bluuebunny/crossref_metadata_2025 huggingface dataset:
Sphincter of Oddi motility
Authors: Toouli J
Published: March 2007

Recent developments of manometric and endoscopic instrumentation have rekindled interest in sphincter of Oddi function. As a result of human and animal studies, our understanding of normal sphincter of Oddi physiology has increased and possible motility abnormalities are being identified. Manometric studies have shown that the sphincter of Oddi is characterized by prominent phasic contractions which are superimposed on a low tonic pressure. The phasic contractions are orientated mainly in an antegrade direction; however, both simultaneous and retrograde contractions are registered. Cineradiography has demonstrated that the phasic contractions have a propulsive function, expelling small volumes of fluid from the common bile duct into the duodenum. Intravenously administered cholecystokinin-octapeptide normally inhibits the phasic contractions and reduces the sphincter tone. Motility abnormalities may occur if the sphincter of Oddi exhibits abnormally high tone, alteration in the direction of the phasic contractions, abnormal changes in the contraction frequency, or abnormal responses to hormonal stimulation. Preliminary human studies demonstrate disorders in sphincter of Oddi motility patterns, suggesting that motility abnormalities may be associated with choledocholithiasis, dyskinesia and idiopathic relapsing pancreatitis.
Vascular injury with associated bone and joint trauma
Authors: Meek A C , Robbs J V
Published: March 2007

The clinical presentation and management of 102 vascular injuries associated with bone and joint trauma, in 100 patients over a 6-year period, is reviewed. Eighty-three injuries involved the lower limbs. Amputation became necessary in 16 patients. In 12 this was directly attributable to delay in revascularization or the extent of the soft tissue injury with consequent sepsis. Early graft occlusion in an otherwise salvageable limb occurred in four patients (3·9 per cent). Successful therapy involves close co-operation between vascular and orthopaedic surgeons with the vascular injury taking priority. The orthopaedic injury should be treated on its merits. In contaminated or comminuted fractures skeletal traction (or in suitable cases exoskeletal fixation) can be employed without adversely affecting the vascular repair. A plea is made for early diagnosis of concomitant vascular injury in patients with bone and joint injuries; this depends on clinical awareness and careful and repeated examination.
Polyamines in breast cancer
Authors: Kingsnorth A N , Wallace H M , Bundred N J , Dixon J M J
Published: March 2007

A meeting1 was held of the Surgical Research Society with Professor R. Shields in the Chair. The meeting was held at the Imperial College of Science and Technology, South Kensington, London on 5 and 6 January 1984. Seventy-eight papers were presented to the Society, and there were two surgical workshops on ‘Lasers in Surgery’ and ‘Computers for Surgical Audit’ prior to the meeting. The winner of the Patey Prize was awarded to T.W.J. Lennard, for his paper entitled ‘The Cholecystokinin provocation test: a prospective double-blind placebo controlled trial in patients with acalculous biliary pain’.

Polyamine levels (putrescine, spermidine and spermine) in breast cancers (n = 54) were measured as a potential guide to prognosis. Values (expressed as nmol per 100 mg tumour) ranged from: 0·9 to 4·5 for putrescine, 4·2 to 29·8 for spermidine and 5·6 to 39·7 for spermine concentration. Increased intracellular polyamine levels were positively correlated with factors known adversely to affect survival after mastectomy, namely histological grade III and oestrogen-receptor negative status. Advanced T4 tumours and medullary-type carcinomas also contained high polyamine levels. Tumour size and node status did not affect polyamine levels in primary tumours. Tumours that recurred within 2 years of mastectomy had significantly higher levels of spermidine and spermine than those that did not. Breast cancer polyamine levels are a biological marker of tumour aggressiveness and can be used as a prognostic indicator of early tumour recurrence that is independent of node status.
Adequate internal sphincterotomy for chronic anal fissure: Subcutaneous or open technique?
Authors: Boulos P B , Araujo J G C
Published: March 2007

The extent of sphincter division by the subcutaneous or the open technique is examined by comparing the change in anal canal pressure after either method of sphincterotomy in twenty-eight patients with chronic anal fissure randomly allocated. In all patients the fissures healed at one month with significant reduction (P < 0·01) of anal canal pressures to 52 (17–75) cmH2O after subcutaneous and 47·5 (35–100) cmH2O after open sphincterotomy, a 51 (22–77) and 50 (11–68) per cent reduction of their respective pre-operative measurements. Adequate sphincterotomy can be achieved by both techniques.
Insulin- and histamine-stimulated secretion in relation to recurrence of duodenal ulceration after vagotomy
Authors: Boulos P B , Whitfield P F , Hobsley M
Published: March 2007

Gastric secretion after vagotomy for duodenal ulcer in response to a single injection of insulin and in response to a histamine infusion has been compared in 25 patients with and 56 patients without recurrent duodenal ulceration proven by endoscopy. The lower 95 per cent tolerance limits of the pre-operative ranges of secretion to either insulin or histamine stimulation measured in 81 unoperated patients provided thresholds that separated postvagotomy patients with recurrent ulceration and those without. Neither the ratios, nor the regression line, between secretion in response to each secretagogue provided similar discrimination. In a group of 43 patients who had gastric secretion studies before and after vagotomy the reductions in secretion to below the established 95 per cent tolerance limits of secretion were respectively 60 and 80 per cent of their pre-operative insulin- and histamine-stimulated secretion. The percentage reductions however failed to differentiate asymptomatic patients from patients with recurrent ulceration. It appears therefore that, irrespective of the pre-operative level or of the magnitude of the reduction of secretion, a vagotomy to be adequate must achieve a reduction of secretion to below a threshold level.
Gastric emptying after gastroplasty for morbid obesity
Authors: Horowitz M , Collins P J , Chatterton B E , Harding P E , Watts J McK , Shearman D J C
Published: March 2007

