bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single-Dose Antibiotic Prophylaxis of Abdominal Surgical Wound Infection: A Trial of Preoperative Latamoxef against Peroperative Tetracycline Lavage
Authors: Sauven P , Playforth M J , Smith G M R , Evans M , Pollock A V 
Published: January 2017

A randomized controlled clinical trial was undertaken in 542 consecutive emergency and elective abdominal operations, with one group of patients receiving tetracycline peritoneal and wound lavage and the other a single intravenous injection of 1 g latamoxef at induction of anaesthesia. Seventy-five patients were withdrawn because no potentially contaminated hollow viscus was opened, and a further 36 because they could not be assessed for wound infection. Of the remaining 431 patients, 212 received latamoxef resulting in 5 major and 8 minor wound infections in hospital; another 4 minor infections occurred at home (total incidence 8.0%). In the tetracycline group ( n = 219) there were 7 major and 19 minor wound infections in hospital and 10 minor infections later (total incidence 16.4%). This is significantly higher than the rate with latamoxef ( P=0.012). Monitoring of operative and postoperative bleeding revealed no evidence (except in one doubtful case) of excessive bleeding associated with the use of a single dose of latamoxef. It is concluded that single-dose preoperative latamoxef is more effective than peroperative tetracycline lavage for the prevention of wound infections after potentially contaminated abdominal operations.
Abdominal Tuberculosis: Still a Problem Today
Authors: Wells A D , Northover J M A , Howard E R 
Published: January 2017

Thirty cases of abdominal tuberculosis were diagnosed over an 18-year period, 26 being in immigrants; the mean age at presentation was 33 years. There were 25 cases of tuberculous peritonitis, two of tuberculous mesenteric lymphadenitis, and one each of gastric tuberculosis, colonic tuberculosis and tuberculous ischiorectal abscess. The presenting symptoms were of vague ill-health and not diagnostic, and the most common findings were of pyrexia, abdominal tenderness and ascites. The most common haematological abnormalities were raised ESR (22 patients) and mild anaemia (15 patients). Most commonly, diagnosis was made by formal laparotomy (19 cases) with biopsy (18 cases); histological examination gave a positive diagnosis in all 18 cases, but bacteriological examination yielded the tubercle bacillus in only 10 (56%). There were 2 deaths in the series, not directly related to the abdominal tuberculosis. In view of its infrequent and vague presentation, care is required to avoid overlooking the diagnosis of abdominal tuberculosis, particularly in the immigrant population.
Pathology Prize Evening Polycythaemia following Renal Transplantation
Authors: Davis H P 
Published: January 2017

Polycythaemia has developed in 10 of 59 regularly reviewed patients with renal transplants surviving more than three months. The pathology of the raised haemoglobin level was heterogeneous. Three patients had a picture characterized by a normal red cell mass and reduced plasma volume. Seven patients had a raised red cell mass; in 3 of these this was associated with a period of abnormal liver function and fitted with the state of raised red cell mass in association with hepatic transaminitis. The remaining 4 patients form a unique, previously undefined group with no features to explain the underlying aetiology of the polycythaemia. The patients had a trouble-free post-transplant course with early establishment of graft function. It is proposed, from the data obtained from in vitro culture studies, that the early return of good renal function allows the erythroid compartment to expand in response to circulating erythropoietin. The establishment of an erythron of increased size allows for a persistently raised haemoglobin in the presence of normal erythropoietin levels.
Postviral Fatigue Syndrome: Persistence of Enterovirus RNA in Muscle and Elevated Creatine Kinase
Authors: Archard L C , Bowles N E , Behan P O , Bell E J , Doyle D 
Published: January 2017

Enterovirus-specific probes have been prepared by reverse transcription of conserved sequences in purified Coxsackie B2 virus genomic RNA and molecular cloning techniques. These probes were used in quantitative slot blot hybridizations to test for the presence of enterovirus-specific RNA in skeletal muscle biopsy specimens from 96 patients who had suffered from the postviral fatigue syndrome myalgic encephalomyelitis for up to 20 years. Biopsy specimens from 20 patients were positive for the presence of virus-specific RNA with hybridization signals more than three standard deviations greater than the mean of the normal muscle controls. Biopsies from the remaining 76 patients were indistinguishable from the controls. These data show that enterovirus RNA is present in skeletal muscle of some patients with postviral fatigue syndrome up to 20 years after onset of disease and suggest that a persistent virus infection has an aetiological role.
Pattern, Severity and Aetiology of Injuries in Victims of Assault
Authors: Shepherd J P , Shapland M , Pearce N X , Scully C 
Published: January 2017

