bluuebunny/crossref_metadata_2025 huggingface dataset:
Eating patterns in patients recovering from major surgery—a study of voluntary food intake and energy balance
Authors: Hackett A F , Yeung C K , Hill G L
Published: March 2007

Voluntary food intake (VFI) and energy balance were studied in 12 adult patients over a 2-week period following elective colectomy. Daily VFI was recorded by weighing all food presented to the patient as well as any rejected by him or her. Home VFI was estimated by a dietary history technique. Energy balance was calculated from the VFI and from the changes in body fat and protein that occurred over the study period.

The home VFI of the males was greater than that of the females with mean values of 2342 ± 542 kcal per day and 1666 ± 444 kcal per day respectively (mean ± 1 s.d.; P < 0.05).

Eleven patients began to eat 2–7 days after the operation, reaching a maximum VFI in stepwise fashion between 7 and 14 days. The maximum VFI reached during this period was related to the home VFI (r = 0.84; P < 0.01). The twelfth patient required a second operation on the fifth postoperative day and began to eat 4 days later, reaching a maximum after a further 9 days.

No simple relationship was found between postoperative VFI and energy output over the study period. The higher the energy output, the more energy was derived from endogenous fat and protein. An average energy deficit of 1155 kcal per day (range +197 to −2758) was observed, and there was no significant relationship between this deficit and the VFI, which averaged 949 kcal per day (range 371–1833).

It is concluded that the amount of food consumed by post-surgical patients is dependent primarily on their previous home intake and not on their energy output. Patients with high energy outputs do not compensate by increasing VFI and large energy deficits can develop.
The role of thrombolytic therapy in the management of phlegmasia caerulea dolens
Authors: Elliot M S , Immelman E J , Jeffery P , Benatar S R , Funston M R , Smith J A , Jacobs P , Shepstone B J , Ferguson A D , Louw J H
Published: March 2007

Two cases of phlegmasia caerulea dolens with peripheral venous gangrene treated with streptokinase are presented. Both patients had excellent results, beyond expectation. The literature is reviewed and the symptomatology, aetiology, pathogenesis and current thoughts on treatment are discussed.
Short term metronidazole therapy contrasted with povidone-iodine spray in the prevention of wound infection after appendicectomy
Authors: Salem R J , Johnson J , Devitt P
Published: March 2007

In a prospective, randomized trial metronidazole was found to be significantly better than povidone-iodine in reducing the incidence of wound infection after appendicectomy (P < 0.005). The metronidazole was given as a 3-day course and was found to be as effective as the established 7-day course. Over 65 per cent of the wound infections presented after the patients had been discharged from hospital.
Chronic relapsing pancreatitis: A review of 64 cases
Authors: Trapnell J E
Published: March 2007

A collected series of 64 cases of chronic relapsing pancreatitis is reported. Analysis of this material reveals several points of interest. There is a difference in the aetiological spectrum in Britain when compared with reports from France and the United States. In particular, nearly half the British cases were idiopathic. The clinical presentation and the age and sex ratios also varied with aetiology. Endoscopic retrograde cannulation of the pancreatic duct was of little value in confirming a diagnosis of pancreatitis in the problem case. This investigation did, however, demonstrate that a widespread dilatation of the pancreatic duct was a minority finding. In those patients with alcoholic pancreatitis follow-up studies have shown that, if the addiction can be broken, there is a 75 per cent chance that pain will diminish or disappear with the passage of time. The main indication for surgical intervention was severe pain and this study has shown that if strict criteria are observed, a worth-while relief of symptoms can be achieved. In particular, subtotal pancreatectomy produced good results in up to 85 per cent of cases, although with an appreciable short term postoperative morbidity.
Bile composition and osmolarity in the interpretation of formation of bile stones and their classification
Authors: Chaimoff Ch , Menache R
Published: March 2007

We studied the bile and gallstone composition of 38 surgical patients. According to their composition, the stones were classified as: 1, cholesterol stones, when they have more than 60 per cent cholesterol, or 2, pigment or pigment-mixed stones, when they have more than 40 per cent pigments (including stones with more than 30 per cent calcium). In the cholesterol-stone-forming group (24 cases) a ‘supersaturation’ in the cholesterol component of the bile and a concomitant reduction in bile salts was found. No such bile supersaturation was found in those with pigment or pigment-mixed stones (14 cases), or in the control group (8 cases).

The osmolarity of bile in patients with pigment or pigment-mixed stones is significantly higher than in those with cholesterol stones or in controls.

These results suggest a different mechanism for gallstone formation in the two groups: a ‘supersaturation’ of cholesterol with respect to bile salts and phospholipids in the formation of cholesterol stones and an ‘overconcentration’ of all bile components as a whole in the formation of pigment stones.

