bluuebunny/crossref_metadata_2025 huggingface dataset:
THE CONSULTANT SURGEON AND MAMMOGRAPHY
Authors: Hare William S. C.
Published: January 2008

It is important that the mounting wave of criticism of mammography in breast screening programmes should not obscure the fact that it remains the most accurate method of diagnosing breast cancer short of biopsy. Furthermore, breast cancer may be diagnosed by mammography at an early stage before it has spread to regional lymph nodes, at a time when the prognosis is better. At this time it may be beneficial to outline the role of mammography as an aid to the consultant surgeon in the management of patients referred with breast problems.
PITUITARY ADENOMAS AND DYSPITUITARISM
Authors: Lazarus L.
Published: January 2008

Recent studies of the structure and function of pituitary adenomas reveal that the majority are functional and that the commonest type is a prolactin secreting adenoma. Studies of hypothalamic‐pituitary function provide evidence to suggest that the adenoma develops following prolonged hypothalamic stimulation of the pituitary gland, and that the clinical dyspituitarism is due to the hypothalamic‐pituitary dysfunction and not to pituitary destruction by the adenoma. Pituitary adenomas may be classified into those due to a basic neuroendocrine dysfunction (prolactin secreting, acromegaly, Cushing's disease) and those arising secondary to end‐organ failure (TSH and FSH secreting). The former group have APUD characteristics and may form part of a pluriglandular syndrome of apudomas. The persistence of a basic neuroendocrine dysfunction following the surgical removal of an adenoma explains the frequent recurrence of symptoms in patients and indicates a need for continued surveillance and long‐term therapy.
GLIOMAS OF THE OPTIC NERVE AND CHIASM IN CHILDREN
Authors: Klug Geoffrey L.
Published: January 2008

This paper reviews the clinical features, management, and prognosis of patients with gliomas of the optic nerves and chiasm who have received treatment at the Royal Children's Hospital, Melbourne, between 1954 and 1977. The relationship of this tumour to other neoplasms in the region is discussed, and emphasis is placed on the natural history of the disease. The controversy concerning the exact nature of this lesion is summarized, and an attempt is made, in the light of this evidence and from the reviewed series, to formulate an appropriate overall plan of management of these patients.
RECONSTRUCTION OF THE BREAST FOLLOWING RADICAL MASTECTOMY
Authors: Marshall D. R. , Anstee E. J. , Stapleton M. J.
Published: January 2008

A method of reconstruction of the breast following radical mastectomy is presented. The technique involves the use of an individually made Silastic prosthesis inserted three to six months after the mastectomy. A new simple method of nipple reconstruction is described, and the total restoration can be achieved in one operation. It is suggested that reconstruction of the breast be considered more frequently in patients subjected to mastectomy.
THE TRAUMATIC PSEUDOLIPOMA
Authors: Rozner Leo , Isaacs Graham W.
Published: January 2008

A contour deformity, clinically reminiscent of a large lipoma, can develop after a severe shearing‐type injury to the upper thigh, hip, or sacrum, particularly In young women. As the injury is rarely dealt with in the first weeks, it usually presents after a deep scar has contracted. At this stage active surgical Intervention seriously Increases the aesthetic problem. Conservative treatment with massage, pressure, and possibly Injection of steroida is more effective. To the best of our knowledge, this condition has not previously been described.
ALBUMIN‐CONTAINING PLASMA VOLUME EXPANDERS
Authors: Schiff Peter
Published: January 2008

Human albumin‐containing solutions have been used as plasma volume expanders and in the management of severe hypoproteinaemia for over 30 years. Modern indications for their use are described in some detail. These include the management of shock, burns, adult respiratory distress syndrome, and priming of the cardio‐pulmonary bypass pump. Reactions to albumin infusions are rare. Recent reports of hypotension following rapid infusion of SPPS and PPF are under active pharmacological study.
GAS GANGRENE AFTER HIP NAILING
Authors: Dykes Robert G.
Published: January 2008

Three fatal cases of gas gangrene occurring after nalling of hip fractures are reported, a summary is given, with comparisons with previously published series.
RESTORATION OF GRASP AND PINCH IN A BURNT HAND BY POLLICIZATION OF AN ISLAND FLAP TAKEN FROM THE SAME FINGER
Authors: Mehrotra O. N.
Published: January 2008

A unique opportunity to reconstruct a deformed hand by designing two neurovascular island flaps from a damaged index finger has been presented. One flap, a composite carrying the index tip, was used basically as in pollicization, while the second flap was used to reconstruct the web space. An excellent functional result was achieved.
IN‐VITRO STUDIES OF GALLSTONE DISSOLUTION: THE EFFECT OF ADDED HEPARIN IN BILE SALT SOLUTIONS
Authors: Furnival C. M. , Burnett W. , Green M. K. , Selvage N. C. , Cavaye G. , Hardie I. R.
Published: January 2008

The dissolving effect of four bile salt solutions (sodium cholate, sodium taurocholate, sodium deoxycholate and sodium chenodeoxycholate) upon gallstones was tested in an in‐vitro preparation, using 226 stones from 38 patients. The effect of each solution was measured by recording weight loss in the gallstone at the end of a ten‐day period of immersion in the bile salt solution.

Sodium deoxycholate and sodium chenodeoxycholate produced the greatest average weight loss in the groups of stones tested with pure bile salt solutions, but the addition of heparin to solutions of sodium cholate and sodium deoxycholate produced a significant increase in weight loss in these solutions. This effect of heparin in the presence of bile salts, in comparison with the failure of heparinized saline to induce weight loss in gallstones, is discussed.

