bluuebunny/crossref_metadata_2025_split huggingface dataset:
Postoperative urinary retention in general surgical patients
Authors: Stallard S , Prescott S 
Published: March 2007

Abstract
A prospective study has been performed to measure the incidence of postoperative urinary retention in 280 general surgical patients. Eighteen patients (6 per cent) were catheterized after a range of operations under general anaesthesia. There was no statistical difference in the retention rate between men and women. Increasing age did not predispose to retention of urine. Of 72 patients who had either herniorrhaphy, haemorrhoidectomy or testicular operations, only 1 was catheterized, whereas 16 (23 per cent) of 70 patients undergoing laparotomy were catheterized. Most of these laparotomy patients had upper abdominal procedures carried out. Those having lower abdominal operations were usually catheterized pre-operatively and were excluded from the study. There was a significantly higher incidence of retention among patients who had long anaesthetics (&gt;60 min). There was also a significantly higher incidence of retention among those who were ventilated, relaxed and reversed by atropine and neostigmine. Of those 193 patients who had opiate analgesia, 15 (8 per cent) developed retention of urine, compared with 3 (3 per cent) of the 87 patients who had non-opiate analgesia. There was a significantly higher retention rate among the patients who had opiate analgesia by intravenous infusion compared with those who had opiates by intramuscular bolus injection; 7 patients had painful and 11 had painless retention. This study suggests that postoperative retention of urine is a result more commonly of diminished awareness of bladder sensation, than of factors such as anxiety or local pain.
Calmodulin antagonist trifluoperazine inhibits polyamine biosynthesis and liver regeneration
Authors: Alexander R W , Saydjari R , MacLellan D G , Townsend C M , Thompson J C 
Published: March 2007

Abstract
Polyamines are essential for cell growth and differentiation. Trifluoperazine (TFP) is a potent, competitive inhibitor of the calcium—calmodulin complex. TFP, when given to rats after partial hepatectomy, causes a significant decrease in DNA synthesis. The purpose of this study was to examine the effects of TFP on polyamine biosynthesis and on liver regeneration after partial hepatectomy. TFP (60 mg/kg, bodyweight) or saline control was administered to 80 male Sprague-Dawley rats 2 h before, 2 h after, or at the time of hepatectomy. Polyamines (putrescine, spermidine and spermine) were measured at the time of hepatectomy, and at 6, 24, 48, and 72 h after hepatectomy. TFP, when it was administered either 2 h before or at time of hepatectomy, blocked increases in putrescine that are seen normally at 6 h after hepatectomy. When TFP was given at the time of partial hepatectomy, putrescine was increased at 24 h, and then returned to normal levels at 72 h. Spermidine was inhibited at 24 h, but not at 48 and 72 h. Spermine was not significantly altered at any time. The administration of TFP 2 h after hepatectomy did not significantly alter concentrations of polyamines. The weight of regenerating liver was decreased by TFP at 48 h (23 per cent) and 72 h (22 per cent) after hepatectomy. These findings provide evidence that the calcium—calmodulin complex is required for the synthesis of liver polyamines before liver regeneration can proceed.
Effect of continuous postoperative epidural analgesia on intestinal motility
Authors: Ahn H , Bronge A , Johansson K , Ygge H , Lindhagen J 
Published: March 2007

Abstract
The effect of postoperative epidural bupivacaine on intestinal motility was studied by measuring the transit time of barium contrast through the intestines in 16 patients after resection of the left colon and/or rectum. Fourteen patients served as controls and received postoperative injections of pentazocine. Mean transit time through the intestinal tract was 35 h in the epidural group and 150 h in the control group, a difference that is significant at the 0·1 per cent level. The average time before passage of flatus and faeces was different between the two groups at the 0·1 per cent level. We conclude that postoperative epidural bupivacaine constitutes an effective means of analgesia after colorectal surgery and is associated with a short duration of intestinal paralysis.
Techniques for better suturing
Authors: Seki S 
Published: March 2007

