bluuebunny/crossref_metadata_2025 huggingface dataset:
Bile duct stents in the management of hepatolithiasis with long-segment intrahepatic biliary strictures
Authors: Jeng K-S , Yang F-S , Chiang H-J , Ohta I
Published: March 2007

Biliary stricture represents a challenging problem in the treatment of hepatolithiasis because of its association with treatment failure and stone recurrence. The long-segment type of stricture is difficult to manage and is likely to recur. To investigate the necessity for biliary stenting after balloon dilatation therapy, 20 consecutive patients with long-segment strictures who had 22 stents (group 1) were compared with ten patients who refused stenting (group 2). The long-segment strictures in group 1 were located on the right side in 80 per cent of patients, on the left side in 10 per cent, and were bilateral in 10 per cent. The stents, varying from 8 to 12 Fr, were retained for at least 6 months. They were inserted through the routes of a matured T tube track (five cases), percutaneous transhepatic track (14 cases), a jejunal limb (two cases) and a fistula (one case). Complications of stenting consisted of dislodgement (one case), haemobilia (two cases), cholangitis (two cases) and intrahepatic abscess (one case). The cumulative probability of stricture recurrence in group 1 was 10 per cent, 15 per cent and 21 per cent at 2, 3 and 4 years, respectively, whereas in group 2 it was 80 per cent at 2 years (P < 0.003). The results suggest that intrahepatic biliary stenting after balloon dilatation appears necessary and helpful in the management of hepatolithiasis with long-segment biliary strictures.
Potential candidates for small bowel transplantation
Authors: Clark C L Ingham , Lear P A , Wood S , Lennard-Jones J E , Wood R F M
Published: March 2007

The number of potential candidates for small bowel transplantation in the UK is unknown. Potential recipients are those with irreversible small intestinal failure, including those treated with permanent parenteral nutrition. This study of one of the largest groups of patients receiving such nutrition identified ten of 25 adult patients as possible recipients. The remaining 15 were considered unsuitable, mainly because of multiple previous abdominal operations or abscesses. Extrapolation of these data to national figures on the incidence of irreversible small intestinal failure suggests that each year up to 20 new adult patients in the UK might benefit from small bowel transplantation.
Primary versus staged resection for acute obstructing colorectal carcinoma
Authors: Sjödahl R , Franzén T , Nyström P-O
Published: March 2007

The management of 115 patients with complete neoplastic obstruction of the colon was studied retrospectively. Primary resection was carried out in 40 patients, 22 with right-sided and 18 with left-sided tumours. Staged resection was planned in 48 patients and actually performed in 40. Creation of a stoma only was carried out in 25 patients because of advanced disease. There were no differences between primary and staged resection regarding the patients' general condition, concurrent disease, tumour stage according to Dukes' classification, postoperative complications, or mortality. The postoperative mortality rate was 10 per cent after primary and 15 per cent after staged resection (P not significant). The median hospital stay was 18 and 45 days, respectively. The 5-year survival rate was 38 per cent after primary and 29 per cent after staged resection. All primary resections but one were performed by qualified surgeons, while trainees created stomas as emergency treatment. The similarity in outcome suggests that in future this condition should, where possible, be treated by primary resection, by surgeons experienced in colorectal operations.
Role of congenital hypertrophy of the retinal pigment epithelium in the predictive diagnosis of familial adenomatous polyposis
Authors: Morton D G , Gibson J , Macdonald F , Brown R , Haydon J , Cullen R , Rindl M , Hulten M , Neoptolemos J P , Keighley M R B , McKeown C M
Published: March 2007

A study was carried out to evaluate congenital hypertrophy of the retinal pigment epithelium (CHRPE) as a disease marker in a defined population with familial adenomatous polyposis (FAP). Indirect ophthalmoscopy was performed on 75 individuals from 25 known families with FAP, of whom 32 were known to be affected and 43 were at a 50 per cent prior risk of developing the disease. A further ten individuals from five families with hereditary non-polyposis colorectal cancer (HNPCC) were also tested. CHRPE was seen in 28 of the 32 affected individuals, 27 of whom met the criteria for a positive examination. Three individuals at risk of FAP also had positive examinations. Five individuals from the families with HNPCC also had CHRPE, although none met the criteria for a positive examination. Of four types of CHRPE analysed, one (small pigmented dots) was found to be more frequent in older family members (P = 0.012), suggesting that this type of lesion may proliferate with age. Compliance with ophthalmic screening was 97 per cent in families with FAP. Using a combined set of diagnostic criteria, CHRPE identified aflected individuals with a specificity of at least 94 per cent and a sensitivity of 84 per cent. Results argue for a combined screening programme for FAP of DNA analysis, indirect ophthalmoscopy and bowel examination.
Estimation of small bowel transit time following colectomy and ileal reservoir construction
Authors: Kmiot W A , O'Brien J D , Awad R , Keighley M R B
Published: March 2007

