bluuebunny/crossref_metadata_2025 huggingface dataset:
A case of retroperitoneal haemangioma
Authors: Powis S J A , Rushton D I
Published: March 2007

A case is reported of a retroperitoneal haemangioma occurring in a 26-year-old multiparous patient. The literature is reviewed and the pathology considered.
Glomus tumour. A review of 15 clinical cases
Authors: Strahan J , Bailie H W C
Published: March 2007

Fifteen cases of glomus tumour are recorded. Twelve patients presented with a solitary limb lesion. One patient had a glomus arising in a pilonidal sinus. Two members of one family had multiple lesions.

Complete surgical removal is curative, and malignancy is not a hazard. It is important to make a preoperative diagnosis, so that at operation a capsule can be looked for carefully. If no capsule is found an en bloc excision is imperative.

It is suggested that pain may sometimes be initiated by trauma, by thrombosis, or by the vascular congestion associated with menstruation and pregnancy.
A technique for detecting rejection episodes in human transplant recipients using radioactive fibrinogen
Authors: Salaman John R
Published: March 2007

Radioactive 125I-labelled human fibrinogen was given to 32 patients who had received renal transplants. In each case radioactivity was measured over the transplant and expressed as a percentage of the value recorded over the heart. Recipients that were experiencing rejection episodes had higher levels of radioactivity over their transplants when compared with patients who were free of rejection at the time. It is suggested that this technique could be of value in the diagnosis of rejection episodes, particularly in those recipients who remain oliguric after transplantation.
Abdominal wound infections and plastic wound guards
Authors: Williams J Alexander , Oates G D , Brown P P , Burden D W , McCall Jane , Hutchison A G , Lees Lorna J
Published: March 2007

A study is reported of the influence of plastic wound protectors on the incidence of wound infection in patients having abdominal operations involving the opening of the alimentary tract or biliary system.

Of 167 patients, 84 were randomly allocated to a group in which Vi-Drape wound protectors were used during the operation. In the whole series there was a low incidence of wound infection (12 per cent), but no difference was found between those who had plastic wound protectors and those who did not.
Ligation of the left renal vein in splenorenal anastomosis without impairment of renal function
Authors: Simon John S , Brown Ashley A , Ross Harvey B
Published: March 2007

This paper draws attention to the fact that the left renal vein or one of its major tributaries may be ligated without apparent impairment of function of the left kidney. This information has been of great value in constructing splenorenal shunts in operations for portal decompression. Other situations in which this information might be of value are suggested.
Rectal and colonic ulceration in Behçet's disease
Authors: Empey D W
Published: March 2007

Two patients with Behçet's disease and involvement of the gastro-intestinal tract are described. One patient presented with rectal bleeding and perianal pain, and later developed peritonitis due to perforation of the sigmoid colon. The second patient developed rectal bleeding 4 years after the diagnosis of Behçt's disease, and examination showed this to be due to an ulcer in the anal canal. Behçet's disease should be considered as a possibility, albeit rare, in the differential diagnosis of rectal and colonic ulceration.
The value of frusemide in 110 consecutive prostatectomies
Authors: Williams C R
Published: March 2007

One hundred and ten patients undergoing open prostatectomy had an induced diuresis using frusemide. The results of this treatment are reviewed. Seventy-one patients (65 per cent) presented as emergencies with acute retention, while the remainder presented with chronic retention or prostatism. The average age was 69 years, and 25 patients (23 per cent) were aged 75 years or more. Only rarely was a patient refused operation because of confinement to bed or failing mental faculties. Blood-loss, fluid and elctrolyte balance, and postoperative urinary infection were studied in detail, and the following points are emphasized:— The average postoperative 24-hour urinary out-put was 4·5 litres, 40 per cent of which was passed in the first 3 hours when the danger of clot retention is greatest.Clot retention was eliminated as a problem, and bladder wash-outs were not necessary.The average blood replacement was 1·05 U., and the average fall in postoperative haemoglobin level was 1·1 g.The postoperative urinary infection rate was low, being 8 per cent at 1 week after operation.A low morbidity was recorded and the mortality was 0·9 per cent.

A vigorous diuresis induced by frusemide after suitable fluid loading is both effective and safe. It is a distinct advance over previous methods used.
The effect of intermittently applied external pressure on the haemodynamics of the lower limb in man
Authors: Roberts V C , Sabri S , Beeley A H , Cotton L T
Published: March 2007

The effects of intermittently applied external pressure on blood-volume flow-rate in the femoral vein have been investigated in a series of 6 patients undergoing surgery for bilateral varicose veins. During the investigation, pressure was applied to the legs with the aid of an inflatable plastic splint, while blood-flow in the femoral veins was measured with an electromagnetic blood flow-meter.

