bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changing pattern of admissions and operations for duodenal ulcer
Authors: Bardhan K D , Cust G , Hinchliffe R F C , Williamson F M , Lyon C , Bose K 
Published: March 2007

Abstract
The admission rates for duodenal ulcer (DU) and the effect of H2-receptor antagonists (H2RA), introduced in the Trent Region of the UK in 1977, were examined. The admission rates are expressed per 106 of resident population. The use of H2RA has risen 3·7-fold (from 1978 to 1983), yet overall admission rates for perforation have changed little: 99 in 1972-76 (pre-H2RA period) compared with 103 in 1977-84 (H2RA period). Admission rates for haemorrhage have risen by 8 per cent, from 130 to 140 (P&lt;0·01). However, the overall rates conceal large increases (P&lt;0·01) in the admission rates for those aged ⩽ 65 years, of 33 per cent (from 264 to 352) for perforation and of 28 per cent (from 381 to 489) for haemorrhage. Emergency admissions for uncomplicated DU were unchanged: 88 in 1972-76 and 89 in 1977-84. However, the proportions operated on fell by 58 per cent (P&lt;0·01), from 30 per cent of admissions in the pre-H2RA period compared with only 12 per cent in the H2RA period. Waiting-list admissions for uncomplicated DU fell by 43 per cent, from 187 to 106 (P&lt;0·01), and the proportions operated on fell from 162 to 76; the combined effect resulted in a reduction of 53 per cent in the operation rates (P&lt;0·01). In Rotherham, the use of H2RA has risen 6·2-fold (from 1978 to 1983) and they were generally used intermittently in 1976-78 and later for maintenance therapy and high-dose treatment. Yet admissions for perforation and for haemorrhage were unchanged. Emergency admissions for uncomplicated DU rose by 40 per cent, from 130 in 1972-75 to 182 in 1976-84, but the proportions operated on fell markedly, from 20 to 6 per cent (P&lt;0·01); waiting-list admissions fell in 1976-78 by 29 per cent and in 1979-84 by 73 per cent. The proportions operated on in the three periods fell from 74 to 53 per cent and 25 per cent respectively and these two factors led to decreases in elective surgery of 50 per cent in 1976-78 and 91 per cent in 1979-84 (P&lt;0·01). Thus, H2RA have not reduced emergency admissions in DU patients but they are associated with a reduction in waiting-list admissions and in the numbers operated on for uncomplicated DU; where the drugs have been used more intensively, the decrease has been even more marked. Much of this decline can be attributed to the changing natural history of the disease; however, when used intensively, H2RA have a significant additional effect.
A clinicopathological study of synchronous multiple gastric cancer
Authors: Mitsudomi T , Watanabe A , Matsusaka T , Fujinaga Y , Fuchigami T , Iwashita A 
Published: March 2007

Abstract
In a 7 1/2-year period (from 1 January 1980 to 30 June 1987), 997 patients with gastric cancer underwent gastric resection at the Department of Surgery, Matsuyama Red Cross Hospital, Japan. We studied clinico-pathologically 83 patients (182 lesions) with synchronous multiple gastric cancer and compared them with patients who had solitary cancers only in the same period. We found that elderly men had a relatively high incidence of multiple gastric cancer, and that early cancer of the elevated well differentiated type was the most common. Of the 182 lesions, as many as 42 (23·1 per cent) were missed in the preoperative examination. Eighteen of these 42 lesions were found only with the aid of a microscope in sections almost incidentally excised. Small flat lesions tended to be missed. We should always be conscious that other gastric lesions may be present when treating patients with gastric cancer.
Oesophageal transit of marshmallow after the Angelchik procedure
Authors: Robertson C S , Smart H , Amar S S , Morris D L 
Published: March 2007

