bluuebunny/crossref_metadata_2025 huggingface dataset:
Aorto-iliac thrombo-endarterectomy
Authors: Spiro M , Cotton L T
Published: March 2007

A series of 46 patients, all of whom underwent thrombo-endarterectomy for occlusive atherosclerotic disease of the abdominal aorta and iiiac arteries, is presented. The operative mortality of the whole series is 10 per cent but in the last 32 cases only 3 per cent. This compares favourably with other published series and other reconstructive procedures.

The follow-up ranges from 6 months to 9 years and averages 2 years 6 months in the 42 postoperative survivors. In this group the patency rate is 90 per cent.

The incidence and causation of impotence post-operatively are discussed and measures suggested for avoiding this complication.

Emphasis is laid on the anatomical distribution of the atheroma and its haemodynamic effects as determining factors in the prognosis and the suitability of this disease for treatment by thrombo-endarterectomy. Further advance in the operative treatment of atherosclerosis of the great abdominal vessels should continue to take an ever-increasing account of the perfusion and flow problems intimately associated with the disease and its relief.
Villous tumours of the rectum associated with severe fluid and electrolyte disturbance
Authors: Lee Ralph O , Keown Denis
Published: March 2007

Two cases of villous tumour of the rectum associated with severe electrolyte disturbance leading to renal failure are presented.

Evidence is produced to show that electrolyte loss is general rather than selective and certainly not confined to potassium.

The ratio of sodium to potassium lost in rectal fluid is of the order of 3–4 : 1.

Correction of sodium deficiency, acidosis, and hypovolaemia by the intravenous route is of paramount importance.

Total correction of potassium deficiency in this way is neither practicable nor necessary but particular care should be taken to maintain plasma potassium levels during correction of metabolic acidosis.

Operative removal of the tumour should await restoration of electrolyte and fluid balance.
The effects of systemic zinc supplements on the strength of healing incised wounds in normal rats
Authors: Groundwater W , Macleod Ian B
Published: March 2007

The effect of the systemic administration of zinc sulphate (4.5 mg. Zn per day) to rats on a normal dietary intake of zinc was studied with reference to the tensile strengths of healing skin and musculofascial wounds.

In comparing control and zinc-treated groups, no significant differences in the tensile strengths of 4-day, 7-day, or 10-day wounds were demonstrated.

A new method of testing the strength of anterior abdominal wall wounds by measuring increasing intra-abdominal pressure up to bursting point is described.

Sutured incised wounds of the linea alba were of identical strength in control and zinc-treated animals after 4, 7, and 10 days.

No toxic effects were observed with the dosage of zinc used.

It is concluded that the administration of supplementary zinc has no effect on the healing of sutured, incised wounds in normal rats.
A laboratory appraisal of the effects of truncal and selective vagotomy
Authors: Dignan A P
Published: March 2007

Maximal acid output and insulin tests were carried out in a series of 56 consecutive patients who had either a truncal or a bilateral selective vagotomy and drainage operation. The results of the insulin tests are discussed in the light of criteria established by several authors. The postoperative reduction in basal and maximal acid output was considered, and also the risk of recurrent ulceration. A comparison of the test results of the two types of vagotomy was made, and no significant difference was found.
The diagnostic cytology of breast carcinoma
Authors: Webb A John
Published: March 2007

Fine-needle aspiration of the breast is illustrated, together with a brief review of the development of cytological diagnosis in this field. A series of 168 surgical out-patients presenting with breast pathology have been studied by this method in an attempt to make an early diagnosis. In 108 patients, histological confirmation was available and the accuracy of cytology was 97.3 per cent. The significance of false diagnosis is discussed. It is concluded that the method is reliable.
Routine operative cholangiography
Authors: McEvedy Brian V
Published: March 2007

The usual clinical and operative indications for exploration of the common bile-duct in cholecyst-ectomies or the selective use of operative cholangio-graphy in such cases are discussed and compared with 150 unselected cases of cholecystectomy and routine operative cholangiography. As far as calculi in the common duct are concerned, it seems fair to say that routine operative cholangiography demonstrates stones that would otherwise be left in situ and reduces the cases in which exploration of the common duct is needed. In this series, stones were present in the common bile-duct in 16 per cent; in about one-fifth of these their presence was unsuspected clinically and at laparotomy. Routine use of the technique is found to reduce the number of false positives.

An important secondary benefit of cholangiography is its demonstration of duct anatomy.

Various points of technique are discussed, in particular the use of the cystic duct catheter for post-exploration radiography, drainage, and postoperative radiography.

Routine operative cholangiography appears to be a useful adjunct to cholecystectomy.
Liver scanning in surgical practice
Authors: Watson A , Bruce Torrance H
Published: March 2007

Liver scanning is a simple, safe investigation which can be of value in several clinical situations commonly encountered in surgical practice:— The differential diagnosis of upper abdominal masses.The differential diagnosis of hepatomegaly.The differential diagnosis of jaundice.The detection of right subphrenic abscess.The detection of focal intrahepatic lesions, and the screening of patients with malignant disease.The response of hepatic metastases to therapy.

