bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in the apparently normal limb in unilateral venous ulceration
Authors: Stacey M C , Burnand K G , Pattison Marion , Thomas M Lea , Layer G T 
Published: March 2007

Abstract
Forty-seven patients with unilateral venous ulceration have been investigated to determine if any abnormalities were present in the contralateral limbs which had not had lipodermatosclerosis or ulceration. Ascending phlebography in the non-ulcerated limbs showed post-thrombotic changes in 28 per cent and incompetent lower leg communicating veins in 19 per cent. This incidence was not significantly different to the limbs with healed ulceration (45 and 23 per cent respectively, χ2 test, P = 0·10). Half volume refilling time measured by foot volumetry suggested that 79 per cent of the non-ulcerated limbs had evidence of deep vein incompetence or incompetent lower leg communicating veins, which was again similar to the incidence in the previously ulcerated limbs (85 per cent). Transcutaneous oxygen readings, expressed as a ratio of a reading at a standard site in the gaiter region of the leg over a reading from the upper arm, were significantly lower in non-ulcerated limbs (mean 0·84 ± 0·26 s.d.) than in a cohort of age and sex matched controls (mean 1·02 ± 0·14, Student's t test, P &lt; 0·001), and significantly higher than in previously ulcerated limbs (mean 0·68 ± 0·31, P &lt; 0·01). Abnormalities in venous anatomy and function have been shown, in conjunction with evidence of reduced oxygen diffusion, through the gaiter skin before overt skin changes develop.
Preservation of the entire anal canal in conservative proctocolectomy for ulcerative colitis: A pilot study comparing end-to-end ileo-anal anastomosis without mucosal resection with mucosal proctectomy and endo-anal anastomosis
Authors: Johnston D , Holdsworth P J , Nasmyth D G , Neal D E , Primrose J N , Womack N , Axon A T R 
Published: March 2007

Abstract
Mucosal proctectomy with endo-anal pull-through anastomosis (MP + PTA) for ulcerative colitis reduces resting anal pressure and low RAP has been found to correlate with minor leakage of faeces or mucus. Our hypothesis was that conservative proctocolectomy with an end-to-end ileo-anal anastomosis (EEA) would result in higher anal pressure and less leakage. Twelve patients were studied after EEA and 24 after MP + PTA: each was in good health several months after operation. After EEA, maximal RAP decreased from a median 90 cmH2O (60–116 cmH2O) to 70 cmH2O (25–104 cmH2O, P &lt; 0·01), whereas after MP + PTA maximal RAP decreased from 85 cmH2O (70–125 cmH2O) to 40 cmH2O (22–80 cmH2O, P &lt; 0·003). RAP after EEA was significantly greater than RAP after MP + PTA (P &lt; 0·001). The pressure profile of the anal sphincter in the EEA group did not differ significantly from that of the pre-operative group at any point from 6 to 1 cm from the anal verge, and the sphincteric high pressure zone averaged 4 cm in length both before and after operation. After MP + PTA, resting anal pressure at stations 1 to 4 cm from the anal verge was significantly less than pre-operative pressure (P &lt; 0·001) and the sphincteric high pressure zone was only 3 cm in length compared with 4 cm before operation. Anal squeeze pressures were similar in the two groups of patients. After EEA 11 of 12 patients achieved perfect continence, day and night, whereas after MP + PTA 58 per cent of patients experienced minor faecal leakage (P &lt; 0·01). These findings suggest that the entire anal canal should be kept intact in the course of conservative proctocolectomy for ulcerative colitis.
Surgical management of posterior pharyngeal pulsion diverticula: Inversion versus one-stage excision
Authors: Bowdler D A , Stell P M 
Published: March 2007

Abstract
At present one-stage excision of the posterior pharyngeal pulsion diverticulum is the most popular method of treatment in the UK and the USA. We have reviewed 53 patients who have presented to this unit between 1968 and 1986, to compare the results of different surgical techniques. Of these, 21 underwent excision and myotomy, 20 inversion and myotomy, and 9 myotomy alone. The results show that the mortality for the whole group was 4 per cent, but there were no deaths in either the inversion or myotomy group. The excision group had a complication rate of 52 per cent, compared with 30 per cent for inversion, and also had more major problems such as fistula. Median hospital stay was shorter for inversion than for excision, at 7 and 10 days respectively. In summary we believe that inversion of the posterior pharyngeal pulsion diverticula is now the surgical treatment of choice.
Hazards of thrombolytic therapy in deep vein thrombosis
Authors: Meissner A J , Misiak A , Ziemski J M , Scharf R , Rudowski W , Huszcza S , Kucharski W , Wislawski S 
Published: March 2007