In an attempt to clarify the aetiology of gallstone formation, we measured in the bile of patients operated on for cholelithiasis the following parameters: cholesterol, bile salts, phospholipids and, for the first time, osmolarity. Chemical analysis of the gallstones was conducted to ascertain the content of cholesterol, pigments and calcium salts. We report the results of our study and the conclusions we have drawn.
Absorption from the jejunum is increased by forward and backward pacing
Authors: Collin Jack , Kelly Keith A , Phillips Sidney F
Published: March 2007

In 4 dogs a 75-cm segment of jejunum was isolated from the intestinal stream. Stimulating electrodes were implanted at each end of the segment and recording electrodes at intervals between. The two ends of the segment were fashioned as stomas on the anterior abdominal wall. After recovery, the electrical activity of the segment was continuously recorded, whilst a solution of 100 mmol/l glucose and 90 mmol/l NaCl was infused into the proximal stoma at 2.9 ml/min. Effluent from the distal stoma was collected in 5-min aliquots for three consecutive 30-min periods. In the second period electrical stimuli were given via either the proximal or the distal bipolar electrodes to entrain pacesetter potentials. Both forward and backward electrical pacing decreased the output of water, glucose and sodium from the jejunal segment, but the decrease was significantly greater with backward pacing. We conclude that pacing a segment of jejunum backwards with electrical stimuli produces a greater increase in absorption from the segment than pacing it forwards, a finding which has therapeutic implications in patients with the short bowel syndrome.
An experimental evaluation of segmental reversal after massive small bowel resection
Authors: Barros D'Sa Aires A B
Published: March 2007

The technique of reversal of a distal segment of residual small intestine was applied to the management of massive resection. A controlled evaluation was carried out in dogs into the effects of segmental reversal on the proximal remnant after the distal 75 per cent of the small bowel had been resected. The variables studied were survival, body weight, glyceryl tri(palmitate-1-14C) absorption and mouth-to-caecum transit time. Animals subjected to resection alone had accelerated intestinal transit, poor absorption, serious weight loss and a high early mortality. It was clearly demonstrated that segmental reversal after resection produced marked and progressive delay in transit time from mouth to caecum, sustained improvement in fat absorption and body weight and enhanced survival.
Reduction in road fatalities and injuries after legislation for compulsory wearing of seat belts: Experience in Victoria and the rest of Australia
Authors: McDermott F T , Hough D E
Published: March 2007

In 1970 the Government of the State of Victoria became the first in the ‘western’ world to introduce legislation for compulsory wearing of seat belts. Within 14 months the other Australian states followed. Seat belt wearing rates increased to attain 90 per cent in 1977.

This paper presents an evaluation of changes during the period 1955–77 in the incidence of road crash fatalities and injuries for vehicle occupants in Victoria and the rest of Australia.

The introduction of the legislation in Victoria and subsequently in the other Australian states coincided with significant and marked decreases in driver and passenger fatality and injury rates (numbers per 10 000 registered vehicles). The decreases were enough to reduce the total numbers of vehicle occupant fatalities and injuries for all post-legislation years in Victoria. The improvements have been maintained throughout the entire post-legislation period.

The legislation did not apply to child passengers of less than 8 years of age and the frequency of seat belt or harness wearing among them remained low. These children did not share in the overall improvement for passengers.

The Australian experience supports the view that legislation for compulsory wearing of seat belts is the singt most effective method available for the protection of vehicle occupants in road crashes.
Prolonged post-vagotomy gastric atony treated by oxytocin
Authors: Hashmonai M , Torem S , Argov S , Barzilai A , Schramek A
Published: March 2007

Persistent and complete post-vagotomy gastric atony was treated in 3 patients by intravenous infusion of oxytocin. Despite failure of both convetional treatment with gastric aspiration and intravenous fluids or jejunal feeding, as well as the reported trials with bethanechol chloride and metoclopramide, these patients promptly responded to oxytocin. It appears that the latter may represent a solution to this uncommon but recalcitrant complication of peptic ulcer surgery.
Experience in the management of 50 consecutive penetrating wounds of the heart
Authors: Mandal Ashis K , Awariefe S Okpako , Oparah Sonny S
Published: March 2007

Fifty patients with penetrating wounds of the heart were grouped into three categories, based on the clinical severity of the injuries.

Gunshot wounds consistenly resulted in a higher mortality than knife wounds. Central venous pressure (CVP) was the single most important means of determining cardiac tamponade. The survival rates in the respective groups were 6, 79 and 100 per cent. The improved survival in our series was due to a rapid transportation system, increased awareness of the significance of cardiac injuries and an aggressive surgical approach.
Pyloric diaphragm, antral web, congenital antral membrane—a surgical rarity?
Authors: Mitchell K G , McGowan A , Smith D C , Gillespie G
Published: March 2007

Three cases of pyloric diaphragm in elderly patients are reported. The finding of these patients within a 2-year period (1976–8) suggests that the condition is not as rare as previously thought. Diagnosis was achieved endoscopically and the condition managed surgically.

While there has been controversy in the past over whether the disorder is acquired or congenital, the histological evidence of the cases presented here tends to suggest that it is a late presentation of a congenital abnormality.
Two gas-gangrene-like infections due to Bacillus cereus
Authors: Fitzpatrick D J , Turnbull P C B , Keane C T , English L F
Published: March 2007

Two cases of postoperative gas-gangrene-like infection due to Bacillus cereus are reported, drawing attention to the fact that Bacillus cereus, a common environmental bacterium, can occasionally give rise to severe postoperative infection. Characteristics of the organism related to the epidemiology and pathogenesis of such infections are discussed.
Leucocyte ascorbate levels and postoperative deep venous thrombosis
Authors: Taylor T V , Raftery A T , Elder J B , Loveday Christine , Dymock I W , Gibbs A C C , Jeacock Julie , Lucas S B , Pell M A
Published: March 2007

