bluuebunny/crossref_metadata_2025_split huggingface dataset:
The pelvic floor musculature in the descending perineum syndrome
Authors: Henry M M , Parks A G , Swash M 
Published: March 2007

Abstract
We have studied 20 patients with the descending perineum syndrome, half of whom were incontinent of faeces. Objective criteria were established in 103 control subjects for determining the relationship of the perineum to the bony pelvis. The anal reflex latency was increased in the 10 patients in whom perineal descent was associated with faecal incontinence, but not in the 10 without incontinence. However, there was hypertrophy of the muscle fibres in external anal sphincter muscle biopsies in all the patients. Thus, abnormal degrees of perineal descent are associated with changes in the external anal sphincter muscle, consistent with damage to its nerve supply.
The management of the perforated appendix: A controlled clinical trial
Authors: Brennan S S , Smith G M R , Evans Mary , Pollock A V 
Published: March 2007

Abstract
Seventy-one patients with peritonitis due to perforation of the appendix were treated by preoperative rectal metronidazole, appendicectomy and omission of skin closure. They were then randomized to have either no further antibacterial treatment, or rectal metronidazole twice-daily for 5 days. No major wound infections occurred, but 8 patients developed intraperitoneal abscesses. In addition, I died of a pulmonary embolus and 1 required further laparotomy for intestinal obstruction.
Patients in the 5-day-metronidazole group suffered fewer intraperitoneal abscesses and less pyrexia, but the differences did not achieve statistical significance. This series shows a considerable improvement over a previously published series in terms of morbidity, duration of pyrexia and length of hospital stay.
Ischaemia and partial resection for control of splenic hyperfunction
Authors: Witte C L , van Wyck D B , Witte M H , Corrigan J J , Zukoski C F , Pond G D , Woolfenden J M 
Published: March 2007

Abstract
Patients with blood dyscrasia are particularly susceptible to fulminant sepsis after splenectomy. We therefore examined the therapeutic response to partial splenic amputation in 2 patients and transcatheter splenic artery occlusion or embolization in 3 patients with splenic hyperfunction. Partial splenectomy relieved associated symptoms and corrected peripheral cytopenias while preserving a substantial splenic remnant on radionuclide scintiscan and preventing appearance of Howell–Jolly bodies in the peripheral blood. Gelatin sponge embolization promoted selective splenic infarction and also corrected peripheral cytopenias, thereby facilitating immunosuppression to prevent renal allograft rejection. Steel coil occlusion of the main splenic artery in a patient with hepatic cirrhosis, however, although initially reducing splenic inflow, ‘decompressing’ the mesenteric portal system and ameliorating pancytopenia ultimately proved of only temporary benefit, confirming the results of prior attempts to curtail splenic hyperfunction by interruption of the extrasplenic arterial supply alone. Partial splenic preservation or hyposplenism is preferable to total splenectomy but, depending on the mass of splenic tissue left behind and the nature of the stimulus for hypersplenism, a fine line may exist between haematological recurrence and increased risk of overwhelming sepsis.
The Monark bicycle ergometer in screening arterial patients
Authors: De Cossart Linda , Marples M , Cloherty G , Marcuson R W 
Published: March 2007

Abstract
In patients with peripheral arterial disease, maximum walking distance on a treadmill is commonly used for studying the effect of exercise on ankle systolic pressure. Exercise on the Monark bicycle ergometer for 1 min at a workload of 1 kp and cycling at 20 kph has been compared with treadmill walking in 30 patients presenting with calf pain on exercise at the vascular clinic and in 6 normal volunteers. The bicycle test produced a significant fall in ankle systolic pressure in all patients with advanced arterial disease. There was no statistical difference in the results obtained on the bicycle compared with the treadmill. There was better patient compliance with the bicycle test. The Monark bicycle ergometer, a simple inexpensive instrument, is a viable alternative to the treadmill for exercising arterial patients.
Bacteriological implications in the pathogenesis of secondary aortoenteric fistulas
Authors: Wilson S E , Bennion R S , Serota A I , Williams R A 
Published: March 2007

