bluuebunny/crossref_metadata_2025 huggingface dataset:
Subphrenic abscess: A study of 241 patients at the Royal Prince Edward Hospital, 1950–73
Authors: Halliday P , Halliday J H
Published: March 2007

A series of 241 patients with subphrenic abscess was analysed to seek reasons for the continuing mortality.

Aspects of pathology, clinical presentation, special investigations and management were affected by therapy with broad spectrum antibiotics to make diagnosis more difficult, particularly in relation to left subphrenic abscesses. When transperitoneal exploration and drainage were employed, high morbidity and mortality resulted.

Satisfactory results followed extraserous drainage. The introduction of parenteral hyperalimentation promised control of fistulas associated with abscesses, a situation hitherto associated with a poor prognosis.
Ovarian tumours in childhood: A 27-year review
Authors: Orr P S , Gibson A , Young D G
Published: March 2007

Twenty-five children treated for ovarian neoplasms at the Royal Hospital for Sick Children, Yorkhill, Glasgow, between 1947 and 1974 are reported. Eight of the patients had malignant tumours and 17 benign. The patients with benign tumours were treated by either salpingo-oophorectomy or oophorectomy. The malignant cases were treated with either surgery alone or in combination with deep X-ray therapy and/or chemotherapy. Two patients died of malignant teratoma, but the remaining 6 with malignant teratoma, dysgerminoma or endodermal sinus are well. The management of these patients is discussed.
Benign obstruction of subclavian and axillary veins possibly due to filariasis
Authors: Nagaratnam N , Fernando D J S , Deen M F O , Kulasecaram V , Ismail M M
Published: March 2007

This paper analyses the clinical features of 8 patients with post-thrombotic obstruction of the subclavian and axillary veins demonstrated by phlebography. The classic physical signs of swelling of the arm with dilated superficial collateral veins were seen. The causes of thrombotic obstruction are discussed and the precipitating cause in this study was possibly filariasis.
Bilateral hydrothorax following internal jugular catheterization
Authors: Carvell J E , Pearce D J
Published: March 2007

A case of bilateral hydrothorax associated with catheterization of the internal jugular vein for feeding purposes is described. The possible mechanisms of this complication are discussed.
The prognosis after surgical treatment for carcinoma of the rectum
Authors: Whittaker M , Colicher J C
Published: March 2007

The results of surgical treatment of 550 cases of carcinoma of the rectum presenting to the Professorial Surgical Unit of the General Infirmary, Leeds, from 1955 to 1968 have been analysed.

Operation of some kind was undertaken in 98.5 per cent of the cases and rectal excision in 90.5 per cent. The operative mortality for all the cases undergoing rectal excision was 10.6 per cent, for those having anterior resection 6.8 per cent and for those submitted to combined abdominoperineal excision 12.5 per cent. The commonest causes of death were various forms of sepsis and cardiothoracic complications.

The corrected 5-year survival rate for all the immediate survivors of rectal excision was found to be 56. 0 per cent. For cases having Dukes' A lesions it was 91.9 per cent, for those with B lesions 71.3 per cent and for those with C lesions 37.7 per cent. For patients treated by sphincter-saving resection it was 68.3 per cent and for those submitted to combined excision 47.2 per cent.

The 5-year survival rate was also found to be adversely affected by, among other factors, extensive circumferential spread of the primary growth in the bowel wall, fixity of the lesion, involvement of the overlying or adjacent peritoneum and the presence of hepatic metastases, but the prognosis with these developments was sometimes better than might have been anticipated.
Jaundice and wound healing: An experimental study
Authors: Bayer I , Ellis Harold
Published: March 2007

Obstructive jaundice was induced in rats by ligation and division of the common bile duct. The healing of a standard gastric incision and a parietal peritoneal defect in these animals showed histological evidence of delayed healing compared with controls. The bursting strength of the abdominal incision was also lowered, but not that of the stomach, probably because of the adhesions which reinforced the gastric incisions. Angiography did, however, reveal delay in angiogenesis in the gastric wounds of jaundiced animals. The possible causes of this delay in healing and its clinical implications require further investigations.
The results of colostomy closure
Authors: Finch D R A
Published: March 2007

Complications arose in 93 (44 per cent) of 213 patients following the closure of a temporary colostomy. These complications included 1 death, 19 faecal fistulas, 3 large bowel obstructions and 24 incisional hernias. Complications were most commonly seen following closure of colostomies of the sigmoid colon, especially when such closure was undertaken between the fourth and twelfth weeks after definitive surgery. It is concluded that still greater care is needed in both the operative technique and the preoperative care of these patients.
Manometric studies of anorectal disorders in infancy and childhood: An investigation of the physiopathology of continence and defaecation
Authors: Meunier P , Mollard P , de Beaujeu M Jaubert
Published: March 2007

Anorectal manometry was performed on 126 infants and children with anorectal disorders. In addition, 14 normal children were studied.

Pressure measurements were taken with two perfused open-tip catheters. The activity of the external and internal sphincters of the anus was also assessed. A latex balloon was used to distend the rectal ampulla with air.

The following factors were particularly studied: The value of the basal pressure in the anal canal, which provides an estimation of sphincteric competence.

