bluuebunny/crossref_metadata_2025 huggingface dataset:
Inhibition of plasma cyclic AMP, glucose and cortisol response to surgery by epidural analgesia
Authors: Madsen Stig Nistrup , Brandt Mogens R , Engquist Allan , Badawi Ibrahim , Kehlet Henrik
Published: March 2007

Cyclic AMP, glucose and cortisol in plasma were measured in three groups of patients undergoing hysterectomy. The operations were performed under general anaesthesia, under general anaesthesia combined with epidural analgesia and under epidural analgesia alone.

Surgery elicited a significant rise in plasma cyclic AMP, glucose and cortisol when performed under general anaesthesia alone. Epidural analgesia extending from T4–6 to S5 combined with general anaesthesia abolished the rise in cyclic AMP and reduced the increase in glucose and cortisol and epidural analgesia alone extending from T4 to S5 blocked the rise in glucose and cortisol as well as that in cyclic AMP.

The results support the theory that afferent nerve impulses from the area of trauma are of major importance for the catabolic state induced by surgical procedures and indicate that anaesthetic management which includes blockade of afferent nerve impulses from the area of trauma can reduce the catabolic response to surgery. These observations could be of value in the operative management of patients with diabetes mellitus and possibly in other groups of patients with a high surgical morbidity.
Knot properties of surgical silk: Model study
Authors: Holmlund D E W
Published: March 2007

The knot properties of surgical silk of different dimensions and from different manufacturers have been studied. Large variations were found. It is proposed that the differences are due mainly to the braiding technique. Only very few surgical silk sutures can be securely tied with a square (reef) knot today. A knot with three square throws is therefore recommended for modern surgical silk.
Primary vaginal stone following abdominoperineal excision of the rectum with total hysterectomy
Authors: Weaver R M
Published: March 2007

This paper reports a case of primary vaginal calculus developing following abdominoperineal excision of the rectum with total hysterectomy. A review of the previous literature on primary vaginal calculus is included.
A non-invasive test of gastric function
Authors: Taylor T V , Bone D , Torrance Bruce
Published: March 2007

Using 99Tcm a non-invasive test of gastric function has been developed which completely obviates the need for a nasogastric tube and which adds to the accuracy of existing tests by overcoming losses due to incomplete aspiration or gastric emptying. 99Tcm is handled by the stomach like Cl−, the gastric secretion of which is equal to that of H+. The value of the pentagastrin stimulation test in the presence of varied gastric pathology is discussed in relation to 50 patients. Other possible diagnostic uses of the test are evaluated and a method of carrying out an insulin test by a modification of the technique is described.
Postoperative pulmonary perfusion defects: their natural history, origin and significance
Authors: Knight M T N , Metrewelli C
Published: March 2007

Unmatched perfusion defects occur during the early postoperative period. These defects can persist until the tenth postoperative day and their presence is not related to the transfusion of blood or to peripheral thrombosis detected by the 125I-labelled fibrinogen uptake test. It is suggested that prophylactic agents against deep venous thrombosis should be evaluated by using a combination of krypton ventilation-perfusion lung scans and 125I-labelled fibrinogen leg scans.
Varicocele: A review of radiological and anatomical features in relation to surgical treatment
Authors: Hill J T , Green N Alan
Published: March 2007

The patterns of venous drainage of the testis and scrotum have been evaluated in patients with varicocele by a variety of radiological procedures, including left renal venography, and at the time of operation by ascending venography and retrograde injection of contrast medium into prominent varicosities. These studies have allowed classification of the system of veins involved in the condition into several groups, including involvement of the internal spermatic vein alone, pure cremasteric varicocele, mixed internal spermatic and cremasteric varicosities in one or both systems with valvular incompetence or mere dilatation without apparent incompetence of valves. As a result, an anatomical approach to the surgical management of varicocele is suggested which attempts to place the operative treatment on a more rational basis appropriate to each case.
Closed renal trauma
Authors: Smith J M , O'Flynn J Dermot
Published: March 2007

A series of 76 cases of closed renal trauma is presented. The clinical and radiological features are described and the indications for conservative and surgical treatment discussed.
Alpha-adrenergic blockers in prostatism
Authors: Boreham P F , Braithwaite P , Milewski P , Pearson H
Published: March 2007

Thirty patients awaiting prostatectomy with no history of cardiovascular disease were selected for a trial of alpha-adrenergic blocking agents. Twenty-seven patients completed the trial, 19 of them with unpleasant side effects. Eighteen of them found their symptoms were improved and 10 showed urodynamic improvement.
Neoplasms at the site of ureterocolic anastomosis
Authors: Mogg Richard A
Published: March 2007

This paper discusses one of the more uncommon sequelae of ureterocolic anastomosis, namely the formation of tumours at the site of anastomosis. This is a very rare complication and until 1971 the literature recorded only 28 cases of this phenomenon. This present communication adds 2 more cases to the literature—a unilateral tumour and bilateral tumours at the site of anastomosis.
Closure of a loop colostomy by a modified Le Gac's operation
Authors: Qvist George
Published: March 2007

The results of closure of a loop colostomy presented by various authors are reviewed. It is suggested that postoperative faecal fistula is due most frequently to oedema and constriction at the site of bowel closure. Le Gac's method of closure is described. It comprises excision of the stoma and spur with side-to-side as well as end-to-end anastomosis, and it results in a wide lumen closure. A modified Le Gac's operation is described in which the mesocolic spur is not removed.
T cells and protein nutrition in hospitalized surgical patients
Authors: Warren Judith V , Hill G L
Published: March 2007

Percentage and number of T cells in peripheral blood and several indices of protein nutrition were assessed in a random sample of 51 hospitalized surgical patients.

