bluuebunny/crossref_metadata_2025_split huggingface dataset:
Home parenteral nutrition: A review of 100 patient years of treatment in 76 consecutive cases
Authors: Stokes M A , Almond D J , Pettit S H , Mughal M M , Turner M , Shaffer J L , Irving M H 
Published: March 2007

Abstract
Over the last 10 years, the Nutrition Unit at Hope Hospital has trained and looked after 76 patients on home parenteral nutrition for a total of 100 patient years. Although 40 per cent of patients have required home parenteral nutrition for 6 months or less one patient has been on treatment for 7 years. The quality of life measured on a 4 point scale was good for the majority of patients. Sepsis and superior vena caval thrombosis are the main problems encountered. Overall mortality rate was 18 per cent and the sepsis rate was 0·14 episodes per patient per year. Home parenteral nutrition is an effective and safe treatment of intestinal failure.
Dietary fibre and gastrointestinal disease
Authors: Cranston D , McWhinnie D , Collin J 
Published: March 2007

Abstract
This review examines the evidence linking dietary fibre to gastrointestinal disease. Fibre increases stool weight, decreases whole gut transit time and lowers colonic intraluminal pressure. While it may be of benefit in the treatment of constipation, the irritable bowel syndrome and diverticular disease, its role in the prevention or treatment of other gastrointestinal disease has yet to be established.
Hepatic trauma: Risk factors influencing outcome
Authors: Prêtre R , Mentha G , Huber O , Meyer P , Vogel J , Rohner A 
Published: March 2007

Abstract
This retrospective study analyses the fate and associated risk factors of 99 patients who underwent laparotomy for hepatic trauma from 1977 to 1986. Blunt trauma (88 patients) and stab wounds (7 patients) had mortality rates of 36 and 14 per cent respectively. The overall death rate was 35 per cent. Multiple trauma patients had a significantly higher mortality for each additional system that was seriously injured. Pre-operative shock raised the mortality from 20 to 58 per cent (P &lt; 0.001). For patients over 50 years of age, the mortality rate increased from 30 (younger patients) to 63 per cent (P = 0.028). Minor hepatic wounds required relatively simple surgical measures in 60 patients, yet 13 died (22 per cent) of other causes. More sophisticated surgical management was applied to 27 major hepatic lesions, with 10 deaths (37 per cent). Twelve patients (seven with minor and five with major hepatic wounds) died before surgical treatment of the liver injury could be undertaken. The overall mortality rate of major hepatic wounds was 47 per cent and for minor wounds 30 per cent. However, the difference was not significant (P = 0.152). Resection was resorted to in 15 patients, 5 of whom subsequently died (33 per cent). Classical hepatic lobectomy led to 4 deaths (50 per cent). Among the 35 deaths, 6 were due to the hepatic trauma itself (5 exsanguinations and 1 intra-abdominal sepsis). Isolated hepatic injury was fatal in three patients. We believe that conservative surgical measures should be used whenever possible in patients with hepatic trauma, especially when risk factors are encountered.
Pulmonary complications after subtotal oesophagectomy
Authors: Nishi M , Hiramatsu Y , Hioki K , Hatano T , Yamamoto M 
Published: March 2007

Abstract
The postoperative pulmonary complications in 25 patients undergoing subtotal oesophagectomy for intrathoracic oesophageal carcinoma during the 3-year period 1981–1983 were compared with those of 25 patients undergoing surgery from 1984 to 1986. Although more extensive lymphadenectomies were performed from 1984, the mortality rate caused by the postoperative pulmonary complications was zero in the later period (1984–1986) compared with a rate of 16 per cent in the earlier period (1981–1983). The incidence of postoperative pulmonary complications was lower in the later series but the difference was not statistically significant. Factors which may have contributed to the decrease in critical pulmonary complications after surgery during the later period were the selection of the posterior mediastinal route for reconstruction, the introduction of selective endobronchial intubation by a double lumen tube with combined epidural anaesthesia, fluid restriction during and after surgery, postoperative mobilization and the administration of an expectorant.
Carcinogenic potential of the non-cancerous epithelium in patients with oesophageal cancer
Authors: Maeta M , Koga S , Shimizu N , Inoue Y , Ishiguro M , Sawada T 
Published: March 2007

