British Journal of Surgery

Darke, S G; Parks, A G; Grogono, J L; Pollock, D J

doi: 10.1002/bjs.1800600302pmid: 4693566

Two cases of carcinoma developing in a segment of Crohn's disease are described, one in the large intestine and one in the small intestine. From an analysis of the literature, evidence is advanced with regard to age at the time of developing carcinoma, duration of symptoms attributable to Crohn's disease, anatomical distribution, and observed incidence compared with chance incidence. It is concluded that there is a small but significant risk of carcinoma developing, both in the small and large intestines, in Crohn's disease.

Symes, M O; Riddell, A G

doi: 10.1002/bjs.1800600303pmid: 4735046

The treatment of 14 patients with advanced malignant disease by the infusion of pig lymph-node cells pre-immunized against the appropriate tumour is described.Marked tumour necrosis was seen in 7 cases and 4 of the patients obtained definite clinical benefit.It is suggested that the therapy may be of most value when used in conjunction with other forms of treatment.

Webb, P

doi: 10.1002/bjs.1800600304pmid: 4144330

The left plantaris and soleus and the right and left sternohyoid muscles of rats were transected surgically and cross-repaired to form conjoined muscle bellies composed of two innervated muscles, two denervated muscles, and one denervated and one innervated muscle.Subsequent maceration of the conjoined muscle belly showed that regeneration had taken place by inoculation of the growing tips of the regenerating fibres in the doubly denervated muscle belly and in the innervated-denervated muscle belly but not in the case of the doubly innervated muscle belly.Muscle type was not found to influence this process.The significance of these findings is discussed.

Barabas, A P; Offen, D N; Meinhard, E A

doi: 10.1002/bjs.1800600305pmid: 4693567

Of 200 patients referred for management of polycythaemia vera, 98 (49 per cent) had presented with vascular complications and 68 (34 per cent) of these involved arteries. Transient but recurrent cerebrovascular accidents and digital artery occlusions were the typical arterial complications. If polycythaemia was not promptly treated there was a risk of perimanent hemiplegia, monocular blindness, and severe ischaemia of the leg.Embolism may have accounted for some of the arterial complications. A possible source for emboli—a proximal mural thrombus—was demonstrated in all 5 patients who were examined with femoral arteriography and in 2 patients who underwent surgery. In selected cases thrombectomy may be indicated to prevent further embolism.

Dormandy, John A; Edelman, Joy B

doi: 10.1002/bjs.1800600306pmid: 4693568

This is a preliminary report on a prospective study of 52 general surgical and gynaecological patients designed to investigate a possible relationship between a high blood viscosity and the development of deep venous, thrombosis (D. V. T.). The blood viscosity of the patients was measured immediately before operation and the development of venous thrombosis was monitored with the radioactive fibrinogen technique. The 11 patients who developed a D.V.T. had a blood viscosity, prior to operaton, 21 per cent higher than the patients who did not develop venous throbosis. The difference was 29 per cent if correction was made for variation in the heamatocrit. It was found that a general surgical patient, over 40 years of age, with a preoperatife blood viscosity above 4.3 cP (corrected to a heamatocrit of 45 per cent) will have a 73 per cent chance of deveiopin a D.V.T. after operation.

Steichen, Felicien M; Ravitch, Mark M

doi: 10.1002/bjs.1800600307pmid: 4571416

Following the original introduction of an automatic stapling instrument producing B-form staples by de Petz (1924, 1927), there has been derived from the very important first generation of Soviet stapling instruments a second generation of American stapling instruments characterized by: (1) the use of preloaded, pre-sterilized, and disposable staple cartridges; (2) the adaptability of one instrument to a variety of cartridges for use in a variety of tissues and operative situations; (3) the transfer from the instrument itself to the disposable cartridge of delicate and fragile moving parts simplifying the maintenance and operation of instruments. The instruments have found wide and satisfactory application in numerous areas of thoracic, vascular, gastro-intestinal, and gynaecological surgery.

Wheeler, M H; Prescott, R J; Forrest, A P M

doi: 10.1002/bjs.1800600308pmid: 4693569

In 6 dogs with innervated antral pouches (4 with vagally innervated fundic pouches and 2 with vagally denervated fundic pouches) the effect of irrigating the antral pouches with acid on the pentagastrin-induced secretion from the fundic pouches was assessed. A range of doses of pentagastrin (0.25–8.0 μg. per kg. body-weight per hour) was given by intravenous infusion for 3 hours at a constant rate, each dose being given on six occasions in separate experiments carried out on separate days. No consistent inhibition of secretion was observed in either preparation. The results do not support the concept of either an inhibitory hormone or an inhibitory neural reflex of antral origin active against pentagastrin-stimulated acid secretion.

Pagliero, K M; Yates, A K; Hill, D G

doi: 10.1002/bjs.1800600309pmid: 4144331

The fundamental importance of precise measurement of cutaneous temperature rather than the cursory assessment with the back of the hand in cases of shock or diminished tissue perfusion has been well described by Ross, Brock, and Aynsley-Green (1969). They showed examples where core/toe temperature gradients reflected hypovolaemia in postoperative cardiac surgical patients and further showed how this information could be used to guide α-blockade therapy to overcome peripheral vasoconstriction, thus allowing rapid correction of hypovolaemia by transfusion.One criticism levelled by antagonists to this form of treatment is that α-blockade drugs cause hypotension. This article shows that with careful control α-blockade should not cause significant hypotension. Furthermore, in patients with hypotension of cardiogenic origin, α-blockade may be safely used in the treatment of coincidental hypovolaemia.

Williams, D Innes; Keeton, James E

doi: 10.1002/bjs.1800600310pmid: 4693570

Two series of primary reconstructions of the classic exstrophied bladder are reviewed and a brief description of the operative procedure is given.There has been a significant improvement in the results since 1963 and a discussion of the possible reasons is given along with a policy for the future.

Andrews, M J; Pearson, F G

doi: 10.1002/bjs.1800600311pmid: 4693571

An analysis of 59 cases of tracheal stenosis after tracheostomy with cuffed tube and assisted ventilation is reported. Special emphasis is placed upon diagnosis and treatment. The detection of severe strictures is usually easily achieved, but mild to moderate degrees of stenosis may present difficulties in diagnosis and may remain undetected for some time.Management of the strictures included dilatation (14 cases), segmental tracheal resection with primary end-to-end anastomosis (34 cases), staged plastic reconstruction (2 cases), and permanent tracheostomy (4 cases). No treatment was given in 5 cases.Dilatation achieved a good result in 6 cases and a satisfactory one in 8. Of 34 strictures treated by segmental resection, a good result was obtained in 29 cases, although 7 required a second operation for restenosis. Three cases had an unsatisfactory result and there were 2 operative deaths. Postoperative complications are discussed.Mild strictures may be satisfactorily managed by dilatation, but some mild strictures and all severe strictures are best treated by segmental resection with primary end-to-end anastomosis. Segmental defects ranging from 0.5 to 5.5 cm. in length can be satisfactorily resected.