The presence or absence of rectal internal sphincteric relaxation and rectal external sphincteric contraction, which are altered in certain neurological defects.

The rectal sensitivity, which initiates the urge to defaecate.

All the diseases which affect continence and defaecation justify a manometric investigation. The results obtained in Hirschsprung's disease, idiopathic constipation, anal malformations and spina bifda are reported and discussed.

The main interest of the manometric technique lies in the diagnosis of congenital megacolon, but constipation and the little investigated fields of anal imperforation and spina bifida are likely to be of great interest in future manometric studies.
The hydraulic impedance of the lower limb: Its relevance to the success of bypass operations for occlusion of the superficial femoral artery
Authors: Cave F D , Walker A , Naylor G P , Charlesworth D
Published: March 2007

Simultaneous measurements of pressure and 80w waves were made in the course of 25 femoropopliteal bypass operations. From these measurements the hydraulic impedance of the arterial system in the lower limb was calculated. The values obtained were correlated with the results of the operations. Although reconstruction reduced the impedance we were unable to predict accurately the probable result of the operation on the basis of these measurements. The results suggest that success is more closely related to a good collateral circulation than to ‘run-off’.
Carcinoma in a long-standing pharyngeal diverticulum
Authors: Nanson Eric M
Published: March 2007

A brief review of carcinomas arising in pharyngeal diverticula is given. An 80-year-old patient is described who has survived 3 years after operative removal of a diverticulum containing a carcinoma. The seriousness of the condition is shown by the mortality rate which has been reported as 65 per cent within 2 years.
Effect of plastic skin and wound drapes on the density of bacteria in operation wounds
Authors: Raahave D
Published: March 2007

Operation wounds were sampled quantitatively by the velvet pad rinse technique to determine the effect of impervious plastic skin and wound drapes on the density of bacteria.

A controlled trial (clean operations) revealed no significant difference between the bacterial density of herniotomy wounds for which the skin had been covered with adhesive plastic drapes, and the bacterial density of wounds in which skin drapes had not been used. The bacterial density in the wounds did not differ significantly from that on the adjacent skin; both densities were slightly higher at the end of operation than at the beginning. Within the operation wound, sites of low bacterial density were close to sites with a high density. Staphylococcus epidermidis predominated, while Staphylococcus aureus occurred only once; intestinal species were not isolated.

In another controlled trial (potentially contaminated operations) plastic wound drapes gave an equally high reduction in bacterial density before closure of laparotomy wounds after either truncal vagotomy and pyloroplasty or gastric and colorectal operations. The reduction in the density of intestinal species was close to 100 per cent and did not differ significantly from that of æ-haemolytic streptococci, the density of this species being significantly more reduced than that of staphylo-cocci, diphtheroids and bacilli.

It is concluded that plastic skin drapes were without influence on the species and density of bacteria in operation wounds. Plastic wound drapes, on the other hand, considerably reduced not only exogenous but in particular endogenous bacteria, which otherwise would have remained in the operation wounds.
Assessment of portasystemic shunt patency by estimation of d-xylose excretion
Authors: Smith R C , Macpherson A I S
Published: March 2007

The D-xylose excretion test appears to be a useful method of monitoring shunt patency after a portasystemic venous anastomosis for portal hypertension. A 5-hour urinary excretion greater than 6 g appears an acceptable indicator that the shunt is patent. A second criterion of patency is an increase of 4 g or more over the result of preoperative tests. If the excretion rate falls in the postoperative period or remains less than 4.2 g/5 h, the anastomosis may be assumed to be occluded.
A comparison of operative cholangiographic techniques
Authors: Evans G A , Jenkins D H R
Published: March 2007

The accuracy and postoperative morbidity of cannulation of the cystic duct in routine operative cholangiography were compared with those of needle puncture of the common bile duct. The results are comparable and a case is made for the simpler procedure of needle puncture of the common duct.
Bilharzial polyposis of the rectum and sigmoid colon
Authors: Tikriti Farouk , Al-Saleem Tahseen
Published: March 2007

The case is reported of n 10-year-old boy who had severe diarrhoea with blood and mucus for I year which was found to be due to bilharzial polyposis of the rectum and sigmoid colon. He was treated first with anti-bilharzial drugs. Later, because of multiple polyps and secondary infection, local surgical resection was performed.
Outpatient treatment of haemorrhoids by cryotherapy
Authors: Kaufman H D
Published: March 2007

The treatment of haemorrhoids by cryosurgery is fairly new. One hundred cases have been analysed and the results presented as a preliminary report. Although the maximum follow-up is only 18 months, so far the results have been encouraging, and should they be maintained this method of outpatient haemorrhoidectomy could dramatically alter the management of this condition.
Congenital absence of the vas deferens
Authors: Rubin G P , Taylor I
Published: March 2007

A case is presented of congenital absence of the left vas deferens, kidney and ureter, and the literature relating to this anomaly is reviewed.
Torsion of the testis and allied conditions
Authors: Williamson R C N
Published: March 2007

In 15 years at Bristol there have been 293 cases of torsion of the testis, 55 cases of torsion of a testicular appendage and 5 cases of testicular ischaemia due to other causes. The risk of a male developing torsion of the testis or its appendix by the age of 25 is about 1 in 160. Both conditions occurred primarily in adolescents, but among prepubertal boys torsion of an appendage was as common as torsion of a normally descended testis. There was a slight left-sided preponderance in testicular torsion, more marked in torsion of the appendages; the incidence of bilateral torsion was 2.0 and 1.8 per cent respectively.

