bluuebunny/crossref_metadata_2025 huggingface dataset:
The low stapled anastomosis
Authors: Heald R J , Leicester R J
Published: March 2007

The complications of 100 stapled anastomoses onto the rectum or anus are reviewed. Anastomotic leakage in very low cases is the major problem; no leak occurred if the anastomosis was performed above 7 cm, but 3 leaks in 17 patients occurred if the anastomosis was performed between 5·5 and 7 cm, and 10 leaks occurred in 52 patients if the anastomoses was less than 5 cm from the anal margin. A covering colostomy is essential for these lower anastomoses, and for those not covered by a colostomy, an immediate colostomy with a distal loop washout is performed, if a leak develops. Attention to technique is mandatory, with a good blood supply, absence of tension and the elimination of the pelvic cavity being of great importance.
Complications of anterior resection of the rectum using the EEA stapling device
Authors: Cade David , Gallagher Patrick , Schofield Philip F , Turner Leslie
Published: March 2007

Fifty patients had anterior resection of the rectum performed with end-to-end anastomosis using the EEA stapling device. The instrument certainly facilitated low anastomoses, but anastomotic dehiscence occurred in 3 cases, stenosis in 2, wound sepsis in 10, some degree of incontinence (usually only temporary) in 7 and anal fissure in 4 cases.
British experience with duodenoscopic sphincterotomy for removal of bile duct stones
Authors: Cotton Peter B , Vallon A G
Published: March 2007

Duodenoscopic sphincterotomy is rapidly becoming popular in Britain. Representatives of 14 British centres met in January 1980 to discuss progress and problems with the technique. This report summarizes current experience, with particular reference to hazards.

Duodenoscopic sphincterotomy is mainly being used in patients who have previously undergone cholecystectomy and who no longer have a T tube drain in place. Sphincterotomy was achieved in 87 per cent of 679 patients attempted, and the common duct was cleared of stones in 87 per cent of these. Immediate complications followed in 8·5 per cent; 1·6 per cent required urgent surgery and 7 patients (1 per cent) died. Centres with the greatest experience had better results and fewer complications.

Those performing duodenoscopic sphincterotomy believe it to be a major advance in the management of high risk patients with common duct stones, after cholecystectomy. Its use remains controversial in high risk patients who still have gallbladders and in low risk patients after cholecystectomy; long term follow-up studies are essential.
Endoscopic sphincterotomy: Indications and results
Authors: Viceconte Giovanni , Viceconte Guido W , Pietropaolo Vincenzo , Montori Alberto
Published: March 2007

Endoscopic sphincterotomy (ES) is a simple, effective and remarkably safe method of treatment of choledocholithiasis and papillary stenosis. In this series, ES was technically successful in 255 (86·1 per cent) of 296 patients in whom it was attempted. Forty-nine of the successful cases had papillary stenosis complicated by pain, cholangitis and/or jaundice in patients after cholecystectomy; 205 had choledocholithiasis, of whom 164 had a cholecystectomy and 41 were poor surgical risks and did not have cholecystectomy. One patient had a tumour of the ampulla of Vater. ES has been performed as an emergency in 16 subjects because of severe septic cholangitis in 11 and acute biliary pancreatitis in 5.

Of the 205 patients with choledocholithiasis, spontaneous passage of calculi after ES occurred in 151 cases (73·6 per cent), and instrumental extraction of stones was possible in 44 (21·5 per cent); 10 patients (4·9 per cent) had residual stones and required surgery. In this series the overall success rate of ES in removing common bile duct stones was 82 per cent in 238 cases; in the patients with benign papillary stenosis ES was successful in relieving symptoms and biochemical cholestasis in 72 per cent of 57 cases.

Complications occurred in 18 cases (7 per cent): cholangitis in 4 (1·6 per cent) and haemorrhage in 14 (5·4 per cent). Two patients (0·8 per cent) with acute bleeding following ES died; in one of these surgery had been performed to arrest the haemorrhage, but the patient died 3 days after operation of hepatorenal failure. The other complications were treated conservatively without mortality.
Acute pancreatitis associated with campylobacter infection
Authors: Gallagher P , Chadwick P , Jones D M , Turner L
Published: March 2007

We report a case of acute pancreatitis associated with campylobacter infection. The patient presented with clinical symptoms and signs which suggested acute appendicitis. However, she was found to have acute pancreatitis with an acute campylobacter infection.

Recent reports have shown that campylobacter is pathogenic in the biliary tract, and we suggest that it may also be responsible for some cases of acute pancreatitis in the absence of biliary disease.
The clinical significance of heterotopic pancreas in the gastrointestinal tract
Authors: Armstrong C P , King P M , Dixon J M , Macleod I B
Published: March 2007

A series of 34 histologically verified cases of pancreatic heterotopia in the records of the Department of Pathology at the University of Edinburgh between 1959 and 1979 has been analysed in order to determine the clinical significance of this unusual condition. In 13 patients (38 per cent) the heterotopic pancreatic tissue was symptomatic (i.e. the symptoms regressed completely on its removal). A correlation has been established between the presence of symptoms, the size of the lesion and the extent of mucosal involvement. Clinically significant lesions are greater than 1·5 cm in maximum diameter and are adjacent to or directly involve the mucosa.
The measurement of gastric emptying: A comparison of fixed scintillation detection and the double-sampling technique
Authors: Blake G , McKelvey S T D
Published: March 2007

The gastric emptying of a fluid meal was measured simultaneously by fixed scintillation detection and the double-sampling technique in 14 normal subjects and 15 patients who had a vagotomy and drainage procedure. In the normal subjects good correlation was obtained between the two methods but in the operated group there was poor correlation owing to difficulty in measuring the initial rapid emptying phase by fixed scintillation detection.

