bluuebunny/crossref_metadata_2025_split huggingface dataset:
Routine or selective peroperative cholangiography
Authors: Mofti A B , Ahmed I , Tandon R C , Al-Tameem M M , Al-Khudairy N N 
Published: March 2007

AbstractThe routine use of peroperative (pre-exploration) cholangiography was prospectively studied in 433 consecutive patients undergoing elective cholecystectomy. Satisfactory peroperative cholangiography was achieved in 396 patients using a C-arm image intensifier with image retention facility. Clinical indications for exploration of the common bile duct were noted for each patient but the decision for choledochotomy was determined by the cholangiographic results. Two hundred and forty-nine (63 per cent) patients had no clinical indications for duct exploration and cholangiographic findings were all normal. Of the 147 patients with positive clinical criteria, 39 (9.8%) had abnormal cholangiograms and required exploration of the common bile duct. In three patients duct exploration was negative giving a false positive rate of 0.73 per cent. The use of the image intensifier allowed dynamic study during cholangiography and optimum evaluation of the duct system. The results support the view that peroperative cholangiography could be restricted to patients with clinical indications for exploration of the common bile duct.
Testicular torsion in the armed services: Twelve year review of 179 cases
Authors: Jones D J , Macreadie D , Morgans B T 
Published: March 2007

Abstract
All cases of testicular torsion occurring in the Armed Services between 1972 and 1983 have been reviewed. All cases were post-pubertal. The incidence in older age groups is higher than previously reported. No cases were seen in undescended testes. No seasonal variation in presentation was detected. Recurrent scrotal pain before acute presentation occurred in 29 per cent of cases. The testicular salvage rate was 75 per cent. The salvage rate in patients with pain for &gt; 24 h was 46 per cent. Patients with a history of intermittent scrotal pain should be explored as a matter of urgency. Operation should still be considered in patients who have had pain for &gt; 24 h.
Incidence of postoperative adhesion obstruction following neonatal laparotomy
Authors: Wilkins Barbara M , Spitz L 
Published: March 2007

Abstract
Of 649 neonates undergoing laparotomy in a 10 year period, 54 (8.3 per cent) developed adhesion related intestinal obstruction requiring surgical treatment. In 16 infants the obstruction followed a period of prolonged postoperative ileus, while the remaining 38 had completely recovered from the previous surgical procedure before the development of obstruction. The adhesion obstruction occurred after a single neonatal laparotomy in 35 cases but the remaining 19 had undergone subsequent laparotomies; 75 per cent of the obstructions developed within 6 months and 90 per cent within 1 year of surgery. The highest risk groups were infants undergoing correction of gastroschisis (15.4 per cent) and malrotation (15 per cent). There were nine deaths, two of which were a direct consequence of the adhesion obstruction.
Pre-Operative assessment of local invasion in rectal cancer: Digital examination, endoluminal sonography or computed tomography?
Authors: Beynon J , Mortensen N J McC , Foy D M A , Channer J L , Virjee J , Goddard P 
Published: March 2007

AbstractForty-four patients with primary rectal cancers and six patients with benign rectal lesions were examined pre-operatively digitally, with endorectal sonography (ELU) and also computed tomography (CT). Digital examination of the rectal cancers had an overall accuracy of 68 per cent and predicted invasion beyond the muscularis propria with a sensitivity of 68 per cent, specificity of 83 per cent, positive predictive value of 100 per cent and negative predictive value of 46 per cent. In comparison CT had an accuracy of 82 per cent, sensitivity of 86 per cent, specificity of 62 per cent, positive predictive value of 91 per cent and negative predictive value of 50 per cent. ELU was the most reliable indicator of local invasion in rectal cancer when compared with postoperative histopathology with an accuracy of 91 per cent, sensitivity of 94 per cent, specificity of 87 per cent, positive predictive value of 97 per cent and negative predictive value of 78 per cent.
Carcinoma arising in posterior pharyngeal pulsion diverticulum (Zenker's diverticulum)
Authors: Bowdler D A , Stell P M 
Published: March 2007