Whole blood counts of the patients' lymphocytes and E rosette tests (after separation of lymphocytes from whole blood on Ficoll-Metrizoate) showed no difference from a control group of well-nourished people attending hospital for minor complaints. In general there was no consistent relationship between the level of protein nutrition and low T cell numbers, except for 5 malnourished patients tested less than 1 week after major surgery.

Although a group of 11 patients who fulfilled the criteria for ‘malnutrition’ had normal T cell numbers, the percentage of T cells was significantly higher and the number of total lymphocytes was significantly lower than in the controls.
Effect of selective gastric vagotomy on histamine concentration in gastric mucosa of patients with duodenal ulcer
Authors: Troidl H , Rohde H , Lorenz W , Häfner G , Hamelmann H
Published: March 2007

In a prospective controlled trial, histamine concentrations in human gastric mucosa were determined fluorometrically in 23 patients 6–11 months after selective gastric vagotomy with drainage and in patients who had undergone other types of operation for duodenal ulcer. The study was in two parts: part 1, a synchronous investigation of mucosal histamine concentrations in patients who had undergone vagotomy, in duodenal ulcer patients before operation and in control subjects; part 2, a consecutive study of the same patients before and after vagotomy.

In part 1, patients with Hollander-negative vagotomy were found to have significantly higher mucosal histamine concentrations than ‘healthy’ control subjects or duodenal ulcer, however, had as low mucosal histamine concentrations as duodenal ulcer patients who had not been operated on. In part 2, all duodenal ulcer patients showed an increase in gastric mucosal histamine concentration after vagotomy (P < 0·01). The smallest increase was in a patient with an incomplete vagotomy. Control patients who were not operated on but who underwent endoscopy and biopsy twice in the period of investigation, did not show any increase in mucosal histamine concentration between the times of the first and the second biopsy. The overall results of selective vagotomy and drainage in this study, with respect both to clinical Visick gradings and to radiological and acid secretory findings, were comparable to those reported by other authors. No significant change in numbers of parietal cells was found after vagotomy. Thus, selective gastric vagotomy with a drainage procedure leads to increased concentrations of histamine in the mucosa of the body of the stomach in man. The mechanism is not clear, but might be through inhibition of histamine release from mast cell stores.
Effect of pyloroplasty on gastric emptying: Long term results as obtained with a labelled test meal 14–43 months after operation
Authors: Binswanger R O , Aeberhard P , Walther M , Vock P
Published: March 2007

The mean gastric transit time (t) and the half-time of gastric emptying (t/2) of a labelled test meal have been studied in 18 patients more than I year after gastrc surgery for peptic ulcer and compared with those in 18 healthy controls.

Of the patients, 6 had undergone proximal gastric vagtotomy alone (PGV), 6 had had proximal gastric vagotomy and pyloroplasty (PGVP) and in 6 truncal vagotomy and pyloroplasty (TVP) had been performed.

The t and t/2 of patients with PGV alone did not differ significantly from the values of the control group. The t and t/2 in patients after PGVP and TVP, however, were significantly lower than in both controls and patients after PGV alone. There was no statistically significant difference between the groups with PGVP and TVP.

The results of this study suggest that the lasting effects of vagotomy operatins on gastric emptying are due to the drainage procedure rather than the vagotomy.
The early diagnosis of non-union of fractures of the tibial shaft by osteomedullography
Authors: Boobbyer G N
Published: March 2007

Osteomedullography (osteomyelography) is a radiographic technique which demonstrates the intraosseous venous circulation. Its use in demonstrating the state of bone healing in fractures of the tibial shaft is described. Its importance lies in the fact that if, 3 months after the initial injury, there is doubt as to the state of union of the fracture, the information gained from osteomedullograhy allows an immediate decision as to the need for bone grafting. Twenty patients with fractures of the tibial shaft were studied. It was demonstrated that 14 patients had established non-union and 6 patients had delayed union.
Arterial anastomoses in renal transplantation
Authors: Mosley J G , Castro J E
Published: March 2007

A consecutive series of 260 renal transplants was analysed to find the outcome of different arterial anastomoses. In 177 cases the renal vessel was anastomosed to the end of the internal iliac artery; 125 per cent developed vascular complications. Thirty-eight of these patients subsequently underwent allograft nephrectomy; none died from haemorrahage.