Modification of the fixed scintillation method allows it to be used accurately in postoperative patients. The radioactivity of the meal is measured in vitro before ingestion and this reading is converted, using a constant derived from normal subjects, to a baseline value to which the subsequent in vivo readings are related. This modified technique permits the investigation of gastric emptying of fluid meals in patients with postvagotomy syndromes without the discomfort of a nasogastric tube. The equipment required is inexpensive.
Chemotherapy following palliative resection of gastric cancer
Authors: Lawton John O , Giles Geoffrey R , Hall Robert , Bird G G , Matheson Thomas
Published: March 2007

Twenty-five patients with residual tumour after resection of a primary gastric cancer were randomized to receive either 5-Fluorouracil or BCNU postoperatively or kept under close observation. Some patients receiving chemotherapy may have benefited by a delay in progression of their disease but this was short lived and subsequently all but one patient has died within a 4-year period of follow-up. There does not seem to be any advantage in treating patients who have residual gastric cancer with 5-FU and BCNU therapy.
Treatment of anal fissure by lateral subcutaneous sphincterotomy should be under general anaesthesia
Authors: Keighley M R B , Greca F , Nevah E , Hares M , Alexander-Williams J
Published: March 2007

Seventy-one consecutive patients with acute anal fissure were randomly allocated to treatment by lateral subcutaneous sphincterotomy under either local anaesthesia (n=34) or general anaesthesia (n=37). Four months after treatment there were 18 patients with a recurrent or persistent anal fissure, 17 had had local anaesthesia (50 per cent) and only one had a recurrent fissure after general anaesthesia (3 per cent). These results indicate that if lateral subcutaneous sphincterotomy is used for treatment of anal fissure the operation should be performed under a general anaesthetic.
Segmental mega-ileum presenting as anaemia
Authors: Leinster S J , Hughes L E
Published: March 2007

Three cases are described of an unusual malformation of the ileum at the site of the vitelline duct, which presented with chronic anaemia. In each case localized mega-ileum was associated with a simple, non-specific ulcer leading to chronic blood loss. Two cases were at the site of and associated with a Meckel's diverticulum, while the third case was at the same level and associated with a vascular abnormality probably of vitelline artery origin. This syndrome of adult segmental ileal dilatation associated with non-specific ulcer and chronic anaemia does not appear to have been described previously.
Correlation of Doppler-derived high thigh pressure and intra-arterial pressure in the assessment of aorto-iliac occlusive disease
Authors: Flanigan D Preston , Gray Billie , Schuler James J , Schwartz John A , Post Kenneth W
Published: March 2007

Ninety-five lower extremities in 53 patients underwent iliofemoral arteriography, high thigh wide cuff Doppler pressure measurements and direct intra-arterial pressure measurements at the common femoral level to determine the accuracy of the high thigh Doppler technique in the evaluation of aorto-iliac occlusive disease using intra-arterial pressure as the standard.

Results showed the high thigh cuff Doppler technique to be 79 per cent sensitive, 56 per cent specific and 63 per cent accurate in the evaluation of haemodynamically significant aorto-iliac disease. There was a false negative rate of 13 per cent, but a false positive rate of 59 per cent. All false positive tests were shown to be secondary to superficial femoral artery disease.

These results indicate that a normal high thigh wide cuff Doppler pressure is generally reliable in ruling out haemodynamically significant aorto-iliac occlusive disease at rest. An abnormal result, however, does not differentiate between aorto-iliac and superficial femoral artery disease.
Diagnosis, treatment and operative complications of carotid body tumours
Authors: Van Asperen De Boer F R S , Terpstra J L , Vink M
Published: March 2007

A series of 42 patients who were treated in the Surgical Clinic of the University of Leyden on suspicion of a carotid body tumour between 1958 and 1979 is reported. Thirty-four patients in this series were operated upon in the University Hospital Leyden. Only 6 per cent of the tumours were malignant according to the criteria of nuclear polymorphia and metastases. Local infiltration, either histological or clinical, has no correlation with later outcome. In 11 per cent of the patients, vascular complications occurred. The necessity of operative damage to the surrounding cranial nerves increased with the size of the tumour. In one case the cranial nerve lesion was accidental. No per- or postoperative mortality was seen in this series.
Hyperparathyroidism in peptic ulcer patients
Authors: Mowat Elizabeth , Gunn A , Paterson C R
Published: March 2007

The high incidence of peptic ulcers and abdominal pain from other causes in patients with primary hyperparathyroidism has been recognized for many years. This paper reports 20 patients with hyperparathyroidism: 12 with peptic ulcers and 8 with abdominal pain from other causes. Only in a minority of these was the diagnosis of hypercalcaemia made as a result of a deliberately sought assay; in most the plasma calcium had been measured as part of a ‘screening’ procedure with a multichannel analyser. In almost all of the patients who had parathyroid surgery the abdominal symptoms were completely relieved. We urge that plasma calcium assays should be made in all patients with dyspepsia particularly those with recurrent symptoms.
Massive hepatobiliary ascariasis in childhood
Authors: Lloyd D A
Published: March 2007

