bluuebunny/crossref_metadata_2025 huggingface dataset:
The Impact of Smoking and Quitting Smoking on Patients With Diabetes
Authors: Sherman Justin J.
Published: March 2007

Although cigarette smoking is the leading avoidable cause of death in the United States, its specific effects on people with diabetes are even more intricate and profound. Macrovascular and microvascular complications ensue more quickly in smokers with diabetes, and risk of mortality increases. The increased blood pressure and altered lipid profiles in smokers with diabetes could encourage development of the insulin resistance syndrome, setting patients up for further cardiovascular problems. Therefore, smoking cessation programs should be offered to the diabetic population. Such group programs can benefit from using behavioral change methods to devise specific strategies for smoking cessation and to prevent unique problems, such as postcessation weight gain and depression.

A variety of medications are available to clinicians advising smoking cessation for patients with diabetes. Studies have not proven any one smoking cessation medication to be more effective than another, so the choice for pharmacotherapy depends on the unique needs of the individual. Bupropion may be a reasonable choice because of its use for depression and its ability to delay weight gain. However, many patients prefer the ease of use of certain nicotine replacement strategies. Clinicians may find combination strategies to be particularly useful.

Although further studies are needed for this special population regarding the impact on outcomes, providers should give cessation interventions high priority for diabetes control. This challenging population will need creative interventions to overcome their unique problems during smoking cessation, but the potential benefits may be considerable.
Current and Future Treatment of Metabolic Syndrome and Type 2 Diabetes in Children and Adolescents
Authors: Mallare Johanna T. , Karabell Ana H. , Velasquez-Mieyer Pedro , Stender Sarah R.S. , Christensen Michael L.
Published: March 2007

In Brief The metabolic syndrome and type 2 diabetes are occurring at alarming rates in children. Obesity plays an important role in the increased prevalence of its comorbid conditions including dyslipidemia, hypertension,and type 2 diabetes. Lifestyle modification is the mainstay of prevention and treatment for metabolic syndrome and type 2 diabetes; however, it can be costly and labor-intensive. Pharmacotherapy is considered a second line of therapy in adults, but its use in children is controversial. This article reviews current and potential future drugs for the treatment of obesity,dyslipidemia, hypertension, and type 2 diabetes in children. Surgical procedures for treating severely obese adolescents are also discussed.
Association of zoonotic Ljungan virus with intrauterine fetal deaths
Authors: Niklasson Bo , Samsioe Annika , Papadogiannakis Nikos , Kawecki Anne , Hörnfeldt Birger , Saade George R. , Klitz William
Published: March 2007

BACKGROUND:

It has recently been shown that Ljungan virus (LV) is associated with disease in its wild rodent reservoir. In addition, it has been demonstrated that LV causes malformations and perinatal death in a mouse model. The question was therefore raised whether LV is a zoonotic agent in humans.

METHODS:

Population fluctuations of native rodents in Sweden were compared to the incidence of intrauterine fetal deaths (IUFDs) using the Swedish national hospitalization database. Formalin‐fixed tissues from cases of IUFD were investigated using LV‐specific immunohistochemistry.

RESULTS:

Variation in the incidence of IUFDs closely tracked the fluctuations in native rodent populations. LV was detected in the brain tissue in 4 of 10 cases of IUFDs investigated by immunochemistry. LV was also detected in the placenta in 5 of the 10 IUFD cases, but in none of 20 placentas from normal pregnancies.

CONCLUSIONS:

LV may play an important role in IUFDs. Birth Defects Research (Part A) 2007. © 2007 Wiley‐Liss, Inc.
Health care expenditures of children and adults with spina bifida in a privately insured U.S. population
Authors: Ouyang Lijing , Grosse Scott D. , Armour Brian S. , Waitzman Norman J.
Published: March 2007

BACKGROUND:

We provide new estimates of medical care utilization and expenditures over the lifespan for persons living with spina bifida in the United States. Updated estimates are essential for calculations of lifetime costs and for economic evaluations of prevention and management strategies for spina bifida.

METHODS:

We analyzed data from the 2001–2003 MarketScan database on paid medical and prescription drug claims of persons covered by employer‐sponsored health insurance in the United States. Medical care utilization and expenditures during 2003 were analyzed for persons with a diagnosis of spina bifida recorded during 2001–2003 who had 12 months of coverage in a fee‐for‐service health plan. To calculate expenditures during infancy, a separate analysis was performed for those born during 2002 with claims and expenditures data during the first 12 months of life. We compared medical expenditures for persons with and without spina bifida by age groups.

RESULTS:

Average incremental medical expenditures comparing patients with spina bifida and those without were $41,460 per year at age 0, $14,070 at ages 1–17, $13,339 at ages 18–44, and $10,134 at ages 45–64. Children ages 1–17 years with spina bifida had average medical expenditures 13 times greater than children without spina bifida. Adults with spina bifida had average medical expenditures three to six times greater than adults without spina bifida in this privately insured population.