In 83 patients the renal vessel was anastomosed end to side to the iliac artery, and vascular complications occurred in 14 per cent. Thirty-two patients subsequently underwent allograft nephrectomy; 8 wre associated with severe haemorrhage and 5 of these were fatal.
The emergency surgical management of massive and persistent intestinal haemorrhage due to typhoid fever: A report of 3 cases
Authors: Wong S H
Published: March 2007

The classic approach to the management of intestinal haemorrhage due to typhoid infection has been conservative, with sedation, rest to the intestine, blood transfusion and antibiotics. However, in the event of massive and persistent haemorrhage which does not respond to conservative measures, emergency resection should be considered. Surgical resection by removing the major ulcer-bearing areas will stop the bleeding and the intestine is not friable.
The value of an operative wound swab sent in transport medium in the prediction of later clinical wound infection: A controlled clinical and bacteriological evaluation
Authors: Kelly M J , Warren R E
Published: March 2007

Operative wound swabs taken at 214 transperitoneal operations were examined during the course of three controlled clinical trails to determine the value of transport medium in the carriage of specimens. The use of Stuart's transport medium more than doubled the number of swabs yielding pathogens in the laboratory compared with a control series of duplicate swabs not sent in transport medium. Anaerobes were even more severely affected than aerobes by ‘dry’ carriage. A polyester foam swab was shown to have no advantage over the standard cottonwool variety. Bacteriological swabs from superficial wound fat were shown to be superfluous if a peritoneal wound swab had already been taken. We suggest that operative abdominal wound swabs should not be accepted for processing by a microbiological laboratory unless sent in transport medium.

Wound infection, assessed on the fifth postoperative day, was shown to be related to the result of operative swab culture only when the swab was sent in transport medium. When the operative culture was negative at 48 h, only 1 per cent later became infected. When the operative swabs grew obligate anaerobes alone, 13 per cent became infected–aerobes alone, 23 per cent, and mixed aerobes plus anaerobes, 71 per cent. The growth of mixed aerobes plus anaerobes from the operative swab was a far superior predictive factor for later infection than the degree of operative contamination or the type of operation, and provided a simple, rapid means of identifying a subgroup of patients at high risk (71 per cent) of developing infection who might benefit from planned antibiotic therapy.
The insulin infusion test: a safe procedure?
Authors: de Vries B C , Holtkamp H C , Leeuwerik P J J , Muller H
Published: March 2007

One hundred and thirty insulin infusion tests (dose 0.05 u kg−1 h−1) were carried out in 87 patients with peptic ulcer or after a vagotomy. During the test ECG tracings were taken and blood was sampled for blood glucose and serum potassium determination.

In 31 per cent of the tests electrocardiographic changes were seen. The cardiovascular effects were supraventricular and ventricular ectopic beats, ST-T changes and U waves. In 2 tests there were potentially dangerous arrhythmias.

A significant relationship was seen between ECG abnormalities and the age of the patients. Such a relationship was not present between ECG changes and glucose and potassium values.

It is concluded that the insulin infusion test is probably safer than the conventional Hollander test, but constant monitoring is still required.
Extra-abdominal desmoid of the face involving the orbit
Authors: Craig R D P , Studd D
Published: March 2007

A case of musculoaponeurotic fibrosis of the face invading the orbit is presented. The need for radical local excision of such lesions to prevent recurrence and the value of adequate prostheses following excenteration of the orbit are emphasized.
Familial phaeochromocytoma with von Hippel's disease in one sister and ectopic adrenal cortex in the kidney in another
Authors: Mendelow A David , Kay S , Levin E , Mieny C J
Published: March 2007

Two sisters with bilateral adrenal phaeochromocytomas are reported. Von Hippel's disease of the retina was found in the one and ectopic adrenal cortical tissue was found in the kidney of the other. The latter association has not previously been described with familial phaeochromocytoma.
The clinical significance of gallstones and their radiological investigation
Authors: Earlam R J , Thomas M
Published: March 2007

The symptoms of 122 patients with gallstones were correlated with the radiological findings. No specific indigestion was present which could be termed “flatulent dyspepsia”. Sensitivity to fatty foods occurred in 69 per cent, heartburn in 42 per cent, regurgitation of acidtasting or bitter fluid to the mouth in 31 per cent and increased passage of flatus from the stomach upwards in 38 per cent. If the gallbladder concentrated contrast medium on an oral cholecystogram but did not contract after a fatty meal, the patients suffered less heartburn than if the gallbladder functioned normally. However, since surgeons rarely perform a cholecystectomy for flatulent dyspepsia alone, knowledge of gallbladder function may be unnecessary.
An assessment of the accuracy of modern endoscopic diagnosis of oesophageal stricture
Authors: Eastman M C , Gear M W L , Nicol A
Published: March 2007

The results of 135 fibreoptic endoscopic examinations of oesophageal strictures carried out in a district general hospital are reported. The endoscopic diagnosis was correct in 90 per cent, uncertain in 3 per cent and incorrect in 7 per cent of these cases. This study indicates that endoscopic examination should include tissue sampling; this not only allows a precise tissue diagnosis to be made but also is shown to increase the accuracy of diagnosis. Tissue sampling should include cytological as well as histological material. Analysis of cases of stricture correctly diagnosed has shown that target biopsy and brush cytology each makes a significant contribution to diagnosis. The routine collection of cytological specimens in addition to the more commonly obtained histological specimens is strongly advocated.