Gastric emptying was studied in 11 patients who had undergone gastroplasty for morbid obesity 6 to 8 months previously and in 22 normal controls without gastrointestinal disease. A dual isotope technique for measuring solid and liquid emptying was used. Liquid emptying was slower in patients than controls. The emptying of solid was initially faster, but was followed by a prolonged slow rate of emptying indicating retention of solid food in the proximal partitioned pouch. There was no correlation between the weight loss produced by the operation and rates of solid or liquid emptying. Unlike gastric bypass, the changes in gastric emptying produced by gastroplasty were relatively small and gastric emptying rates in patients overlapped considerably with the range of emptying rates found in control subjects. The success of the procedure may depend on the induction of satiety by the filling of the partitioned pouch.
Exclusion of the oesophagus: Is this a dangerous manoeuvre?
Authors: Mannell Aylwyn , Epstein B
Published: March 2007

If oesophagectomy is contra-indicated or dangerous, oesophageal bypass can restore the ability to swallow. It is not known if excluding the bypassed oesophagus by closing both ends will lead to serious complications. In this study we report on 89 patients who underwent bypass surgery for benign and malignant strictures of the oesophagus. The thoracic oesophagus was completely excluded in 51 patients and in 30 cases the bypass procedure was combined with distal oesophageal drainage. Gastro-oesophageal continuity was preserved in eight patients undergoing an extra-oesophageal colon bypass. The operative mortality was similar in the three groups. Neck abscesses, probably due to leakage from the upper end of the bypassed oesophagus, occurred in 17 per cent of patients with oesophageal exclusion and in 9 per cent of the remainder. Changes occurring in the bypassed oesophagus of 38 patients were monitored with computed axial tomography. Segmental, mucus-filled dilatations (mucocoeles) of the oesophagus were identified in 20 patients. In 19 patients these mucocoeles remained small and asymptomatic. One patient with achalasia developed an oesophago-airway fistula two years after operation. Provided both ends of the oesophagus are securely closed, oesophageal exclusion is not a dangerous manoeuvre in patients undergoing bypass surgery for locally invasive tumours or corrosive injuries of the oesophagus.
Pancreatic cystadenoma and cystadenocarcinoma
Authors: von Segesser L , Rohner A
Published: March 2007

Cystadenomas and cystadenocarcinomas are rare but not exceptional tumours of the pancreas. In this report six cases are added to the more than 300 cystadenomas and over 100 cystadenocarcinomas reported in the literature. We present here the case histories of four cystadenomas and two cystadenocarcinomas with complete follow-up. There is no evidence of recurrence after a maximum of 22 years in cystadenoma and 4 years in cystadenocarcinoma following resection. We have the impression that cystic lesions of the pancreas are nowadays more often detected than in former years. This might be due to abdominal investigation by computerized tomography and ultrasound on a large scale. Pathological features of proliferative cystic lesions of the pancreas permit distinction of three different tumours: serous cystadenoma, mucinous cystadenoma and cystadenocarcinoma. The serous cystadenoma is benign. The mucinous cystadenoma has to be considered as potentially malignant. The cystadenocarcinoma is malignant by definition. As benign and malignant elements can be found in the same cyst biopsy cannot exclude cystadenocarcinoma. Therefore all cystadenomas and cystadenocarcinomas should be totally excised, especially as prognosis after resection of cystadenocarcinoma is much better than after resection of adenocarcinoma of the pancreas.
Subcutaneous mastectomy for primary operable breast cancer
Authors: Hinton C P , Doyle P J , Blamey R W , Davies C J , Holliday H W , Elston C W
Published: March 2007

Subcutaneous mastectomy has been performed on 98 patients with primary breast cancer. Eighty-four have undergone breast reconstruction using a silicone prosthesis. The overall complication rate has been low. The rates of local recurrence and survival are similar to those in patients undergoing simple mastectomy.
Diagnosis and treatment of superior mesenteric artery syndrome
Authors: Gustafsson L , Falk A , Lukes P J , Gamklou R
Published: March 2007

Superior mesenteric artery syndrome (SMAS) is a rare clinical condition. Eleven cases of SMAS treated surgically are reported after follow-up periods of 6 months to 6 years. The value of hypotonic duodenography in the diagnosis of the syndrome is emphasized.
Haemodynamics of the adjunctive arteriovenous fistula in femorodistal bypass grafting: An experimental study
Authors: Parvin S D , Bentley S , Asher M J , Prytherch D R , Evans D H , Bell P R F
Published: March 2007

