bluuebunny/crossref_metadata_2025_split huggingface dataset:
Anastomotic dehiscence after anterior resection of rectum and sigmoid
Authors: Goligher J C , Graham N G , De Dombal F T 
Published: March 2007

AbstractThe incidence of dehiscence of the anastomosis after anterior resection of the sigmoid colon and rectum was studied by digital examination of the rectum, sigmoidoscopy, and radiological examination after a small barium enema in 73 patients who had undergone the operation for carcinoma, villous papilloma, or diverticular disease. Dehiscence was detected in 37 (or 51 per cent) of the entire series, in 19 (or 40 per cent) of the 47 cases treated by high anterior resection, and in 18 (or 69 per cent) of the 26 cases submitted to low anterior resection. The dehiscences were usually much more extensive after low resection. The possible reasons for these differences are discussed. The effect of other factors on the occurrence of dehiscence was examined:— A simultaneous transverse colostomy was performed in 28 of the 68 patients undergoing primary resection. It was used in most cases after low resection, whilst after high resection it was reserved largely for cases with faecal loading. The unfavourable nature of the patients submitted to simultaneous covering colostomy makes it impossible to evaluate the influence of this step on the incidence of dehiscence.A preliminary transverse colostomy was established 14–21 days before resection in 5 patients. Three of these cases developed anastomotic dehiscence after the resection, so that clearly an empty distal colon at the time of resection provides no certain guarantee against breakdown of the suture line.Preoperative administration of bowel antiseptics in the form of phthalylsulfathiazole and neomycin was associated with a significantly lower rate of dehiscence after high anterior resection, but had no obvious beneficial effect on the incidence of this complication after low resection. Though minimal dehiscences, especially after high anterior resection, often pursued an innocuous, subclinical course, major dehiscences endangered the patient's life and prolonged convalescence. There were 2 deaths in this series attributable to dehiscence, a mortality of 2.7 per cent. The mean period in hospital after high anterior resection was 17 days in patients who did not develop dehiscence and 35 days in those who did; and after low anterior resection it was 44 days when dehiscence did not occur and 48 days when it did.
Hiatus Hernia, a follow-up of 53 operations
Authors: Tanner Norman C , Hardy Kenneth J 
Published: March 2007

Abstract
Fifty-three patients having a hiatal hernia repair between 1951 and 1956 are reviewed. Three patients died within 1 year of surgery and were excluded from the assessment of symptoms. Of 41 having an abdominal repair 80 per cent were classed as Visick 1 or 2. The results for anterior repair of the oesophageal hiatus were better than an anterior and posterior repair; posterior repair was the least effective. Six patients required resection for stenosis, and 10 per cent of the group died of a subsequent carcinoma of the cardia.
Idiopathic and drug-induced ulceration of the small intestine
Authors: Davies D R , Brightmore Terence 
Published: March 2007

Abstract
Ulceration of the small intestine is an uncommon lesion of multifactorial origin. The most important factor responsible for the reported increased incidence is the ingestion of enteric-coated potassium chloride. It is desirable that potassium supplements be given in another form, for example as a slow-release preparation. Other drugs which may play a part in the aetiology include corticosteroids and phenylbutazone.
Diagnosis is difficult and ulceration is usually only demonstrated after one of the complications (obstruction, perforation, or haemorrhage) has occurred. It is imperative that a full drug-taking history is obtained.
Laboratory tests are not helpful in diagnosis, but where radiological studies are carried out they often contribute useful information.
If the symptoms of such an ulcer are severe enough to warrant laparotomy, then the treatment of choice is excision of the affected segment followed by end-to-end anastomosis.
Aorto-iliac thrombo-endarterectomy
Authors: Spiro M , Cotton L T 
Published: March 2007