Sodium chenodeoxycholate cannot be recommended for clinical use on the grounds of its toxicity, and in view of the possible toxicity of sodium deoxycholate it is concluded that a combination of sodium cholate with heparin is the optimum solution for the dissolution of retained intraduct calculi in vivo.
THE CURRENT PRACTICE OF PAEDIATRIC SURGERY IN MALAYSIA
Authors: SOMASUNDARAM K.
Published: January 2008

This 10‐year review of surgical conditions In Infants at the University Hospital, Kuala Lumpur, highlights some of the more common problems encountered and outlines their management. Anorectal agenesis and Hirschsprung's disease were seen relatively more frequently than other anomalies of the gastrointestinal tract. The management of these two conditions and the operation of colostomy and its complications are singled out and presented In some detail.
MASTECTOMY IN A LARGE PUBLIC HOSPITAL
Authors: BATTERSBY CAMERON , ARMSTRONG JEAN , ABRAHAMS MARY
Published: January 2008

Thirty women undergoing mastectomy for carcinoma of the breast in a large teaching hospital were interviewed. All indicated a very real need to discuss their experiences, and felt that the interview had been beneficial to them. Most had found the “lump” themselves – but often described it as a “hardness”, a “ridge”, or a “thickening”. More than half felt that the counselling afforded to them had been inadequate – especially in the realm of sexual adjustment – but, if their marriages had been stable before operation, subsequent deterioration was unlikely. The threat of malignancy, rather than that of breast loss, was uppermost in the minds of most patients. It should not be assumed that postmastectomy problems do not exist because patients do not mention them, especially in large busy follow‐up clinics, where privacy may be inadequate. If doctors are unable or unwilling to afford this service to their mastectomy patients, It may be necessary to delegate it to other health professionals and mastectomy volunteers.
THE RESULTS OF COLONIC ANASTOMOSES AT THE ROYAL MELBOURNE HOSPITAL
Authors: COLLINS JOHN P. , BUTTERFIELD DAVID
Published: January 2008

One hundred consecutive colocolic and colorectal anastomoses are reviewed. The operative mortality was 5%, wound infection rate 27%, and faecal fistula rate 15%. These complications are shown to double the hospital bed stay. Factors affecting their occurence are examined, and recommendations are made with a view to lower this morbidity.
POSTOPERATIVE HYPOXAEMIA: PREOPERATIVE CONSIDERATIONS
Authors: MORTON A. P.
Published: January 2008

In a group of 31 consecutive patients undergoing major abdominal surgery, severe postoperative arterial hypoxaemia was present In 10 cases (32%). The predictive value of the preoperative expiratory spirogram and the arterial PO2 have been examined. It is concluded that a history of chronic bronchitis may be of more value than either of these investigations in predicting the likely occurrence of postoperative hypoxaemia.
COLLOID OSMOTIC PRESSURE IN SURGICAL PATIENTS AND ITS RELATIONSHIP TO SERUM PROTEIN AND ALBUMIN ESTIMATIONS
Authors: MORTON A. P. , HOLLING J.
Published: January 2008

A series of calculated colloid osmotic pressure (C. O.P.) results have been compared with concurrently performed total serum protein and serum albumin estimations. It Is concluded that in most critically ill patients, serial estimations of total serum protein, which are very easy to perform using a hand refractometer or copper sulphate bottles, give a useful guide to the C. O.P. level. In a second series of patients, colloid osmotic pressure has been calculated before and after operation in a group of patients undergoing routine abdominal surgery, and significant falls In C. O.P. have been found to occur after operation. It Is suggested that this may be a contributing factor in some of those patients who suffer postoperative respiratory complications.
EXPERIMENTAL REPLACEMENT OF THE CERVICAL OESOPHAGUS WITH A FREE TRANSVERSE COLON AUTOGRAFT USING MICROVASCULAR ANASTOMOSES
Authors: SULIANEGARA R. , RYAN PETER , O'BRIEN BERNARD MCC. , COLLOPY BRIANT. , PIANTA ROBERT M.
Published: January 2008

Microsurgical revascularization in the neck has improved the survival rate of free small‐bowel grafts used to replace the cervical oesophagus. Colon vessels are larger than those in the jejunum, and even with naked‐eye technique good results have been reported following free colon grafting of the oesophagus. The authors thought it might be possible to achieve even better results using microvascular anastomoses in the neck, and in this way replaced the cervical oesophagus in each of 15 dogs with a free transverse colon autotransplant. Four dogs died during operation and four within three days, two of the latter with graft necrosis. The next seven dogs survived eight days or more, and all their colon grafts were viable. Where patent arteries were demonstrated (three cases) the mucosa and myenteric plexuses of the graft survived. In all four dogs where the arteries were thrombosed or not demonstrated, the mucosa was absent, myenteric plexuses were absent in three, and one graft was grossly stenosed. Among these seven dogs there were three fistulae, one where graft arteries were patent and two where they were not; immediate anastomotic healing was not guaranteed by graft survival or arterial patency.
ENDOMETRIOSIS OF THE SIGMOID COLON AND RECTUM
Authors: EYERS TONY , MORGAN BRIAN , BIGNOLD LEON
Published: January 2008

Endometriosis is a common disease of women which occasionally causes serious symptoms in virtue of involvement of the distal large intestine. Two cases are reported, illustrating opposite ends of the spectrum of this disorder, one presenting with a complete large‐bowel obstruction, and the other with periodical per‐rectal bleeding. Endometriosis in these locations can closely mimic carcinoma, and from a consideration of our cases and the literature, those features which might help to distinguish one from the other are discussed. The treatment of endometriosis itself is briefly outlined.

