bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Anomanometer: Its Use in the Assessment of Continence and in the Diagnosis of Hirschsprung's Disease
Authors: VARMA F. K. , HUNT T. W. , STEPHENS F. DOUGLAS 
Published: January 2008

The purpose of this paper is to describe the anomanometer, a versatile instrument, portable and easy to use. It has been used for (a) assessment of continence after surgery for anorectal malformations; and (b) the diagnosis of Hirschsprung's disease in children. The measurement of the resting and voluntary squeeze pressures provides the criteria upon which it is possible to quantify continence after surgical correction of anorectal malformations. The anomanometer records the biphasic response of the sphincters to rectal distension in normal children and the lack of the relaxation phase in Hirschsprung's disease, thus providing a convenient and simple method of diagnosis.SummaryA portable anomanometer has been devised and has proved useful for the purposes of (a) assessment of continence after surgery for anorectal anomalies, and (b) the diagnosis of Hirschsprung's disease.It consists of a single air‐filled tambour‐type balloon mounted on a Perspex probe and connected through a transducer to an analogue readout, so that changes of pressure in the balloon induced by the sphincter muscles of the anal canal are registered as deflections of the needle of the meter.Two measurements obtained by the anomanometer provide criteria of postoperative anal sphincter function, namely the resting tone of the sphincter muscle and the voluntary squeeze pressure. Children who had had surgical reconstruction of the anal canal for supralevator, intermediate and translevator abnormalities were tested. A combination of a resting tone of 20 mm Hg with a voluntary squeeze pressure of 30 mm Hg or more was associated with an excellent state of continence, whereas the combination of a resting tone below 15 mm Hg and a voluntary squeeze less than 30 mm Hg corresponded with a clinical state of socially unacceptable incontinence. Those children with borderline resting tone of the sphincter and voluntary squeeze pressures above 30 mm Hg have varied degrees of impaired sphincter function, which may be improved in some by hardening of the fæces, education or the lapse of time.The anomanometer detected in a very reliable manner the anal responses to rectal distension, and in particular the lack of reflex relaxation of the internal sphincter in patients with Hirschsprung's disease. It proved to be a simple economical apparatus not only for the detection of Hirschsprung's disease, but also for eliminating this possibility in many patients.
Combined Chemotherapy, Radiotherapy, and Surgery in the Treatment of Advanced but Localized Solid Malignant Tumours1
Authors: Stephens Frederick O. 
Published: January 2008

The most effective use of chemotherapeutic agents is in a planned combined approach in the treatment of lesions in patients who would not be expected to have a good prognosis with standard therapy. For advanced squamous carcinomata, the combination of bleomycin and Methotrexate has been effective in reducing the size and extent of the tumours in this series. Chemotherapy alone does not “cure” cancers, but follow‐up radiotherapy or surgery should be used to achieve the best long‐term results. The use of chemotherapeutic agents for the treatment of carcinomata which are recurrent after previous radiotherapy or surgery is much less likely to be effective. Newer chemotherapeutic approaches are required to attempt to improve the outlook of patients with lesions which cannot be directly infused intraartcrially, for patients with massive lymph node involvement, and especially for patients who have recurrent lesions after previous irradiation or surgery. The combination of bleomycin and Methotrexate with vincristine was highly effective in some patients, but in two of eight patients given this combination by intravenous administration there was a fatal pancytopenia, and this combination is therefore not recommended. From our small experience of a good result in three patients treated with the combination or bleomycin, Methotrexate and hydroxyurea, two of whom had massive metastatic involvement of lymph nodes which responded to chemotherapy, while the other had a fungating carcinoma of lip recurrent after previous irradiation and surgery, it would seem that further use of this combination should be evaluated.Finally, it is imperative that all patients with advanced lesions or lesions which are not readily eradicated by standard means are better seen in a properly constituted consultative clinic for patients with malignant disease before therapy is commenced. No one clinician alone, be he physician, surgeon, or radiotherapist, can have all the appropriate expertise required for coping with patients with these most formidable problems. The opinions of others must be sought and obtained in order to be certain that each patient is given the most appropriate treatment in a well‐planned regimen. It is no longer appropriate for any one clinician to treat his patients with the expertise which he has available to himself and refer his failures for some other form of treatment which at that stage may well be ineffective.
The Detection of Serological Factors in Acute Ulcerative Colitis Indicating a Favourable Short‐Term Prognosis
Authors: Hunt P. S. , Trotter S. 
Published: January 2008