A study was carried out to evaluate the breath hydrogen test as a method of estimating small bowel transit in patients with an ileal pouch and to determine whether gut transit time influenced functional outcome. Twelve patients with an ileal reservoir and ten control subjects ingested a test meal of 400 ml chicken soup, 20 g lactulose and 50 ml dilute barium solution. Concurrent breath hydrogen testing and radiological screening was carried out until the head of the test meal reached the ileal pouch or caecum. At the time that the test meal arrived in the pouch, faecal anaerobic bacterial counts were obtained. Pouch compliance, functional capacity and anal sphincter pressures were also measured. While there was an excellent correlation between radiological and breath hydrogen measures of orocaecal transit time in controls (P < 0.001), no such relationship was found for oropouch transit. Four of the 12 patients with a pouch produced no hydrogen after test meal ingestion, while in two other such patients breath hydrogen peaks occurred when the head of the meal was in the jejunum. The magnitude of the breath hydrogen rise in patients with an ileal pouch correlated well with faecal anaerobic bacterial counts (P < 0.01). The median (95 per cent confidence interval) radiological small bowel transit time was more rapid in patients with a pouch than in control subjects: 28 (23–33) versus 72 (46–86) min (P < 0.01). Increased 24-h frequency of defaecation was associated with more rapid small bowel transit after ileal reservoir construction (P < 0.01) but correlated with neither pouch capacity nor compliance. These data show that small bowel transit time may be a determinant of ileal pouch function but that breath hydrogen estimation of gut transit time in patients with an ileal reservoir is unreliable.
Subcutaneous rectal stump closure after emergency subtotal colectomy
Authors: Ng R L H , Davies A H , Grace R H , Mortensen N J McC
Published: March 2007

Subtotal colectomy with preservation of the rectum is now the procedure of choice for patients with severe colitis requiring emergency surgery. The use of subcutaneous ‘rectal closure’ when the retained distal bowel is placed at the caudal end of the abdominal incision in the subcutaneous or fasical layer is studied. An anal catheter may be placed to drain the rectum. Thirty-two patients (14 men, 18 women) of mean age 33 (range 17–77) years with severe inflammatory bowel disease (29 ulcerative colitis, one Crohn's disease, one indeterminate colitis, one Camphylobacter colitis) underwent emergency colectomy with subcutaneous rectal stump closure. Twenty-three stumps were closed with staples, four sutured and five by both staples and sutures. Complications developed in seven patients (22 per cent), of which two required surgical intervention. One significant wound infection was treated successfully with a course of antibiotics. Three minor wound infections did not require specific treatment. The rectal stump was always readily located at the time of restorative surgery. This techniques is recommended as a simple and safe alternative to an open mucus fistula provided that surgeons adhere to standard surgical principles; in particular the distal bowel should not be brought out into the wound under tension.
Elective versus emergency surgery for patients with colorectal cancer
Authors: Anderson J H , Hole D , McArdle C S
Published: March 2007

A prospective study of 570 patients presenting with colorectal cancer over a 6-year period was undertaken. Of these, 363 were admitted electively and 207 presented as emergencies. The outcome following elective admission was more favourable than after emergency admission. In the elective group the proportion of resected tumours was greater (77 versus 64 per cent, P < 0.001), the operative mortality rate lower (9 versus 19 per cent, P < 0.001) and the 5-year disease-related survival rate higher (37 versus 19 per cent, P < 0.001). These differences may relate to the greater resection rates in the elective situation. Results of surgical intervention might be improved if emergency colorectal operations were undertaken by surgeons with more experience of this type of surgery.
Chest physiotherapy for the surgical patient
Authors: Stiller K R , Munday R M
Published: March 2007

This article reviews the evidence that chest physiotherapy is effective in the prevention and treatment of pulmonary complications after major abdominal and thoracic surgery. There is some evidence that regular chest physiotherapy significantly decreases the incidence of pulmonary complications, although the mechanism of this effect is uncertain. It is not known whether chest physiotherapy is effective in the treatment of postoperative pulmonary complications after they have developed.
In situ versus reversed femoropopliteal vein grafts: Long-term follow-up of a prospective, randomized trial
Authors: Moody A P , Edwards P R , Harris P L
Published: March 2007

In a prospective, randomized trial, 226 patients undergoing femoropopliteal bypass for lower limb ischaemia were allocated to reversed (123 patients) or in situ (103) techniques. The groups were comparable for age, sex, incidence of diabetes, and indications for surgery. Eleven veins were rejected at operation, nine in the reversed group and two in the in situ group, leaving 114 reversed and 101 in situ grafts for study. Cumulative patency rates were not significantly diferent between reversed and in situ grafts at any time up to 6 years after operation, with primary patency rates at 1,3 and 5 years of 84.8, 69.5 and 62.4 per cent for reversed grafts and 79.9, 71.2 and 63.5 per cent for in situ grafts. Small vein grafts (< 4 mm in diameter) were associated with patency rates at 1, 3 and 5 years of 63.5, 46.7 and 36.0 per cent compared with 93.9, 82.5 and 75.9 per cent for vein grafts ⩾ 4 mm in diameter (P < 0.002, log rank test). The patency rates of small veins employed in situ and reversed were similar. The in situ technique confers neither short- nor long-term advantage over reversed vein grafting for femoropopliteal bypass.
Success rates for rehabilitation of vascular amputees: Implications for preoperative assessment and amputation level
Authors: Houghton A D , Taylor P R , Thurlow S , Rootes E , McColl I
Published: March 2007