Abstract
Suturing techniques enhancing the accuracy of suture placement and reducing the forces on the tissue being sutured were evaluated in six surgeons, each with 6 years' surgical experience. The accuracy was assessed by the distance between the actual and designated needle exit sites. Force was expressed in terms of the torque on the needle holder using a maximum of the torques (max. F), maximum derivative (dF/dt) and integral (IF). The effects of four factors (suturing techniques) on suturing were evaluated: (1) placement of the needle holder on the needle; (2) inclining the tissue at needle entrance, as is commonly done by elevating with forceps (unnoted role of the forceps); (3) adjustment of the needle's exit during suture placement, as is unknowingly employed in practice, and (4) variation between individual surgeons. All these factors affected the accuracy and force of suturing. Gripping the needle closer to the tip strongly reduced the max. F, dF/dt, and IF per time, as did inclining the tissue. Adjustment of exit improved accuracy, but has the potential for causing avoidable tissue injuries. Differences between surgeons suggest the necessity of addressing fundamental surgical techniques and formally incorporating them into the training programme.
Treatment of Crohn's disease in relapse with cyclosporin A
Authors: Parrott N R , Taylor R M R , Venables C W , Record C O 
Published: March 2007

Abstract
It has been suggested that cyclosporin A might be of some benefit to patients with Crohn's disease. The clinical response and side-effects of cyclosporin A in Crohn's disease are described in a series of 13 adults. The majority of patients had ileal disease and all but one were started on an initial oral dose of 15 mg/kg per day. Duration of treatment ranged from 3 to 42 weeks. Of the 13 patients, 6 showed a response to therapy; the remainder showed no response or deteriorated. The commonest side-effect was hyperaesthesia, but one patient developed nephrotoxicity and one developed hepatotoxicity. Significant drug malabsorption occurred in one case. The side-effects were dose dependent and reversible. Cyclosporin A may have a part to play in the treatment of resistant Crohn's disease, and in our hands has been associated with a 46 per cent response rate; however, the precise role of cyclosporin A in the management of Crohn's disease awaits further study.
A protocol for the safe treatment of acute lower limb ischaemia with intra-arterial streptokinase and surgery
Authors: Walker W J , Giddings A E B 
Published: March 2007

Abstract
Over a 5-year period 70 patients, presenting with subacute ischaemia of the lower limb (more than 12 h), were treated with low-dose intra-arterial streptokinase. There were 72 infusions and effective lysis was achieved in 52 (72 per cent), with an average infusion time of 25 h. A total of 23 (32 per cent) also underwent percutaneous transluminal angioplasty when lysis showed an underlying stenosis, and a further 19 (26 per cent) required surgery to remove persistent stenosis, organized thrombus or atheromatous debris. Significant bleeding occurred in 4 patients (6 per cent) and 13 (18 per cent) underwent amputation. There were five deaths (7 per cent), one of which was directly related to the infusion, while three were due to myocardial infarction. All of the major complications occurred in the early part of the study and both the selection of patients and the technique of infusion were modified to improve safety. Complementary treatment by percutaneous transluminal angioplasty and surgery was used more frequently in the later part of the study. The technique is not recommended for the white leg of acute ischaemia (&lt;12 h), or for lysis of clot in a retroperitoneal Dacron® graft, but may be uniquely valuable to demonstrate the cause of subacute ischaemia.
Local thrombolytic therapy of acute peripheral arterial ischaemia with tissue plasminogen activator: A dose-ranging study
Authors: Earnshaw J J , Westby J C , Gregson R H S , Makin G S , Hopkinson B R 
Published: March 2007

Abstract
Low-dose streptokinase has been established as an alternative to surgery in selected patients with acute peripheral arterial ischaemia. Tissue plasminogen activator (t-PA) is responsible for normal plasma fibrinolytic activity and has recently become available for clinical use owing to recombinant DNA technology. It has the theoretical advantage of fibrin specificity, which may result in enhanced thrombolytic effects with greater safety. Twenty-three patients with recent lower limb arterial occlusions received t-PA over a tenfold range of concentrations and five patients received low-dose streptokinase. One month after treatment with t-PA or streptokinase 19 (68 per cent) patients had limb salvage, five (18 per cent) had required amputations and four (14 per cent) had died. Systemic fibrinolytic effects were variable but basically dose related. Haemorrhage occurred most frequently at the highest t-PA concentration and was major in four (17 per cent) cases, including a fatal stroke. Plasma fibrinogen concentration fell below 1·2 g l−1 in five (22 per cent) patients who received t-PA and was found to be a significant risk factor for haemorrhage. t-PA was an effective thrombolytic agent at all concentrations studied. The dose currently used in clinical studies at this institution is 0·5 mg h−1.
Blood flow in diabetics with foot lesions due to ‘small vessel disease’
Authors: Irwin S T , Gilmore J , McGrann S , Hood J , Allen J A 
Published: March 2007