The investigation has shown that intermittently applied pressure increases the pulsatility of the venous flow-wave while leaving its mean level largely unaltered. It has been shown that the increase in peak flow is directly proportional to the rate of pressure application, being maximal at about 10 mm. Hg per second. It has further been shown that the increase in both the pulsatility and the peak flow reaches a maximum when the interval between successive pressure applications is 1 minute.
The treatment of achalasia by cardiomyotomy
Authors: Wingfield H V , Karwowski A
Published: March 2007

The results of treatment in 27 cases of achalasia carried out in the Tehidy Thoracic Surgical Unit are reviewed. The value of air insufflation of the oesophagus to assist in the division of the muscle and to ensure that the mucosa is not damaged is stressed. The advantages of early operation using a modified Heller's procedure are shown, and the results demonstrate that a poor outcome is most common in cases with a long history and that usually these cases have been treated by conservative measures.
Tuberculosis of the gall-bladder
Authors: Bergdahl Leif , Boquist Lennart
Published: March 2007

Three female patients with tuberculous cholecystitis are reported. They had symptoms of cholecystopathy of varying duration. No jaundice was recorded. Cholecystograms disclosed non-functioning gallbladders in 2 cases and a functioning gall-bladder with two stones in the other case. At cholecystectomy, cholelithiasis was found in all the patients, and in addition 1 of them showed tuberculous peritonitis. Microscopic examination showed tuberculous changes in the gall-bladders. Postoperative tuberculostatic treatment was given. The presence of stones is believed to have been of importance for the development of the tuberculous infection in the present cases.
Spontaneous Aortoduodenal Fistula
Authors: Evans D M , Webster J H H
Published: March 2007

Two further cases, 1 fatal and 1 with long-term recovery, of patients treated surgically for spontaneous aortoduodenal fistula are reported, bringing the total number of published operations to 20. Thirty-six further examples of the lesion which were not treated by operation have been reported since 1957.

Of a wide variety of causes for this lesion, the commonést is arteriosclerotic aneurysm of the aorta.

The association of recurrent gastroduodenal haemorrhage with severe pain and collapse may indicate this lesion, and the treatment should be surgical.

Control of the aorta proximal to the fistula is the essential first step in prosthetic grafting of the aorta and closure of the duodenum. Otherwise, spontaneous aortoduodenal fistula is uniformly fatal.
Deep-Vein Thrombosis in Patients With Fractures of the Femoral Neck
Authors: Field E S , Nicolaides A N , Kakkar V V , Crellin R Q
Published: March 2007

Fifty patients with fractures of the femoral neck have been studied, using the 125I-labelled fibrinogen test for diagnosing deep-vein thrombosis (D.V.T.). There was an overall incidence of D.V.T. of 54 per cent in fractured limbs. In pertrochanteric fractures there was an incidence of 75 per cent and in subcapital fractures the incidence was 34 per cent.

The radioactive fibrinogen test is a most useful method of screening for D.V.T. under the conditions presented by these patients.
Orbbital Hydatid Disease in Iraq
Authors: Talib H
Published: March 2007

Twenty-one patients with orbital hydatid disease are presented, constituting 19·8 per cent of the cases with unilateral exophthalmos seen from 1959 to 1971. The presenting features, investigations, and type of treatment are discussed.
Leiomyosarcoma of the Spermatic Cord a Case Report
Authors: Jenkins D G , Subbuswamy S G
Published: March 2007

A case of leiomyosarcoma of the spermatic cord is presented, the twenty-sixth case in the world literature. The tumour metastasized to the skin and to the lungs, and had to be differentiated from a neurofibromatous lesion. There was histological evidence to suggest that the lesion had originated as a benign leiomyoma and then had undergone malignant change. The primary tumour was excised. The secondary deposits were radioresistant but showed some response to chemotherapy. It is suggested that the most suitable form of treatment is wide excision of the primary tumour with close follow-up and chemotherapy when recurrence or metastasis occurs.
A Method of Repair of Myelomeningoceles
Authors: Bannister Carys M
Published: March 2007

We believe that it is possible in the majority of myelomeningoceles to achieve a satisfactory repair of the lesion. To achieve dural closure the mobilization must be extensive and this can only be done if the anatomy of the myelomeningocele is thoroughly understood. Large skin defects can be closed with primary wound healing provided that the skin is mobilized extensively. To do this it is essential that the subcutaneous layer be retained intact to maintain the blood-supply to the skin. Only exceptionally large lesions require relieving incisions, skin-grafts, or swinging of skin-flaps.
An Assessment of the Value of Measuring Uncollected Gastric Secretion During Routine Secretion Studies in Man
Authors: Venables C W
Published: March 2007

A simple “wash-out” collection technique employing phenol red as a marker has been used during routine gastric secretion studies and its value has been assessed. Studies repeated on a single individual showed good reproducibility. When measured this way loss was not affected greatly by the volume secreted.

With this technique the repeatability of pentagastrin tests has been assessed at intervals of 6 weeks. This demonstrated that both acid and pepsin outputs could vary considerably, with a mean variation in acid of over 26 per cent.

The effects of histamine, pentagastrin, and insulin upon loss have been studied.

Loss has been found to vary considerably from one study to another and from one patient to another and may on occasions be considerable, particularly after previous surgery.

These findings suggest that a method of measuring loss should be adopted by any centre which wishes to use secretion studies to analyse the effects of treatment.
Hydatid Disease of the Spleen Report of an Unusual Case
Authors: Torbati M
Published: March 2007

A case of an unusually large hydatid cyst of the spleen measuring 53 cm. in diameter and containing 21 litres of fluid and scolices is reported in a 40-years-old farmer. He had a brief history of nausea, intermittent vomiting, and shortness of breath.