All lower limb amputations performed during 1986 and 1988 in eight hospitals in the south-east region were assessed. Of 440 amputations for vascular disease, 193 were above-knee, 193 below-knee, 15 Gritti—Stokes, 15 through-knee and 24 bilateral. Of the 440 patients, 75 died in hospital, 113 were considered unsuitable for a prosthesis and 252 (57 per cent) were referred for prostheses. Rehabilitation questionnaires were sent to 179 patients (41 per cent), as a further 54 had died and 19 had become known non-wearers before the study commenced. The response rate was 81 per cent; 102 patients completed the questionnaire, 21 were reported dead, and 22 were non-wearers. Of a maximum rehabilitation score of 12, 52 patients scored 6 or more (consistent with mobility on their artificial limb around the home), and 21 scored 9 or more (a standard accepted as successful rehabilitation). It is concluded that 10–15per cent of amputees achieve mobility around the home on their prosthesis. Only 5 per cent, however, rehabilitate well and become independent of their wheelchair. When amputation is inevitable, more consideration should be given to surgery that optimizes wheelchair rehabilitation.
Parotid disease and human immunodeficiency virus infection in Zambia
Authors: Bem C , Barucha H , Patil P S
Published: March 2007

Among the salivary glands the parotid is unusual in that it contains lymphoid tissue within its capsule. The focus of infection with human immunodeficiency virus (HIV) is the lymphatic system and this results in a specific HIV-related pathology in the parotid. This 2-year surgical audit of parotid disease in HIV-infected patients in Lusaka shows patients presenting with parotid lymphadenopathy, bilateral diffuse parotid enlargement and parotid lymphoepithelial cysts. Clinical presentation and management are discussed.
Selective necrosis in hamster pancreatic tumours using photodynamic therapy with phthalocyanine photosensitization
Authors: Chatlani P T , Nuutinen P J O , Toda N , Barr H , Macrobert A J , Bedwell J , Bown S G
Published: March 2007

Photodynamic therapy (PDT) is often thought to be able to effect selective tumour necrosis. This therapeutic selectivity, based on transient diferences in tumour: normal tissue photosensitizer concentration ratios, is rarely useful clinically in extracranial tumours, although PDT itself may be of value by virtue of the nature of the damage produced and healing of normal tissue by regeneration. This report describes the effects of PDT on normal pancreas and chemically induced pancreatic cancers in the hamster, where a diferent mechanism of selective necrosis may be seen. Photosensitizer distribution in normal and neoplastic pancreas was studied by chemical extraction and fluorescence microscopy. Correlation of distribution studies with necrosis produced by PDT shows that the photodynamic dose (product of tissue concentration of sensitizer and light dose) threshold for damage is seven times as high for normal pancreas as for pancreatic cancer. Tumour necrosis extended to the point where tumour was invading normal areas without damaging the normal tissue. In rat colonic cancer, photodynamic dose thresholds in tumour and normal tissue are similar and so such marked selectivity of necrosis is not possible. The reason for this selectivity in the pancreas is not clear, but recent evidence has suggested a diference in response to PDT between normal and neoplastic pancreatic cell lines and the presence of a singlet oxygen scavenger in normal pancreas is postulated. Furthermore, the present fluorescence microscopy studies suggest that tumour stroma contains the highest level of photosensitizer and thus receives the highest photodynamic dose during PDT. These results suggest a possible role for PDT in treating small pancreatic tumours or as an adjuvant to other techniques, such as surgery, that reduce the main bulk of tumours localized to the pancreas.
Duodenogastric reflux enhances growth and carcinogenesis in the rat pancreas
Authors: Watanapa P , Flaks B , Oztast H , Deprez P H , Calam J , Williamson R C N
Published: March 2007

Surgery for peptic ulcer disease may increase the risk of pancreatic cancer. The effect of duodenogastric reflux on pancreatic carcinogenesis was tested, and changes in the circulating levels of cholecystokinin (CCK) and gastrin were measured. Male Wistar rats (n = 40) weighing 250–300 g were randomized to undergo gastrotomy (control) or split gastrojejunostomy (to produce complete duodenogastric reflux) and then to receive azaserine (30 mg/kg/ week intraperitoneally) or saline injections for 3 weeks. At 6 months, blood CCK was assayed and the pancreas was excised for quantitative estimation of atypical acinar cell foci (AACF), the precursor lesions of carcinoma. Rats that had undergone split gastrojejunostomy weighed 15–19 per cent less than controls (P < 0.05), but their relative pancreatic weight (mg pancreas per 100 g body-weight) was 52–60 per cent greater (P < 0.001). Acidophilic AACF occurred only in azaserine-treated rats with duodenogastric reflux. Although plasma CCK concentrations were unchanged, split gastrojejunostomy increased basal and postprandial gastrin levels by 98–175 per cent (P < 0–05). Duodenogastric reflux produces sustained hypergastrinaemia and promotes experimental pancreatic carcinogenesis.
Results of surgical palliation for cancer of the head of the pancreas and periampullary region
Authors: Prětre R , Huber O , Robert J , Soravia C , Egeli R A , Rohner A
Published: March 2007

