bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Klippel–Trenaunay syndrome: Clinical, radiological and haemodynamic features and management
Authors: Baskerville P A , Ackroyd J S , Thomas M Lea , Browse N L 
Published: March 2007

Abstract
Forty-nine patients with the Klippel-Trenaunay syndrome have been studied. Sixty-eight per cent have a superficial, embryological venous channel on the lateral aspect of the limb, 25 per cent have had one or more severe spontaneous haemorrhages from dilated varices and 22 per cent have suffered a venous thrombo-embolism. Twenty-nine per cent have had episodes of rectal bleeding or haematuria associated with pelvic angiomas. Foot volumetry (n = 31) showed that calf emptying was decreased in only five patients and only one of these had phlebographic evidence of deep venous obstruction, which conflicts with previous findings. The rate of calf refilling was increased in 81 per cent and phlebography demonstrated incompetent communicating veins in 45 per cent of patients. No patient had clinical evidence of an arteriovenous fistula, and arteriography (n = 22) and calf blood flow (n = 33) were normal, but lymphangiography (n = 14) showed lymphatic hypoplasia in 55 per cent of limbs. Eighty-eight operations have been performed on 38 patients but symptoms persist in 90 per cent. We suggest that surgery should be limited to the excision of localized symptomatic abnormalities and that the best form of control is provided by graduated compression stockings.
Ultrasonography, HIDA scintigraphy or both in the diagnosis of acute cholecystitis?
Authors: Gill P T , Dillon E , Leahy A L , Reeder A , Peel A L G 
Published: March 2007

Abstract
The benefit of early surgery for patients with acute cholecystitis is now accepted but rapid accurate pre-operative diagnosis is important and the single best investigation has not yet been clearly established. All 47 patients with suspected acute cholecystitis admitted to a district general hospital during a 6 month period underwent ultrasonic examination and scintigraphy with HIDA within 48 h of admission. In 23 patients acute cholecystitis was proven. Ultrasound correctly diagnosed this in 21 patients but in 2, changes attributed to chronic cholecystitis only were detected. Two false positive ultrasound results also occurred, one in a patient with adenomyomatosis and acute pancreatitis, the other in a case of duodenitis. HIDA scan was diagnostic in 19 patients but in the remaining 4 the presence of abnormal liver function tests accounted for non-visualization of the biliary tree (a non-diagnostic result). In the absence of jaundice a HIDA scan is the more specific test for confirming acute cholecystitis.
Suction drainage of the gallbladder bed does not prevent complications after cholecystectomy: A random control clinical trial
Authors: Playforth M J , Sauven P , Evans Mary , Pollock A V 
Published: March 2007

Abstract
Some surgeons drain the gallbladder bed routinely, some selectively and some not at all. We aimed to clarify this confusion by entering 155 consecutive patients undergoing emergency and elective cholecystectomy without exploration of the common bile duct into a random control clinical trial. In 78 patients a 3 mm suction drain was left in the gallbladder bed and in 77 the abdomen was closed without drainage. There were no withdrawals, one death (in the drainage group) from myocardial infarction and one intraperitoneal abscess complicating postoperative pancreatitis (in the no-drainage group). Other events studied were postoperative pyrexia, wound infection, respiratory tract infection and duration of hospital stay. In none of these did the two groups differ either clinically or statistically. We conclude that drainage or non-drainage of the gallbladder bed must remain a matter of individual preference.
Local radiotherapy in the management of squamous carcinoma of the anus
Authors: James R D , Pointon R S , Martin S 
Published: March 2007

Abstract
This paper describes the results of treating 74 patients with squamous cell carcinoma of the anal canal and perianal skin using interstitial radio-therapy as primary treatment. This technique does not involve irradiation of regional lymph nodes. The local control rate for patients with tumours smaller than 5 cm and with negative inguinal nodes was significantly better than for the remaining patients (64 versus 23 per cent). Only 3 of 41 patients with tumours less than 5 cm diameter had clinically significant nodes at presentation, while in 33 patients with tumours larger than 5 cm there were 6 with involved nodes at presentation. Local treatment using interstitial radiotherapy is suggested as useful primary treatment for small, node-negative carcinomas, with surgery held in reserve for failures.
Early gastric carcinoma in Japanese patients under 30 years of age
Authors: Mori M , Sugimachi K , Ohiwa T , Okamura T , Tamura S , Inokuchi K 
Published: March 2007