Abstract
The oesophageal transit time of half a marshmallow was measured radiologically in 17 controls, 28 patients with gastro-oesophageal reflux pre-operatively, 36 patients soon after implantation of the Angelchik prosthesis (2–9 weeks) and in 23 patients later postoperatively (9–48 months). Sixteen postoperative patients also underwent oesophageal manometry. All control and pre-operative patients had a marshmallow transit time of less than 1 min; 67 percent of the early postoperative patients had prolonged transit and 70 per cent of the late tests were similarly abnormal. Prolonged oesophageal transit as measured by marshmallow' swallow correlated well with symptoms of solid food dysphagia. Most, but not all, patients with an abnormal marshmallow swallow had abnormal manometric findings. The oesophageal transit of solid food is significantly slowed after the Angelchik procedure and this is not a transient postoperative phenomenon.
Surgical options in traumatic injury to the extrahepatic biliary tract
Authors: Bade P G , Thomson S R , Hirshberg A , Robbs J V 
Published: March 2007

Abstract
A series of 53 patients who sustained extrahepatic biliary tract trauma were analysed to define the role of the various surgical options. Of the 45 patients with gallbladder injuries, 39 were due to stab wounds. Nine of the 45 injuries were repaired by primary suture without complication. Five patients underwent cholecystostomy and all developed biliary fistulae, which resulted in prolonged hospitalization. Cholecystectomy was performed in 31 patients; in retrospect many of these gallbladders could have been preserved because on only eight occasions was the gallbladder extensively damaged. Of eight extrahepatic bile duct injuries, the three partial transections managed by primary repair had a successful outcome, while the five complete transections were managed by a variety of techniques. Delayed diagnosis, failure of operative recognition of the injury and improper management were factors that led to mortality in two patients and prolonged morbidity in another. We conclude that suture repair is the operation of choice for gallbladder stab wounds without extensive injury. Ductal injury must be recognized. Partial transections are best managed by primary repair. Complete transections should be managed by primary duct jejunal anastomosis if the expertise is available.
Contrast-enhanced abdominal computed tomography scanning and prediction of severity of acute pancreatitis: A prospective study
Authors: London N J M , Neoptolemos J P , Lavelle J , Bailey I , James D 
Published: March 2007

Abstract
One hundred and fifty-two patients were admitted to a single hospital with a aiagnosis of acute pancreatitis during a 31-month period. Of these, 126 patients had contrast-enhanced abdominal computed tomography (CT) scans within 72 h of admission; 92 of these attacks were clinically mild, 34 were clinically severe. A single consultant radiologist reported the scans ‘blind’ and noted whether pancreatic enhancement was normal, increased or decreased, and whether there was loss of peripancreatic tissue planes. The maximum anteroposterior measurement of the pancreatic head and body were multiplied together to produce a ‘pancreatic size index’ (cm2). Significantly more patients with severe attacks had decreased pancreatic enhancement (79 versus 58 per cent, P = 0·01) and loss of peripancreatic tissue planes (82 versus 54 per cent, P = 0·006). The median (range) pancreatic size index for clinically severe attacks was 12·8 cm2 (3·0-52·5), and for mild attacks was 6·0 cm2 (1·1-23·4), P&lt;0·0001. Modified Glasgow criteria had a sensitivity of 85 per cent and specificity of 79 per cent for clinically severe attacks. A pancreatic size index of ⩾ 10 cm2 had a sensitivity of 71 per cent and specificity of 77 per cent for clinically severe attacks. In conclusion, although there were highly significant differences between the clinically severe and mild groups with respect to pancreatic enhancement, peripancreatic tissue planes and pancreatic size indices, these CT criteria did not improve on modified Glasgow criteria for prediction of disease severity.
Preoperative assessment of mesorectal lymph node involvement in rectal cancer
Authors: Beynon J , Mortensen N J McC , Foy D M A , Channer J L , Rigby H , Virjee J 
Published: March 2007

Abstract
One hundred patients with rectal adenocarcinoma were examined preoperatively with rectal endosonography (ES) and 50 were also examined with computed tomography (CT). ES predicted mesorectal lymph node involvement with an accuracy of 83 per cent, sensitivity of 88 per cent, specificity of 79 per cent, positive predictive value of 78 per cent and negative predictive value of 89 per cent. CT in comparison had an accuracy of 57 per cent, sensitivity of 25 per cent, specificity of 91 per cent, positive predictive value of 75 per cent and negative predictive value of 53 per cent. No particular histological architectural feature could be identified as responsible for false positive diagnosis though nodal size was significantly larger in the true positive and false positive group when compared with the true negatives (P &lt; 0·001 and P &lt; 0·01 respectively).
Value of a risk questionnaire in screening for colorectal neoplasm
Authors: Kewenter J , Haglind E , Smith L 
Published: March 2007