Migration of one or two worms into the biliary tree is a well-known complication of Ascaris lumbricoides infestation of the intestine. Massive infestation of the bile ducts and liver is uncommon, often difficult to diagnose and leads to complications if not promptly and effectively treated.
The solitary thyroid nodule
Authors: Sykes David
Published: March 2007

In a 4-year period the solitary thyroid nodule was the most common form of thyroid pathology seen in the surgical section of a thyroid clinic. The cold thyroid nodule was the most frequent type of solitary nodule and half of these were unilocular cysts which were treated by aspiration and sclerotherapy. Cytological examination of the aspirated fluid revealed no evidence of malignant cells. Emphasis is placed on recommending operation if aspiration fails to cause the mass to disappear.
Cholecystectomy and cancer of the large bowel
Authors: Turnbull P R G , Smith A H , Isbister William H
Published: March 2007

A matched case control study was conducted in order to determine the association between previous cholecystectomy and the development of large bowel cancer. One hundred and sixty men and 145 women presenting with large bowel cancer were studied. One control was selected for each case matched according to age, sex and date of admission. The medical records for each patient in the study were reviewed for evidence of previous cholecystectomy. No association was found among male patients, but for women an estimate of relative risk of 2·7 was obtained for patients who had had previous cholecystectomy. This association was largely a consequence of the fact that 10 female patients with rectal cancer had had a previous cholecystectomy compared with only one of their controls. It is possible that carcinogenic breakdown products of bile salts are most concentrated in the distal portion of the large bowel, but it is difficult to explain why the association should be confined to women only.
The microflora of the postoperative stomach
Authors: Muscroft T J , Deane S A , Youngs Denise , Burdon D W , Keighley M R B
Published: March 2007

The microflora and pH have been assessed in gastric aspirates from 163 patients after gastric surgery and have been compared with 51 patients with gastro-oesophageal carcinoma, 152 unoperated patients with peptic ulceration, 72 of whom were receiving cimetidine, 3 patients with pernicious anaemia and 27 normal subjects. The total viable bacterial count was closely related to the pH of the aspirate and was independent of the cause of the hypochlorhydria; 90 per cent of aspirates of pH 1–2 were sterile, while 94 per cent of those of pH 4–8 contained bacteria.

Escherichia coli was found significantly more frequently in the postoperative and cancer groups, and Clostridium spp. were significantly more common in patients with carcinoma. Elevated gastric juice nitrite concentrations were significantly more common in aspirates of pH 4–8 and this correlated well with the presence of nitratereducing bacteria. The pH of an aspirate is a good indicator of the presence of bacteria and may be useful in selecting patients requiring postoperative prophylactic antibiotic cover. Hypochlorhydric patients are exposed to increased concentrations of nitrite and there may be an increased risk of gastric cancer induced by N-nitrosocompounds.
The laboratory assessment of a new fabric for reducing bacterial penetration of operating theatre apparel
Authors: Goldthorp Steven L
Published: March 2007

A one-piece experimental suit was made up from Gore-Tex fabric and assessed in an environmental chamber using 20 male volunteers with respect to reducing airborne contamination. Comparison was made with a similar cotton suit, a two piece short-sleeved cotton suit (blues) and ‘Y-front’ underpants (briefs). The Gore-Tex suit produced a reduction in contamination (with 95 per cent confidence limits) of 85·9±5·9 per cent over the cotton suit and over the blues and briefs at similar levels. Scanning electron microscopy showed that bacterial penetration would not occur.
Perforation of the oesophagus: Experience in a general hospital
Authors: Banks James G , Bancewicz John
Published: March 2007

The results of a retrospective study of 62 patients who sustained perforation of the oesophagus during the period 1956–78 are reviewed. Oesophageal instrumentation was implicated in 40 patients. A total of 69 per cent of perforations occurred in the lower third; 45 per cent of patients remained undiagnosed for at least 24 h and in 23 per cent the diagnosis was made only at post-mortem examination. Operative and non-operative management resulted in mortality rates of 48 per cent and 62 per cent respectively. Delay in operative treatment for more than 6 h was associated with increased mortality. However, 5 of 8 patients in whom diagnosis was delayed for more than 48 h recovered. The reason for this is discussed. The indications for conservative treatment are few and well defined; surgery is the treatment of choice. Early diagnosis and treatment are required if the mortality from oesophageal perforation is to be reduced.
The results of Ramstedt's operation in a district general hospital
Authors: Bristol J B , Bolton R A
Published: March 2007

From 1970 to 1979 78 pyloromyotomies were performed for congenital hypertrophic pyloric stenosis in the Royal United Hospital in Bath. Fourteen surgeons were involved. Fifty-eight operations were performed using local anaesthesia, and in this group a significantly smaller number of infants vomited postoperatively compared with those given general anaesthesia. There were no deaths, but a relatively high proportion of complications were encountered. These complications were related to the infrequent performance of the operation by the surgeons concerned rather than to the choice of anaesthetic. Pyloromyotomy should be carried out by surgeons with a special interest in the condition. Local anaesthesia offers an advantage by limiting postoperative vomiting.
Prevention of arterial prosthetic graft infection by lavage and peritoneal dialysis in diffuse peritonitis: A report of 2 cases
Authors: Renvall Seppo , Havia Tapani
Published: March 2007