The natural history of malignant oesophageal strictures in this study is reviewed. The mean survival in 58 cases was 6·9 months.
Tuberculous fistula between the 5th lumbar vertebra and the colon presenting as a left thigh abscess
Authors: Johnson A D , McIntosh W J
Published: March 2007

An abscess of the left thigh due to a fistula between a tuberculous 5th lumbar vertebra, the sigmoid colon and the muscles and subcutaneous tissues of the left thigh is described. This appears to be a unique occurrence and was only diagnosed at post-mortem. The treatment and diagnosis are discussed.
The bruit–occlusion test: A clinical method for localizing arterial stenosis
Authors: Dowell A J , Sladen J G
Published: March 2007

The bruit–occlusion test is accomplished by listening to a bruit whilst occluding and releasing an efferent artery, e. g. bruit in the groin, occluding the superficial femoral artery. If the bruit disappears, that efferent artery is stenosed. Changes in intensity of the bruit imply stenosis in the parent or alternate efferent vessels. The test is useful in the follow-up of aortofemoral and particularly femoropopliteal vein grafts. It can be applied in the abdomen and neck.

This simple manoeuvre can be added to a vascular examination whenever a bruit is discovered. It often allows specific anatomical diagnosis and can be more reliable than arteriography.
Meconium ileus equivalent in an adult: A case report
Authors: Benghiat A
Published: March 2007

A case is described of meconium ileus equivalent presenting as a small bowel obstruction in an adult putient with cystic fibrosis. The importance of conservative management with acetylcysteine and intravenous fluids is emphasized.
The nature of hypocalcaemia in acute pancreatitis
Authors: McMahon M J , Woodhead J S , Hayward R D
Published: March 2007

A retrospective and prospective study was made of 82 attacks of acute pancreatitis occurring in 80 patients. Attacks were defined as mild (55) or severe (27) according to clinical criteria. Severe attacks were associated with significantly low levels of uncorrected calcium and calculated ionized calcium, both at the time of admission and 48 h later.

Patients with severe attacks were found to have lower levels of parathyroid hormone than either those with mild attacks or other patients who had undergone an abdominal operation. These results indicate that severe pancreatitis is associated with true hypocalcaemia, and that deficiency of circulating parathyroid hormone may be a factor in its production.
Cushing's syndrome: 20 years after adrenalectomy
Authors: Montgomery D A D , Welbourn R B
Published: March 2007

The long term results (over 20 years) of our first 13 patients treated by adrenalectomy for Cushing'ssyndrome are described. Twelve survived operation and 5 of these died within 5 years, but thereafter the expectation of life of the treated patients was similar to that of the general population. At 20 years 7 patients were alive and 6 were well. If modern therapeutic measures to control adrenocortical function before operation had been available 20 years ago, some of the early deaths might have been prevented.
Inhibition of aldosterone response to surgery by saline administration
Authors: Engquist A , Blichert-Toft M , Ølgaard K , Brandt M R , Kehlet H
Published: March 2007

The renin-angiotensin system, ACTH and hyperkalaemia are known to induce increased plasma levels of aldosterone. In order to assess the relative significance of these mechanisms during surgical stress, aldosterone, cortisol and electrolytes in plasma were measured in 12 otherwise healthy women during and after cholecystectomy. The patients received either isotonic sodium chloride or 5 per cent glucose in water during the experimental period of 22 h.

The results showed that the pronounced increase of aldosterone and the concomitant decrease of sodium in plasma found in patients given glucose in water could almost be inhibited by the administration of saline. Cortisol and potassium concentrations were identical in the two groups of subjects.

It is concluded that the aldosterone response to surgery is mainly mediated via the renin-angiotensin system. This response is probably due to a reduced sodium content or volume of extracellular fluid, since it could almost be inhibited by administration of sodium chloride. The rationale of saline restriction during and after surgery is questioned.
Morbidity and mortality in renal transplant patients after incidental surgery
Authors: Bakkaloglu M , Hamilton D N H , Macpherson S G , Briggs J D
Published: March 2007

Sixty-five further surgical procedures were carried out in 39 renal transplant patients without mortality and with low morbidity. There was a 9 per cent incidence of clean wound infection, and minor chest infection occurred in another 9 per cent. Stay in hospital for these procedures was not prolonged. The function of the transplanted kidney showed no deterioration after these further surgical procedures. The successfully transplanted patient is thus a good candidate for further surgery despite the previous renal failure and the continuing immunosuppressive therapy.
Anorexia nervosa and Crohn'sdisease
Authors: Metcalfe-Gibson C
Published: March 2007

Two cases of anorexia nervosa who were subsequently found to have Crohn'sdisease are presented. The difficulties in determining whether they had anorexia nervosa and Crohn'sdisease concomitantly or whether the Crohn'sdisease alone was responsible for their condition are discussed without definite conclusion. The importance of excluding occult organie disease before assuming a diagnosis of anorexia nervosa is stressed.
Postoperative recurrence of hydatid disease
Authors: Mottaghian Hassan , Saidi Farrokh
Published: March 2007

Since larval scolices of the parasite Echinococcus granulosus are capable of developing in vivo into mature hydatid cysts in the human intermediate host, operative spillage of cyst contents can lead to local regrowth of hydatid cysts after a suitable interval. The overall rate of postoperative recurrence of hydatid cysts of soft tissue organs in 106 patients, followed-up form 6 months to 3 years, was 11.3 per cent. Both host and parasite factors determine recurrence. Serosal and surgical wound surfaces, unlike mucosal surfaces, provide fertile ground for the development of implanted scolices into hydatid cysts. No correlation was found between the size of removed cysts and postoperative recurrence. The risk of recurrence and associated morbidity was highest in patients with multiple intra-abdominal cysts. Certain technical problems increase the chance of inadvertent operative rupture and spillage of cyst contents, with subsequent regrowth of cysts. Routine measures against operative spillage of hydatid fluid are mandatory, but the actual method of surgical treatment must be individualized for every case.
The selective use of combined supraduodenal and transduodenal exploration of the common bile duct
Authors: Aubrey D A , Edwards J L
Published: March 2007

