcifications in the liver reflecting tumour necrosis and resorption. This therapeutic principle must undergo further clinical trials.
Gastro-oesophageal reflux and intestinal malrotation in children
Authors: Kumar D , Brereton R J , Spitz L , Hall Christine M
Published: March 2007

In a series of 74 children undergoing Nissen fundoplication for persistent gastro-oesophageal reflux unresponsive to intensive medical treatment, there was an unexpectedly high incidence (54 per cent, n = 40) of intestinal malrotation. The series was not homogeneous, 25 of the children having reflux as a complication of a serious congenital abnormality (48 per cent incidence of intestinal malrotation), and 49 presenting with ‘idiopathic’ reflux (57 per cent incidence of intestinal malrotation). Intestinal malrotation is best detected pre-operatively by careful barium radiology, requiring clinicians to be aware of the association. In our experience, in children over the age of 3 months, both an antireflux operation and Ladd's procedure are often necessary to stop gastro-oesophageal reflux when an intestinal malrotation is present.
Surgical management of substernal goitre
Authors: Michel L A , Bradpiece H A
Published: March 2007

This paper presents the clinical features and problems in the management of 34 patients with substernal goitre. Complete evaluation of the mediastinum relied on computed tomography. Thyroid function tests were performed routinely and showed a clinically underestimated incidence of hyperthyroidism (44 per cent). The incidence of occult malignancy in substernal goitres was high (12 per cent). In the majority of patients (88 per cent) the substernal goitres were removed by a collar incision. Four cases of goitres located in a retrotracheal position required a combined cervical and sternotomy approach. None of the 34 patients died. Transient postoperative hypocalcaemia was found in 41 per cent of our patients. The presence of a substernal goitre is an indication for resection based on the risk of malignancy, the risk of acute respiratory distress, the high incidence of thyrotoxicity and a low surgical morbidity.
Non-operative management of retroperitoneal fibrosis
Authors: Higgins P M , Bennett-Jones D N , Naish P F , Aber G M
Published: March 2007

It is generally recognized that in many patients the ureteric obstruction and other manifestations of non-malignant retroperitoneal fibrosis will respond to treatment with corticosteroids. However, most surgeons are reluctant to use steroids as the primary treatment for patients with this condition, mainly because of the risk of mismanagement of malignant retroperitoneal fibrosis. Our experience in the care of 17 patients with non-malignant retroperitoneal fibrosis has led us to believe that an initial non-surgical approach is both safe and preferable.
Augmentation of lymphokine-activated killer cell activity in patients with gastrointestinal cancer
Authors: Sedman P C , Ramsden C W , Brennan T G , Giles G R , Guillou P J
Published: March 2007

Adoptive cellular immunotherapy with lymphokine-(interleukin 2) activated killer (LAK) cells is not as successful in patients with gastrointestinal cancer as with other tumour types. This may be because the cytotoxic capacity of LAK cells from such patients is suboptimal. In this study we have sought to augment this activity by stimulating the lymphocytes with recombinant human interferon-γ (r-HuIFN-γ) in addition to interleukin 2 or by depleting the lymphocytes of adherent suppressive mononuclear cells. Both procedures augment LAK activity in gastrointestinal cancer patients but adherent cell depletion results in fewer cells being available for adoptive cellular immunotherapy. No further augmentation of LAK activity of adherent cell depleted cells could be accomplished by addition of r-HuIFN-γ. Co-stimulation of unfractionated peripheral lymphocytes with r-HuIFN-γ is the preferable procedure for the generation of LAK cells for adoptive cellular immunotherapy in patients suffering from gastrointestinal cancer.
Effect of LHRH agonist, Zoladex, on ovarian histology
Authors: Williamson Karen , Robertson J F R , Ellis I O , Elston C W , Nicholson R I , Blamey R W
Published: March 2007