AbstractCarcinoma is a rare but recognized complication of posterior pharyngeal pulsion (Zenker's diverticulum). Such diverticula merit radiological and endoscopic examination before operation. Surgery is preferred to radiotherapy in the treatment of carcinoma, the choice of operation resting between one-stage diverticulectomy for cancer confined to the body of the sac and pharyngolaryngectomy for more extensive lesions.
Defective fibrinolysis: A risk factor in early femoropopliteal graft thrombosis
Authors: Earnshaw J J , Westby J C , Makin G S , Hopkinson B R 
Published: March 2007

AbstractResting plasma fibrinolytic activity and fibrinolytic activity after stimulation by 10 min of venous occlusion (fibrinolytic potential) were estimated in 51 patients before femoropopliteal reconstructive surgery. Twelve patients suffered a graft thrombosis in the first month. Resting plasma fibrinolytic activity was similar in patients with thrombosed grafts and those with functioning grafts. However reduced fibrinolytic potential was found to be a risk factor for graft thrombosis in the month after surgery (P = 0·01). Other risk factors were increasing age (P = 0·007) and the indication for surgery (P = 0·03). Thirty-four patients whose grafts were functioning after 1 month were followed up for a mean of 9 months. A further eight grafts thrombosed. Neither fibrinolytic activity nor fibrinolytic potential were found to be risk factors for late graft thrombosis. Fibrinolytic potential has been shown to be an independent risk factor for early graft thrombosis. Peri-operative fibrinolytic stimulation might be a method of improving femoropopliteal graft patency.
Left intrahepatic cholangio-enteric anastomosis (round ligament approach): An effective palliative treatment for hilar cancers
Authors: Traynor O , Castaing D , Bismuth H 
Published: March 2007

Abstract
Palliation of obstructive jaundice in patients with hilar cancer can be achieved either by surgical bypass or by intubation and drainage. A simple and effective technique is presented which gives excellent palliation without the need for tubes or stents: left intrahepatic cholangio-enteric anastomosis, using the duct of segment III (i.e. the inferolateral segment of the left liver). The procedure is performed by using the round ligament approach to the duct of segment III in the base of the umbilical fissure. A defunctioned loop of jejunum is then anastomosed to this duct. Over a period of 25 years, 48 patients with hilar cancer had this procedure in this unit. The operative mortality (death within 2 months) was 6 per cent and the complication rate was 17 per cent. Seventy-three per cent of patients had complete relief of jaundice and a further 23 per cent had partial relief. The mean survival was 9·2 months and the quality of life was excellent. These data suggest that this is a very satisfactory palliative technique for patients with hilar cancer who are not suited for radical tumour excision.
History of colorectal polypectomy and risk of subsequent colorectal cancer
Authors: Kune G A , Kune Susan , Watson Lyndsey F 
Published: March 2007

AbstractIn a case control study, which formed part of a large, population-based investigation of the incidence, aetiology and survival of colorectal cancer, 24 of 715 cases and 4 of 727 age/sex group matched controls gave a past history of bowel polypectomy (χ12 = 17, P &lt; 0·001, relative risk = 6·37, 95 per cent confidence interval = 2·2-18·6). There was no significant sex or site difference associated with a history of previous polypectomy. These findings are consistent with the view that colorectal polyps are markers of risk (sixfold in the present study) for the subsequent development of colorectal cancer. The data also support the emerging practice that those with adenomatous polyps need regular surveillance of their large bowel as a screening measure.
Incisional hernia in re-opened abdominal incisions: An overlooked risk factor
Authors: Lamont P M , Ellis H 
Published: March 2007

Abstract
Many patients undergoing laparotomy will have had a previous incision in the abdominal wall which offers a convenient and logical route for re-exploration. This study aims to examine the risk of subsequent incisional herniation in incisions made through previous scar tissue compared with incisions made through fresh tissues. Out of a total of 1022 laparotomies performed in a 5-year period on one surgical unit, the incisional hernia rates were available for assessment in 699 freshly made incisions, 142 re-incisions and 36 incisional hernias. The incidence of incisional hernia was 6 per cent after freshly made incisions and this incidence was increased after both re-incision (12 per cent, P&lt;0·05) and incisional hernia repair (44 per cent, P &lt; 0·01). With the exception of jaundice, none of the other commonly accepted risk factors for incisional herniation were significantly increased in those patients with re-incised wounds who subsequently developed a hernia, when compared with patients who did not develop a hernia. An increased risk of incisional herniation is present when laparotomy is performed through a previous abdominal incision.
Anal sensation after restorative proctocolectomy for ulcerative colitis
Authors: Holdsworth P J , Johnston D 
Published: March 2007