Large‐intestinal epithelial cells were obtained from operation specimens and by biopsy at sigmoidoscopy frotn 16 patients with acute severe mucosal ulcerative colitis and II control subjects with normal large‐bowel mucosa. The ability of lymphocytes to release 51Cr label from large‐intestinal epithelial cells was quantitatively assessed as percentage lymphocyte activity. The mean ± standard deviation of percentage lymphocyte activity in 16 patients with acute ulcerative colitis on admission to hospital (88 ± 8) was significantly greater than that in n normal subjects (16 ± 8) (P <0.01).In each study, samples of autologous serum were added to two reactions between lymphocytes and autologous large‐intestinal epithelial cells. The results in the seven patients who came to urgent colectomy differed significantly from those in the nine who responded to corticosteroids. The mean ± S.D. of percentage serological inhibition of lymphocyte activity in the group coming to colectomy was 44 ± 16, and in those responding to steroids 12 ± 5. When the serum of these patients was studied for immunofluorescent autoantibodies to normal human colonic mucosa, none of the seven patients treated by colectomy had detectable autoantibodies, in contrast with three of the nine patients with a more favourable short‐term prognosis, in that they responded to steroid treatment.
PERFORATED PEPTIC ULCER: AN ANALYSIS OF 246 CASES1
Authors: Anseline P. 
Published: January 2008

An analysis of 246 cases of perforated peptic ulcer, treated at the Royal Newcastle Hospital from 1964 to 1974, is presented. The incidence has fallen considerably over that period. The rising proportion of women has reached a plateau. A perforated peptic ulcer in an Australian woman is still just as likely to be located in the stomach as In the duodenum. In men, however, 84% of perforations are pyloroduodenal. A perforated gastric ulcer is closely associated with the use of salicylate preparations. The mortality rate has remained steady at 15% over the last 30 years. It is significantly higher in women.There is a highly significant relationship between the mortality and (a) the duration of perforation; and (b) the size of the perforation, particularly if it is located in the stomach.
THE EFFECT OF COLLOID CONCENTRATION ON THE FUNCTIONAL CHARACTERISTICS OF ISOLATED PERFUSED RAT LIVER
Authors: Lee D. , Holland Robyn K. , Groufsky Anne K. 
Published: January 2008

The volume of bile produced by isolated perfused rat liver was dependent on the concentration of bovine serum albumin (BSA) in the perfusate, the lowest volumes being obtained with Krebs Ringer bicarbonate (KRB) alone and with 70 g/l. BSA In KRB. Increasing amounts were produced as the concentration of BSA was reduced from 70 g/l. to 8.5 g/l. The concentration of bile salts in the bile decreased rapidly during the first hour, but much more slowly thereafter. The highest concentration observed during the first hour was with KRB alone and the lowest with 20 g/l. BSA; subsequently, the highest concentrations were obtained with 70 g/l. BSA and the lowest with 20 g/l. BSA.Urea synthesis was lowest with KRB alone, but increased as the concentration of BSA increased; however, values obtained with 8.5, 20, and 40 g/l. were fairly close together. With KRB alone there was a rapid release of potassium during the first hour, but thereafter the rate of release was similar to that found when BSA was present. The lowest concentrations of potassium were obtained with 20 and 40 g/l. BSA. With KRB alone, GOT was released from the start of perfusion of 300 units per minute. With BSA present, GOT release was delayed 4 hours, and thereafter the rate was dependent on the concentration of BSA, being lowest with 20 and 40 g/l. (200 units per min), higher with 8.5 g/l. (350 units per min) and highest with 70 g/l. (400 units per min).
BONE SCINTIGRAPHY IN DISCITIS AND RELATED DISORDERS IN CHILDREN
Authors: ATKINSON R. N. , PATERSON DENNISC. , MORRIS L. L. , SAVAGE J. P. 
Published: January 2008