Forty-four general surgical patients were included in a prospective, randomized double-blind controlled trial of ascorbic acid (500 mg b.d.) or placebo for 7 days before operation. This was to test the hypothesis that vitamin C may reduce the instance of deep venous thrombosis postoperatively. Venous blood samples were taken before entering the trial, just immediately before surgery, on the day of operation and on three further occasions at 3-day intervals postoperatively for leucocyte ascorbic acid concentration (LAC). Venous thrombosis was diagnosed using the 125I-fibrinogen test and the leg scans interpreted by Roberts' criteria. There was no significant difference in the incidence of DVT between the treatment and placebo groups. In those with DVT (n = 23) the mean LAC on the day of operation was not significantly different from that in those without DTV. However, on the sixth and ninth postoperative days LAC levels were significantly lower in the DVT group. These results suggest that the administration of ascorbic acid preoperatively does not reduce the incidence of DVT, but a striking decrease in the LAC levels in the DVT patients in in keeping with the hypothesis that the initial event in the pathogenesis of DVT is adherence of leucocytes to the venous endothelium.
Solitary toxic adenoma of the thyroid gland
Authors: Bransom C J , Talbot C H , Henry L , Elemenoglou J
Published: March 2007

The incidence of solitary toxic adenoma of the thyroid in a general surgical unit with an interest in thyroid disease has been reviewed over a 15-year period. Six hundred and thirty thyrotoxic cases were treated surgically, 35 (5.6 per cent) having a solitary toxic adenoma. Thyroid enlargement or toxicity had been present for more than 5 years in 7 patients (20.0 per cent). Cardiovascular complications were present in 6 cases (17.1 per cent).

Thyroid lobectomy resulted in 30 (85.7 per cent) euthyroid and 5 (14.3 per cent) hypothyroid patients. One toxic adenoma contained a focus of carcinoma. The clinical features, diagnosis and management of solitary toxic adenoma, and the management of symptomatic nodules which are ‘hot’ but not biochemically toxic, are discussed.
Rupture of the abdominal oesophagus: A review
Authors: Walsh P V
Published: March 2007

‘Spontaneous’ rupture of the oesophagus usually affects the lower third, less commonly the middle third and rarely the cervical oesophagus. Rupture limited to the intra-abdominal oesophagus is rare. Such a case is described here and previously reported cases are reviewed. Vomiting-induced gastro-oesophageal injuries and their aetiology are discussed and the management of spontaneous rupture is reviewed.
Dysphagia following selective vagotomy
Authors: Suleiman S I , Maglad S A , Hobsley M
Published: March 2007

Progression of dysphagia after vagotomy to the stage of complete obstruction due to a peri-oesophageal fibrotic collar needing operaton is a rare event. Review of the 4 such cases previously described, all needing further operation and all after truncal vagotomy, indicates that the oesophageal mucosa was normal on oesophagoscopy and that bouginage appeared to make the condition worse. This paper describes the first patient in whom (a) the vagotomy was selective and (b) no bouginage was carried out before the condition was relieved by a further surgical operation.
Anastomotic recurrence in the oesophagus complicating gastrectomy for adenocarcinoma of the stomach
Authors: Papachristou D N , Karas M , Fortner J G
Published: March 2007

Gastric adenocarcinomas often spread to the distal oesophagus. Failure to control the disease in this area during total and proximal subtotal gastrectomy results in recurrence at the oesophageal anastomosis. The incidence of recurrence in a series of 351 such patients was 10 per cent and was influenced by the location of the main lesion, the stage of the disease, the presence of tumour at the margin of resection and the length of clearance of the oesophageal margin. Recurrences were prevented only with in vivo margins greater than 12 cm. Dysphagia combined with radiological signs of oesophageal obstruction was diagnostic of anastomotic recurrence regardless of the results obtained by oesophagoscopy and biopsy.

Treatment was seldom effective in patients developing recurrence. Complete excision of the entire recurrent process offered the only hope for a long survival in these patients. Prevention by obtaining adequate oesophageal clearance at the time of gastrectomy is the only reasonable approach to this problem. The adequacy of resection cannot be judged accurately by intraoperative palpation of the oesophagus or by frozen section examination of the surgical margins.
Fulminating amoebic colitis: A clinical evaluation
Authors: Vajrabukka T , Dhitavat A , Kichananta B , Sukonthamand Y , Tanphiphat C , Vongviriyatham S
Published: March 2007

Eleven cases of fulminating amoebic colits seen in 5 years are reported. Only people of low socioeconomic status were affected and most were in good health previously. The disease appeared to follow a fulminant course from the onset and was rarely a secondary phenomenon superimposing on the chronic amoebic dysentery. The diagnosis was difficult due to severe systemic manifestations and the periodic absence of Entamoeba histolytica in the stool. The development of colonic necrosis was often masked by the severe preexisting local signs and perforation could occur in spite of adequate anti-amoebic therapy. Mortality was related to late diagnosis, delayed recognition of irreversible colonic necrosis and inadequate surgical treatment.