Between 1977 and 1986, 101 patients underwent surgical bypass for periampullary carcinoma. The hospital mortality rate was 18 per cent and the morbidity rate 43 per cent. Mortality was not influenced by the extent of the tumour. Survival rates at 1, 2 and 3 years were 28, 9 and 4 per cent, respectively. The median survival time was 17 months for localized tumours, 10 months for those that had invaded surrounding tissues, 6 months in the presence of lymph node involvement and 3 months with distant metastasis. The quality of survival was good for most patients with localized tumours but poor for those with parenchymal metastasis, in whom palliation was transient for 85 per cent and effective for less than half of their survival time for 60 per cent. These results suggest that patients with distant metastasis but without impending duodenal obstruction should undergo palliation by endoscopic or percutaneous routes while those with less advanced disease or with duodenal involvement remain candidates for surgical bypass.
Direct surface cooling of the exocrine pancreas in the rat
Authors: Hirano T , Manabe T , Imanishi K , Ando K
Published: March 2007

A study was carried out to evaluate the eflects of direct cooling on the exocrine pancreas. Changes in amylase and cathepsin B release, and in the subcellular distribution of amylase and cathepsin B were measured after 1, 2 and 3 h of direct pancreatic cooling in rats. Cooling for 2 and 3 h caused significant hyperamylasaemia and increased pancreatic amylase content, but minimal histological change. Furthermore, 3 h of cooling caused marked redistribution of cathepsin B activity from the lysosomal fraction to the heavier zymogen fraction, and co-localization of lysosomal and digestive enzymes; amylase and cathepsin B output into pancreatic juice after caerulein stimulation were also reduced. These results show that direct pancreatic cooling impairs exocrine function and implicate lysosomal enzymes in the pathogenesis of pancreatic injury, in agreement with results from other models of experimental pancreatitis.
Operative common bile duct imaging by operative cholangiography and flexible choledochoscopy
Authors: Menzies D , Motson R W
Published: March 2007

A consecutive series of 108 common bile duct (CBD) explorations was studied to examine the efficacy of routine operative cholangiography and flexible choledochoscopy in the identification of choledocholithiasis. CBD exploration was performed according to the findings of routine operative cholangiography. Nine negative explorations were performed, only one of which would have been avoided had selective cholangiography been employed. Eight patients had unsuspected choledocholithiasis that would have been missed if selective operative cholangiography had been used. Flexible choledochoscopy identified CBD stones on 97 occasions; no additional retained stones were found on subsequent T tube cholangiography. In two cases stones were seen but could not be removed; immediate identification allowed planning for early removal. Flexible choledochoscopy is the most eflective method of CBD exploration and should be used in all patients with suspected choledocholithiasis.
Laparoscopic versus open appendicectomy: A prospective evaluation
Authors: McAnena O J , Austin O , O'Connell P R , Hederman W P , Gorey T F , Fitzpatrick J
Published: March 2007

A prospective evaluation of laparoscopic surgery for acute appendicitis over a 6-month period is reported. Sixty-five patients with signs and symptoms of appendicitis necessitating surgery were assigned to open (n = 36) or laparoscopic (n = 29) appendicectomy. Thirty-seven patients were female (22 open) and 28 were male (14 open). The median age was 24 (range 14–64) years for open appendicectomy and 18 (range 14–60) years for the laparoscopic procedure. The mean postoperative stay for open operation was 4.8 (range 1–21) days and for the laparoscopic route 2.2 (range 1–11) days (P < 0.05). Inflammation was confirmed histologically in 72 per cent of the open cases and in 74 per cent of the laparoscopic cases (P not significant). The wound infection rate was 11 per cent (n = 4) for open and 4 per cent (n = 1) for laparoscopic appendicectomy (P < 0.05). The median anaesthesia time was 52 (range 15–90) min for open appendicectomy and 48 (range 20–120) min for laparoscopic surgery (P not significant). After open appendicectomy patients had a median of 5 (range 2–12) intramuscular injections of analgesia compared with a median of 1 (range 0–5) in the laparoscopic group (P < 0.05). Two laparoscopic operations were converted to an open procedure. The results suggest that emergency laparoscopic appendicectoiny should be explored further as an alternative to open surgeŕy for acute appendicitis.
Decreased sensitivity of muscarinic but not 5-hydroxytryptamine receptors of the internal anal sphincter in neurogenic faecal incontinence
Authors: Speakman C T M , Hoyle C H V , Kamm M A , Henry M M , Nicholls R J , Burnstock G
Published: March 2007

Previous studies of the internal anal sphincter in patients with neurogenic faecal incontinence have indicated an abnormality of the adrenergic innervation, but little is known about the responsiveness of other receptors in the internal anal sphincter in this condition. In this study the in vitro sensitivity to carbachol and 5-hydroxytryptamine (5-HT) of muscle strips from patients with neurogenic incontinence (n = 6 and n = 7) and from control patients (n = 9 and n = 10) was examined. Preparations of internal anal sphincter from patients with incontinence were less sensitive to the relaxant actions of carbachol than preparations from the control group. The pD2 value for carbachol (i.e. the negative logarithm of the concentration f o r half-maximal response) was signficantly greater in the controls than in the incontinent group (mean(s.e.m.) 6.03(0.15) versus 5.43(0.24), P < 0.05). There was no significant difference in the contractile responses to 5-HT, which had pD2 values of 6.93(0.13) and 6.63(0.27) for the control and incontinent groups respectively. The unaffected state of the 5-HT receptor and the subsensitivity of the muscarinic receptor are discussed in relation to intrinsic neural control of the internal anal sphincter in neurogenic, faecal incontinence.
Screening for colorectal carcinoma: An analysis of the sensitivity of Haemoccult
Authors: Thomas W M , Pye G , Hardcastle J D , Walker A R
Published: March 2007