Abstract
The role of bacterial infection in the pathogenesis of aorto-enteric fistula was examined by a collective review of the clinical features and bacteriology in 213 patients. The most common presentation, gastrointestinal bleeding, occurred in 49 per cent of patients, although 32 per cent had systemic or local signs of infection as a presenting symptom. Results of intraoperative cultures were available in 115 patients, 33 of whom had two or more isolates. The predominant organisms were Escherichia coli, Staphylococcus aureus, group D Streptococcus and Bacteroides spp. The Gram-positive aerobic cocci predominated in fistulas developing within the first postoperative year which is compatible with a primary infection due to intraoperative contamination with skin flora. The Enterobacteriaceae and anaerobes showed no predilection for early or late occurring fistulas, suggesting that infection in these patients may be secondary to mechanical erosion of the graft through the adjacent duodenum. In either event, the likelihood that the aorto-enteric fistula is complicated by prosthetic infection should be seriously considered by the surgeon in planning the operative procedure.
Skew flap myoplastic below-knee amputation: A preliminary report
Authors: Robinson K P , Hoile R , Coddington T 
Published: March 2007

Abstract
A preliminary report is made of a modified technique of below-knee amputation using skewed sagittal skin flaps, combined with a posterior myoplasty. The satisfactory initial shape eliminates any delay for maturation of the stump and allows early casting of the socket for a prosthesis which can be worn within 3 weeks of operation for non-vascular amputations and within 4 weeks for vascular amputations. Forty-seven of these amputations have been performed; 4 patients required re-amputation at a higher level and 6 required secondary minor revision before full healing was achieved. In the remaining patients healing was uneventful.
Long term results of a consistent policy of sphincter preservation in the treatment of carcinoma of the rectum
Authors: Jones P F , Thomson H J 
Published: March 2007

Abstract
With increasing emphasis on sphincter preservation in the treatment of low carcinomas of the rectum, it is important to know whether such a policy results in satisfactory rectal function and long term survival. In 368 patients operated upon for carcinoma of the rectum between 1958 and 1980, a consistent policy of sphincter preservation was followed, and resulted in 222 (61 per cent) patients having a restorative resection (RR), whilst 132 (37 per cent) had an abdominoperineal excision (APE); 271 (76 per cent) had a radical operation with a hope of cure. Overall operative mortality was 5 per cent (2·6 per cent in the radical group) and the leakage rate in the 222 restorative anastomoses was 5 per cent. Follow-up of 98 per cent of patients treated over 5 years ago has been possible. Special attention has been paid to the late results in patients having a restorative resection of tumours at and below 8 cm: all these patients are continent and there is no excess of late pelvic recurrence. Corrected 5-year survival rates are 72 per cent for abdominoperineal excision and 84 per cent for restorative resection.
Intraluminal versus humoral factors in intestinal cell proliferation
Authors: Li A K C , Jeppsson B W , Jamieson C G 
Published: March 2007

Abstract
Since both intraluminal and humoral factors have been implicated in postresectional intestinal hyperplasia, we investigated the relative importance of these factors by using cutaneous parabiotic rats with shared gut. Paired cutaneous parabiosis with a common peritoneal cavity was established in inbred Fischer rats. One month later, in one group of animals one member of the pair had a 64 per cent small bowel resection, while in the control group transection alone was performed. Immediately all the rats underwent intestinal crossover, achieved by anastomosing the proximal small bowel of each rat to the distal small bowel of its partner.
In the jejunum 2 weeks later there was an 18 per cent increase in DNA content and a 26 per cent increase in wet weight in the animals with resection compared with their parabionts (P &lt; 0·05). There was no difference between the parabionts without resection and the control animals. Because of the intestinal crossover, the more proximally placed ileum from the rats without resection showed a 53–58 per cent increase in DNA content, 28–29 per cent increase in RNA content and 51–57 per cent increase in wet weight compared with the normally placed ileum from the partners that had resection and with the control (P &lt; 0·001). There was no difference between the control and the normally placed ileum from the animals that had resection. The position of the ileum after resection appeared to be the major influence on hyperplasia, since no measurable difference in nucleic acid contents was detected between the ileum of the animals with resection and the control. However, humoral factors do operate locally and may play a permissive role because the jejunum of the animals with resection showed DNA increase when compared with the control.
Operative approach to cancer of the head of the pancreas and the peri-ampullary region
Authors: Obertop H , Bruining H A , Schattenkerk M Eeftinck , Eggink W F , Jeekel J , Van Houten H 
Published: March 2007