To reduce the present 55 per cent mortality further it is proposed that, in an endemic area, early specific antiamoebic therapy is justified in severe and undiagnosed colitis. Even under specific anti-amoebic treatment the patient with severe amoebic colitis remains a potential surgical candidate. Surgery is indicated when the patient continues to deteriorate in spite of the therapy, when there is an acute episode which signifies perforation, or when severe diarrhoea, toxaemia and abdominal tenderness persist after a full course of specific anti-amoebic therapy. Primary total resection of the diseased colon is the treatment of choice.
Thyroid cancer: Prognosis in 469 patients
Authors: Staunton M D , Skeet R G
Published: March 2007

A computer study of 469 patients with thyroid cancer is presented. There were 40 per cent anaplastic, 30 per cent papillary, 15 per cent follicular and 15 per cent rarer tumours. The 20-year survival was 7·5 per cent for anaplastic, 55 per cent for papillary and 35 per cent for follicular carcinoma. The dominant role of histology in prognosis is confirmed.

Other important factors are: all patients under 45 reap benefit; females survive longer than males with papillary and follicular tumours. Cervical node metastases confer no depression in papillary tumours. Local tumour advance depresses survival but cililates diagnosis. We find merit in the TNM classification, but warn against overelaboration.

We regret our failure to assess the differential effect of individual treatment, which poses a continuing challenge to oncologists.
Randomized prospective matched pair study comparing peritoneovenous shunt and conventional therapy in massive ascites
Authors: Wapnick Simon , Grosberg Saul J , Evans Mark I
Published: March 2007

A prospective randomized matched pair study was designed to test the efficacy of the peritoneovenous (LeVeen) shunt as a treatment for massive cirrhotic ascites compared with traditional medical therapy. Patients who failed to lose weight while on a low salt diet and fluids restricted to 1000 ml daily were placed in the study group. Weight loss, decrease in abdominal girth and diuresis were significantly greater (P < 0·01) for surgical patients than for their medically treated counterparts. The surgical technique is simple, quick and inexpensive. The surgical patients outlived their matched partners in 12 of 14 pairs where a definitive comparison was possible (P < 0·02). The median stay in hospital after randomization was shortened from 32 days with medical therapy to 15 days for those undergoing the shunt operation. Those treated medically experienced a significant rise in mean blood urea nitrogen and K+ (P < 0·02). Patients with alcoholic hepatitis, hyperbilirubinaemia (bilirubin > 154 m̈mol/l), peritoneal sepsis, severe coagulopathy and those who had recently bled from oesophageal varices are poor risks for the surgical procedure.
The use of the Hickman catheter in the management of patients with leukaemia and other malignancies
Authors: Thomas Meirion
Published: March 2007

The use of the Hickman right atrial catheter in 25 patients with leukaemia and other malignancies is reported, and it is concluded that with careful selection of patients, the benefits of this semi-permanent catheter outweigh the risks of infection. The catheter may be useful in the intensive care of children or adults with non-malignant conditions.
Breast cancer and prostaglandins: A new approach to treatment
Authors: Leaper D J , French B T , Bennett A
Published: March 2007

The effect of the non-steroidal inhibitor of prostaglandin synthesis, flurbiprofen, has been studied on a transplanted mouse mammary tumour of spontaneous origin. Daily administration of 2·5 mg/kg flurbiprofen significantly reduced the growth of this NC adenocarcinoma transplanted subcutaneously into the right flank of WHT/Ht mice. Histological examination showed that primary tumours excised at 3 weeks from treated mice tended to have a more prominent lymphocytic infiltration. There was a non-significant tendency for mice treated with flurbiprofen alone to survive longer after tumour excision and to develop less local metastases, although scar recurrences seemed unaffected. The effect of adjuvant chemotherapy and local radiotherapy on local metastases and survival time tended to be greater when flurbiprofen was also given. This work supports and extends the basis for prospective clinical trials to evaluate the role of prostaglandins in Luman cancer and the value of prostaglandin synthesis inhibitors in cancer therapy.
The effect of uraemia upon wound healing: An experimental study
Authors: Colin J F , Elliot P , Ellis H
Published: March 2007

Acute uraemia was induced in rats by performing a 70 per cent nephrectomy. Uraemia was shown to delay the healing of intestinal anastomoses and abdominal wounds in rats as judged by bursting strength tests. Cellular proliferation was depressed at wound edges but there was no reduction in the total amount of hydroxyproline present in the wounds. Fibroblast growth in tissue culture was affected by the addition both of uraemic plasma and of urea solution to the culture medium. The possible causes of these effects are discussed.
Adjuvant cytotoxic liver perfusion for colorectal cancer
Authors: Taylor I , Rowling J , West C
Published: March 2007

Colorectal liver metastases develop by malignant cells entering the portal venous circulation. A randomized prospective clinical trial was commenced in 1975 to assess the value of adjuvant umbilical vein cytotoxic perfusion (with 5-fluorouracil) following colorectal resection.

One hundred and fifty-four patients without macroscopic liver secondaries have so far entered the trial. The mean age, sex, site and stage of the disease were similar in the control and perfusion groups and there was no statistically significant difference in postoperative complications or hospital stay (17·1 ± 7·9 days control, 15·8 ± 7·4 days perfusion group).

So far, 23 deaths have occurred in the control group (20 due to recurrent disease) and 7 in the perfusion. group (5 due to recurrent disease) Liver metastases were present in 13 control patients and 2 perfusion patients.