AbstractThe hypothesis that anal sensation might be better after restorative proctocolectomy with end-to-end ileoanal anastomosis than after mucosal proctectomy with endo-anal anastomosis was tested in this study. Anal sensation was measured in 14 patients before operation, 16 patients after restorative proctocolectomy with end-to-end anastomosis (RP + EEA) and 13 patients after mucosal proctectomy with endo-anal anastomosis 1 cm above the dentate line (MP + EAA). Threshold electrosensitivity was measured in the upper, mid and lower anal canal by means of a bipolar constant current stimulator probe. The ‘recto’-anal inhibitory reflex was tested, and the patients' ability to discriminate between flatus and faeces and to release flatus ‘safely’ was assessed by interview. In the upper anal canal, threshold sensitivity was significantly greater in patients who had undergone MP + EAA than in patients who had undergone RP + EEA (P &lt; 0.05). In the mid and lower anal canal, electrosensitivity in the three groups of patients did not differ significantly. Twelve patients (75 per cent) regained the ‘recto’-anal reflex after RP + EEA, but after MP + EAA only three patients (23 per cent) did so (P &lt; 0.02). Thirteen patients after RP + EEA could release flatus safely without fear of faecal leakage, compared with only four after MP + EAA (P &lt; 0.02). The proportions of patients in these two groups who said they were able to discriminate flatus from faeces did not differ significantly. Anal sensation and discriminatory function are significantly better after end-to-end ileoanal anastomosis than after mucosal proctectomy with endo-anal anastomosis.
Prospective randomized trial to compare the stapled double lumen pouch and the sutured quadruple pouch for restorative proctocolectomy
Authors: Keighley M R B , Yoshioka K , Kmiot W 
Published: March 2007

AbstractThirty-three consecutive patients having restorative proctocolectomy since April 1986 were randomly allocated to reconstruction using a stapled J pouch (n = 18) or a sutured W pouch (n = 15). There were no deaths, but one patient required pouch excision for isohaemia (J). One patient developed a leak from the pouch necessitating loop ileostomy (J) and one patient had a low pouch vaginal fistula successfully treated by a seton (W). There were no other major complications. Median (range) operative time was 200 min (165–290) for J pouch and 255 min (220–330) for the W pouch (P&lt;0.05). In 24 patients followed up for more than 4 months after restoring intestinal continuity, median frequency of defaecation over 24 h was 4 (3–6) for the J pouch and 4 (3–6) for the W pouch. There was no incontinence, urgency or soiling. These results indicate that the quicker J pouch provides identical functional results to the larger W pouch in this series of patients.
Femorofemoral bypass in unilateral iliac artery occlusion
Authors: Fahal A H , McDonald A M , Marston A 
Published: March 2007

AbstractBetween January 1973 and January 1988, 188 patients with unilateral iliac artery occlusion were treated at The Middlesex and University College Hospitals, 185 for primary disease and three for blockage of a previous aortobifemoral graft. In the early part of the series, a variety of operations, including aortofemoral and iliofemoral bypass, and endarteriectomy, was used. Femorofemoral bypass was at first reserved for patients who were considered unfit for major surgery, but the results seemed so good that it was adopted as the procedure of choice. Latterly, percutaneous transluminal angioplasty became available, and the role of this is discussed. Over the 15-year period, 150 patients underwent femorofemoral bypass (all but two receiving a prosthetic graft). Of these, 90 per cent had disabling claudication and 8 per cent had critical ischaemia. There were six early deaths (within 30 days of operation) and five late deaths, and two surviving amputees; nine patients could not be traced. The remaining 128 patients have been assessed at intervals of from 3 to 92 months, both clinically and with Doppler studies. The cumulative patency was 86 per cent at 13 years, and all of these patients experienced subjective and haemodynamic improvement in the recipient limb. Eight grafts occluded in the early postoperative phase. In five patients there was deterioration in the donor limb; it is postulated that the effect was due to causes other than the operation. There were two serious postoperative complications due to technical error, one of which led to early above-knee amputation. These are presented in detail. In the light of this experience, the advantages and indications for femorofemoral bypass and the results to be expected from it have become clarified, and the technique standardized so that errors can be avoided. We suggest that femorofemoral bypass is now the operation of choice for unilateral iliac artery occlusion.
Results of external sphincter repair in Crohn's disease
Authors: Scott A , Hawley P R , Phillips R K S 
Published: March 2007