Abstract
Detailed histopathological examination of serial blocks and subserial sections of the entire resected oesophagus in 63 patients operated upon for oesophageal cancer revealed 11 associated minute superficial cancers, independent and apart from the main tumours, in 10 patients (15.9 per cent). Only one of these eleven lesions was diagnosed pre-operatively, and only three of the eleven lesions were detected macroscopically on the resected specimens. The high incidence of such coexisting independent lesions may indicate a possible increased multicentric carcinogenic potential in the non-cancerous epithelium of patients who have had an antecedent oesophageal cancer. These results emphasize the need for careful attention to the choice of margins during surgical resection of the oesophagus.
Implication of duodenogastric reflux in the pathogenesis of Barrett's oesophagus
Authors: Gillen P , Keeling P , Byrne P J , Healy M , O'Moore R R , Hennessy T P J 
Published: March 2007

Abstract
Fasting and postprandial intragastric bile acid concentrations have been estimated and compared in patients with complications of Barrett's oesophagus, patients with Barrett's oesophagus without complications, patients with oesophagitis and a group of normal subjects who acted as controls. There was no significant difference in fasting intragastric bile acid concentrations between the groups. Postprandial bile acid concentrations were significantly greater in the patients with complications of Barrett's than in the remaining groups at 60, 90 and 120 min. Significant concentrations of bile acids were seen in gastric juice of unaltered pH and may be undetected on intra-oesophageal pH monitoring. Duodenogastric reflux may be implicated in the pathogenesis of complications of Barrett's oesophagus.
Plain abdominal radiographs and acute abdominal pain
Authors: Campbell J P M , Gunn A A 
Published: March 2007

Abstract
The records of all (5080) patients presenting to a district general hospital with acute abdominal pain over a 4-year period were examined. The contribution of abdominal radiographs to the assessment of patients with suspected appendicitis, urinary tract infection, and non-specific abdominal pain was evaluated, these conditions accounting for 48 per cent of patients with abdominal pain and 32 per cent of those with abdominal radiographs. Any positive information from these radiographs was less likely to be helpful than incidental or inconsistent (and hence potentially misleading). Because of this high ‘false positive’ rate it is suggested that if the initial diagnosis is suspected appendicitis, urinary tract infection, or non-specific abdominal pain, there is little value in the routine use of abdominal radiographs.
Tuberculous cervical abscess: comparing the results of total excision against simple incision and drainage
Authors: Cheung W L , Siu K F , Ng A 
Published: March 2007

Abstract
In 40 patients with tuberculous cervical abscesses a prospective study was undertaken to determine the results of surgical treatment by either total excision or incision and drainage, together with 6 months of chemotherapy in both groups. While both procedures were well tolerated, the results showed that 17/22 (77 per cent) of those having a simple drainage procedure required a second operation to excise the residual infected lymph glands because of persistent sinus discharge, recurrent abscesses or enlarging lymphadenopathy. In contrast, 17/18 (94 per cent) of those having total excision as the primary procedure had no local ward problem afterwards. Most of the patients remained asymptomatic after completion of the chemotherapy but small painless lymph nodes might still be palpable during follow-up at 2 years.
Traumatic retroperitoneal venous haemorrhage
Authors: Smith S R G 
Published: March 2007

Abstract
Vena caval injury is rare in the UK, but changes in society suggest that it may become more frequent. The problem is always unexpected and presents a major surgical challenge. Modern techniques have led to a substantial improvement in survival so that most patients with an infrarenal injury should now survive but only with prompt, effective treatment. In this review the problems and techniques of surgical management are illustrated by three cases of traumatic injury and two of peroperative accidents.
Operative mortality rate and surgery for colorectal cancer
Authors: Brown S C W , Walsh S , Sykes P A 
Published: March 2007

Abstract
Different authors use different definitions of operative mortality rate when reporting results of their operations. Four definitions used in current literature were applied to our own series of 578 patients with colorectal carcinoma. The operative mortality rate was found to vary from 7·3 per cent to 12·2 per cent, depending on the definition used. ‘Death within 30 days of the last operation’ was the definition which best reflected true operative deaths. We urge that this definition of operative mortality rate be adopted as a standard for all operations.
Natural history and treatment of anorectal strictures complicating Crohn's disease
Authors: Linares L , Moreira L F , Andrews H , Allan R N , Alexander-Williams J , Keighley M R B 
Published: March 2007

