bluuebunny/crossref_metadata_2025 huggingface dataset:
The effect of ischaemic injury on kidneys preserved for 24 hours before transplantation
Authors: Johnson R W G
Published: March 2007

Kidneys have been preserved for 24 hours by three methods–continuous hypothermic perfusion with plasma protein fraction (P.P.F.), simple ice storage using the method of Collins, Bravo-Shugarman, and Terasaki (1969), and a combination of simple ice storage followed by continuous perfusion. Prior to preservation the kidneys were subjected to warm ischaemic intervals varying from 0 to 180 minutes.

Kidneys preserved without warm ischaemia functioned immediately whichever method was used. Kidneys preserved by perfusion after up to 60 minutes of warm ischamia returned to normal function; kidneys preserved by Collins's method did not function after ischaemic injury.

The period of storage of ischaemically injured kidneys initially preserved by Collins's method can be extended to 24 hours by subsequent continuous perfusion, but the results are not as good as with perfusion alone. A fall in perfusate pH was a reliable indication that kidneys would not function after 24 hours' storage.
Bilateral traumatic renal artery occlusion with survival after late reconstitution of arterial flow
Authors: Birkenstock W E , Rabkin R , Stables D P
Published: March 2007

Survival after bilateral traumatic renal artery occlusion is uncommon. A patient is described who recovered useful renal function despite a 12-hour delay in reconstitution of arterial flow. Postoperative oliguria latest 45 days, necessitating prolonged haemodialysis.
Investigation of oedema of the lower limb following successful femoropopliteal by-pass surgery: The role of phlebography in demonstrating venous thrombosis
Authors: Hamer J D
Published: March 2007

Of 21 limbs having successful femoropopliteal vein by-pass grafts, 20 showed peripheral oedema 7 days after operation. Circumferential enlargement of more than 4.5 cm. was associated with thrombosis of the popliteal or tibial veins, whereas legs enlarging less than 1.5 cm. did not show radiological evidence of venous thrombosis.

Venous thrombosis is less likely after surgery for intermittent claudication than for rest pain or gangrene of the toes.

Distal anastomosis of the vein-graft to the popliteal artery is more often accompanied by venous thrombosis than anastomosis above the knee-joint.
Factors influencing prognosis in the surgery of peripheral vascular disease: Platelet adhesiveness, plasma fibrinogen, and fibrinolysis
Authors: Hamer J D , Ashton F , Meynell M J
Published: March 2007

A study of 76 patients having aorto-iliac (46) and femoropopliteal (30) surgery for atherosclerosis has shown a significant correlation between increased platelet adhesiveness, prolonged clot lysis, and failure of the reconstruction between 3 months and 5 years after operation. In addition, a raised plasmafibrinogen level, persisting 1 year after reconstruction, is often associated with failure. Patients having predominantly femoropopliteal disease show a significantly higher plasma-fibrinogen level than those with localized aorto-iliac disease. This correlation is such that when a high plasma-fibrinogen level is found in a patient with the clinical features of aorto-iliac disease it may be inferred that the femoropopliteal segment is also involved.
Gastric ulcer treated by vagotomy, pyloroplasty, and ulcerectomy
Authors: Daniels H A , Strachan A W B
Published: March 2007

Sixty-two patients with gastric ulcers have been treated by vagotomy, pyloroplasty, and excision of the ulcers from 1963 to 1971. There has been only 1 recurrence.

It is suggested that excision of the ulcer is an important step in conservative surgery for gastric ulcer.
Mousseau-barbin tubes for the treatment of carcinoma of the lower two-thirds of the oesophagus results and operative techniques
Authors: Holden M P , Wooler G H , Ionescu M I
Published: March 2007

Twenty-three patients have undergone insertion of a Mousseau-Barbin tube for the correction of dysphagia due to inoperable carcinoma of the stomach or the oesophagus. All the patients obtained relief of their symptoms and there was no postoperative mortality or infection.

Technical details are discussed which are designed to reduce the occurrence of obstruction of the tube and erosion of the mucosa of stomach and oesophagus, and to facilitate insertion of the tube in difficult cases.
Duodeno-ureteric fistula
Authors: Hoare E M
Published: March 2007

A case of a duodeno-ureteric fistula in a man of 46 years is described. This is a rare condition, only 2 previous cases having been reported. The patient did not agree to operation and no tissue is available for histological examination. However, reasons are given for believing this to be the first case in which the primary pathology is in the duodenum.
Reversed rotation of the gut incidental to cholecystitis in a left-sided gall-bladder
Authors: Stagg L H , Sheiner H J
Published: March 2007

A patient with reversed rotation of the midgut loop of the retro-arterial colon type is reported. She is unique in being the first case recorded in the literature with a right-sided colon and a left-sided liver without situs inversus of the abdominal viscera. An explanation of the findings is suggested, based on known embryological facts.