Abstract
From 1965 to 1985, 64 deep vein thrombosis (DVT) patients were treated with streptokinase (SK). In 26 cases ‘high-dose SK’ (IV 100000 units/h for 4 days) was used and in 38 patients a ‘low-dose SK’ regime (IV 250000 units every 12 h for 4 days) was employed. The clinical signs of DVT subsided in 78 per cent of treated patients within 30 days of completing SK treatment. A repeat phlebography was performed immediately after SK therapy in 29 patients (45 percent) and a total recanalization or partial thrombolysis was achieved in 80 per cent of the studied cases. In 15 patients minor and major haemorrhagic complications occurred. There were five fatalities, all in the high-dose SK group (three intracranial haemorrhages and two major bleeds). Three patients developed pulmonary embolism and none of them died. The post-treatment clinical and phlebographic evaluation did not reveal any significant difference between the two methods of SK administration, but more haemorrhagic complications (P &lt; 0·02, χ = 5·50825) occurred in the high-dose SK patients. This report emphasizes the risk of bleeding complications during thrombolytic therapy. If SK is to be used, therefore, careful selection of patients and meticulous monitoring are mandatory.
Choice of surgery for early breast cancer: Pre- and postoperative levels of clinical anxiety and depression in patients and their husbands
Authors: Morris Jenny , Royle G T 
Published: March 2007

Abstract
Two groups of patients with early breast cancer were studied prospectively to assess whether being offered a choice of surgery (simple mastectomy or wide excision plus radiotherapy) influenced levels of anxiety and depression pre- and postoperatively. A significantly higher percentage of the patients not offered a choice of surgery experienced high levels of anxiety and depression pre-operatively and up to 2 months postoperatively compared with patients offered a choice; the results were also similar for the husbands of these patients. At 4 months, differences between the two groups were not statistically significant, although the trend remained the same with more patients not offered a choice of treatment showing high levels of anxiety and depression. Patients offered a choice of surgery had similar pre- and postoperative levels of anxiety and depression to patients with benign breast disease and patients undergoing surgery for non-cancerous conditions.
Use of sodium nitroprusside induced hypotensive anaesthesia for reducing blood loss in patients undergoing lienorenal shunts for portal hypertension
Authors: Sood S , Jayalaxmi T S , Vijayaraghavan S , Nundy S 
Published: March 2007

Abstract
A randomized study was performed on 18 patients to determine whether hypotensive anaesthesia, induced by sodium nitroprusside (SNP), would reduce blood loss during elective proximal lienorenal shunt operations for portal hypertension which was due to extrahepatic obstruction or non-cirrhotic portal fibrosis. Eight patients received SNP intra-operatively to reduce the systolic blood pressure to below 95 mm Hg, and there were 10 control patients. Blood loss, the number of units of blood transfused, and urine output during surgery were measured together with the postoperative drainage from the abdominal and chest tubes over the first 24 h. There was a significantly lower blood loss (mean ± s.d. 517 ± 220 versus 1286 ± 523 ml; P&lt;0·01) and number of units of blood transfused was less (0·9 ± 0·9 versus 3·0 ± 1·2; P&lt;0·01) in the SNP patients than in the controls. The urine output was greater in the SNP group (606 ± 211 versus 399 ± 139 ml, n.s.). Postoperative drainages from the chest and abdomen were similar. Hypotensive anaesthesia with SNP reduces operative blood loss and transfusion requirement in patients with good liver function undergoing proximal lienorenal shunts for portal hypertension.
Hyperthyroidism and hypothyroidism complicating the treatment of thyrotoxicosis
Authors: Reid D J 
Published: March 2007