Abstract
A retrospective study was made of 75 consecutive patients treated for a tumour of the head of the pancreas and the peri-ampullary region from January 1978 to August 1981. These patients underwent either pancreatic resection—pancreatoduodenectomy (n = 24) and total pancreatectomy (n = 10)—palliative procedures (n = 29) or exploratory laparotomy (n = 12). Clinical signs and diagnostic procedures, such as ultrasonography and coeliac arteriography, were studied for their value in preoperative assessment of operability. Vaso-invasion, as revealed by arteriography and, to a lesser extent, ultrasonographic signs of a tumour and the absence of jaundice were poor prognostic signs.
The operative mortality was 8 per cent for the group as a whole, but somewhat higher (13 per cent) for the group that underwent pancreatoduodenectomy. No patient died after total pancreatectomy. The operative mortality was 27 per cent in all patients aged 70 years or older, but only 3 per cent in patients under 70 years. One-year patient survival was 94 per cent after pancreatoduodenectomy for peri-ampullary cancer and 57 per cent after resection for cancer of the head of the pancreas.
The results of this study point to pancreatic resection as the treatment of choice for resectable tumours of the peri-ampullary region and the head of the pancreas in patients under 70 years of age. Coeliac arteriography and ultrasonography have been found to be useful for preoperative classification of tumour stage.
The treatment of autonomous functioning thyroid nodules
Authors: Eyre-Brook I A , Talbot C H 
Published: March 2007

Abstract
The clinical features and management of 90 thyrotoxic and 11 euthyroid patients with a single autonomous hot nodule in the thyroid have been reviewed to assess the results of surgery and radio-iodine therapy. Symptoms and signs of thyrotoxicosis were often minimal but histories were frequently long with cardiac complications predominating. Thyrotoxicosis was permanently eradicated in the 60 patients treated surgically, although hypothyroidism occurred in 6·6 per cent. Twelve of the 37 (32 per cent) thyrotoxic patients receiving radio-iodine needed further definitive treatment for persistent or recurrent thyrotoxicosis, but only 2 patients (5 per cent) became hypothyroid. Early surgery for the autonomous toxic thyroid nodule ensures control of the thyroid overactivity and minimizes the risk of permanent cardiac damage. The absence of morbidity justifies surgical excision of autonomous hot nodules in patients who are euthyroid to eliminate the risk of thyrotoxicosis supervening.
Late follow-up of highly selective vagotomy with excision of the ulcer compared with Billroth I gastrectomy for treatment of benign gastric ulcer
Authors: Reid D A , Duthie H L , Bransom C J , Johnson A G 
Published: March 2007

Abstract
We present the late results of a prospective randomized trial of highly selective vagotomy with excision of the ulcer (HSV + E) (n = 26 cases) versus standard Billroth I partial gastrectomy (BI) (n = 30). The operations were performed by registrars, senior registrars or consultants. Results of postoperative morbidity, functional outcome and recurrence rates have previously been reported at an average follow-up period of 4 years (1), at which stage neither operation offered a distinct advantage. At an average follow-up period of 8 years, 54 of the original 56 patients have been reassessed, using a standard Visick grading. HSV + E offers a better symptomatic result. There is an increased recurrence rate in both groups with time, 6 following HSV + E and 5 following BI gastrectomy.
The value of the small bowel enema to the general surgeon
Authors: Keddie N , Watson-Baker R , Saran M 
Published: March 2007