Abstract
The value of a postal questionnaire and of Hemoccult II (Smith Klein Diagnostic Inc., Sunnyvale, California, USA) testing in screening for colorectal neoplasms was compared. In the questionnaire, the subjects were asked about previous treatment for colorectal neoplasm and rectal bleeding during the previous 6 months, specified as to type. All participants were asked to perform Hemoccult II blood testing over 3 days. Of 13 759 randomly selected subjects 9040 (66 per cent) performed the test and returned the questionnaire. Three hundred and fifty-four subjects with a positive Hemoccult II test and/or a proven previous colorectal neoplasm had a full assessment including double-contrast enema and rectosigmoidoscopy to 60 cm. Eighteen carcinomas and 61 adenomas were thus diagnosed. The population was followed for from 20 to 29 months, during which time rescreening was undertaken. An additional 34 subjects with carcinomas and 90 with adenomas were identified during this period. A significant correlation between the presence of a colorectal neoplasm and a previous history of colorectal neoplasm, a positive Hemoccult II and a previous history of bright red bleeding but not dark bleeding was found. The possibility of diagnosing a neoplasm was two, four and 19 times higher in a subject with a previous history of bleeding, a history of colorectal neoplasm, or a positive Hemoccult II respectively. Screening by faecal occult blood testing, therefore, at the moment seems to bethe best and only practicable method.
Recessive mutations and chromosome deletions leading to cancer
Authors: Berne J , McColl I , Adinolfi M 
Published: March 2007

Abstract
This review examines the effect that a small chromosome deletion affecting a specific DNA sequence may have in producing a state of ‘hemizygosity’ for a gene or genes, and so triggering malignancy of the cells concerned. The association between such deletions and a variety of cancers will be considered and the implications for clinical practice will be outlined.
Recurrence after strictureplasty or resection for Crohn's disease
Authors: Sayfan J , Wilson D A L , Allan A , Andrews H , Alexander-Williams J 
Published: March 2007

Abstract
This study attempts to define whether there is an increased need for reoperation in patients with small bowel Crohn's disease treated by strictureplasty compared with those treated by small bowel resection. Previous studies of the rate of reoperation for small bowel Crohn's disease do not distinguish between reoperation performed because of a lesion at the original operation site and that undertaken because of a lesion at a distant site. This study analyses the need for reoperation only at the original site of operation and measures operation-free intervals. The site specific operation-free intervals in 41 patients with small bowel Crohn's disease treated by strictureplasty were not significantly different from the similar intervals in 41 patients treated by a small bowel resection.
Anorectal physiology measurement: Report of a working party
Authors: Keighley M R B , Henry M M , Bartolo D C C , Mortensen N J Mcc 
Published: March 2007

Abstract
A 2-day meeting was held in Bristol on 5 and 6 July 1988 immediately before the Tripartite meeting of the Surgical Research Society in order to discuss methods and identify areas of agreement with regard to measurement of indices of anorectal physiology. The following report highlights our findings.
Relationship between bile colonization, high-risk factors and postoperative sepsis in patients undergoing biliary tract operations while receiving a prophylactic antibiotic
Authors:   West of Scotland Surgical Infection Study Group, Wells G R , Taylor E W , Lindsay G , Morton L 
Published: March 2007

Abstract
A prospective audit of 644 patients undergoing biliary tract operations has been conducted to assess the incidence of bile colonization and its association with the incidence of postoperative sepsis when all patients received the same prophylactic antibiotic. The accuracy of the determination of high-risk factors has been assessed as has the correlation between bile colonization and patients assessed as ‘high risk’. Organisms were cultured from the bile of 121 (19 per cent) patients and among these the incidence of wound or intra-abdominal sepsis was 22 per cent whereas among patients with sterile bile the incidence was only 2 per cent (P&lt;0·0001). Although the incidence of bile colonization within the high-risk group (32 per cent) was more than twice that in the low-risk group (14 per cent), more than half (54 per cent) of the patients with positive bile cultures were in the low-risk group. It is concluded that, despite prophylactic antibiotics, bile colonization remains the major factor associated with postoperative sepsis, but that this cannot be predicted accurately by preoperative assessment of high-risk factors. Furthermore, we believe that a policy of selective administration of prophylactic antibiotics solely to high-risk patients cannot be justified.
Gallbladder carcinoma: Role of radiation therapy
Authors: Houry S , Schlienger M , Huguier M , Lacaine F , Penne F , Laugier A 
Published: March 2007