The results of femorotibial bypass for limb salvage vary a great deal. One of the reasons for this might be the discrepancy between potential inflow and run-off into the foot. An arteriovenous fistula at the distal graft anastomosis may improve results but the best anatomical arrangement for the fistula is unknown. Ileofemoral grafts were performed in dogs after the hind limb was rendered ischaemic. The distal end of the graft was anastomosed proximal to, superimposed upon, or distal to an arteriovenous fistula between the femoral artery and its accompanying femoral vein. The effect of the fistula on graft/run-off haemodynamics was then measured. The adjunctive arteriovenous fistula increased inflow by a mean of 900 per cent and reduced systemic pressure by 10 per cent. Peripheral resistance was reduced by 85 per cent. Distal arterial run-off was maximized with respect to total graft flow when the graft was placed distal to the fistula (P < 0·05). The venous steal of flow and perfusion pressure produced by the fistula was minimized with the same configuration compared to the two other arrangements (P < 0·01 and P < 0·05). Placement of the graft distal to the adjunctive arteriovenous fistula maximized distal arterial flow and pressure, and significantly increased graft flow.
Does dihydroergotamine potentiate the thromboprophylactic effect of dextran 70? A controlled prospective study in general and hip surgery
Authors: Bergqvist D , Lindblad B , Ljungström K-G , Persson N H , Hallböök T
Published: March 2007

In a prospective randomized controlled study on postoperative thromboembolism, 259 patients undergoing elective general surgery, emergency general surgery, total hip replacement or hip fracture surgery were given thromboembolic prophylaxis with either a combination of dextran 70 and dihydroergotamine (DHE) or with dextran 70 alone. 500 ml dextran 70 was infused twice on the day of operation, once on postoperative days 1 and 3, and also on day 5 if the patient was still confined to bed. 0·5 mg DHE was given s.c. twice daily starting before operation and continued for 3 or 5 postoperative days. In hip fracture patients prophylaxis was started as soon as the diagnosis was made. 500 ml dextran 70 was given every other day before operation. DHE was given twice daily if so indicated from randomization. The patients were screened for deep-vein thrombosis (DVT) with the 125I-labelled fibrinogen test for 8 days and followed for one month postoperatively. In hip fracture surgery the incidence of DVT was significantly reduced by the combination of dextran 70 and DHE compared to dextran 70 alone (1/32 vs. 11/36, P = 0·003). However, this synergistic effect of DHE could not be detected in the other patient groups. Fatal pulmonary embolism did not occur. No severe side effects attributable to prophylaxis were noted in either group.
Surgical treatment of the ‘slipping rib syndrome’
Authors: Copeland G P , MacHin D G , Shennan J M
Published: March 2007

This review seeks to draw attention to the existence of the ‘slipping rib syndrome’ as a not uncommon clinical entity. It is characterized by trunk pain in a radicular distribution, often related to certain movements or activity, but not associated with other visceral symptoms. The diagnosis is a clinical one, with surgical excision of the affected rib and costal cartilage a successful simple treatment for relieving those patients of a severe and persistent pain syndrome.
Wound sepsis after low risk elective cholecystectomy: The effect of cefuroxime
Authors: Morran C G , Thomson G , White A , McNaught W , Smith D C , McArdle C S
Published: March 2007

A prospective randomized double-blind study was performed to assess the value of a single intravenous injection of 1·5 g cefuroxime in the prevention of wound sepsis after low risk elective cholecystectomy. Wound infection developed in 10 of 81 control patients compared with 2 of 79 treated patients (P < 0·05). Wound sepsis occurred more commonly in patients with infected bile or with a positive culture from a closing wound swab. Cefuroxime significantly reduced the isolation of staphylococci but not other organisms from the closing wound swab and also produced a significant reduction in wound infection in patients with sterile bile.
Results of colectomy for severe idiopathic constipation in women (Arbuthnot Lane's disease)
Authors: Preston D M , Hawley P R , Lennard-Jones J E , Todd I P
Published: March 2007

Twenty-one women with slow-transit constipation have been treated by bowel resection. All had a normal barium enema, but an increased colonic transit time. Pathological examination of the resected colons showed no evidence of aganglionosis. Some of the patients were treated by segmental colonic resection, anorectal myectomy, anal stretch or internal sphincterectomy but were not helped. Colectomy with ileorectal or caecorectal anastomosis gave the best results; on balance, ileorectal anastomosis seems preferable. Of sixteen patients who underwent colectomy, ten subsequently had normal bowel function and four were markedly improved. The spontaneous bowel frequency in this group rose from 0·3 ± 0·1 (s.e.m.) to 21·7 ± 8·3 weekly (P < 0·001).
Parathyroid surgery in chronic renal failure: Subtotal parathyroidectomy or autotransplantation?
Authors: Welsh C L , Taylor G W , Cattel W R , Baker L R I
Published: March 2007

In the period 1970–1983, 27 patients with end stage renal failure underwent neck exploration for hyperparathyroidism. In 1977 the operative policy changed from subtotal parathyroidectomy to total parathyroidectomy and autotransplantation. Eight patients underwent subtotal parathyroidectomy while fifteen patients underwent total parathyroidectomy and autotransplantation. All were cured of their symptoms and hypercalcaemia was resolved. There was no significant difference in the requirement for postoperative calcium and vitamin D supplements between the two groups. Recurrent hypercalcaemia developed in one patient who had undergone total parathyroidectomy and autotransplantation. Resolution followed removal of approximately half the transplant. There were four deviations from the operative policy.
Advanced gastric cancer: Experience in Scotland using 5-fluorouracil, adriamycin and mitomycin-C
Authors: Cunningham D , Soukop M , McArdle C S , Carter D C , Smyth J F , Allan S G , Kaye S B , Sangster G , Calman K C , Hutcheon A W , Boyle P
Published: March 2007