Two cases of peritonitis following insertion of an aortofemoral bypass graft are reported. In both, treatment with peritoneal lavage and postoperative dialysis was successful.
Dynamic radionuclide scanning of the testis in acute scrotal conditions
Authors: Thomas W E G , Cooke P H , Davies E R , Jackson P C , Williamson R C N
Published: March 2007

The role of dynamic radionuclide scanning of the testis has been assessed in 45 patients presenting with acute testicular pain or swelling. The technique is a simple, safe and rapid method for assessing testicular blood flow; the results correlate closely with the clinical course or the findings at surgical exploration. Decreased uptake is diagnostic of testicular ischaemia resulting from acute torsion of the spermatic cord. A resolved torsion may not be detected because the testis is no longer ischaemic and may actually show increased uptake due to reactive hyperaemia.
The influence of high and low sodium intakes on postoperative antidiuresis
Authors: Tindall S F , Clark R G
Published: March 2007

There remains some doubt over the influence of intravenous fluid and electrolyte therapy on the development of postoperative hyponatraemia. We believe the effect of varying sodium intakes on fluid balance during both the early antidiuresis phase and the later postoperative period has received insufficient emphasis. Therefore, the effects of intravenous regimens. containing either 450 mmol/24 h of sodium (saline group) or no sodium (dextrose group), on salt and water balance, plasma sodium and plasma water concentrations have been studied in two groups of 6 patients undergoing upper abdominal surgery.

Hyponatraemia was not seen in the saline group but marked salt (+1023 mmol) and water retention (+3509ml) were seen by day +4. The dextrose group became relatively hyponatraemic (131.8 mmol/1) by day +1 but, following a phase of fluid retention during the 24 h following surgery, they developed negative fluid balance with some recovery of plasma sodium levels.

This study confirms the importance of the sodium content of intravenous fluids both on the early development of hyponatraemia and on water and salt balance during the later postoperative period.
Total gastrectomy for gastric carcinoma: A retrospective study of different procedures and assessment of a new technique of gastric reconstruction
Authors: Lygidakis N J
Published: March 2007

A retrospective study of the value of reconstructive surgery after total gastrectomy for gastric carcinoma in 118 patients who underwent different types of reconstructive procedures is presented.

Dissatisfaction with established methods of reconstruction led to the development of a new technique. The new method was associated with less regurgitation, less dumping and functioned as a reservoir without undue delay in emptying time. It was associated with an improved quality of life in the postoperative period, with minimal dumping symptoms, maintenance of weight and the ability to return to work. The mortality and morbidity of the new method are acceptable and it thus offers not only an improved reconstructive procedure for total gastrectomy after resection for gastric cancer, but offers potential for reconstructive surgery after total gastrectomy carried out for other reasons.
‘Currents and clots’—an approach to the problem of acute variceal bleeding
Authors: Taylor T V , Neilson J M M
Published: March 2007

The Sengstaken—Blakemore tube will frequently control haemorrhage from oesophageal varices but a large proportion of patients rebleed soon after removing the tube and the hospital mortality in these patients is high. It has been demonstrated that the passage of an electric current across a blood vessel wall will precipitate a thrombus on the positively charged electrode, leading to complete occlusion of the vessel. A direct current of 3.2mA/cm2 of electrode passed for 1 h produced complete occlusion of the femoral vein in the dog, without arterial occlusion or adjacent tissue damage. A system of longitudinal flexible gold-plated strip electrodes was placed around the oesophageal component of a Sengstaken tube. The technique has been applied in 8 poor risk patients with active variceal bleeding; haemorrhage was arrested in 7 of these on removal of the tube.
Retrograde electrical pacing of the small intestine—a new treatment for the short bowel syndrome?
Authors: Layzell Trevor , Collin Jack
Published: March 2007

Retrograde electrical pacing has been shown to increase absorption of sodium, glucose and water from a continuously perfused jejunal segment in dogs. Under similar circumstances, absorption of xylose, magnesium, calcium and chloride was also increased by pacing compared with before and after its use (P<0.005). Following massive distal small intestinal resection, dogs undergoing post-cibal retrograde pacing showed an increase in body weight (P<0.005) and a decrease in faecal fat (P<0.005) and nitrogen (P<0.01) losses during the test period, compared with similarly prepared dogs who did not undergo pacing. These results suggest that post-cibal retrograde electrical pacing of the small intestine may have a place in the management of patients with the short bowel syndrome.
Perineal rectopexy for rectal prolapse
Authors: Wyatt Arthur P
Published: March 2007

Twenty-two female patients (mean age 75 years) with complete rectal prolapse have been treated by operative fixation of the rectum to the sacrum using a perineal approach. There has been no operative mortality, sepsis or serious morbidity. Recurrence of complete prolapse has been seen once only within a month of operation and was due to inadequate operative fixation. The other 21 patients have been followed for up to 4 years. This type of operation may be the treatment of choice in the elderly patient considered unfit for major abdominal surgery but further experience is required before it can be advocated in other groups of patients.
Surgical management of injuries of the large intestine
Authors: Parks T G
Published: March 2007