Previous reports indicate that patients with reversed rotation all present with obstructive symptoms secondary to the altered anatomy. This patient is unusual in that her symptoms and pathology were unrelated to the anatomical abnormality.
The surgical management of acute renal papillary necrosis
Authors: Jameson R M , Heal M R
Published: March 2007

Analgesic nephropathy can present as an obstructive uropathy by ureteric impaction of a sloughed renal papilla. Five out of 12 patients admitted with analgesic nephropathy presented with obstructive renal failure. Endoscopic surgery to deal with the obstruction was successful in every case. Removal of the necrotic renal papilla with a Dormia ureteric stone basket was performed six times whilst ureteric catheterization was sufficient to restore urine flow on two occasions. Two of the 5 patients had had a previous nephrectomy for obstructive pyelonephritis. These results suggest that endoscopic surgery is safe and effective in the treatment of acute obstructive renal papillary necrosis.
The effect of insulin hypoglycaemia on serum gastrin and gastric acid in normal subjects and patients with duodenal ulcer
Authors: Cowley D J , Baron J H , Hansky J , Korman M G
Published: March 2007

Serum gastrin was measured by radio-immuno-assay in normal subjects and in patients with duodenal ulcer during insulin hypoglycaemia with and without concomitant aspiration of gastric acid. Insulin hypoglycaemia alone caused a rise in serum gastrin from 8.0 to 45.0 pg. per ml. in patients with duodenal ulcer, which was significantly greater than the rise from 13.0 to 29.0 pg. per ml. in normal subjects. During gastric aspiration serum-gastrin levels remained elevated for longer periods. The maximum increase of serum gastrin after insulin during gastric aspiration provided an almost complete discrimination between patients with duodenal ulcer and normal subjects. This discrimination between the groups was complete when serum gastrin was measured during insulin hypoglycaemia combined with intragastric neutralization of acid. The timing of the peak serum gastrin and the lowest blood-glucose coincided, but the peak acid output occurred 15–30 minutes later. Serum gastrin was inversely correlated with blood-glucose. Blood-glucose decreased to significantly lower levels in unaspirated than in aspirated subjects.

These studies suggest that patients with duodenal ulcer produce more gastrin than normal subjects in response to insulin hypoglycaemia (and, by inference, to vagal stimulation). The results support the concept of an increased functional G-cell mass in duodenal ulcer patients, and indicate the physiological roles of vagally released gastrin and of the acid inhibitory mechanism. Discriminant functions observed in the study could form the basis of tests for the presence of the duodenal ulcer diathesis.
Volvulus of the caecum: Caecopexy by polyvinyl alcohol sponge
Authors: El-Katib Y
Published: March 2007

Six cases of caecal volvulus were encountered. In one, with a gangrenous caecum, a right hemicolectomy was carried out. In the other five, with a viable caecum, caecopexy using a strip of polyvinyl alcohol sponge was carried out. No complications or recurrences have followed this form of treatment.
The effect of intestinal preparation on fluid and electrolyte balance
Authors: Irvin T T , Hayter C J , Warren K E , Goligher J C
Published: March 2007

It has been suggested that circulatory instability in elderly patients after the induction of anaesthesia is frequently accounted for by undiagnosed hypovolaemia, particularly in cases of intestinal cancer when preoperative mechanical bowel preparation has been used.

In the present study measurements were made in 25 patients undergoing mechanical bowel preparation for large-bowel cancer surgery.

Blood-volume measurements remained within normal limits after bowel preparation, and in 5 patients no change was found in total body exchangeable sodium, extracellular fluid volume, and plasma volume measured before and after bowel preparation.

Fluid and electrolyte balance studies in 11 cases showed that renal conservation of sodium occurred in the 24 hours preceding surgery and this is probably accounted for by diminished dietary intake. Circulatory instability after the induction of anaesthesia was commonly encountered but in most cases this was not the result of preoperative dehydration.
The response of the lower oesophageal sphincter to a test-meal stimulus
Authors: Roszkowski A , Guillou P , Giles G R
Published: March 2007

The response of the lower oesophageal sphincter to test meals has been assessed using two manometric techniques. Tests in which the sphincteric pressures were continuously monitored proved to be the most satisfactory and test meals which were predominantly meat extract provided the greatest stimulus. Normal subjects increased the sphincteric pressure 86.7 per cent above the basal levels within 30 minutes of the introduction of the test meal, whereas patients with symptomatic hiatus hernia had diminished responses with pressure increases of only 30 per cent above basal levels. Patients with peptic ulceration or stricture of the oesophagus failed to respond to any form of test meal.
The effect of hypophysectomy on the cortisol secretion in 4 patients with advanced metastatic breast cancer
Authors: Lewis A A M , Deshpande N
Published: March 2007

A raised cortisol production rate is found in patients with advanced breast cancer. The cortisol production rate was estimated before and after hypophysectomy in 4 patients with metastatic disease and was found to fall to one-sixth of the original level. It is concluded that the high preoperative cortisol production rate was dependent on pituitary function and was not due to the production of corticotrophin by the tumour cells.
Meningioma following trauma
Authors: Whatmore W J , Hitchcock E R
Published: March 2007

A case report is given of the development of an intracranial meningioma at the site of an authentic head injury incurred 21 years previously. The available literature on the subject is reviewed. The criteria satisfying the concept of trauma being a significant aetiological factor in the production of such tumours are stated and it is shown that the meningioma reported in this paper fulfils all these criteria. The aetiology of such tumours is discussed in further detail.
Acid secretion in relation to recurrence of duodenal ulcer after vagotomy and drainage
Authors: Cowley D J , Spencer J , Baron J H
Published: March 2007

The acid secretory responses of patients with recurrent ulcer after vagotomy and drainage have been compared retrospectively with those of patients with a positive insulin test but no recurrent ulcer and with those of patients with a negative insulin test. Patients with recurrent ulcer were on average 10 years younger than patients with an incomplete vagotomy but no recurrence, although their preand postoperative acid secretory responses were similar.