In the detection of focal intrahepatic lesions an overall accuracy of about 90 per cent was achieved in our series of 185 scans. Clinical findings were suggestive in 57 per cent and liver-function tests in 48 per cent of the patients.
Intrathoracic phaeochromocytoma
Authors: McNeill A D , Groden B M , Neville A M
Published: March 2007

A review of the 22 reported examples of intrathoracic phaeochromocytoma is presented. A further patient is described who also had a second phaeochromocytoma in an ectopic adrenal gland situated in the hilum of the left kidney.

The diagnosis, localization, and pathology of multiple phaeochromocytomas are discussed.
Management of arterial complications in a case of the arterial type of ehlers-danlos syndrome
Authors: Dales H C , O'Neill J J
Published: March 2007

A 15-year-old boy with the arterial type of Ehlers-Danlos syndrome is described with a rupture of the left axillary artery. Suture of the artery was impossible because of the friability of the wall and proximal ligation of the axillary artery, and transfusion of 12 units of blood was necessary to save the patient's life.

Arteriography led to thrombosis of the right common femoral artery, and it is suggested that arteriography should not be attempted in these cases.

The Ehlers-Danlos syndrome is an inherited connective-tissue disorder which has recently been found to be heterogeneous (Barabas, 1967). The ‘arterial type’ is of considerable surgical interest because of the possibility of lethal complications.
One hundred consecutive cases of complete prolapse of the rectum treated by operation
Authors: Küpfer C A , Goligher J C
Published: March 2007

One hundred patients, 17 male and 83 female, ranging in age from a few days to 97 years, have been treated between 1955 and 1969 for complete prolapse of the rectum. One hundred and twelve operations were performed, 91 by the abdominal route, mostly Roscoe Graham repairs or Ivalon sponge implants, with only 2 immediate deaths. The late results were assessed usually by interview and physical examination 6 months to 14 years (mean 5 years 5 months) postoperatively. Seventy-five of the patients who had had abdominal operations were available for such assessment; 5, or 6.6 per cent, were found to have recurrent complete prolapses (and 11 mucosal recurrences of doubtful significance). Anal incontinence, so frequently associated with rectal prolapse, was improved in some of the patients after abdominal repair, but in roughly half the patients there was no improvement and in I case anal control apparently deteriorated after operation.
Proximal gastric resection in the treatment of bleeding gastro-oesophageal varices in patients with portal hypertension due to extrahepatic obstruction
Authors: Rothwell-Jackson R L , Hunt Alan H
Published: March 2007

Proximal gastric resection is, in our opinion, the operation of choice in the treatment of recurrent haemorrhage in three groups of patients with extrahepatic portal obstruction leading to portal hypertension:— In children who are too small for splenorenal or mesocaval anastomosis, when the haemorrhage can no longer be controlled by periodic injection of the varices through an oesophagoscope.In patients of any age with no suitable radicle of the portal venous tree available for portal systemic anastomosis.In patients who have had splenectomy alone or with gastric transection, or who have had previous shunt operations which have failed to control haemorrhage.

It is the only operation short of total gastrectomy in which the varix-bearing area of the stomach is removed. Twenty-eight patients have had this operation at St. Bartholomew's Hospital in the 16-year period 1949-65. The total and late mortality (4 patients) is 14 per cent during a mean follow-up period of 10 years. Only I patient could remotely be considered as an operative death (3.5 per cent). There was no recurrence of haemorrhage in 53 per cent. Three patients (10.5 per cent) had severe haemorrhage from recurrent varices. Two of these died and are included in the mortality figures. The operative procedure is described.
Cryosurgery for neoplasia
Authors: Gill W , Long W , Fraser James , Lee P
Published: March 2007

Certain laboratory findings are presented which we think directly relate to the clinical problems of cryosurgery. Our experience in dealing with a variety of neoplasms is recorded. It is our opinion that the majority of skin tumours, benign and malignant, are best treated in this way and the advantages over radiotherapy and conventional excision are pointed out. Cryotherapeutic results on large tumours such as sarcomas and rectal carcinomas we regard as less satisfactory because of technical reasons.

Cryoprostatectomy on a highly selected group of patients has produced encouraging results although we would still regard this method of treatment as in its infancy and requiring further assessment. A brief comment is made on 33 cases of benign enlargement and 3 carcinomas of the prostate.
The effect of hepatic artery inflow on regeneration, hypertrophy, and portal pressure of the liver following 50 per cent hepatectomy in the dog
Authors: Mizumot R , Wexler M , Slapak M , Kojima Y , McDermott W V
Published: March 2007

Interruption of the hepatic arterial supply in the dog followed by hemihepatectomy has no deleterious effect on the subsequent regeneration or function of the remaining liver. Deprivation of portal flow to half of an intact liver will result in atrophy of that portion and compensatory hypertrophy of the remaining half. This hypertrophy is unaffected by loss of arterial inflow. Thus hepatic arterial inflow appears to be inessential for either regeneration or hypertrophy of the normal canine liver. Hepatic artery ligation significantly decreases the portal hypertension resulting from hemihepatectomy or ligation of a portion of the portal vein, yet subsequent regeneration and hypertrophy are unaffected. Thus increased intrasinusoidal pressure is probably not a controlling factor in regeneration or hypertrophy of the normal canine liver. The above data may apply to the normal human liver: however, in states where compensatory increase of portal blood-flow cannot occur, hypoxic liver failure may result from interruption of hepatic arterial inflow.
Benign prostatic hypertrophy and uraemia. A review of 315 cases
Authors: David Beck A
Published: March 2007