Although the incidence of assault and other violent crime is increasing in the UK, the cause and overall pattern of injury, and the need for admission have not been defined in adult victims who attend hospital. In a prospective study, all 539 adult victims of assault attending a major city centre Accident & Emergency department in 1986 were therefore interviewed and examined. Facial injury was extremely common: 83% of all fractures, 66% of all lacerations and 53% of all haematomas were facial. The upper limb was the next most common site of injury (14% of all injuries). Twenty-six per cent of victims sustained at least one fracture and nasal fractures were the most fiequently observed skeletal injuries (27%) followed by-zygomatic fractures (22%) and mandibular body (12%), angle (12%) and condyle (9%) fractures. Seventeen per cent of victims required hospital admission. Overall, the type of injury observed correlated with the alleged weapon used ( P=<0.001) though 20% of victims who reported attacks with sharp weapons sustained only haematomas or fractures. Injury most often resulted from punching (72% of assaults) or kicking (42% of assaults). Only 6% of victims reported injury with knives but 11% were injured by broken drinking glasses. Those who were kicked were most likely to need hospital admission.
Psychological Aftermath of the King's Cross Fire
Authors: Rosser R , Dewar S , Thompson J 
Published: January 2017

The King's Cross fire occurred at the end of the evening rush hour, on 18 November 1987. King's Cross station is within the department's health district and we felt a responsibility to respond to the psychological aftermath. The unique features of our intervention were the degree of inter agency coordination, the use of a systematic outreach and screening programme, the collection of psychotherapy outcome measures and the development of an ongoing clinic. The work represents a sustained attempt to assess the nature and prevalence of post-traumatic reactions and the most medically and economically effective form of intervention. In this paper we describe the way our team responded to the high level of psychological distress that we found, we present some preliminary results, outline two therapeutic trials, and refer to the long-term consequences for the work of our department.
Residual Gastric Content after Gastric Lavage and Ipecacuanha-Induced Emesis in Self-Poisoned Patients: An Endoscopic Study
Authors: Saetta J P , Quinton D N 
Published: January 2017

Flexible endoscopy was used to assess the intragastric residue after either ipecacuanha-induced emesis or gastric lavage in 30 self-poisoned patients. Of the 13 patients treated by induced-emesis, five (38.5%) had residual solid in the stomach; 17 patients were treated by gastric washout, and 15 (88.2%) of these had residual intragastric solid. The study provides direct evidence that the gastric decontaminating procedures employed, and especially gastric lavage, do not remove stomach contents completely.
Surgery for Recurrent Sapheno-Femoral Incompetence Using Expanded Polytetrafluoroethylene Patch Interposition in Front of the Femoral Vein: Long-Term Outcome in 119 Extremities
Authors: Creton D. 
Published: January 2017

Objective: To assess the long-term results of re-do surgery for recurrent varicose veins using polytetrafluoroethylene patch interposition to correct a recurrent varico-femoral junction (RVFJ). Methods: In 170 extremities (137 patients) with RVFJ greater than 3 mm in diameter, re-do surgery was done with patch interposition and without extensive resection of neovascularisation. Follow-up data based on physical and ultrasound examinations were obtained for 119 of these extremities (100 patients). Setting: Private-practice vascular surgery centre. Results: At follow-up (mean 4.9 years), 5 extremities (4.2%) had another RVFJ. In the 114 extremities with no RVFJ, 27.7% had no varicose veins or incompetent superficial veins, 45.3% had several small varicose veins without reflux, and 22.6% had diffused varicose veins and a new site of incompetence between the deep and superficial venous system. Conclusions: Re-do surgery using patch interposition lowers the long-term risk of another RVFJ. Wide resection of neovascularisation in the groin seems unnecessary.
Factors Associated with Varicose Veins in Pregnant Women
Authors: Coughlin L. B. , Gandy R. , Rosser S. , de Cossart L. 
Published: January 2017