Abstract
Gallbladder carcinoma continues to be a discouraging disease. Prognosis after resection still remains poor. Radiation therapy has been used in an attempt to improve the prognosis but only a few series of less than ten cases have been reported. Since 1977 we have treated 20 patients with gallbladder carcinoma with postoperative radiotherapy (mean total dose 4200 radiation absorbed dose). In four patients all the tumour was resected with the intent of cure. In 12 patients, the lesion was partially resected and in four patients no resection was performed. Seven patients in whom the tumour was partially resected or not resected also had chemotherapy. Our evaluation was retrospective and we compared our results with historical control groups comparable with respect to surgical procedures and pathological staging. In patients operated on for cure, one patient is alive at 84 months, the others died at 7, 8 and 33 months. In patients in whom the tumour was partially resected the mean survival time was 8.1 months and two patients are still alive 7.0 months after treatment. According to the Nevin classification the mean survival time in stage IV and V patients was respectively 9.2 and 7.2 months. There was no difference in survival between patients treated or not treated with chemotherapy. This experience is the largest published and suggests that radiotherapy may increase survival after no resection or palliative resection of gallbladder carcinoma.
Gastric cancer: A 25-year review
Authors: Allum W H , Powell D J , McConkey C C , Fielding J W L 
Published: March 2007

Abstract
Between 1957 and 1981, 31716 cases of gastric cancer were registered in the West Midlands, UK. The age-standardized incidence has shown a decrease from 17·42 per 100000 population during the first quinquennium to 15·30 per 100000 in the last. There was an apparent increase in the proportion of proximal lesions with a decrease in the proportion of distal, antral cancers. The stage of disease at diagnosis remained constant with 79 per cent of patients having stage IV disease. Less than 1 per cent presented with stage I disease. As a result, the curative resection rate was 21 per cent. The operative mortality rates for curative partial gastrectomy and total gastrectomy were 13 and 29 per cent respectively. Surgeons undertaking more than nine total gastrectomies annually had an overall mean operative mortality rate of 22 per cent. Overall age-adjusted survival at 5 years was 5 per cent. Survival at 5 years for stage I, II and III disease was 72, 32 and 10 per cent respectively. There was a significant increase in survival time for those treated by curative resection between 1972 and 1981 compared with the previous decade. The implications for the management of gastric cancer are discussed.
Arm morbidity within a trial of mastectomy and either nodal sample with selective radiotherapy or axillary clearance
Authors: Aitken R J , Gaze M N , Rodger A , Chetty U , Forrest A P M 
Published: March 2007

Abstract
The aim of this study was to assess upper limb morbidity following treatment for operable breast cancer. Patients were randomized to either mastectomy and axillary clearance (40 women: 12 with axillary nodal metastasis and 28 without axillary metastasis) or mastectomy and axillary sampling (54 women). Adjuvant radiotherapy was delivered to those in whom the sample revealed axillary nodal metastasis (28 women) but not to those with no axillary nodal metastasis (26 women). A subjective assessment of the state of the arm was made using a standard questionnaire. Objective assessment included upper and forearm circumference, shoulder joint mobility and assessment of power in the pectoralis muscle. The mean age was 56·8 years (range 33–77 years) and the mean elapsed time from treatment was 5·72 years (range 4·0–7·5 years). Subjective limb oedema was greatest in those who had axillary lymph node metastasis but there was no objective difference. Subjective joint mobility was reduced in the women who received radiotherapy and this was confirmed by objective assessment (P &lt; 0·05). The objective reduction in arm mobility was related to the treatment rather than the axillary lymph node status. There was no difference in power. In this study women receiving adjuvant radiotherapy had significantly reduced shoulder mobility. This may have implications for current conservation studies using adjuvant radiotherapy.
Capsular penetration and perforation in pleomorphic adenoma of the parotid salivary gland
Authors: Lawson H H 
Published: March 2007