The overall hospital mortality-rate of 315 patients with benign obstructive prostatic disease and renal failure was 21 per cent. One hundred and ninety-four patients (61·6 per cent) were dealt with by prostatic surgery, in the majority of whom a significant improvement in renal function followed a short period of bladder drainage. Only 10 per cent of the patients managed by preliminary suprapubic cystostomy underwent definitive surgery, the greater proportion dying within 15 months of this minor procedure. The importance of fluid and electrolyte imbalance following the acute relief of a chronic lower urinary-tract obstruction is emphasized and the possible use of preoperative dialysis discussed.
Infected adenolymphoma: A New parotid syndrome
Authors: Patey D H , Thackray A C
Published: March 2007

Two cases are presented of acute inflammatory swellings developing in a parotid gland in elderly men and going on to abscess formation. Both proved to be due to secondary infection of adenolymphomas. In the first case the rupture of the abscess led to a salivary fistula; in the second an associated septicaemia threatened the life of the patient. Both patients were successfully treated by a conservative parotidectomy. From a consideration of the clinical and pathological features, it is suggested that the most likely route of infection of the tumours is the blood-stream.
The effect of hypoxia on the platelet count
Authors: Atkins P , Lempke R E
Published: March 2007

The occurrence of low arterial oxygen tensions in postoperative patients is well established. The effect of hypoxia on platelets was therefore studied in 36 rabbits. Two groups were exposed to low oxygen mixtures and a third group was exposed to air in an environmental chamber. In all groups the period of exposure was 24 hours. The hypoxic rabbits showed increased platelet counts from the first to nineteenth days after exposure. The difference in counts between both hypoxic groups and the control rabbits was statistically highly significant after exposure. An increase in platelets may well be an important factor in the aetiology of venous thrombosis. It is consequently suggested that a prophylactic régime against thrombo-embolism should include vigorous efforts to prevent hypoxia in the postoperative period.
Colitis cystica profunda
Authors: Ghani A
Published: March 2007

A localized type of colitis cystica profunda is described. Its clinical presentation, pathology, and treatment together with a short review of the literature are considered.
Popliteal cysts in children
Authors: Malloch J D
Published: March 2007

Twenty-six popliteal cysts arising in persons under 20 years of age have been excised. In no case was the cyst found to communicate with the knee-joint. Preoperative radiographs in 10 cases confirmed the absence of such a communication. Popliteal cysts in children are congenital bursae and not synovial herniations from the joint. The apparent disappearance of such cysts on flexing the knee is due to the displacement of the bursa to the medial aspect of the knee and not to the displacement of the fluid contents into the joint.
Traumatic perforation in carcinoma of the oesophagus
Authors: Ong G B , Van Langenberg Arthur
Published: March 2007

Two cases of perforated oesophagus due to trauma at the time of examination and biopsy for carcinoma of the mid-thoracic oesophagus are presented. Both had undergone emergency surgical extirpation of growth. One patient, although operated on while still in a state of shock despite resuscitation, survived the procedure and is still alive after more than 5 years. The other case, which was considered to be unsuitable for surgical treatment due to her poor cardiac condition, died on the seventh postoperative day. The cause was probably sudden myocardial insufficiency.
Annular pancreas and jaundice
Authors: Morrell M Tessa , Keynes W Milo
Published: March 2007

1. Eight adult cases of jaundice associated with an annular pancreas have been reported. Two more are added.

2. Jaundice and dilatation of the common bile-duct are usually due to recurrent pancreatitis of the annulus and are rarely due to gall-stones.

3. The dilated duct should be explored for a stone. It is not always necessary to cut the annulus. A stone impacted in the ampulla of Vater may be removed through the common bile-duct if counter-pressure is applied over the papilla.
A controlled trial of inverting versus everting intestinal suture in clinical large-bowel surgery
Authors: Goligher J C , Morris C , McAdam W A F , de Dombal F T , Johnston D
Published: March 2007

A controlled evaluation of a single-layer everting technique of suture versus a conventional two-layer inverting technique has been attempted in clinical large-bowel surgery. Thirty-five patients suffering from carcinoma or other diseases of the large intestine were allocated randomly to each technique in the conduct of various forms of colonic resection with anastomosis or closure of a transverse colostomy. There were 3 operative deaths after everting suture and 1 after inverting suture, all attributable mainly to anastomotic failure. A higher proportion of patients developed wound infection or peritonitis after everting than inverting suture—51 as against 35 per cent. Overt faecal fistulation was observed in no less than 43 per cent of the patients having everting suture, but in only 8·6 per cent of those treated by inverting suture. Late stricture formation was noted in 2 cases after everting suture, but in none after inverting suture.