Abstract
The clinicopathological characteristics of early gastric carcinoma (EGC) in 23 Japanese under 30 years of age were reviewed and the findings compared with data on 53 patients over age 70. In the young patients, there was a female preponderance, a macroscopic solitary lesion and the cancer was of the poorly differentiated type without intestinal metaplasia in the surrounding mucosa. In the old patients, there was a male preponderance; about half the number of patients had macro-scopically elevated lesions and 10 of the 53 had a multifocal gastric carcinoma. Here, most lesions were well to moderately differentiated types with intestinal metaplasia in the surrounding area. Growth patterns of EGC in the young patients were analysed. Curative operations with dissection of regional lymph nodes were done in all the young patients. Metastases to the regional lymph nodes were present in only 2 of 23. Twenty of twenty-three followed for 5 years or longer are well.
Circumferential skin blood flow measurements in the ischaemic limb
Authors: McCollum P T , Spence V A , Walker W F 
Published: March 2007

Abstract
Skin blood flow (SBF) values were estimated on the posterior, medial and lateral aspects of the lower leg in 47 patients presenting for assessment of amputation level. Measurement was made using a radioisotope (iodo-antipyrine) clearance technique. Medial SBF was 9±0±5±2 ml 100 g−1 min−1; posterior SBF was 8±3±5±0 ml 100 g−1 min−1 and lateral SBF was 6±5±4.1 ml 100 g−1 min−1. The results gave significantly higher SBFs on the medial and posterior aspects of the ischaemic leg. The finding of an uneven distribution of blood flow at the below knee amputation level has important implications in the planning of amputation flaps.
Asymptomatic carotid stenosis: Is prophylactic endarterectomy justifiable?
Authors: Colgan Mary P , Kingston Wiley , Shanik D G 
Published: March 2007

Abstract
Carotid endarterectomy is well established in the treatment of selected cases of atherosclerosis of the carotid bifurcation; however, its role in the management of asymptomatic stenosis of the internal carotid artery remains controversial. Over a 4 year period 190 patients with 209 asymptomatic stenoses of the internal carotid artery were prospectively studied by means of Doppler ultrasound in combination with real time spectral analysis to determine the natural history of asymptomatic carotid stenosis. We report a cumulative stroke-free survival of 97 per cent at 3 years and we therefore question the merit of prophylactic endarterectomy in the management of asymptomatic carotid disease.
Aortofemoral bypass and the role of concomitant femorodistal reconstruction
Authors: Harris P L , Bigley D J Cave , McSweeney L 
Published: March 2007

Abstract
A consecutive series of 200 patients having aortofemoral bypass grafts were studied in order to determine the effect of femoropopliteal occlusive disease on the results and the role of concomitant femorodistal bypass. Bifurcated aortic grafts were used in 177 patients and unilateral aortofemoral grafts in 23 giving 377 limbs for study. Of the 377 limbs, 184 (49 per cent) had minimal femoropopliteal disease (Group 1), 24 (6·4 per cent) had a femoropopliteal stenosis (Group 2) and 169 (44·6 per cent) had complete femoropopliteal occlusion (Group 3). In Group 3 aortofemoral bypass was carried out alone in 106 cases (Group 3a): in the other 63 cases femorodistal bypass was carried out at the same time as aortoiliac reconstruction (Group 3b). The cumulative patency at 5 years for all aortofemoral grafts together was 91 per cent. However, that for grafts in Group 3a was only 65 per cent compared with 98 per cent for Groups 1 and 3b and 94 per cent for Group 2. The cumulative patency rate for grafts in Group 3a was significantly lower than for all other groups (P&lt;0·001). The operative mortality for those patients who had concomitant aortofemoral and femorodistal grafts (Group 3b) did not differ significantly from that of any of the other groups (P &gt; 0·1). Of the cases in Group 3a, 21 (26 per cent) required femoropopliteal reconstruction at a later date. The results indicate that in the presence of combined aortoiliac and femoropopliteal occlusive disease concomitant reconstruction of both arterial segments yields significantly better results than aortoiliac bypass alone.
Solid and liquid gastric emptying in patients with gastro-oesophageal reflux
Authors: Maddern G J , Chatterton B E , Collins P J , Horowitz M , Shearman D J C , Jamieson G G 
Published: March 2007

