bluuebunny/crossref_metadata_2025_split huggingface dataset:
Doppler ultrasonography in the diagnosis of acute scrotal pain
Authors: Bickerstaff K I , Sethia K , Murie J A 
Published: March 2007

Abstract
Pre-operative Doppler ultrasonography was performed on 41 patients who underwent an emergency scrotal exploration because of the clinical suspicion of a testicular torsion. The final diagnoses were testicular torsion in 18 patients, epididymitis in 15 patients and torsion of a testicular appendage in 8 patients. An unequivocal indication as to the presence or absence of a testicular torsion was obtained in 31 patients (76 per cent), an equivocal result was obtained in 5 patients and in 5 patients the examination was unsatisfactory. The sensitivity and specificity of the investigation for the diagnosis of testicular torsion were 67 per cent and 83 per cent respectively, and the predictive value of either a positive or negative result was 100 per cent. Our results suggest that the use of Doppler ultrasonography could reduce the incidence of unnecessary operations without incurring the risk of reduced testicular salvage.
High prevalence of abdominal aortic aneurysm in men with peripheral vascular disease: Screening by ultrasonography
Authors: Allardice J T , Allwright G J , Wafula J M C , Wyatt A P 
Published: March 2007

Abstract
A study was carried out to see if an ultrasonic examination of the abdominal aorta was indicated in every patient who attended an outpatient clinic with peripheral vascular disease (PVD). One hundred consecutive patients were studied and compared with a control group. The incidence of abdominal aortic aneurysm (AAA) in the control group was 2 percent. In the study group, the male patients had an incidence of 20 per cent of aneurysm and ectasia, while the female patients had an incidence of 12 per cent. Of all the abnormal aortas found by ultrasound, only 31 per cent were palpable clinically. Two aneurysms that required operation were found, while the remainder are to be followed by regular ultrasound assessment. Further studies are necessary to conclude if screening of a high risk group, such as patients with PVD, is worthwhile.
Ultrasound mammography in the management of breast cancer
Authors: Warwick D J , Smallwood J A , Guyer P B , Dewbury K C , Taylor I 
Published: March 2007

Abstract
In this centre, ultrasound mammography has been shown to be more accurate in elucidating the nature of palpable breast lesions than X-ray mammography. A prospective study was devised to determine whether this accuracy could be translated into improved management of patients with breast carcinoma. A total of 223 patients with palpable breast masses were assessed by clinical examination, imaging (X-ray and ultrasound mammography) and aspiration cytology. Each was scored on a five-point scale and treatment was planned according to the total score. According to the protocol, an adequate total score would permit definitive surgery avoiding frozen section. By using sonography rather than radiology, the number of correct diagnoses could be improved by 25 per cent. This was because the greater sensitivity of ultrasound (92·8 per cent) compared to X-ray mammography (82·5 per cent) was reflected in a higher total score, which was sufficient to allow definitive surgical treatment without prior histological confirmation of diagnosis.
Fate of the ischaemic limb in Buerger's disease
Authors: Ohta T , Shionoya S 
Published: March 2007

Abstract
The clinical course of 328 patients with Buerger's disease (thrombo-angiitis obliterans: TAO) was followed. Neither ischaemic ulcers nor gangrene occurred in 26 per cent of the patients. Almost all of the ulcers occurred in patients between 20 and 50 years of age, with a peak incidence between 40 and 45 years. The younger the patient at the onset of the disease, the later the first ulcer occurred, and the later the first ulcer occurred, the shorter the period in which ulceration may recur. Recurrent ulcers were observed in 45 per cent of the patients. The progression of symptoms was influenced by smoking, but this was not the only deleterious factor as there were patients with stable TAO unaffected by smoking. In the 30 patients over the age of 60 years, ulceration and gangrene were not observed. In all patients, the progression of symptoms was self-limited and recurrent ulcers occurred less frequently with ageing. The rate of major amputation was low (3·9 per cent) although minor digital amputations were sometimes required. The survival rate of patients with TAO was higher than that of patients with arteriosclerosis obliterans. The aim of treatment in patients with TAO is to make patients abstain from smoking to prevent ulceration and to shorten the period of healing of trophic lesions without major amputation, as ulceration and gangrene in TAO are limited to the most distal part of the limbs, and seems to have healing potential.
Diagnosis of Meleney's synergistic gangrene
Authors: Davson J , Jones D M , Turner L 
Published: March 2007