The clinical features and differential diagnosis of the two conditions are compared. Torsion of a testicular appendage is the most commonly misdiagnosed scrotal lesion, the preoperative diagnosis being correct in only 11 per cent of cases compared with 90 per cent fix torsion of the testis. Twenty-one cases of recurrent torsion underwent prophylactic bilateral orchidopexy. There were 20 cases of torsion of undescended testes, with a salvage rate of only 20 per cent.

The overall testicular survival rate was 55.3 per cent. Viability depends upon the possibility of spontaneous reduction, the preoperative delay after the onset of symptoms, the degree of torsion of the cord and the length of follow-up in doubtful cases. Urgent scrotal exploration is advised in every case of acute testicular pain unless there is overwhelming evidence of epididymo-orchitis. Exploration of' the opposite side is mandatory in torsion of the testis and advisable in torsion of an appendage.
Factors determining the rate of disappearance of sperm from the ejaculate after vasectomy
Authors: Spencer Brenda , Charlesworth D
Published: March 2007

The relative importance of age and frequency of coitus in determining the time needed for the semen count to become negative after vasectomy was studied in a group of 831 men. Irrespective of the frequency of coitus, there was a highly signifcant positive correlation between a patient's age and the time taken to become aspermic. This has implications for general practice: the older patient should be warned that he will take longer than a younger man to become sterile.
Cryosurgical haemorrhoidectomy
Authors: Wilson Martin C , Schofield Philip
Published: March 2007

One hundred consecutive cases of haemorrhoids were treated by cryosurgery. The cryoprobe used is a convenient and simple instrument and gave a satisfactory result in 94 of the patients. The technique and complications are described. The patients were treated as outpatients, usually without anaesthesia.
Ascorbic acid levels in stored blood and in patients undergoing surgery after blood transfusion
Authors: McGinn F P , Hamilton Judith C
Published: March 2007

Blood was obtained from 11 healthy volunteers, mixed with two standard types of anticoagulant used in blood transfusion centres and stored for 21–28 days at 4°C. Leucocyte ascorbic acid (LAA) fell to deficient levels after 7 days in all cases. There were no corresponding changes in plasma ascorbic acid (PAA) levels. LAA and PAA were measured before, during and after surgery in 5 control patients who underwent definitive operations for benign peptic ulceration and in 4 patients undergoing surgery for bleeding peptic ulceration. The average amount of blood administered to the latter group was 10 units. There was a fall in LAA and PAA in both groups of patients after operation. This fall had returned to normal by 7 days in the controls, but the LAA remained at a deficient level at 7 days in the patients who had bled.

Deficient ascorbic acid in stored blood may contribute to low leircocyte ascorbic acid levels in patients after blood transfusion and may contribute to the increased complication rate when surgery is undertaken in these patients.
Bilateral nephrectomy prior to renal transplantation
Authors: Calman K C , Bell P R F , Briggs J D , Hamilton D N H , Macpherson S G , Paton A M
Published: March 2007

Bilateral nephrectomy was perjormed in 53 patients on regular haemodialysis. The indications were pyelonephritis in 30, polycystic kidneys in 6, glomeruloneph-ritis in 7, uncontvollable hypertension in 9 and horseshoe kidney in 1. In 87 per cent of cases the operation was carried out as a separate procedure prior to transplantation. The mortality was 9 per cent and the postoperative complications included hypotension, clotting of arterio-venous shunts, pneumonia and subphrenic abscess. As a result of our experience we have revised our indications for bilateral nephrectomy which now are pyelonephritis only when associated with persistent bacteriuria or ureteric reflux, polycystic kidneys and uncontrollable hypertension.
Postgastrectomy afferent loop obstruction due to efferent loop herniation simulating acute pancreatitis
Authors: McMaster Paul , Wijetunge D B
Published: March 2007

A case of afferent Ioop obstruction due to eferent loop retro-anastomatic herniation following a Polya gastrectomy is presented.

The clinical picture closely mimicked that of acute pancreatitis. The dificulty in diagnosis in this situation is discussed and the importance of operntive techniques in its prevention emphasized.
Multivariate analysis of clinical and operative findings associated with biliary sepsis
Authors: Keighley M R B , Flinn R , Alexander-Williams J
Published: March 2007

A cluster analysis of 17 preoperative and 10 operative variables has been undertaken from a prospective study of 181 patients undergoing operations on the biliary tract in order to identify those with organisms in the bile who would therefore benefit from prophylactic antibiotic cover.