Abstract
Forty-four patients seen between 1975 and 1985 with anorectal strictures complicating Crohn's disease have been reviewed to determine the natural history and outcome of surgical treatment. Proctitis was present in 98 per cent, and 93 per cent of patients had severe perianal disease. The site of strictures was rectal in 22, anal in 15 and anorectal in 11 (4 patients had a stricture at 2 sites). Initial treatment was by rectal excision alone in 6, dilatation in 33, and 5 needed no treatment at all. Single dilatation was effective in 15, 8 required two dilatations and in 10 repeated dilatation was necessary. Proctocolectomy was eventually required in 19 patients, 2 have a loop ileostomy and I has an ileostomy with a rectal stump in situ. Only 21 remain asymptomatic while 3 continue to need dilatation. Perineal wound healing was delayed in 9 of 19 patients having a proctocolectomy and in 3 the perineal wound has never healed.
The task of a statistical referee
Authors: Murray G D 
Published: March 2007

Abstract
The results are presented of an audit of the statistical standard of papers published in The British Journal of Surgery. A number of deficiencies are highlighted, many of which stem from an over-emphasis on statistical significance at the expense of any assessment of the clinical relevance of research findings. The flaws in the design of published studies, and in particular the many instances of inadequate sample sizes, emphasize that statistical input should be sought at the beginning of a research project rather than at the end.
Hydroxyethyl starch: an alternative to plasma for postoperative volume expansion after cardiac surgery
Authors: Munsch C M , Maclntyre E , Machin S J , Mackie I J , Treasure T 
Published: March 2007

Abstract
Hydroxyethyl starch (HES) is a recently developed synthetic volume expander. Forty patients undergoing coronary artery surgery were randomized to receive either HES or plasma protein fraction (PPF) as non-blood volume replacement according to standard haemodynamic criteria. The two groups were comparable in all respects. The median colloid use in the first 24 h was 950 ml (range 500–1500) in the HES group and 975 ml (350–2000) in the PPF group (not significant). There was no difference in blood use, urine output or blood loss between the two groups. Tests of coagulation showed the postoperative changes usual in cardiac surgical patients. There was no difference between the two groups in thrombin time, prothrombin time, activated partial thromboplastin time, or fibrinogen concentration. Similarly, tests of platelet function and Factor VIII and von Willebrand Factor activity showed no difference between the two groups. We conclude that HES is a safe and effective volume expander, and its relative lack of expense and ease of availability make its routine use after cardiac surgery an attractive proposition.
Effect of surgery on neutrophil functions, superoxide and leukotriene production
Authors: Utoh J , Yamamoto T , Utsunomiya T , Kambara T , Goto H , Miyauchi Y 
Published: March 2007

Abstract
Perioperative changes of neutrophil function were investigated in 28 patients who underwent major surgery, particularly focusing on the potential capacity for superoxide and leukotriene production, which seem to be important in host defence. The superoxide-producing capacity of neutrophils, which was examined using N-formyl-peptide or phorbol myristate acetate as an attractant, significantly decreased postoperatively to 55 and 69 per cent of the pre-operative values, respectively. The leukotriene-producing capacity of neutrophils, which was stimulated with calcium ionophore A23187 in the presence of arachidonic acid, significantly changed postoperatively. The leukotriene B4 (LTB4) production increased together with an increment of production of 6-trans 6-trans LTB4, however, increased postoperatively to 1·2 times the (LTC4) production decreased postoperatively. The total production of leukotriene A4 (LTA4) metabolites consisting of LTB4, LTC4, and 6-trans LTB4, however, increased postoperatively to 1·2 times the pre-operative values. This indicates that neutrophils in the postoperative period have a higher capacity for LTA4 production but a lower capacity for superoxide production than those in the pre-operative period.
Enterostomy as an adjunct to treatment of intra-abdominal sepsis
Authors: Hesp W L E M , Lubbers E J C , De Boer H H M , Hendriks T 
Published: March 2007