Either to avoid unnecessarily radical surgery, or to plan appropriate specific treatment at the time of surgery for the colorectal lesion, a preoperative diagnosis is desirable, but it Is unlikely unless the clinician is aware of this unusual form of endometriosis.
LASER SURGERY FOR MALIGNANT MELANOMA AND SUPERFICIAL MALIGNANCIES
Authors: MCCARTHY W. H. , SHAW H. M. , JONES P. H.
Published: January 2008

This study describes 18 months' experience with the CO2 laser in the treatment of malignant melanoma and other superficial malignancies. In 110 patients, a general assessment was made of the advantages commonly claimed for the laser. In addition, a comparison between laser and scalpel surgery was made by means of a small retrospective study. Results from 39 patients undergoing wide excision and graft for primary malignant melanoma in association with axillary lymph node dssection indicated that the laser offered no specific advantages over the scalpel for this particular type of operation. The laser was shown to have specific advantages in the treatment of extensive superficial malignancy, in locally recurrent tumours, and in malignancy of soft tissues. In these situations it did minimize blood loss and achieve satisfactory extirpation of the lesion.
A SURGICAL APPROACH TO DIAGNOSTIC ULTRASOUND AND ITS RELATION TO OTHER ORGAN IMAGING TECHNIQUES
Authors: DUFFY PETER
Published: January 2008

Ultrasound can be of considerable help to the surgeon in the diagnosis ot non‐bowel abdominal lesions and of peripheral soft tissue masses. Its relationship to established radiological and nuclear medicine techniques and computed tomography is discussed. The place ol ultrasound in an organ imaging department is outlined.
HORMONE RECEPTORS AND BREAST CANCER
Authors: KEIGHTLEY D.D.
Published: January 2008

The hormones of reproduction have been implicated in breast cancers of women. A short reproductive life, and a pregnancy prior to the age of 30 years, both reduce the risk of breast cancer (Doll, 1975). In addition, removal of endogenous sources of oestrogens, and administration of anti‐oestrogens, cause some breast cancers to regress (Stoll, 1969). Such observations have led to an investigation of the role of the hormones of reproduction, and of oestrogen in particular, in the maintenance of breast cancers.
MALIGNANT MELANOMA: MICROSTAGES AND INDIVIDUALIZED THERAPY
Authors: TONAK J. , HERMANEK P. , GROITL H.
Published: January 2008

In the prognosis of malignant melanoma the clinical stage and the microstage are the most important factors. According to the microstage, malignant melanomas can be divided into low‐risk and high‐risk melanomas. The subungual‐volar melanoma seems to be an exception. Irrespective of the microstage, the prognosis of this type is probably worse than that of other types of melanoma. In patients with clinical Stage I the therapy should be individualized. In a low‐risk melanoma, a wide local excision iS sufficient; in a high‐risk melanoma an additional regional lymph node dissection appears to be indicated; and if the primary tumour is located on an extremity a hyperthermic perfusion is also called for.
ANGIODYSPLASIA OF THE SMALL BOWEL: A METHOD OF INTRAOPERATIVE IDENTIFICATION
Authors: BAMBACH C.P. , COUPLAND G.A.E. , SORBY W. , ROCHE J.
Published: January 2008

Two cases of recurrent bleeding from the gastro‐intestlnal tract are described. The Initial diagnosis and the identification of the lesions at laparotomy were difficult problems. In both cases the bleeding was due to a vascular lesion of the small bowel, referred to as anglodysplasla. The lesions were detected before operation by selective angiography and Identified at laparotomy by a preoperative and an Intraoperative Injection of a vital stain through the catheter into the feeding vessels.
THE SPITZ NAEVUS
Authors: Weedon David , Little J. H.
Published: January 2008

The clinical and histological features of the Spitz naevus are reviewed in the light of a recently reported study of 211 cases seen at the Queensland Melanoma Project.
BLOCKING FACTORS AGAINST MELANOMA LEUCOCYTE‐DEPENDENT ANTIBODY: RELATIONSHIP TO DISEASE ACTIVITY IN MELANOMA PATIENTS
Authors: HERSEY P. , MURRAY E. , RUYGROK S. , EDWARDS A. , MILTON G. W.
Published: January 2008

Previous studies have shown that many melanoma patients have cytotoxic leucocyte‐dependent antibody (LDA) which is inhibited by factors in their sera. These factors were shown to be small molecular weight glycoproteins which could also be identified in the supernatants of melanoma cultures, and which were therefore most likely to be melanoma cell surface antigens. The present studies have shown that these blocking factors against melanoma LDA can be detected in patients with primary melanoma, and that the levels of this activity show an inverse correlation with the levels of LDA in the sera of melanoma patients. The appearance of melanoma LDA after surgery for localized melanoma was shown in approximately a third of the patients, and this pattern was shown to result from the disappearance of the LDA blocking activity after surgical removal of the melanoma. Assays were designed specifically to measure the melanoma LDA blocking factors by plasmapheresis. It is not yet known whether the melanoma LDA blocking activity has correlation with tumour growth in melanoma patients. The potential value of measuring this activity to assess response to therapy was shown by studies designed to remove the blocking factors by plasmapheresis. It is not yet known whether the melanoma LDA blocking activity has biological significance in regard to tumour growth, but these studies appear to indicate that measurement of these factors in the sera of melanoma patients may provide a useful in vitro monitor of tumour growth in melanoma patients.
THE SIGNIFICANCE OF URINARY MELANOMA ANTIGEN EXCRETION AND THE ABILITY OF THYMOSIN TO RAISE THE LEVEL OF DEPLETED LYMPHOCYTES IN VITRO IN MALIGNANT MELANOMA
Authors: VOLKERS C. , COOKE B. , BENNETT C. , BYROM N. , CAMPBELL M. , ELLIOT P. , WHITFIELD P.
Published: January 2008