These results show an encouraging trend and suggest that adjuvant cytotoxic liver perfusion may reduce the development of colorectal liver metastases and hence improve the subsequent prognosis.
Continent anal ileostomy with mucosal proctectomy: A bloodless technique using a surgical ultrasonic aspirator in dogs
Authors: Hodgson W J B , Finkelstein J L , Woodriffe Phillipa , Aufses A H
Published: March 2007

At present, mucosal proctectomy with ileo-anal anastomosis is a difficult, time-consuming operation involving much blood loss, often associated with impaired postoperative continence. A new operation has been devised in our department in which a surgical ultrasonic aspirator, the CUSATM System (Cavitron Corporation) was used to fragment directly and strip bloodlessly mucosa from the rectal wall in 20 dogs as part of a simple ileo-anal sleeve anastomosis. All dogs were closely followed for up to 10 months. The only operative mortality occurred in the first dog where the upper rectum sloughed because the superior haemorrhoidal artery was divided. Preoperative weight was regained within the first 2 months. Initially stools were loose and frequent. Within 2 weeks the daily stool count was 5–6 with gradual thickening to semisolid consistency by 6 weeks. Finally 3–4 normal stools were passed daily. Postoperatively, all dogs remained continent.
Modulation of the immune response and control of tumour spread by a new synthetic compound
Authors: Falk R E , Makowka L , Nossal N , Falk J A , Fields J E , Asculai S S
Published: March 2007

A small molecular weight biofunctional polymer, NED 137, has been investigated for its anti-neoplastic effect. Through its effect on the immune system, particularly the induction of B cell differentiation to antibody producing cells, this synthetic compound can retard tumour growth and prevent the development of distant metastases. Reactivity to tumour developed following administration of the NED 137. No toxicity has been observed. The polymer NED 137 is now being tested in phase I and phase II clinical trials.
The effect of epidural analgesia on postoperative sodium balance
Authors: Gow N Menzies , Cochrane J P S
Published: March 2007

The effect of a high epidural blockade on postoperative sodium (Na) retention has been studied in 8 patients undergoing cholecystectomy, with a further 8 patients, who received conventional anaesthesia and analgesia, acting as a control group. Preoperatively, all the patients received 90 mmol of Na per day and were in Na balance at the start of operation; this intake was continued for 48 h after the operation by intravenous infusion, and the epidural blockade was maintained with regular supplements of bupivacaine throughout. In addition to urine Na excretion and blood pressure changes, plasma levels of aldosterone, cortisol, renin activity and glucose were measured at appropriate intervals.

The Na retention in both the epidural and control groups was the same (139 mmol and 135 mmol respectively at 48 h), but there were significant differences in the measurements of all the other factors. It is concluded that the epidural was providing effective blockade, but that the factors which cause Na retention were not affected by the epidural blockade. These results are at variance with another study of the effect of epidural blockade on postoperative Na retention (Bevan, 1971), and the possible reasons for this are discussed.
The value of routine preoperative urological assessment in patients undergoing elective surgery for diverticular disease or carcinoma of the large bowel
Authors: Peel A L G , Benyon L , Grace R H
Published: March 2007

A consecutive series of 176 patients was studied prospectively in order to assess the value of full urological assessment prior to elective colorectal surgery for carcinoma or diverticular disease.

Fifty-one patients had urological symptoms and 29 of these had an abnormal intravenous urogram (IVU); when compared with the 125 asymptomatic patients, they were twice as likely to develop acute retention of urine and four times more likely to require prostatectomy.

Twenty of the 31 patients with an abdominal mass had an abnormal intravenous urogram, and the presence of this physical sign may be regarded as an absolute indication for IVU.

Forty-five patients had a urological abnormality on the preoperative IVU; of these, 1 in 6 required treatment prior to elective large bowel surgery and 1 in 3 developed acute retention of urine postoperatively (half required prostatectomy). Twenty-two patients had a disease-related abnormality on preoperative IVU and in 12 planned urological surgery was undertaken at the time of the colorectal resection. In the 91 patients with no urological symptoms, no abnormal mass and normal blood urea and mid-stream urine sample, the incidence of IVU abnormalities and of postoperative complications was low and surgical management was not altered in these patients.
Intraoperative irrigation of the colon to permit primary anastomosis
Authors: Dudley H A F , Radcliffe A G , McGeehan D
Published: March 2007

A technique is described which permits intraoperative application of antegrade bowel irrigation to clear the obstructed or loaded colon of faeces with minimal risk of cantamination. The procedure extends the indications for safe primary anastomosis in surgery of the left colon.
Haemodynamic effects of splenectomy and vasoligation in bilharzial hepatic fibrosis
Authors: El Masri S H , Boulos P B , Ibrahim O H , Hassan M A
Published: March 2007

Patients with bilharzial hepatic fibrosis, when compared with control subjects, were found to be hypervolaemic as a result of increased plasma volume. The estimated hepatic blood flow in these patients was not significantly different from that of healthy individuals.

Splenectomy and vasoligation was followed by a drop in portal pressure measured through an omental vein at operation. The estimated hepatic blood flow, however, was not altered by this surgical procedure. The blood volume, which was found to correlate with the size of the spleen, diminished and so did the plasma volume when measured after this operation.
Graduated, static, external compression of the lower limb: A physiological assessment
Authors: Lawrence D , Kakkar V V
Published: March 2007

A five-chambered pneumatic vinyl sleeve was used to determine the optimum pressure range of graduated, static, external compression of the lower limb, which would be most beneficial in increasing deep venous velocity.