The results of combined supraduodenal and transduodenal exploration of the common bile duct in 42 selected cases are presented. The indications for this operation were: the presence of multiple calculi in the common bile duct: stones impacted in the ampullary region; residual stones in the common bile duct following previous surgery on the biliary tract; stricture at the papilla and pancreatitis associated with cholelithiasis. After the procedure no patient had residual stones in the common bile duct. Serious complications were infrequent; there were no postoperative deaths and postoperative pancreatitis occurred in only one patient.
The use of endoscopy in the surgical treatment of the Mallory-Weiss syndrome
Authors: Metcalfe-Gibson C , Chaudhury S C
Published: March 2007

Fibreoptic endoscopy has provided a new dimension in the diagnosis and management of oesophageal and upper gastrointestinal disorders. Its value as an aid to surgery of the lower oesophagus is demonstrated in a case of the Mallory-Weiss syndrome.
Evaluation of the thrombogenic potential of three types of arterial graft studied in an artificial circulation
Authors: Hamlin G W , Rajah S M , Crow M J , Kester R C
Published: March 2007

The thrombogenic potential of woven Dacron, expanded polytetrafluoroethylene (Gore-Tex) and gluteraldehydetreated human femoral artery (HFA) grafts was evaluated using an artificial circulation. The differences in the platelet parameters (platelet count, adhesion and aggregation) and scanning electron microscopy (SEM) appearances before and after perfusion were used as indices of thrombogenicity. Platelet counts fell significantly with woven Dacron, moderately with HFA and no fall was observed with Gore-Tex. Platelet aggregation was unaffected by any graft, but platelet retention was significantly marked in woven Dacron. SEM studies revealed minimal adherence of platelets to Gore-Tex and HFA endothelium, but marked adherence to woven Dacron, accompanied by morphological changes of the adhered platelets.

In an artificial circulation, of the three types of arterial graft, woven Dacron has the greatest influence on platelet function, indicating significant thrombogenicity, whereas HFA is intermediate in its effect and Gore-Tex appears to have the lowest thrombogenic potential.
Clinically silent gross hypergastrinaemia from a multiple hormone-secreting pancreatic apudoma
Authors: Joffe S N , Elias E , Rehfeld J F , Polak J M , Bloom S R , Welbourn R B
Published: March 2007

A patient is described who had a malignant pancreatic islet cell apudoma secreting corticotrophin (ACTH) and melanocyte-stimulating hormone (MSH), both of which were clinically active, and very large quantities of immunoreactive gastrins, which were biologically active but clinically silent (normal gastric acid secretion and no peptic ulceration). The presence of parietal cell antibodies, with no increase in the plasma concentrations of hormones which can inhibit gastric acid secretion (secretin, GIP and VIP), suggests that many of the parietal cells may have been blocked by the autoantibodies.
The role of the profunda femoris in aorto-iliac surgery
Authors: Ward A S , Morris-Jones W
Published: March 2007

The results of aorto-iliac surgery in 90 ischaemic limbs (68 patients) have been reviewed. The mean follow-up period was 18 months (rang 6 monts to 3.5 years). In 48 limbs the disease was confined to the aorto-iliac segment (group 1), while in 42 limbs severe occlusive changes were present in both the aorto-iliac and superficial femoral segments (group 2).

In group intermittent claudication was obolised or substanitally improved in 86 per cent. Rest pain was relieved in all cases. Lumbar sympathectomy was with out obvious additional benefit in either group. Pedal pules were restored in all except 3 limbs. A highly significant (P <0.001) increase in the ankle systolic pressure (ASP) index occurred after surgery and normal values were restored both in claudicants and in those with rest pain. This response was maintained through out the follow-up period.

Claudication was effectively relived in 38 per cent of cases in group 2 following aortoprofunda reconstruction. Rest pain was abolished in 83 per cent of cases, the remainder requrining a major amputation. Lumbar sympathectomy failed to produce any additional benefit among either claudicants or those with rest pain. Pedal pulses were restored in only 2 limbs. Among claudicants the ASP index was uncharged, and although a significatn (P <0.001) increase occurred in the rest pain group, the index remained within the ischaemic range. There was little variation in the value of the ASP index throughout the follow-up period in either group. The difference between the ASP response to surgery in patients with aorto-iliac disese alone and those with dual occlusion was highly significant (P <0.001).