During the period 1969–79, 106 patients were admitted to the Royal Victoria Hospital in Belfast suffering from injuries of the large intestine as a consequence of civil disturbances in Northern Ireland. Eighty-eight of these had penetrating wounds of the colon or rectum. Eighteen patients died as a result of multiple injuries. In these patients there was an average of 3.6 intra-abdominal organs injured compared with a mean of 2.2 in non-fatal cases. There were no deaths among patients who had isolated colonic or rectal injuries.
Lord's procedure for haemorrhoids: A prospective anal pressure study
Authors: Hancock Brian D
Published: March 2007

Forty-eight patients treated by Lord's procedure were studied prospectively with preoperative and several postoperative anal pressure recordings over at least 5 years.

Excellent long term results were obtained in the patients with first and second-degree haemorrhoids but only just under half of those with third-degree haemorrhoids were symptom-free.

There was some evidence that patients with the most active internal sphincter had the best clinical results.

Pressure was significantly reduced by dilatation and pressure remained static over the next 5 years. Five patients developed recurrent symptoms between 1 and 5 years after dilatation. It was not possible to predict relapse from serial anal pressure measurements.
Assessment of exocrine pancreatic function by oral administration of N-benzoyl-l-tyrosyl-p-aminobenzoic acid (Bentiromide): 5 years' clinical experience
Authors: Lang C , Gyr K , Stalder G A , Gillessen D
Published: March 2007

Exocrine pancreatic function was assessed in 588 sublets by oral administration of 1 g of the chymotrypsin-labile peptide N-benzoyl-l-tyrosyl-p-aminobenzoic acid Bentiromide) from 1974 to 1979. The pancreatic nmction test (PFT) was performed in 126 controls, 217 patients with pancreatic diseases, 196 patients with various non-pancreatic gastrointestinal disease, 18 patients with renal disease and 31 patients with various jiher diagnoses.

In 62 of 72 patients (86 per cent) with chronic pancreatitis and in 19 of 25 patients (76 per cent) with pancreatic carcinoma, the excretion of p-aminobenzoic acid (PABA) in the urine was significantly less than in the controls. In contrast, 328 of 353 controls and patients with non-pancreatic diseases (93 per cent) had PABA excretion within normal limits. The sensitivity and specificity of the Bentiromide-test observed in this study is sufficient to detect moderate to severe disturbances of pancreatic exocrine function.

The PFT has proved to be an easy and reliable screening test for pancreatic exocrine function in ambulatory as well as in hospitalized patients.
Radical resection for cancer of the hypopharynx and cervical oesophagus with repair by stomach transposition
Authors: Harrison D F N , Thompson A E , Buchanan G
Published: March 2007

The results of 58 consecutive cases of pharyngolaryngooesophagectomy and pharyngogastric anastomosis are presented. The Grey Turner technique is used, but modified by adding bilateral chest drainage established by guidance from below the diaphragm and a jejunostomy. The immediate postoperative therapy management of hypocalcaemia with calcium gluconate and long term control with calciferol is described.

An overall 3-year survival rate of 29 per cent has been obtained. Seven patients survived longer than 7 years, the longest living over 10 years. The authors conclude that, with careful management this technique is within the compass of competent surgeons with good facilities and should be the surgical treatment of choice for these difficult tumours.
Prognosis in relation to symptom duration in colon cancer
Authors: McDermott F T , Hughes E S R , Pihl E , Milne B J , Price A B
Published: March 2007

Between 1950 and 1978 754 patients underwent operation by one of the authors for carcinoma of the colon. Follow-up data were available on 99 per cent. Tumour stage distribution did not differ significantly with increasing duration of symptoms. The proportion of curative to palliative operative procedures was unrelated to symptom duration. Cancer specific survival for the entire patient series was worse when symptoms had been present for less than 3 months compared with 3–6 months, 6–12 months or 12 months or more (P<0·001, P<0·02 and P<0·04, respectively). Cancer specific survival after curative resection was also worse in patients with a symptom duration of less than 3 months compared with 3–6 months or 12 months or more (P<0·02 and P<0·03, respectively). These results show that colon cancer patients in whom the diagnosis is made and operation performed after a short symptomatic period do not have less advanced tumours nor better survival prospects.
Comparative results of surgical management of single carcinomas of the colon and rectum: A series of 1939 patients managed by one surgeon
Authors: McDermott F T , Hughes E S R , Pihl E , Milne B J , Price A B
Published: March 2007