The effects of four different ranges of pressure upon deep venous velocity (technitium-99), calf muscle blood flow (xenon-133) and subcutaneous tissue flow (sodium-24) were measured in recumbent patients.

The pressure range 18, 14, 8, 10, 8 mmHg produced a significant increase in mean deep venous velocity (P < 0·02) without any consequent impairment of either calf muscle blood flow or subcutaneous tissue flow. A higher pressure range of 30, 26, 14, 18, 12 mmHg also produced an increase in mean deep venous velocity, but caused a significant impairment of calf subcutaneous tissue flow.
The release of vasoactive intestinal peptide during altered mid-gut blood flow
Authors: Bateson P G , Buchanan K D , Stewart Davina M , Parks T G
Published: March 2007

In a series of 17 dogs of which 6 were controls experiments were undertaken to measure arterial and portal vasoactive intestinal peptide (VIP) levels during reduced cephalic mesenteric artery flow states and following reperfusion of the ischaemic mid gut. The flow states examined were basal flow, 50 per cent of basal flow and 25 per cent of basal flow. Zero flow was examined for 20 min and reperfusion of the ischaemic mid gut for 20 min. Peripheral and portal VIP levels were found to be massively elevated during all the flow states studied but particularly during reperfusion of the ischaemic mid gut.
Selective primary suture of the battle-injured colon: An experience of the Nigerian Civil War
Authors: Nwafo David C
Published: March 2007

During the 1967–9 phase of the Nigerian Civil War, 38 primary sutures of battle-injured colons were carried out, with 3 deaths, all in patients with severe concomitant injuries to the liver, diaphragm and right iliac crest. In carefully selected cases—one-third of the total—primary suture was a safe and reliable technique for dealing with battle-lacerated colons. Although there was a substantial morbidity (71 per cent) from wound sepsis, there was also a considerable reduction in the period spent in hospital.
Dependent proximal loop colostomy: Does it defunction the distal colon?
Authors: Schofield Philip F , Cade David , Lambert Mark
Published: March 2007

The operation of dependent proximal loop colostomy is described. This colostomy avoids the complications of prolapse and paracolostomy hernia and is easy to close. It appears clinically to totally defunction the distal colon; his ability was studied by means of a radioactive tracer. Ten patients were given chromium-51 by mouth and it was found that none of this spilled over into the distal loop. It is concluded that dependent proximal loop colostomies effectively defunction the distal colon.
Simultaneous isotope clearance from the muscles of the calf and thigh
Authors: Angelides N S , Nicolaides A N
Published: March 2007

There has been no end to the attempts made to determine the site and severity of arterial lesions in claudicants by the use of non-invasive methods but, so far, their diagnostic value has been limited. A method whose diagnostic accuracy in determining the site and functional severity of the lesions approaches that of arteriography is discussed.

The hyperaemic index, which is the ratio of the total excess of blood supply during post-exercise hyperaemia over the maximum hyperaemic flow, has been determined in the thigh and calf simultaneously, by measuring the 99Tcm muscle clearance in 30 limbs of 20 healthy volunteers and 139 limbs of 145 patients with claudication. Lumbar arteriography classified the lesions in all patients as 0–10 percent, 10–40 percent, 40–70 percent and more than 70 per cent stenosis.

A bivariate analysis of the hyperaemic indices of the thigh and calf determined the site and whether single lesions consisted of a stenosis greater or less than 70 per cent. In limbs with combined aorto-iliac and superficial femoral lesions the values of the hyperaemic indices could determine which of the two lesions was the more severe in addition to whether lesions consisted of a stenosis greater or less than 70 per cent.

These findings have been confirmed in a further blind prospective study of 47 limbs in which determination of the site and severity of lesions preceded aortography.
Amputation for vascular disease: The experience of a peripheral vascular unit
Authors: Finch D R A , Macdougal M , Tibbs D J , Morris P J
Published: March 2007

One hundred and forty-five lower limb amputations were performed on 133 patients over a 3 1/2 year period with a hospital mortality of 15 per cent. The mean age of the amputees was 72·2 years (range 43–90 years). The most common site of amputation was below the knee (42 per cent). Failure to obtain primary healing of the stump occurred in 20 per cent of patients and proximal reamputation was required in 8·3 per cent of patients. The ankle systolic blood pressure was not found to be of value in predicting those below-knee amputation stumps which would fail to heal.

Accumulated survival figures showed that 45 per cent of amputees died within 2 years of amputation and only 25 per cent were alive at the end of 4 years. The survival of diabetic amputees was significantly worse than that of non-diabetic amputees.

Sixty-nine per cent of amputees were admitted to a special rehabilitation unit. At a mean of 2 1/2 years after amputation, 95 per cent of surviving amputees had been successfully integrated back into the community. Seventy-five per cent of amputees who had been fitted with a prosthesis made regular daily use of it but only 50 per cent were mobile beyond their own home. Progression of generalized vascular disease was the most common cause of restricted mobility.