In a phase 1 clinical trial Zoladex was used as first line hormonal therapy in premenopausal women with advanced breast cancer. Patients on progression of their disease underwent surgical oöphorectomy. The histology of ovaries from 23 women treated with Zoladex has been compared with the ovaries from 34 patients who, before the clinical trial of Zoladex, underwent surgical oöphorectomy as primary therapy. Both groups show similar follicular phase development. Only 13 per cent of the Zoladex group developed corpora lutea while 58 per cent showed evidence of luteinization in the primary oöphorectomy group (P < 0.01). Non-neoplastic follicular cysts were seen more often in the ovaries of the Zoladex treated patients than in the primary oöphorectomy group (P < 0.05). Zoladex appears to arrest not folliculogenesis but follicular maturation with inhibition of ovulation, the follicles subsequently undergoing atresia with follicular cyst formation.
Growth rate of hepatic metastases in colorectal carcinoma
Authors: Finlay I G , Meek D , Bruntont F , McArdle C S
Published: March 2007

The rates of growth of 29 hepatic metastases from 15 patients with primary colorectal carcinoma were studied using serial computed tomography (CT). Eleven metastases were found by the surgeon at laparotomy (overt metastases); the remaining eighteen were not evident to the surgeon at laparotomy, but were detected by CT scan during the immediate postoperative period (occult metastases). An estimate of tumour volume doubling time was obtained from a semi-logarithmic plot of tumour cell number against time. The mean doubling time for the overt metastases was 155 ± 34 days (± s.e.m.) compared with 86 y 12 days (P < 0·05) for the occult metastases. The age of the metastases at the time of surgery was estimated by extrapolation of the observed growth curve assuming Gompertzian kinetics. The mean age of the overt metastases was 3·7 ± 0·9 years (±s.e.m.) The corresponding age of the occult metastases was 2·3 ± 0·4 years.
Clinicopathological assessment and staging of colorectal cancer
Authors: Williams N S , Jass J R , Hardcastle J D
Published: March 2007

Compared with various common neoplasms, there is no national or international agreed clinicopathological staging system for colorectal cancer. Before such a system can be developed, however, there has to be agreement on the methods used for assessment. The Colorectal Subcommittee of the United Kingdom Co-ordinating Committee on Cancer Research has, through its working party on staging, agreed various recommendations as to how the clinical and pathological assessment of patients with colorectal cancer can be standardized. By applying these standardized criteria, patients undergoing surgery can be divided into those having curative or non-curative operations, or operations which are indeterminate for cure. These recommendations represent the first step in ensuring uniformity in the classification of patients with colorectal cancer.
Effects of autologous mesothelial cell seeding on prostacyclin production within Dacron® arterial prostheses
Authors: Bull H A , Pittilot R M , Drury J , Pollock J G , Clarke J M F , Woolf N , Marston A , Machin S J
Published: March 2007

Canine abdominal aortas have been replaced with Dacron® arterial prostheses to assess the effects of mesothelial cell seeding on graft prostacyclin and thromboxane A2 release. At both 2 weeks and 6 weeks after surgery, three seeded and two unseeded control grafts were examined for prostacyclin release. In addition, thromboxane release was assessed in one seeded and one unseeded graft. Sections of aorta and graft were removed and incubated in PBS containing either 10 μM calcium ionophore A23187 or 20 μM arachidonic acid. The incubation mixture was sub-sampled at 5 min intervals over a 20 min period to assess the progressive release of prostacyclin and thromboxane A2 using a radioimmunoassay for 6-keto-prostaglandin F1α and thromboxane B2 respectively. In seeded grafts, 6-keto-prostaglandin F1α release averaged 15 per cent compared with aorta at 2 weeks and 45 per cent compared with aorta at 6 weeks. By contrast, release from unseeded grafts was undetectable at 2 weeks; however, by 6 weeks there was some release amounting to 15 per cent compared with aorta. There was a statistically significant increase in the release of 6-keto-prostaglandin F1α from mesothelial cell seeded grafts at 6 weeks compared with unseeded grafts (P < 0·01). Thromboxane release from the graft sections was variable and unrelated to whether the grafts had been seeded or not. These preliminary results, showing that grafts seeded with autologous peritoneal mesothelial cells release more prostacyclin than unseeded grafts, further highlight the role of the mesothelial cell as an alternative to the endothelial cell for improving the patency of arterial Dacron prostheses in the early postoperative days.
Oxygen consumption following trauma: a reappraisal in severely injured patients requiring mechanical ventilation
Authors: Edwards J D , Redmond A D , Nightingale P , Wilkins R G
Published: March 2007