CONCLUSIONS:

Although per capita medical care utilization and expenditures are highest among children, adults constitute an important and growing share of the population living with spina bifida. Birth Defects Research (Part A) 2007. © 2007 Wiley‐Liss, Inc.
Energy and protein requirements of general surgical patients requiring intravenous nutrition
Authors: Hill G L , Church J
Published: March 2007

General surgical patients require intravenous nutrition either because their gastrointestinal tract is blocked, too short or inflamed or because it cannot cope. Such patients can be grouped into four nutritional/metabolic categories: normal and unstressed; normal and stressed; depleted and unstressed; depleted and stressed. The energy requirements of patients in each of these groups vary according to their energy expenditure. Normally nourished and stressed patients have the highest energy expenditure and therefore require the highest energy input (45–55 kcal.kg−1day−1). Other groups of patients rarely require more than 40 kcal.kg−1day−1. Energy can be given mainly as dextrose although calories needed above 40 kcal kg−1day−1 should be given as fat (unless lipogenesis is desirable). In very stressed patients high rates of glucose infusion can themselves constitute a metabolic stress and fat may play a bigger role as a calorie source. For long term feeding, 1 litre of 10 per cent fat emulsion should be given weekly to avoid essential fatty acid deficiency.

The level of nitrogen intake required to maintain a positive nitrogen balance is a lot higher in surgical patients than the suggested recommended dietary allowances for normal subjects. It is dependent not only on the nutritional and clinical state of the patient but also on the levels of energy and nitrogen intake given. When energy intake is below energy needs, normally nourished patients cannot retain nitrogen, although depleted patients can. When energy intake exceeds energy needs, both normally nourished and depleted patients retain nitrogen at levels of nitrogen intake ranging from 250 mg kg−1day−1 (depleted and unstressed) to over 400 mg kg−1day−1 (stressed). Depleted patients can maintain a positive nitrogen balance at lower levels of calorie and nitrogen intake than normally nourished patients and in this respect are analogous to a growing child. In all surgical patients, energy and nitrogen intakes can be manipulated to provide for a controlled maintenance or restoration of either wet lean tissue and/or fat. There is little place for protein sparing therapy or the use of insulin and anabolic steroids to promote nitrogen retention in surgical patients requiring intravenous feeding.
Local recurrence following ‘curative’ surgery for large bowel cancer: I. The overall picture
Authors: Phillips R K S , Hittinger Rosemary , Blesovsky Lynda , Fry J S , Fielding L P
Published: March 2007

The Large Bowel Cancer Project is a collaborative prospective study of 4228 patients with a histologically proven adenocarcinoma, of whom 2336 (55 per cent) survived a ‘curative’ resection. Follow-up information is available on 2220 patients (95 per cent). Subsequently, 309 (14 per cent) have developed a local recurrence confirmed by: biopsy (127; 41 per cent), clinical examination (77; 25 per cent), X-ray (15; 5 per cent), a raised CEA (2; 1 per cent), or some other method — e.g. CT scan or a confident unbiopsied laparotomy finding (88; 29 per cent).

Statistically significant factors (χ2 test, P<0·05) associated with local recurrence are:

Dukes' classification: A 4 per cent; B 13 per cent; C 18 per cent

Tumour differentiation: Well 11 per cent; Moderate 14 per cent; Poor 21 per cent

Obstruction: Absent 13 per cent; Present 21 per cent

Perforation: Absent 13 per cent; Present 28 per cent

Tumour mobility: Freely mobile 11 per cent; Others 21 per cent Operation performed (rectal and rectosigmoid tumours):

Abdomino-perineal 12 per cent; Anterior resection 18 per cent; Surgeon (Consultant only): Range < 5 per cent to > 20 per cent. Stratification of the above variables altered only the statistical significance pertaining to tumour differentiation (P < 0·1, d.f. = 2). In particular, the differences between Consultant surgeons remained.
Local recurrence following ‘curative’ surgery for large bowel cancer: II. The rectum and rectosigmoid
Authors: Phillips R K S , Hittinger Rosemary , Blesovsky Lynda , Fry J S , Fielding L P
Published: March 2007

1988 patients with an adenocarcinoma of the rectum (1292; 65 per cent) or rectosigmoid (696; 35 per cent) have been studied. A resection (1700 patients) or polypectomy (124 patients) was performed in 1824 (92 per cent) and, of the former, 1376 patients either underwent abdominoperineal (AP) excision of the rectum (788 patients) or an anterior resection (598 patients). The in-hospital mortality was 63 patients (8 per cent) for AP and 44 (7 per cent) for anterior resection, and a curative resection had been performed in 504 (71 per cent) of those undergoing an AP, and 393 (71 per cent) of those undergoing an anterior resection. Follow-up information is available for 478 patients (95 per cent) who underwent an AP and 370 (94 per cent) who underwent an anterior resection.

More patients have developed a local recurrence after an anterior resection (67; 18 per cent) than after AP (57; 12 per cent) (Logrank χ2 = 6·6, d.f.=1, P<0·02) (stratified for sex and Dukes' stage). This difference is not accounted for by a lesser margin of distal clearance after an anterior resection; firstly because the margin of clearance was not different in those who did and those who did not develop a local recurrence (AP: whole group = 4·4 cm, local recurrence = 4·5 cm; anterior resection: whole group = 3·0 cm, local recurrence = 3·1 cm) and secondly because for each centimetre of distal clearance there was a consistently greater probability of recurrence for anterior resection (Logrank χ2 = 9·1, d.f. = 1, P<0·01) (stratified for sex, Dukes' stage and distal clearance margin).
The balloon proctogram
Authors: Preston D M , Lennard-Jones J E , Thomas B M
Published: March 2007

A balloon filled with barium has been used to simulate a soft stool for the radiological study of disorders of defaecation. Lateral radiographs demonstrate the level of the pelvic floor in relation to the pubococcygeal line, the change in the anorectal angle and the behaviour of the anal sphincters.