Abstract
Lesions of the small bowel are notoriously difficult to diagnose, many only coming to light at laparotomy. At this hospital the small bowel enema has been used for radiology of the small bowel for many years. The procedure is uncomfortable for the patient, as intubation of the proximal small bowel is essential, and for the radiologist it can be very time-consuming. A review of patients referred by the general surgeons over the past 5 years has demonstrated the value of the technique. It has proved to be accurate in over 90 per cent of cases with only 2 per cent false negative and I per cent false positive results. The most common diagnosis has been Crohn's disease which can be very accurately assessed. Other lesions diagnosed include lymphoma, involvement by metastases, benign stricture and adhesions. A normal result has prevented an unecessary laparotomy in several patients. It is concluded that this technique is the most satisfactory method for radiology of the small bowel and it should be much more widely available.
The lateral paramedian incision—experience with 850 cases
Authors: Donaldson D R , Hegarty J H , Brennan T G , Guillou P J , Finan P J , Hall T J 
Published: March 2007

Abstract
We present our experience in 850 consecutive patients who had a laparotomy through a lateral paramedian incision during the period 1977–1981. These patients underwent both elective and emergency procedures covering a wide range of intra-abdominal conditions, and had a high incidence of factors known to predispose to wound dehiscence and incisional hernia formation. Follow-up in each case for at least 1 year revealed no wound dehiscences and 3 incisional hernias (0·37 per cent). We conclude that the lateral paramedian incision is inherently strong and that this strength is due to the splintage of the wound by the rectus abdominis muscle and the wide shutter mechanism that this provides.
Parotid fistulas: a review
Authors: Ananthakrishnan N , Parkash S 
Published: March 2007

Abstract
A series of 17 cases of parotid fistulas seen at one hospital over a 10-year period is presented with detailed analysis of aetiological factors, clinical presentation and therapy. Distinctions between glandular and ductal fistulas have been enumerated and the poorer prognosis of the ductal fistulas, especially of the proximal part, is emphasized. Two-thirds of the fistulas were iatrogenic. Malignancy and oral leucoplakia were unusual causes. Direct duct suture is rarely successful. Ablative surgery carries a significant risk of facial nerve injury. A wide choice of treatment exists for glandular and distal duct fistulas, while for the proximal duct injuries excision is usually necessary. A new alternative operation of vein grafting for such cases is described. Successful closure is obtained in only 50 per cent of patients with long standing fistulas with any method of treatment.
The influence of delayed feeding on postoperative vomiting in hypertrophic pyloric stenosis
Authors: Leahy A , Fitzgerald R J 
Published: March 2007

Abstract
The influence of delayed feeding on postoperative vomiting after Ramstedt's pyloromyotomy was investigated. Two feeding regimens were compared, both of which involved a gradual increase in the strength of feeds: regimen A incorporating a 4-h fasting period and regimen B one lasting 24 h. Of the 67 patients who underwent Ramstedt's pyloromyotomy in 1978 and 1979, 33 were fed by regimen A and 34 by regimen B. Postoperative vomiting was significantly reduced both in incidence and severity in group B. This decrease in vomiting was accomplished without any increase in postoperative stay.
Testicular venography for the localization of the impalpable undescended testis
Authors: Khan O , Williams G , Boley N B , Allison D J 
Published: March 2007

Abstract
An undescended abdominal testis has a high potential for the development of malignancy. Surgery may require both an inguinal and an abdominal exploration. We have used selective testicular venography in 7 men for preoperative testicular localization. In 5, the origin of the testicular vein was identified using this technique and the information acquired proved to be of considerable assistance to the surgeon. We recommend that this technique is used routinely in the localization of the impalpable undescended testis.
Leucocyte mobilization and function in vitro of blood and exudative leucocytes after inguinal herniotomy
Authors: Wandall J H 
Published: March 2007

Abstract
The effect of surgical trauma on leucocyte mobilization in vivo and the function of blood and exudative leucocytes was studied in 15 patients after inguinal herniotomy. Mobilization of leucocytes to skin windows with chambers was reduced 48h after anaesthesia (P &lt; 0·01) compared with 21 healthy volunteers. Blood leucocyte chemotaxis was reduced during the period of anaesthesia (P &lt; 0·05). Serum independent phagocytosis was increased from 24h after anaesthesia (P &lt; 0·01) but without a corresponding increase in the serum dependent phagocytosis. The oxidative metabolic activity of resting leucocytes in terms of Nitro Blue Tetrazolium (NBT) reduction decreased 24–48h after anaesthesia without any change in NBT reduction during phagocytosis. In contrast, exudative leucocytes exhibited reduced phagocytosis independent of serum factors (P &lt; 0·5) and increased NBT reduction by resting leucocytes. It is concluded that a diminished accumulation of leucocytes at inflammatory lesions occurs postoperatively and that changes in the function of circulating leucocytes do not always reflect the changes in function of the exudative leucocyte.
Prognostic factors in breast cancer
Authors: Palmer M K , Lythgoe J P , Smith Alwyn 
Published: March 2007