Insulin tests were unreliable when performed less than 3 months after vagotomy. The only possible criterion by which recurrent ulceration could be predicted was a postoperative reduction in the peak acid output after pentagastrin of less than 60 per cent. Equal numbers of patients with ‘early’ and ‘late’ positive responses to insulin developed a recurrent ulcer.

Routine postoperative insulin tests may be helpful in assessing the efficiency of the vagotomist but are of limited prognostic value.

The chief value of postoperative insulin tests appears to be in the diagnostic evaluation of postvagotomy dyspepsia.
Lobular carcinoma in situ of the breast
Authors: Macaulay R A A , Mitchinson M J
Published: March 2007

Ten patients with lobular carcinoma in situ of the breast have been seen in 2 1/2 years in Cambridge. Within that period of time 8 of these patients also had infiltrating carcinoma. Four out of 5 cases had bilateral lobular carcinoma in situ and 2 patients had bilateral infiltrating carcinomas. The premalignant nature of lobular carcinoma in situ is not proven but is likely. It is suggested that the evidence supports previously expressed views that a histological diagnosis of lobular carcinoma in situ merits mastectomy and a large contralateral biopsy in the first instance.
Acute mesenteric vascular occlusion occurring on top of chronic localized occlusion
Authors: Petty A H , Goode A W
Published: March 2007

Acute mesenteric arterial occlusion occurring on top of chronic occlusion and causing necrosis of a short length of bowel is rare.

Three such cases are described. All were operated upon but only 1 has survived.

The literature on the subject is discussed.
Oesophageal perforation a report of 13 cases
Authors: van Walleghem J , Muller H
Published: March 2007

A series of 13 cases of oesophageal perforation seen between 1961 and 1972 is reported. The various causes of perforation are discussed, with emphasis on the need for rapid diagnosis.

Conservative treatment is considered to lead to a high mortality-rate. One of the 10 patients who were treated surgically in this series died. It is recommended that patients with a carcinoma be treated in a single operation, and in achalasia of the cardia the use of a rigid oesophagoscope should be avoided.
The occurrence of carcinoid tumour in teratoma of the testis
Authors: Sinnatamby C S , Gordon A B , Griffiths J D
Published: March 2007

The third reported case of a carcinoid tumour arising in a teratoma of the testis is presented. The points of difference between the present case and the 2 previously reported ones are discussed.

Unusual locations of carcinoid tumours are considered in the light of theories explaining their origins. The features of ovarian carcinoid tumours are reviewed and parallels drawn between them and the rarer testicular carcinoid tumours.
Colonoscopy in the differential diagnosis of carcinoma from diverticulitis of the sigmoid colon
Authors: Dean Alan C B , Newell J P
Published: March 2007

Thirty-six patients in whom barium-enema examination had suggested the possibility of carcinoma in a segment of diverticular disease were examined by colonoscopy. Colonoscopy is particularly difficult in such patients and it failed to examine the diseased segment in 17 cases. Colonoscopy gave a firm diagnosis of carcinoma in 4 cases, excluded it in 5, and was helpful in another 9. There was 1 false negative.
Long-term results of surgical treatment for bleeding oesophageal varices in children with portal hypertension
Authors: Keighley M R B , Girdwood R W , Wooler G H , Ionescu M I
Published: March 2007

The long-term results of surgical treatment for bleeding oesophageal varices in children with portal hypertension are reviewed. Twenty-four children below the age of 13 years who presented with gastrointestinal bleeding over a 20-year period form the basis of this study. The importance of the aetiology of portal hypertension on the long-term follow-up has been studied. The results of surgical treatment in controlling haemorrhage are assessed.

Though extrahepatic obstruction is considered to be associated with a better long-term prognosis than intrahepatic disease the results of treatment in both groups were similar, with a 7-year survival rate of 75 per cent. Shunt surgery as a definitive procedure is advised in both groups, though the type of shunt used will depend on the age of the child and the site of obstruction.
Circulatory patterns in the normal hand
Authors: Little J M , Zylstra P L , West J , May J
Published: March 2007

Circulation in 100 apparently normal hands was studied clinically by the use of the Allen test and ultrasonically with a Doppler flowmeter. Circulatory dynamics in the hand were found to follow a very variable pattern, the ulnar artery being the dominant source of supply in most hands. It was concluded that collateral circulation in the hand would generally maintain viability of the fingers when either the radial or ulnar artery was occluded at the wrist. In 9 per cent of hands, however, there was evidence of more drastic disturbance of the circulation on occlusion of the ulnar artery, and in 6 per cent the same finding was made upon occlusion of the radial artery. The Allen test was positive in only 3 per cent of the hands, and in each case the ultrasonic examination confirmed the dependence of the digital circulation on a single artery at the wrist. It is suggested that these variations in collateral adequacy in the hand may explain ischaemic phenomena seen in some patients with the ‘hammer-hand’ syndrome, in a few patients after radial artery cannulation for monitoring purposes, and in a somewhat higher percentage of patients having arteriovenous fistulae constructed at the wrist for long-term haemodialysis. It is also suggested that patients undergoing procedures which will distort radial artery haemodynamics in the hand should be screened to test collateral adequacy.
‘Spontaneous’ rupture of the diaphragm during delivery
Authors: Dave K S , Bekassy S M , Wooler G H , Ionescu M I
Published: March 2007