Objective: To examine the associated features in pregnant women with superficial venous reflux, compared with those without reflux. Methods: Pregnant women were recruited at booking and underwent colour flow duplex ultrasound scanning of the lower limbs to ascertain the presence or absence of reflux in the superficial veins. Body mass index and CEAP scores were calculated. A questionnaire regarding parity, smoking habit and family history of varicose veins was administered. Statistical analysis was carried out using ARCUS. Results: Three hundred and twenty-nine women were recruited, of whom 83 were identified as having reflux (25%). No relationship was observed between reflux and obesity, smoking or family history. Multiparity was significantly correlated with varicose veins (p<0.03). CEAP scores were higher in multiparous women with varicose veins. An increase in symptoms was associated with a positive family history (especially maternal). Smoking was associated with fewer symptoms in those with reflux, as was obesity. Conclusion: Increased parity increased the likelihood of varicose veins, but obesity and family history appeared to make no difference. Symptoms were greater in multiparous women, but less inobese women. An association was made between smoking and fewer symptoms.
Evaluation of the Microcirculatory Effects of Venoruton (H.R.) in Patients with Chronic Venous Hypertension by Laser-Doppler Flowmetry, Transcutaneous PO2 and PCO2 Measurements, Leg Volumetry and Ambulatory Venous Pressure Measurements
Authors: Belcaro G. , Rulo A. , Candiani C. 
Published: January 2017

The effect of Venoruton on the symptoms and microcirculation was investigated in an open randomised placebo controlled study involving 35 patients with chronic venous hypertension. Treatment was for 6 weeks. There was a significant symptomatic relief (ache, cramps, skin irritation and swelling) according to an analogue scale line score in the active treatment group, but not in the placebo group. The symptomatic relief in this group was associated with a reduction in leg volume ( p < 0.5), resting and standing skin blood flow ( p < 0.05), restoration of the venoarteriolar reflex, a decrease in transcutaneous PO2 ( p < 0.01) an increase in PO2 ( p < 0.05). These parameters did not change in the placebo group. The results of this study demonstrate that Venoruton therapy has a marked effect on the microcirculation and indicate possible mechanisms of the relief of symptoms.
The Role of External Banding Valvuloplasty with the Venocuff in the Treatment of Primary Deep Venous Insufficiency
Authors: Guarnera G. , Furgiuele S. , Camilli S. 
Published: January 2017

Objective: Evaluation of the role of external banding valvuloplasty in the treatment of primary deep venous insufficiency. Design: Retrospective analysis of patients subjected to external banding valvuloplasty (EBV) with the Venocuff in relation to the evolution of venous reflux. Setting: Department of Vascular Surgery, Instituto Dermopatico dell'Immacolata, Rome, Italy. Patients: Ten patients with signs and symptoms of chronic venous insufficiency. Interventions: Application of a Venocuff to the superficial femoral vein. Main outcome measures: The correction rate of the primary deep venous reflux assessed by venography and colour duplex ultrasound. Results: In a mean follow-up period of 10 months, deep vein reflux was completely abolished in nine patients (90%). Conclusions: The Venocuff is an improvement over the previous techniques, of surgical treatment of primary deep venous insufficiency in reducing the dilated valve bulb to the correct size in a quick, standardized and precise way.
Neovascularization in Recurrent Sapheno-Femoral Incompetence of Varicose Veins: Surgical Anatomy and Morphology
Authors: Glass G. M. 
Published: January 2017

Objective: To investigate the surgical anatomy and morphology of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation. To test the hypothesis that such recurrence develops through neovascularization. Design: Prospective study of single patient group. Setting: Varicose vein clinic of teaching hospital. Patients: One hundred and twenty-eight patients (141 limbs) were reviewed 4 or more years after accurately performed sapheno-femoral ligation with catgut, silk or tantalum wire. Intervention: Clinical assessment, phlebography, surgical exploration and examination of recurrent veins by radiographic and histological methods. Main outcome measures: Presence of reflux through newly formed veins at the site of previous ligation. Results: Of 141 limbs, clinical or phlebographic evidence of sapheno-femoral recurrence was confirmed in 35 of 37 on surgical exploration. The continuity of the saphenous vein with the previously ligated sapheno-femoral junction was restored through a newly formed vein or complex of veins. Conclusions: Neovascularization was the cause of recurrent sapheno-femoral incompetence after correctly performed sapheno-femoral ligation.
In Vivo Compliance of the Human Saphenous Vein Measured by Sonography: Comparison with Plethysmographic and in vitro Measurements
Authors: Lefthériotis G. , Pochet Th. , Abraham P. , Subayi-Kamuanga J. B. , Jardel A. , Saumet J. L. 
Published: January 2017