These experiences are considered to provide a clear condemnation of the use of an everting technique of suture in the large intestine in clinical practice.
Dysphagia following colon pedicle grafts
Authors: Higton D I R , Lord I J
Published: March 2007

A short series of 7 cases who have had colon grafts is presented; postoperative swallowing difficulties are analysed.
A review of three popular methods of treatment of postanal (pilonidal) sinus disease
Authors: Notaras M J
Published: March 2007

Three popular surgical techniques for the treatment of postanal (pilonidal) sinus disease have been evaluated. The lay-open technique appears to have several advantages over the open excision and the primary closure methods.

As the aetiology of this condition is still disputed, and as a result of clinical facts obtained from this study, it is suggested that it be known as a postanal sinus rather than as a pilonidal sinus.
The site of calcification in the human renal papilla
Authors: Cooke S A R
Published: March 2007

In a study of kidneys obtained from adult human subjects at necropsy, the specificity and sensitivity of the alizarin red S method for detecting calcification is confirmed.

A survey of the relevant literature indicates that, while calcification is frequently found in the human renal papilla at necropsy, conflicting opinions have been expressed regarding its anatomical site. In the present study of 62 adult human kidneys, in which specific renal disease had been excluded, papillary calcification was present in 43 (69 per cent). A detailed histological study of the papilla, using thin and thick sections, demonstrates the predominant site of calcification to be in the walls of the long loops of Henle, where it is closely related to the basement membrane.

The nature of papillary calcification and its possible relationship to the physiology of the renal medulla are briefly discussed. The question is raised as to the possible part played by the loops of Henle in the genesis of renal calculi.
Rupture of an abdominal aortic aneurysm into the inferior vena cava. A report of 3 cases
Authors: Seal P V , Shepherd R C
Published: March 2007

Three cases of spontaneous abdominal aortocaval fistula are described and the rarity of this condition is commented upon.

The distinct syndrome which may be associated with an aortocaval fistula is described. The authors emphasize that this syndrome is not an inevitable accompaniment of such a fistula. The management and the surgical technique of repair are restated.
Evaluation of a new alpha-blocking vasodilator agent (thymoxamine) in peripheral vascular disease
Authors: Kane S P
Published: March 2007

The effects on peripheral cutaneous blood-flow of the alpha-receptor blocking drug thymoxamine were measured by strain-gauge plethysmography in 58 subjects. The intravenous drug produced a substantial, though often transient, vasodilatation in the feet of normal subjects, and in most instances increased pedal blood-flow in non-sympathectomized patients with lower-limb arterial occlusions and healthy feet. In patients previously sympathectomized for either non-occlusive or occlusive disease of the lower limbs the effect of the drug was variable, even bringing about a reduction in pedal blood-flow in a number of cases. Intravenous thymoxamine regularly though briefly produced vasodilatation in the hands of patients sympathectomized for primary Raynaud'S disease, but the oral drug had no such action in most instances. It is concluded that systemic thymoxamine is unlikely to be of therapeutic benefit to the sympathecromized patient.
Treatment of carcinoma of the large intestine 1939-1968
Authors: Butler E C B
Published: March 2007

The immediate and late results of 196 cases of carcinoma of the colon and 669 cases of carcinoma of the rectum treated under the care of one surgeon between 1937 and 1968 are reviewed.

In tumours confined to the bowel the uncorrected 5-year survival rate was 75-90 per cent. Spread of the growth to the regional lymph-nodes greatly affected the prognosis. The changing pattern of surgical treatment undertaken during this period is discussed.
Perforated choledochus cyst
Authors: Jackson B T , Saunders P
Published: March 2007

Two cases of perforated choledochus cyst are presented and the literature reviewed. One patient also had cysts of both hepatic ducts and the other hab been followed up for 14 years.

The difficulty of making the diagnosis at laparotomy is stressed and operative cholangiography recommended as a diagnostic aid. A two-stage biliary reconstruction is advised.

Other complications of choledochus cysts are discussed.
Radical mastectomy in the treatment of breast cancer: A follow-up study over ten and fifteen years
Authors: Lee R O , Lambley D G
Published: March 2007

Four hundred and two radical mastectomies have been followed up over a minimum period of 10 years. Postoperative radiotherapy was used only in cases with histologically proved glandular metastasis. The operation mortality was 1.5 per cent; crude survival rate, 44.8 per cent; deaths from other causes, 8.5 per cent; and cancer recurrence rate, 45 per cent. A 15-year follow-up of patients treated before 1955 has shown a further 5.6 per cent of late recurrences. Local recurrence, apart from generalized metastasis, has proved extremely rare in this series.
Resection with exteriorization in the management of faecal fistulas originating in the small intestine
Authors: Goligher J C
Published: March 2007

The management of faecal fistulas originating in the small intestine is discussed, with particular reference to the problems of surgical intervention. A plea is made for the use of resection of the fistulated segment of bowel with exteriorization of the ends whenever this proves practicable. This method was successful in 9 out of 10 cases in which it was employed.
The fate of experimental occlusive venous thrombi a combined histological and venographic study
Authors: Karmody A M , Walker F
Published: March 2007

Although recanalization of occluded veins is thought to be a common occurrence, careful repeated venographic follow-up of patients suggests that this is rare.