Abstract
A retrospective and comparative study of 127 case reports of Meleney's postoperative progressive synergistic gangrene and of 62 examples of postoperative amoebic skin gangrene, showed that these two entities were clinically indistinguishable and that therefore a purely clinical diagnosis of Meleney's gangrene could not be made. Furthermore, a critical appraisal of the bacteriological data indicated that a certain diagnosis of Meleney's gangrene cannot be provided by the clinical bacteriologist. Finally, the histological features were entirely non-specific thus precluding a definitive diagnosis by the histopathologist. If Meleney's entity cannot be diagnosed its existence becomes debatable. The alternative diagnosis of cutaneous amoebiasis is advanced for consideration. Several of the outstanding features of Meleney's progressive gangrene, hitherto unexplained, are better understood if Entamoeba histolytica is accepted as the prime cause rather than bacteria.
Relationship between gastric emptying of liquid and postvagotomy diarrhoea
Authors: Parr N J , Grime S , Brownless S , Critchley M , Baxter J N , Mackie C R 
Published: March 2007

Abstract
Gastric emptying of liquid was studied in 10 normal volunteers and in 27 patients previously treated with truncal vagotomy and drainage. Thirteen of the twenty-seven patients complained of persistent postvagotomy diarrhoea. For each study 300 ml 15 per cent dextrose, labelled with 99mTc-diethylene triamine penta-acetic acid (DTPA), was ingested at a standard rate by subjects who sat facing a gamma camera. Imaging proceeded for 30 min. Gastric area activity curves were corrected for emptying of the test meal during ingestion, and for movement using a new image alignment technique. Gastric emptying at 15 min was 10±2·6 per cent (mean ± s.e.m.) in healthy volunteers, 48±7·3 per cent in patients without diarrhoea, and 84±2·3 per cent in those with diarrhoea (P &lt; 0·001, ANOVA). Gastric emptying from 15 min onwards was slower than normal in both patient groups (P &lt; 0·001). These results show that initial gastric emptying is rapid following truncal vagotomy and drainage, and this change is greater in patients with postvagotomy diarrhoea. No patient with diarrhoea had normal initial gastric emptying.
Bypass surgery for unresectable oesophageal cancer: Early and late results in 124 cases
Authors: Mannell Aylwyn , Becker P J , Nissenbaum M 
Published: March 2007

Abstract
The early and late results of bypass surgery in 124 patients with unresectable oesophageal cancer are reported. Patients were grouped according to the extent of disease: group A, tumour localized to the oesophagus where severe pulmonary disease contra-indicated oesophagectomy (n = 9); group B, tumour ⩽ 10 cm in length with mediastinal invasion (n = 81); group C, tumour &gt; 10 cm in length with mediastinal invasion and/or fixed malignant lymph nodes (n = 33). Extent of disease was not recorded in one patient. The operative mortality was 4 per cent but 9 other patients died in hospital (hospital mortality, 11 per cent). Mortality was increased in patients undergoing colon bypass and in those with a large tumour load but these differences failed to reach statistical significance. The most frequent complication was neck sepsis, secondary to leakage from the proximal end of the excluded oesophagus. Eighty-nine per cent of the survivors could eat a normal, unrestricted diet on discharge and eighty-two per cent of survivors had complete and lasting relief from dysphagia. Median survival after bypass was 5 months but survival was significantly improved by radiotherapy to the tumour (P &lt; 0·001). Gastric bypass with radiotherapy is indicated in patients with extra-oesophageal spread of malignancy and in patients with tumours localized to the oesophagus who are unfit for resection. Bypass surgery may be contra-indicated in patients with a primary tumour &gt; 10 cm in length and/or fixed lymph node metastases because mortality is increased and survival after operation is short.
Role of collagenase in colonic anastomoses: a reappraisal
Authors: Chowcat N L , Savage F J , Hembry R M , Boulos P B 
Published: March 2007