Eighty-four patients with advanced gastric cancer treated in four centres in Scotland between June 1980 and December 1982 were reviewed following treatment with 5-fluorouracil, adriamycin and mitomycin-C (FAM). Eighty-one patients were evaluable. Twenty-eight patients (35 per cent) responded (four complete) with a median duration of response of 10·5 months and median survival of 17 months. Ten are still alive. Response was associated with an improvement in performance status. Eight patients (10 per cent) had stable disease with a median survival of 10 months. Forty-five (55 per cent) had progressive disease with a median survival of 4·5 months; one patient remains alive. Analysis of prognostic variables indicated that the presence of hepatic metastases had a negative influence on response to FAM (P <0·001). Treatment was well tolerated on an outpatient basis. FAM offers good palliative therapy in a proportion of patients with this disease, especially those without overt liver metastases.
Surgical excision of first cleft branchial fistulae
Authors: Miller P D , Corcoran M , Hobsley M
Published: March 2007

Three patients were studied who had fistulae in the neck derived from the first branchial cleft. Evidence is presented to show that although these fistulae usually pass superficial to the facial nerve they may also pass deep to one or both main divisions of the nerve. We conclude that a formal superficial conservative parotidectomy with full exposure of the facial nerve is the safest operative course when excising these fistulae.
Lymphomas presenting as lumps in the parotid region
Authors: Watkin G T , MacLennan K A , Hobsley M
Published: March 2007

The clinical and pathological features of 17 patients who had lymphomas of the parotid region are discussed. Although it is in general impossible on clinical grounds to make a pathological diagnosis on clinical examination of a lump in the parotid region, features which are not typically seen in the majority of patients with parotid lumps, but which were present in 11 (65 per cent) of those patients, are emphasized. Multiple ipsilateral and bilateral lumps were seen in 30 per cent of our patients with lymphomas of the parotid region. However, these are statistically more likely to indicate the benign adenolymphoma. Palpable lymph nodes were seen in association with the parotid mass in 53 per cent of our patients. Whereas a clinical diagnosis cannot be established simply by the presence of an enlarged lymph node in association with the parotid lump, we suggest that the probability of the lump being a lymphoma is sufficient to justify biopsy of the lymph node as a first line of treatment. Biopsy of associated palpable lymph nodes enabled the diagnosis to be made in seven out of eight patients subjected to biopsy, and avoided the necessity for parotidectomy in these patients.
The aetiology and management of acute epididymitis
Authors: Redfern T R , English P J , Baumber C D , McGhie D
Published: March 2007

The aetiology of acute epididymitis presenting to a surgical unit in a District General Hospital is presented. Patients over 45 years old frequently have a coliform urinary tract infection which may be associated with bladder neck obstruction. These patients require treatment with a suitable antibiotic (Co-trimoxazole) and further investigation. This condition occurs more commonly in patients under 45 years old in whom it is not associated with urinary tract infection. We have not demonstrated significant chlamydial infection and in a double blind study the antibiotic Co-trimoxazole did not hasten recovery. In this group the aetiology remains obscure.
Plasma fibronectin and complement in surgical patients
Authors: Chadwick S J D , Mowbray J F , Dudley H A F
Published: March 2007

Plasma fibronectin and a fragment of the third component of complement (C3b) are both opsonins of the reticulo-endothelial system. Twenty patients undergoing uncomplicated gastro-intestinal surgery were studied. There was a significant reduction in plasma fibronectin and total haemolytic complement, but not C3, in the early postoperative period (days 1 to 3). In six surgical patients critically ill with severe sepsis both plasma fibronectin concentrations and C3 concentration were reduced significantly when compared with the early postoperative period of uncomplicated surgery. In addition, in the critically ill patients, direct evidence of complement activation was demonstrated. These studies show a transient reduction of humoral host defence mechanisms following surgery which may be permissive to bacteraemia and complement activation.
Incidence of pre-operative deep venous thrombosis in abdominal surgery
Authors: Rodzynek J J , Damien J , Huberty M , Abramowicz C , Garcez J L , Govaerts J P
Published: March 2007

In order to determine the incidence of pre-operative and postoperative deep venous thrombosis (DVT) in patients not receiving prophylactic anticoagulant therapy, bilateral phlebography was performed in a prospective study pre-operatively and on the 9th postoperative day, in 51 consecutive patients submitted for major abdominal surgery. The presence of a DVT before surgery was demonstrated in 15·7 per cent of the patients. This high frequency confirms objectively the rationale of starting prophylactic anticoagulant therapy before the surgical procedure. Thrombi were demonstrated postoperatively by phlebography in 54·9 per cent of the patients. Thus the true incidence of DVT induced by surgery was 39·2 per cent taking into account the 15·7 per cent pre-operative DVT rate.
Selective variceal decompression in portal vein thrombosis
Authors: Henderson J M , Millikan W J , Galambos J T , Warren W D
Published: March 2007