Abstract
Three separate studies of recurrent hyperthyroidism and hypothyroidism in groups of patients treated for thyrotoxicosis by anti-thyroid drugs, surgery and radioiodine are presented. The incidence is compared in the three groups. Two hundred and fifty-three patients with primary thyrotoxicosis received a year-long course of anti-thyroid drugs: 43 per cent relapsed in the first year following the completion of treatment. Of those remaining euthyroid at the beginning of the second year after treatment a further 21 per cent relapsed during that year and in subsequent years, 21 per cent, 18 per cent and 13 per cent of those remaining euthyroid at the start of the third, fourth and fifth years relapsed. Of those followed for the full 5 years 26 per cent remained in remission and 74 per cent had relapsed over this period. After bilateral subtotal thyroidectomy for thyrotoxicosis in 146 patients, 19 per cent were hypothyroid and 1·4 per cent had relapsed 18 months after surgery. The incidence of postoperative hypothyroidism was lower in the younger patients (under 25 years). The absence of thyroid auto-antibodies pre-operatively is an indication of a favourable result. The histological recognition of lymphocytic infiltration in the gland and the presence of thyroid auto-antibodies indicated an unfavourable outcome. Radioactive iodine gave an unpredictable response at therapeutic doses with 24 per cent relapsing in the first year after treatment. With ablative doses of radioactive iodine the incidence of hypothyroidism reached 94 per cent at 5 years after treatment. Surgery gives the best long-term results of the three treatment options and is the treatment of choice for the young, the severely toxic and those with toxic multinodular goitre.
Endoscopic biliary drainage
Authors: Kiil J , Kruse A , Rokkjaer M 
Published: March 2007

Abstract
Endoscopic biliary drainage (EBD) has become an established method of relieving posthepatic jaundice. This study comprises 399 patients in whom 472 EBD procedures were performed during a 5 year period; 272 patients had malignant obstruction, 36 had a benign stricture, 79 had common duct stones and 12 patients had other benign conditions requiring drainage. A 7F double pigtail endoprosthesis was used in the majority of patients and was inserted with an Olympus JF-IT duodenoscope. Ninety-two percent of the prostheses were correctly positioned, and 88 per cent of these functioned well with relief of symptoms. The 30-day mortality was 22 percent and one-third of these deaths were due to the procedure, septicaemia being the dominant hazard. This was more marked if the obstruction was not relieved satisfactorily. Antibiotic cover was not used routinely and had not been prescribed in any of the fatal cases. This omission probably made a significant contribution to the septicaemia. Acute pancreatitis and haemorrhage were rare complications and both were probably related to the coincidental sphincterotomy. Prostheses intended for permanent relief of malignant obstruction remained patent for 2-3 months (median) with a wide range of 1-618 days. Survival among these patients is so short, that one or two EBD procedures will keep the majority of patients free from symptoms related to biliary obstruction, and only two patients needed more than three procedures. Fifty-one patients with pancreatic head carcinoma had EBD as a bypass before an intended operation. Only 16 patients actually had a resection. The median survival among the 51 patients was 106 days (compared with 59 days among 100 patients with a permanent prosthetic bypass). Only one patient with a very small periampullary carcinoma has survived for more than 3 years. Forty-seven patients are dead. Among the 51 patients in whom radical resection was intended two-thirds were actually treated by permanent surgical or prosthetic bypass.
Reticulo-endothelial function in obstructive jaundice
Authors: Pain J A 
Published: March 2007

Abstract
A study of reticulo-endothelial function was performed in 30 patients with obstructive jaundice. Reticulo-endothelial phagocytic function, measured by the clearance of intravenous human micro-aggregated albumin, was significantly depressed in jaundiced patients compared with non-jaundiced controls (P&lt;0·001). There was a significant correlation (P&lt;0·001) between phagocytic function and plasma bilirubin level but not with transaminase or bile salt level. Phagocytic function was not related to the presence of malignancy, but was markedly reduced in patients with cholangitis. There was no reduction in hepatic sinusoidal blood flow, opsonin levels (fibronectin, IgG, complement) or serum opsonic activity to account for the reticulo-endothelial dysfunction.
Morbidity and mortality of common bile duct exploration
Authors: Sheridan W G , Williams H O L , Lewis M H 
Published: March 2007

Abstract
This retrospective study reviews the complications which occurred in 257 patients who had supraduodenal exploration of the common bile duct in one hospital during a 15-year period. One hundred and eighteen patients (46 per cent) developed complications: septic and cardiorespiratory complications were most common, occurring in 19·5 per cent and 16·7 per cent of patients respectively. Postoperative retained stones were detected in 37 patients (14 percent), causing complications in 54 per cent. Peroperative postexploratory cholangiography did not significantly reduce the incidence of this problem. None of the 12 patients who had postexploratory choledochoscopy had retained stones. Five patients (1·9 per cent) died, three of whom had duct procedures in addition to supraduodenal exploration and two of whom had retained stones. It is concluded that common bile duct exploration has a high associated morbidity, particularly due to sepsis and retained stones.
Acute cholangitis in association with acute pancreatitis: Incidence, clinical features and outcome in relation to ERCP and endoscopic sphincterotomy
Authors: Neoptolemos J P , Carr-Locke D L , Leese T , James D 
Published: March 2007