Abstract
Increased collagenolysis, with reduction in collagen concentration, has been incriminated in the breakdown of colonic anastomoses but previous studies have measured only collagen levels and non-specific collagenolytic activity. Collagenase, the initiating enzyme in collagen degradation, is synthesized on demand and controlled by tissue inhibitor of metalloproteinases (TIMP). Antibodies to collagenase and TIMP were applied to colonic anastomoses in rabbits to investigate the role of the enzyme during healing. Within 12 h of operation, secreting cells and extracellular collagenase were identified at the everted edges of the bowel wall. After 24 h, collagenase activity was accompanied by TIMP secretion in the same localized regions, and by the third postoperative day very few cells were still synthesizing enzyme in these areas, although extracellular activity remained visible. TIMP-secreting cells, however, were seen in a layer of connective tissue sealing the serosal surface of the anastomosis. At 7 days, both enzyme and inhibitor were found only in small aggregates of secreting cells in the deeper layers. The localization and extent of collagenase and TIMP activity accorded well with a normal healing response as, at all times, the enzyme was confined to the immediate vicinity of the suture line.
Resectability rate of hepatocellular carcinoma in rural southern Africans
Authors: Maraj Rinah , Kew M C , Hyslop R J 
Published: March 2007

Abstract
The purpose of this analysis was to ascertain the resectability rate of symptomatic hepatocellular carcinoma in rural southern African black males. All 224 such patients proven to have hepatocellular carcinoma in a single hospital were included in the study. Of 205 patients undergoing a complete diagnostic work-up, 134 (65·3 per cent) were judged on clinical criteria to be inoperable, 23 (11·2 per cent) had pulmonary or osseous metastases, and 38 (18·5 per cent) proved on hepatic imaging and 5 (2·4 per cent) on hepatic arteriography to have an irresectable tumour. Thus, only five (2·4 per cent) of these patients proceeded to laparotomy. Another 7 patients who did not have an arteriogram, 9 with surgical emergencies, and 2 mistakenly believed to have an amoebic hepatic abscess also underwent laparotomy. Only 2 patients (0·9 per cent of 223) proved to have a resectable tumour. The extremely low resectability rate reinforces the urgent need for a surveillance programme to detect early tumours in high-risk members of this population.
Parastomal hernia in relation to site of the abdominal stoma
Authors: Sjödahl R , Anderberg B , Bolin T 
Published: March 2007

Abstract
Parastomal hernia is a common late complication of enterostomy, especially colostomy, and sometimes requires surgical treatment. A possible contributory factor, location of the stoma in relation to the rectus abdominis muscle, was studied by examination of 130 patients with permanent intestinal stoma. The bowel had been brought out through the rectus abdominis muscle in 107 patients and lateral to it in 23 patients. The respective prevalence of parastomal hernia in these groups was 2·8 per cent and 21·6 per cent. The highly significant difference indicates that enterostomy should be constructed through the rectus abdominis muscle, not lateral to it.
The pulsed dye laser and atherosclerotic vascular disease
Authors: Murray A , Crocker P R , Wood R F M 
Published: March 2007

Abstract
The use of a pulsed dye laser to ablate atheromatous tissue obtained from post-mortem human aortic specimens is reported. Laser energy was delivered with a 600 μm quartz fibre, at a wavelength of 504 nm and a pulse length of 1 μs. Pulse energy was varied from 30–140 mJ, producing peak pulse powers of the order of 100 kW. With these parameters the laser ablated fatty, fibrous and calcified plaques. At this wavelength atheroma is vaporized but there is minimal damage to normal vessel wall, due to preferential absorption of the laser light. Light microscopy shows that by microsecond pulsing, thermal damage to surrounding tissues associated with continuous wave lasers is avoided. Transmission electron micrographs reveal a sharp demarcation between a laser crater and the adjacent vessel wall with little ultrastructural disruption. Scanning electron micrographs show the crater walls to be smooth. The pulsed dye laser may therefore be effective in the treatment of occlusive peripheral vascular disease without undue risk of vessel perforation.
Venous reflux: Quantification and correlation with the clinical severity of chronic venous disease
Authors: Christopoulos D , Nicolaides A N , Szendro G 
Published: March 2007