A case of ‘spontaneous’ diaphragmatic rupture occurring during a normal delivery and resulting in herniation, incarceration, and gangrene of the stomach and omentum is described. Resection of incarcerated viscera was followed by complete recovery. To the best of our knowledge this is the first report of such a complication of a ‘normal’ delivery.
Acute tuberculous abscess of the thyroid gland
Authors: Johnson A G , Phillips M E , Thomas R J S
Published: March 2007

A case is reported of acute tuberculous abscess of the thyroid gland in a young woman. The rarity of this presentation is discussed in the context of the other forms of tuberculous thyroiditis.
The prevention of postoperative deep venous thrombosis with dextran 70
Authors: Carter A E , Eban R
Published: March 2007

One hundred and six patients undergoing major surgery were given dextran 70-500 ml. during operation, 500 ml. on the following day, and then 500 ml. on alternate days until discharge. Of these patients, I developed a deep venous thrombosis after the operation (0-94 per cent). One hundred and one patients acted as control subjects and, of these, 10 developed deep venous thrombosis (9-9 per cent). This reduction in incidence of thrombosis is significant at the 2 per cent level, indicating that dextran 70, as macrodex 6 per cent in 5 per cent dextrose, in the régime given is a simple and effective means of reducing deep venous thrombosis after major surgery.
A new method for detecting clotting in shunts used for haemodialysis
Authors: Salaman J R , Chu J , Crosby D L
Published: March 2007

Thermographic materials were used to monitor the rate of blood-flow through haemodialysis shunts. In an experimental and clinical study it was found that these materials would indicate by a change in colour when blood-flow through a shunt had become diminished or had ceased altogether. As a result clotting episodes were rapidly and easily diagnosed by the patients, and subsequent declotting of the shunts was readily achieved.
Infarction of fibro-adenoma of the breast
Authors: Newman Joseph , Kahn Leonard B
Published: March 2007

Infarction of benign lesions of the breast is very uncommon and may lead to difficulties in clinical and pathological diagnosis. Five instances of infarction occurring in a fibro-adenoma are described; in 2 of them thrombo-occlusive vascular changes were seen. The aetiology, pathogenesis, and helpful diagnostic features are discussed.
Phytohaemagglutinin-stimulated transformation of peripheral and lymph-node lymphocytes in patients with gastro-intestinal cancer
Authors: Guillou P J , Brennan T G , Giles G R
Published: March 2007

Phytohaemagglutinin-induced lymphocyte transformation has been studied in 10 patients with gastro-intestinal cancer and in 8 control subjects. When cultured in autologous serum, peripheral lymphocytes from cancer patients exhibited lower transformation indices (L.T.I.) than did those of control subjects. Culture in AB serum resulted in an elevation of the L.T.I. of peripheral lymphocytes from cancer patients whilst those of the controls were essentially unchanged. Of 6 control subjects, 5 showed reduced L.T.I.'s when their circulating lymphocytes were cultured in serum from cancer patients. Mesenteric lymph-node lymphocytes from patients with cancer also showed lower indices compared with the control group and these were elevated by culture in AB serum.
Analysis of flow patterns in venous insufficiency
Authors: Somerville J J F , Byrne P J , Fegan W G
Published: March 2007

A study has been made of 44 patients with venous insufficiency. Tape recordings of Doppler shift signals during reverse flow in the long saphenous vein have been subjected to frequency analysis to determine whether laminar or turbulent flow was present. Analysis of flow patterns along with evidence of calf muscle pump dysfunction enabled the patients to be classified into three groups: Group 1Patients showing laminar reverse flow, minimal varices and minimal symptoms.Group 2Patients with laminar reverse flow, minimal varices, severe symptoms and signs of calf pump dysfunction.Group 3Patients with turbulent reverse flow, gross varices, negligible symptoms and no evidence of calf pump dysfunction.

The relationship between the three groups and their possible prognoses are discussed.
Postoperative pulmonary complications — a prospective study in the tropics
Authors: Ti T K , Yong N K
Published: March 2007

A prospective study over a 4-month period in 663 patients operated on under general anaesthesia yielded 66 postoperative pulmonary complications (tracheobronchitis 29, atelectasis 10, pneumonia 21, pleurisy 6). An increased incidence occurred after abdominal surgery, especially emergency upper abdominal surgery, in males, tobacco smokers and patients over 40 years of age. Chronic respiratory disease is common and an important factor in the development of postoperative pulmonary complications in the tropics. The large proportion of underweight patients are also at greater risk of developing these complications.
Insensible water loss in surgical patients
Authors: Baumber C D , Clark R G
Published: March 2007

Insensible water loss has been studied before, during and after abdominal surgery of moderate severity. It has been shown that if normal hydration is maintained there is no significant change in insensible water loss. Patients who become relatively dehydrated have a significant fall in insensible water loss but there is no evidence that this is detrimental to their postoperative progress.