Abstract
In 60 patients a small bowel enterostomy was constructed as part of the treatment of various intra-abdominal infectious and obstructive conditions. Eleven patients (18 per cent) died in the immediate postoperative period from continuing sepsis. In one patient closure of the stoma was not considered because of disseminated malignancy. In the remaining 48 patients continuity of the gut was subsequently restored. In 22 patients (46 per cent) complications occurred, 12 (25 per cent) of which were intra-abdominal septic complications. The occurrence of intra-abdominal complications was found to be linked to premature (i.e. within 3 months) closure of the stoma. Reasons for premature closure were stomal difficulties and prerenal azotaemia. Stomal closure was attended by a 10 per cent mortality rate.
Abdominal aortic aneurysm
Authors: Thomas P R S , Stewart R D 
Published: March 2007

Abstract
Between 1981 and 1986, 282 cases of abdominal aortic aneurysm were diagnosed in Waltham Forest. Rupture had occurred in 183, 15 underwent urgent operation for intact aneurysm, and 84 had elective surgery. The incidence of rupture increased from 13 to 21 per 100000 population during the 6-year period. Operative mortality for patients with rupture was 54.7 per cent, but the mortality overall was 81.4 per cent. In 59 per cent of patients with rupture no operation was performed, and 35.0 per cent of all deaths occurred in the community. The mortality for rupture in women was significantly higher than in men, although the operative mortality was comparable. Fifty patients (27 per cent) were found to have attended hospital within 2 years of rupture and many had documented evidence of an aneurysm. One-third of all patients admitted with rupture were undiagnosed. This study complements the previous small number of community studies and suggests that the incidence of rupture is increasing nationally particularly in women, where the mortality was exceptionally high. Early elective surgery is the key to the problem and improved clinical awareness could save many patients without elaborate and expensive programmes to screen the ‘at risk’ population.
Femorodistal vein bypass graft stenoses
Authors: Grigg M J , Nicolaides A N , Wolfe J H N 
Published: March 2007

Abstract
Eighty femorodistal in situ vein bypass grafts have been evaluated at 3-monthly intervals clinically, with ankle:brachial pressure indices (ABI), by intravenous digital subtraction angiography (IV DSA) and by Duplex scanning. Five grafts (6 per cent) failed in the perioperative period. Nineteen (25 per cent) of the remaining 75 grafts subsequently developed stenoses on IV DSA during the first 12 months. All angiographic stenoses were detected by Duplex scanning using velocity ratio criteria before the development of symptoms or a measurable decline in ABI, i.e. while non-haemodynamically significant. This technique involves scanning the entire length of the graft but allows even minor stenoses to be detected and progression of stenoses can be determined. At a mean follow-up of 12 months (3–18 months), four (7 per cent) of the fifty-six grafts without stenoses occluded. Eight (42 per cent) of the nineteen stenosed grafts either occluded or developed symptoms. None of the occluded grafts in this series could be salvaged. Non-haemodynamically significant vein stenoses can be detected non-invasively, occur frequently and are associated with graft failure.
Endoscopic sclerotherapy in the treatment of gastric varices
Authors: Sarin S K , Sachdev G , Nanda R , Misra S P , Broor S L 
Published: March 2007

Abstract
Of 309 patients with portal hypertension, gastric varices were found in 48 (16 per cent). While the majority (88 per cent) of the patients had gastric varices in association with oesophageal varices, 6 (12 per cent) patients had ‘isolated’ gastric varices. Gastric varices were seen significantly (P &lt; 0.01) more often with grade 4 than with grade 3 varices. In 11 (28 per cent) of the 40 patients who completed sclerotherapy for oesophageal varices, gastric varices disappeared concurrently on eradication of oesophageal varices or during the following 6 months. Of the initial five patients with gastric varices who received direct intravariceal injections, four rebled; this technique was therefore replaced by combination (paravariceal + intravariceal) gastric variceal sclerotherapy. Emergency combination sclerotherapy successfully controlled bleeding from gastric varices in six of the eight treated patients. Thirty-two patients entered a programme of elective combination gastric variceal sclerotherapy. Variceal obliteration was achieved in 12 cases (38 per cent) and reduction in size was noted in another 7 patients (22 per cent) after a minimum of four courses. There were 11 (23 per cent) deaths, 8 due to uncontrolled bleeding from gastric varices and 3 due to hepatic coma. The other complications of gastric variceal sclerotherapy were minor and included retrosternal pain, fever and dysphagia. It is concluded that gastric varices often coexist with large oesophageal varices. If they persist for 6 months after eradication of oesophageal varices, a combination of paravariceal and intravariceal sclerotherapy should be attempted for their obliteration.
Value of endoscopic surveillance in the detection of neoplastic change in Barrett's oesophagus
Authors: Robertson C S , Mayberry J F , Nicholson D A , James P D , Atkinson M 
Published: March 2007