An experimental study of the fate of occlusive venous thrombi was carried out by matching the function of the occluded veins over varying intervals of time up to 12 weeks with their histological appearance.

The results show that although large endotheliallined spaces regularly occur in occluded veins, they seldom interconnect to allow a continuous functional channel. In this experiment, therefore, there was little evidence of functional recanalization.

The difficulties of the interpretation of both histological and venographic examinations are discussed and it is suggested that where possible a combination of both methods of investigation would provide the most accurate information on the fate of occlusive venous thrombosis.
Phytobezoar after gastrectomy
Authors: Cohen Yahya , Heun Sung Wing
Published: March 2007

A case of phytobezoar following a Billroth-I partial gastrectomy is reported. It is felt that surgery had interfered with the mechanical and acid-secreting mechanisms of the gastro-intestinal tract causing the formation of a bezoar.
The solitary thyroid nodule: A review of 771 thyroidectomy specimens
Authors: Knowlson G T G
Published: March 2007

A review of 771 thyroidectomy specimens showed an incidence of carcinomas of 4.2 per cent. Despite opinion that the incidence of carcinomas in thyroid nodules is overmphasized, it is felt necessary still to encourage the careful examination of solitary nodules in young patients.
Alimentary complications of non-malignant retroperitoneal fibrosis
Authors: Mitchell R J
Published: March 2007

The incidence of involvement of the alimentary tract by non-malignant retroperitoneal fibrosis is reviewed from the litrature. A further case of involvement of the rectosigmoid is reported. The difficulty of making a preoperative diagnosis is emphasized.
Autografting of small-bowel mucosa
Authors: Wapnick Simon
Published: March 2007

A technique is described whereby small-bowel mucosa has been successfully grafted to the denuded inner submucosal surface of the colon and to the serosa of the stomach.

Small-bowel mucosal grafting may have some application for patients who have had extensive small-bowel resections.
Chylous ascites following vagotomy
Authors: Clain Allan
Published: March 2007

Chylous ascites following vagotomy is of utmost rarity, the second instance in the world literature being herein described. It is probably due to injury to an anomalous lymph-duct at operation. Treatment should be conservative at first, but if ascitic fluid reaccumulates after repeated paracentesis the damaged vessel should be sought operatively.
Triplication of the ureters: A case report
Authors: Corney C
Published: March 2007

A case report of unilateral triplication of the ureters with a single ureteric orifice is described.
A contribution to the study of Hodgkin's disease: A late follow-up
Authors: Patey David H
Published: March 2007

The histories are given of 5 patients treated for Hodgkin's disease in 1955 by thymectomy in addition to the standard procedures of radiotherapy, chemotherapy, and surgery. One died of myeloid leukaemia 6 1/2 years later, 1 died of Hodgkin's disease nearly 13 years later, and 3 are alive and in good general health at between 14 and 15 years later, 2 without disease and 1 with evidence of the disease on radiology and scanning in the liver and spleen. The probability is that these results stem from the standard procedures of treatment rather than from the thymectomy. Possible ways in which thymectomy might have an influence on the course of Hodgkin's disease are discussed. An additional case is reported of a young man who is alive and well without evidence of disease 8 years after excision of a mass of lymphosarcomatous lymph-nodes from the neck followed by thymectomy. No radiotherapy was given.
Carcinoma developing in a drainage sinus of chronic osteomyelitis of the humerus
Authors: Horn C V , Templeton A C
Published: March 2007

A case is reported of a squamous-cell carcinoma arising in a drainage sinus of chronic osteomyelitis of the humerus. The site, the early age of onset, and the short history are remarkable It is suggested that racial variation may account for the early malignant change.
Topical noxythiolin antisepsis. Report of a controlled trial
Authors: Bird G G , Bunch G A , Croft C B , Hoffmann D C , Humphrey C S , Rhind J R , Rosenberg I L , Whittaker M , Wilkinson A R , Hall R
Published: March 2007

Noxythiolin powder, 600 mg., deposited in the layers of the abdominal wall of right iliac fossa musclesplitting incisions after appendicectomy seemed to be without serious side-effects. However, no benefit was observed.
Desmoid tumour (fibroma of the abdominal wall) occurring in siblings
Authors: Gaches Christopher , Burke James
Published: March 2007

The first 2 recorded cases of desmoid tumours occurring in siblings are described. The temporary regression of tumour growth by the use of radiotherapy is noted in 1 case. The treatment of this condition in 1970 remains necessarily surgical despite the evolution of advanced techniques in radiotherapy and chemotherapy.
Muscle blood-flow studies by the technetium (99mTc) clearance technique in normal subjects and in patients with intermittent claudication
Authors: Cutajar C L , Brown N J G , Marston Adrian
Published: March 2007

Muscle blood-flow was estimated in 37 subjects (42 legs) with clinically patent arteries and in 50 patients (82 legs) with a peripheral vascular block by studying the clearance of technetium (99mTc) as sodium pertechnetate injected into the lateral head of the gastrocnemius. The data were computed to determine the clearance of the isotope, expressed as a half-life (T½), during exercise and in the post-exercise period.

The results showed that 99mTc is a convenient and reliable tracer for the investigation of muscle blood-flow.