We would like to thank Professor H. L. Duthie for permission to study patients under his care, and the nursing, dietetic and technical staff who helped to carry out this study.
Postmastectomy lymphangiosarcoma-temporary response to cyclophosphamide chemotherapy in 2 cases
Authors: Tong David , Winter John
Published: March 2007

Two cases of lymphangiosarcoma developing in oedematous arms following radical mastectomy (Stewart-Treeves syndrome) are reported. Both patients showed marked symptomatic improvement and tumour regression on cyclophosphamide therapy although remission was only temporary.
Evaluation of a bulk-forming evacuant in the management of haemorrhoids
Authors: Broader J H , Gunn I F , Alexander-Williams J
Published: March 2007

Constipation is considered to play a part in causing haemorrhoids and the regular use of a bulk-forming aperient has been advocated in their management. The incidence of constipation in 140 patients with haemorrhoids was only 10 per cent. A double blind trial on 40 patients designed to compare a bulk-forming aperient (sterculia) with a non-bulk-forming placebo (starch) showed a slight but insignificant advantage for sterculia.
A controlled trial of Trasylol in the treatment of acute pancreatitis
Authors: Trapnell John E , Rigby C C , Talbot C H , Duncan E H L
Published: March 2007

Although Trasylol has been available for the treatment of acute pancreatitis for 15 years a review of the literature reveals that its effectiveness has never been either proved or disproved. A prospective double blind controlled trial was therefore started in 1967. The results are now reported.

One hundred and five patients were studied. They provided a uniform clinical material and all were managed on an identical strict protocol except that patients received either Trasylol A or B, allotted in sequence using random numbers. At the conclusion of the acute episode the illness was assessed according to criteria which were not open to observer variation and each attack was categorized as mild, moderate, severe or fatal. The trial showed that there was a mortality of 4 out of 53 cases (7.5 per cent) in group A and 13 out of 52 cases (25 per cent) in group B. Statistically this difference is significant (χ2 = 4.675, d.f. = 1, P = 0.05). The code was then broken and this revealed that group A had received the active Trasylol. Analysis of age patterns showed that in the Trasylol-treated group the usual tendency for mortality to rise with advancing age was abolished. Trasylol must therefore be regarded as a drug which is beneficial in the treatment of acute pancreatitis.
Haemangiomas of the gastro-intestinal tract
Authors: Taylor T V , Torrance H Bruce
Published: March 2007

Four cases of haemangiomatous malformations of the gastro-intestinal tract are described. In the first the lesion involced the whole stomach. The second case exhibited lymphangiomatosis together with haemangiomatosis which appears to be a unique situation. In the third the absence of the spleen, a rare condition in itself, emphasizes the association of apparently unrelated congenital anomalies which can occur. In the fourth a ‘cloacal’ haemangioma is described which was treated in an unusual manner, namely by ligation of the feeding vessels with the unexpected sequel of gross abdominal ascites.
Carcinoma of the stomach following partial gastrectomy for benign gastroduodenal lesions
Authors: Nicholls John C
Published: March 2007

Thirty-six patients presenting with a carcinoma in their gastric remnant following operation for benign lesions have been studied. The original pathology was found to be a gastric ulcer in 22 of 28 patients whose initial operation was undertaken at St James's Hospital. This represents an incidence of at least 1 carcinoma appearing for every 76 patients undergoing partial gastrectomy for gastric ulceration. Carcinoma is far more likely to develop in the stomach following partial gastrectomy when the original lesion is a gastric ulcer rather than a duodenal ulcer.
Traumatic pneumocephalus
Authors: Briggs Michael
Published: March 2007

The presentation and management of 33 patients with traumatic pneumocephalus have been analysed and two main groups recognized. The first consisted of 12 patients who developed an intracerebral aerocele, the onset of which was delayed for up to 52 days from the time of injury. These patients presented with signs of raised intracranial pressure which required urgent surgical treatment.

The intracranial air in the second group was situated in the subdural or subarachnoid spaces and was usually visible on the first X-ray taken after injury. Adequate early prophylactic antibiotic treatment against meningitis was of great importance to these patients, who did not all require surgical intervention.
A further comparison of the use of internal fixation and prosthetic replacement for fresh fractures of the neck of the femur
Authors: Hunter G A
Published: March 2007

Two hundred patients with femoral neck fractures have been reviewed. One hundred were treated by a primary prosthesis and the remainder by internal fixation. The complications and results of the two groups are compared and discussed. These results are compared with a similar survey carried out in Oxford 5 years ago. The mortality rate in the group treated by prosthetic replacement is higher than in the group treated by internal fixation. This survey again indicates that internal fixation offers the patient with a displaced fracture of the neck of the femur a lower morbidity and mortality rate and better results than the insertion of a prosthesis. The use of a primary prosthesis should be confined to patients in whom accurate reduction of the fracture is impossible or in pathological fractures where maintenance of the reduction is unlikely.
Chorda tympani neurectomy–a new approach to submandibular salivary obstruction
Authors: Zalin H , Cooney T C
Published: March 2007

Fifteen cases of chorda tympani neurectomy for the treatment of submandibular salivary gland obstruction have been under detailed observation for a minimum of 3 years. Complete relief of symptoms has been obtained in all the cases and there have been no significant complications.