In 12 patients with faecal incontinence, successfully treated surgically by postanal sphincter repair, the anorectal angle was reduced from 135°±4·4° (s.e.m.) to 103°±4·1° and the anorectal junction rose by 1·5±0·4 cm.

In 10 patients with slow-transit constipation there was no pelvic descent and no change in the anorectal angle on straining. These patients were unable to expel the balloon and the results suggest that the pelvic floor does not relax normally.
An investigation into how the geometry of an end-to-side arterial anastomosis affects its function
Authors: Klimach O , Chapman B L W , Underwood C J , Charlesworth D
Published: March 2007

The effects of altering the geometry of an end-to-side junction were investigated in a hydraulic model. The dimensions of the tubes, pressures and flow rate and the frequency of pulsation were calculated by dimensional analysis, to produce a model which simulated pulsatile flow in small arteries. The ratio between the impedance of the ‘bypass’ and the impedance downstream from the junction was greater than unity when the two tubes forming the junction were of unequal diameter. No increase in downstream impedance was measured when the angle of junction was increased from 45° to 135°. Cine photographs of streamlines at the junction showed that flow passed smoothly through the junction irrespective of angle and that perturbations occurred only during that part of the cycle when flow was reversed. The results indicate that the angle at which a junction is made affects flow. The effect is small and is only seen when the ratio of diameters of the tubes is unity. The ratio of the diameters of the two tubes which make up the junction has the greatest effect on flow through the junction.
Carotid endarterectomy and the Javid shunt: The early results of 215 consecutive operations for transient ischaemic attacks
Authors: Browse N L , Ross-Russell R
Published: March 2007

This paper describes a consecutive series of 215 carotid bifurcation endarterectomies performed by one surgeon for transient ischaemic attacks. One patient died from a pulmonary embolism (0·47 per cent). One patient developed a permanent stroke related to the contralateral hemisphere 3 days after operation (0·47 per cent). Five patients developed a weakness of one arm or hand which had clinically recovered 2 months after operation (2·35 per cent); four patients had a transient weakness of one arm or hand which had recovered in less than 24 h of the operation. There were no serious ocular complications. The incidence of serious permanent complications was therefore 0·94 per cent. The Javid shunt could not be used in only 4 of the 193 operations in which its insertion was attempted. It caused arterial damage in only one patient. The results suggest that the routine use of the shunt was of value and that carotid endarterectomy can be a safe, relatively complication-free, procedure.
On thrombo-embolism after total hip replacement in epidural analgesia: A controlled study of dextran 70 and low-dose heparin combined with dihydroergotamine
Authors: Fredin H O , Rosberg B , Arborelius M , Nylander G
Published: March 2007

A prospective study of thrombo-embolism after total hip replacement in epidural analgesia was carried out in 116 patients, randomly allocated to dextran 70 or low-dose heparin combined with dihydroergotamine (HDHE).

Amounts of blood loss and transfused bank blood did not differ significantly between dextran 70 and HDHE prophylaxis.

There was a lower incidence of femoral deep vein thromboses in patients given dextran prophylaxis as compared with those on HDHE (P<0·05). However, the total frequency of DVT and the frequency of pulmonary embolism did not differ between the two groups. There was no case of fatal pulmonary embolism. The side effects were major bleeding complications in 7 per cent of the HDHE group as compared to none in the dextran group. No anaphylactic reaction was noted from dextran 70 using hapten-dextran prophylaxis.
Subcutaneous heparin, plasma heparin levels and postoperative wound haematoma
Authors: Nicolaides A N , Harbourne Tikva , Russell R C G
Published: March 2007

Ninety-five patients, over the age of 40, having general surgical operations, were randomly allocated to a control and test group. The test group received 5000 units of subcutaneous heparin two hours before operation and then 12-hourly for seven days. The patients in the control group received the same regimen of isotonic saline. There was a marked variation in the plasma heparin levels from patient to patient, and from day to day in the same patient. There was a significant increase in the incidence of wound haematoma in patients with a plasma heparin level greater than 0·2 units/ml. The results suggest that the increased incidence of wound haematoma previously reported is due to the increase of incidence in patients who have plasma heparin levels greater than 0·2 units/ml.
Early results of surgery in patients considered cimetidine failures
Authors: Pickard W R , Mackay C
Published: March 2007

Fifty-two consecutive unselected duodenal ulcer patients (Group 1), who had failed to respond to cimetidine and who subsequently underwent elective vagotomy and drainage, were studied. All patients were symptomatic on cimetidine in full recommended dosage. This group has been compared with another group of 634 duodenal ulcer patients (Group 2) undergoing elective vagotomy and drainage in the ‘pre-cimetidine era’. The groups were similar pre-operatively with regard to age, sex, length of history and maximal acid output. Completeness of vagotomy and amount of acid reduction were similar in the two groups. The incidence of recurrent ulceration was 5 per cent in Group 1 and 5·7 per cent in Group 2. Although, of necessity, follow-up is shorter in the cimetidine failures (mean 2·3 years), there is nothing to suggest that failure to respond to cimetidine precludes a satisfactory surgical result.
The management of common bile duct calculi by endoscopic sphincterotomy in patients with gallbladders in situ
Authors: Neoptolemos J P , Carr-Locke D L , Fraser I , Fossard D P
Published: March 2007