The sensitivity of Haemoccult for asymptomatic colorectal carcinoma has been estimated in a large randomized controlled trial of mass population screening, with a minimum follow-up of 2 years. A total of 111 cancers were diagnosed in those who completed the screening tests; of these, 36 appear to have been missed by Haemoccult and 75 were detected by the test, giving an overall sensitivity of 67.6 per cent. Haemoccult was shown to be significantly more sensitive for carcinoma of the sigmoid and descending colon than for rectal or right-sided cancers (81 versus 45 and 47 per cent, respectively). The sensitivity was higher when tests were completed over 6 rather than 3 days (74 versus 65 per cent), but this diference was not statistically significant. There was no evidence for a detrimental effect on tumour stage of a false-negative Haemoccult test; indeed, a higher proportion of the interval cancers were Dukes' A tumours than cancers in the control group.
Timing and method of reversal of Hartmann's procedure
Authors: Pearce N W , Scott S D , Karran S J
Published: March 2007

The outcome of 145 patients undergoing Hartmann's resection between 1973 and 1989 has been reviewed. The mortality rate of the primary procedure was 8 per cent. Eighty patients proceeded to reanastomosis. Multifactorial analysis of these patients was undertaken to determine the risk involved. The interval between the primary and secondary procedures was found to be the most important factor. Six of 12 patients had clinical evidence of a leak when this interval was <3 months, compared with seven of 28 for 3–6 months, and none of 40 when the second operation was delayed for >6 months. All deaths (three patients) and clinical septicaemia (four) occurred in the two ‘early’ groups. All colovaginal fistulae (three patients) and strictures (three) were associated with stapled anastomoses. No association was found between the complication rate following reanastomosis and the initial pathology or grade of surgeon undertaking the secondary operation.
Editorial committee of the British Journal of Surgery
Authors: Williamson Robin
Published: March 2007

In recent months we have presented the Members of Council of The British Journal of Surgery Society, the body that owns and administers the Journal, and we now conclude Council and continue with the other Members of the Editorial Committee.
Surgical treatment of hidradenitis suppurativa
Authors: Banerjee A K
Published: March 2007

The management of hidradenitis suppurativa is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment - quick healing, no hospital admission, minimal patient inconvenience and low recurrence - but greater awareness of the strengths and weaknesses of existing methods should lead to improved management. Good reports of the relative cure rates of the different surgical options are scarce and controlled trials non-existent, but existing evidence is reviewed critically and summarized. The operation of choice in most instances is wide local excision and healing by secondary intention.
Perforated duodenal diverticulum
Authors: Duarte B , Nagy K K , Cintron J
Published: March 2007

Duodenal diverticula are present in up to 20 per cent of the population but few patients require surgery for acute complications. Perforation is the rarest of these complications; only 101 affected patients have been reported in the world literature. These reports of perforated duodenal diverticulum are reviewed and strategies for the diagnosis and management of this unusual condition are discussed.
Anatomy and function of the anal longitudinal muscle
Authors: Lunniss P J , Phillips R K S
Published: March 2007

The longitudinal muscle in the intersphincteric space has received little attention despite an explosion of interest in anorectal physiology in the past decade. Its anatomy is contested and its function unknown. Speculation, however, gives it a role as a skeleton supporting and binding the rest of the internal and external sphincter complex together, as an aid during defaecation by everting the anus, as a support to the haemorrhoidal cushions, and as a determining factor in the ramification of sepsis.
Selection for screening for familial aortic aneurysms
Authors: Adamson J , Powell J T , Greenhalgh R M
Published: March 2007

The reported familial clustering of abdominal aortic aneurysm (AAA) indicates the possible rewards of family-based screening programmes with respect both to the number of asymptomatic aneurysms detected and to identifying associated genes. Ultrasonographic screening of 28 families (25 brothers and 28 sisters) was carried out together with collecting a history and a blood sample for analysis of the cholesterol level and genetic markers. Among the screened siblings six (11 per cent), all >60 years old, had an AAA ⩾3.0 cm in diameter. A further 11 siblings (21 per cent), six of whom were < 60 years old, had a wide (2.5–2.9 cm) aorta. The presence of an aneurysmal or wide aorta was significantly associated with smoking (P = 0.027), male sex (P = 0.008) and a proband age of < 60 years (P = 0.031). Polymorphic genetic markers for type III collagen and haptoglobin were not informative in these families. These results indicate that the eficiency of screening siblings of patients with AAA could be improved by limiting it to brothers with a smoking history and/or siblings of younger patients. The familial component appears to be greatest in these younger patients.
Randomized trial of loop ileostomy in restorative proctocolectomy
Authors: Grobler S P , Hosie K B , Keighley M R B
Published: March 2007