Thirty‐nine children with suspected pathology Involving the vertebral column were Investigated haematoiogi‐cally, radlographically, and by bone scintigraphy using technetium 99M pyrophosphate. Fifteen children were shown to have Inflammatory disease of the vertebrae. A further six suffered from Scheuermann's disease, two from benign tumours, and the remainder from miscellaneous diseases not specifically Involving bony pathology.The nuclide scan was abnormal in all cases of discitis and osteomyelitis, and in the two tumours. All of the other conditions were associated with a normal bone scan. This finding is of considerable diagnostic importance, and lends support to the theory that discitis is due to bacterial infection.
THE “YO‐YO” OPERATION FOR INGUINAL HERNIA
Authors: LESLIE DOUGLAS 
Published: January 2008

This article presents a new principle in the repair of inguinal hernia in the male. Like the yo‐yo, the testis, having come down, can be mobilized and drawn up again, and then made to redescend, this time by a more approriate route. The inguinal canal can then be obliterated without hazard to the blood supply of the testis.SummaryThis article presents a new principle in the repair of difficult inguinal herniae. The testis is mobilized from the scrotum, returned to the abdominal cavity, brought down again through a new canal constructed through the rectus abdominis muscle, and then restored to the scrotum. The original inguinal canal can then be completely obliterated.
THE URINARY MELANOGEN CYSTEINYLDOPA IN MELANOMA AND IN SUNTANNING: AUSTRALIAN EXPERIENCE1
Authors: NIXON PETER F. 
Published: January 2008

Determination of urine cysteinyldopa excretion is the most sensitive chemical test for the detection of melanoma metastases and has been successfully applied during the Scandinavian winter, when sun irradiation is low. The value of this determination, under Australian conditions of greater sun irradiation, has been assessed by comparing the cysteinyldopa excretion of patients with that of normal subjects exposed to sunlight. Cysteinyldopa is an intermediate in the biosynthesis of the red‐brown pnaeomelanin.Of 20 patients without known secondary melanoma, the cysteinyldopa concentration of “spot” urines ranged from 0 to 190 (mean 48) μg/ml; of six known to have local metastases, 0 to 80 (mean 19) μg/ml; and of four known to have extensive metastases 80 to 1350 (mean 330) μg/ml.The effect of sun irradiation alone was assessed in nine healthy subjects followed one to 11 weeks before and after recorded periods of sun exposure. The cysteinyldopa concentrations of 24‐hour urines ranged from 40 to 3100 μg/ml. Increases occurred three to 10 days following sun exposure and were greatest following multiple small exposures in an individual with “Celtic” complexion.It is concluded that measurement of cysteinyldopa concentration would be of value in the follow‐up of melanoma patients in Australia only if patients could be persuaded to live under conditions free of all direct sun‐irradiation.
WHERE IS THE IMMUNOLOGY IN CANCER?
Authors: BRAY A. E. 
Published: January 2008

Whether the common human cancers possess tumour‐specific antigens which produce an immune response in the host still remains the crucial question in tumour immunology. Recent reports and discussions at the Third International Congress of Immunology suggested that much of the previously published work was not valid. The reasons for this have been analysed by comparing the well‐established experimental data with human cancer.It is suggested that much of the current confusion in tumour immunology stems from the poor models used to study human cancer and the inadequate assessment of in vitro assays which have measured the host response. The present methods require refinement, or new techniques need to be developed, before this question can be answered. The field has been well researched, and there do not appear to be any recent major advances in tumour immunology which can be applied in clinical practice.
THE DIAGNOSIS OF REFLUX OESOPHAGITIS: AN EVALUATION OF FIVE INVESTIGATIVE PROCEDURES
Authors: BREEN KERRY J. , WHELAN GREGORY 
Published: January 2008