Endoscopic sphincterotomy (ES) is widely used in the treatment of patients with common bile duct (CBD) stones following cholecystectomy. The technique has now been extended to patients with gallbladders still present and the results of ES in 100 such patients is reported. Fifty-nine were considered unsuitable for surgery (Group A), in 38 ES was performed as a preliminary to cholecystectomy (Group B) and in 3 ES was performed following emergency cholecystostomy (Group C). ES was achieved in 98 patients and stones completely extracted in 91 patients. In Group A 5 patients required surgery, in 3 because of technical failure and in 2 because of empyema of the gallbladder. One patient who presented in extremis died following failure to extract a large CBD stone. On follow-up (4-50 months), 16 patients have died but in only one from gallbladder sepsis, and one has had a cholecystectomy for pain. In Group B choledochotomy was avoided in 29 of the 37 patients who agreed to cholecystectomy. In Group C no further surgery was required and all patients in Groups B and C remain well. These results indicate that ES is an effective technique for treating patients with CBD stones with the gallbladder in situ, either alone in patients considered unsuitable for surgery or as an adjunct to surgery.
Intrahepatic biliary papillomatosis
Authors: Gouma D J , Mutum S Singh , Benjamin I S , Blumgart L H
Published: March 2007

Intrahepatic bile duct papillomatosis associated with changes of nuclear atypia is described in a young man. Radical excision was performed by left hepatic lobectomy and removal of the common bile duct and left hepatic ducts. Fourteen previous cases of intrahepatic or diffuse intrahepatic and extrahepatic biliary papillomatosis are reviewed. While local recurrence and progression to death from obstructive jaundice and cholangitis is the rule, only two definite cases of malignant change have been reported. Radical surgery may be curative for this rare condition.
Cardiac penetrating injuries: Personal experience of 45 cases
Authors: Demetriades D
Published: March 2007

This study represents the personal experience of the author, in 45 cases of penetrating cardiac wounds. Eleven patients with no signs of life had surgical intervention on the stretcher in the emergency room (ER). One patient survived (mortality 91 per cent). Thirty-four patients were operated on in the operating theatre (OT) with a mortality rate of 12 per cent. The clinical triad of a low blood pressure, high central venous pressure (CVP) and distant cardiac sounds, proved diagnostic in 82 per cent of the patients with cardiac tamponade. Pulsus paradoxus was found in only 7 per cent of tamponade cases. Pericardiocentesis seems to have little value in diagnosing or treating tamponade. The most commonly injured cardiac chamber was the right ventricle (RV) (36 per cent). Coronary artery damage occurred in 4 cases with a mortality of 75 per cent. Aspiration of the ventricles for air embolism was performed in all 16 cases who arrested during operation. A significant volume of air was aspirated in 4 (25 per cent). Early intervention saved three of them.
Correlations between clonogenicity and prognostic factors in human breast cancer
Authors: Smallwood J A , Morgan G R , Cooper A , Kirkham N , Williams C J , Whitehouse J M A , Taylor I
Published: March 2007

The pursuit of more effective systemic treatments in breast cancer has been limited by a failure to maintain or grow tumour cells in vitro. This study reports our experience in obtaining clonogenic growth in 54 primary breast cancers obtained at mastectomy. Of 47 assays free of infection, clonogenic growth was achieved in 22 (41 per cent). Only 5 of 23 oestrogen receptor positive tumours grew compared to 14 of 21 oestrogen receptor negative tumours (χ2 = 9.03; P < 0.01). None of the 5 cytosolic receptor positive tumours contained a nuclear receptor for oestrogen. Growth was not related to tumour stage, menopausal status, age or histological grade. Receptor negative tumours had higher thymidine labelling indices, but these were no different to the tumours grown in the assay.
Carcinoma of the oesophagus
Authors: Ihekwaba F N , Solanke T F
Published: March 2007

A 10-year review of oesophageal cancer in Ibadan, Nigeria, is presented. Seventy-two patients representing a mean annual incidence of 0.31 per 100 000 of the population were found. The age range was 27–96 years, with a mean of 57 years for men and 65 for women. Dysphagia, weight loss and anaemia were the significant features in the majority and 40 per cent of the patients presented between 4 and 12 months (mean 7.5 months). None of the commonly used dietary ingredients could be implicated in the causation of this tumour in which squamous cell cancer accounted for 88.5 per cent of all types. The middle third was the commonest site of tumour formation (45 per cent) while the lower third accounted for 40 per cent. A low operability rate of 32 per cent is recorded and only 21 per cent were suitable for oesophagectomy. Survival among this group was 50 per cent at 1 year, 20 per cent at 3 years and 10 per cent at 4 years.
Adaptation to jejunoileal bypass promotes experimental colorectal carcinogenesis
Authors: Bristol J B , Wells M , Williamson R C N
Published: March 2007

The co-carcinogenic potential of 85 per cent jejunoileal bypass (JIB) was tested in male Sprague-Dawley rats (n = 81) given 6 preliminary injections of the selective intestinal carcinogen azoxymethane (total dose 90 mg/kg). Controls had sham JIB. Colorectal adaptation was studied 30 weeks postoperatively in rats given injections of vehicle alone. JIB caused 17–33 per cent increments in colonic length, weight and crypt depth; crypt cell production rate was more than doubled (P < 0.01). Despite lowering body weight by 27 per cent, JIB increased the median number of colorectal tumours per rat from 3 to 8 (P < 0.01). The findings suggest that evidence of hyperplasia and dysplasia should be sought in patients receiving subtotal jejunoileal bypass for obesity.
Neglected role of torsion and constriction in pathogenesis of simple adhesive bowel obstruction
Authors: Maetani S , Tobe T , Kashiwara S
Published: March 2007