Abstract
A dual isotope radionuclide technique has been used to assess solid and liquid gastric emptying simultaneously in 72 patients with symptomatic gastro-oesophageal reflux and 22 normal controls. Objective evidence of gastro-oesophageal reflux was obtained from standard acid reflux testing and/or endoscopy in all patients. Solid emptying was delayed in 32 patients (44 per cent), liquid emptying was delayed in 27 patients (37 per cent) and 16 of those two groups had delayed solid and liquid emptying. Thus 29 patients (40 per cent) had normal solid and liquid emptying. The solid lag period was significantly delayed in the patient group (P&lt;0.01). There was a significant correlation (P&lt;0.01) between the solid and liquid gastric emptying values obtained in patients. No significant correlation was found between gastric emptying and the resting lower oesophageal sphincter pressure or the presence of symptoms of regurgitation and epigastric fullness. In the patients with delayed solid emptying there was a higher incidence of oesophagitis than in patients with normal emptying (P&lt;0.05).
Cerebral blood flow and CO2 responsiveness as an indicator of collateral reserve capacity in patients with carotid arterial disease
Authors: Bullock R , Mendelow A D , Bone I , Patterson J , Macleod W N , Allardice G 
Published: March 2007

Abstract
Resting cerebral blood flow (CBF) and the response to inhalation of 7 per cent CO2 was measured in 74 patients with symptoms of cerebrovascular disease. In order to evaluate their role in the identification of patients with significant arterial lesions, these measurements were correlated with the angiographic appearances, the clinical picture and the presence or absence of infarction on CT scan. Patients with carotid stenosis of 60 per cent or more had normal resting flows, but reduced responsiveness to CO2 inhalation. Patients with carotid occlusion had both reduced resting flow and reduced CO2 responsiveness. Infarcts were visible in 25 per cent of the hemispheres studied, and were more common in patients with fixed neurological deficits, but were also present in 17 per cent of patients with transient ischaemic attacks (TIAs). Reduction in the collateral supply from the contralateral carotid artery via the Circle of Willis further reduced CO2 responsiveness with ipsilateral internal carotid occlusion. The normal increase in CBF which occurs with the inhalation of carbon dioxide is diminished with increasingly severe bilateral disease, with infarction and with a fixed neurological deficit.
A randomized controlled trial of adjuvant portal vein cytotoxic perfusion in colorectal cancer
Authors: Taylor I , Machin D , Mullee M , Trotter G , Cooke T , West C 
Published: March 2007

Abstract
In this randomized trial adjuvant cytotoxic portal vein perfusion in patients undergoing surgery for colorectal cancer without liver metastases was assessed to determine whether the incidence of meta-chronous liver metastases could be reduced and survival thereby improved. There were 127 control patients and 117 patients who received adjuvant perfusion. A further 13 patients were excluded following randomization because of cirrhosis in 1, liver metastases at laparotomy in 3 and technical problems with cannulation in 9. Dukes' staging and degree of differentiation were similar in the two groups. There were fewer liver metastases in the perfusion patients and overall survival was improved. However, the benefit appears to be greatest in patients with Dukes' B colon cancer.
Probability of false negative nodal staging in conjunction with partial axillary dissection in breast cancer
Authors: Kjærgaard J , Blichert-Toft M , Andersen J A , Rank F , Pedersen B V 
Published: March 2007

Abstract
There is a risk of overlooking lymph node metastases and thereby contributing to inaccurate nodal staging when performing partial axillary dissection in conjunction with total mastectomy in female breast cancer. The Danish Breast Cancer Cooperative Group (DBCG) analysed this risk in a prospective nation-wide adjuvant trial dealing with primary operable breast carcinoma. The series comprised 3114 patients, initially found to have lymph node negative axillae, followed for a median of 24 months (quartiles 12-40). It was found that the probability of early ipsilateral axillary relapse of cancer, estimated by means of the life table method, decreased with the number of nodes removed. After 2 years the recurrence rate was 12 per cent for patients with no lymph nodes removed, 7 per cent with one or two nodes removed and 2 per cent with three or more nodes removed. It is concluded that the risk of false negative nodal staging in conjunction with partial axillary dissection is modest, provided at least three lymph nodes are removed and found to be negative on histological examination.
Factors affecting survival in patients presenting with synchronous hepatic metastases from colorectal cancer: A clinical and computer analysis
Authors: Finan P J , Marshall R J , Cooper E H , Giles G R 
Published: March 2007