It was found that all legs prodcing symptoms were abnormal according to one or both of the following criteria:— The exercise T½ was more than 3 minutesThe post-exercise T½ was less than the exercise T½.

Possible reasons to account for the slower clearance of technetium from the ischaemic limb during exercise as compared with normal muscle are discussed.

The test may have useful application in the selection of patients for reconstructive arterial surgery and in the assessment of operative results.
A large pharyngeal diverticulum
Authors: Morris T M O , Wright P J M
Published: March 2007

A large pharyngeal diverticulum is described which was treated by one-stage excision.
Technique of orthotopic liver transplantation in the pig
Authors: Chalstrey L J , Parbhoo S P , Tappin A , Baker G J , Gracey L R H , Mullen P A , Lester R
Published: March 2007

A technique of orthotopic liver transplantation in the pig is presented. Details of modifications in anaesthesia, collection of blood, and preparation of the donor liver are given. The use of a single venous by-pass, end-to-end hepatic artery anastomosis, and vagal crush with pyloromyotomy to prevent gastric ulceration have simplified the procedure and so reduced the operation time.
Arterial autografts in the rat
Authors: Froggatt D L
Published: March 2007

It is shown that important histological changes occur in autografts in the rat aorta. These changes include the loss of endothelium and the degeneration of elastin.

Such changes may be the result of ischaemia in the grafts caused by destruction of the vasa vasorum.
Intracranial neurological complications of frontal and ethmoidal osteomas
Authors: Bartlett J R
Published: March 2007

The clinical histories of 5 patients with osteomas involving the fronto-ethmoidal air sinuses who had cranial complications are reported. The importance of an adequate exposure to reveal the defects in the dura is emphasized. The selection of asymptomatic patients for surgical treatment is discussed in the light of the natural histories of the present cases.
Percutaneous transhepatic cholangiography
Authors: Machado Antonio Lacerda
Published: March 2007

The author reports his experiences with a technique which is extremely helpful not only in distinguishing between intra- and extrahepatic cholestasis but also in establishing preoperatively the aetiology of the jaundice, in this way helping the surgeon to choose the best surgical procedure.

The technique employed, the criteria of selection of the patients, the complications, and the results obtained in 53 patients are described.

To date, 53 patients have undergone percutaneous transhepatic cholangiography, and a total of 56 examinations have been performed in the radiography department under local anaesthesia.

In 1 patient a severe bile leakage occurred with signs and symptoms of biliary peritonitis and peralytic lesions.

The biliary tree was outlined in 41 patients out of 47 (87.2 per cent) with obstructive jaundice. In 6 patients the method failed (12.8 per cent).
A possible vascular factor in the aetiology of duodenal ulceration
Authors: Piasecki C
Published: March 2007

Study of vascular pathways showed a variation of pattern localized to the ulcer-bearing area of the duodenum in 7 out of 10 specimens. This together with gastric distension may afford an explanation of the localization of duodenal ulcers.
Subcutaneous lateral internal anal sphincterotomy for anal fissure
Authors: Millar D M
Published: March 2007

This paper describes a method of lateral internal sphincterotomy for anal fissure entirely by palpation, a technique which gives results similar to those performed under direct vision, and is superior to posterior sphincterotomy and stretching of the sphincter. It has been employed in patients with episodic and chronic diarrhoea with equally satisfactory results. Lateral sphincterotomy preserves the external anal sphincter and it is suggested that this is the main reason for the low incidence of defects of anal continence as compared with other procedures.
Prediction of success or failure of gastric surgery
Authors: McColl I , Drinkwater J E , Hulme-Moir I , Donnan S P B
Published: March 2007

By means of the Eysenck Personality Inventory and a careful interview it proved possible to predict the outcome of surgery for duodenal ulcer as far as patient satisfaction was concerned. Success was accurately predicted in 20 out of 22 cases and failure was accurately predicted in 8 out of 10 cases.
Factors affecting the metabolic expenditure of surgical patients
Authors: Tweedle David , Johnston Ivan D A
Published: March 2007

The estimation of resting metabolic expenditure in surgical patients by indirect calorimetry is possible using Noyon's (1937) diaferometer. The limitations of this instrument are described.

Utilization of carbohydrate appears to be diminished following operation. Fat becomes the main calorie source and there is an increased catabolism of protein. Patients who are undergoing uncomplicated, elective surgery of moderate severity and who are given a low calorie intake show no change in total metabolic expenditure after operation. The administration of parenteral nutrients reverses the negative balances of nitrogen and of energy and increases resting metabolic expenditure.
Conservative surgery in 100 patients with bleeding peptic ulcer
Authors: Boulos P B , Harris J , Wyllie J H , Clark C G
Published: March 2007

The results of treatment of 100 patients with bleeding peptic ulcer, using the conservative surgical approach of vagotomy and pyloroplasty with suture of the ulcer, have been analysed. This approach is satisfactory for patients with doudenal ulcer and in selected cases of gastric ulcer. It is not satisfactory in the treatment of erosive gastritis.
Elective lymph-node dissection for melanoma
Authors: Davis Neville C , McLeod G Roderick
Published: March 2007

The value of elective lymph-node dissection in the treatment of malignant melanoma is controversial. It can be beneficial only if the apparently normal lymph-nodes contain metastases. Unfortunately, there is no way of telling before operation whether they do or not. However, a knowledge of the factors which suggest, on statistical grounds, a good or bad prognosis can help to forecast whether the lymphnodes are likely to contain metastases.