We critically analysed the mechanism of simple adhesive bowel obstruction in 88 re-laparotomies for this condition, paying special attention to obstructing factors beside angulation. Twenty-six obstructions were caused by bowel-to-bowel adhesion, and 42 by adhesion of bowel to other structures, whereas in the remaining 20 these two types were combined. Although angulation was almost always found at the site of obstruction, torsion (twisting of bowel about its axis) was detected in 25 of the 33 in situ observations, usually accompanied by various degrees of organic constriction. In bowel-to-bowel adhesion, the torsion and constriction were produced by a unique relation of the bowel to the adhesion; the latter connected one side of the mesenteric margin to the opposite side, encircling the bowel wall obliquely. This was never seen on non-obstructing adhesions.

We conclude that torsion and constriction are important causes of simple bowel obstruction as well as strangulated obstruction.
Control of major haemorrhage associated with pancreatic pseudocysts by transcatheter arterial embolization
Authors: Huizinga W K J , Kalideen J M , Bryer J V , Bell P S H , Baker L W
Published: March 2007

Massive haemorrhage from a pancreatic pseudocyst is an uncommon cause of upper gastrointestinal bleeding. The condition carries a high mortality and presents a major clinical problem both in terms of timely diagnosis and appropriate surgical therapy. Four patients are presented with pseudocyst-related bleeding arising from the gastroduodenal artery. In all instances the bleeding was successfully controlled by transcatheter embolization with gelfoam. No untoward sequelae were noted and the occlusion remained effective as shown by follow-up angiography 2 months later. The importance of early diagnostic angiography is stressed and it is concluded that interventional angiography may obviate the need for high risk emergency surgery.
Muramyl dipeptide increases tolerance to shock and bacterial challenge in mice
Authors: Ausobsky J R , Cheadle W G , Brosky B G , Polk H C
Published: March 2007

We measured the phagocytic capacity of the reticulo-endothelial system by assay of the clearance of colloidal carbon from the blood stream in both normal mice and mice in which shock had been induced by intraperitoneal injection of hypertonic glucose. The group of shocked mice was further subdivided into those pretreated with the immunoadjuvant, muramyl dipeptide (MDP), and those given placebo. Shock reduced reticulo-endothelial phagocytosis (P < 0.01), whereas pretreatment of shocked mice with MDP led to a hyperphagocytic state (P < 0.01). In a second series of experiments we subjected shocked mice, pretreated with MDP or placebo, to a virulent Klebsiella pneumoniae infection. MDP significantly improved survival (P < 0.01).
Permanent-access hepaticojejunostomy
Authors: Barker E M , Winkler M
Published: March 2007

A new technique of hepaticojejunostomy is described. The technique involves the incorporation of a cutaneous access stoma in the Roux-en-Y loop of jejunum used for the anastomosis. This stoma provides permanent access to the biliary-intestinal anastomosis and to the hepatobiliary tree for non-operative management of chronic and recurrent biliary tract problems.
The septic complications of sigmoid diverticular disease
Authors: Underwood J Weston , Marks C G
Published: March 2007

In 2 years 41 patients were treated surgically for septic complications of diverticular disease of the sigmoid colon. Nine patients had fistulae arising from sigmoid diverticular disease. Resection of the sigmoid was undertaken as the primary procedure in 8 patients with anastomosis in 5. Thirty-two patients had pericolic abscesses or peritonitis. The outcome (morbidity, length of stay) of the 21 patients who underwent primary resection was compared with that of the 11 patients treated by defunctioning colostomy alone. The better results in the larger group of 21 patients indicate that primary resection should be the treatment of choice for the septic complications of diverticular disease.
The treatment of primary hyperparathyroidism during pregnancy
Authors: Nudelmann J , Deutsch A , Sternberg A , Reiss R
Published: March 2007

Data on the management of primary hyperparathyroidism during pregnancy are sparse and relatively few parathyroidectomies have been performed during pregnancy. Provided the diagnosis can be established with reasonable certainty, removal of a parathyroid adenoma should be undertaken during the second or at the beginning of the third trimester. Parathyroidectomy in the hands of a surgeon familiar with this operation carries few risks. The complication rate of untreated cases may reach 80 per cent and include spontaneous abortion, fetal death and neonatal tetany. We present two cases of pregnant women who underwent successful parathyroidectomy during the course of gestation.
Surgical experience of deeply jaundiced patients with bile duct obstruction
Authors: Armstrong C P , Dixon J M , Taylor T V , Davies G C
Published: March 2007

One hundred and twenty consecutive deeply jaundiced patients undergoing surgery for bile duct obstruction were analysed. Diagnosis by either ultrasound or percutaneous transhepatic cholangiography was correct in 84 per cent and 86 per cent of patients respectively. Combination of the two procedures resulted in a diagnostic accuracy of 96.5 per cent. Despite pre-operative antibiotics and intravenous fluids, including Mannitol, infective complications and renal failure were common. Gastrointestinal haemorrhage was a major cause of postoperative morbidity and mortality. The operative mortality in this series was 14.2 per cent and was related to the depth of jaundice in patients with benign disease. The same relationship did not appear to occur in those with malignant disease. The median survival after palliative bypass surgery in patients with malignant obstruction was 6.5 months.
A study of endoscopic sphincterotomy in recurrent pyogenic cholangitis
Authors: Lam S K
Published: March 2007