One hundred and fifty‐six patients were screened for the presence of urinary melanoma antigen and serum cytoplasmic antibody. It was fuund that 44% of symptomless Stage 1 patients tested five to 15 years after operation had detectable antigen (Ag) in their urine: the urines of 67% of Stage 2A (local recurrence) patients were positive for Ag; while in only 38% of those patients graded 2B (lymph‐node involvement) were these tests positive. Urines of 83% of patients with generalized metastases (Stage 3) were positive. A sequential study was made of 23 patients seen and treated in 1976. Of this group, 14 reverted from a positive state to a negative one following excision of their tumour, while six were negative on first postoperative testing and subsequently became positive. Three out of the 23 remained persistently negative. T lymphocyte levels were assessed in 71 melanoma patients, and a stage‐related fall was noticed. Thymosin (Hoffman LaRoche) on in vitro incubation significantly raised the levels of T lymphocytes.
ANTIBIOTICS IN THE MANAGEMENT OF INFLAMMATORY LESIONS OF THE INTERVERTEBRAL DISCS IN YOUNG CHILDREN1
Authors: BYE W. D. , TAYLOR T. K. F.
Published: January 2008

A review of 35 cases of inflammatory lesions of the intervertebral discs in young children has failed to establish a role for antibiotics in management. There is a tendency to overinvestigate and overtreat this benign, self‐limiting malady, for which a period of six weeks of immobilization in a double hip spica is recommended.
ANTIBIOTICS IN THE MANAGEMENT OF POSTOPERATIVE DISC SPACE INFECTIONS1
Authors: TAYLOR T. K. F. , DOOLEY B. J.
Published: January 2008

The place of antibiotics in the management of postoperative disc space infections is examined on the basis of a review of 14 cases. Whereas the role of antibiotics is clear in acute infections which manifest themselves in the early postoperative period, this is not so for cases which present late with a chronic process. Here, immobilization in a double hip spica is the single therapeutic measure recommended.
FOREARM FRACTURES IN CHILDREN
Authors: HARBISON J. S. , STEVENSON T. M. , LIPERT J. R.
Published: January 2008

A prospective survey of over 1,000 forearm fractures in children is presented. Individual fracture patterns are considered and specific complications and methods of treatment are discussed. Conservative treatment produces satisfactory results in the majority of fractures, provided that it is done with care and the patients are adequately followed up.
ARTHROSCOPY OF THE KNEE
Authors: Davie Brian
Published: January 2008

Arthroscopy of the knee is an essential diagnostic aid for difficult knee problems. It is safe and is indicated especially in the problem knee of adolescents, where it is most undesirable to remove a normal cartilage; in litigation cases; in the post‐surgery knee problem; in planning surgical procedures; and in surgery on professional sportsmen.
CHRONIC LOW BACK PAIN: EVALUATION AND THERAPY1
Authors: HlCKEY R. F. J.
Published: January 2008

Chronic low back pain is a common complaint afflicting a large percentage of the population. More interest is required in solving this problem, which is of large economic proportions. This paper reports some procedures by which this may be achieved.
THE PRESENT STATUS OF PROXIMAL GASTRIC VAGOTOMY
Authors: COLLOPY BRIAN , RYAN PETER
Published: January 2008

It is now clearly established that proximal gastric vagotomy, which has been in clinical use for over seven years, has lower mortality and morbidity rates than all other forms of operation currently used in the treatment of chronic duodenal uicer. Although no long‐term figures are yet available, the ulcer recurrence rate is not likely to be greater than that for truncal vagotomy. The technique is not without problems, however, and has yet to gain wide acceptance in this country.
BILE PERITONITIS AFTER THE USE OF LATEX RUBBER T‐TUBES
Authors: MULLANY C. J.
Published: January 2008

Three cases of biliary peritonitis following the removal of a latex rubber T‐tube from the common duct in the second postoperative week are reported. This is a well‐recognized complication following the use of polyvinyl chloride T‐tubes in biliary duct surgery, but its occurrence with latex rubber T‐tubes is extremely uncommon.
VILLOGLANDULAR ADENOMA OF THE DUODENUM
Authors: SHEAD G. V. , MATHAN MINNIE
Published: January 2008

Two cases of villoglandular adenoma of the duodenum presenting with features of peptic ulcer are reported. At surgery both patients had intussusception of the duodenum. One of them had carcinoma in situ. The literature is briefly reviewed, and the importance of keeping in mind this rather rare condition, even in areas where duodenal ulcer is widely prevalent, is emphasized.
DUODENAL HAEMATOMA IN ASSOCIATION WITH COELIAC AXIS STENOSIS
Authors: MERWYK A. J. VAN , YU S. FONG
Published: January 2008

Duodenal haematoma is now a welt‐established clinical entity. The aetiology, however, is not always clear. Trauma or bleeding due to anticoagulant therapy is the cause in most cases. It is suspected that unreported minor trauma may cause the remainder. A case is reported in which the pancreaticoduodenal circulation was markedly dilated and tortuous because of severe coeliac axis stenosis. It is suggested that no trauma is required in this situation to cause bleeding, which may be due to spontaneous rupture of the smaller vasa recta.
OPERATIVE BIOPSY OF THE PANCREAS USING THE TRUCUT NEEDLE
Authors: INGRAM D. M. , SHEINER H. J. , SHILKIN K. B.
Published: January 2008