Abstract
A series of 46 patients, all of whom underwent thrombo-endarterectomy for occlusive atherosclerotic disease of the abdominal aorta and iiiac arteries, is presented. The operative mortality of the whole series is 10 per cent but in the last 32 cases only 3 per cent. This compares favourably with other published series and other reconstructive procedures.
The follow-up ranges from 6 months to 9 years and averages 2 years 6 months in the 42 postoperative survivors. In this group the patency rate is 90 per cent.
The incidence and causation of impotence post-operatively are discussed and measures suggested for avoiding this complication.
Emphasis is laid on the anatomical distribution of the atheroma and its haemodynamic effects as determining factors in the prognosis and the suitability of this disease for treatment by thrombo-endarterectomy. Further advance in the operative treatment of atherosclerosis of the great abdominal vessels should continue to take an ever-increasing account of the perfusion and flow problems intimately associated with the disease and its relief.
Villous tumours of the rectum associated with severe fluid and electrolyte disturbance
Authors: Lee Ralph O , Keown Denis 
Published: March 2007

Abstract
Two cases of villous tumour of the rectum associated with severe electrolyte disturbance leading to renal failure are presented.
Evidence is produced to show that electrolyte loss is general rather than selective and certainly not confined to potassium.
The ratio of sodium to potassium lost in rectal fluid is of the order of 3–4 : 1.
Correction of sodium deficiency, acidosis, and hypovolaemia by the intravenous route is of paramount importance.
Total correction of potassium deficiency in this way is neither practicable nor necessary but particular care should be taken to maintain plasma potassium levels during correction of metabolic acidosis.
Operative removal of the tumour should await restoration of electrolyte and fluid balance.
The effects of systemic zinc supplements on the strength of healing incised wounds in normal rats
Authors: Groundwater W , Macleod Ian B 
Published: March 2007

Abstract
The effect of the systemic administration of zinc sulphate (4.5 mg. Zn per day) to rats on a normal dietary intake of zinc was studied with reference to the tensile strengths of healing skin and musculofascial wounds.
In comparing control and zinc-treated groups, no significant differences in the tensile strengths of 4-day, 7-day, or 10-day wounds were demonstrated.
A new method of testing the strength of anterior abdominal wall wounds by measuring increasing intra-abdominal pressure up to bursting point is described.
Sutured incised wounds of the linea alba were of identical strength in control and zinc-treated animals after 4, 7, and 10 days.
No toxic effects were observed with the dosage of zinc used.
It is concluded that the administration of supplementary zinc has no effect on the healing of sutured, incised wounds in normal rats.
A laboratory appraisal of the effects of truncal and selective vagotomy
Authors: Dignan A P 
Published: March 2007

Abstract
Maximal acid output and insulin tests were carried out in a series of 56 consecutive patients who had either a truncal or a bilateral selective vagotomy and drainage operation. The results of the insulin tests are discussed in the light of criteria established by several authors. The postoperative reduction in basal and maximal acid output was considered, and also the risk of recurrent ulceration. A comparison of the test results of the two types of vagotomy was made, and no significant difference was found.
The diagnostic cytology of breast carcinoma
Authors: Webb A John 
Published: March 2007

Abstract
Fine-needle aspiration of the breast is illustrated, together with a brief review of the development of cytological diagnosis in this field. A series of 168 surgical out-patients presenting with breast pathology have been studied by this method in an attempt to make an early diagnosis. In 108 patients, histological confirmation was available and the accuracy of cytology was 97.3 per cent. The significance of false diagnosis is discussed. It is concluded that the method is reliable.
Routine operative cholangiography
Authors: McEvedy Brian V 
Published: March 2007

Abstract
The usual clinical and operative indications for exploration of the common bile-duct in cholecyst-ectomies or the selective use of operative cholangio-graphy in such cases are discussed and compared with 150 unselected cases of cholecystectomy and routine operative cholangiography. As far as calculi in the common duct are concerned, it seems fair to say that routine operative cholangiography demonstrates stones that would otherwise be left in situ and reduces the cases in which exploration of the common duct is needed. In this series, stones were present in the common bile-duct in 16 per cent; in about one-fifth of these their presence was unsuspected clinically and at laparotomy. Routine use of the technique is found to reduce the number of false positives.
An important secondary benefit of cholangiography is its demonstration of duct anatomy.
Various points of technique are discussed, in particular the use of the cystic duct catheter for post-exploration radiography, drainage, and postoperative radiography.
Routine operative cholangiography appears to be a useful adjunct to cholecystectomy.
Liver scanning in surgical practice
Authors: Watson A , Bruce Torrance H 
Published: March 2007