Surgical removal of the spleen with the cyst was followed by complete recovery.
Subcutaneous Rupture of the Breast: A Seat-Belt Injury
Authors: Eastwood D S
Published: March 2007

Subcutaneous rupture of the breast caused by a car seat belt is reported. The patient was 7 months pregnant, and there was difficulty in suppressing lactation; the management of this problem is discussed.
Visceral Neurofibromatosis an Unusual Cause of Obstrutive Jaundice
Authors: Curry Bernadette , Gray Norman
Published: March 2007

A case of visceral neurofibromatosis presenting as obstructive jaundice is described. Laparotomy revealed an ampullary tumour which was presumed to be malignant. A palliative cholecystojejunostomy was performed but death occurred 10 days postoperatively as a result of obstructive jaundice. At necropsy the ampullary tumour was found to be a benign neurofibroma.
Malignant tumours of the bile-ducts
Authors: Warren Kenneth W , Mountain John C , Lloyd-Jones William
Published: March 2007

The 77 cases of malignant neoplasm of the extrahepatic bile-ducts treated at the Lahey Clinic between 1965 and 1969 are reviewed. Exploratory laparotomy was performed in 68 cases, although in 9 cases operation was not indicated because of the patients' poor condition. Of the 68 surgical patients, 24 (35 per cent) had a radical procedure, of which 17 survived for more than 1 year and 5 are still alive more than 3 years later, 3 having no evidence of recurrent disease. Forty-one patients had palliative treatment usually with some form of decompression procedure of the obstructed common bile-duct, and in 15 patients this was combined with hepatic artery infusion chemotherapy. Of these patients, 16 survived for more than 1 year, including 9 from the group treated by hepatic artery infusion chemotherapy. Only 1 patient is still alive after more than 3 years.

Of all the patients, 44 per cent survived for more than 1 year, 23 per cent for more than 2 years, and 8 per cent for more than 3 years. The mean survival time was 13 months. These results compare favourably with those of the previous survey from the Lahey Clinic, and it is concluded that the improvement is the result of the increase in the radical resection rate from 18 to 31 per cent and in the institution of hepatic artery infusion chemotherapy in palliative cases.
Repair of the laryngopharynx and cervical oesophagus after irradiation
Authors: Shaw H J
Published: March 2007

The present situation regarding the nature and treatment of cancer in this area is given. Types of defect and methods of repair, their complications, and the choice of methods are described. Emphasis is laid on the increased hazards of surgery for the patient after full dosage of irradiation. Treatment should be based on surgical resection, usually preceded by a modified plan of irradiation often completed after surgery.

In conclusion the most valuable recent advances in the techniques of surgical repair of the laryngopharynx and cervical oesophagus afer irradiation and resection for cancer are the use of large regional skin-flaps from outside irradiated areas, and total pharyngooesophageal replacement by means of vascular pedicled gut segments.
The effect of experimental bile-duct obstruction on critical biosynthetic functions of the liver
Authors: Lee Emanoel , Ross B D , Haines J R
Published: March 2007

Using biosynthetic activities which have a maximum energy requirement, the effect of obstruction of the bile-duct has been studied in isolated perfused rat livers, and compared with controls undergoing “sham” ligation and with normal animals. The maximum rate of gluconeogenesis from lactate was inhibited by 67 per cent after bile-duct ligation when compared with the normal value. The maximum rate of urea synthesis which occurred in the presence of ornithine was the same in the jaundiced and in the normal animals. ‘Sham’ operation, without ligation of the bile-duct, inhibited gluconeogenesis by less than 20 per cent but doubled the maximum rate of urea synthesis.

It is concluded that complete biliary obstruction seriously impairs gluconeogenesis and prevents the normal increase of urea synthesis which occurs in response to trauma and that these changes develop earlier than might be expected after the onset of obstruction.

Some possible mechanisms of these effects are discussed. If similar abnormalities of hepatocyte function are demonstrated in man it is suggested that surgical relief of obstructive jaundice is indicated at an early stage.
A case of gall-stone ileus in the absence of a biliary-enteric fistula
Authors: Newman J H
Published: March 2007

A case of gall-stone ileus is reported in which at operation no fistula between the biliary tree and the gut was found. The obstruction was removed and cholecystectomy and exploration of the common bile-duct were performed with a successful outcome. The pathogenesis of intestinal obstruction due to gall-stones in the absence of a fistula is briefly discussed.
Vesico-intestinal fistulae
Authors: Slade Norman , Gaches Christopher
Published: March 2007

Vesico-intestinal fistulae carry a serious prognosis by the nature of the underlying pathology. The inflammatory lesions offer the best hope for surgery and the necessity for early radical surgery in this group is stressed. The clinical details of 74 cases of vesico-intestinal fistulae are given together with their investigations, treatment, and results. The improved results over the past 10 years appear to bear out the necessity for early treatment.
Treatment of peritonitis with per- and postoperative irrigation of the peritoneal cavity with noxythiolin solution
Authors: Pickard R G
Published: March 2007