The results of 14 operative biopsies of the pancreas using the Trucut technique are presented. There was no significant complication attributable to the biopsy, and in all cases an adequate tissue specimen was obtained, facilitating either frozen or paraffin section histological diagnosis. One false negative result was obtained which was due to sampling error. This technique is recommended as a good alternative when operative pancreatic biopsy is required. It is technically simple, has an acceptably low sampling error, provides a good tissue specimen for histological examination, and has few complications.
ANTERIOR AND POSTERIOR RUPTURES OF THE URETHRA: SIMPLIFIED METHODS OF IMMEDIATE SURGICAL MANAGEMENT
Authors: EARLAM MALCOLM S. S.
Published: January 2008

The aetiology and relative incidence of anterior and posterior ruptures of the urethra are briefly discussed. Methods of surgical management of both types of injury are described, which obviate any necessity to expose the site of rupture. A series of five such cases is reported, the outcome in each being satisfactory.
THE EFFECT OF 5‐FLUOROURACIL ON ABDOMINAL WOUND HEALING IN RATS
Authors: MORRIS TOM , LINCOLN FAY , LEE ALAN
Published: January 2008

We carried out experiments to test the hypothesis that 5‐Fluorouracil would retard wound healing when administration was started on the day of operation. Abdominal wounds were made in rats and closed again, and some of the animals were given daily 5‐FU, the rest acting as controls. Test animals were killed three, five, seven and 10 days after operation, and the strength of their wounds was measured. At five and seven days the control wounds were 10 times stronger than those of the treated animals, and at 10 days they were four times stronger. We speculated that the difference in strength might be largely due to the observed fact that the muscle layer in the treated animals was considerably weaker than in the controls. We concluded that it would be unsafe to start giving 5‐FU to patients immediately after operation.
MYOCARDIAL INFARCT IMAGING AFTER CARDIAC SURGERY*
Authors: PANETTA F. , WONG C. C. L. , DUGDALE L. M. , WAN A. T. , STIRLING G. R. , ANDERSON S. T. , PITT A.
Published: January 2008

One hundred and nineteen patients undergoing cardiac surgery had postoperative myocardial imaging performed with technetium pyrophosphate in order to assess the incidence of perioperative myocardial infarction. Fifty‐six patients had only coronary artery bypass graft (CABG) surgery, of whom 13 (23%) had a positive scintigram. Thirteen patients had CABG with other cardiac surgery and six (46%) had a positive scintigram. Fifty patients had other cardiac surgery but no CABG, and of these eight (16%) had a positive scintigram. The overall incidence of positive scintigrams was 23%, whereas definite or probable ECG diagnosis of infarction was present in 14 patients (12%). Serum levels of cardiac enzymes were higher in patients with positive scintigrams, but this finding did not consistently reach statistical significance. The use of a left ventricular vent during surgery did not correlate with a positive scintigram, nor did the total time on cardiopulmonary bypass or aortic cross‐clamping. Patients having cardiac surgery, including CABG and valve replacement, have a 23% overall incidence of positive scintigrams. This suggests that the incidence of infarction after cardiac surgery is higher than can be recognized from the conventional criteria of ECG and enzyme changes.
THE IMPACT OF A NEW OPERATING THEATRE SUITE ON SURGICAL WOUND INFECTIONS
Authors: MILLAR K. J.
Published: January 2008

An overall fall in wound infection rates from 9% to 3% following the opening of a new operating theatre block is discussed in the light of a continuing infection control programme.
RUBBER SUMP DRAINAGE OF ENTEROCUTANEOUS FISTULAE
Authors: STEWART G. RAMSEY , HURST R. , HADGIS C. , LOEWENTHAL JOHN
Published: January 2008

Effective sump drainage of high enterocutaneous fistulae, together with alimentary rest and total parenteral nutrition, is now an integral part of the modern management of patients with this condition. The low tissue reactivity of the plastic and polymer materials currently used in most drainage tubes appears however, to be counterproductive to the establishment of a discrete fistula track and control of the fistula. A case is made for the use of red rubber sump drains for enterocutaneous fistulae. The greater tissue reactivity of rubber is reviewed and confirmed by animal experimentation. A method of rubber sump drainage of enterocutaneous fistulae developed during the management of 83 such fistulae is described.
DIAGNOSTIC PNEUMOPERITONEUM IN TRAUMATIC RUPTURE OF THE RIGHT DIAPHRAGM
Authors: WYNNE J. M. , GOUGH I. R.
Published: January 2008

The diagnosis of diaphragmatic rupture following blunt trauma is difficult and often delayed. Introduced pneumoperitoneum can provide important diagnostic information. Its use is illustrated in a case of massive rupture of the right diaphragm where diagnostic pneumoperitoneum was valuable in distinguishing recent rupture from preexisting pathology.
EPIDURAL ABSCESS: A HAZARD OF SPINAL EPIDURAL ANAESTHESIA
Authors: NORTH J. B. , BROPHY B. P.
Published: January 2008

Two cases of spinal epidural abscess following prolonged epidural anaesthesia are presented. The clinical features included fever, malaise, and signs of nerve root compression; backache was not marked. Prompt surgical drainage and appropriate antibiotics are required to avoid the costly sequelae of bladder and leg paralysis from spinal cord compression. Both infections were caused by bacterial contamination of catheter, and although this complication is uncommon, it emphasizes that strict asepsis is essential during continuous epidural anaesthesia.
AXIAL MUSCLE AND MYOCUTANEOUS FLAPS: A RECENT CONCEPT IN WOUND CLOSURE
Authors: HOLMES ANTHONY , CARLISLE IAN
Published: January 2008