The operation is indicated in all cases hitherto regarded as requiring surgical extirpation of the gland, with the very rare exception of neoplasia.
Emergency surgery for calculous diseases of the upper urinary tract
Authors: Leong C H , Yu Henry , Ong G B
Published: March 2007

Nineteen patients with calculous disease of the upper urinary tract presenting as anuria or acute pyonephrosis are reported. The necessity for emergency surgical treatment is stressed. The methods of surgical treatment and the results are discussed.
Spontaneous rupture of the ureter
Authors: Newman C E , Dawson-Edwards P , Howarth F H
Published: March 2007

A case of spontaneous perforation of the ureter in a 58-year-old woman is described. The difficulties in differential diagnosis from acute intraperitoneal catastrophes and the helpful role of the urgent intravenous pyelogram in atypical cases are stressed.

The literature has been reviewed to yield 41 previous cases, and some of the common factors in aetiology, diagnosis and management are discussed.
Topical ampicillin in the prevention of wound infection after appendicectomy
Authors: Bates T , Down R H L , Houghton Mary C V , Lloyd G J
Published: March 2007

The effect of topical ampicillin on the rate of wound infection after emergency appendicectomy was studied in a prospective controlled trial of 200 patients. Sixteen per cent of patients in the control group developed a wound injection compared with 3 per cent of those receiving ampicillin powder in the wound (P<0·01). When patients with peritonitis were considered, 64 per cent of the 14 patients in the control group developed a wound infection compared with 13 per cent of the 15 patients in the ampicillin group.

Patients in the control group were discharged from hospital in a mean of 8·7 days postoperatively compared with 6·4 days in the ampicillin group (P<0·05).
Obturator hernia
Authors: Martin Nimit C , Welch Theodore P
Published: March 2007

Twenty patients with obstructed obturator hernia were seen at the City of Chiang Mai Hospital between 1962 and 1973. The most helpful diagnostic points are described. The relative frequency with which this disease has been seen at this hospital has made preoperative diagnosis possible in most cases in recent years and this has helped to lower the mortality.
Haematoma of rectus abdominis from the use of an exercise wheel: A report of 3 cases
Authors: Fraser-Moodie Alistair , Cox Simon
Published: March 2007

Three cases are presented each with a haematoma of the rectus abdominis muscle. All 3 patients were using an exercise wheel at the time of onset of the abdominal pain. The fact that use of an exercise wheel can cause a haematoma of the rectus abdominis muscle is not well documented.
Elastofibroma: A rare cause of painful shoulder
Authors: McGregor J C , Rao S S
Published: March 2007

A case of elastofibroma presenting in a 72-year-old male with shoulder pain and limitation of movement is reported. Removal of this benign lesion resulted in relief of pain and gradual restoration of full shoulder mobility. No other cases of this condition appear to have been reported in the British literature. The histological characteristics of this rarity are described and the possible aetiology discussed although this is uncertain. It may be rare only because of its benign course and its obscure situation which render it liable to be overlooked. Elastofibroma may occur bilaterally and asynchronously.
Early postoperative small bowel obstruction
Authors: Sykes Peter A , Schofield Philip F
Published: March 2007

A prospective study is presented of the clinical features and laparotomy findings in 26 patients who were re-explored for complete mechanical small bowel obstruction which occurred when they were in hospital after abdominal surgery. This complication occurred particularly in patients after colorectal and pelvic surgery and operations for acute appendicitis. Attention is drawn to the fact that small bowel distension occurring after the fourth postoperative day is usually due to mechanical obstruction or intra-abdominal sepsis and rarely, if ever, due to ‘adynamic ileus’.

Evidence is presented that plain abdominal radiography is of high diagnostic accuracy in postoperative small bowel obstruction and that early re-exploration of the abdomen and surgical relief of the mechanical obstruction are indicated in these patients.
The features and course of bile vomiting following gastric surgery
Authors: Griffiths J M T
Published: March 2007

In a retrospective study 119 (9.1 per cent) of 1311 patients undergoing peptic ulcer surgery developed postoperative bile vomiting. Patients aged over 60 years at operation appeared particularly at risk. The sex distribution was equal. Operations that aim at reducing acid secretion had a similar incidence of vomiting, although the complication was not seen following 55 simple gastrojejunostomies. Vomiting developed within I month of operation in 39 per cent of patients, and 57 per cent suffered a significant degree of disability for 6–14 years after onset. Twenty-four per cent of patients underwent reoperation. Aetiological factors were gastric outlet obstruction and gastritis due to bile reflux; pre-existing constitutional and psychological abnormality seldom contributed significantly to the syndrome. It is concluded that bile vomiting as a persistent and disabling complication of gastric surgery demands objective physical and psychological assessment prior to a decision regarding management.
Oesophagogastrectomy in the treatment of malignancy of the thoracic oesophagus and cardia
Authors: Leverment J N , Milne D Mearns
Published: March 2007

Of 452 patients suffering from malignancy of the thoracic oesophagus and cardia of the stomach, 381 were treated by oesophagogastrectomy.

