British Journal of Surgery

Maxwell Anderson, J; De Sousa, Maria A B; Halnan, K E; Kelly, F; Hannah, G

doi: 10.1002/bjs.1800570802pmid: 4916192

David Beck, A

doi: 10.1002/bjs.1800570803pmid: 4194997

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.

Trapnell, John; Roberts, Michael

doi: 10.1002/bjs.1800570804pmid: 4916193

Chitty (1957), reporting on prostatic abscess from the Bristol Department of Urology, suggested that the treatment of choice was transurethral resection of the entire gland. Over the 10 years since this initial report our experience has amply confirmed this view and a further series of 67 patients is now analysed. It would appear that there is no absolute means of establishing the diagnosis, either from the history or the clinical findings, and that even when the diagnosis is suspected it may only be confirmed by resection of the gland. The abscesses are not infrequently multiple and thus a simple saucerization of one cavity may leave further significant foci undiscovered. A full transurethral prostatectomy is therefore the treatment of choice. This policy of radical treatment by the transurethral route has been followed by minimal postoperative complications or recurrence.

Patey, D H; Thackray, A C

doi: 10.1002/bjs.1800570805pmid: 5451932

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.

MacPhee, Ian W

doi: 10.1002/bjs.1800570806pmid: 4916194

The treatment of 6 patients is described. In sarcomas treated with cyclophosphamide it is suggested that regular daily doses throughout may offer a better form of treatment than repeated intensive courses of treatment.

Lagundoye, S B; Itayemi, S O

doi: 10.1002/bjs.1800570807pmid: 5465555

Two cases of tension pneumoperitoneum seen in 2 female adults in the University College Hospital, Ibadan, are described. One was a complication of abdominal and pelvic tuberculosis with tuberculous ulcers of the colon detected at autopsy. The other developed tension pneumoperitoneum following puerperal sepsis. In neither was a site of perforation detected nor were gas-forming organisms grown on culture. The literature on the subject is reviewed.

Barakat, T; MacPhee, I W

doi: 10.1002/bjs.1800570808pmid: 5451933

Atkins, P; Lempke, R E

doi: 10.1002/bjs.1800570809pmid: 5451934

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.

Ward, J P

doi: 10.1002/bjs.1800570810pmid: 5451935

The reasons for treatment of large goitre by thyroid extract are discussed and the preliminary results of treatment are reported. The problems are discussed.A more extensive study is essential to draw any conclusions from this mode of therapy.

Kennedy, J T; McOmish, D; Bennett, R C; Hughes, E S R; Cuthbertson, A M

doi: 10.1002/bjs.1800570811pmid: 5451936

Three independent observers have surveyed the results in 158 patients treated by abdomino-anal pull-through excision of the rectum and reached the following conclusions:—The operative mortality of the procedure (4·5 per cent) was low and quite comparable with that following alternative methods of rectal excision.The operation compares favourably with anterior resection and combined excision as a cancer-curing procedure for growths similarly sited in the rectum.Some degree of morbidity following operation occurred in almost half the patients, but significant complications occurred in only about 20 per cent. Colonic necrosis (4·6 per cent) and pelvic sepsis (18 per cent) were the most important. Permanent colostomies were ultimately established in 6 per cent of patients.In the majority of patients the operation was ultimately compatible with good anorectal function. Continence usually improved after about 1 year, though adequate control was often achieved within 6 months. Of those patients with stable bowel function at the time of interview, 89 per cent had a satisfactory result.