The present paper describes a technique for irrigating the peritoneal cavity in severe peritonitis, both at the time of laparotomy and in the immediate postoperative period, with a solution of noxythiolin. A consecutive series of 9 cases with fulminating peritonitis of various causes treated by this method is presented together with the operative findings, a discussion of the postoperative progress, and the bacteriological studies of the irrigating device. A full review of the literature of peritoneal lavage in the management of peritonitis is included in the discussion.
Central rupture of the liver with massive liver-cell necrosis. A case report and review of the literature
Authors: Soni S R , Persaud V
Published: March 2007

A case of massive central rupture of the liver in which the patient became jaundiced is described. Autopsy revealed, in addition to the intrahepatic haematoma, large areas of infarction in the liver, some of which had become infected and had given rise to septic embolization to various organs. There was deranged liver function which is ascribed to the structural changes found in the liver. The occurrence of hepatocellular jaundice with this type of liver injury has not, to our knowledge, been previously recorded. It is suggested that immediate investigation and treatment are essential if the patient is to survive.
Venous stasis and deep-vein thrombosis
Authors: Nicolaides A N , Kakkar V V , Field E S , Fish P
Published: March 2007

A venographic technique for studying stasis in the deep veins of the legs of conscious patients is described. A second technique involving the clearance of radioactive material from the veins has been developed for use during operation. The results of the two methods correlate closely.

There is considerable stasis of the blood, particularly in the soleal veins, in conscious patients with the legs horizontal, and it is prolonged considerably during surgery. Using these new techniques the effectiveness of various methods said to prevent stasis has been assessed.
Chronic schistosomal appendicitis
Authors: Voigt J C , Gregory M M
Published: March 2007

A case of schistosomiasis of the vermiform appendix in an immigrant patient is presented.
A model which can be used to improve the treatment of acute hepatic failure
Authors: Winch John
Published: March 2007

A model using the pig from wich the liver has been removed for isolated perfusion, as a subject showing some of the features of acute hepatic failure for later treatment by cross-circulation with its own perfused liver, is desceribed. Effects of such a procedure on such a procedure on the glucose and halothane metabolism and intravascular coagulation and bleeding are detailed.
A technique for creating a skin-lined hemithorax
Authors: Wosornu Lade
Published: March 2007

Prosthetic lungs could permanently occupy the pleural space which must first be lined with silicone ‘skin’, i.e., Dacron-backed silicone membrane (Peirce, 1966). Initial experiments in dogs showed that the pleural membrane would not readily accept silicone ‘skin’; rather, the solution lay in the use of autogenous skin-grafts. A readily reproducible technique has been eveloped for transforming the left hemithorax of SPF rats into stable skin-lined cavities which can be opened to atmospheric pressure without embarrassing breathing in the contralateral lung.

Authogenous skin was formed into 35 × 20-mm. sacs and grafted into the left pleural spaces of 150 male SPF rats of mean weight 240±30 g. One hundred and thirty-two (88 per cent) survived 4 weeks or more. In these the skin-lined cavity grew to occupy the hemithorax, displacing the left lung. In 75 rats the cavity was opened to the exterior and sutured to the skin, thereby creating a permanent 5–8-mm. opening directly through the chest wall. Fifty-nine of the 75 rats so exposed survied.

The mean pressure in the cavity was +2.9±0.6 cm. H2O before it was opened to the exterior; after the creation of the stoma the mean pressure in the cavity became −2.5±0.6 cm. H2O (P < 0.001), and the new pressure was in phase with and was similar in magnitude to the oesophageal pressure. The skin-lined hemithorax is presented as the model of a cavity which could be employed to house prosthetic organs designed for permanent implantation insie the chest cavity.
Twenty-four-hour preservation of canine kidneys exposed to 45 and 60 minutes of warm ischaemia
Authors: Snell M E , Hopkinson W I , Porter K A
Published: March 2007

This investigation was designed to test the ability of a new hyperbaric organ preservation system to preserve canine kidneys for 24 hours after they had been subjected to significant periods of warm ischaemia. In group I (45 minutes of warm ischaemia) all the kidneys functioned well, and the mean maximum serum creatinine was 4.4 ± 1.7 mg. per 100 ml. In group II (60 minutes of warm ischaemia) I dog died on account of acute tubular necrosis. The mean maximum serum creatinine was 5.4 ± 4.02 mg. per 100 ml. The results indicate that hyperbaric oxygen warrants serious consideration as an adjunct to organ preservation.
A review of 460 patients admitted to the intensive-therapy unit of a general hospital between 1965 and 1969
Authors: Skidmore F D
Published: March 2007

Four hundred and sixty patients with various severe disease processes were admitted to the intensive-therapy unit of a general hospital under the care of the anaesthetic and surgical staff in the 5-year period 1965-9 inclusive. The problems presented by these cases, their prognosis, and the lessons learnt in their management are reported, and the implications for similar units in the future are discussed.
The influence of electrical stimulation of the leg during surgical operations on the subsequent development of deep-vein thrombosis
Authors: Dejode L R , Khurshid M , Walther W W
Published: March 2007