The present results suggest that among claudicants revascularization of the profunda alone may be followed by a limited clinical and hoemodynamic response. However, as a limb salvage procedure, aortoprofunda reconstruction can be recommended with confidence. When both the superficial and deep femoral vessels are patent, on excellent response is to be expected after aorto-iliac surgery in claudicants and patients with rest pain alike.
The treatment of early colorectal cancer by local excision
Authors: Lock M R , Cairns D W , Ritchie Jean K , Lockhart-Mummery H E
Published: March 2007

An analysis is presented of 143 patients with early colorectal carcinoma treated by local excision between 1948 and 1972 at St Mark's Hospital. The tumours are considered in three groups; colonic tumours, pedunculated rectal tumours and non-pedunculated rectal tumours. The importance of careful clinical assessment and accurate pathological examination is emphasized. Local excision of the tumours, using various operative techniques, gave good results and this method of management can be recommended in the carefully selected case.
Popliteal vein entrapment
Authors: Connell John
Published: March 2007

A case of popliteal vein entrapment by an abnormal ‘third’ head of the gastrocnemius muscle is reported. Complete relief of disabling symptoms was obtained by dividing the abnormal muscle band.
A study of technetium-labelled sulphide colloid uptake by regional lymph nodes draining a tumour-bearing area
Authors: Boak J L , Agwunobi T C
Published: March 2007

With appropriate controls, experimental groups of inbred C3H mice bearing a syngeneic mammary carcinoma challenge in their right rear footpads were injected in both rear footpads with 99Tcm ASC. Mice were sacrificed 15 and 90 min after the labelled colloid injection. Popliteal and sacral lymph nodes were weighed and counted in a well scintillation counter. A marked inhibition of labelled colloid uptake was demonstrated in regional lymph nodes draining a tumour-bearing area.

Rabbits bearing VX2 carcinoma in a forelimb received 99Tcm ASC into each front footpad. Depression of labelled colloid uptake by regional lymph nodes draining tumour was evident on gamma-camera scanning.
Secondary acute pancreatitis: Aetiology, prevention, diagnosis and management
Authors: Imrie C W , McKay A J , Benjamin I S , Blumgart L H
Published: March 2007

Secondary acute pancreatitis occurs soon after surgery, upper abdominal trauma or the clinical investigations of endoscopic retrograde choledochopancreatography (ERCP) or translumbar aortography (TLA). In this study of secondary acute pancreatitis, 30 patients developed acute pancreatitis after surgery, 12 following trauma and 8 following ERCP or TLA. These 50 patients were drawn from a total of 501 patients with all forms of acute pancreatitis admitted to Glasgow Royal Infirmary from 1960 to 1976. Thirty-seven of the patients were part of a prospective study of 361 patients, while the remainder were examined retrospectively.

Important features in the prevention of secondary acute pancreatitis are avoidance of forceful surgical dilatation of the lower common bile duct and unnecessary operative procedures at the sphincter of Oddi. Careful technique is nessary when performing ERCP or TLA. In the prospective phase of this study, early diagnosis of secondary acute pancreatitis was achieved by careful clinical observation and biochemical screening of ‘at risk’ patients. The mortality rate in patients studied retrospectively was 46 per cent while in those studied prospectively it was 13.5 per cent.

Postoperative acute pancreatitis had the highest mortality rate (30 per cent) and most frequently followed biliary tract surgery. A disproportionately large number of patients developed pancreatitis after sphincterotomy or sphincteroplasty.

Early laporotomy is advocated in patients with pancreatitis occurring after blunt abdominal trauma. Where the initial management was conservative in this group, late pseudocyst formation requiring surgical drainage was common.
Arterial reconstruction extending below the popliteal bifurcation
Authors: Ferguson I A , Rosengarten D S , Stuchbery F E , Barnett A J
Published: March 2007

Results are reported for 172 anastomoses below the popliteal artery in patients almost exclusively suffering from severe distal ischaemia with an in-hospital mortality of 7.6 per cent. The patency rate in survivors was 83 per cent on discharge and 39 per cent at 3 years.

There were 37 major amputations following 172 operations and 15 following 47 operations on diabetics. As most of the patients would have lost their limbs if arterial repair was not undertaken this constitutes a considerable salvage rate.

Diabetes mellitus does not appear to influence the results unfavourably, so patients suffering from this disease should be considered for operation.
Pneumoperitoneum following hernia repair
Authors: Halsall A K , Benson E A
Published: March 2007

In a small series of 20 consecutive patients it proved impossible, using conventional radiography, to detect free intraperitoneal air following herniorrhaphy.
Management of recurrent peptic ulceration
Authors: Green W E R , Kennedy T , Hassard T , Spencer E F A
Published: March 2007

A series of 117 consecutive patients having operations for recurrent peptic ulcer is reported. There were no initial deaths but 9 patients developed further recurrent ulcer and 2 of 8 who had a third operation died, giving an overall patient mortality of 1.7 per cent. A further 6 patients underwent a third operation to correct bile vomiting or dumping, with no deaths.

The mean time of onset of symptoms of recurrent ulcer was 1.9 years after proximal gastric vagotomy, 3.2 years after vagotomy and drainage, 3.3 years after gastrectomy and 12.6 years after gastrojejunostomy.

One hundred and four patients were followed for more than 1 year (mean 5.2 years) and the result was good in 77 per cent. After a third operation the proportion of good results was improved to 88 per cent.