Abstract
A review of 90 patients presenting in Leeds over the period 1976-80 with synchronous hepatic metastases from colorectal cancer has been undertaken. The median survival for the group was 10.3 months (range 1–48 months). A multivariate analysis identified factors in the history and examination of the patient, results of biochemical and haematological investigations and characteristics of both the primary and secondary tumour, which influenced survival. Recognition of these factors allowed both a clinical scoring index and computer survival model to be constructed. When applied to the group as a whole both were reasonably accurate at predicting survival (62 per cent for the survival model and 66 per cent for the scoring index). However, the computer model correctly identified 80 per cent of the long-term survivors (&gt; 12 months from the time of diagnosis). It is concluded that many trials of therapy for hepatic metastases from colorectal cancer have failed to consider the natural history of the disease and the identification of prognostic indices should allow for adequate stratification within the treatment arms of any future study.
The role of peptidases in cancer of the rectum and sigmoid colon
Authors: Durdey P , Cooper J C , Switala S , King R F G J , Williams N S 
Published: March 2007

Abstract
Increased levels of peptidases are found in some human carcinomas and may be related to invasive potential. We therefore measured the activity of four peptidases in 50 specimens of tumour and normal colonic wall from patients with a rectal or sigmoid carcinoma, and correlated this with the stage, differentiation, fixity of the tumour and presence of venous invasion, determined histologically. Since acute phase reactant proteins (APRP) may inhibit these proteolytic enzymes we have also measured serum levels of two relevant APRPs, α1 acid glycoprotein (AGP) and C-reactive protein (CRP) pre-operatively. Activity of cathepsin B, cathepsin H and collagenase-like peptidase (CLP) was determined fluorimetrically and collagenase photometrically. Significantly elevated activity of cathepsin B, CLP and collagenase was found in tumour compared with normal colonic wall (median values: (nmol (mg protein)−1 min−1) Cat B 0.71 and 0.42 (P&lt;0.001), CLP 25.24 and 12.25 (P&lt;0.001) and collagenase 0.49 and 0.31 (P&lt;0.001)). There was no correlation between the activity of these enzymes expressed as a ratio of tumour/colonic wall, and differentiation or Dukes' stage of the tumour. However, there was significant elevation of activity of cathepsin B in tumours with local spread (n = 13) compared with those with no spread (n = 37) (median values 2.76 and 1.36 respectively (P&lt;0.001)) and also in tumour with venous invasion (n = 24) compared with tumours without (n = 26) (median values 1.82 and 1.18 respectively (P&lt;0.01)). Pre-operative serum levels of CRP were inversely correlated with the activity of CLP and cathepsin H and collagenase in the tumours (rs = 0.332, 0.359 (P&lt;0.05) and 0.302 (P = 0.05) respectively). Thus certain peptidases are raised in rectal and sigmoid tumours. Activity of cathepsin B appears related to local tumour invasion. APRP may have a role in inhibiting the activity of these enzymes. These findings may have therapeutic implications.
Effects of somatostatin and a long-acting somatostatin analogue on the prevention and treatment of experimentally induced acute pancreatitis in the rat
Authors: Baxter J N , Jenkins S A , Day D W , Roberts N B , Cowell D C , Mackie C R , Shields R 
Published: March 2007