The effect of galvanic stimulation of the calf muscles during surgical operations on the development of postoperative deep-vein thrombosis was assessed using 125I fibrinogen in 64 patients over 40 years of age undergoing major surgery. Alternate legs were stimulated in alternate patients using the opposite leg as a control. No significant difference in the incidence of deep-vein thrombosis was observed either in the immediate postoperative period or later.
Subtotal colectomy and caecoproctostomy
Authors: Webster C U , Howard R R S
Published: March 2007

The technique of subtotal colectomy with caecoproctostomy is described, together with clinical details of 6 patients in whom it was performed. An important feature of the operation is retention of the ileocaecal sphincter which helps to maintain almost normal bowel function.
Observations on acute pancreatitis. A retrospective clinical study
Authors: Gillespie W J
Published: March 2007

Aetiological features were sought in a retrospective review of 93 cases of acute pancreatitis diagnosed and treated in Edinburgh hospitals between 1961 and 1970. The incidence of alcoholism or precipitation by an excess of alcohol was 23 per cent, a figure which accords with reports from other parts of the world but which has no precedent in Great Britain. Possible reasons for this are discussed. There were no other unusual features. The need for a prospective study to reassess our current experience in Great Britain is stressed.
Bacterial flora in the duodenum of patients after biliary fenestration
Authors: Thomas E , Grant A Kerr , Holford M , Ringwood D , Derrington A W , Magarey J R
Published: March 2007

Fasting duodenal aspirates were studied in 15 patients with a biliary fenestration, 5 patients with a single duodenal diverticulum, 1 patient with a biliary fenestration and duodenal diverticulum, and 11 control subjects. A colonic type of bacterial flora, consisting of coliforms, Clostridium welchii, and Streptococcus faecalis, was found in 10 patients with biliary fenestration, 4 patients with a duodenal diverticulum, the patient with a fenestration and duodenal diverticulum, and in 1 of the control subjects. A high incidence of deconjugation of biles salts (10 out of 15 patients) and of steatorrhoea (8 out of 15 patients) was noted in the patients with biliary fenestration, as well as in those with a duodenal diverticulum (5 and 3 patients out of 5 respectively). Above-normal serum-folate levels were observed in 3 subjects with coliform colonization.

It is possible that vague abdominal symptoms which may be experienced by patients after biliary fenestration, may be due to the presence of an abnormal bacterial flora in the duodenum.
Kocher's perampullary approach for common bile-duct calculi
Authors: Carter A E
Published: March 2007

Supraduodenal choledochotomy for common bileduct stones carries the risk of biliary leakage, a predilection to stricture, and no certainty that all the stones are removed. Stones left behind after the first exploration and new stones formed later require secondary surgery, which is often difficult and has an even greater risk of serious complications.

Perampullary exploration, on the other hand, does not carry an increased initial risk of death or of the complications of biliary fistulae and retained stones of which none occurred in this series. Late complications of stricture and secondary unpassable stones similarly did not occur.

Neither method is free from the risk of postoperative pancreatitis (1 per cent in this series), but there is no evidence that perampullary exploration carries a greater risk than supraduodenal exploration. Even so, it is considered wise to give propantheline for 72 hours after perampullary exploration to reduce this risk.

It has been suggested that a wide, poorly competent, distal common-duct orifice might predispose to ascending cholangitis. No case in this series developed such cholangitis, nor has any case developed stenosis at the sphincteroplasty which might encourage cholangitis. In fact, in the 3 cases that came to post-mortem examination at intervals of 2 and 3 years the sphincteroplasties were still widely patent. Boulter (1961) suggested that sphincterotomy increased the flow of bile in the physiological pressure range and thus might be an additional benefit from the procedure.
Embryonic rhabdomyosarcoma of the urogenital tract
Authors: Ghazali S
Published: March 2007

Forty-two cases of embryonic rhabdomyosarcoma of the urogenital tract are reviewed. Their distribution, modes of presentation, clinical features, surgical management, and prognosis are discussed.
Malnutrition and malabsorption in crohn's disease with reference to the effect of surgery
Authors: Dyer N H , Dawson A M
Published: March 2007

Sixty-three patients with Crohn's disease showed a high incidence of nutritional deficiencies as judged by laboratory tests. Malabsorption of fat (33 per cent) and vitamin B12 (60 per cent) was not sufficiently severe to account for the malnutrition. Malnutrition was especially severe in unoperated patients with active disease, whereas malabsorption was prominent in patients with recurrent disease after resection although they had less active disease and less severe nutritional deficits. Surgery should not be withheld from a malnourished patient for fear of inducing further malnutrition; excision of toxic inflammatory disease will not only improve the immediate outlook but will also reduce the severity of further recurrences. Xylose-excretion tests give a spurious impression of malabsorption in Crohn's disease, possibly as a result of occult renal impairment, and should be abandoned.
The influence of the vagus nerves on the biliary system
Authors: Hopton D S
Published: March 2007

Vagotomy has become accepted as a standard operation for the treatment of peptic ulcer during the past 15 years. Although used to treat a specific lesion in the stomach or duoddenum, vagus division can have a much wider effect on the digestive system, but little attentionhas been paid by most surgeons to the efffects of the vagus on other organs and it is timely to review the influence of the vagus nerves on the biliary system.