Abstract
Air-plethysmography has been used to measure, in ml and in ml 100 ml−1 of tissue, the blood volume that filled the leg veins on changing posture from the recumbent position to standing. The venous filling index (VFI) (average filling range) was measured in ml s−1 and in ml 100 ml−1 min−1. We studied 24 normal legs (N), 21 with primary varicose veins without chronic swelling, skin changes (liposclerosis, eczema, pigmentation) or ulceration (PVV) and 59 with chronic swelling and/or skin changes and/or ulceration; of these 59 legs, 31 had primary varicose veins (PVV/S) and 28 had popliteal reflux (PR). The classification was done according to clinical examination, Duplex scanning, ambulatory venous pressure measurements and venography. There was an increased incidence of sequelae with increasing values of VFI. The incidence of these sequelae was irrespective of whether reflux was in the deep or in the superficial veins. VFI is a practical non-invasive measurement of reflux. It should be used to study the effect of therapy and particularly to evaluate new reconstructive procedures designed to abolish reflux in the deep veins.
Evaluation of peritoneal tube grafts in the inferior vena cava of the pig
Authors: Ribbe Else B , Alm P , Hallberg E , Norgren L E H 
Published: March 2007

Abstract
A tube graft 2·5 or 5 cm long, was constructed from the peritoneum of the anterior abdominal wall of 12 pigs. It was anastomosed end-to-end as an interposition graft in the infrarenal vena cava. The observation period was 4 months. Three of the six short grafts were venographically patent at 2 weeks, while all the long grafts were occluded. After 4 months two short grafts had recanalized, giving a patency rate of five out of six short grafts. No long grafts recanalized. In three of the patent specimens no clear tissue changes were found with light microscopy, while in the others changes of inflammation and fibrosis were noted. Scanning electron microscopy revealed good ‘endothelialization’ in two specimens, and partial ‘endothelialization’ in the others. No dilatation or severe stenosis of the patent grafts was seen. The occluded grafts remained only as a fibrous strand with sutures.
Pulse-generated runoff: a new method of determining calf vessel patency
Authors: Beard J D , Scott D J A , Evans J M , Skidmore R , Horrocks M 
Published: March 2007

Abstract
A non-invasive method of determining calf vessel patency before femorodistal bypass has been developed. This pulse-generated runoff (PGR) system generates blood flow in patent calf arteries by means of a pulsatile cuff even if the existing Doppler signal is inaudible. PGR was compared with pre-operative arteriography in 95 ischaemic limbs and both were compared with the peripheral resistance measured at operation in 62 limbs. There was a highly significant correlation between the PGR and arteriogram scores (rs = 0·74, P&lt; &lt;0·001) but PGR tended to detect more patent vessels than arteriography. The peripheral resistance correlated better with PGR than arteriography (rs = −0·71 and −0·54 respectively, P&lt; &lt;0·001). PGR is a simple, non-invasive method of determining calf and foot vessel patency pre-operatively.
Dihydroergotamine and the thromboprophylactic effect of dextran 70 in emergency hip surgery
Authors: Rørbæk-Madsen M , Jakobsen B W , Pedersen J , Sørensen B 
Published: March 2007

Abstract
In a prospective randomized controlled trial treatment with a combination of dextran 70 and dihydroergotamine (DHE) was compared with the administration of dextran 70 alone as prophylaxis against postoperative thrombo-embolic complications in emergency hip surgery. Forty-five consecutive patients with a fractured hip entered the study. Twenty-one were randomized to prophylactic treatment with dextran 70 (group 1) and twenty-four patients received dextran 70 and DHE (group 2). Both regimens were initiated pre-operatively and the surgical and postoperative procedures were the same in the two groups. On the first and fourth postoperative day, Tc-plasmin scintigraphy of the lower extremities and pulmonary ventilation/perfusion scintigraphy were performed to detect any deep vein thrombosis (DVT) and/or pulmonary emboli. A total of 19 per cent of group 1 patients developed DVT and so did 25 per cent in group 2; this difference was not statistically significant. Of the detected DVT, 60 per cent were subclinical, and 7 per cent of the patients had minor pulmonary emboli, all of which were symptomless. No therapeutic difference could be demonstrated between the two regimens. A recent report claiming that adding DHE to the prophylactic administration of dextran 70 considerably reduces the incidence of postoperative DVT in emergency hip surgery is questioned.
Changes in plasma and buffy layer vitamin C following surgery
Authors: Vallance S 
Published: March 2007