A randomized controlled trial was performed to assess the role of loop ileostomy in totally stapled restorative proctocolectomy. Entry criteria included all patients who were not on corticosteroids in whom on-table testing revealed a watertight pouch with intact ileoanal anastomosis. Of 59 patients undergoing restorative proctocolectomy over 36 months, 45 were eligible and were randomized to loop ileostomy (n = 23) or no ileostomy (n = 22). The age and diagnosis of the groups were similar. There were no deaths; two ileoanal anastomotic leaks occurred, one in each group. Ileoanal stenosis occurred in five patients with and one without an ileostomy. The incidences of wound and pelvic sepsis, bowel obstruction and pouchitis were similar. Twelve patients (52 per cent) developed ileostomy-related complications. The median total hospital stay was 23 (range 13–75) days with ileostomy and 13 (range 7–119) days without (P < 0.001). This study indicates that there is a low risk of pelvic sepsis which is not increased by avoiding a protective ileostomy. Loop ileostomy was associated with a high incidence of complications.
Reduction of thrombus formation in vivo using a thrombolytic agent targeted at damaged endothelial cells
Authors: Underwood M J , Pringle S , De Bono D P
Published: March 2007

Endothelial damage in saphenous vein harvested before coronary artery and peripheral vascular surgery has been well documented. Autogenous saphenous vein grafts are subject to early thrombotic occlusion, a process that is related to injury of this endothelial monolayer. A monoclonal antibody that binds to areas of endothelial damage (P14G11) and a non-specific immunoglobulin G (IgG) have been linked to urokinase. These conjugates were investigated in vivo using a rat vena cava model. The P14G11–urokinase conjugate significantly reduced thrombus formation compared with controls and non-conjugated urokinase (P < 0.02). No reduction in thrombus formation was seen with the IgG-urokinase conjugate. This shows that thrombus formation after endothelial damage in an in vivo model can be reduced with a targeted thrombolytic agent. Conjugates such as this may have a role in preventing early thrombotic occlusion in vein grafts.
Recombinant basic fibroblast growth factor in red blood cell ghosts accelerates incisional wound healing
Authors: Slavin J , Hunt J A , Nash J R , Williams D F , Kingsnorth A N
Published: March 2007

The pharmacological manipulation of wound healing with locally applied growth factors is now a practical possibility. The effect of topical applications of recombinant basic fibroblast growth factor (bFGF) on the strength and cellularity of healing incisional rat skin wounds was investigated. Applications of bFGF in a simple vector (either a collagen suspension or saline) were not associated with any positive effects on wound breaking load at 7 days after injury in comparison with vector-treated control wounds; at the highest dose of 50 μg per wound, breaking loads were significantly decreased from a mean(s.e.m.) of 287(22) g/cm2 in controls to 201(23) g/cm2 (P < 0.005). Increasing doses of applied peptide were paralleled by increasing wound cellularity. Delay of bFGF release at the site of application was achieved by encapsulation into red blood cell ghosts. Wounds treated with bFGF in such ghosts were 50 per cent stronger than paired control wounds (388(27) versus 256(28) g/cm2, P < 0.002) 7 days after injury. Treated wounds were significantly more cellular at 4 days than paired control wounds. Topical applications of bFGF applied at the time of injury exert a positive effect on incisional wound strength only when a vector that delays release is used.
Smoking predisposes to parotid adenolymphoma
Authors: Cadier M , Watkin G , Hobsley M
Published: March 2007

Of 574 patients with previously untreated, unremarkable parotid lumps, 194 proved to have pleomorphic adenomas and 73 adenolymphomas. ABO blood group details were available in 59 and 85 per cent of patients respectively. Smoking details were available in 84 per cent of a randomly chosen 46 per cent subgroup of patients with pleomorphic adenomas and in 86 per cent of all those with adenolymphomas. The incidences of smoking and of the ABO blood groups in these two diagnoses were compared with standard sources. There was no evidence that either histological diagnosis of parotid tumours was linked to an abnormal pattern of ABO blood groups. However, there was a much greater incidence of smoking among the adenolymphoma than in the pleomorphic adenoma group: only one of 63 patients with adenolymphoma as opposed to 31 of 75 with pleomorphic adenoma had never smoked, while the mean number of cigarettes smoked by each patient with an adenolymphoma was estimated to be 300 000 as opposed to 80 000 for those with pleomorphic adenoma.
Surgery for primary hyperparathyroidism performed under local anaesthesia
Authors: Bergenfelz A , Algotsson L , Ahrén B
Published: March 2007

Patients with primary hyperparathyroidism are often elderly with cardiovascular disease and in some an operation might be hazardous owing to anaesthetic complications. A technique for operation for primary hyperparathyroidism under local anaesthesia is described. The method uses a unilateral approach. Seventeen consecutive patients operated on under local anaesthesia were compared with a group of 15 patients undergoing surgery under general anaesthesia. Normocalcaemia was achieved in 14 patients in each group. There was no difference in the extent of pain or the overall well-being between the two groups as determined by a visual analogue scale. Patients receiving local anaesthesia, however, experienced significantly less nausea after operation (P < 0.01). There was more fluctuation in blood pressure and heart rate in the general anaesthesia group compared with the other group. Surgery for primary hyperparathyroidism can be performed safely under local anaesthesia, and could be offered to patients if general anaesthesia were not suitable or involved an increased perioperative risk. It should not be recommended for routine use in patients who are fit for general anaesthesia.
Surgical resection for stage I cancer of the oesophagus and cardia
Authors: Moghissi K
Published: March 2007