In 1887 Ruggero Oddi suggested that the sphincter which is named after him was partly controlled by a nervous reflex. Since then many anatomists, physiologists, and clinicians have investigated the effects of the vagus nerves on the biliary system. The anatomical distribution of the vagus nerve and its hepatic and coeliac branches has been more thoroughly worked out than have their physiological effects.
Submandibular duct lithiasis associated with a mixed salivary gland tumour a case report
Authors: Hinder R A , Proctor N S F
Published: March 2007

A case of submandibular gland pleomorphic adenoma in association with duct lithiasis is presented. These are probably incidental findings, but it is possible that they may be causally related.
Primary adenocarcinoma arising in a vitello-intestinal duct remnant at the umbilicus
Authors: Glazer G
Published: March 2007

A case is presented of a primary adenocarcinoma which arose from a vitello-intestinal duct remnant at the umbilicus in a 46-year-old woman. The incidence, diagnosis, and management of these unusual tumours are reviewed.
Hereditary sacral agenesis associated with presacral tumours
Authors: Kenefick John S
Published: March 2007

This paper reports a family in which 6 females and 3 males have sacral agenesis. Four of the female members of the family have associated presacral tumours: 1 meningocele, 1 dermoid, and 2 of an undetermined nature at present. Similar sacral lesions associated with presacral meningoceles in 4 female members of a family of 29 have been reported by Cohn and Bay-Nielsen (1969).
Gastroduodenal ulceration and haemorrhage of neurogenic origin
Authors: Lewis Elizabeth A
Published: March 2007

The incidence, clinical experience, and management of gastroduodenal ulceration following intracranial disease over a 5-year period at the Royal Children's Hospital, Melbourne, are reported.

Usually the children present with a decline in the conscious state and falling blood-pressure. The maximum danger period is the first 7–10 days after an acute episode of brain-stem compression. The gastro-intestinal bleeding may not be overt, but the haemoglobin falls steadily. Small premonitory haemorrhages may herald torrential blood-loss. Early vagotomy and pyloroplasty with oversewing of the ulcer provide the best operation for these children, and there have been no major postoperative gastrointestinal symptoms in a short-term follow-up.
The management of varicose veins
Authors: Seddon John
Published: March 2007

A clinical trial was carried out to compare the effectiveness of compressive sclerotherapy with that of the traditional operative procedures in the treatment of varicose veins. One hundred and ten patients were treated by compression sclerotherapy and 91 patients by operation.

The results showed that there was no significant difference in the therapeutic value of the two procedures.
The outcome of treatment and changes in presentation of primary hyperparathyroidism
Authors: Britton D C , Johnston I D A , Thompson M H , Fleming L B
Published: March 2007

A review of 105 patients operated on over a 25-year period for primary hyperparathyroidism indicates that the diagnosis is now being made at an earlier stage of the disease. The incidence of bone disease is falling but renal symptoms remain the principal reason for presentation.

Hypertension in the presence of established disease persists after successful surgery and renal function frequently continues to deteriorate. Renal function is little affected in patients with minimal symptoms.

An accurate diagnosis can be made on the basis of persistent hypercalcaemia and elevated serum parathormone levels in peripheral or neck venous blood measured by sensitive immuno-assay.

Surgery is indicated as soon as the diagnosis is established with certainty even in the absence of any symptoms.
Highly selective vagotomy without a drainage procedure in the treatment of haemorrhage, perforation, and pyloric stenosis due to peptic ulcer
Authors: Johnston D , Lyndon P J , Smith R B , Humphrey C S
Published: March 2007

The good results of highly selective vagotomy (H.S.V.) in the elective surgical treatment of uncomplicated duodenal ulcer led to its use in the treatment of 30 patients who were suffering from complications of peptic ulcer, over a period of 21 months. In the emergency situation it is vital to select for H.S.V. patients who are fit enough to withstand a 1–2-hour operation.

Five out of a total of 9 patients with perforated duodenal ulcer were deemed to be suitable for H.S.V. In contrast, H.S.V. was used in the treatment of all 10 patients with haemorrhage (5 patients with duodenal ulcer and 5 with gastric ulcer), because definitive treatment for the ulcer is essential after haemorrhage has been arrested by direct suture.

Pyloric stenosis was diagnosed in 15 of 75 patients who came to elective surgery for duodenal ulcer. The diagnosis was made on clinical and radiological grounds and was confirmed at operation. Seven of the 15 patients had concomitant gastric ulceration. All 15 patients were treated by H.S.V. without a drainage procedure. The stenosis was simply dilated digitally. Seven patients who were followed up for at least a year underwent barium-meal examination, which showed that gastric emptying was normal in each case and that there was no sign of recurrent ulceration.

There was no operative mortality. None of the patients with haemorrhage bled again after operation. Only 1 of the 30 patients developed gastric retention, which was transient. Of the 14 patients who were reviewed more than 1 year after H.S.V., 11 had a perfect clinical result, 2 were very good, and 1 was ‘fair’ (Visick grade 3). The long-term prognosis should be the same as that of patients who have undergone elective H.S.V.