Abstract
Although endoscopic retrograde cholangiopancreatography (ERCP) and endoscopic sphincterotomy (ES) have been shown to be valuable in managing patients with acute cholangitis, their role in patients who have simultaneous acute cholangitis and acute pancreatitis is not known. We have reviewed 32 consecutive patients presenting with both conditions over ten years which represents 23·0 per cent of all cases of gallstone-related acute cholangitis and 14·4 per cent of all cases of biliary acute pancreatitis admitted during the same period. The majority of patients were elderly (median 76 years) and female (75 per cent). Five patients had previously undergone cholecystectomy. Eleven patients were clinically shocked (34 per cent) and blood cultures were positive in 9/14 cases (64 per cent). Twenty patients (63 per cent) had a predicted severe attack of acute pancreatitis (modified Glasgow criteria). Common bile duct (CBD) stones were identified in 15 of 23 patients with successful ERCP. Of these 23 patients, 9 were treated by endoscopic sphincterotomy (ES) alone, 5 by ES and surgery, 4 by surgery alone and 5 were treated conservatively. There was one death (4·3 per cent). Nine patients were managed without cholangiography; four had surgery and five were treated conservatively. There were three deaths (33 percent; P = 0·10). Evidence of recent CBD stone passage was apparent in eight patients (25 per cent) compared with five out of eighty-seven patients (5·7 per cent) with acute cholangitis alone (P&lt;0·05). The results indicate that ERCP and ES may have an important role in the management of these patients.
Ureteric re-implantation in the neuropathic bladder
Authors: Brereton R J , Narayanan R , Ratnatunga C 
Published: March 2007

Abstract
During the last 5 years 174 children with neuropathic bladder were studied, and only 7 required urinary diversions. A total of 31 ureteroneocystostomies were performed in 17 patients, 16 of whom had gross vesico-ureteric reflux. Revisionary surgery was required in four children and two underwent pyeloplasty. Deterioration followed ureteroneocystostomy in two patients, but 13 (76 per cent) of the children were significantly improved.
Periodic gallbladder contraction maintains bile acid circulation during the fasting period: A canine study
Authors: Nally C V , McMullin L J , Clanachan A S , Scott G W 
Published: March 2007

Abstract
Using a canine model we have studied the relationship between the interdigestive cycle in the small intestine, motility changes in the biliary tract and bile acid output into the duodenum from direct hepatic secretion and gallbladder emptying. Under anaesthesia catheters were inserted into the gallbladder, common bile duct and duodenum, and electrodes were attached to the small intestine in five dogs. These animals were subsequently studied conscious and fasting. A double marker technique was used to measure bile acid output from the gallbladder and liver while pressure in the gallbladder and common bile duct and electrical activity in the small intestine were monitored. Four complete interdigestive cycles were recorded in each dog. Output of bile acids from the gallbladder fluctuated with the phases of the cycle: being lowest in phase I (3·9 ± 0·7 μmol/min); increasing significantly (P&lt;0·005) in phase II (9·8 ± 1·0 μmol/min); remaining elevated in phase III (13·9 ± 1·7 μmol/min); and falling significantly (P&lt;0·05) in phase IV (8·4 ± 1·8 μmol/min). In contrast, hepatic secretion of bile acids directly into the duodenum remained fairly constant. Intraluminal pressure in the biliary tract paralleled the fluctuation in gallbladder bile acid output, being significantly increased (P&lt;0·05) in phases II and III. Periodic contraction of the gallbladder would, therefore, appear to be the principal mechanism for the phasic output of bile during fasting.
Raised serum thyrotrophin in women with peripheral arterial disease
Authors: Powell Janet , Zadeh J Alaghband , Carter G , Greenhalgh R M , Fowler P B S 
Published: March 2007