Thirty-two patients with congenital portal vein thrombosis have been managed for bleeding gastro-oesophageal varices. Fifteen had splenectomy and/or other therapy before referral: nine were managed by endoscopie sclerosis, four by devascularization and two by total shunt; six rebled. Seventeen had their spleen “in situ” at referral and were evaluated for selective shunt: thirteen had distal splenorenal shunts (DSRS)—one transiently rebled despite a patent shunt and one had shunt thrombosis; four had no veins suitable for shunt, and were managed by splenectomy and devascularization, with two rebleeds. Detailed study of seven patients before, and 1 year after DSRS, showed a rise in platelet count, maintenance of hepatocyte function, portal perfusion, liver blood flow and liver size. The spleen showed a significant (P < 0.025) reduction in size with trans-splenic decompression. We conclude that DSRS provides an excellent method for long-term control of bleeding in such patients, without alteration of liver function or haemodynamics. Patients managed by splenectomy and direct ablative procedures have a significantly (P < 0.05) greater risk of rebleeding than patients receiving DSRS.
The surgical factors influencing duodenogastric reflux
Authors: Brough W A , Taylor T V , Torrance H B
Published: March 2007

The surgical factors influencing duodenogastric reflux have been assessed in dog and man using the biliary radiopharmaceutical 99mTc-EHIDA. Cholecystectomy led to a significant increase in the amount of reflux (P < 0.01), but the combination of truncal vagotomy and pyloroplasty in addition to cholecystectomy produced a greater amount of reflux (P < 0.01). In man, cholecystectomy also resulted in a significant increase in the amount of reflux (P < 0.01). In ten control subjects reflux occurred but the amount was small and was not significantly different from the modified highly selective vagotomy group (n = 20). Symptomatic patients after truncal vagotomy and pyloroplasty (n = 16) showed a significant increase in the amount of reflux (P < 0.002) but the combination of vagotomy and pyloroplasty in addition to cholecystectomy (n = 15) demonstrated the greatest amount of reflux (P < 0.002). Similarly the addition of cholecystectomy to highly selective vagotomy (n = 9) showed a significant increase in the amount of reflux (P < 0.02). Reconstruction of the pylorus (n = 8) was not a satisfactory procedure for the prevention of reflux but antrectomy and Roux-en-Y biliary diversion (n = 8) resulted in a significant reduction in the amount of reflux (P < 0.001) and this was associated with clinical improvement.
Faecal occult blood testing in the detection of colorectal cancer
Authors: Elliot M S , Levenstein J H , Wright J P
Published: March 2007

5012 asymptomatic patients over the age of 40 years were asked by their general practitioners to perform a Hemoccult faecal blood test over 3 days. 3422 patients on a normal diet completed the test (a compliance rate of 67 per cent). Ninety-nine patients (3 per cent) had a positive result. Those patients with a positive result then underwent a second Hemoccult test over 6 days on a restricted diet. Thirty-two patients had a positive result on repeat testing (1 per cent). Only those patients who were positive on the second testing were fully investigated (including double contrast barium enema and colonoscopy). Twenty-seven patients on investigation were found to have neoplastic disease (84 per cent). Twelve had invasive carcinomas (nine Dukes' A, two Dukes' B, one Dukes' C) and thirty-seven adenomas were identified and removed at colonoscopy (barium enema missed three carcinomas—all Dukes' A and only identified sixteen of the thirty-seven adenomas, 43 per cent). Those patients found to be negative after the second Hemoccult test are being followed up.
Postmastectomy breast reconstruction with an inflatable prosthesis
Authors: Kissin M W , Kark A E
Published: March 2007

Breast reconstruction was carried out in 38 patients after modified radical mastectomy, using a saline-filled inflatable prosthesis placed in a submuscular pocket. In 79 per cent the reconstructed breast had normal texture without complications. One patient was dissatisfied with the cosmetic result. Marked capsular contraction occurred in two cases (6 per cent) and late deflation in five (14 per cent).
The localization of human breast carcinomas by radiolabelled monoclonal antibodies
Authors: Rainsbury R M
Published: March 2007

Immune-deprived mice bearing HX99 human breast carcinoma xenografts were injected with a radiolabelled monoclonal antibody, LICR-LON-M8 (M8), to investigate the dependence of tumour localization on (i) tumour site and (ii) antibody radiolabel. No significant difference was found in the degree of localization of radio-iodinated M8 in subcutaneous, renal or intracranial xenografts, but a highly significant improvement in HX99 localization by M8 was recorded using an 111indium-DTPA conjugate of the antibody (111In-DTPA-M8), related to its rapid tumour uptake and blood pool clearance. Radioiodinated or 111In-labelled M8 was given to 29 patients with breast cancer, 7 with primary tumours and 22 with metastases. Tumour localization was assessed by (i) examination of surgical specimens and (ii) antibody scans, which were compared with conventional X-rays and 99mTc-methylene diphosphonate (MDP) bone scans. Radiolabelled M8 localized preferentially in all primary tumours (radioactivity tumour: normal breast = 6.2±1.4 [mean±s.e.]). All ten patients with skeletal metastases had positive 111In-DTPA-M8 scans, but the correlation with X-rays and MDP scans showed a regional variation. Radio-iodinated M8 failed to identify metastases in any site. The favourable biodistribution of 111In-DTPA-M8 has led to the clear localization of breast carcinomas in patients and mice. In future such reagents may rationalize the clinical management of breast cancer.
A randomized study of a semisynthetic heparin analogue and heparin in prophylaxis of deep vein thrombosis
Authors: Törngren S , Kettunen K , Lahtinen J , Koppenhagen K , Brücke P , Hartl P , Hutter O , Haller U , Lahnborg G , Forsskåhl B
Published: March 2007