As the life expectancy of most amputees is limited every effort must be made to avoid any delay in their recovery and rehabilitation.
The significance of blood pressure measurements in patients with peripheral vascular disease
Authors: Evans David H , Quin Roger O , Bell Peter R F
Published: March 2007

The pressure drop across a stenosis is related only to its geometry and the flow through it. Flow may be manipulated by changing peripheral resistance, enabling information to be gained about the severity of the stenosis. As changes in blood flow may produce changes in local blood pressure in patients with peripheral arterial disease, measurements of blood pressure should be made at flow conditions appropriate to the symptoms under investigation, or should be performed by methods which do not intrinsically alter flow.
The insertion of oesophagogastric tubes in malignant oesophageal strictures: Endoscopy or surgery?
Authors: Lishman A H , Dellipiani A W , Devlin H B
Published: March 2007

Oesophagogastric tubes were inserted into 16 patients with malignant strictures of the distal oesophagus by a method employing the flexible fibreoptic endoscope, and these patients were compared with 28 patients in the same hospital whose tubes were inserted by surgical methods. Four patients (25 per cent) in the endoscopic group died in the immediate post-insertion period as a result of the procedure, compared with 13 patients (45 per cent) in the surgical group. Of the remainder, the majority were mobilized and taking diet on the day following the procedure, and the morbidity associated with the surgical method was not seen in the endoscopic group. It is concluded that the endoscopic insertion of oesophagogastric tubes has advantages over surgical insertion in the palliation of malignant oesophageal strictures.
Ligation of the pancreatic duct in pancreatectomy
Authors: Papachristou D N , D'Agostin H , Fortner J O
Published: March 2007

This study was undertaken to determine the safety of duct ligation in pancreatic surgery. Duct ligation was performed in 43 patients after pancreaticoduodenectomy and in 108 patients after distal pancreatectomy; 33 patients had a pancreaticojejunostomy after a pancreaticoduodenectomy. All procedures were performed between 1965 and 1975; the analysis was retrospective. The mortality and morbidity for the duct ligation group after pancreaticoduodenectomy were 19 per cent and 77 per cent and after distal pancreatectomy were 4 per cent and 9 per cent respectively. After pancreaticoduodenectomy with pancreaticojejunostomy the mortality was 18 per cent with a morbidity of 33 per cent. It is concluded that distal pancreatectomy with duct ligation is a relatively safe procedure, while after pancreaticoduodenectomy the morbidity is significantly reduced (P < 0·001) by a pancreaticojejunostomy.
Rectal stricture resection using the EEA autostapler
Authors: Ross A H McLean
Published: March 2007

A case of postoperative rectal stricture treated using an autostapling device is reported.
Spontaneous closure of choledochoduodenostomy: Diagnosis by endoscopy and ERCP
Authors: Reuben A , Jourdan M H , Isaacs P E T , McColl I
Published: March 2007

Choledochoduodenostomy has been recommended for the management of benign lower common bile duct obstruction, but opinion on this is still divided. Two cases are presented of recurrent cholangitis following choledochoduodenostomy, in which endoscopy and ERCP demonstrated closure of the choledochoduodenal anastomosis, continuing lower biliary obstruction and retained stones or debris. Persistent or recurrent symptoms following this operation may be due to stoma closure without adequate biliary drainage, and in these circumstances endoscopy with ERCP is proving most useful and in difficult cases may be the investigation of choice.
A pocket calculator program for intravenous requirements
Authors: Rich A J , Wright P D
Published: March 2007

A program to calculate the 24-h intravenous requirements of water, nitrogen, energy and six electrolytes on a card-programmable pocket calculator is described. Comparison of calculator-generated requirements with intravenous feeding regimens prescribed by junior clinicians for 8 ill patients suggests that the clinicians provide too much water and too little nitrogen and energy. Certain program modifications are necessary to widen the useful clinical application of the calculator, but in general it is a useful bedside tool capable of further application to suitable medical tasks.
Bile bacteria in patients with benign bile duct stricture
Authors: Jackaman F R , Hilson G R F , Smith Lord
Published: March 2007

In a prospective study of 73 patients undergoing hepatodochojejunostomy for benign bile duct stricture who were covered by antibacterial prophylaxis with gentamicin and cephalothin, bacteria were cultured from bile sampled at operation in 80 per cent of cases. Aerobic organisms were found in 50 cases (82 per cent) and anaerobic organisms in 11 cases (18 per cent). Seventy-three per cent of the patients with postoperative septic complications had bile cultures positive for anaerobes at operation, and the same organisms were cultured from pus. All patients with anaerobes in the bile at some time in the perioperative period developed postoperative sepsis. Antibacterial prophylaxis with gentamicin and cephalothin, together with specfic therapy with drugs effective against anaerobes when indicated, are recommended in the management of these cases.
Occipital ‘sebaceous cysts’—a trap for the unwary
Authors: Lye Richard H , Pickard John D
Published: March 2007

The risk of delayed intracranial abscess formation following excision of an occipital dermal sinus or cyst is illustrated by three recent cases. Once suspected, posterior fossa epidermoid and dermoid cysts are readily diagnosed by CT scanning.
The functional results of aorto-iliac reconstruction
Authors: Galland R B , Hill D A , Gustave R , Jamieson C W
Published: March 2007

We have reviewed the results of aorto-iliac reconstruction in 173 patients. We found that the presence of distal disease resulted in significantly worse results, when assessed by the patients' ability to walk and by postoperative pressure index changes, than if the run-off were clear. The importance of subsequent or simultaneous distal reconstruction in these cases is discussed.