Oxygen consumption (Vo2) immediately following major injury in man has been said to be reduced. The evidence for this is poor. We have therefore measured Vo2 soon after major injury in 16 patients. Vo2 was reduced in only two patients, within the normal range in four and increased in ten. Vo2 was maintained by increased oxygen extraction in six patients leading to low levels of mixed venous oxygen saturation. There is no evidence for an ‘ebb phase’ response in man.
Microdochectomy for single-duct discharge from the nipple
Authors: Locker A P , Galea M H , Ellis I O , Holliday H W , Elston C W , Blamey R W
Published: March 2007

Microdochectomy has been the accepted treatment for single-duct nipple discharge. Review of 97 consecutive patients undergoing microdochectomy between 1980 and 1987 revealed a total of eight patients with ductal carcinoma in situ. All of these had pre-operative mammography, results of which were highly suspicious of malignancy in six patients. Tiny foci of ductal carcinoma in situ were found in the two patients with normal mammograms. We suggest an expectant policy in cases where the mammogram is normal, omitting routine microdochectomy.
Breast cyst type does not predict the natural history of cyst disease or breast cancer risk
Authors: Ebbs S R , Bates T
Published: March 2007

The sodium (Na) and potassium (K) concentrations were measured in the fluid of 169 breast cysts aspirated from 101 consecutive patients presenting to a single clinic. The Na/K ratio was used to define cysts as either apocrine (Na/K < 3) or flattened (Na/K > 3) in type. There was no consistency in the type of cyst for individual patients. Cyst type was not predictive of further cyst development, neither was a particular cyst type associated with the development of, or a history of, breast cancer.
Effect of vertical banded gastroplasty on the natural history of gastritis in patients with morbid obesity: a follow-up study
Authors: Flejou J-F , Owen E R T C , Smith A C , Price A B
Published: March 2007

Vertical banded gastroplasty is an accepted surgical treatment for morbid obesity. The aim of this study was to evaluate its effect on the natural history of gastritis, as the occurrence of gastritis and dysplasia have been reported after gastric bypass, another type of bariatric surgery. Thirty-four patients who underwent vertical banded gastroplasty between 1983 and 1987 were studied, and the follow-up varied from 1 to 47 months (mean 22 months). We found no increase of gastritis and intestinal metaplasia after surgery, and we did not observe any case of gastric dysplasia. Only one patient with pre- and postoperative specimens showed a deterioration in gastric histology after surgery, and this was of a minor degree. These initial results are encouraging for surgeons interested in the treatment of morbid obesity.
Treatment of stomach cancer, a national experience
Authors:   Members of the Norwegian Stomach Cancer Trial, Valen B , Viste A , Haugstvedt T , Eide G E , Søreide O
Published: March 2007

A total of 1165 patients with stomach cancer were entered into a prospective, observational national study. They represented 54 per cent of all stomach cancer patients reported to the Cancer Registry in Norway during the study period, and data are analysed for three hospital levels (local, county and university hospitals). The median age was 71 years (range 18–96 years). The median pretreatment delay was 113 days, and 46 per cent of patients had a performance status (Karnofsky index) of 80. The diagnosis was confirmed by pre-operative histology in 88 per cent of cases. In all, 88 per cent of patients underwent surgery, the resectability rate was 67 per cent and 50 per cent had a potential curative operation. Total gastrectomy was most commonly performed. Lymph node dissection was performed in 14 per cent of those undergoing a curative resection. The postoperative complication rate was 27 per cent but varied with the type of operation, being highest in proximal resection (55 per cent) and lowest after distal resection (19 per cent). A total of 7 per cent of the patients died postoperatively. Most patients had advanced disease at the time of treatment and only 6 per cent had stage I tumours. There were significant differences in patient and treatment characteristics between the three hospital levels. In conclusion, patient selection bias which will influence results does occur. A fairly aggressive attitude towards local disease was found; but the low proportion of patients undergoing lymph node dissection not only leads to questions regarding the efficacy of this treatment policy, but also casts doubt on the validity of staging of stomach cancer. Morbidity and mortality rates are still high. The consequences of the differences revealed between hospital groups are difficult to interpret. Proponents of both regionalization of treatment and small hospital care may find arguments for their case in the data.
Trial of sclerosing agents in patients with oesophageal varices
Authors: Kitano S , Iso Y , Yamaga H , Hashizume M , Higashi H , Sugimachi K
Published: March 2007