Until the last decade, the greatest advances in reconstructive surgery have been skirt grafting and the advent of pedicle flaps. More recently a new understanding of the discrete vascular anatomy of the skin and other composite tissues has enabled the transfer of these tissues with far more reliability, either locally or – using microvascular techniques – to a distance. The axial and random concept of blood supply of flaps will be outlined. A brief historical background of the development of axial flaps is included. A synopsis of the anatomy, uses and limitations of the commonly used and proven muscle and myocutaneous flaps in our experience is reported. In the final discussion, a new and simple classification of wound closure is proposed which encompasses all the recent developments in this field.
SUBCUTANEOUS MASTECTOMY: INDICATIONS AND TECHNIQUE
Authors: ACKLAND T. H. , HUESTON J. T. , ROBBINS T. H.
Published: January 2008

For a certain group of patients, carefully selected by criteria which are here discussed, subcutaneous mastectomy offers a real prospect of minimizing the risk of breast cancer developing. It will also relieve pain in most of those for whom it has become intolerable and will usually provide the patient with both comfort and peace of mind. Performed by the technique described, subcutaneous mastectomy can now produce an aesthetically pleasing result. Regular review of all patients is, however, mandatory.
PRIMARY ISOLATED EXTRAMEDULLARY PLASMACYTOMA OF THE DUODENUM
Authors: MANNELL AYLWYN
Published: January 2008

The first case of primary isolated extramedullar plasmacytoma (EMP) of the duodenum is reported. The features which differentiate primary isolated EMPs from EMPs associated with multiple myeloma are discussed. The prognosis for a primary isolated EMP of the gastrointestinal tract is uncertain.
SPONTANEOUS EXTERNAL BILIARY FISTULA
Authors: ORR K. B.
Published: January 2008

A patient with spontaneous external biliary fistula is presented. Points from the literature on this rare event are discussed.
THE MALLORY‐WEISS LESION AS A CAUSE OF UPPER GASTROINTESTINAL BLEEDING
Authors: STERN A. I. , KORMAN M. G. , HUNT P. S. , HANSKY J. , HILLMAN H. S. , SCHMIDT G. T.
Published: January 2008

A prospective study of patients with upper gastrointestinal bleeding admitted to a haematemesis and melaena unit has revealed an incidence of Mallory‐Weiss tears of 8% (59 of 762 patients undergoing endoscopy). Prior vomiting was present in 60% and an associated upper gastrointestinal lesion in 44 percent. The majority of patients had a recent ingestion of alcohol and/or analgesics, whilst 34% had chronic heavy alcohol intake. Approximately 50% of patients required no blood transfusion, whilst 37% had over three units of blood. No patient in the group required surgical intervention, and one patient died because of general debility. This study suggests that the Mallory‐Weiss tear accounts for a significant proportion of patients admitted with upper gastrointestinal bleeding, but that the mortality and morbidity are low.
LOW ANTERIOR RESECTION
Authors: KILLINGBACK MARK
Published: January 2008

A personal series of 93 patients treated by low anterior resection for carcinoma (87) and benign disease (6) is reviewed to highlight the technical problems and complications of the operation. The series comprises two groups for comparison of (i) technique of anastomosis; (ii) the use of protective stoma; and (Hi) methods of drainage.
CONGENITAL ABDUCTION CONTRACTURE WITH DISLOCATION OF THE SHOULDER IN CHILDREN: A REPORT OF TWO CASES
Authors: CHARI P. R. , RAO Y. VENKATESWARA , RAO B. K.
Published: January 2008

Isolated congenital contracture of the deltoid muscle in children is uncommon. There are no reports in the literature of such cases associated with anterior dislocations of the shoulder. Two young girls with deltoid contracture and associated dislocation of the shoulder are reported.
HIP PROBLEMS IN A BATTERED CHILD: A CASE REPORT
Authors: MACFARLANE I. J. A.
Published: January 2008

A battered child with a stiff right hip, a pseudarthrosis of the left femoral neck, and a grossly shortened left femur, is described. Conservative care is suggested.

A 16‐year‐old girl presented 14 years after allegedly being battered, having had no medical care in the interim. Her bilateral hip problems are to be managed conservatively at present.
THE USE OF METHYLMETHACRYLATE IN THE TREATMENT OF GIANT CELL TUMOURS OF THE PROXIMAL TIBIA
Authors: BADDELEY S. , CULLEN J. C.
Published: January 2008

Two cases of giant cell tumour of the proximal tibia are presented where the defect remaining after curettage has been filled with methylmethacrylate bone cement. The problems associated with the present management of giant cell tumours and the potential advantages of using methylmethacrylate are discussed.
ANOTHER LOOK AT KERATOACANTHOMA
Authors: RANK B. K. , DIXON P.L.
Published: January 2008

In a retrospective survey over a three‐year period there were found 199 patients with keratoacanthoma among 3,180 patients with malignant skin disease. The clinical features of the series are presented, with particular attention to the diagnostic error. Amongst experienced clinicians there was an 8.5% error in calling an invasive squamous cell lesion a keratoacanthoma.