The prophylactic effect of a semisynthetic heparin analogue (SSHA) on deep vein thrombosis was investigated in a prospective double-blind multicentre trial. 440 major general surgical and gynaecological patients were randomized to one of three treatment groups: 50 mg SSHA, 37·5 mg SSHA and 5000 units sodium heparin subcutaneously 12-hourly. Deep venous thrombosis (DVT) was diagnosed with the fibrinogen uptake test and verified with phlebography. Bleeding complications and other side-effects were carefully monitored. There were no significant differences between the three treatment groups of patients in age, sex, type of operation or risk factors. A DVT was diagnosed in 16 patients (12 per cent) in the SSHA 50 mg group, in 21 patients (15 per cent) in the SSHA 37·5 mg group and 21 patients (14 per cent) in the heparin-treated group. No significant differences were found in the number of patients who bled unexpectedly in the postoperative period, required transfusion or developed wound haematomas. Blood loss at operation was similar in all three groups. Three pulmonary emboli were diagnosed by pulmonary scintigraphy, one in each group.
Contrast tomography of the gallbladder wall and ultrasonography in the diagnosis of acute cholecystitis
Authors: Herlin P , Alinder G , Karp W , Holmin T
Published: March 2007

Rapid and reliable diagnostic methods are necessary for regular early surgical intervention in patients with acute cholecystitis. Eighty-three patients with clinical suspicion of acute cholecystitis were investigated with ultrasonography (US) and contrast tomography of the gallbladder wall (CTGW). The diagnosis in each case included in the study was verified either at operation or follow-up cholecystography. The sensitivity and specificity of US were 69 and 100 per cent, respectively. With CTGW the corresponding figures were 73 and 100 per cent. The combined use of these methods resulted in a sensitivity of 89 per cent and a specificity of 100 per cent.
Direct vision brush cytology with colonoscopy: An aid to the accurate diagnosis of colonic strictures
Authors: Mortensen N J McC , Eltringham W K , Mountford R A , Lever J V
Published: March 2007

The accuracy of direct vision brush cytology at colonoscopy was compared with colonoscopic biopsies, colonoscopy alone and radiology in the diagnosis of colonic strictures. There were 82 brushings in 79 patients; 55 had malignant and 24 had benign lesions. Cytology was correct in 66 (81 per cent), and biopsy was less accurate with 53 (68 per cent) correct reports. The combined accuracy of cytology and biopsy was 88 per cent. Whilst an endoscopic diagnosis was usually correct (96 per cent), direct vision brush cytology had an important place in the accurate tissue diagnosis of colonic strictures, particularly those in the rectosigmoid.
Is laparotomy for small bowel obstruction justified in patients with previously treated malignancy?
Authors: Walsh H P J , Schofield P F
Published: March 2007

We report 53 patients who developed small bowel obstruction some time after the treatment of a primary malignant tumour. Previous treatment of the primary tumour in these patients had been by abdominal surgery (22 patients) or pelvic radiotherapy (20 patients) but 11 of the patients had not received previous abdominal surgery or radiotherapy. All the patients had a laparotomy in an attempt to relieve the obstruction. Seventeen patients had a cause for the obstruction other than secondary malignancy. This was noted particularly when the patients had had pelvic radiotherapy, when radiation change of the ileum causing obstruction was common. Thirty-six patients had obstruction due to secondary tumour and it was found possible to overcome the obstruction in all but two of these. The operative mortality in the patients with secondary malignancy was 19 per cent, but 15 patients (42 per cent) survived for more than a year and the median survival was 11 months. It is concluded that a policy of aggressive surgical intervention is desirable in patients who develop small bowel obstruction after previous treatment for malignant disease.
Incidence of synchronous and metachronous colorectal carcinoma
Authors: Cunliffe W J , Hasleton P S , Tweedle D E F , Schofield P F
Published: March 2007

Two hundred and twenty-three patients with colorectal carcinoma were treated consecutively at the University Hospital of South Manchester from May 1976 to January 1981. Twenty-four patients (10·7 per cent) were found to have more than one colorectal carcinoma. In 18 patients this was recognized either immediately or within 6 months of the initial diagnosis—synchronous carcinoma. In the other six cases a second carcinoma was found at a later time—metachronous carcinoma. The incidence of synchronous, and consequently the combined incidence of synchronous and metachronous carcinoma, was higher than previously documented. The anatomical distribution of the multiple carcinomas and the sex incidence in these patients was similar to that seen in patients with a single carcinoma of the large bowel. A high association of adenomatous polypi with multiple large bowel carcinomas was observed. The possibility of more extensive colonic resection in the younger patient with a favourable carcinoma is discussed.
Improving prognosis for malignant melanoma in Britain
Authors: Taylor B A , Hughes L E , Williams G T
Published: March 2007

Analysis of a consecutive series of 225 patients with malignant melanoma in Cardiff has shown a 5 year cumulative survival rate of 73·3 per cent. This survival rate is considerably better than those reported in previous British series, equal to the high rates reported in the past from Australia, and far exceeds that of all common internal malignancies. It is suggested that the improving prognosis is associated with more accurate diagnosis and an increasing incidence of superficial spreading melanoma, a type for which earlier diagnosis might be expected to lead to improved prognosis. These facts provide a basis of optimism for future programmes of public and professional education.
Accessory sphincterotomy (endoscopic and surgical) in patients with pancreas divisum
Authors: Russell R C G , Wong N W , Cotton P B
Published: March 2007