Objective: To evaluate a non-invasive and selective measurement of in vivo venous compliance of the human saphenous vein using sonography. Design: An experimental study in patients prior to coronary bypass surgery. Setting: Departments of Physiology and Cardiothoracic Surgery, University Hospital of Angers. Patients: Thirty patients investigated prior to coronary bypass surgery. Interventions: Simultaneous strain-gauge venous occlusion plethysmography (VOP) and measurements of the circumference of the great saphenous vein by sonography at four different occlusion pressures: 20, 30, 40 and 50 mmHg. In 10 of the same patients, in vitro determination of pressure–volume relationship during progressive inflation of excised saphenous vein samples. Main outcome measures: Venous compliance obtained with the three methods. Results: Weak correlation coefficients were found between in vitro measurements and VOP ( r=0.478, p<0.01) and sonography ( r=0.497, p<0.02). Although individual correlations between in vitro and VOP measurements ranged from 0.928 to 0.999, a wide heterogeneity was found with sonography (from 0.620 to 0.985). Conclusions: Sonography allows the selective measurement of in vivo venous compliance, although the measured compliances differ from other techniques.
Reproducibility of Duplex Ultrasound in the Measurement of Venous Reflux
Authors: Evans C. J. , Leng G. C. , Stonebridge P. , Lee A. J. , Allan P. L. , Fowkes F. G. R. 
Published: January 2017

Objective: To determine the reproducibility of duplex ultrasound in the measurement of reflux duration in lower limb veins. Design: Repeatability study. Setting: Vascular clinic in a tertiary referral centre. Participants: Twenty-one patients with severe venous disease. Interventions: Patients were scanned using duplex ultrasound by two of three observers, then rescanned by a different pair of observers after a mean interval of 51 days. Main outcome measures: Duration of venous reflux. Results: On a Wilcoxon signed rank test, observers 2 and 3 showed no significant interobserver variability. The other pairs of observers agreed at the majority of segments, but differed at the popliteal vein ( p≤0.001), and superficial femoral and common femoral veins ( p≤0.05). Observer 2 showed no significant intraobserver variability, but observer 1 differed at the common femoral and superficial femoral veins ( p≤0.05), and observer 3 differed at the short saphenous vein ( p≤0.05). Conclusions: Reproducibility was reasonable at certain sites, but appeared to be influenced by position of the vein.
Clinical Predictors of the Severity of Chronic Venous Insufficiency of the Lower Limbs: A Multivariate Analysis
Authors: Mota-Capitão L. , Menezes J. Daniel , Gouveia-Oliveira A. 
Published: January 2017

Introduction: Chronic venous insufficiency (CVI) affects a large proportion of individuals and, with the ageing of the Western European population, its prevalence is bound to increase. Epidemiological data, particularly regarding risk factors, are scarce and controversial. Objective: Identification of clinical factors associated with an increase in severity of CVI. Setting: Community-based study of patients presenting to their general practitioner. Methods: Four hundred and seventy-four unselected patients with symptoms suggesting CVI were evaluated by 18 general practitioners. CVI was diagnosed and assessed by clinical examination and portable continuous-wave Doppler. Severity of CVI was graded according to the nomenclature of the International Society for Cardiovascular Surgery. Patient demographic and clinical factors showing a linear relationship with the severity of CVI were analysed with the proportional odds model to evaluate the simultaneous effect of several factors in the severity of CVI. Results: A multivariate model is proposed, where age is a major risk factor for increased severity. Other factors that are independently correlated with the severity of CVI are body weight, environmental heat, sedentarily, CVI in both parents, high-dose oestrogen formulations, osteoarticular disease of the lower limbs, presence of truncal varices, involvement of the internal saphena, lymphoedema and history of thrombophlebitis. Conclusion: Because most studies do not adjust for age when testing for risk factors, this may be an important reason for the multiplicity of reported factors and the lack of consistency of their results.
The Long Saphenous Vein Compartment
Authors: Caggiati A. , Ricci S. 
Published: January 2017