Second recurrence occurred in 1 of 43 patients after revagotomy and gastrectomy, in 2 of 28 after resection alone and in 6 of 33 after vagotomy or revagotomy alone (P <0.05). When the patients whose primary operation included neither vagotomy nor gastric resection were excluded, there was a similar trend but the differences were not significant. It is suggested that gastric resection or re-resection should be combined with vagotomy or revagotomy whether the primary operation has been gastrectomy, vagotomy with or without drainage or gastrojejunostomy alone.
Endoscopic appearances and histological changes in ulcer-associated doudenitis
Authors: Stephen J G , Lesna M , Venables C W
Published: March 2007

A simple system of grading the endoscopic appearances of duodenitis is described. There was a good association between the degree of duodenitis recorded using this method and that obtained from a histological grading system in a group of duodenal ulcer patients and a group of dyspeptic patients with no endoscopic evidence of duodenitis. Endoscopic assessment is recommended as a reliable guide to the presence of duodenitis.

After 1 month of treatment with cimetidine there was a significant improvement in the endoscopic duodenitis scores of a group of 17 duodenal ulcer patients. In 16 of these patients there was complete ulcer healing.

Duodenitis can be a manifestation of chronic duodenal ulcer disease. In the absence of ulceration, the endoscopic diagnosis of duodenitis is of value in the recognition of patients with this condition.
Thermography in screening postoperative deep vein thrombosis: A comparison with the 125I-fibrinogen test
Authors: Bergqvist D , Hallböök T
Published: March 2007

The value of thermography as a screening method for postoperative deep vein thrombosis has been evaluated in 308 patients (616 legs). Comparison was made with the 125 I-fibrinogen test. The overall diagnostic agreement was 81.0 per cent; the sensitivity was 62.1 per cent and the specificity 90.3 per cent. The agreement increased with proximal extension of the thrombi. Thermography became positive 0.26 days after the 125 I-fibrinogen test but in 19.8 per cent thermography was positive before a positive fibrinogen test.
The origin of thrombi in the deep veins of the lower limb: A venographic study
Authors: Stamatakis J D , Kakkar V V , Lawrence D , Bentley P G
Published: March 2007

A series of 952 patients was examined by ascending venography; 812 with clinically diagnosed deep vein thrombosis (DVT) (group 1) and 140 with clinical features suggestive of pulmonary embolism (group 2). Thrombus was demonstrated in 401 (49.4 per cent) of group 1 and in 74 (53 per cent) of group 2 patients. A total of 535 limbs contained thrombus. In 493 (92 per cent) thrombus was present in the calf with either no further clot, or clot in continuity with that in more proximal veins. In the remaining 42 legs (8 per cent) thrombus either originated from multiple discontinuous sites in the legs and pelvis, or in proximal major veins without concomitant calf involvement. The clinical implications of these findings are discussed.
Saphenous neuralgia: A complication of arterial surgery
Authors: Jones N A G
Published: March 2007

The saphenous nerve may be damaged during arterial surgery in the thigh as it emerges through the aponeurotic covering of the adductor canal. A clean cut of the nerve gives rise to anaesthesia, but an incomplete cut or tearing of the nerve, followed by its involvement in scar tissue, leads to saphenous neuralgia–a painful sensation in the area supplied by the nerve.

Two hundred and fifty-seven arterial operations involving the course of the saphenous nerve in the thigh have been reviewed. Twenty-six of these operations were complicated by early failure of the arterial procedure necessitating amputation and have not been considered in assessing the incidence of damage to the nerve. One in five superficial femoral thromboendarterectomies and one in nine femoropopliteal bypass grafts were complicated by saphenous neuralgia. Profundaplasty was not followed by this complication.

Appreciation of this troublesome symptom should lead to greater care of the nerve during surgery.
Revascularization of an arm for incipient gangrene after Blalock-Taussig anastomosis
Authors: Mearns A J , Deverall P B , Kester R C
Published: March 2007

A case is reported of incipient gangrene of the right arm developing after a Blalock-Taussig (subclavian-pulmonary) shunt operation in an infant. The ischaemia was reversed by immediate common carotid-axillary artery-vein bypass, using a microvascular technique.
Vitamins in intravenous feeding: A study of watersoluble vitamins and folate in critically ill patients receiving intravenous nutrition
Authors: Bradley J A , King R F J G , Schorah C J , Hill G L
Published: March 2007

Red cell B vitamins, folate and white cell vitamin C were measured in a group of critically ill surgical patients before and following a course of intravenous nutrition.

Patients received a widely used vitamin supplementation regimen in the form of one ampoule of watersoluble vitamins daily and recommended doses of intramuscular folate, vitamin B12 and vitamin K weekly. This regimen was adequate to maintain tissue levels of the water-soluble vitamins and folate. Patients with initially low values had normal values at the end of the treatment period.
Effect of gastrointestinal hormone infusions on lower oesophageal competence of Rhesus monkeys
Authors: Moossa A R , Hall A W , Hughes R G , Moraldi A , Moossa D E , Skinner D B
Published: March 2007

The lower oesophageal high pressure zone (HPZ) was studied in 5 non-refluxing and 3 refluxing Rhesus monkeys. The changes in HPZ and reflux status in response to infusion of various doses of secretin, cholecystokinin and glucagon were measured in all animals, and, in the 5 non-refluxing monkeys, after oesophagogastrectomy with replacement of the lower oesophagus by a stomach tube. All three hormones consistently produced a transient decrease in the HPZ pressure. The only change in response following oesophagogastrectomy and gastric tube replacement was a significant delay in the response to each hormone. Neither hormone infusion nor operation altered gastro-oesophageal reflux status.