Recurrent pyogenic cholangitis is a condition prevalent in Asia. Surgery has been the only form of treatment when extrahepatic and/or intrahepatic biliary dilatation, irregularity, debris and calculi are present. Endoscopic sphincterotomy was attempted in 134 such patients, the majority of whom had calculi confined to the common bile duct, and in whom 85.8 per cent were over 60 years old, 61.2 per cent had previous biliary surgery, and 36.6 per cent had an associated major medical illness. Sphincterotomy was successful in 88 per cent of patients, good results were obtained in 81.3 per cent, and stone removal was achieved in 91.7 per cent of those with demonstrable biliary calculi. Major complications occurred in 7.5 per cent, resulting in emergency surgery in 3 per cent and death in 1.5 per cent. The mortality of surgical sphincteroplasty in 143 patients with this condition who were over 60 years old was known to be 7 per cent. Five of 109 patients without residual calculi after endoscopic sphincterotomy developed mild to moderate symptoms after a follow-up period of 6 months to 6 years (median 2.3 years). Endoscopic sphincterotomy is a safe and effective form of treatment in patients with recurrent pyogenic cholangitis whose calculi are confined to the common bile duct.
Wound healing in obstructive jaundice
Authors: Armstrong C P , Dixon J M , Duffy S W , Elton R A , Davies G C
Published: March 2007

Wound healing has been investigated in 373 patients undergoing surgery for obstructive jaundice and 760 anicteric patients undergoing cholecystectomy. Reduced wound healing manifested by a higher frequency of wound dehiscence (3.2 per cent vs. 0.5 per cent) and incisional hernia (10.3 per cent vs. 1.8 per cent) was seen in the jaundiced patients. The factors related to this reduced wound healing have been analysed by univariate and multivariate analysis. The independent factors related to wound dehiscence in the 373 jaundiced patients were: an initial low haematocrit (< 30 per cent), an initial low plasma albumin (< 30 g/l), a history of pancreatitis, a malignant obstructing lesion, and postoperative wound and/or abdominal sepsis. Haematocrit, albumin and postoperative wound and/or abdominal sepsis were also independent factors for incisional hernia. A raised plasma bilirubin was not of independent significance for either wound dehiscence or incisional hernia. It is concluded that reduced wound healing occurs in jaundiced patients and that this is due to the associated features of poor nutritional status (manifested by low haematocrit and low albumin) and malignancy and not to the raised bilirubin per se.
Survival and recurrence after sphincter saving resection and abdominoperineal resection for carcinoma of the middle third of the rectum
Authors: Williams N S , Johnston D
Published: March 2007

Sphincter saving resections (SSR) are being performed with increasing frequency in patients with carcinoma of the lower two-thirds of the rectum. It is not clear, however, whether local and distant recurrence and long term survival after these operations will be comparable with those following abdominoperineal resection (APER). In this retrospective study, we have compared survival and recurrence in patients with carcinoma of the middle third of the rectum (7.5–12 cm from the anal verge) who were treated by APER (n = 83) or low SSR (n = 71). There was a higher proportion of men in the APER group, the mean age was higher and APER patients had tumours with less favourable pathological features. To minimize bias between the two groups, patients with tumours with similar pathological characteristics were compared. The overall cancer specific 5-year survival rate after SSR was 74 per cent and after APER was 62 per cent; the overall recurrence rates were 27 per cent after SSR and 41 per cent after APER; the incidence of local recurrence was 11 per cent after SSR and 8 per cent after APER. In these comparisons and when the patients' tumours were matched for one or two pathological variables, no significant difference was found between the two groups. These results suggest that patients with carcinoma of the middle third of the rectum who are treated by SSR will fare as well as patients who are treated by APER, with respect both to recurrence and to survival. A prospective controlled trial, however, is required to provide final proof of these points.
A personal view of abdominal aortic aneurysms
Authors: Bergan J J
Published: March 2007

Based on the Surgikos Lecture delivered to the Association of Surgeons of Great Britain and Ireland, London 1983.
Hypomagnesaemia after small bowel resection: Treatment with 1 α-hydroxylated vitamin D metabolites
Authors: Selby P L , Peacock M , Bambach C P
Published: March 2007

Seven patients with severe neuromuscular symptoms due to hypomagnesaemia together with hypocalcaemia following extensive resection of the small bowel were treated orally with 1 α-hydroxylated metabolites of vitamin D and magnesium oxide. There was a rapid response in both plasma calcium and magnesium concentrations. The mean plasma magnesium rose from 0·24 to 0·45 mmol/l with the vitamin D metabolites alone and to 0·81 mmol/l when magnesium oxide was added. The plasma calcium rose from 1·78 to 2·21 mmol/l on vitamin D alone and then remained within the normal range. This was accompanied by a rapid resolution of the neuromuscular symptoms. Such oral treatment is both acceptable to the patient and effective both for acute symptoms and in the long term to maintain plasma magnesium concentrations.
The relationship of background mammographic pattern to hormone dependency in breast cancer
Authors: Hinton C P , Williams M R , Roebuck E J , Blamey R W , Glaves J , Nicholson R I , Griffiths K
Published: March 2007