Objective: To define the relationship between the long saphenous vein and the connective framework of the subcutaneous tissue (hypodermis) of the lower limb. Methods: The connective skeleton of the hypodermis was studied by anatomical dissection, stereomicroscopy of cross-sectioned specimens and ultrasound imaging in 88 lower extremities. Results: The long saphenous vein runs for most of its length in a narrow compartment delineated deeply by the muscular fascia and superficially by a connective tissue lamina descending from the inguinal ligament in the anteromedial part of the thigh and medial aspect of the calf. These two fascia fuse at the boundaries of the compartment. The long saphenous vein adventitia is anchored to both fasciase by thick connective tissue strands. Conclusion: The anatomical relationship between the long saphenous vein and the connective framework of the hypodermis suggests that: (1) only the vein running within the deep compartment of the hypodermis should be considered as the ‘true’ long saphenous vein; (2) the other subcutaneous veins running outside the compartment should be considered as collaterals of the long saphenous vein; (3) the connective sheath surrounding the long saphenous vein could oppose dilatation of this vessel should valvular incompetence develop; and (4) thigh muscle contraction could modify the calibre of the long saphenous vein as happens in the deep veins. Finally, the authors propose to term the deep compartment of the medial thigh and the leg hypodermis the ‘long saphenous vein compartment’ and consequently the hypodermic connective lamina, by which it is superficially delimited, as the ‘long saphenous vein fascia’.
Inferior Vena Cava Compression Caused by Ruptured Abdominal Aortic Aneurysms: Report of Two Cases
Authors: Martínez-León J. I. , Bohórquez-Sierra J. C. , Sánchez-Guzmán A. R. , Arribas-Aguilar F. N. , Ceijas-Lloreda F. , Rodríguez-Piñero M. , Bohórquez-Sierra C. 
Published: January 2017

Objective: To report two cases of inferior vena cava (IVC) and iliac vein thrombosis secondary to expansive and ruptured abdominal aortic aneurysms. Design: Case report. Setting: Angiology and Vascular Surgery Unit, Hospital Universitario Puerta del Mar, Cádiz, Spain. Patients: Patients with clinical and radiological evidence of IVC and iliac vein thrombosis secondary to a sealed rupture from expanding aortic aneurysms. Interventions: Surgical repair in one case and conservative management in the second case. Conclusions: Venous compression was relieved, avoiding the risk associated with anticoagulant therapy in the presence of an aortic aneurysm. Ultrasound scanning is useful in assessing deep venous thrombosis and detecting compressive masses such as aortic and iliac aneurysms. Inappropriate management of patients with venous obstruction from undiagnosed arterial aneurysms may cause serious complications.
A Simple Technique to Reduce Blood Loss and Improve Cosmesis in Varicose Vein Surgery
Authors: Rehman A. , Rallapalle V. S. P. , Iqbal R. , Grimley R. P. , Jayatunga A. P. 
Published: January 2017

Objective: To assess the effectiveness of preoperative compression hosiery in reducing blood loss during surgery for varicose veins and improving cosmetic results. Setting: Vascular Surgical Unit, Dudley Group of Hospitals NHS Trust, West Midlands, UK. Design: Randomized, single-blind, prospective, controlled trial. Patients: Thirty-nine patients with varicose veins in 50 legs. Intervention: Group A, the control group ( n = 19), were given compression stockings on the first postoperative day after the bandages were removed. Group B, the study group ( n = 20), used compression stocking 24 h before surgery as well as in the postoperative period. The surgical procedure was standardized. Main outcome measures: Blood loss, weight of veins removed, operation time and cosmetic result after 6 weeks. Results: In group B, patients were noted to have reduced blood loss, a shorter operation time and a greater weight of avulsed veins. Poor cosmetic results were recorded in group A. Conclusions: Preoperative emptying of veins by using a compression stocking is useful in reducing blood loss and improving the cosmetic result after routine varicose vein surgery.