Five methods of diagnosis have been compared prospectively in 43 patients referred for suspected reflux oesophagitis. A final diagnosis of reflux oesophagitis, as defined by the presence of at least two of the three features of typical symptoms, abnormal endoscopic findings, and abnormal findings on oesophageal biopsy, was made in 27 patients.Observer error in the interpretation of endoscopic and histological appearances was small. Measurement of resting pressure of the lower oesophageal sphincter (LES) failed to identify individual patients with reflux oesophagitis, although the mean pressure in 26 patients with oesophagitis (10 1 ± 5 2 mm Hg) was significantly lower than in 13 patients without oesophagitis (16.8 ± 10.2 mm Hg, P<0.005). Barium studies were unhelpful, as a hiatus hernia was present in only 14 and barium reflux in only 11 of the 27 patients with oesophagitis. Acid perfusion (Bernstein test) was positive at 15 minutes in 23 of the 27 oesophagitis patients, but was falsely positive in seven of the 14 patients without oesophagitis. By accepting only those responses to acid perfusion which were positive at or before seven minutes, the false positive responses were reduced to one out of the 14 patients. Typical symptoms and/or an early positive Bernstein response will correctly identify most patients with reflux oesophagitis, but the diagnosis should be confirmed by endoscopy and biopsy when important therapeutic decisions are pending.
WORK LOADS OF A SAMPLE OF GENERAL SURGEONS IN N.S.W
Authors: HAM J. M. , GRAY E. 
Published: January 2008

The work loads of 34 general surgeons in New South Wales during a six week period in 1977 have been determined. Data was obtained on the number of elective, emergency and supervised procedures, and of elective and emergency first consultations. The operative work loads were assessed by a simple grading system, and also by the “hernia‐equivalent” method which relates the work involved in a given operation to that for an adult unilateral inguinal herniorrhaphy. The latter is arbitrarily given a score of one.The hernia‐equivalent scores for academics, country and city surgeons were similar. The mean hernia‐equivalent rating for the 2,321 operations assessed was 1.1; thus, the “typical” operation was equivalent to a herniorrhaphy. The mean number of operations per week was 11.4, or 12.6 hernia‐ equivalents. Assuming a 48‐week working year, these figures represent an annual work load of 547 operations, or 605 hernia‐equivalents.Comparison of these results with those obtained in the U.S.A. (the “SOSSUS” report) indicates that these work loads are almost three times those found for board‐certified general surgeons in the U.S.A.
THE SURGICAL PATHOLOGY OF BREAST CANCER IN RELATION TO RECONSTRUCTION AFTER MASTECTOMY1
Authors: FURNIVAL C. M. 
Published: January 2008

Pathological features such as tumour type, tumour size and lymph node invasion have an important bearing on the prognosis of the patient with breast cancer.It is suggested that such prognostic facto'rs should be considered in the selection of women for post‐mastectomy breast reconstruction.The implications of pathological and other factors are reviewed and a summary of favourable prognostic factors is presented.
SALVAGE OPERATIONS FOR MALIGNANT OBSTRUCTION OF THE OESOPHAGUS
Authors: ONG G. B. , LAM K. H. , LIM S. T. K. , WONG JOHN 
Published: January 2008

Two patients with locally advanced carcinoma of the oesophagus, who did not obtain palliation with radiotherapy, underwent salvage operations to restore their ability to swallow. One patient was subjected to pharyngolaryngo‐oesophagectomy together with excision of the involved posterior tracheal wall. Reconstruction was by pharyngoglossogastrostomy, with a deltopectoral flap used to replace the tracheal defect. The second patient, who had cervical metastases and severe pulmonary complications, underwent a jejunal loop bypass operation. Both patients were able to eat normally before dying many months later from metastatic disease.Salvage operation should be considered for patients with primary tumours which appear to be slow‐growing, even though locally advanced and free of widespread disease. Worthwhile palliation is obtained when the operation, either resection or bypass, has been successful.
A COMPARISON OF PROXIMAL WITH DISTAL ARTERIAL RECONSTRUCTION IN THE TREATMENT OF ADVANCED LOWER LIMB ISCHAEMIA
Authors: HILL DAVID A. , LORD REGINALDS. A. , DOUGLAS G. , TRACY  
Published: January 2008