Abstract
Blood flow was measured in the feet and toes of 23 diabetics, 7 controls and 6 non-diabetic neuropathic controls, using venous occlusion plethysmography. All of the diabetics showed a characteristic flow abnormality with mild hyperperfusion of the foot at rest but impaired peak flow following arterial occlusion. When the diabetics were subdivided into those with ‘small vessel disease’, those with neuropathic ulceration and those with neuropathy but no ulceration, the groups had remarkably comparable blood flows, except that peak great toe blood flow was rather lower in small vessel disease. In small vessel disease, the combination of high resting blood flow and elevated foot venous oxygen saturation suggests that the hyperperfusion is due to arteriovenous shunting. It seems likely that the toe lesions ascribed to small vessel disease were in fact manifestations of severe diabetic neuropathy. The term small vessel disease should be avoided in the context of diabetic foot lesions.
Plasma arginine vasopressin levels and arterial pressure during open heart surgery
Authors: Woods W G A , Forsling M L , Le Quesne L P 
Published: March 2007

Abstract
A study of plasma arginine vasopressin (AVP) levels and their relation to changes in arterial pressure was undertaken in 13 patients undergoing open heart surgery. Seven of the patients received high doses of intravenous morphine (1 or 2 mg/kg) as part of their anaesthetic, whereas the other six did not. Increases in the AVP levels during cardiopulmonary bypass (CPB) were significant in both groups, but were significantly greater in the patients not receiving morphine (median 86·1 fmol/ml) than in those who did (47·5 fmol/ml). In both groups there was a linear correlation between the natural logarithm of the plasma AVP level and the percentage fall in the mean arterial pressure, although the slope of the relationship was significantly less in the group receiving morphine than in the group not receiving morphine. These results indicate that in patients undergoing cardiac surgery the neuroendocrine reflex control of plasma AVP levels in relation to changes in arterial pressure is intact, but that the sensitivity of the reflex (i.e. the increase in plasma AVP level for a given fall in arterial pressure) is reduced by the administration of high doses of intravenous morphine.
Posterior sagittal anorectoplasty for reoperation in children with anorectal malformations
Authors: Brain A J L , Kiely E M 
Published: March 2007

Abstract
A prospective study was carried out in 12 consecutive patients (7 boys and 5 girls), to evaluate posterior sagittal anorectoplasty for patients incontinent of faeces after anorectal reconstruction. Examination revealed anatomical problems such as: recurrent fistula (two), massive urethral diverticulum (one), absent vagina (one), and a missed urogenital sinus (one). Preliminary electromyography showed the external sphincter to be displaced from the anus in nine patients. Posterior sagittal anorectoplasty, with correction of anatomical defects and precise reconstruction of bowel within the sphincters, was carried out after the formation of a loop colostomy. No postoperative complications were observed. Contrast studies confirmed healed suture lines before stoma closure. Follow-up, between 4 and 46 months, revealed good faecal control in only two patients, with a significant improvement in two others. The rest remained incontinent although sensation was improved. These disappointing results, at variance with other published reports, lead us to conclude that posterior sagittal anorectoplasty, when used as a secondary procedure, is good for correcting anatomical defects but not for improving faecal continence.
Paget's disease of the anus: A clinicopathological study
Authors: Armitage N C , Jass J R , Richman P I , Thomson J P S , Phillips R K S 
Published: March 2007

Abstract
Paget's disease of the anus is a rare disorder of controversial origin and is frequently associated with malignancy. We studied eight patients and carried out immunohistochemical studies to determine whether particular functional profiles might be indicators of a malignant association. One patient presented with synchronous carcinoma and two developed carcinomas 3 and 10 years after excision of Paget's disease. Five patients underwent wide local excision and have not developed cancer (median follow-up 6 years, range 5-13 years). However, four patients developed recurrent Paget's disease. Immunohistochemical studies showed that in general Paget cells stained positively with CAM 5·2 (a cytokeratin marker), gross cystic disease fluid protein (a marker for apocrine cells), human milk fat globule glycoprotein (HMFG 1 and 2) and carcinoembryonic antigen but negatively for PR3A5 (a marker for colonic goblet cells). Three cases had a staining profile which was quite different from that usually observed and these were associated with malignancy. One showed an antigenic profile more typical of a large bowel carcinoma. Paget's disease of the anus appears to run one of two clinical courses: to develop malignancy; or to recur locally, often on repeated occasions. Wide local excision is the treatment of choice but long-term follow-up is necessary because of the cancer risk. An immunohistochemical staining pattern which is different from usual may indicate a higher malignant risk and/or identify some cases of Paget's disease as representing a downward ‘pagetoid’ extension from a anorectal adenocarcinoma rather than a true epidermotropic apocrine neoplasm of the perianal skin.
Anorectal function after abdominal rectopexy: Parameters of predictive value in identifying return of continence
Authors: Yoshioka K , Hyland G , Keighley M R B 
Published: March 2007