Abstract
Both penetration and perforation of the capsule were seen on the superficial aspect of pleomorphic adenomas. Only penetration was noted on the deep aspect, where the tumour was adjacent to the facial nerve. In terms of local recurrence this may explain why it appears to be safe to separate the deep aspect of the tumour from the facial nerve without a wide margin of normal parotid tissue.
Conservative proctocolectomy: A dubious option in ulcerative colitis
Authors: Talbot R W , Ritchie J K , Northover J M A 
Published: March 2007

Abstract
Conservative proctocolectomy was performed for ulcerative colitis in 19 patients, Crohn's disease in three and familial adenomatous polyposis in one. Healing was uncomplicated in only three patients (13 per cent). Eleven developed an anal discharge and nine an infected pelvic haematoma despite peranal drainage. Fourteen patients developed pelvic sepsis and, despite surgical curettage in 11, none healed. Six of these patients have had the anal sphincter divided, with healing in only one, and the anal canal has been excised in two. Eleven patients have ultimately healed at a median time of 28 months and eight have persistent sepsis after a median period of 45 months. Two patients with sepsis have had a successful ileoanal anastomosis. Conservative proctocolectomy cannot be recommended as a definitive operation for ulcerative colitis even though it may permit a subsequent restorative procedure.
Effect of nutritional supplementation on protein synthesis in tumour and host tissues of rats with colonic cancer
Authors: Emery P W , Ward M W N , Lewin M R 
Published: March 2007

Abstract
Rats with colonic cancer were given a palatable liquid diet which enabled them to gain weight while those fed on stock diet, either ad libitum or in restricted amounts, lost weight. Protein synthesis was measured in vivo using a flooding dose technique. Increased nutrient intake caused increases in the rate of protein synthesis in muscle, liver and non-diseased parts of the colon, but had no effect on protein synthesis in the tumours. These data suggest that enteral hyperalimentation may be safely employed in the preoperative management of patients with cancer, as it is likely to stimulate nitrogen retention in the host tissues without increasing the growth rate of the tumour.
Management of thyroglossal cysts in children
Authors: Athow A C , Fagg N L K , Drake D P 
Published: March 2007

Abstract
Forty children with a suspected thyroglossal cyst were operated on by one paediatric surgeon receiving primary and secondary referrals in an 8-year period. Nine patients (22 per cent) proved to have other pathology. Multiple operations were required in eight of 17 patients (47 per cent) who had infected thyroglossal cysts but in only one of 14(7 per cent) with uninfected cysts. In the infected group preliminary incision and drainage was necessary in five cases and cyst recurrence occurred in four (24 per cent), whereas in the uninfected group there was only one recurrence (7 per cent) in a patient with double pathology. Infection and recurrent cysts were the chief reasons for multiple operations. Recurrence was caused by inadequate performance of the correct operation (Sistrunk's) or choice of the wrong operation. Two of our own three recurrences were due to the latter, other pathology being suspected intraoperatively. Histological study of the specimens showed that thyroglossal ducts were frequently multiple and widely spaced. In children any lesion whose presentation is typical of a thyroglossal cyst should be treated with an early Sistrunk's operation. The operation in children who have other pathology has no complications and is justified.
Surgical management of neutropenic enterocolitis
Authors: Koea J B , Shaw J H F 
Published: March 2007

Abstract
Three cases of histologically confirmed neutropenic enterocolitis, each presenting as an acute abdomen in patients with leukaemia are presented. All three patients presented with fever and abdominal pain within 14 days of completing a course of chemotherapy. Signs of peritonitis localized to the right iliac fossa developed in each patient, in spite of aggressive antibiotic therapy and bowel rest. All three patients were found, to have non-viable caecum at laparotomy and were treated by right hemicolectomy. Primary ileocolic anastomosis was performed in one patient, who recovered following a stormy postoperative course owing to sepsis. Two patients underwent formation of an ileostomy with distal mucous fistula and each recovered with minimal postoperative complications; secondary anastomosis was performed electively in both cases. The difficulty in diagnosing neutropenic enterocolitis pre-operatively is discussed and the place of non-operative management is reviewed but we recommend surgical intervention as a means of ensuring removal of a localized septic focus until marrow regeneration occurs.