The analysis defined populations of high risk (45 patients) and low risk (136 patients) in which the incidence of infected bile was 67 and 19 per cent respectively (P < 0·001). Eight variables were more common in the high risk than in the low risk group (P < 0·001). These ‘high risk factors’ were: jaundice at operation, recent rigors, emergency operation or one within 4 weeks of an emergency admission, age over 70 years, previous biliary operation, common duct obstruction and stones in the bile duct. In 67 patients where one or more ‘high risk factors’ was present, the bile contained organisms in 37 (53 per cent); when 4 ‘high risk factors’ occurred in the same patient (16 cases) biliary organisms were isolated in 14 (87 per cent). We conclude that the presence of one or more ‘high risk factors’ indicates a patient in whom prophylactic antibiotics would be advised during an operation on the biliary tract.
Carcinoma of the periampullary region: A review of a personal series of 87 patients
Authors: Balasegaram M
Published: March 2007

Eighty-seven patients with carcinoma of the periampullary region treated by the author are reviewed. The clinical presentation and investigations are reported, and it is emphasized that the poor prognosis of this disease is due to the delay in presentation and diagnosis. Consequently, in most cases treatment can only be palliative, and the various forms of treatment are discussed.
Anorectal function after major resections of the sacrum with bilateral or unilateral sacrifice of sacral nerves
Authors: Gunterberg B , Kewenter J , Petersén I , Stener B
Published: March 2007

The anorectal function in 3 patients with bilateral and 4 patients with unilateral well-defined loss of sacral nerves after radical tumour excision was studied by clinical examination and by simultaneous registration of the following variables: volume and pressure in the rectum, pressure in the internal anal sphincter area and myoelectrical activity in the external anal sphincter.

The patients with bilateral loss of sacral nerves had serious impairment of function. Constipation was their only safeguard against incontinence. The preservation of the first and second sacral nerves bilaterally was not sufficient for discrimination between different qualities of rectal contents passing the anal canal. The sensation of rectal distension was also impaired, The reflex pattern of the internal anal sphincter was, however, intact. The external anal sphincter displayed a weak spontaneous myoelectrical activity in the patients who had at least one second sacral nerve intact, and a weak increase of the activity could be induced voluntarily. The normal transient increase of myoelectrical discharge from the external anal sphincter in response to rectal distension could not, however, be elicited.

In patients with total unilateral loss of the sacral nerves no significant impairment of anorectal function was noted. Total one-sided denervation implied deficient sensibility of the anal canal unilaterally, but no disturbance of sphincter function as judged from the reflex response of the internal and external anal sphincters to rectal distension.
Altered viscosity and yield stress in patients with abdominal malignancy: Relationship to deep vein thrombosis
Authors: Humphreys W V , Walker Anne , Charlesworth D
Published: March 2007

Twenty-eight patients undergoing laparotomy were studied. Blood viscosity at both high and low rates of shear and a yield stress index were measured preoperatively and correlated with the incidence of postoperative deep vein thrombosis (DVT). There was a correlation between a raised index of yield stress and the incidence of D VT. Patients with cancer had a very high incidence of postoperative DVT and a high index of yield stress.
‘Hitch-hike’ grafts for limb salvage in peripheral arterial disease
Authors: Bliss B P , Fonseka N
Published: March 2007

A technique of arterial reconstruction suitable for patients with extensive arterial occlusions and for previous failed arterial surgery is described, The ‘hitchhike’ graft consists of a proximal limb of 6-mm velour Dacron prosthesis and a distal limb of autogenous vein. The intermediate prosthesis-to-vein anastomosis is made into an endarterectomized segment of upper popliteal artery.

The results in the first 16 limbs are described. Eleven grafts are functioning from 2 to 14 months after operation and 5 of these have functioned for more than I year, The advantages of the technique are: long arterial occlusions may be bridged; autogenous vein is used to cross the knee joint; good measured blood flows may be demonstrated at operation; acceptable patency rates may be obtained up to 1 year.
Simple mastectomy and pectoral node biopsy
Authors: Forrest A P M , Roberts M M , Cant E , Shivas A A
Published: March 2007

Evidence is presented to support the view that biopsy of the pectoral and axillary tail nodes obtained at simple (total) mastectomy gives a reliable estimate of axillary node status. The technique is described.
The relationship between thermographic findings and size and depth of tumour in carcinoma of the breast
Authors: Johnson J M S , James W B , Evans A L , Feasey C M
Published: March 2007

Fifty thermograms of histologically proved breast carcinomas have been analysed without knowledge of the clinical or mammographic findings. Thermographic asymmetry between the breasts was found in 76 per cent of the patients, but in only 64 per cent of the patients was the correct side indicated. Poor correlation has also been found between the thermographic findings and the size of a tumour and its distance from the skin.
Mortality of oesophagal surgery in the elderly
Authors: Mohansingh M P
Published: March 2007

The operative mortality in pulmonary surgery was found to be four times higher in patients aged above 70 compared with those below 65. A similar study has been carried out in patients undergoing oesophageal surgery. A corresponding increase in operative mortality with advancing age was not found in this group. Anastomotic leakage remains the most common cause of operative mortality, the incidence of which is no higher in the elderly, though they are more liable to general complications. The overall mortality figures are comparable. The surgical approach to carcinoma of the oesophagus must be radical, and advanced age should not be a reason for withholding surgery.
Is the lesser curvature an area especially susceptible to injury by duodenal contents?
Authors: Lawson H H
Published: March 2007