The need for early diagnosis is stressed in that palliation is all that can be achieved by this method of treatment in most cases, but palliative resection appears to offer the patient a better chance of survival and a more satisfactory relief of his distressing symptoms than palliative intubation.

The hospital mortality has been relatively high. However, surgical experience, improved anaesthetic technique and the recent establishment of postoperative intensive cure facilities have resulted in a marked decrease in this mortality, while still maintaining a high resection rate.

The causes of death and pathology encountered are also discussed.
Ruptured hepatic artery aneurysm treated by saphenous vein graft
Authors: Knox A J S
Published: March 2007

The first recorded case in which a ruptured hepatic artery aneurysm has been treated with a saphenous vein graft replacement is presented. The indications for restoration of hepatic artery blood flow in patients with ruptured hepatic aneurysm are discussed.
The use of angiography in a case of recurrent epistaxis after multiple arterial ligation
Authors: Taylor P H , McCall I W
Published: March 2007

A patient with severe recurrent epistaxis which persisted despite multiple arterial ligation is described. The place of this procedure in the management of epistaxis is discussed. In the present case the bleeding was due to an underlying haemangioma which could only be demonstrated by angiography. It is suggested that this investigation should be carried out in patients who fail to respond to concentional treatment for recurrent epistaxis.
The Limulus test in experimental and clinical endotoxaemia
Authors: Fossard D P , Kakkar V V
Published: March 2007

Gram-negative septicaemia is being recognized (is an increasingly common cause of mortality in hospital practice. In this paper the value of a simple and rapid test which can be used to detect the presence of circulating endotoxins is assessed in experimental and clinical situations. The test is based on the ability of Gram-negative endotoxins to coagulate a protein moiety obtained from the horseshoe crab (Limulus polyphemus).

The sensitivity of a highly purified lysate when measured in vitro showed a positive Limulus test with as little as 510 μg/ml of endotoxin. In experimental animals we were able to detect endotoxin in the portal circulation only after the endotoxin was injected into the peritoneal cavity or when the bowel was made ischaemic or perforated, but never spontaneously.

The clinical studies were performed in 50 surgical patients to determine if the Limulus test was useful in detecting endotoxaemia. Seventeen patients were diagnosed clinically as having local infection, and Gram-negative organisms were cultured from various sources in 16. Fifty-one (77per cent) out of 66 Limulus tests performed during the episode of infection were positive, while only 1 (3 per cent) of the tests was positive once the infection had been adequately treated. Four patients in this group had persistent endotoxaemia, and all died. In the 8 patients with generalized peritonitis, 16 (73 per cent) out of 17 Limulus tests performed were positive at the time of peritonitis. In 25 patients with no clinical evidence of infection or peritonitis, 19 (18 per cent) out of 125 Limulus tests were positive.

The patients were also screened by the 125I-fibrinogen test for the presence of deep vein thrombosis, which was found in 13 (26 per cent). Thrombosis was detected in only 3 (19 per cent) of 16 patients in whom the Limulus test was negative throughout the investigation period. In contrast, 10 (29 per cent) of 34 patients who had positive Limulus tests developed thrombosis. In 6 the disease was bilateral, 5 had extensive thrombi which involved the major veins and 1 of these subsequently had a massive pulmonary embolism.

The implications of these findings and the use of the Limulus test in clinical practice are discussed.
Serum fibrin/fibrinogen degradation products after experimental pulmonary embolism
Authors: Jones D R B , Ruckley C V , Owens Rosemary , Cash J D
Published: March 2007

Serum fibrin/fibrinogen degradation products (FDP)have been measured for up to 12 hours after pulmonary embolism in 11 anaesthetized dogs. Embolism was produced by the reinjection of 3 ml/kg of clotted autologous blood. Five control animals received a similar volume of injected saline.

There was a significant increase in FDP levels in 8 out of 11 animals. The rise appeared within 10 minutes and reached a maximum at 30-60 minutes. High levels were sustained for up to 7 hours. There was considerable individual variation in response.

A second embolus 4 hours after the first in 5 animals tended to produce a greater increase in FDP.
The effect of truncal and selective vagotomy on the release of pancreatic glucagon, insulin and enteroglucagon
Authors: Russell R C G , Thomson James P S , Bloom S R
Published: March 2007

To study the effect of vagotomy on the endocrine function of the pancreas, plasma pancreatic glucagon levels were studied during insulin-induced hypoglycaemia, and the plasma insulin and enteroglucagon levels after an oral hypertonic glucose meal, These tests were performed on patients who had either a truncal or selective vagotomy, all of them also having a drainage procedure.

The rise of pancreatic glucagon levels during hypoglycaemia was significantly less in the truncal vagotomy group compared with the selective vagotomy group. The rise of enteroglucagon in the two groups was identical, but whereas in those with a selective vagotomy there was a significant correlation between the rate of rise of the plasma enteroglucagon and the 2-hour insulin output, no such correlation was present in those having a truncal vagotomy.

These results are interpreted as indicating that division of the coeliac branch of the vagus nerve impairs the pancreatic secretion of both glucagon and insulin.
Simplified repair of abdominal aortic aneurysms using non-bifurcated (straight) inlay prostheses
Authors: Orr W McN , Davies M
Published: March 2007

The treatment of abdominal aortic aneurysms by prosthetic replacement is still attended by considerable hospital mortality, particularly when rupture has already occurred. We consider that the results could be significantly improved by the more widespread use of a simplified repair which consists of the insertion of a non-bifurcated (straight) tubular inlay prosthesis within the aneurysm. No attempt is made to resect or to transect the aorta and its bifurcation is preserved.