Abstract
The effects of somatostatin (SRIF) and its long-acting analogue, SMS 201-995 on the prevention and treatment of acute pancreatitis were studied in rats. Acute pancreatitis was established by ligating the bile duct at the point of entry into the duodenum, thereby allowing reflux of bile into the pancreas. Administration of SRIF (4 μg kg−1 body wt IV followed by a 12 h infusion of 4 μg kg−1 body wt h−1) or SMS 201-995 (2 μgkg−1 body wt SC) at the time of bile duct ligation prevented the increase in the serum concentrations of amylase and lipase observed in control rats 12 h after bile duct ligation. Moreover, SRIF and SMS 201-995 administration prevented development of the histological changes consistent with acute pancreatitis observed in control animals. These results suggest that SRIF or SMS 201-995 may be of value in preventing acute pancreatitis following ERCP or after surgery on the pancreas. In rats with established pancreatitis, SRIF (IV bolus of 4μg kg−1 body wt followed by a 24h continuous infusion of 4μgkg−1 body wt h−1) or SMS 201-995 (2μgkg−1 body wt SC followed by a similar dose 12h later): (1) significantly improved survival; (2) produced histological changes in the pancreas consistent with organization and healing; (3) prevented the accumulation of ascitic fluid; (4) reduced the serum levels of amylase and lipase. These results suggest that SRIF and SMS 201-995 may prove valuable in the treatment of established acute pancreatitis in man.
Management of gallstones in a district general hospital
Authors: Crumplin M K H , Jenkinson L R , Kassab J Y , Whitaker C M , Al-Boutiahi F H 
Published: March 2007

Abstract
This survey reviews 815 consecutive patients undergoing surgery for benign biliary disease. There were no deaths following elective operations and the overall mortality was 0.7 per cent. One-third of patients had one or more complications. The mortality in patients having common bile duct exploration (n = 160) by one or more methods was 2.5 per cent (4 patients) with 46 per cent of these patients having complications. Of 95 patients undergoing duct exploration and postoperative T-tube cholangiography, 7 had unexpected residual calculi after initial cholecystectomy. Five have had further surgery to clear the duct. All patients having duct surgery alone for retained stones (n = 24) had previously had cholecystectomy with or without supraduodenal duct exploration. Of all patients undergoing choledochoduodenostomy or transduodenal sphincter exploration only one has returned with evidence of retained calculi. Patients with choledocholithiasis were examined in an attempt to identify a high risk group. These were found to be elderly patients, having emergency surgery for sepsis and on whom more than one duct procedure was performed (mortality 10 per cent).
Screening for acute pancreatitis: A rapid assay for plasma lipase
Authors: Mayer A D , McMahon M J , Holdsworth P J , Wilson D H , Flowers M W , Brown D A 
Published: March 2007

Abstract
A simple agglutination test for plasma immunoreactive lipase has been evaluated in 101 patients. A positive agglutination reaction was observed if, and only if, plasma lipase exceeded 300 μg/l. The test was positive in all 23 patients with acute pancreatitis who were tested on the day of admission to hospital, in one patient with a pancreatitic pseudocyst and in one patient with hyperamylasaemia and hyperlipasaemia due to a perforated duodenal ulcer. The simplicity and reliability of this test make it suitable as an urgent diagnostic investigation for acute pancreatitis.
Long-term survivors after breast cancer
Authors: Dixon J M , Page D L , Anderson T J , Lee D , Elton R A , Stewart H J , Forrest A P M 
Published: March 2007

Abstract
A retrospective analysis of two groups of patients, one surviving 16–20 years and the other dying within 10 years after diagnosis and treatment of primary breast cancer has been undertaken to determine whether there were particular clinical or histological features associated with long-term survival. The striking histological dijfference between the tumours of the two groups of patients was the prevalence of tumours of ‘special’ invasive types (cribriform, tubular, lobular and medullary) in the long-term survivors. M icro-invasive and non-invasive carcinomas were also more common in the survivors. The tumours of the surviving group which were not of a ‘special’ type more commonly had a better histological grade than those tumours of patients dying early from breast cancer. In the overall group elastosis was present in significantly more tumours of the survivors whereas tumour necrosis, vascular and lymphatic invasion were ail significantly more common in the short-term survival group. Although there was a significantly increased incidence of earlier stage tumours in the long-term survivors, the histological distinctions between the two groups were independent of the differences in clinical features.
First experimental results with the oxygen electrode as a local blood flow sensor in canine colon
Authors: Piasecki C 
Published: March 2007

Abstract
A modified oxygen electrode was tested against the electromagnetic flowmeter to see if its reading indicated blood flow to the canine colon. Although gross inflow was compared with local flow, the correlation was good in each of seven individuals (r ranged from 0.86 to 0.97). The closeness of the relative values gives the instrument potential for cheap, fast, repeatable and non-invasive estimation of regional blood flow, in colon and other exposed tissues.