Sixteen patients with the congenital anomaly of pancreas divisum have been treated by enlarging the orifice of the accessory papilla. Attempts to do this at duodenoscopy succeeded in only 5 of 12 patients, and only one had a good clinical result. Sphincteroplasty was performed surgically in seven patients; five had a good or fair result. Most patients with poor results have undergone pancreatic resection. One patient died post-operatively; the remaining 15 divide equally as good (5), fair (5) and poor (5) results at follow-up after periods ranging from 7 months to 5 years. Results appear to be better in patients presenting with recurrent attacks of acute pancreatitis than in those with chronic pain. The preferred management for these patients remains unclear.
A simple screening test for acute pancreatitis
Authors: Holdsworth P J , Mayerf A D , Wilson D H , Flowers M W , McMahon M J
Published: March 2007

A urinary test strip for amylase (Rapignost-Amylase) was compared with plasma amylase assay in samples of urine and plasma collected on the day of admission to hospital from 23 patients with acute pancreatitis and 38 patients with other causes of acute abdominal pain. Plasma amylase was greater than 1200 IU/l in 24 patients (23 with pancreatitis and 1 with a perforated duodenal ulcer) and all were Rapignost-Amylase positive. Twenty-nine of the remaining patients were Rapignost-Amylase negative, but there were eight ‘false positives’ with plasma amylase levels of 86–474 IU/l. The Rapignost-Amylase test is of potential value to screen for clinically occult acute pancreatitis.
Conservative management of post-traumatic parotid fistulae and sialoceles: A prospective study
Authors: Landau R , Stewart M
Published: March 2007

A prospective study of 14 consecutive patients with parotid injuries treated over a 4-month period, is presented. Three patients underwent emergency duct repair and 11 patients, presenting with delayed fistulae or subcutaneous collections of saliva (sialoceles), were treated conservatively with uniform success. Glandular injury closed within an average of 5 days of treatment and ductal leaks within approximately 14 days.
Lugol's iodine: Its effect on thyroid blood flow in patients with thyrotoxicosis
Authors: Marigold J H , Morgan A K , Earle D J , Young A E , Croft D N
Published: March 2007

It has been established practice for 60 years to prepare thyrotoxic patients undergoing thyroidectomy with Lugol's iodine. However, evidence in support of its claimed benefits, namely a reduction in the vascularity and friability of the toxic thyroid gland, is scanty. We have therefore determined the effect of Lugol's iodine on thyroid blood flow, as measured by thyroid uptake of thallium-201, in nine patients with Graves’ disease and one euthyroid patient. Thallium-201 uptake, as well as serum thyroxine and triiodothyronine, fell significantly after treatment with iodine. Although not correlated with thyroid function tests, thallium-201 uptake was significantly correlated with thyroid weight. These results support the contention that thyroid blood flow is reduced in thyrotoxic patients treated with Lugol's iodine.
Prolonged ambulatory pH monitoring in patients following oesophageal transection and control subjects
Authors: Spence R A J , Johnston G W , Parks T G
Published: March 2007

Prolonged ambulatory oesophageal pH monitoring using a radiopill was carried out in 19 patients following oesophageal transection for varices. The results were compared with 14 asymptomatic control subjects. The duration of oesophageal pH less than five while erect was significantly greater in the post-transection group than in the control subjects. The duration of pH less than 4 while erect was also greater following transection but this did not quite reach statistical significance. The number of reflux episodes did not differ between the two groups. There was no significant difference in duration or number of reflux episodes while supine between the two groups.
A study of the mechanical properties of fresh and preserved human femoral vein wall and valve cusps
Authors: Ackroyd J S , Pattison M , Browse N L
Published: March 2007

In the hope that some varieties of the post-phlebitic syndrome might be treated by implanting a preserved vein valve, studies have been made of the mechanical properties of vein valves and vein wall before and after preservation with glutaraldehyde. The ultimate tensile strength (breaking stress) and strain (extensibility) of strips of vein wall and valve leaflet were measured with a Nene tensiometer. The ultimate tensile strength of valve leaflet was found to be twice that of vein wall. Preservation in glutaraldehyde (0.2 per cent, pH 7.4, for 7 days) with valve cusps closed by a minimum head of pressure caused no change in breaking stress or extensibility.
Deranged liver blood flow patterns in the detection of liver metastases
Authors: Leveson S H , Wiggins P A , Giles G R , Parkin A , Robinson P J
Published: March 2007

Hepatic flow scintigraphy has been used to evaluate 150 patients with gastrointestinal carcinoma. A normal range has been obtained on a group of 23 healthy volunteers. The flow scintigraphic findings have been correlated with the presence of metastases at the time of primary surgical therapy. The group of patients with livers ostensibly clear of metastases have been followed up over a one-year period. At one year the specificity of the investigation is 72 per cent with a sensitivity of 96 per cent. We conclude that flow scintigraphy is capable of not only detecting established hepatic metastases, but will also identify patients harbouring occult metastatic disease.
Re-routing of the track for the treatment of high anal and anorectal fistulae
Authors: Mann C V , Clifton M A
Published: March 2007

A transposition technique for the management of high anal and anorectal fistulae is described. The method involves re-routing the extrasphincteric portion of the track into an intersphincteric position with immediate repair of the external sphincter. The newly positioned intersphincteric fistula is then dealt with at a later date when the external sphincter is soundly healed. In this way the number of operations needed to deal with such a fistula may be reduced, a colostomy is not necessary, healing is more rapid and continence is preserved. Details of the first five cases dealt with in this way and their successful outcome are reported.
A randomized controlled trial of prophylactic cytotoxic chemotherapy in potentially curable breast cancer
Authors: Gough M H , Durrant K R , Giraud-Saunders A M , Paine C H , McPherson K , Vessey M P
Published: March 2007