Abstract
Women with symptomatic peripheral arterial disease were screened for impaired thyroid function using a sensitive immunoradiometric assay for thyrotrophin (TSH). The arterial disease in the aortotibial segment was documented by an abnormal brachial/ankle pressure index in 80 patients. An age-matched control group of elderly women (n = 30) with a normal pressure index was established. In the control group the mean serum TSH was 1·6 × 1·1 milliunits/l, median 1·5 milliunits/l and this established a normal range of 0·2–3·9 milliunits/l. Seven patients (8·8 per cent) were already receiving treatment for myxoedema. In the remaining patients, the overall distribution of serum TSH was skewed to higher levels; the mean was 3·7 milliunits/l, median 2·4 milliunits/l, P&lt;0·001 compared with controls and 15 (19 per cent) had a serum TSH &gt; 4 milliunits/l, compared with only one (3·3 per cent) of the controls. Therefore 22 patients (28 per cent) had myxoedema or a raised serum TSH. For all subjects with a normal TSH, there was a positive correlation of serum TSH with serum cholesterol, r = 0·68, P&lt;0·001. For patients with a raised TSH, there was a continuing, but non-linear, increase of serum cholesterol with TSH. These results suggest that a raised serum TSH may be one of the risk factors for the development of peripheral arterial disease in women, possibly by increasing cholesterol levels.
Triple therapy in cadaver renal transplantation
Authors: Jones R M , Murie J A , Allen R D , Ting A , Morris P J 
Published: March 2007

Abstract
One hundred consecutive first (n = 72) and regrafted (n = 28) cadaver renal allograft recipients were immunosuppressed with cyclosporin, azathioprine and prednisolone (triple therapy) and followed for a median of 17.3 months (range, 7-26 months). Actuarial patient survival at 12 and 24 months was 97.7 per cent. Actuarial graft survival at 12 and 24 months was 79.5 per cent (first graft recipients 81.3 per cent and regrafted recipients 75 per cent). HLA-DR matching significantly improved graft survival which was 93 per cent at 1 year in patients given HLA-DR compatible kidneys, compared with 83 and 54 per cent, respectively, in patients who received kidneys mismatched for one or two HLA-DR antigens. There were 0.8 (s.d. = 0.7) episodes of acute rejection per patient during the first 3 months after transplantation. Triple therapy provides effective immunosuppression without evidence of over immunosuppression and reduces the incidence of cyclosporin side-effects. Although acute nephrotoxicity was uncommon, serum creatinine remained elevated 6 and 12 months after transplantation.
Results of resection of gastric cancer extending to adjacent organs
Authors: Korenaga D , Okamura T , Baba H , Saito A , Sugimachi K 
Published: March 2007

Abstract
We report the late results of resection in 281 patients with gastric carcinoma extending to adjacent organs. In 92 without incurable factors (peritoneal dissemination, liver metastasis and widespread nodal involvement) the 5-year survival rate was 36.7 per cent in those treated by gastrectomy and complete removal of the invaded organ. This value is significantly higher than the 17.4 per cent recorded in those undergoing gastrectomy alone or with incomplete removal of the invaded organs (P &lt; 0.05). In 189 patients with incurable factors, the 5-year survival rates were 5.4 and 2.8 per cent respectively in cases of complete and incomplete excisions. This tendency was similar in patients with a single invaded organ and also in those with plural organ involvement. In potentially curable patients treated by complete excision, the probability of long-term survival was statistically better than that following incomplete excision only when the pancreas was involved (P &lt;0.05). We recommend complete excision of invaded organs, irrespective of the number or site of organs involved, provided that there is no evidence of incurable factors.
Improvements in the treatment and prognosis of colorectal carcinoma
Authors: Järvinen H J , Ovaska J , Mecklin J-P 
Published: March 2007

Abstract
In a survey of the surgical results in 709 patients with colorectal carcinoma (CRC) treated between 1976 and 1985 a favourable shift of stage distribution was observed. The tumour was localized (Dukes' classification A or B) in 61 per cent of patients, as compared with 47 per cent in the previous 10-year period. This change was, in part, due to different interpretation of stage definitions. Clear improvements of the results were, however, also noted. Radical surgery was possible in 76 per cent of patients and the primary tumour was removed in 93 per cent. Surgical mortality was 4·4 per cent and complication rate 15 per cent, significantly less than earlier (6·5 and 38 per cent, respectively). Increasing numbers of sphincter-saving operations were performed in rectal cancers (47 per cent as compared with 24 per cent in the previous 10-year period). The overall 5-year survival rate improved from 40·5 to 52·5 per cent. Premalignant conditions were identified in 12.6 per cent of patients: previous CRC 4.8 per cent, cancer family syndrome 4·1 per cent, ulcerative colitis 1·7 per cent and familial adenomatosis 0·6 per cent. In order to sustain the favourable trend of improving survival prospects, more emphasis must be directed to the detection of early stage cancers.