The lesser curvature does not appear to be an area of increased susceptibility to injury. The fact that this is the usual area for the development of chronic gastric ulceration could in part be explained by reflux of duodenal contents along the lesser curvature.
Extragastric gastrinoma or G-cell hyperplasia of the antrum? The preoperative diagnosis in a case of hypergastrinaemia
Authors: Gray G R , Gillespie G , Gordon I
Published: March 2007

A patient is described with recurrent peptic ulceration, evidence of hypersecretion of gastric acid and excess circulating gastrin. The preoperative differentiation between extragastric ‘gastrinoma’ and G-cell hyperplasin of the pyloric antrum as a source for the hypergastrinaemia can be made by immunofluorescent staining of an antral biopsy for ‘gastrin cells’, and by measuring the response of the gastric antrum to an amino acid meal or secretin infusion stimulus. The site of excessive gastrin production determines the nature of the surgery required. A classification of recurrent peptic ulceration types is suggested.
The effect of Metiamide on the prolonged serum gastrin response to feeding observed in patients with duodenal ulcer
Authors: Blair E L , Grund E R , Reed J D , Sanders D J , Thompson M H , Venables C W
Published: March 2007

The response of serum gastrin to a meal has been studied in 11 normal subjects and 16 patients with duodenal ulceration. The mean serum gastrin concentration rises after a meal to similar peak values in both normal subjects and duodenal ulcer patients, and falls to basal values within 3 hours in normal subjects. In duodenal ulcer patients the peak concentration is sustained throughout the 3-hour test period, and this response is not affected by the administration of Metiamide.

It is concluded that the control of gastrin release is defective in duodenal ulceration, and this may be due to a failure of the antral pH feedback mechanism.

Gastrin may be a primary pathogenetic factor in duodenal ulceration.
Cancer of the stomach: A review of 854 patients
Authors: Cassell Paul , Robinson James O
Published: March 2007

A review is presented of 854 patients suffering from cancer of the stomach who attended St Bartholomew's Hospital between 1948 and 1962. The presentations and methods of investigations showed little change over the 15-year period, which is similar to other large series. The symptoms of anaemia and indigestion appear to be paramount in making an early diagnosis, and negative barium meal studies should not be accepted when these two symptoms are present. There are indications that early laparotomy and a more aggressive surgical approach may increase the 5-year survival rate.
Drug therapy for postvagotomy gastric stasis
Authors: Sheiner H J , Catchpole B N
Published: March 2007

An unusual but well-recognized complication of truncal vagotomy with a drainage procedure is severe gastric stasis (atony). In 6 patients presenting with this problem drug therapy was initiated after mechanical obstruction of the gastric outlet was excluded by radiology. Bethanechol chloride was successful in stimulating gastric peristalsis in all the patients, with consequent improvement of symptoms in 5 out of the 6 subjects. Metoclopramide alone was of no value in starting peristalsis but of possible benefit once gastric motility had begun.
Ischaemic necrosis of the gallbladder following hepatic artery embolism
Authors: De Jode L R , Nicholls R J , Wright P L
Published: March 2007

A case of ischaemic necrosis of the gallbladder due to hepatic artery embolism diagnosed at operation and treated successfully by cholecystectomy and embolectomy is presented. The clinical and biochemical features are described, together with a short review of the literature.
Cholecystostomy
Authors: Havard Cyril , Parry David
Published: March 2007

The role of cholecystostomy in the surgical treatment of gallstones has been considered. In a consecutive series of 558 patients who underwent surgery for gallstones, 30 (5·4 per cent) had cholecystostomy alone and a further 17 (3.1 per cent) cholecystostomy combined with exploration of the bile ducts. Cholecystostomy was done because cholecystectomy was technically very hazardous in 15 patients. In the remaining patients cholecystostomy was preferred to cholecystectomy because of the poor general condition of the patient or the presence of pancreatitis. Of the 47 patients submitted to cholecystostomy, 2 (4·2 per cent) died post-operatively and 4 (8·4 per cent) subsequently underwent cholecystectomy. Of 24 patients who were available for long term follow-up, only 1 patient had pain which was definitely considered to be due to gallstones, although 3 other patients also had abdominal pain, while 7 patients showed radiological evidence of gallstones.

It is contended that cholecystostomy has a small but definite part to play in the immediate surgical treatment of gallstones and that the long term results of the operation are sufficiently good to justify its use in selected patients.
Intraperitoneal rupture of hydronephrotic kidney
Authors: Ekwueme O , Adibe S O
Published: March 2007

Two cases of intraperitonenl rupture of hydronephrotic kidney are presented. The possibility of making a pre-operative diagnosis and the type of management are discussed.
Follow-up study of left suprarenal to inferior mesenteric venous shunt for advanced breast cancer
Authors: Inokuchi Klyoshi , Nomura Yasuo , Ikejlri Taiji , Kaibara Nobuaki
Published: March 2007

Major endocrine ablation therapy was carried out in 133 patients with advanced breast cancer. of 40 patients undergoing left suprarenal to inferior mesenteric venous shunt with bilateral oophorectomy and right adrenalectomy, 16 cases (40 per cent) had an objective response. The mean postoperative survival of the patients with a positive response, those showing some response and those who failed to respond was 35·8, 26·5 and 8·8 months respectively. Thus, the results of the present procedure are comparable to those of adrenalectomy. No replacement therapy with corticoids was necessary. An increase in the response rate and extension of the survival time can be expected with the addition of postoperative long term maintenance therapy with chemotherapeutic agents and androgens.
The haematological hazards of autotransfusion
Authors: Stillman Richard M , Wrezlewicz Walenty W , Stanczewski Boguslaw , Chapa Liberato , Fox Michael J , Sawyer Philip N
Published: March 2007