AbstractThe results of anal sphincter repair in a group of six patients with anorectal Crohn's disease are reported. All patients had previously undergone anal surgery which was followed by faecal incontinence in five. The sixth patient became incontinent following obstetric injury. Of the six patients, five are completely continent and one has a permanent stoma (follow-up from 18 months to 16 years, mean 7·8 years). Anal sphincter repair in this highly selected group of patients with Crohn's disease has not been complicated by wound breakdown or fistula formation, and has given good results.
Non-condylomatous perianal disease in homosexual men
Authors: Carr N D , Mercey D , Slack W W 
Published: March 2007

Abstract
This retrospective study details the findings and outcome in 34 homosexual men, out of a total of 177 patients, who underwent surgery for non-condylomatous perianal disease over a 2-year period. Of 34 homosexuals 20 presented with anorectal sepsis compared with 11 of 79 heterosexual male patients (χ2 = 24.47, P&lt;0.001). Lesions included chronic intersphincteric abscess (eight patients), anal fistula (seven patients) and chronic intersphincteric abscess and fistula (five patients). Anal fissure occurred in 15 patients, anal ulcer in three, skin tags in six, haemorrhoids in two and Kaposi's sarcoma in one. Eight patients were human immunodeficiency virus (HIV) antibody negative, four were asymptomatic HIV antibody positive, 12 had symptomatic HIV infection using the Centers for Disease Control classification and in ten patients HIV status was unknown. Irrespective of the type of surgery performed, healing occurred within 6 weeks of operation in all HIV antibody negative patients, all asymptomatic HIV antibody positive and in only one of nine patients with symptomatic HIV infection. Eight of nine patients with symptomatic HIV infection failed to heal by this time (χ2 = 8.98, P&lt;0.05). These findings suggest that the prevalence of anorectal sepsis in homosexual men is high and that symptomatic HIV infection is an important determinant of progress after surgery.
Common femoral artery volume flow in peripheral vascular disease
Authors: Lewis P , Psaila J V , Morgan R H , Davies W T , Woodcock J P 
Published: March 2007

AbstractCommon femoral artery volume flow was measured at rest and during postocclusive reactive hyperaemia in 80 normal subjects and 67 patients with radiological evidence of occlusive peripheral vascular disease. At rest, mean(s.d.) common femoral artery volume flow in normal subjects (344 (135) ml/min) and all patients with peripheral vascular disease (401(168) ml/min) was not significantly different. During postocclusive reactive hyperaemia, mean(s.d.) peak flow was significantly higher in normal subjects (1951 (438) ml/min) than in patients with peripheral vascular disease (996(457)ml/min) (P &lt; 0·01). Common femoral artery volume flow in patients with critical ischaemia and intermittent claudication did not differ at rest but mean(s.d.) peak flow in patients with critical ischaemia (697(276) ml/min) was significantly lower than in claudicants (1131 (447)ml/min) (P &lt; 0·01). Mean(s.d.) resting common femoral artery volume flow in limbs with femoropopliteal disease (457(185) ml/min) was significantly greater than that in limbs with occlusion of the aortoiliac segment (308(130) ml/min) (P &lt; 0·01). However, this difference did not persist during postocclusive reactive hyperaemia. A hyperaemic index, calculated from the hyperaemic responses to below knee and whole limb ischaemia, was used to quantify segmented perfusion during postocclusive reactive hyperaemia. The mean(s.d.) value in normal subjects, 46(9) per cent, and in those with aortoiliac disease, 52(12) per cent, indicated approximately equal perfusion of the above and below knee limb segments. In those with femoropopliteal disease the mean(s.d.) hyperaemic index was 17(13) per cent, revealing relative hypoperfusion of the below knee segment.
Spontaneous rupture of renal allografts: The importance of renal vein thrombosis in the cyclosporin era
Authors: Richardson A J , Higgins R M , Jaskowski A J , Murie J A , Dunnill M S , Ting A , Morris P J 
Published: March 2007