It appears that lower oesophageal competence in primates is more dependent on the presence of a narrow, muscular, intra-abdominal tube than on a specialized segment of the lower oesophagus.
Heterotopic mediastinal goitre
Authors: Nwafo D C
Published: March 2007

The unusual coexistence in a woman of 34 years of a cervical thyroid and a heterotopic mediastinal thyroid is recorded. Both thyroids had undergone non-toxic nodular enlargement. Recurrent enlargement was noted in the cervical gland 12 months after transpleural thoracic removal of the mediastinal goitre, whilst no corresponding change has so far been noted in the mediastinum. The literature on heterotopic thyroid is briefly reviewed and the diagnosis discussed.
Diagnosis and management of a gastric carcinoid tumour with hepatic metastases
Authors: Maempel F Zammit , Modlin I
Published: March 2007

The gastric carcinoid tumour is a rare variety of carcinoid characterized by atypical production of 5-hydroxytrytophane rather than serotonin. In our case it is likely that other polypeptides are the source of symptoms, though these are as yet unidentified. Since surgery was not feasible in the management of the hepatic metastases, we have used a non-operative technique of embolization to destroy the carcinoid secondaries and ameliorate symptoms. The patient tolerated this procedure well and improved dramatically, with remarkable diminution of liver size and the disappearance of all carcinoi symptoms. Destruction of hepatic secondaries without recourse to surgery has obvious advantages in severly ill patients. Careful attention should, however, be paid to the large quantities of pharmacologically active compounds released from the liver by the procedure.
The injuries of terroist bombing: A study of 1532 consecutive patients
Authors: Hadden W A , Rutherford W H , Merrett J D
Published: March 2007

Of 1532 explosion victims only 9 died in hospital Injury to the chest or abdominal organs was rare (10 patients of whom 5 died). Primary blast lung was apparent in only 2 patients. Major limb amputations occurred in 16 patients of whom 4 died). Primary blast lung was apparent in only 2 pateints. Major limb amputations occurred in 16 pateints of whom 4 died. None of the 50 patients with burns required skin grafts.

Injuries were predominantly to the head and neck and limbs, suggesting the protective effect of clothing. Half of the patients suffered from emotional shock, most with no physical injury and 82 per cent of whom were female.

Eighty-three per cent of patients arrived at hospital between 10.00 a. m. and 7.00 p. m.
Isolated complete transection of the common bile duct by blunt abdominal trauma
Authors: Shorthouse A J , Singh M P , Treasure T , Franklin R H
Published: March 2007

Isolated complete transection of the common bile duct due to blunt trauma is rare. Its occurrence and successful treatment in an 8-year-old boy are described.

Initial minor peritonism resolved quickly, followed by a deceptive asymptomatic period and insidious development of jaundice, anorexia, vomiting, pain, acholic stools and progressive abdominal distension due to sterile biliary ascites. A preliminary cholecystostomy was followed by construction of a Roux-en-Y chole-cystojejunostomy.
Influence of bowel preparation and antimicrobials on colonic microflora
Authors: Arabi Y , Dimock F , Burdon D W , Alexander-Williams J , Keighley M R B
Published: March 2007

The influence of three types of preoperative mechanical bowel preparation on colonic microflora has been studied in 88 patients undergoing elective bowel resection and compared with 21 controls. Neither conventional bowel preparation (CBP) using oral magnesium sulphate, enemas and rectal washouts nor whole bowel irrigation (WBI) via a nasogastric tube influenced the type or number of organisms in the colon at the time of operation. The administration of an elemental diet (ED) was associated with only a small reduction in the numbers of Escherichia coli (P <0.02). The addition of oral neomycin and metronidazole for 48 h before operation to all three methods of bowel preparation was associated with a highly significant reduction in the counts per ml of E. coli (P<0.001) and Bacteroides fragilis (P<0.001) in the colon. There was no correlation between the diameter of the lesion being resected with the numbers of bacteria in the colon even when oral neomycin and metronidazole were added to the bowel preparation.
Primary suture of the perineal wound following rectal excision for inflammatory bowel disease
Authors: Marks C G , Ritchie Jean K , Todd I P , Wadsworth Jane
Published: March 2007

Delay in healing of the perineal wound is a major cause of disability in patients after excision of the rectum.

The outcome of primary suture in 76 patients treated at St Mark's Hospital between 1967 and 1976 was correlated with a number of factors describing the patients, their preparation for surgery and details of surgical technique and management.

The perineal wound healed by first intention in 33 patients. The remaining 43 patients regarded as failures included 7 with delayed breakdown after initial healing.

The results showed that women fared better than men. Excision of the rectum following colectomy and ileostomy was associated with failure of the perineal wound to heal in 9 out of 10 patients. Treatments with peroperative ampicillin and topical antibacterial agents were both correlated significantly with success. Preoperative sepsis and operative contamination were followed by perineal sepsis and wound breakdown on 16 out of 21 occasions.

Discriminant analysis showed that topical and peroperative antibacterial treatments, sex, preoperative sepsis and finally ACTH were the most important variables in descending order of importance. The prediction of success and failure by this procedure was 72.4 per cent correct.