Abstract
Liver scanning is a simple, safe investigation which can be of value in several clinical situations commonly encountered in surgical practice:— The differential diagnosis of upper abdominal masses.The differential diagnosis of hepatomegaly.The differential diagnosis of jaundice.The detection of right subphrenic abscess.The detection of focal intrahepatic lesions, and the screening of patients with malignant disease.The response of hepatic metastases to therapy.
In the detection of focal intrahepatic lesions an overall accuracy of about 90 per cent was achieved in our series of 185 scans. Clinical findings were suggestive in 57 per cent and liver-function tests in 48 per cent of the patients.
Intrathoracic phaeochromocytoma
Authors: McNeill A D , Groden B M , Neville A M 
Published: March 2007

Abstract
A review of the 22 reported examples of intrathoracic phaeochromocytoma is presented. A further patient is described who also had a second phaeochromocytoma in an ectopic adrenal gland situated in the hilum of the left kidney.
The diagnosis, localization, and pathology of multiple phaeochromocytomas are discussed.
Management of arterial complications in a case of the arterial type of ehlers-danlos syndrome
Authors: Dales H C , O'Neill J J 
Published: March 2007

Abstract
A 15-year-old boy with the arterial type of Ehlers-Danlos syndrome is described with a rupture of the left axillary artery. Suture of the artery was impossible because of the friability of the wall and proximal ligation of the axillary artery, and transfusion of 12 units of blood was necessary to save the patient's life.
Arteriography led to thrombosis of the right common femoral artery, and it is suggested that arteriography should not be attempted in these cases.
The Ehlers-Danlos syndrome is an inherited connective-tissue disorder which has recently been found to be heterogeneous (Barabas, 1967). The ‘arterial type’ is of considerable surgical interest because of the possibility of lethal complications.
One hundred consecutive cases of complete prolapse of the rectum treated by operation
Authors: Küpfer C A , Goligher J C 
Published: March 2007

AbstractOne hundred patients, 17 male and 83 female, ranging in age from a few days to 97 years, have been treated between 1955 and 1969 for complete prolapse of the rectum. One hundred and twelve operations were performed, 91 by the abdominal route, mostly Roscoe Graham repairs or Ivalon sponge implants, with only 2 immediate deaths. The late results were assessed usually by interview and physical examination 6 months to 14 years (mean 5 years 5 months) postoperatively. Seventy-five of the patients who had had abdominal operations were available for such assessment; 5, or 6.6 per cent, were found to have recurrent complete prolapses (and 11 mucosal recurrences of doubtful significance). Anal incontinence, so frequently associated with rectal prolapse, was improved in some of the patients after abdominal repair, but in roughly half the patients there was no improvement and in I case anal control apparently deteriorated after operation.
Proximal gastric resection in the treatment of bleeding gastro-oesophageal varices in patients with portal hypertension due to extrahepatic obstruction
Authors: Rothwell-Jackson R L , Hunt Alan H 
Published: March 2007

Abstract
Proximal gastric resection is, in our opinion, the operation of choice in the treatment of recurrent haemorrhage in three groups of patients with extrahepatic portal obstruction leading to portal hypertension:— In children who are too small for splenorenal or mesocaval anastomosis, when the haemorrhage can no longer be controlled by periodic injection of the varices through an oesophagoscope.In patients of any age with no suitable radicle of the portal venous tree available for portal systemic anastomosis.In patients who have had splenectomy alone or with gastric transection, or who have had previous shunt operations which have failed to control haemorrhage.
It is the only operation short of total gastrectomy in which the varix-bearing area of the stomach is removed. Twenty-eight patients have had this operation at St. Bartholomew's Hospital in the 16-year period 1949-65. The total and late mortality (4 patients) is 14 per cent during a mean follow-up period of 10 years. Only I patient could remotely be considered as an operative death (3.5 per cent). There was no recurrence of haemorrhage in 53 per cent. Three patients (10.5 per cent) had severe haemorrhage from recurrent varices. Two of these died and are included in the mortality figures. The operative procedure is described.
Cryosurgery for neoplasia
Authors: Gill W , Long W , Fraser James , Lee P 
Published: March 2007