Abstract
Postoperative changes in plasma and buffy layer (BL) vitamin C were studied in 107 patients receiving either 0 (37 patients), 100 mg (33 patients) or 500 mg (37 patients) vitamin C supplements daily. In patients receiving no supplement plasma vitamin C concentrations had fallen (mean 33 per cent) by the first postoperative day and thereafter changed little. The falls occurred irrespective of initial plasma concentration, were greater the higher the initial concentration, but tended to be proportional to the length of operation. In patients given supplements this loss of vitamin C was evident but modified, and from the second postoperative day the response to the supplements was as would have been expected in non-operated subjects. The most probable explanation for the loss of vitamin C from plasma was an increased urinary excretion during operation. Changes in BL vitamin C concentrations were studied in relation to changes in leucocyte and platelet counts. The previously reported postoperative falls in BL vitamin C were found to be the result of a major artefact in the methods routinely used for BL vitamin C estimation, caused by changes in the leucocyte and platelet populations, most importantly the platelet to leucocyte ratio. No true demand for vitamin C, as measured from the buffy layer cells, was evident.
Surgical care of patients over eighty: A predictable crisis at hand
Authors: Williams J H , Collin J 
Published: March 2007

Abstract
The number of people over the age of 80 in Britain will increase by around 30 per cent over the next 15 years. Little attention has been paid to the acute surgical services required to meet the surgical needs of this population. This study reviews 198 surgical admissions in 1 year of patients aged 80 years and over, of which 74·9 per cent were admitted as emergencies. The overall mortality was 10·1 per cent of all admissions and 41 per cent of admissions were accompanied by at least one serious complication. Eighty-eight patients underwent surgery with an operative mortality of 11·3 per cent. In only 63·5 per cent of cases could the patient be discharged directly home. By 2001, in Oxford, the proportion of acute surgical beds occupied by patients aged over 80 will increase to 9·2 per cent from the present 7·0 per cent. Unless additional resources are provided to meet this extra demand for acute surgical care of the old, elective surgery for younger patients will inevitably be curtailed.
Fine needle aspiration cytology: An in vitro study of cell yield
Authors: Hartley M N , Tuffnell D J , Hutton Jane L , Palmer Margaret , Al-Jafari M S 
Published: March 2007

Abstract
To investigate the effect of needle size and number of passes into a tumour mass on the cell yield from a fine needle aspirate, an in vitro study was undertaken in 19 consecutive tumours removed surgically for biopsy. Different needle sizes (23G, 21G, 19G) passed in random order, five, ten and fifteen times into the tumours, were compared. The type of tumour, needle size and number of passes independently and significantly influenced cell yield. A 21G(green) needle passed into the tumour at least 10 times was the most efficient in obtaining cells. This in vitro study could explain the variation in the reported accuracy of fine needle aspiration cytology from groups using different techniques and is perhaps one reason why the highest diagnostic accuracy and the lowest rate of unsatisfactory aspirates comes from a centre which uses a 21G needle and at least 10 passes through the tumour.
Operative treatment of median cervical cysts
Authors: Tetteroo G W M , Snellen J P , Knegt P , Jeekel J 
Published: March 2007

Abstract
Median cervical cysts are congenital anomalies arising from remaining thyroglossal duct epithelium. A major problem in the surgical treatment of these cysts is the high frequency of recurrence. Embryonic considerations indicate an important causal role for the hyoid bone in these recurrences. We studied the relationship between operative techniques and the number of recurrences in 36 patients treated in our hospital. Fourteen patients sent from other hospitals had a recurrent fistula; in thirteen cases the hyoid bone was still in place. All patients who had the central part of the hyoid bone excised were cured. In 14 patients without adequate excisions of the hyoid bone we found four recurrences. To prevent recurrence a total excision of thyroglossal duct epithelium is necessary.