Granted a modicum of case selection, H.S.V. is a safe operation in the treatment of emergencies such as haemorrhage or perforation. In pyloric stenosis H.S.V. preserves and makes use of the stomach's compensatory mechanisms of hypertrophy and hyperperistalsis, whereas both gastrectomy and vagotomy with drainage destroy them. Vagotomy of the entire stomach makes necessary the addition of a drainage procedure. Vagotomy with drainage impairs the ability of the antrum to ‘mill’ food and to propel chyme onwards, and destroys or by-passes the pyloric sphincter. These surgical insults to normal gastric physiology harm the patient by producing dumping, diarrhoea, bilious vomiting, steatorrhoea, and gross elevation of serum gastrin. The main conclusion of this paper is that such harm can be avoided, because it is shown that even patients with pyloric stenosis can be treated by H.S.V. without a drainage procedure. The routine use of complete gastric vagotomy with a drainage procedure in the elective surgical treatment of duodenal ulcer is no longer justified.
Urinary hydroxyproline excretion in early and advanced breast cancer–a sequential study
Authors: Cuschieri A
Published: March 2007

A sequential study of urinary hydroxyproline was performed in 47 patients with cancer of the breast. The results have shown that hydroxyproline excretion in the urine provides a sensitive index of the early development of secondary deposits in bone from primary breast cancer. Elevation of the urinary excretion of hydroxyproline may predate by several months the radiological demonstration of osseous deposits. Sequential estimations have shown that the elevated urinary hydroxyproline excretion is persistent in patients who subsequently develop deposits in bone.
The aetiology of hypertension after renal transplantation in man
Authors: Sampson D , Kirdani R Y , Sandberg A A , Murphy G P
Published: March 2007

The renin-angiotensin-aldosterone system was studied in renal allograft patients, 70 per cent of whom were hypertensive.

Plasma-renin levels were found to be normal, and a normal increase was observed when patients were changed from the supine to the erect posture (P<0.01). However, aldosterone-secretion rates were found to be approximately four times normal, and a positive correlation between these values and diastolic blood-pressure was observed (r = 0-5, P = 0-05). In patients with intact kidneys a highly significant correlation between plasma-renin activity and aldosterone-secretion rate was observed (r = 0.8, P>0.05), but this normal correlation was not apparent in the patients with transplanted kidneys (r = 0.1, P>0.5). Thus the aldosterone-secretion rates in these patients was not under the control of the renin-angiotensin system.

Concurrent studies in adrenalectomized patients showed that they also had elevated aldosteronesecretion rates, and the injection of 14C-labelled cortisone acetate showed that they were capable of converting this steroid into aldosterone or an aldosterone-like metabolite. It is suggested that the hypertension seen after renal transplantation is related to the conversion of prednisone to a mineralocorticoid.

Further support for this hypothesis was obtained from studies in patients who had their therapy changed from daily prednisone to alternate-day methylprednisolone. They were found to secrete less aldosterone and all the patients became normotensive following this régime (P >0.1). In addition, patients treated with an aldosterone antagonist, spironolactone, showed a prompt decrease in blood-pressure.

It is concluded that the denervated transplanted kidney is able to maintain normal blood-pressure homeostasis in man, and that hypertension Seen after renal allografting is largely due to the therapy with immunosuppressive steroids.
The role of cellular immunity in control of neoplasia
Authors: Bone G , Camplejohn R
Published: March 2007

Using assessment of the delayed hypersensitivity response to a new antigen–in this study 2–4-dinitrochlorobenzene–as a measure of cellular immunity in patients with rectal cancer has shown highly significant correlation with pathological staging. No relationship between cellular immunity and rate of proliferation of rectal tumours could be established. The significance of these results is discussed.
Measurement of stoma size following choledochoduodenostomy by transduodenal cholangiography
Authors: Ham J M , Sorby W
Published: March 2007

Previous reports, concerning the operation of choledochoduodenostomy have stressed the importance of an ‘adequate’ stoma. However, there does not appear to have been an attempt to measure the stoma size by some objective method.

The results with a new technique for the assessment of the stoma and duct system postoperatively are reported. The method involves the use of a transnasal guided catheter system with selective catheterization of the common bile-duct via the stoma. Accurate delineation of the stoma and ducts is then possible.

The stoma was successfully catheterized in 13 out of 16 attempts, and satisfactory radiographs were obtained in 1 other patient by a modification of the technique. The measurements of the maximum diameter of the stoma were considerably less than those reported previously; despite this the clinical result in the short term was good in all except the 2 patients in whom the stoma could not be demonstrated.
Selective or truncal vagotomy?: Five-year results of a double-blind, randomized, controlled trial
Authors: Kennedy T , Connell A M , Love A H G , MacRae K D , Spencer E F Anne
Published: March 2007

The 5-year results of a double-blind, randomized, controlled trial of selective versus truncal vagotomy, each with pyloroplasty, are reported. of 100 patients entering the trial, 95 are available for study. There were 4 suspected or proven recurrent ulcers in the truncal group and 1 suspected but no proven recurrence in the selective group. The incidence of episodic diarrhoea was significantly less in the selective group; 4 mild and no severe cases compared with 11 mild and 2 severe cases among the truncal vagotomies. There was no severe dumping; mild symptoms were more common in the selective group but not significantly so. Miscellaneous dyspeptic symptoms were a little more common in the truncal group. Taking all these symptoms into consideration, the Visick clinical status of the selective group was superior. Weight changes, haemoglobin levels, and calcium levels were similar and satisfactory in each group. Selective vagotomy is superior to truncal vagotomy when each is combined with pyloroplasty.
The effect of increased oxygen in prolonged acute limb ischaemia
Authors: Stalker C G , Ledingham I McA
Published: March 2007