A randomized controlled trial of the value of oral adjuvant cytotoxic chemotherapy in the treatment of potentially curable breast cancer has been in progress in the Oxford Region since 1977. Eighty-seven patients were allocated to treatment with melphalan 0.2 mg/kg for 5 consecutive days every 6 weeks for 2 years; 98 patients were allocated to treatment with oral combination therapy consisting of melphalan 10 mg daily for 5 consecutive days, plus methotrexate 15 mg and 5-fluorouracil 250 mg on the first day, courses being repeated every 6 weeks for 2 years; and 88 patients were allocated to a control group which received no adjuvant chemotherapy. So far, 125 patients have suffered a recurrence of breast cancer and 85 have died. No statistically significant differences in outcome are apparent between the three treatment groups, although there is some indication of a beneficial effect of chemotherapy on disease-free interval in pre-menopausal women. Toxic effects of treatment, notably nausea, vomiting and bone marrow depression, have been moderately severe. In our view, the beneficial effects of current adjuvant cytotoxic chemotherapy, if any, are too modest to justify the suffering which such treatment can cause at a time when a woman with breast cancer might otherwise expect to feel physically well.
Epidermal growth factor receptors on human breast cancers
Authors: Sainsbury J R C , Farndon J R , Harris A L , Sherbet G V
Published: March 2007

Epidermal growth factor (EGF) is a potent mitogen for many tissues including breast. The receptor for EGF (EGF-r) has the same peptide sequence as a known oncogene. Sixty-one human breast cancers and nine associated lymph node metastases have been examined for the presence of EGF receptors by competitive binding and immunocytochemical techniques. Oestrogen receptor analysis on the same specimens was performed by the dextran coated charcoal method and compared with EGF-r status. These were correlated with the clinical findings and histological data. An inverse relationship between EGF-r and ER was found (χ2 = 7·81, P<0·01) with a higher incidence of EGF-r positive tumours in the metastatic group (χ2 = 14·51, P<0·001). EGF-r positive tumours were of poor differentiation and had characteristics associated with poor prognosis.
Cholecystectomy in the elderly: A prospective study
Authors: Houghton P W J , Jenkinson L R , Donaldson L A
Published: March 2007

The mortality and morbidity of 151 elderly patients (>64 years of age) undergoing biliary surgery for benign disease were prospectively studied. The overall mortality was 3·3 per cent. This comprised a 0·77 per cent mortality in the elective group and a 19 per cent mortality in the emergency group. In spite of 77 per cent of the emergency group having a gangrenous gallbladder, a complication difficult to predict pre-operatively, the majority of deaths were from cardiovascular disease. The overall incidence of common bile duct exploration was 36 per cent, which was similar in the elective and emergency groups. A comparison between the old (65–74 years) and the aged (over 74 years of age) revealed twice the number of emergency cases in the aged. Considering elective biliary surgery, there was no difference between the mortality, morbidity, or common bile duct exploration rate comparing the old with the aged. This suggests that elective biliary surgery is safe even in the aged.
Testicular torsion does not cause autoimmunization in man
Authors: Fraser I , Slater N , Tate Cathy , Smart J G
Published: March 2007

Forty-seven patients have been reviewed 2–10 years after torsion of the testicle. Thirty-six (77 per cent) were found to have abnormalities of exocrine or endocrine gonadal function. None showed evidence of testicular autoimmunization using standard assays of sperm agglutination and immobilization by serum or seminal plasma, and the serum mixed agglutination reaction (MAR) test. In addition, 11 cases of acute torsion were followed at intervals for 3–6 months after surgery, but no evidence was observed of the transient development of sperm antibodies. Our findings confirm poor gonadal function after torsion, but do not support the recent suggestion that it is caused by autoimmunization.
Experience using the carbon dioxide laser in the removal of cutaneous tattoos
Authors: James S E , Venn G E , Russell R C G
Published: March 2007

A preliminary study was undertaken to determine if the carbon dioxide laser was a suitable technique for the removal of tattoos. Twenty-eight patients with 47 tattoos had their tattoos removed by the carbon dioxide laser. The results were assessed by an independent observer 1 year after completion of treatment. The most satisfactory results were obtained in patients with discrete linear tattoos of amateur origin. In those with polychromatic blocked-in tattoos of professional origin, hypertrophic scars occurred and the overall result was unsatisfactory.
Long term results of the enteromesenteric bridge operation in the treatment of primary lymphoedema
Authors: Hurst P A E , Stewart G , Kinmonth J B , Browse N L
Published: March 2007

Eight patients with primary lymphoedema secondary to iliac lymph node and vessel obstruction were treated in 1977 and 1978 by the construction of an enteromesenteric bridge. All patients have been followed clinically for periods of 2·5–7 years. Six patients showed sustained clinical improvement. Two failed to improve and subsequently required leg reducing operations. Contrast lymphography was performed in the early postoperative period on all cases and showed function of the bridge in five. Isotope lymphography 6–7 years postoperatively showed normal clearance of isotope from three of the four limbs studied. In one patient contrast lymphography, performed 7 years postoperatively, confirmed continued conduction of lymph by the enteromesenteric bridge. These results have encouraged us to reintroduce this operation for suitable patients.