We have studied the relationship between mammographic parenchymal pattern of the breast and oestrogen receptor (ER) status in the primary tumour in 337 patients with operable invasive breast cancer, and the response to endocrine therapy in patients subsequently developing secondary disease. Patients with dysplastic (DY) parenchymal pattern are significantly more likely to develop tumours which are ER-positive. In 92 patients who subsequently developed secondary disease, those whose primary tumour arose in a DY pattern breast were significantly more likely to respond to endocrine therapy irrespective of their ER status.
The pre-operative assessment of advanced gastric cancer by computed tomography
Authors: Dehn T C B , Reznek R H , Nockler I B , White F E
Published: March 2007

Forty-five patients with proven gastric adenocarcinoma underwent pre-operative abdominal computed tomography (CT). The radiological findings of tumour spread were prospectively compared with the surgical findings obtained at laparotomy. CT evidence of involvement of three organs, together with the presence of a large gastric tumour mass, correlated with the inability to resect the tumour in this series.
Transduodenal sphincteroplasty: An analysis of 118 consecutive cases
Authors: Antrum R M , Hall R
Published: March 2007

The results of 118 consecutive common bile duct explorations via transduodenal sphincteroplasty are presented and analysed. The operations were performed for suspected choledocholithiasis by one surgeon over a 10-year period. Choledocholithiasis was proved in 22 per cent of the cholecystectomies carried out during this period and tended to present significantly earlier in females, 14·5 per cent presenting before 35 years of age. One hundred and four survivors were traced and 93·5 per cent had achieved a good result at a mean 5-year follow-up.
Cellulose granulomatous peritonitis
Authors: Brittan R F , Studley J G N , Parkin J V , Rowles P M , Le Quesne L P
Published: March 2007

The case history of a patient developing granulomatous peritonitis due to cellulose is described. At a second laparotomy following an operation for intestinal obstruction due to adhesions, the peritoneum was found to be studded with multiple, yellow nodules, closely resembling tuberculous lesions, but shown on microscopy to be tuberculoid granulomata containing cellulose fibres. The main features of the condition, which is self-limiting, and probably more common than is generally realized, are discussed.
Lymph node imprint cytology for the rapid assessment of axillary node metastases in breast cancer
Authors: Quill D S , Leahy A L , Lawler R G , Finney R D
Published: March 2007

Lymph node imprint cytology was performed on 86 nodes from 13 consecutive patients with breast cancer undergoing simple mastectomy with axillary node sampling, and a prospective comparison with paraffin section was made. The results showed a diagnostic sensitivity and specificity of 0·93 and 0·98 respectively. The predictive value of a positive result was 0·98. This technique can be used to identify patients with Stage I disease rapidly, thereby allowing their exclusion from treatment with peri-operative chemotherapy.
Prediction of prognosis in axillary lymph node positive breast cancer patients: A statistical study
Authors: Mæhle B O , Skjærven R
Published: March 2007

This work has identified variables of importance to short- and long-term prognosis in 97 node positive breast cancer patients followed for a minimum of 98 months. The diameter of the primary tumour (⩽3 cm/>3 cm) is shown to be an important prognostic variable. Its addition to the presence/absence of tumour cells in the efferent nodal vessels and the mean nuclear area of the tumour cells gave correct prediction of the disease outcome, 60 and 98 months after the operation, in 83 and 80 per cent of the patients respectively. Although the number of tumour-bearing nodes is shown to be a strong variable, more information was gained from the tumour diameter. Histological grade was only of value for 5-year prognosis. Factors that did not add information of prognostic value in these circumstances were identified. The proposed models demonstrate the great heterogeneity within this group of patients.
The value of serial bone scanning in operable breast cancer
Authors: Monypenny I J , Grieve R J , Howell A , Morrison J M
Published: March 2007

The value of initial and serial isotope bone scans was assessed in 685 patients with operable primary breast cancer. Nineteen (2·8 per cent) patients had a positive initial scan and negative skeletal radiographs; only nine of these developed other evidence of metastatic disease after a mean follow up of 21 months. Five hundred and ten patients had serial scans up to five years after simple mastectomy; 51 (10 per cent) had scan conversion, of whom 37 developed clinical or radiological confirmation of recurrent disease at a mean follow-up of 13 months. Compared with clinical or radiological methods for the detection of first metastases serial bone scans gave a mean lead time of five months in 15 patients and no lead time in the remaining 22 patients. Twelve of forty-five patients with radiologically proven bone metastases had negative scans. Neither initial or serial bone scanning is clinically useful or economically viable as a routine screening or follow-up procedure for patients with operable breast cancer.
The uses and abuses of life-table methods in vascular surgery
Authors: Underwood C J , Faragher E B , Charlesworth D
Published: March 2007

This paper details the calculations involved in a life-table analysis and appraises the current use of this technique in vascular research. We suggest that the presentation of patency curves should be standardized and recommend that: curves are presented as step rather than continuous graphs;the number of patients remaining in a study are shown at intervals along patency curves;the length of time for which a curve is claimed to hold is more rigorously defined;an attempt is made to increase, where possible, the frequency of patient review, particularly in the immediate postoperative period;ways of increasing the total sample size (e.g. multicentre studies) are investigated.