Elective arterial surgery for lower limb ischaerrfia due to chronic occlusive disease has been performed in 212 patients over a five‐year period. Of this group, 93 patients were treated for limb‐threatening ischaemia. The remainder were treated for intermittent claudication. The clinical and haemodynamic responses to surgery are analysed in this series of 93 patients. The results of proximal reconstruction, in terms of a living patient with patent graft and functional limb, were significantly better (75%) at one yearthan in patients undergoing distal segment reconstruction (45%). Successful aortoiliac surgery was associated with a mean increase in the ankle systolic pressure index of 0.36, compared with 0.46 in the distalreconstruction group.
CEREBRAL METASTATIC MELANOMA PRESENTING AS SPASTIC PARAPARESIS
Authors: STUART GORDON , MERRY GLEN 
Published: January 2008

A case of bilateral deposits from melanoma in the posterior frontal parasagittal region of the brain is recorded. A mechanism to explain the mode of spread is suggested. C.T. headscanning in patients with disseminated malignancy should be considered prior to invasive investigations or major surgical procedures.
CLINICAL EXPERIENCE WITH THE SMELOFF‐CUTTER PROSTHESIS: ONE TO TWELVE YEAR FOLLOW‐UP
Authors: Starr David S. , Lawrle Gerald M. , Morris George C. 
Published: January 2008

In order to determine the long‐term results of aortic valve replacement with the Smeloff‐Cutter prosthesis, the fate of 134 of 139 (96%) consecutive patients was determined one to 12 years after operation. The mean age at operation was 54 years (range 18 to 76 years). Aortic stenosis was the dominant lesion in 77 patients (55%), aortic regurgitation in 36 patients (26%), and 22 (15%) had both aortic stenosis and regurgitation. In addition to aortic valve replacement, 25 patients (18%) had coronary artery bypass, seven (5%) had mitral commis‐surotomy, and four (4%) had other procedures. Preoperative status by NYHA Class was: Class I … 3 patients (2%); Class II … 36 (26%); Class III … 67 (48%); Class IV … 33 (24%). Perioperative (30‐day) mortality was 7% (10/139). Functional improvement was obtained in all postoperative survivors with 86 (70%) in NYHA Class I,28 (23%) in Class II, and nine (7%) in Class III. A perivalvular leak developed in one patient and subacute bacterial endocarditis in two (2%). There were no cases of prosthesis failure or haemolysis. Actuarial long‐term survival was 85% at five years, 75% at eight years. Thromboembolism occurred in eight patients (6%). The incidence of thromboembolism per 100 patient years for patients receiving no anticoagulants was 5·5; taking warfarin 2·4; and taking antiplatelet agents 2·7. Major thromboembolism was uncommon in patients taking warfarin (0·9 episodes per 100 patient years.)The study confirms that the Smeloff‐Cutter aortic valve prosthesis is mechanically durable, has good long‐term haemodynamic performance, and carries a low incidence of thromboembolism even in patients not receiving anticoagulants.
TWO AIDS IN OESTROGEN RECEPTOR CHARACTERISATION
Authors: SMYTH C. M. , REEVE T. S. 
Published: January 2008

1. Eighty three breast carcinoma primary and metastatic lesions were submitted for oestrogen receptor (ER) assessment using a standard dextran coated charcoal saturation analysis (0.1 nM‐0.8nM tritiated oestradlol), as well as a single saturating dose (SSD) assay (8nM tritlated oestradiol). Excellent correlation between the two methods was demonstrated. The single dose assay also provided additional information to aid the construction of adequate Scatchard plots In those biopsies which exhibited high levels of specific receptor proteins.2. Three hundred and fifteen consecutive breast carcinoma primary or metastatic lesions, assessed for ER, had imprint cytological examinations to verify the malignancy of the specimen. Seven per cent demonstrated sparse epithelial cellularity with a low or nil malignant cell proportion and showed a lower receptor positlvlty than the remaining specimens.