Fourteen heparinized dogs were autotransfused from 1·5 to 6 times their calculated blood volume. Five animals retransfused 12 litres from an intraperitoneal bleed had marked decreases in all cellular elements, haematuria and a large (82 per cent) drop in fibrinogen. All these animals died within 12 hours and post-mortem examination revealed evidence of disseminated intravascular coagulopathy. The dogs in which a smaller volume (3–6 litres) was recycled showed similar, but less devastating, changes. Haematocrit and platelet count dropped by a half and fibrinogen by 20 per cent. A leucocytosis of about 30 000/mm3 occurred within 24 hours. Autotransfusion of salvaged blood which was not allowed extravascular tissue contact significantly lessened these adverse effects.

We conclude that the risk of cellular destruction and defibrination in large volume intra-operative autotransfusion is significant and must be weighed against its potential benefits in each case, and that red cell and platelet damage results primarily from extravascular tissue contact and is therefore unavoidable.
The effect of an infusion of low molecular weight dextran on peripheral resistance in patients with arteriosclerosis
Authors: Humphreys W V , Walker A , Cave F D , Charlesworth D
Published: March 2007

Low molecular weight dextran is frequently given to improve the flow of blood to the periphery, but its mode of action is uncertain. We measured the effect of an infusion of 500 ml of Dextran 40 on the peripheral resistance in 12 patients undergoing reconstructive surgery for atherosclerotic occlusion of the superficial femoral artery.

After the infusion, values of packed cell volume and blood viscosity indicated haemodilution. There was a consistent increase in mean flow and a fall in peripheral resistance, There was no correlation between change in viscosity and change in peripheral resistance, but there was a good correlation between the percentage change in resistance and the initial resistance. This suggests that the increase in flow of blood was due to reflex vasodilatation rather than to any reduction in viscosity.
Plasma fibrinolysis and postoperative deep vein thrombosis
Authors: Macintyre I M C , Webber R G , Crispin J R , Jones D R B , Wood J K , Allan N C , Prescott R J , Ruckley C V
Published: March 2007

In 23 high risk patients the change in plasminogen activator activity in response to surgical operation was studied by euglobulin lysis time (ELT) and fibrin plate lysis before, during and for up to 6 days following a major surgical procedure. Fibrin degradation products (FDP) were also measured. The aim was to relate any changes to postoperative deep vein thrombosis (DVT) as diagnosed by the 125I fibrinogen test. Peroperative increase and postoperative inhibition of fibrinolytic activity were seen in all the patients, Changes in fibrinolytic activity as measured by the ELT and during the first 24 hours by the fibrin plate technique were similar. This suggests that during this period the response was independent of plasma fibrinogen changes. There was no significant difference in these parameters between patients who developed DVT and those who did not. The relationship between venous thrombo-embolism and elevation of serum FDP was confirmed.
An acute abdomen: Spontaneous rupture of liver during pregnancy
Authors: Baumwol Max , Park W
Published: March 2007

Spontaneous rupture of liver during pregnancy is presented as an example of an acute abdomen admitted to a casualty department of a general hospital. The literature is reviewed and emphasis is placed on clinical awareness and earlier diagnosis as a means to reduce the high mortality.
The microflora of the obstructed bowel
Authors: Sykes Peter A , Boulter Kenneth H , Schofield Philip F
Published: March 2007

A study of the alterations of intestinal microflora that occur in acute small and large bowel obstruction is presented. The results are discussed in relation to the duration of obstruction, the site of obstruction, the recovery following relief of obstruction and the septic complications which profoundly aflect the prognosis of these common surgical emergencies.
Major disasters: Hospital admission procedures
Authors: Irving Miles
Published: March 2007

Triage in the accident and emergency department and the admission of all patients needing further care to one ward can form the basis of the successful hospital management of the victims of a major disaster.
Blast injuries of the lungs
Authors: Coppel Dennis L
Published: March 2007

Up until 1968 Northern Ireland was a relatively peaceful community. The outbreak of civil disturbance has resulted in many patients being admitted to hospital with severe injuries from bullets and bomb explosions. Initial resuscitation must not be unduly delayed to be effective and should be carried out by experienced personnel. Respiratory failure from bomb explosions is rare and invariably fatal. The mechanism is discussed and is thought to be due to direct compression.
A new approach to the treatment of renal failure
Authors: Rosin R D
Published: March 2007

There is an apparent need for an alternative form of treatment for renal failure. This study, therefore, sought to determine the feasibility of dialysing across an isolated loop of colon and its possible application to augment failing renal function in chronic uraemic patients.

Haemodialysis and renal transplantation are undisputedly effective in treating renal failure but have many drawbacks. They are unavailable in the underdeveloped world, extremely expensive to institute and maintain, and their need and expense are compounded every year by the discovery of new cases.