Abstract
Certain laboratory findings are presented which we think directly relate to the clinical problems of cryosurgery. Our experience in dealing with a variety of neoplasms is recorded. It is our opinion that the majority of skin tumours, benign and malignant, are best treated in this way and the advantages over radiotherapy and conventional excision are pointed out. Cryotherapeutic results on large tumours such as sarcomas and rectal carcinomas we regard as less satisfactory because of technical reasons.
Cryoprostatectomy on a highly selected group of patients has produced encouraging results although we would still regard this method of treatment as in its infancy and requiring further assessment. A brief comment is made on 33 cases of benign enlargement and 3 carcinomas of the prostate.
The effect of hepatic artery inflow on regeneration, hypertrophy, and portal pressure of the liver following 50 per cent hepatectomy in the dog
Authors: Mizumot R , Wexler M , Slapak M , Kojima Y , McDermott W V 
Published: March 2007

Abstract
Interruption of the hepatic arterial supply in the dog followed by hemihepatectomy has no deleterious effect on the subsequent regeneration or function of the remaining liver. Deprivation of portal flow to half of an intact liver will result in atrophy of that portion and compensatory hypertrophy of the remaining half. This hypertrophy is unaffected by loss of arterial inflow. Thus hepatic arterial inflow appears to be inessential for either regeneration or hypertrophy of the normal canine liver. Hepatic artery ligation significantly decreases the portal hypertension resulting from hemihepatectomy or ligation of a portion of the portal vein, yet subsequent regeneration and hypertrophy are unaffected. Thus increased intrasinusoidal pressure is probably not a controlling factor in regeneration or hypertrophy of the normal canine liver. The above data may apply to the normal human liver: however, in states where compensatory increase of portal blood-flow cannot occur, hypoxic liver failure may result from interruption of hepatic arterial inflow.
Benign prostatic hypertrophy and uraemia. A review of 315 cases
Authors: David Beck A 
Published: March 2007

Abstract
The overall hospital mortality-rate of 315 patients with benign obstructive prostatic disease and renal failure was 21 per cent. One hundred and ninety-four patients (61·6 per cent) were dealt with by prostatic surgery, in the majority of whom a significant improvement in renal function followed a short period of bladder drainage. Only 10 per cent of the patients managed by preliminary suprapubic cystostomy underwent definitive surgery, the greater proportion dying within 15 months of this minor procedure. The importance of fluid and electrolyte imbalance following the acute relief of a chronic lower urinary-tract obstruction is emphasized and the possible use of preoperative dialysis discussed.
Infected adenolymphoma: A New parotid syndrome
Authors: Patey D H , Thackray A C 
Published: March 2007

Abstract
Two cases are presented of acute inflammatory swellings developing in a parotid gland in elderly men and going on to abscess formation. Both proved to be due to secondary infection of adenolymphomas. In the first case the rupture of the abscess led to a salivary fistula; in the second an associated septicaemia threatened the life of the patient. Both patients were successfully treated by a conservative parotidectomy. From a consideration of the clinical and pathological features, it is suggested that the most likely route of infection of the tumours is the blood-stream.
The effect of hypoxia on the platelet count
Authors: Atkins P , Lempke R E 
Published: March 2007

Abstract
The occurrence of low arterial oxygen tensions in postoperative patients is well established. The effect of hypoxia on platelets was therefore studied in 36 rabbits. Two groups were exposed to low oxygen mixtures and a third group was exposed to air in an environmental chamber. In all groups the period of exposure was 24 hours. The hypoxic rabbits showed increased platelet counts from the first to nineteenth days after exposure. The difference in counts between both hypoxic groups and the control rabbits was statistically highly significant after exposure. An increase in platelets may well be an important factor in the aetiology of venous thrombosis. It is consequently suggested that a prophylactic régime against thrombo-embolism should include vigorous efforts to prevent hypoxia in the postoperative period.
Popliteal cysts in children
Authors: Malloch J D 
Published: March 2007