Forty-five cirrhotic patients with oesophageal varices underwent endoscopic injection sclerotherapy in a prospective randomized trial carried out to compare two sclerosing agents (5 per cent ethanolamine oleate and 2 per cent sodium tetradecyl sulphate (STD)) with respect to safety, efficacy and complications. Twenty-three patients were allocated to the ethanolamine group and twenty-two to the STD group. The rate of control of acute bleeding was 100 per cent (6/6) in the ethanolamine group and 75 per cent (3/4) in the STD group. There was a significantly lower rate of postinjection bleeding after the over-tube was removed at the initial session of sclerotherapy when ethanolamine was injected 0/23 versus 7/22, 32 per cent; P < 0.01) and at the second session there was a significantly (P < 0.01) higher rate of jet-like bleeding from injection sites in the STD group (6/21, 29 per cent) than in the ethanolamine group (0/22). The disappearance rate of red colour signs 1 week after the initial session of sclerotherapy in the ethanolamine group was 100 per cent and 62 per cent in the STD group. Early oesophageal ulcers developed less frequently in the ethanolamine group (0 and 9 per cent) than in the STD group (24 per cent and 43 per cent both after the initial (P < 0.05) and the second session of sclerotherapy (P < 0.01)). Early bleeding from an oesophageal ulcer occurred only in the STD group (5/21, 24 per cent) before the third session of sclerotherapy (P < 0.05). The rate of early mortality did not differ between the two groups. We conclude that ethanolamine seems to be safer and more efficacious than STD for sclerosing oesophageal varices.
Intramural haematoma of the alimentary tract in children
Authors: Chittmittrapap S , Chandrakamol B , Chomdej S
Published: March 2007

Thirteen children with intramural haematoma of the alimentary tract were treated in Chulalongkorn University Hospital during an 8-year period (1978–1986). A history of trauma was obtained in 11 cases, 1 case presented as a result of a coagulation defect secondary to a haematotoxic snake bite and no causative factor was apparent in 1 patient. Profound vomiting with abdominal pain is the typical presentation. Upper gastrointestinal contrast study is usually characteristic and diagnostic. Conservative treatment was successful in 12 of the cases with no morbidity and mortality.
Perforated gastric ulcer
Authors: Lanng C , Hansen C Palnæs , Christensen A , Thagaard C S , Lassen M , Klærke A , Tønnesen H , Ostgaard S E
Published: March 2007

A retrospective study is presented of 297 patients operated upon for perforated benign gastric ulcer in Denmark from 1975 to 1984. Male: female ratio was 0.9:1, mean age 64.2 years. The numbers of gastric and prepyloric perforations were almost equal (156:141), but gastric perforations were more frequent in elderly women and prepyloric perforations in younger men. Simple closure was performed in 83 per cent of the patients, gastric resection in 14 per cent and simple closure and vagotomy in 3 per cent. The postoperative mortality rate was 21 per cent and was related to the high proportion of elderly patients with concurrent diseases and delayed treatment.
Enucleated parotid tumours
Authors: Maynard J D
Published: March 2007

Five pleomorphic, one monomorphic adenoma and one acinic cell lower pole parotid tumours were thought to be lymph nodes and enucleated. Wide excision of the operative site within 2 months revealed microscopic recurrence in three cases. Three carcinomas were enucleated and two had recurred rapidly. It is suggested that such cases of inadvertent enucleation should undergo wide resection of the operative site with nerve dissection.
Use of older patients as cadaveric kidney donors
Authors: Foster M C , Wenham P W , Rowe P A , Blamey R W , Bishop M C , Burden R P , Morgan A G
Published: March 2007