A comparative analysis has been made of the results of surgical management of single carcinomas of the colon and rectum in a series of 1939 patients treated by one surgeon. The data were prospectively collected, with 99 per cent follow-up. Cancer specific survival did not differ significantly between patients with colonic or rectal cancer. Survival prospects were better for women (P = 0·02) and for patients less than 40 years of age (P = 0·03). Survival was significantly related to tumour staging (P<0·001). Cancer specific survival was better after curative resection for colonic than rectal carcinoma (P = 0·003). Five-year survival for patients with colonic tumours was 76 per cent and for rectal tumours 69 per cent. The 10-year survival figures were 73 per cent and 61 per cent respectively. This difference was accounted for by a higher proportion of Dukes' stage C tumours in the rectum (P<0·001) and better survival prospects for colonic compared to rectal stage C1 tumours (P = 0·02). Sphincter-saving resections were performed in 64 per cent of rectal cancer patients managed by curative resection. Survival tended to be better than after sphincter-sacrificing operations. After palliative resection, median survival for colonic and rectal cancer was 14 and 13 months respectively. After palliative bypass operations the corresponding figures were 4 and 8 months.
Structural deterioration of prosthetic oesophageal tubes: An in vitro comparison of latex rubber and silicone rubber tubes
Authors: Branicki F J , Ogilvie A L , Willis M R , Atkinson Michael
Published: March 2007

In a series of 100 patients with carcinoma of the oesophagus or cardia undergoing palliative intubation at endoscopy using a latex rubber or a silicone rubber tube 2 cases of tube fragmentation were encountered and are described.

The effects of hydrochloric acid, bile and irradiation on the tubes have been studied in vitro. After incubation in hydrochloric acid (0·1 mol/l), the breaking force of latex rubber tubes fell by 31 per cent (48 N) but did not change significantly for silicone rubber tubes. The addition of bile to the hydrochloric acid (0·1 mol/l) did not further influence the breaking force of either type of tube. Megavoltage irradiation with 7500 rad did not affect the breaking strength of silicone rubber tubes but caused a reduction of breaking strength of latex rubber tubes. These findings suggest that silicone rubber has advantages over latex rubber as a material for prosthetic oesophageal tubes.
Pulmonary function and fibrinogen metabolism in acute pancreatitis
Authors: Berry A R , Taylor T V , Davies G C
Published: March 2007

Respiratory complications were studied in 50 patients with acute pancreatitis, and the relationship of these complications to parameters of fibrinogen metabolism was investigated. The mean arterial Po2 of the patients was 9·85±3·8 kPa (s.d.). Forty-three per cent of patients on admission were hypoxaemic. The mean Po2 was lower in patients who subsequently developed complications of acute pancreatitis (mean Po2 7·85±1·42 kPa (s.d.), P<0·01). Vital capacity on admission was decreased by 50 per cent in 41 per cent of patients and by 20 per cent in 77 per cent of patients with pancreatitis. At discharge, 38 per cent of patients still had a 20 per cent decrease in their vital capacity.

Fibrinogen levels were elevated in 80 per cent of patients on admission and there was a negative correlation between these levels and the arterial Po2 (r = −0·6, P<0·001). Fibrinogen degradation products were elevated in 45 per cent of patients.

The results confirm that marked lung damage occurs in acute pancreatitis and suggest that the effects are prolonged. The possibility that this damage may be related to pulmonary fibrin deposition is discussed.
The effect of altered luminal nutrition on cellular proliferation and plasma concentrations of enteroglucagon and gastrin after small bowel resection in the rat
Authors: Sagor G R , Al-Mukhtar M Y T , Ghatei M A , Wright N A , Bloom S R
Published: March 2007

Luminal nutrition is known to have a trophic effect on small bowel mucosa after intestinal resection. Humoral agents, however, may also contribute to this process. Two of the proposed humoral agents, enteroglucagon and gastrin, were therefore investigated after intestinal resection and transection in the rat, and changes in their concentration in the plasma were related to cellular proliferation.

Forty-eight male Wistar rats had either 75 per cent proximal small bowel resection or jejunal transection. The animals were further divided into three groups, each with a different nutritional intake. The first group were allowed food ad libitum. The second group were kept under hypothermic conditions which resulted in hyperphagia, while the last group were nourished intravenously. A further 8 animals had a laparotomy only (sham operation). All animals were killed 12 days after operation, plasma enteroglucagon and gastrin were measured, while determination of the crypt cell production rate (CCPR) was used to denote cellular proliferation.

In each group resected rats had significantly higher crypt cell production rates and greater enteroglucagon levels compared with transected animals. However, only in the normally fed group was plasma gastrin increased in resected animals, there being no significant difference in the plasma concentration of this peptide in transected compared with resected rats, in both the intravenously fed and hyperphagic groups.

In the models studied enteroglucagon appears to be a more likely candidate for a humoral trophic agent than gastrin in intestinal adaptation.
The amylase-to-creatinine clearance ratio—a non-specific response to acute illness?
Authors: McMahon M J , Playforth M J , Rashid S A , Cooper E H
Published: March 2007