A study was carried out to establish the long-term survival of patients with stage I carcinoma of the oesophagus and cardia, and to assess the influence of various factors on the 5-year survival rate. The study, which was partly prospective and partly retrospective, involved 60 patients with early (stage I) carcinoma of the oesophagus or cardia from a total of 811 consecutive patients with such carcinomas who were referred to one regional centre over a 15-year period, 425 of whom underwent resection. Survival at 5 years was taken as the main measure of outcome. Forty-two patients (70 per cent) were alive at 5 years. None of the factors studied (sex, age, site or histological type of tumour) had a significant effect on outcome.
Oesophageal reflex responses: Abnormalities of the enteric nervous system in patients with oesophageal symptoms
Authors: O'Hanrahan T , Bancewicz J , Thompson D , Marples M , Williams D
Published: March 2007

An intraluminal balloon was used to study the peristaltic reflex, which is mediated by the intrinsic nerves of the oesophagus. Serial balloon distension was performed in nine asymptomatic volunteers and 133 patients with oesophageal symptoms. Eight of the volunteers had a normal response with proximal stimulation and distal inhibition of motility. Only 42 patients (31.6 per cent) had a normal response. The commonest abnormal response (39.1 per cent) was some form of failure of the distal inhibitory reflex. Other patterns of abnormality were an unresponsive oesophagus (15.8 per cent) with no motility change during balloon inflation, or spasm (13.5 per cent) proximal to the balloon. These alterations of secondary peristaltic activity suggest that there are abnormalities of the intrinsic (enteric) nerves of the oesophagus. Different abnormalities were found in patients with similar symptoms. Awareness of this difference might allow a more rational approach to treatment. This hypothesis was tested in a small pilot study treating functional dysphagia with cisapride. Three of nine patients had marked symptomatic improvement within 4 weeks and all three had an unresponsive oesophagus. The remaining six patients, who had failure of distal inhibition or a normal response, did not improve.
Adequacy of paracardial dissection in subtotal versus total gastrectomy
Authors: Hüscher C , Chiodini S , Freni V , Recher A , Torri F , Bozzetti F
Published: March 2007

Right and left paracardial dissection represents an obligatory step in gastrectomy for gastric cancer of the lower half of the stomach because a second-level lymphadenectomy is part of the radical surgery for malignancy at this site. Whereas right and left paracardial dissection is easily accomplished during total gastrectomy, there is doubt as to whether subtotal gastrectomy achieves the same radical clearance of these groups of lymph nodes. This study therefore compared the number of lymph nodes dissected and the frequency of metastases in these compartments in 14 patients undergoing total gastrectomy and 22 submitted to subtotal gastrectomy. The mean number of lymph nodes dissected in the right paracardial compartment was 7.1 per patient undergoing total gastrectomy and 6.7 per patient in subtotal gastrectomy (P = 0.7). The mean numbers of left paracardial lymph nodes dissected in total and subtotal gastrectomy were 3.4 and 4.1 per patient respectively (P = 0.3). These data show that the same degree of radical clearance can be achieved in these nodal compartments, irrespective of the extent of gastric resection.
Zinc-deficient diet impairs adaptive changes in the remaining intestine after massive small bowel resection in the rat
Authors: Tamada H , Nezu R , Matsuo Y , Takagi Y , Okada A , Imamura I
Published: March 2007

An investigation was conducted on the influence of the presence of zinc in an elemental diet on the mucosa of residual intestine after massive small bowel resection. A total of 34 male Sprague-Dawley rats were divided into five groups: control animals (n = 10) were killed after overnight fasting; a second group (n = 14) underwent massive small bowel resection preserving 10 cm of terminal ileum, and the third group (n = 10) underwent sham operation. Animals in the second and third groups were fed either a commercially available elemental diet or a zinc-deficient diet for 2 weeks; they were then killed. In animals receiving the zinc-deficient diet, a significant decrease (P < 0.05) was noted in plasma zinc and total protein, and in mucosal wet weight (duodenum), thickness (duodenum and ileum), and protein (duodenum) and DNA (duodenum) content. Mucosal sucrase and maltase specific activities in the duodenum and ileum fell but diamine oxidase levels did not. These results suggest that zinc plays an important role in intestinal adaptation in the rat, and indicate that this trace element is essential for intestinal mucosal preservation in this animal.
Laparoscopy in developing countries in the management of patients with an acute abdomen
Authors: Ogbonna B C , Obekpa P O , Momoh J T , Obafunwa J O , Nwana E J C
Published: March 2007

Surgeons in developing countries see a need to improve diagnosis and decision making in patients with an acute abdomen. Without the benefit of diagnostic aids such as computers and high-resolution ultra-sonography, the rate of unnecessary laparotomy is often unacceptably high. The laparoscope is usually available in a developing country and its use easily acquired. Using laparoscopy in doubtful situations the unnecessary laparotomy rate was significantly reduced from 14.0 to 6 per cent (P < 0.05). Laparoscopy achieved a diagnostic accuracy of 86 per cent and prevented unnecessary laparotomy in 57 per cent of those in whom it was used.
Endotoxin, septic shock and acute lung injury: Neutrophils, macrophages and inflammatory mediators
Authors: Welbourn C R B , Young Y
Published: March 2007