We also recommend that a set of definitive guidelines on the presentation of graft patency data acceptable to all the major vascular journals be sought.
Prostaglandin E1 in severe lower limb ischaemia: A double-blind controlled trial
Authors: Telles G S , Campbell W B , Wood R F M , Collin J , Baird R N , Morris P J
Published: March 2007

Thirty patients with ischaemic ulceration or rest pain due to lower limb atherosclerosis were treated with intravenous prostaglandin E1 (PGE1) or placebo in a prospective double-blind controlled trial. There was no significant improvement of rest pain, nor was PGE1 effective in promoting ulcer healing. This study provides no support for the use of intravenous PGE1 in the treatment of end-stage lower limb atherosclerotic disease.
The demonstration of saphenofemoral incompetence; Doppler ultrasound compared with standard clinical tests
Authors: McIrvine A J , Corbett C R R , Aston N O , Sherriff E A , Wiseman P A , Jamieson C W
Published: March 2007

Patients with primary varicose veins were examined by a combination of the standard tourniquet test with detection of reflux by Doppler ultrasound. Results were compared with standard clinical tests: impulse or thrill at the saphenous opening on coughing, tap impulse at the groin, and the ‘Trendelenburg’ tourniquet test. The state of competence of the saphenofemoral junction was noted at operation. One hundred and sixty-one limbs of 105 patients were studied. The saphenofemoral junction was incompetent in 132/161 limbs (82 per cent) and was judged competent in 29/161 limbs (18 per cent). The combined Doppler and tourniquet test assessed the saphenofemoral junction correctly in 82 per cent of limbs and was more accurate than all the other tests. The test had good sensitivity (0·9) but poor specificity (0·45). Poor specificity was a feature of all the tests except for thrill which was a highly insensitive test. The combined Doppler and tourniquet test appears to be the most simple, rapid and accurate means of detecting saphenofemoral incompetence.
Computer aided diagnosis in acute testicular pain
Authors: Goulbourne I A , Nixon S J , MacIntyre I M C
Published: March 2007

Over an 11-year period in Edinburgh, 495 patients with a proven diagnosis of testicular torsion or acute epididymo-orchitis were admitted to hospital. The final diagnosis in 227 was epididymitis, in 236 torsion of the testis and in 32 torsion of a testicular appendage. The immediate salvage rate from torsion of the testis was 67 per cent. To try to improve diagnostic accuracy in these three conditions, a computer program was constructed using a data base derived from the literature. On retrospective analysis of the 495 patients, the program achieved a 92·3 per cent accuracy in differentiating torsion from epididymitis. If the computer's diagnosis had been followed it would have reduced the exploration rate in epididymitis from 18 to 1·8 per cent. It would further have increased the diagnostic accuracy of a junior doctor to that of a senior colleague, but the number of torsions ‘missed’ by the computer and senior doctor would have been similar. The technique is inexpensive, rapid, immediately available, non-invasive and easy to use. It is suggested that such a program will increase diagnostic accuracy in acute testicular pain and, hopefully, the salvage rate from torsion of the testis.
Colostomy irrigation with prostaglandin E2 and bisacodyl. A double-blind cross-over study
Authors: Kjærgaard J , Christensen U , Stadil F , Anderson B
Published: March 2007

The emptying of the colon and the side-effects after intraluminal application of prostaglandin E2 and of bisacodyl in 14 patients was studied by employing colostomy irrigation. The design was double-blind with cross-over. the irrigation was one litre of tap water to which was added in randomized sequence placebo, prostaglandin *2 (350, 700 and 1400 μg) or bisacodyl (1·25, 2·5 and 5 mg). Neither prostaglandin E2 nor bisacodyl had any significant effect.
Abnormalities of muscle metabolism and histology in malnourished patients awaiting surgery: Effects of a course of intravenous nutrition
Authors: Church J M , Choong S Y , Hill G L
Published: March 2007

Malnourished surgical patients have metabolic and functional abnormalities of skeletal muscle and it has been suggested that these are due to reduced activities of glycolytic enzymes associated with abnormalities of muscle fibres. We have measured the activities of four key enzymes of glucose utilization and the size and distribution of muscle fibre types in vastus lateralis biopsies from 14 undernourished patients awaiting surgery (mean weight loss 24 ± 10 per cent). These results were compared with those from 14 normally nourished controls, comparable in age, sex, race and habitual activity. Fructose bisphosphatase activity was reduced in undernourished patients by 44 per cent (P < 0·01), phosphofructokinase by 40 per cent (P = 0·005) and hexokinase by 37 per cent (P < 0·001). Both fibre types were smaller in patients than controls (area I, 41·4 μm2 × 10−2 ± 0·4 vs. 73·3 μm2 × 10−2 ± 0·6, P < 0·001; area II, 27·7 μm2 × 10−2 ± 0·4 vs. 72·5 μm2 × 10−2 ± 0·5, P < 0·001), and there was a smaller proportional number of type II fibres in patients (35 per cent vs. 65 per cent, P < 0·01). This loss of type II fibre numbers and preferential type II atrophy may account for the enzyme depression associated with it and could produce the syndrome of impaired glucose tolerance, muscle weakness and fatigue seen in undernourished patients. In a subgroup of 11 patients, biopsy was repeated after 14 days of intravenous nutrition. Only phosphofructokinase activity rose significantly (19·62 ± 1·85 to 30·74 ± 2·99 μmol min−1 g−1, P < 0·01) and both type II fibre size (40·6 ± 18·5 to 47·4 μm2 ± 20·3 × 10−2, P < 0·05) and number (42 per cent ± 6 to 56 per cent ± 5, P < 0·05) also rose. Intravenous nutrition may therefore increase maximum glycolytic rate and improve muscle function in undernourished surgical patients.