Prolonged acute hindlimb ischaemia was produced in anaesthetized ventilated dogs. During ischaemia, oxygen extraction and consumption rose initially but later consumption fell towards normal in the least severely ischaemic limbs; a progressive fall to below normal occurred in the most severely ischaemic limbs. Hyperbaric oxygen (2 ATA) did not influence blood-flow or metabolic exchange in either of these groups; in the remaining 40 per cent of the animals blood-flow fell significantly but oxygenation of the perfused areas of the limbs appeared to improve.
Popliteal aneurysm: a review of 116 cases
Authors: Bouhoutsos John , Martin Peter
Published: March 2007

One hundred and sixteen cases of popliteal aneurysm have been studied. The condition most commonly represents a local manifestation of generalized degenerative arterial disease, either occlusive or dilating. In the latter instance the condition is more often bilateral and there is a higher incidence of aortic aneurysm.

Symptoms occur from complications irrespective of the size of the aneurysm.

The results of reconstructive operations in false aneurysrns are bad, and unless there is good cause to consider that some form of reconstruction would be successful a lumbar sympathectomy is probably the best treatment.

Operation should be advised in all cases with a patent aneurysm and in those with a thrombosed aneurysm and patent tibia1 vessels. In cases with tibial vessel obstruction due to embolism, clearance can often be effected by the use of an embolectomy catheter to allow distal anastomosis. When a popliteal aneurysm is a manifestation of generalized dilating disease the results of surgery are excellent and long lasting, but if there is generalized stenosing disease the results are the same as after operation for diffuse atherosclerosis.

In patients with bilateral popliteal aneurysms, one of which is complicated, the uncomplicated one should probably be operated upon first, although sometimes both may be done at the same session.

Sympathectomy seems a worth-while operation in patients in whom no distal vessel is available for anastomosis, and other proximal reconstructions may be indicated, particularly when diffuse stenosing disease is present.
The role of frozen section in the diagnosis and management of malignant melanoma
Authors: Davis Neville C , Little John H
Published: March 2007

Provided that the pathologist is experienced, frozen section diagnosis of suspected malignant melanoma of the skin is remarkably accurate. Not only can the pathologist diagnose malignancy but he can often indicate the level of invasion of the dermis by the tumour cells. This is a most important prognostic sign and guides the surgeon in his further management of the patient. The use of a cryostat is considered essential to allow better study of the cytological changes. The main indications for the technique are to make a precise diagnosis when there is suspicion of a malignant melanoma, and to confirm the clinical diagnosis before deciding on the extent of surgery. Its use in small tumours and for the detection of lymph node metastases is not advocated.

A series of 329 frozen sections from 316 patients with an accuracy rate of 98·8 per cent is reported.
Secondary carcinoma of the thyroid gland
Authors: Thomson John A , Kennedy J S , Browne M K , Hutchison J
Published: March 2007

Two patients are described who presented with clinically solitary thyroid nodules which were found to be due to metastatic disease from the kidney and colon respectively. Removal of the solitary metastatis in one patient resulted in disease-free survival for over 5 years.
A classification of fistula-in-ano
Authors: Parks A G , Gordon P H , Hardcastle J D
Published: March 2007

A classification of anal fistulas is presented, which is the result of an analysis of 400 cases treated over the past IS years, based on the pathogenesis of the disease and the normal muscular anatomy of the pelvic floor. Four main types were found but numerous variations of each occur, which are described. It is hoped that this will alert the surgeon to the various complex situations that he may encounter.
Fissure-in-ano: The initial management and prognosis
Authors: Lock M R , Thomson James P S
Published: March 2007

The results of treatment of 188 consecutive new patients with a primary diagnosis of fissure-in-ano presenting to the Outpatient Department of St Mark's Hospital are reviewed. One-third underwent operation as the primary treatment and were not studied further. Of the remaining patients who underwent non-operative treatment only, one-half were initially cured. Follow-up at 4 years showed that this cure was maintained in half of these-cases, suggesting that there is aplace for treatment with a dilator in the correctly selected case.

The presence of a sentinel skin tag or a fibrous anal polyp is shown to have a statistically significant association with operative treatment. The use of a paediatric sigmoidoscope ro diagnose a fibrous anal polyp is recommended.
Appendicectomy: An assessment of the advisability of stump invagination
Authors: Sinha A P
Published: March 2007

Seven hundred and thirty-two cases of appendicectomy performed over a period of 5 years are reviewed to compare the incidence of complications and the length of the postoperative stay in hospital, depending on whether the appendix stump was simply ligated or was invaginated by purse string suture following ligation. No detrimental effects are noted following simple ligation, whereas patients who had stump invagination remained in hospital on average more than a day longer, mainly owing to a higher incidence of wound infection (16 per cent as against 6 per cent).