Pertinent features of the clinical nature of keratoacanthoma with particular reference to immunological surveillance are discussed.
A METHOD FOR THE OPERATIVE TREATMENT OF CHRONIC ISCHAEMIA OF THE GUT1
Authors: CATCHPOLE BERNARD
Published: January 2008

A method of revascularizing the coeliac axis or its branches, and the superior mesenteric artery, is described. A saphenous vein graft is brought from the lumbar aorta behind the pancreas to the recipient host artery. Two illustrative patients' histories are presented.
THE COMBINED USE OF ANTILYMPHOCYTIC SERUM AND BONE MARROW INFUSION IN IMMUNOLOGICAL SUPPRESSION
Authors: CARIDIS D. T.
Published: January 2008

The combined use of antilymphocytic serum and live donor‐specific bone marrow cells has produced significant immunosuppressionln dogs as judged by renal allograft survival. This combined action is specific in that it cannot be reproduced whether given alone or when live donor‐specific bone marrow cells are replaced by dead donor‐specific bone marrow cells or other antigens. The study has paved the way for human trials.
CORONARY HAEMODYNAMICS AND MYOCARDIAL METABOLISM DURING CARDIOPULMONARY BYPASS
Authors: RICHARDSON J. P. , BAKER T. G. W.
Published: January 2008

An experimental animal preparation is described which has allowed us to determine coronary haemodynamics and the overall myocardial metabolic rate of the disease‐free, beating, normothermic heart during total cardiopulmonary bypass. We have confirmed that under these conditions the required coronary blood flow is about 50ml/min/100g myocardium, which can be achieved at a low perfusion pressure (60 mm Hg or 8 kPa), and that overall myocardial metabolism is represented by an oxygen utilization of just over 2ml/min/100g. We have also defined the associated dynamic parameters which characterize oxygen transport in the coronary circulation during bypass. By controlling coronary perfusion, analogous in a clinical setting to selective coronary perfusion, we have demonstrated a simple linear correlation between perfusion pressure and coronary flow, indicating a “fixed” coronary vascular resistance. Under these conditions the myocardial oxygen uptake rises towards a maximum of 4ml/min/100g with the expected associated changes in the parameters characterizing oxygen transport in the coronary circulation. These trends are postulated as being a reflection of alterations in regional myocardial perfusion.

By extrapolating to the clinical situation, these data have appeared to give valid information concerning the adequacy of coronary perfusion.
ISOLATED LIVER PERFUSION: THE CHOICE OF ANAESTHETIC
Authors: DOBBS B. R. , BAXTER J. N. , GALLAND B. C. , LEE D.
Published: January 2008

Perfused livers isolated from rats under halothane anaesthesia produced greater amounts of bile, released smaller amounts of aspartate aminotransferase, and had a much greater ability to maintain a constant concentration of glucose in perfusates than those obtained with ether or pentobarbitone. Little or no effect was shown on the ability of the liver to synthesize urea and to retain potassium within the organ. It appears, therefore, that halothane is the anaesthetic of choice when removing the liver from the laboratory rat.
CHANGES IN LIVER BLOOD FLOW WITH DEVELOPMENT OF BILIARY OBSTRUCTION IN THE RAT1
Authors: HUNT DAVID R.
Published: January 2008

As well as causing retention of biliary secretory products, bile duct obstruction is associated with other hepatic and systemic effects which are poorly understood. These latter changes contribute to the increased morbidity and mortality associated with surgery for biliary obstruction. This study examines the changes in liver blood flow occurring after common bile duct (CBD) ligation in the belief that relative hepatic ischaemia may contribute to dysfunction. A new method for measuring liver blood flow (LBF) based on the clearance of 133Xe from the liver following injection into the portal vein is described. With this new development, serial measurements of LBF can be performed in the conscious, unfasted rat. With the development of jaundice, a highly significant reduction in LBF is seen which is first evident 36 hours after CBD ligation. By the third day after ligation, LBF is only 54% of the control value. No fall in LBF is seen in rats subjected to sham ligation. The mechanism for the reduction in LBF is uncertain, but the delayed onset makes any reflex autonomic reaction unlikely.
RETARDATION OF HEALING OF LARGE‐BOWEL ANASTOMOSES BY 5–FLUOROURACIL
Authors: TOM MORRIS
Published: January 2008

Experiments were performed to test the hypothesis that 5‐Fluorouracil (5‐FU) would delay or prevent healing of large‐bowel anastomoses. The caecums of 120 specific‐pathogen‐free rats were transected and reanastomosed at once. Daily intravenous injections of 5‐FU were given to half the rats, the other half being controls and receiving an equal volume of saline. At Days 5, 7 and 10, standard‐sized sections of suture line were pulled apart, and the force required to do this was recorded. At five days the strengths of the anastomoses in the 5‐FU treated animals were only 25% of that of the controls, but by ten days they were over 60% of the strength of the controls. It was concluded that 5‐FU delayed, but did not prevent, healing, and that it would be safe to use it in the early postoperative period, but not until several days after operation
ILEOSTOMY RECONSTRUCTION
Authors: Failes David , Killingback Mark , Stuart Malcolm , Luca Catherine De , Riley Christine
Published: January 2008

A study of 47 patients undergoing ileostomy reconstruciton is presented. The most common indications were recession (15 patients) and a desire for a continent type of ileostomy (12 patients), proplapse (4 patients), unsatisfactory siting (3 patients), and parastomal hermia (1 patient). Refashioning at a new site was required in 30 cases. In 28 of these laparotomy was carried out to enable repositioning, but in two cases resiting was perfromed without laparotomy. Alter the original opertation, reconstruciton may become necessary at any time from a few months to over 20 years.
HEMANGIOPERICYTOMA: PROBLEMS IN DIAGNOSIS AND MANAGEMENT
Authors: Saw H. S. , Prathap K.
Published: January 2008

Three cases of haemangiopericytoms with diverse modes of presentation are reported. The difficulties with clinical diagnosis are emphasized. There is no consensus on the best mode of treatment, and we have chosen radical surgical excision in the first Instance, but have not hesitatted to emply radiotherapy or chemotherapy as adjusctive treatment If the need had arisen, The clinical behaviour of this tumour is unpredictable; therefore the prognosis for life must remain uncertain.
INTERCOSTAL HERNIATION OF ABDOMINAL CONTENTS FOLLOWING A PENETRATING CHEST INJURY
Authors: Francis David M. A. , Barnsley W. C.
Published: January 2008