The treatment of septic shock remains a major problem in surgical practice. Current research on the pathogenesis of the sepsis syndrome focuses on the effects of the lipopolysaccharide constituents of bacterial endotoxin. Evidence suggests that endotoxin induces a whole-body inflammatory response that in turn mediates organ damage, eventually leading to multiorgan failure. The first organ in which failure is usually apparent is the lung, with the appearance of nonEndotoxin, septic shock and acute lung injury:-cardiogenic pulmonary oedema as part of the adult respiratory distress syndrome. Inflammatory cells involved in lung injury include neutrophils and macrophages, which release mediators such as elastase, oxygen radicals and cytokines. This review summarizes current experimental work on how endotoxin leads to lung injury, based on its effects in animals and patients. Present knowledge suggests that future treatment of septic shock might involve inhibiting the body's inflammatory response to endotoxin. Possible ways of doing this are discussed.
Synchronous aortic and gastrointestinal surgery
Authors: Brown T H , Kelly J F
Published: March 2007

The synchronous performance of aortic and gastrointestinal surgery may hold an increased risk of aortic graft infection. The experience of one surgeon who performed 32 such synchronous operations over a period of 11 years is reviewed. No graft infection occurred and it is concluded that such combined operations may be safer to perform than staged surgery in elderly patients.
Vein compliance: A preoperative indicator of vein morphology and of veins at risk of vascular graft stenosis
Authors: Davies A H , Magee T R , Baird R N , Sheffield E , Horrocks M
Published: March 2007

Compliance measurements of 53 long saphenous veins before femorodistal bypass have been performed using a duplex scanner with venous occlusion for distension. These have been compared with the histological features of the veins. There was significantly more moderate or severe focal hyperplasia and circular muscle hypertrophy in distal long saphenous vein than in its proximal counterpart (P < 0.01 and P < 0.05 respectively). The mean (95 per cent confidence interval) compliance of distal vein with moderate or severe hyperplasia was 0.16 (0.13-0.19) compared with 0.29 (0.22–0.36) for that with no, minimal or mild hyperplasia (P = 0.001). The mean compliance of distal vein with moderate or severe muscle hypertrophy was 0.19 (0.17–0.21) and of vein with no, minimal or mild hypertrophy 0.25 (0.21–0.29) (P = 0.14). The mean lowest compliance in seven patients who developed stenosis was 0.10 (0.07–0.13) compared with 0.21 (0.16–0.26) in the rest (P < 0.001). Preoperative measurement of vein compliance can be used to identify vein with marked pre-existing intimal hyperplasia and as a predictor of future graft stenosis.
Reperfusion injury in skeletal muscle: A prospective study in patients with acute limb ischaemia and claudicants treated by revascularization
Authors: Adiseshiah M , Round J M , Jones D A
Published: March 2007

A study was carried out to document the occurrence of rhabdomyolysis and renal complications in patients undergoing vascular reconstruction. Indices of muscle damage and renal function were monitored before, during and for up to 10 days after vascular reconstruction for a variety of conditions ranging from intermittent claudication to acute ischaemia. Seven patients with acute limb ischaemia (group 1) and nine with intermittent claudication (group 2) were studied prospectively. In group 1, median creatine kinase (CK) and myoglobin levels were markedly raised 24–48 h after surgery (CK, 29370 units/l myoglobin, 8.17 mg/l). Myoglobin reached its peak concentration and declined more quickly than CK, but both indices gave similar information about the extent of muscle damage. In contrast, patients undergoing elective surgery for claudication showed no significant departure from reference values for myoglobin or CK. All patients in group 1 underwent fasciotomy to relieve raised compartmental pressures and five were treated with alkali and mannitol to produce diuresis. Despite these measures, two patients suffered renal failure (peak creatinine levels 611 and 590 μmol/l) after successful revascularization and subsequently required haemodialysis; these patients did not have diuresis. One of these patients died following a stroke 8 days after surgery; the other survived and was discharged with a normal limb and restored renal function. There was no evidence of muscle damage or renal complications in group 2. It is concluded that: (1) the risk of muscle damage and renal complications is minimal in patients undergoing elective surgery for intermittent claudication; (2) in patients who present acutely, revascularization after several hours of ischaemia leads to rhabdomyolysis and high levels of circulating CK and myoglobin (despite fasciotomy there was evidence of subsequent muscle damage}; (3} it is not possible to predict which patients will go into renal failure; and (4) in all acutely ischaemic patients there is a risk of renal complications and it is suggested that prophylactic measures, such as an alkaline diuresis and mannitol infusion, be instituted during or before the operation as a matter of course.
Colour-coded duplex ultrasonography in the selection of patients for endovascular surgery
Authors: Vashisht R , Ellis M R , Skidmore C , Blair S D , Greenhalgh R M , O'Malley M K
Published: March 2007

Endovascular surgery using angioplasty or atherectomy may potentially relieve the symptoms of claudicants with minimal morbidity, but results are best when short stenoses are treated. In this study, colour-coded duplex ultrasonography has been compared with angiography. In aortoiliac segments duplex examination had a sensitivity of 88 per cent and a specificity of 100 per cent; infemoropopliteal disease the sensitivity was 100 per cent and duplex scanning identified more disease than angiography. Subsequently, 73 symptomatic limbs with femoropopliteal disease were scanned to assess their suitability for endovascular surgery. Of these limbs, 27 (37 per cent) had suitable lesions and the remaining 46 (63 per cent) were spared angiography. Colour-coded duplex ultrasonography can reliably be used to select patients for endovascular surgery.