Abstract
Twenty-six popliteal cysts arising in persons under 20 years of age have been excised. In no case was the cyst found to communicate with the knee-joint. Preoperative radiographs in 10 cases confirmed the absence of such a communication. Popliteal cysts in children are congenital bursae and not synovial herniations from the joint. The apparent disappearance of such cysts on flexing the knee is due to the displacement of the bursa to the medial aspect of the knee and not to the displacement of the fluid contents into the joint.
Traumatic perforation in carcinoma of the oesophagus
Authors: Ong G B , Van Langenberg Arthur 
Published: March 2007

Abstract
Two cases of perforated oesophagus due to trauma at the time of examination and biopsy for carcinoma of the mid-thoracic oesophagus are presented. Both had undergone emergency surgical extirpation of growth. One patient, although operated on while still in a state of shock despite resuscitation, survived the procedure and is still alive after more than 5 years. The other case, which was considered to be unsuitable for surgical treatment due to her poor cardiac condition, died on the seventh postoperative day. The cause was probably sudden myocardial insufficiency.
Annular pancreas and jaundice
Authors: Morrell M Tessa , Keynes W Milo 
Published: March 2007

Abstract1. Eight adult cases of jaundice associated with an annular pancreas have been reported. Two more are added.2. Jaundice and dilatation of the common bile-duct are usually due to recurrent pancreatitis of the annulus and are rarely due to gall-stones.3. The dilated duct should be explored for a stone. It is not always necessary to cut the annulus. A stone impacted in the ampulla of Vater may be removed through the common bile-duct if counter-pressure is applied over the papilla.
A controlled trial of inverting versus everting intestinal suture in clinical large-bowel surgery
Authors: Goligher J C , Morris C , McAdam W A F , de Dombal F T , Johnston D 
Published: March 2007

Abstract
A controlled evaluation of a single-layer everting technique of suture versus a conventional two-layer inverting technique has been attempted in clinical large-bowel surgery. Thirty-five patients suffering from carcinoma or other diseases of the large intestine were allocated randomly to each technique in the conduct of various forms of colonic resection with anastomosis or closure of a transverse colostomy. There were 3 operative deaths after everting suture and 1 after inverting suture, all attributable mainly to anastomotic failure. A higher proportion of patients developed wound infection or peritonitis after everting than inverting suture—51 as against 35 per cent. Overt faecal fistulation was observed in no less than 43 per cent of the patients having everting suture, but in only 8·6 per cent of those treated by inverting suture. Late stricture formation was noted in 2 cases after everting suture, but in none after inverting suture.
These experiences are considered to provide a clear condemnation of the use of an everting technique of suture in the large intestine in clinical practice.
A review of three popular methods of treatment of postanal (pilonidal) sinus disease
Authors: Notaras M J 
Published: March 2007

Abstract
Three popular surgical techniques for the treatment of postanal (pilonidal) sinus disease have been evaluated. The lay-open technique appears to have several advantages over the open excision and the primary closure methods.
As the aetiology of this condition is still disputed, and as a result of clinical facts obtained from this study, it is suggested that it be known as a postanal sinus rather than as a pilonidal sinus.
The site of calcification in the human renal papilla
Authors: Cooke S A R 
Published: March 2007

Abstract
In a study of kidneys obtained from adult human subjects at necropsy, the specificity and sensitivity of the alizarin red S method for detecting calcification is confirmed.
A survey of the relevant literature indicates that, while calcification is frequently found in the human renal papilla at necropsy, conflicting opinions have been expressed regarding its anatomical site. In the present study of 62 adult human kidneys, in which specific renal disease had been excluded, papillary calcification was present in 43 (69 per cent). A detailed histological study of the papilla, using thin and thick sections, demonstrates the predominant site of calcification to be in the walls of the long loops of Henle, where it is closely related to the basement membrane.
The nature of papillary calcification and its possible relationship to the physiology of the renal medulla are briefly discussed. The question is raised as to the possible part played by the loops of Henle in the genesis of renal calculi.