A case of intercostal herniation of the greater omentum occurring 36 years after a penetrating chest injury is presented. The hernia was successfully trated by operative reduction and repair of the diaphragm and chest wall, This rare complication of thoracic injury is discussed and the literature reviewed.
ANTICANCER CENTRES IN FRANCE
Authors: Rinwick Sturat
Published: January 2008

The system of anticancer centres in France is described, with a more detailed description of the largest of these, the Institute Gustave Roussy at Villejuif. The anticancer centres between them see and treat 20% to 25% of the cancer patients in France, control over 4,000 inpatients beds, and see over 75,000 new outpatients annually. The centres are staffed by a full‐time multidisciplinary team, divided into “communittees” which deal with each individual type of malignancy. The committees have full secretarial and research staffs and regularly evaluate their progress at symposia. They provide a standard of excellence for the oncological services in France.
IMMEDIATE RETURN OF SENSATION AFTER DIGITAL NERVE REPAIR
Authors: Chow S. P. , Luk D. K. , Ngai Y. Y. , Hwang J. C. C.
Published: January 2008

Ten patients with immediate return of sensation after digital nerve repair were tested for sensibility and showed an early improvement followed by deterioration at the third week. Animal experlments to test the electrophysiology of the sural nerves in the rabbit after microrepair failed to show nerve impulse conducted across the anastomosis immediately after repair. Further clinical observations including nerve blocks supported the hypothesis of overlap Innervation as the explanation for immediate return of sensibility.
TOE‐TO‐HAND TRANSFER: EXPERIENCE WITH THIRTY‐EIGHT DIGITS
Authors: Yoshimura Mitsuo , Nomura Susumu , Yamauchi Shlgekl , Umeda Shinichiro , Ueno Tatsuya , Iwai Yoshinobu
Published: January 2008

Great functional difficulty and mental agony are experienced when there is traumatic amputation of the thumb or multiple fingers or a congenital defect of the thumb or fingers. With the development of microsurgery during recent years, it has become possible to transfer toes to the hand, which is an excellent procedure for reconstruction of defective thumbs and fingers. This procedure was used on 32 patients involving 38 digits with satisfactory results.
TENDON TRANSFERS FOR RADIAL NERVE PALSY
Authors: Tsuge Kenya
Published: January 2008

Outlined below are the tendon transfer procedures I have used in the treatment of 69 radial nerve palsy cases encountered during the past 25 years. The factors considered in determining which surgical procedure is to be performed are as follows: (i) neurorrhaphy is impossible; or (ii) neurorrhaphy would be possible, but useful recovery cannot be expected; (iii) signs of recovery cannot be seen six months after neurorrhaphy; or (iv) useful restoration cannot be expected because of scar formation or muscular atrophy in the surrounding area. In some cases, there may be some degree of functional restoration of extensor function, which is a welcome bonus, but tendon transfer is the most useful procedure to provide for a built‐in dynamic splint in the hand. Therefore, so long as the correct indications for tendon transfer are carefully observed, this operation deserves to be used frequently.
SALVAGE PROCEDURES FOR MUTILATED BURNT HANDS
Authors: Mehrotra Onkar N.
Published: January 2008

In a severely burnt hand one of the most difficult problems in reconstructive surgery is the prevention of contractures. Early skin grafting, and the reduction of oedema and joint stiffness by early mobilization, will minimize contraction, but will not altogether prevent it. When the dominant hand has also suffered damage, the need for a reconstructive procedure is absolutely essential, and by far the best functional and cosmetic results are achieved with the use of local tissue from the damaged digits. This paper describes various reconstructive salvage procedures for severely deformed hands.
THE MANAGEMENT OF DEEP THERMAL BURNS TO THE HEAD
Authors: Shaw James H. F. , Heslop John H.
Published: January 2008

The management of severe thermal burns of the head with associated bone destruction is discussed, and two patients in this category who were successfully treated by decorticating the dead bone with the high‐speed dental drill are presented. The burns In both cases had defied management with alternative techniques, and both patients achieved satisfactory skin coverage five weeks after dental burring.
THE ASSESSEMENT OF PROTEIN‐CALORIE MALNUTRITION IN PATIENTS WITH GASTROINTESTINAL CANCER
Authors: Hall John C. , Lawton John , Appleton Nicolette , Stocks Hilary , Giles Geoffrey R.
Published: January 2008

Daily protein and calorie intake, three plasma protein estimations, two upper limb anthropometric measurements, and estimated weight loss were all determined in 31 patients attending a surgical oncology outpatient department. The patients, who had had prior resection of a gastrointestinal cancer, could be divided Into three groups depending on (I) the absence of clinically detectable tumour; (ii) the presence of clinically detectable tumour with survival over the ensuing four‐month period. and (iii) clinically detectable tumour without survival over the ensuing four‐month period. The variables least able to discriminate between these groups, and to Interrelate to the other variable in a cross‐correlation matrix, were the dietary intake data and the estimated weight loss, it is concluded that protein‐calorie mainutrition can be adequately assessed In patients with advanced cancer from studies of the plasma albumin, prealbumin, transferrin, arm fat area, and arm muscle area.
CROHN'S DISEASE OF THE OESOPHAGUS: A CASE REPORT
Authors: Mannell Aylwyn , Hamilton D. G.
Published: January 2008

The first case of oesophageal Crohn's disease in a Black African is reported. Transmural chronic inflammatory changes with multiple intramural fistulous tracts were seen in the resected oesophagus of this patient, and these are characteristic features of Crohn's disease. The criteria for a diagnosis of Crohn's disease of the oesophagus are discussed.