AbstractSpontaneous renal allograft rupture occurring within 14 days of transplantation occurred in 15 patients from 791 consecutive transplants. In each of eight patients treated with azathioprine and prednisolone there was pathological evidence of rejection and only two patients had thrombosis of the renal vein. Of the seven cases occurring in patients treated with triple therapy regimen (low dose cyclosporin, prednisolone and azathioprine), histological evidence of rejection was present in only three cases, but renal vein thrombosis was found in all seven. Spontaneous rupture of a transplanted kidney, a relatively uncommon complication, is more likely to be due to renal vein thrombosis than to rejection in the cyclosporin era.
Carcinoma of the rectum: A 10-year experience
Authors: Dixon A R , Maxwell W A , Holmes J Thornton 
Published: March 2007

Abstract
A consecutive series of 303 patients with carcinoma of the rectum and distal sigmoid colon treated by a single surgeon over a 10-year period are reported. Of these, 202 underwent an anterior resection, 85 an abdominoperineal excision of the rectum and 16 a coloanal anastomosis. Surgery was considered palliative in 52 patients undergoing anterior resection and 24 undergoing abdominoperineal resection. The 30-day hospital mortality rate was six patients (3 per cent) for anterior resection and two patients (2 per cent) for abdominoperineal resection. Peroperative anastomotic testing demonstrated leakage in five stapled anastomoses; these were rectified and no clinical sequelae occurred. Two patients (1 per cent) developed a clinical anastomotic leak, one of which proved fatal; in each case the intraoperative test was negative. The overall 5-year survival rate was 64 per cent after anterior resection and 52 per cent after abdominoperineal resection; the median follow-up was 64 months. The incidence of local pelvic recurrence was 6·4 per cent after anterior resection and 14 per cent after abdominoperineal (not significant). These results confirm the success of sphincter-saving anterior resection combined with total mesorectal excision, routine full mobilization of the splenic flexure and cancercidal lavage of the distal rectum in the treatment of low rectal carcinomas; morbidity, local recurrence and survival are not compromised.
Topical application of honey in treatment of burns
Authors: Subrahmanyam M 
Published: March 2007

Abstract
A total of 104 cases of superficial burn injury were studied to assess the efficiency of honey as a dressing in comparison with silver sulfadiazine gauze dressing. In the 52 patients treated with honey, 91 per cent of wounds were rendered sterile within 7 days. In the 52 patients treated with silver sulfadiazine, 7 per cent showed control of infection within 7 days. Healthy granulation tissue was observed earlier in patients treated with honey (mean 7·4 versus 13·4 days). Of the wounds treated with honey 87 per cent healed within 15 days as against 10 per cent in the control group. Relief of pain, a lower incidence of hypertrophic scar and postburn contracture, low cost and easy availability make honey an ideal dressing in the treatment of burns.
Realistic expectations for the patient with intermittent claudication
Authors: O'Riordain D S , O'Donnell J A 
Published: March 2007

AbstractTo determine the natural history of intermittent claudication 112 patients were followed for a minimum of 5 years and a median period of 82 months. Thirty-seven patients (33 per cent) died during the study period. Myocardial infarction (44 per cent) and cerebrovascular disease (28 per cent) were the most common causes of death. Overall mortality rate was 8, 23 and 40 per cent, at 2, 5 and 8 years respectively. Initial ankle-brachial pressure index (ABPI) correlated with subsequent death. With an initial ABPI &lt;0·5 death occurred in 20, 50 and 69 per cent at 2, 5 and 7 years respectively, compared with 5, 16 and 24 per cent respectively for those with an initial ABPI ≤ 0·5 (P&lt;0·0001). Of the survivors only 21 per cent had worsening claudication and 13 per cent progressed to critical ischaemia. Arterial bypass for limb salvage was required in eight patients and four limbs were lost during the study period. ABPI identifies a subgroup of claudicants with an extremely high risk of death from coronary and/or cerebral pathology. In this subgroup an aggressive approach to the correction of atherosclerotic risk factors, rather than emphasis on the peripheral vascular problem alone, may improve survival.