Seven dogs each underwent cholecystectomy, ligation of the accessory pancreatic duct, and insertion of a Thomas duodenal cannula opposite the ampulla of Vater. After full recovery, bile secretions were studied in the unanesthetized dogs by opening the cannula and placing a ureteric catheter through the papilla into the common bile duct. All animals received, throughout study, constant infusions of taurocholic acid to replace losses caused by interruption of the enterohepatic circulation and 14 C-erythritol for measurement of erythritol clearance. After bile flow stabilized somatostatin 800 ng/kg/minute was infused for 100 minutes and bile flow declined from 3.0 +/- 0.7 ml/10 minutes (SD) to 1.19 +/- 0.47 ml/10 minutes (p less than 0.001) and 14C-erythritol clearance fell from 3.6 +/- 1.14 to 1.77 +/- 0.43 ml/10 minutes (p less than 0.001). Bile salt output was unchanged, indicating that somatostatin inhibited bile salt-independent canalicular flow (BSICF). In other experiments animals underwent intraduodenal acidification which resulted in a marked increase in bile flow. Somatostatin infusion again causes a sharp fall in bile flow (p less than 0.05) suggesting that somatostatin also inhibited ductular flow. Infusion of somatostatin did not inhibit choleresis produced by exogenous secretin administration. Thus, somatostatin inhibits 1) ductular flow by inhibiting secretin release and 2) BSICF by a direct effect or by decreasing the release of hormones which induce canalicular flow.
As a result of improvements in diagnostic accuracy, the primary source of the tumour is identified in more than 99% of cases presenting with a malignancy. Whilst the axial skeleton is a common site of metastases, the sternum is rarely affected, especially by isolated metastases.We report a case of a 68 year old male who was referred to the surgical outpatient clinic with a six month history of sternal pain. The patient was known to have essential thrombocythaemia, which had recently transformed into acute myeloid leukaemia but a sternal biospy showed mucinous adenocarcinoma. He had not localising symptoms and full evaluation failed to localise the primary tumour.Solitary sternal metastases are rare and when found an underlying neoplasm is usually identified allowing targeted treatment. If however, there is no symptomatic tumour, the metastasis should simply be treated symptomatically.
Abstract An electron microscope study was made of precipitation in vanadium and titanium-doped MgO single crystals. In both crystals cubic spinel precipitates form in parallel orientation with the cubic matrix lattice in the temperature range 1100°C-1500°c. Precipitation of the vanadium spinel, Mg2VO4 is accompanied by the nucleation and growth of dislocation loops composed of edge dislocation dipoles with their axes parallel to the principal axes of the cubic MgO matrix lattice. It is concluded that dislocation loop nucleation occurs by the condensation of vacancies previously existing in the form of clusters with solute ions in the as-grown crystals. Similar loops grow from existing edge dislocations constituting sub-grain boundaries and those formed by prismatic punching from unidentified impurity particles. The equilibrium structure at 1200°c is that of 0·5 μ diameter spinel particles decorating irregular dislocation networks. No similar dislocation configurations are developed on precipitation of the titanium spinel. It is tentatively suggested that in the latter case, which involves an increase in oxygen ion lattice spacing on precipitation, precipitate nuclei form from solute ion-vacancy clusters which are too small for dislocation loop nucleation.
Abstract Background Open surgery for abdominal aortic aneurysms in the UK is usually performed via a midline transperitoneal incision. However, the left retroperitoneal (RP) approach may be beneficial for juxtarenal abdominal aortic aneurysms and certain physiological reasons. One potential disadvantage is that the left kidney usually requires mobilization anteromedially risking injury to the renal tract and possibly the ureter. Methods In this retrospective study, the time of onset, clinical presentation and treatment of left renal tract complications are scrutinized and discussed. Reasons for open aortic surgery as opposed to endovascular repair being undertaken were documented. Also, the aortic cross‐clamp positions and type of reconstruction were examined. Results A total of 208 patients underwent RP aortic surgery for aneurysmal disease. The aortic cross‐clamp positions were infrarenal in 115 (55%), suprarenal in 78 (38%) and supra‐superior mesenteric artery or supracoeliac in 15 (7%). Two percent (4/208) sustained ureteric complications and all occurred in the upper third of the left ureter. The time of onset of symptoms ranged from 2 to 14 days post‐operatively with a median of 3.5. Clinical signs were non‐specific including pyrexia, tachycardia and flank pain. Conclusion Ureteric complications following left RP aortic surgery is uncommon and usually occurs in the upper third of the renal tract. Trauma appears to be the most common cause, although ureteric ischaemia can occur but presents later particularly in those with comorbidities.
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