In a series of 61 consecutive patients, from which 4 were excluded because they died before definitive surgery, there were 30 intact and 27 ruptured aneurysms. The hospital mortality for prosthetic replacement of intact aneurysms was 15 per cent using bifurcation grafts in 20 patients and nil for straight prostheses in 10 patients. The respective figures for leaking aneurysms were 64 per cent in 14 patients and 38 per cent in 13 patients.

In our experience this simplified technique has resulted in diminished hospital mortality as a consequence of reduced operating times, blood loss and postoperative morbidity. It can, moreover, be universally employed except where gross separation of the origin of the common iliac vessels has occurred, which is uncommon, or in the rare instance of coexistent acute limb ischaemia.
Vertebral osteomyelitis: A complication of urological surgery
Authors: Hale John E , Aichroth Paul
Published: March 2007

Three patients who developed vertebral osteomyelitis following genito-urinary surgery are presented. In each patient a persistent urinary tract infection was noted. Some months after operation these patients developed severe back pain, hut the correct diagnosis WIS not made initially because spinal X-rays were at first normal. In I patienr an abnormal gamma bone scan was thought, mistakenly, to be diagnostic of metastatic bone disease and it was only when the pain increased after radiotherapy that a diagnosis of. spinal osteomyelitis was considered.

The incidence of vertebral osteomyelitis in adults uppears to be increasing, and in order to make the correct diagnosis a high index of clinical suspicion is essential, particularly in patients who have had recent operations on the genito-urinary system.
Epicardial electrode implantation on both right and left ventricles using local anaesthesia
Authors: Guharay B N , Saha A K , Mittra D , Visvanathan Sushila , Gupta S M Sen , Basu A K
Published: March 2007

Experience with a simple method of epicardialintramural pacer lead implantation on either ventricle using local anaesthesia for long term cardiac pacing in cases of symptomatic heart block is presented. The report concerns 40 patients with 41 implants. The follow-up period was 6–19 months. There were 3 operative deaths. One of the deaths was coincidental and the other 2 were attributed to bad selection. Early electrode failure due to the development of an exit block occurred in 1 case; he has done well after his right ventricular electrode was transferred to the left ventricle through the same incision using local anaesthesia. There has been no late electrode failure. Nearly all the survivors have obtained excellent results.

The distinct advantages offered by this technique of epicardial pacing are discussed.

The modification which has been introduced in extending the scope of pacer lead implantation to the left ventricle has increased the usefulness of the technique. Left ventricular placement of the electrode assures better intramural pacing.
A comparison of gastric emptying at 3 and 12 months after proximal gastric or selective vagotomy without pyloroplasty
Authors: Donovan I A , Clarke R J , Gunn I F , Alexander-Williams J
Published: March 2007

A prospective study was performed to determine whether the early postoperative disturbance of gastric emptying after vagotomy altered with the passage of time. In 20 patients the rate of emptying of a 10 per cent dextrose meal was measured by a double sampling dye dilution technique before and 3 months after proximal gastric vagotomy or selective vagotomy without a drainage procedure. Ten of these patients agreed to a further emptying study at 12 months after operation.

Profound changes in the pattern of emptying occurred as a result of either operation. At 3 months after operation both selective and proximal gastric vagotomy were associated with an initial cascading of part of the meal (gastric incontinence). Selective vagotomy was then associated with an increase in the time taken for complete emptying, whereas after proximal gastric vagotomy the time taken for complete emptying was similar to that before surgery. In the next 9 months after operation no significant change occurred in the initial cascading, but the delay in complete emptying after selective vagotomy improved in some patients.
Rupture of the retroperitoneal duodenum after blunt abdominal trauma
Authors: Rasaretnam Rudra , Thavendran A
Published: March 2007

Four cases of rupture of the retroperitoneal part of the duodenum after blunt abdominal trauma are documented. Two of the patients continued with normal activity for some hours before presenting at hospital, and although the other 2 presented shortly after the injury, the diagnosis in both was made after a period of observation. Repeated abdominal examination is the best aid to diagnosis. Rupture of the second part of the duodenum is more common, Delay in diagnosis is associated with a high mortality.
Biliary peritonitis without perforation of the gallbladder in acute cholecystitis
Authors: Kent S J S , Menzies-Gow N
Published: March 2007

Six patients with biliary peritonitis occurring as a complication of acute cholecystitis are reported. Five of the 6 patients had no detectable perforation of the gallbladder. The literature of this topic is reviewed and a theory is put forward to account for biliary peritonitis without perforation of the gallbladder in acute cholecystitis.
A survey of the results of the Boerema anterior gastropexy for hiatus hernia over a 4-year period
Authors: Davies C J
Published: March 2007

The results obtained by using the Boerema anterior gastropexy for symptomatic hiatus hernia over a 4-year period are reviewed. All 68 patients were operated upon by the same surgeon. The success rate as judged by relief of the patients' symptoms was 90 per cent.

It is felt that the operation has advantages such as to justify its wider use.