If there are factors suggesting a good prognosis the regional nodes are not likely to contain occult metastases. In these circumstances elective dissection should be avoided and reliance placed on regular clinical evaluation of the nodes with subsequent therapeutic dissection if indicated.

If there are factors suggesting a bad prognosis the regional nodes may contain occult metastases and prophylactic dissection should be seriously considered. However, if follow-up facilities are good the alternative method of obseration is acceptable and the choice of treatment will rest with the surgeon and the patient.

The site of the tumour is also important. If a deeply invasive melanoma overlies or is immediately adjacent to the regional nodes, elective dissection is indicated. On the other hand, if the melanoma is in an area with unpredictable lymph drainage or if it is at a distance from the nodes, observation is the best policy.
Biliary-tract disease in malaya
Authors: King M S
Published: March 2007

A review was carried out of the pattern of biliarytract disease in Malaya where the population consists of three major groups: Malays, Chinese, and Indians. The review was based upon (a) a study of the comparative incidence of operations for biliary disease in the six large general hospitals serving West Malaya, and (b) a more detailed study of 120 consecutive patients undergoing operations on the biliary tract in the University Hospital, Kuala Lumpur.

Biliary-tract disease requiring operation is common in Malaya, and appears to be more common in Indians and Malays than in the Chinese.

Two distinct patterns of biliary-tract disease are encountered. The majority (two-thirds) of the patients have a disease similar to the Western type of cholelithiasis, but the remaining one-third have a disease, ‘Oriental cholangitis’, of a distinctly different pattern, with a different sex ratio, a high incidence of infected bile, and the almost invariable presence of jaundice and soft stones in the common duct.

Oriental cholangitis was found in Chinese, Indian, Malay, and Aborigine patients in this survey, and is not, therefore, confined to the Chinese and Japanese as previously suggested.
Surgical correction of intrarenal arteriovenous fistula with preservation of the kidney
Authors: State David , Bernstein Robert , Smith Theodore , Reid Roberto
Published: March 2007

A patient with a calcified arteriovenous fistula of the left kidney was correctly diagnosed by selective renal arteriography. At surgery it was possible to identify the single vessel supplying the arteriovenous fistula and to ligate it with correction of the vascular abnormality. The end-artery characteristics of the renal arterial distribution make this surgical approach feasible and, in addition, permits the salvage of the involved kidney.

Although renal arteriovenous fistula is not a common condition, with the increasing number of people having needle biopsies of the kidney as well as experiencing major abdominal injuries, its existence should be kept in mind whenever such patients develop abdominal pain, bruit, cardiomegaly, congestive heart failure, and diastolic hypertension. Early surgery is indicated, with the primary aim being the eradication of the vascular abnormality and salvage of the kidney if at all possible.
Vascular injuries of the upper thorax and the root of the neck
Authors: Samaan H A
Published: March 2007

The great danger of injury to the branches of the arch of the aorta near their origin is the occurrence of severe uncontrolled haemorrhage. Five cases of traumatic injury to the branches of the aortic arch are presented. In the first case the innominate artery was ruptured near its origin and was repaired with a Dacron prosthesis. In the second case the left subclavian and the left common carotid arteries were cut near their origins and these vessels were ligated in an attempt to preserve life following severe unexpected haemorrhage. The patient recovered but developed a left subclavian steal syndrome. A third case developed a right subclavian artery aneurysm following a crush injury of the chest. The first right rib was also broken. In the fourth case a left subclavian steal syndrome developed 10 years after a crush injury to the upper chest. The fifth case, a 76-year-old man, had temporary ischaemic changes in his left hand following a crush injury to his chest. The left subclavian artery was thrombosed at its junction with the axillary artery as a result of a comminuted fracture of the left clavicle. The circulation to the left hand returned to normal 4 days following the injury.
The use of natural rubber latex in the study of the hollow systems of the liver
Authors: Balasegaram M
Published: March 2007

A new injection-corrosive technique for studying the liver architecture using rubber latex is described. The advantages and disadvantages of this technique compared with previous ones are discussed.
Bilateral double nipples
Authors: Brightmore Terence
Published: March 2007

Two cases are reported of bilateral double nipples occurring within the areolae of the normal breasts. The association of congenital lesions of the nipple and certain diseases is discussed.
Spontaneous rupture of the stomach in an adult
Authors: Jefferiss Christopher D
Published: March 2007

A case of spontaneous rupture of the stomach in an adult is described following retching with pyloric stenosis. A table of the more recent of the 47 cases described in the world literature is given with references to all the reported cases.
Hyperkalaemia following temporary occlusion of the portal vein and hepatic artery
Authors: Hall R R
Published: March 2007