Abstract
Data relating to 1022 patients with early breast cancer who were entered into a clinical trial have been analysed to assess the importance of various factors in predicting prognosis. Clinical stage was the major determinant of prognosis, and in each stage patients with a breast tumour 2 cm or less in maximum diameter had a significantly better survival than patients with larger tumours. Patients aged between 40 and 49 years and premenopausal patients had relatively favourable prognosis. Site of the tumour within the breast, whether it was situated on the left or the right side, the patient's marital status and the number of pregnancies did not appear to have any influence.
Gardner's stigmas in patients with familial adenomatosis coli
Authors: Järvinen H J , Peltokallio P , Landtman M , Wolf J 
Published: March 2007

Abstract
Extracolonic lesions compatible with Gardner's syndrome were studied in 34 patients from 17 unrelated families with established familial adenomatosis coli. Thirteen patients (38 per cent) had the complete syndrome and 12 patients (35 per cent) a bisymptomatic syndrome. Bone lesions were found in 79 per cent of the patients examined, epidermoid cysts in 35 per cent, desmoid tumours in 18 per cent and dental changes in 18 per cent. One extracolonic manifestation of the triad in at least one affected family member was detected in 14 families (82 per cent). The findings provide additional evidence for the view that all cases of familial adenomatosis coli belong to a single genetic entity. The usually innocent extracolonic signs of Gardner's syndrome serve as valuable markers for early detection of asymptomatic family members at risk. Panoramic X-ray of the jaws seems to be especially suitable for this purpose.
What is the place of lumbar sympathectomy?
Authors: Lindenauer S M , Cronenwett J L 
Published: March 2007

Abstract
Although sympathetic innervation of the extremities has been studied voluminously, the clinical efficacy of sympathectomy remains controversial. This review will be limited to a consideration of the appropriate role of lumbar sympathectomy for primary treatment of intermittent claudication and skin ischaemia manifested by rest pain or superficial tissue loss.
Transient ischaemic attacks: The static and dynamic morphology of the carotid artery bifurcation
Authors: Lusby R J , Woodcock J P , MacHleder H I , Ferrell L D , Jeans W D , Skidmore R , Sheddon E J , Baird R N 
Published: March 2007

Abstract
Studies evaluating the static and dynamic characteristics of the common carotid bifurcation are described. Slow motion angiographic frames, real time B-mode images and time position M-mode tracings have demonstrated appreciable vessel wall motion with an increase in distensibility at the carotid bulb compared to the proximal common carotid artery. Histopathological studies suggest that changes in the carotid artery elastin and collagen structure may contribute to the increased distensibility at the carotid bulb. The presence or absence of a cervical bruit did not correlate with the ultrasonic demonstration of plaque or blood flow turbulence. Mechanical factors relating to the development of symptoms of cerebral ischaemia are discussed.
Surgical treatment of post-phlebitic syndrome
Authors: Taheri S A , Lazar L , Elias S M 
Published: March 2007

Abstract
The post-phlebitic syndrome which succeeds deep vein thrombophlebitis may be treated by various surgical interventions. Removal of incompetent perforating veins and excision of any concomitant skin ulcer with grafting is a usual course of therapy. However, if the skin ulceration and symptoms are actually due to deep venous incompetence then a more direct approach should be attempted.
Numerous procedures have been advocated, such as valvoplasty, homologous vein transplant, synthetic valve procedures and autogenous vein valve transplant.
It has been demonstrated that autogenous vein valve transplant yields a satisfactory haemodynamically stable result with high valve competency rates.
The authors have operated on 10 patients utilizing an autogenous vein valve with good results. Pre- and postoperative data including ascending and descending venography indicate that valvular competence is restored and ulcers heal.