Colonic loops were isolated in sheep and studies performed to find an effective solution in terms of urea clearance. The best solution was then used in animals in which acute or chronic uraemia was induced and, compared with controls, prolonged life significantly (P < 0·05). Once it had been established that urea could be removed across the colonic mucosa, it was used in patients with established isolated loops of colon. Even though they had normal blood levels, urea was recovered in the dialysate.

Results indicate that colonic dialysis, which is simple and inexpensive, may have a place as an adjunctive therapy in the treatment of chronic renal failure.
Complications of supraduodenal choledochotomy: A comparison of three methods of management
Authors: Keighley M R B , Burdon D W , Baddeley R M , Dorricott N J , Oates G D , Watts G T , Alexander-Williams J
Published: March 2007

The complications of elective choledochotomy in a prospective study of 116 patients with suspected intraduct calculi are reported. Management included T tube drainage (n = 59), primary closure of the bile duct (n = 29) and choledochoduodenostomy (n = 28).

Septicaemia occurred in 12 patients (10 per cent), with 1 death, and was unrelated to the type of operation. Thirty patients (26 per cent) developed wound infection; this complication was more common after T tube drainage than the other procedures. Intra-abdominal abscess occurred in 3 patients only. Thrombo-embolism was recorded in 10 patients (9 per cent), 7 of whom had an intraduct drain. Postoperative pancreatitis occurred in 5 patients (4 per cent), with 2 deaths; a third of the patients in whom sphincteroplasty had been combined with supraduodenal choledochotomy developed this complication. Reoperation for stones was required in 3 patients with T tube; 3 patients developed a temporary biliary fistula after choledochoduodenostomy. The hospital stay was 9·5 days after primary closure, 14·0 days after choledochoduodenostomy and 16·8 days after T tube drainage.

Wound sepsis (32 per cent) and thrombo-embolism (12 per cent) were more common in patients with bacterbilia than in patients where the bile was sterile at operation (13 and 3 per cent respectively). Furthermore, wound sepsis, septicaemia and thrombo-embolism were reduced in patients who were given effective antibiotic cover.
A clinical index for selection of breast cancer patients for adrenalectomy
Authors: Leaper D J
Published: March 2007

Selection of patients with disseminated breast cancer for endocrine surgery has not been facilitated by sophisticated biochemical techniques. The present study was designed to produce a method of prognosis based exclusively on clinical data.

Eighteen features were studied in 95 patients who underwent adrenalectomy and oophorectomy, and correlated with their degree of response to produce predictive variables.

In a further group of 90 patients a prognostic score (the sum of the predictive variables) was calculated. There were 17 patients who scored less than 0 and in no case was a good response to endocrine surgery achieved. There were 40 who scored over 10, 29 of whom had a good response. The remaining 33 scored between 0 and 10 and there was no correlation between score and response.

This predictive system offers significant advantages over accepted methods of clinical assessment (χ2 = 6·61, P < 0·02). When patients with a score between 0 and 10 are excluded, its advantages are even more obvious (χ2 = 11·26, P < 0·001).

Patients who are likely to respond to endocrine surgery can be selected by clinical parameters alone, and total failure to respond can be forecast with complete accuracy. Between these two there is a third group whose response is unpredictable.
The plain X-ray in the acute abdomen: A surgeon's evaluation
Authors: Lee P W R
Published: March 2007

The plain abdominal X-rays of 277 patients suffering from five acute abdominal conditions were reviewed and specific radiological features found to occur in not less than 48 per cent of the cases. In a second series of 249 patients admitted to hospital with an acute abdomen due to all types of disease, the plain abdominal X-rays were helpful in 42 per cent of cases. A questionnaire of 50 plain abdominal X-rays was answered by surgeons and radiologists of varying clinical experience, the scores of the senior radiologists being higher. It is suggested that plain abdominal X-rays should become a routine investigation in the acute abdomen, and should be reported by senior radiologists at the time of the investigation.
Endotoxin, bile salts and renal function in obstructive jaundice
Authors: Bailey M E
Published: March 2007

It is generally agreed that there is an increased incidence of postoperative renal failure in patients with obstructive jaundice. The proposition that this may be due to endotoxin, and that the endotoxin may be absorbed from the patient's own bowel flora, has been investigated. The study was conducted in patients and in animals.

Twenty-four patients with obstructive jaundice were studied. Sixteen had endotoxin in the portal blood at operation and 13 of these had peripheral endotoxaemia at the time of operation or developed it during the 72 hours following operation. Only 3 of the patients had a proved possible site of infective origin for the endotoxaemia, the remainder absorbing the endotoxin from their own gastro-intestinal organisms.

Portal endotoxaemia occurred when the serum bilirubin was 8·5 mg/100 ml or greater.

There was a highly significant decrease in mean endogenous creatinine clearance postoperatively in patients with endotoxaemia, and expression of this as a percentage postoperative fall compared with preoperative levels enhanced the significance. Jaundiced patients without endotoxaemia had no significant fall in endogenous creatinine clearance.

Matched non-jaundiced control patients did not develop portal or peripheral endotoxaemia, and there was no significant fall in postoperative creatinine clearance.

Experiments using animals showed that the absence of bile salts in the intestinal tract in obstructive jaundice allows endotoxin to be absorbed, and that this absorption can be preuented by the oral administration of bile salts.