We have no fixed upper age limit for cadaveric kidney donors and donors over the age of 50 provided kidneys for 22 per cent of our adult transplant recipients between 1983 and 1986. Immediate function following transplantation occurred in 17 per cent of these kidneys compared with 58 per cent for kidneys from donors under the age of 50. The 1-year actuarial graft survival rate for transplants from donors over 50 was 52 per cent, compared with 70 per cent for transplants from donors under 50 (P < 0.05). Thus kidneys from older donors make an important contribution to the total pool of organs available for transplantation, but their use leads to inferior results in comparison with kidneys from younger donors.
Prophylactic antibiotics in elective colorectal surgery
Authors: Lau W Y , Chu K W , Poon G P , Ho K K
Published: March 2007

A randomized prospective study was conducted on 194 patients who underwent elective colorectal surgery for carcinoma. All patients received the same mechanical bowel preparation. In addition, patients in group A received oral neomycin and erythromycin base; patients in group B received systemic metronidazole and gentamicin, while patients in group C received both oral and systemic antibiotics. Postoperative septic complications related to colorectal surgery occurred in 27.4 per cent, 11.9 per cent and 12.3 per cent respectively in groups A, B and C (χ2 = 7; P < 0.05). The incidence of sepsis in groups B and C was almost identical. Patients who received oral antibiotics alone (group A) had significantly higher risks of postoperative sepsis when compared with patients in either group B or group C (P < 0.05). As there is no additional advantage of combining oral and systemic antibiotics, we recommend systemic metronidazole and gentamicin to be used with mechanical bowel preparation in elective colorectal surgery.
Choledochal cyst: A 33-year review
Authors: Robertson J F R , Raine P A M
Published: March 2007

We present 13 patients who were seen at Glasgow hospitals over a 33-year period. Only five (38 per cent) were children. Of the eight adults, two had complications of the cyst at presentation, namely biliary cirrhosis and cholangiocarcinoma respectively. Another adult patient developed a carcinoma in the cyst 9 years after internal drainage. The incidence of malignant change in the series was therefore 15 per cent. Only five patients have remained well after surgery: three had complete excision and two internal drainage. Of the eight other patients, one had complete excision, five had internal drainage, one had partial excision and one had cholecystectomy and (years later) sphincterotomy. We believe that excision of the cyst is the treatment of choice.
Cyclical mastopathy: A critical review of therapy
Authors: Goodwin P J , Neelam M , Boyd N F
Published: March 2007

Because of a recently completed trial which demonstrated that dietary fat reduction improved the symptoms of cyclical mastopathy, we have carried out a critical review of other studies of treatment for this disorder to determine what, if any, mechanisms of action were shared by effective treatments. Therapies were classified as ‘definitely effective’ if their effectiveness was demonstrated in at least one randomized placebo-controlled study of women with cyclical mastopathy, ‘probably effective’ if their effectiveness in relieving breast symptoms was demonstrated in at least one study in women with premenstrual syndrome, and ‘probably not effective’ if they had not been shown to improve breast symptoms in at least two studies in women with premenstrual syndrome. Bromocriptine, danazol, evening primrose oil, tamoxifen and reduction of dietary fat intake were classified as definitely effective and norethisterone and Bellergal as probably effective. Several therapeutic manoeuvres, including reduction of methylxanthine ingestion and the administration of vitamin E or diuretics, have not been adequately evaluated in women with cyclical breast symptoms. A review of the published reports of the physiological effects of therapies that were definitely or probably effective revealed that these agents acted either to alter serum prolactin levels or lipid metabolism, or both. As evidence exists that prolactin influences lipid metabolism it is postulated that cyclical mastopathy may be a disorder of lipid metabolism.
Dosage and duration of tamoxifen treatment for mastalgia: A controlled trial
Authors: Fentiman I S , Caleffi M , Hamed H , Chaudary M A
Published: March 2007