Abstract
Fifty-six patients with Barrett's oesophagus diagnosed between 1977 and 1986 were prospectively studied by 6-monthly endoscopic surveillance and biopsy. During follow-up to-date, four patients have developed high-grade dysplasia and three have adenocarcinoma of the oesophagus. Two of the adenocarcinomas were preceded by progressively severe dysplastic changes but in the third no dysplasia had been previously detected. The incidence of adenocarcinoma was 1 per 56 patient-years of follow-up. Changes in symptomatology or gross endoscopic appearances were usually absent, even after adenocarcinoma had developed, indicating that biopsy is essential for early diagnosis. The high risk of malignant change makes endoscopic surveillance advisable in all patients with Barrett's oesophagus.
Reconstruction after excision of soft tissue sarcomas of the limbs and trunk
Authors: Stotter A , McLean N R , Fallowfield M E , Breach N M , Westbury G 
Published: March 2007

Abstract
From a retrospective analysis of 180 surgical interventions for soft tissue sarcoma of the limbs and trunk, it was concluded that complete excision of the tumour can usually be achieved without sacrifice of major artery, vein, nerve or bone. In this series five major arteries were resected but only one required reconstruction. None of six resected major veins or seven resected nerves were reconstructed. Bone resection in the limb required plating in only two of eleven patients who had limb-sparing resection (there were nine amputations). Both in the limbs and the thorax, resection of bone often involved such a wide excision of the superficial soft tissues as to require a flap repair: four were used in the limbs and three in five chest wall resections. In the majority of operations (140/180) primary wound closure was possible. After 15 procedures for tumour predominantly involving the superficial tissues, split skin grafts were used. These were generally successful (13/15), even occasionally when high-dose radiotherapy had been given. In 16 cases earlier radiotherapy influenced the decision to use a flap repair. A total of 18 flap repairs were performed. In various situations Mersiline mesh (Ethicon, Ltd., UK), Silastic implants and omental swings were used. Wound breakdown in heavily irradiated tissues presented a major challenge for reconstruction. Although major reconstruction was required in only 27 operations (15 per cent), a thorough knowledge of the available methods of reconstruction and repair is essential to allow uninhibited resection with an optimal aesthetic and functional result.
Assessment of the analgesic efficacy of nefopam hydrochloride after upper abdominal surgery: A study using patient controlled analgesia
Authors: McLintock T T C , Kenny G N C , Howie J C , McArdle C S , Lawrie S , Aitken H 
Published: March 2007

Abstract
A randomized, double-blind, placebo-controlled study was performed to assess the analgesic efficacy of intramuscular nefopam hydrochloride after upper abdominal surgery. Patients received either 20 mg nefopam (n = 23) or matching placebo (n = 26), 90 min before surgery, immediately after surgery, and 6, 12 and 18 h after the end of surgery. The 24-h morphine requirements were measured using a patient-controlled analgesia system delivering on-demand intravenous bolus doses of morphine. Pain was assessed using visual analogue scales. Patients receiving nefopam had a mean (± s.e.m.) cumulative morphine consumption of 4.1 ± 0.8 mg in the first hour, compared with 8.5 ± 0.8 mg in the control group (P &lt; 0.01). After 24 h the consumptions were 44.1 ± 7.2 mg and 62.5 ± 6.9 mg respectively (P &lt; 0.05). The pain scores in both groups were similar. This study confirms that nefopam hydrochloride has significant analgesic effects and would be a useful supplement to morphine in the management of postoperative pain.