The therapeutic implications in patients are discussed.
The relationship of the serum gastrin and calcium concentrations in patients with multiple endocrine neoplasia type I
Authors: Thompson M H , Sanders D J , Grund E R
Published: March 2007

The relationship between the serum gastrin and calcium concentrations has been examined in patients with multiple endocrine neoplasia type I. Variations in gastrin concentrations were induced by metiamide and secret in: calcium concentrations were altered by parathyroidectomy and by culcium infusion. Changes in the serum gastrin concentration were not accompanied by changes in the serum calcium concentration. However, alteration of the serum calcium was accompanied by significant parallel changes in the serum gastrin. It is concluded that acute changes in the serum calcium may induce changes in the serum gastrin. Parathyroidectomy in these patients produced a fall in the seruni gastrin, but the ability to produce large quantities of gastrin remains. It is postulated that the thyro-parathyroid hormones may modulate the relationship between calcium and gastrin.
Acalculous gallbladder disease: A prospective study
Authors: Keddie Nigel C , Gough A L , Galland R B
Published: March 2007

A prospective study of 62 cases of acalculous gallbladder disease is reported. The clinical, radiological and pathological features are described as well as the results of cholecystectomy with a minimum follow-up of 3 years. The results compare favourably with those for calculous disease, and it is concluded that there is no clear-cut distinction between acalculous and calculous biliary disease.
Is colostomy closure a hazardous procedure? A comparison of elemental diet and routine bowel preparation
Authors: Tomlinson R J R , Newman B M , Schofield P F
Published: March 2007

Morbidity after closure of a colostomy is low if a simple antiseptic technique of intraperitoneal closure is used. In 26 patients there was no example of major wound sepsis and only 2 faecal fistulas both of which rapidly closed spontaneously. A randomized study of pre-operative bowel preparation incorporating an elemental diet showed no apparent advantage for this method using our criteria for assessment.
Results of jejuno-ileostomy for gross refractory obesity
Authors: Baddeley R Michael
Published: March 2007

The results of jejuno-ileostomy in 182 patients have been studied. The operative mortality was 1·1 per cent and the overall mortality 6·6 per cent, of which 3·3 per cent was attributable to the effects of the small bowel bypass. Weight reduction usually ceased at about 18–24 months postoperatively, by which time the average fall was 36·3 per cent of the mean original body weight. Males and younger patients achieved better than average results. The main side-effects were fatty infiltration of the liver, polyarthralgia, excessive diarrhoea and electrolyte upsets.
Experimental studies on the aetiology of acute scorpion pancreatitis
Authors: Bartholomew C , McGeeney K F , Murphy J J , Fitzgerald O , Sankaran H
Published: March 2007

This study examined the action of the venom of the scorpion Tityus trinitatis on the pancreas and gastrointestinal tract in anaesthetized dogs, on the isolated extracorporeal haemoperfised canine pancreas and on the isolated canine sphincter of Oddi. The venom induces exocrine secretion in both the isolated and intact pancreas and causes contraction of the isolated sphincter of Oddi. These results are discussed in relation to the pathogenesis of acute scorpion pancreatitis and possibly of some other form of acute pancreatitis.
Scanning electron microscopy of normal human scar tissue and keloids
Authors: Hunter J A A , Finlay J B
Published: March 2007

The fibrous architecture of 5 normal human scars between 1 week and 1 year old and 4 keloid scars has been studied by scanning electron microscopy. In normal wounds, significant changes in fibril and fibre orientations and mode of aggregation take place as the scars mature, indicating that remodelling carries on for many months. There are also major differences between the edge and centre of the wound. These changes can be related to the stresses placed on the fibroblasts which have responded by laying down collagen aligned in such a way as to resist these forces. It is suggested that keloid fibroblasts may lack this ability to respond appropriately to orientational stress.
Vascular reconstruction in Buerger's disease
Authors: Shionoya Shigehiko , Ban Ichiro , Nakata Yukifumi , Matsubara Chi , Hirai Umi , Miyazaki Shi , Kawai Chi
Published: March 2007

In 23 of 148 patients with Buerger's disease, it was possible to undertake 27 arterial reconstructive procedures: bypass in 22 and thrombo-endarterectomy in 5. In a follow-up of 10 months to 8 years, the overall patency rate was 26 per cent. The long term patency rate of bypass grafting was good in obstruction of main vessels, but unsatisfactory with multiple occlusions. Bypass grafting was preferred to thrombo-endarterectomy.

To obtain long term patency of revascularized segments, complete abstinence from tobacco is absolutely essential.

The preparatory manæuvres for autogenous venous graft should be as atraumatic as possible.

A functional diagnosis is indispensable when considering operative indications and for follow-up study of patients with peripheral arterial occlusive disease.
Structural deterioration in Celestin tubes
Authors: Mackenzie I , Whyte A S , Tankel H I
Published: March 2007

Two cases are described where, afrer 2 years, a nylon-latex Celestin tube which was left in situ to bypass a benign stricture underwent structural deterioration and produced complications requiring tube replacement. It is recommended that an alternative endo-oesophageal tube should be considered where a lifespan of this order is contemplated.