A controlled trial has been conducted in which 60 women with mastalgia were randomly allocated to receive tamoxifen at a dosage of either 10 mg or 20 mg daily for either 3 or 6 months. All eligible patients had self-rated moderate or severe mastalgia present for at least 6 months, for which no specific therapy had been given for the previous 3 months. End points of the study were pain control, measured by linear analogue scales, relapse rate and side-effects. Pain relief was achieved in 90 per cent of those receiving 10 mg daily and 86 per cent of those given 20 mg daily. The relapse rate was also similar for both dosages, being 48 per cent and 39 per cent respectively and usually occurred within 2–3 months of discontinuing treatment. However, side-effects were reported less frequently among those receiving 10 mg daily (21 per cent versus 64 per cent; x2 = 11·1, P <0·001). Prolongation of treatment from 3 months to 6 months did not materially improve the response rate (85 per cent versus 90 per cent). Side-effects were similar, as was the relapse rate among the patients receiving the two durations of treatment. The agent proved to be significantly more effective in the relief of cyclical rather than non-cyclical pain (94 per cent versus 56 per cent). Use of tamoxifen for the treatment of mastalgia is still experimental. Nevertheless, for the majority of women with mastalgia, pain relief can be achieved using tamoxifen 10 mg daily, given for a 3-month course. As almost half these patients will develop relapse of breast pain it may be necessary to give longer courses of therapy, although the safety of this more protracted treatment has yet to be determined.
Effect of intraperitoneal saline irrigation at different temperatures on adhesion formation
Authors: Kappas A M , Fatouros M , Papadimitriou K , Katsouyannopoulos V , Cassioumis D
Published: March 2007

This study was designed to examine the influence of saline irrigation at different temperatures on adhesion/formation in the rat. Saline irrigation through a laparotomy incision was performed at the following temperatures: 30°C, 34°C, 37°C, 40°C, 45°C, 50°C, 55°C, and 60°C. The control group (Gc, n = 20) underwent laparotomy without irrigation. Adhesions were found in: 5/20 animals of the Gc (all slight); 6/20 of the 30°C group (all slight); 6/20 of the 34°C group (all slight); 6/20 of the 37°C group (all slight); 12/20 of the 40°C group (all slight); 12/20 of the 45°C group (11 slight, 1 moderate); 14/20 of the 50°C group (12 slight, 2 moderate); 18/19 of the 55°C group (2 slight, 6 moderate, 10 marked); and 18/18 of the 60°C group (1 moderate, 8 marked, 9 massive). These results indicate that saline irrigation below body temperature does not prevent adhesions whereas warmed saline encourages adhesion formation in the rat.
Neutrophil degranulation and increased pulmonary capillary permeability following oesophagectomy: A model of early lung injury in man
Authors: Rocker G M , Wiseman M S , Pearson D , Shale D J
Published: March 2007

In nine subjects undergoing oesophagectomy a transient but significant increase in pulmonary vascular permeability to transferrin was detected in both lungs 8 h after surgery. It coincided with a significant increase in plasma lactoferrin, evidence of intravascular and intra-alveolar neutrophil elastase release and with arterial hypoxaemia. The postoperative state in these patients had intravascular and pulmonary features often associated with the adult respiratory distress syndrome, and might be a useful model for the study of the early inflammatory events underlying lung injury in man.
Low molecular weight heparin given the evening before surgery compared with conventional low-dose heparin in prevention of thrombosis
Authors: Bergqvist D , Mätzsch T , Burmark U S , Frisell J , Guilbaud O , Hallböök T , Horn A , Lindhagen A , Ljungnér H , Ljungström K-G , Onarheim H , Risberg B , Törngren S , Örtenwall P
Published: March 2007

A prospective randomized double-blind trial was performed comparing conventional low-dose heparin with a low molecular weight heparin fragment for thromboprophylaxis in elective general abdominal surgical patients. The first dose of the heparin fragment was given the evening before surgery, and further doses were given thereafter every evening. There were 1002 analysable patients, 826 having received correct prophylaxis. Of these 1002 patients, 64 per cent were operated on for malignant disease. A total of 20 patients died, 10 in each group. The 5·0 per cent, P = 0·02). The frequency of bleeding was 6·7 per cent among patients with correct prophylaxis with the heparin fragment (9·2–5·0 per cent, P = 0·02). The frequency of bleeding was 6·7 per cent among the heparin fragment patients and 2·7 per cent among the patients given conventional heparin (P = 0·01), but all bleeds were of minor degree and there was no difference in the reoperation rate for bleeding, or in the transfusion requirements. Local pain at the injection site was reported significantly less often among patients given the heparin fragment.