Patients having rest pain were older, had a worse runoff and had a higher incidence of associated disorders than patients having intermittent claudication alone.
Psoas abscess: A complication of Crohn's disease
Authors: Burul C J , Ritchie Jean K , Hawley P R , Todd Ian P
Published: March 2007

Between 1971 and 1978 at St Mark's Hospital and St Bartholomew's Hospital, 8 patients were seen with a psoas abscess complicating Crohn's disease. All patients had a long history of disease and the diagnosis was usually obvious on clinical grounds. The abscess was drained in all patients and 5 required drainage on more than one occasion. The underlying Crohn's disease was treated surgically in all patients. Seven patients are now well, although 2 have required further excisional surgery; 1 patient died 2– years after the first drainage of the psoas abscess.
Is a fat stitch necessary?
Authors: Milewski P J , Thomson Hamish
Published: March 2007

Two hundred and eight consecutive patients undergoing surgery were allocated randomly in a trial of the use of a plain catgut subcutaneous fat stitch, compared with no fat suture. There was no appreciable difference between the two trial groups in wound infection rate following either clean (4 out of 74 with and 1 out of 68 without a fat stitch) or contaminated operations (4 out of 27 with and 4 out of 41 without). Likewise, there were no differences in haematoma rates. There is therefore no appreciable benefit to be derived from the use of this stitch.
Vertical abdominal incisions—a choice?
Authors: Guillou P J , Hall T J , Donaldson D R , Broughton A C , Brennan T G
Published: March 2007

A prospective randomized trial was carried out on 207 patients undergoing laparotomy using three different vertical abdominal incisions–midline, ‘medial’ paramedian incision and ‘lateral’ paramedian incision. The lateral paramedian incision is slightly more time-consuming to perform than the other two incisions but there is a statistically greater incidence of incisional hernia in midline and medial paramedian wounds than with the lateral paramedian incision. It is suggested that when a vertical abdominal incision is being considered the lateral paramedian should be the incision of choice.
Operative choledochoscopy: Experience with a rigid choledochoscope
Authors: Motson Roger W , Wood Alan J , De Jode Louis R
Published: March 2007

The use of a choledochoscope after exploration of the common bile ducts should minimize the occurrence of retained common bile duct stones. Experience gained at 50 endoscopies with a rigid choledochoscope is reviewed. In 7 cases stones or debris were found remaining in the bile duct. In one case an unsuspected neoplasm was demonstrated and in another a suspected neoplastic stricture was confirmed. In the remaining 41 cases choledochoscopy showed the ducts to be free of stones. Postoperative cholangiography demonstrated a retained stone in 2 cases. There were 2 deaths in the series. The experience of other authors with rigid and flexible scopes is reviewed.
The treatment of complete rectal prolapse by graciloplasty
Authors: Atri S P
Published: March 2007

The treatment of complete rectal prolapse by transposition of the gracilis muscles has been undertaken in 15 patients. It is a simple procedure which cures the prolapse and gives good functional results.
Results following surgery for Hirschsprung's disease: A review of three operations with a reference to neorectal capacity
Authors: Khan Omar , Nixon Harold H
Published: March 2007

The results of operations on a group of 62 patients from those operated for Hirschsprung's disease in a 5-yearperiod have been assessed. The bowel function and control, also the physical development of the child, have been examined following operation by the Swenson, Duhamel and sutured Soave techniques. The best results were achieved by the Duhamel retrorectal pullthrough operation, although the differences were not great.

Late deaths due to an unrecognized enterocolitis remain a problem.
Hemiagenesis of the thyroid gland
Authors: Greening W P , Sarker S K , Osborne M P
Published: March 2007

Three cases of hemiagenesis of the thyroid gland are reported and the literature reviewed. It is emphasized that this rare congenital anomaly is seldom diagnosed except by thyroid scanning or at surgery. If the clinician is aware of it, the diagnosis presents little difficulty and an unnecessary operation may be avoided. All our cases were discovered as a result of an associated thyroid disorder. In 2 cases there was an adenoma and in 1 a papillary adenocarcinoma.
The effect of different calorific doses of carbohydrate on nitrogen excretion after surgery
Authors: Radcliffe A , Johnson A , Dudley H A F
Published: March 2007

The protein-sparing effect of different calorific regimens [0·025 MJ (6 kcal); 0·105 MJ (25 kcal); 0·167 MJ (40 kcal) per kg body weight per 24 h] of postoperatively infused glucose has been studied in 18 patients undergoing operations of intermediate severity. Carbohydrate infusion has a progressive nitrogen-sparing effect. However, the increased negative nitrogen balance associated with surgical stress could not be prevented completely.
The late results of surgical treatment of pressure sores in paraplegics
Authors: Berry R B
Published: March 2007

The findings are presented of a retrospective survey of paraplegic patients who underwent surgical repair of pressure sores between 1973 and 1977. Forty-one patients with 56 sores were studied. The recurrence rate of repaired sores was 47 per cent. In an analysis of the data the only factor associated with a good long term result was a return home rather than chronic hospitalization following surgery. This finding applied to bedridden but not to sitting patients.