It was felt that the apparent specificity of the amylase-to-creatinine clearance ratio (ACCR) in several previous studies of pancreatitis might reflect a failure to utilize adequately ill control subjects. The ACCR and the renal clearances of beta 2-microglobulin (B2-m), similarly related to creatinine (BCCR) as well as the urinary concentration of albumin, were compared in 27 patients with acute pancreatitis, 8 with a perforated peptic ulcer and 7 with mild biliary colic, during the first 5 days in hospital. Acute pancreatitis was graded as mild (6), moderate (14) or severe (7), using a combination of clinical data, diagnostic peritoneal lavage and multiple criteria. Further assessment of the severity of the acute illness was obtained from measurement of C-reactive protein (C-RP). Lowest C-RP levels were found in the patients with mild pancreatitis and biliary colic, and highest levels in the patients with severe pancreatitis and perforated ulcer (P < 0.002). Similarly, ACCR and BCCR levels were significantly lower in the two mild groups than in the two severe ones (P < 0.01 and < 0.002 respectively), although plasma amylase was raised only in patients with pancreatitis and plasma B2-m was similar in all groups. Electrophoresis of urine showed dense bands of tubuloprotein in patients from both severe groups. Urine albumin was higher in severe pancreatitis than in perforated ulcer (P < 0.1), perhaps indicating a more specific glomerular lesion in pancreatitis. Thus a rise in amylase clearance appeared to be related to the severity of the acute illness, and may be a component of a non-specific tubuloproteinuria. In this study patients with a perforated peptic ulcer had increases in ACCR similar to those seen in patients with severe pancreatitis, and we are therefore doubtful whether ACCR has any role in the clinical diagnosis of pancreatic disease.
Malignant oesophageal strictures: A review of techniques for palliative intubation
Authors: Earlam Richard , Cunha-Melo J R
Published: March 2007

A review of the different designs for palliative oesophageal intubation tubes confirms Souttar's original suggestion that they should be flexible, incompressible, non-traumatic, compact, have an adequate lumen and stay in place. The internal diameter should be at least 10 mm. The thickness of the wall should be about 1 mm. The length will vary according to the stricture and should be as short as possible, provided that the proximal rim prevents future longitudinal growth occluding the lumen. Various methods of achieving the ability to stay in place are described, which comprise either a large proximal rim or a roughened barrel. No details about results are given because the original patient populations vary so much. Success probably depends more on the technical expertise and experience of the surgeon than specific variations in design.
Radiotherapy for dysphagia due to gastric carcinoma
Authors: Mantell B S
Published: March 2007

Palliative treatment by radiotherapy was attempted in 17 cases of dysphagia, due to inoperable gastric carcinoma. Thirteen experienced a useful improvement in swallowing. Radiotherapy, using a moderate dose of radiation, is suggested as an alternative to intubation in such patients.
Tamponade and injection sclerotherapy in the management of bleeding oesophageal varices
Authors: Barsoum Maged Sami , Bolous Fathi Iskander , El-Rooby Abushady Ahmed , Rizk-Allah Mounir Azmy , Ibrahim Amal Sami
Published: March 2007

One hundred patients with bleeding oesophageal varices were randomized into two treatment groups after resuscitation. One group was managed by tamponade only (group 1); the other group (group 2) was treated by endoscopic injection of oesophageal varices. The patients in group 2 were further subdivided into 25 patients (group 2a), who had tamponade applied immediately after sclerotherapy, and 25 patients (group 2b), who had sclerotherapy without subsequent tamponade.

Injection of varices controlled the acute bleeding episode more effectively than tamponade (74 per cent in group 2 v. 42 per cent in group 1). There was no significant difference in the overall mortality rate of the two groups, but group 2 had a significantly higher proportion of Child's grade C patients (38/50 v. 29/50 = 76 v. 58 per cent). If only Child's grade C patients are considered, 16 out of 29 (55 per cent) died in group 1, whereas only 12 out of 38 (32 per cent) died in group 2 (P < 0·05).

Tamponade applied after sclerotherapy had no demonstrable effect on the outcome of sclerotherapy. The long term follow-up of patients (maximum 4 years) showed that recurrence of bleeding was less in the sclerotherapy group (8·1 per cent) than in the tamponade only group (27·6 per cent; P < 0·05).
Dacron patch for closure of experimental stomach defects
Authors: Smyrnis Sotiris A
Published: March 2007

A Dacron patch was used to close acute defects of the stomach in rabbits. No deaths were directly attributed to the procedure. The patch was completely covered by new growth of tissue within 6 weeks. In the sixth postoperative month some evidence of rejection of the prosthetic material was present and 1½ years after the operation the patch was found in granulation tissue near the stomach. From this study it was concluded that this new technique is simple, can be performed safely and offers satisfactory results. Moreover, these experiments seem to indicate that this method may have clinical applications in the treatment of gastrointestinal fistulas in carefully selected cases.
Prophylactic lymph node dissection in clinical stage I cutaneous malignant melanoma: Results of surgical treatment in 1319 patients
Authors: Milton G W , Shaw H M , McCarthy W H , Pearson L , Balch C M , Soong S J
Published: March 2007

A retrospective study was made of 1319 patients with cutaneous primary malignant melanoma and regional lymph nodes clinically free of disease, whose first definitive surgical treatment was either (a) wide excision of the primary lesion (WE) or (b) wide excision of the primary lesion plus a prophylactic lymph node dissection (PLND). Patients were stratified according to three dominant prognostic factors, as revealed by multifactorial analyses: sex of patient, the anatomical site and thickness of the primary lesion.

Of 380 patients who underwent PLND for lymph nodes clinically free of disease, there was microscopic evidence of nodal metastases in 5 per cent. Despite this, prognosis in these patients was nearly twice as good as in those patients undergoing lymph node dissection for clinically involved nodes. Five-year survival rates for all those clinical stage I patients with lesions less than 0·8 mm thick were high irrespective of initial surgical treatment. In men with lesions of intermediate thickness (particularly 1·6–3·0 mm), survival rates for those undergoing PLND were considerably higher than for those undergoing WE. There were no survival benefits of PLND in men with lesions thicker than 3·0 mm. This was in contrast to the situation in women, where PLND was indicated for patients with the thickest lesions.