Temporary occlusion of the hepatic artery and the portal vein during operations on the liver has been considered a safe procedure provided that the period of ischaemia is not extended beyond 20–30 minutes. Measurement of serum potassium in the portal and systemic circulation of dogs which were subjected to 20 minutes' hepatic ischaemia reveals a transient hyperkalaemia of sufficient degree to cause cardiotoxicity. It is concluded that even this short period of inflow occlusion to the liver is inadvisable.
The routine use of ultrasound for the diagnosis of postoperative deep-vein thrombosis in a district general hospital
Authors: McIlroy R F
Published: March 2007

The results of 6 months' experience in routine screening for deep-vein thrombosis in all postoperative patients in a district general hospital are presented. Clinical methods and ultrasound diagnosis are compared. Ultrasound was found to be easy and safe to use and to be more accurate than clinical methods. A case is made for the use of ultrasound as a routine method of screening postoperative patients for deep-vein thrombosis.
The fate of aortic valve homografts an experimental study
Authors: Savage P E A , Jones D G Clayton , Thompson A E , Ross D N
Published: March 2007

Segments of homograft aortic valve cusp and aortic sinus wall have been inserted as patches in the abdominal aortic wall of sheep. The donor valves were prepared in one of three ways: (1) fresh valves, (2) freeze-dried valves sterilized with antibiotics and ethylene oxide, and (3) valves which had been cooled at a controlled rate to – 70°C. in a medium containing the cryoprotective agent, dimethyl sulphoxide. Histological examination of the implanted tissue obtained at intervals up to 2 years failed to show survival of any donor cells, whichever method of preparation had been used. The elastic tissue in the freeze-dried series had become calcified by 2 years, and although valves prepared in this way appeared to elicit no immunological response, both the fresh and frozen tissue were infiltrated by lymphocytes and plasma cells by 2 weeks. This round-cell infiltration reached a peak at 4 weeks and then subsided again. The response to fresh valves was more marked and more prolonged than that to frozen valves.
Atrophy Following Testicular Torsion
Authors: Burton James A
Published: March 2007

A personal series of 17 cases of torsion of the testis collected over a 3½-year period is reviewed. The incidence is seen to be low in the general population but misdiagnosis is common in the acute condition. The relevant embryology, histology, and signs and symptoms of the condition are described. A number of the patients had unilateral testicular atrophy following a previously misdiagnosed torsion years earlier. Their subsequent management is described. The differential diagnosis is briefly mentioned.
Aorto-Enteric Fistulae: An Uncommon Complication of Abdominal Aortic Aneurysms
Authors: Reckless J P D , McColl I , Taylor G W
Published: March 2007

Three cases of aorto-enteric fistula which have been treated successfully by resection of the aortic aneurysm are described. Only 5 other successful cases have been reported. One hundred and thirty-one cases are reviewed and analysed, and though more than half of these survived for 24 hours or longer after the first gastro-intestinal haemorrhage, no untreated long-term survival has been recorded. We feel that urgent assessment and early corrective surgery is the only treatment which offers a reasonable chance of survival.
Ruptured mycotic aneurysm of the spleen
Authors: Dukes Heather M , Mynors John M
Published: March 2007

The fourth recorded survivor of a ruptured splenic aneurysm is presented. He is also remarkable for his multiple pathology including bacterial endocarditis, aortic incompetence with multiple peripheral embolism, and neurofibromatosis.

It is emphasized that mycotic aneurysms of the spleen are an unusual complication of bacterial endocarditis, and a high index of suspicion is essential for their diagnosis. Treatment must be prompt and effective.
Leiomyoma of the appendix
Authors: Cullen T H , Voss H J
Published: March 2007

A case of a very large leiomyoma of the appendix is reported. References to this condition are rare and the presentation of this case is unusual.
Femoral aneurysms
Authors: Hardy D G , Eadie D G A
Published: March 2007

Femoral aneurysms are a relative rarity in clinical practice. A series of 15 such aneurysms treated in a variety of ways is presented. The method of treatment did not appear to affect the outcome. Where the aneurysm was found to be infected at operation treatment was not successful. An alternative method of arterial reconstruction by endo-aneurysmorrhaphy is presented.
Haemangiomata of skeletal muscle
Authors: Fergusson I L C
Published: March 2007

Two cases of skeletal muscle haemangiomata are described.

All previous cases of this condition are reviewed and a brief account is given of the important facets of aetiology, diagnosis, and treatment.

Wherever a soft-tissue swelling presents in the region of skeletal muscle the possible diagnosis of a haemangioma should be considered and may frequently be confirmed pre-operatively with the aid of radiography.

Local excision remains the treatment of choice wherever possible.
Spontaneous rupture of the oesophagus. Avoidance of postoperative morbidity
Authors: Keighley M R B , Girdwood R W , Ionescu M I , Wooler G H
Published: March 2007

Twelve cases of ‘spontaneous rupture’ of the oesophagus occurring over a period of 20 years (1951–71) are reviewed. The principal clinical and radiological features are described and the factors concerned in the pathogenesis of this condition are discussed. Although the mortality rate in this study was low (8 per cent) the incidence of severe post-operative complications was considerable, occurring in 10 of the 11 operative survivors. The importance of early diagnosis and adequate surgical treatment in the avoidance of this high morbidity is stressed.