This study has defined three parameters which can serve as useful practical guides for selecting alternative surgical procedures in the management of clinical stage I cutaneous malignant melanoma.
Management of postoperative enterocutaneous fistulas: The roles of parenteral nutrition and surgery
Authors: Sitges-Serra A , Jaurrieta E , Sitges-Creus A
Published: March 2007

A series of 75 patients with 87 postoperative enterocutaneous fistulas (PEF) is reported. All received parenteral nutrition after the diagnosis of PEF was made. There were 16 deaths (21·3 per cent) and 62 fistulas (71·2 per cent) closed spontaneously. A classification of PEF is proposed according to the results obtained. The therapeutic approach cannot be uniform in all types of PEF. We feel that parenteral nutrition has substantially improved the prognosis of fistulous patients by increasing the rate of spontaneous closure and improving the nutritional status of patients needing repeated operations. Comparison between series of patients to establish the usefulness of parenteral nutrition is bound to yield inconclusive data due to marked differences in patient populations. We suggest that proper information be obtained by studying series of homogeneous patients, namely those who develop oesophageal, gastric or intestinal fistulas after surgery.
Pilonidal fistulas mimicking fistulas-in-ano
Authors: Vallance S
Published: March 2007

Four pilonidal fistulas which were initially diagnosed as fistulas-in-ano are reported. Only one perianal pilonidal fistula and four perineal pilonidal sinuses have previously been reported. It is suggested that they are more common than the literature suggests and should be excluded when patients present with symptoms of fistula-in-ano.
The aetiology of perirectal sepsis
Authors: Whitehead S M , Leach R D , Eykyn S J , Phillips I
Published: March 2007

Organisms that are present in the normal faecal flora, especially Bacteroides fragilis, were isolated significantly more often from perirectal abscesses associated with a fistula. Other organisms similar to those associated with infection of obstructed apocrine glands at other sites were isolated from abscesses without fistulas. These findings suggest that perirectal abscesses with and without fistulas may have a different aetiology and that appropriate bacteriological investigation may give an indication of the presence of an unsuspected fistula and thus provide useful guidance to the correct surgical management of the patient. Staphylococcus aureus and other skin organisms were found less frequently than in previous studies on perirectal sepsis and were equally common in cases with or without a fistula-in-ano.
The changing role of staging laparotomy in Hodgkin's disease: A personal series of 310 patients
Authors: Glees J P , Barr L C , McElwain T J , Peckham M J , Gazet J-C
Published: March 2007

A series of 310 patients with Hodgkin's disease having a staging laparotomy under the care of one surgeon (J-C. G.) between October 1969 and June 1980 is presented. A total of 51 per cent had positive laparotomy findings, and 30 per cent had their staging altered, but there was a low incidence of positive laparotomy findings when performed within 2 months of initial treatment by chemotherapy. None of the investigations used to determine possible splenic or hepatic involvement preoperatively was found to be of any value, and their routine use is not recommended. Bipedal lymphography was found to give an accurate assessment of iliac and lower para-aortic nodal involvement, and so the laparotomy protocol since 1975 has not included biopsy of these nodes. The incidence of minor complications was 31 per cent and of major complications 4 per cent. One patient died.

Staging laparotomy has played an important part in the management of Hodgkin's disease over the past decade, but it is likely to assume a less prominent role in the 1980s as the role of chemotherapy in early Hodgkin's disease expands. In non-bulky clinical stage I and II Hodgkin's disease, when radiotherapy alone is curative, then a staging laparotomy is justifiable because it will detect occult abdominal disease, especially in the lymphogram-negative patient, which may require the addition of chemotherapy or more extensive radiotherapy. Laparotomy is essentially an operation to remove the spleen and to obtain adequate liver biopsy specimens in order to ascertain possible involvement of these two organs. Non-opacified nodes at the porta hepatis and coeliac axis should also be sampled, as should a node from the poorly opacified upper paraaortic area. Routine oophoropexy is not recommended.
Electrically induced short-lasting tetanus of the calf muscles for prevention of deep vein thrombosis
Authors: Lindström Björn , Korsan-Bengtsen Kristoffer , Jonsson Olof , Petruson Björn , Pettersson Silas , Wikstrand John
Published: March 2007

Electrical calf muscle stimulation during surgery has been used for the prevention of deep vein thrombosis (DVT) with varied results in several studies. This effect is mainly achieved by the reduction of venous stasis in the legs. Another possible beneficial effect might be an increased fibrinolytic activity of the blood secondary to the muscle contractions. Previously, single electrical impulses have been used for stimulation, giving rise to ‘single twitches’ in the muscles. In the present study the effect on calf volume of muscle stimulation with groups of impulses giving a short-lasting tetanus was investigated. Changes in calf volume were recorded by strain gauge plethysmography. Optimal values for duration, number and frequency of the impulses within the groups were determined. Stimulation with groups of impulses reduced calf venous volume approximately three times more efficiently than stimulation with single impulses. Calf muscle stimulation did not enhance the increase in fibrinolytic activity of venous blood observed after oesophago- or laryngoscopies under general anaesthesia.