Abstract
Posterior abdominal rectopexy was performed in 12 patients with a full-thickness rectal prolapse: 9 had faecal incontinence. The prolapse was successfully controlled in all cases and six of nine patients were rendered continent. Physiological studies in patients were compared with age- and sex-matched controls. Preoperative anal pressures were significantly lower than in controls at rest (R), during maximum pelvic floor contraction (Sq) and attempted defaecation (St) (R, P &lt; 0·005; Sq, P &lt; 0·005; St, P &lt; 0·005). Anorectal angles were significantly more obtuse in patients than in controls (R, P &lt; 0·05; St, P &lt; 0·025). None of these parameters changed significantly after abdominal rectopexy. Median rectal emptying significantly decreased after operation (preoperative 83 per cent/min; postoperative, 58 per cent/min, P &lt; 0·05). Median perineal descent during attempted defaecation also significantly decreased after operation (preoperative, 8·5 cm; postoperative, 7·1 cm; P &lt; 0·025). Parameters which predicted return of continence included: delayed leakage during the saline infusion test (P &lt; 0·025), a narrow anorectal angle during pelvic floor contraction (P &lt; 0·025), minimal pelvic floor descent during contraction (P &lt; 0·05), and a long anal canal at rest (P &lt; 0·05) and during pelvic floor contraction (P &lt; 0·025).
Somatostatin analogue SMS 201–995 (octreotide) as a possible solution to the dumping syndrome after gastrectomy or vagotomy
Authors: Primrose J N , Johnston D 
Published: March 2007

Abstract
The dumping syndrome, which may follow partial gastrectomy or truncal vagotomy and drainage, may be refractory to treatment. The aim of this study was to determine the effect of the somatostatin analogue. SMS 201-995 (octreotide), on dumping provoked by hypertonic glucose. Ten patients with symptoms and signs of dumping were studied. After a dumping provocation test with placebo, all patients developed severe symptoms: seven patients had early dumping, two had both early and late dumping and one had late dumping alone. With either 50 or 100 μg SMS 201-995, the symptoms of early dumping were much reduced in all patients, and those of late dumping were completely abolished. The packed cell volume, pulse and systolic blood pressure changes of early dumping were significantly reduced by SMS 201-995 and the fall in blood glucose in patients with late dumping was abolished. SMS 201-995 may be a useful treatment for early and late dumping.
Reticuloendothelial failure in chronic intra-abdominal sepsis: The role of opsonic fibronectin
Authors: Cheslyn-Curtis S , Aldridge M C , Dudley H A F 
Published: March 2007

Abstract
Severe sepsis leads to depression of the reticuloendothelial (RE) system with delayed bloodstream clearance of particulate matter and bacteria. Fibronectin may be an important opsonin of the RE system and low fibronectin levels often accompany severe sepsis in man. We have investigated the effect of prolonged intra-abdominal sepsis on plasma fibronectin concentrations and RE function. Serial plasma fibronectin concentrations were determined in rabbits for 2 weeks after either the induction of sepsis (appendix abscess) (n = 6) or laparotomy only (n = 6). RE function was measured at 2 weeks by determining the clearance kinetics and organ distribution of low dose technetium tin colloid (TTC). There was an early transient depression in plasma fibronectin values followed by elevated concentrations at 48–72 h which were more marked in the sepsis group. There was a delay in the blood clearance with reduced hepatic and increased bone uptake of TTC. We conclude that depletion of opsonic fibronectin is unlikely to be an important factor contributing to the impairment of RE function associated with intra-abdominal sepsis and that RE depression in septic animals is due to intrinsic Kupffer cell dysfunction.
Characterization of breast cancer subgroups in an African population
Authors: Otu A A , Ekanem I -O A , Khalil M I , Ekpo D , Attah E B 
Published: March 2007

Abstract
A detailed prospective study of 58 consecutive breast cancer patients and contemporaneous controls, using age, duration of tumour and presence or absence of poor prognostic signs as clinical parameters, clearly showed that the patients fell into three distinct groups. Group A accounted for 30 per cent of cancers and consisted of young women (21–45 years) with advanced cancers, a short history (3 months or less) and poor prognostic signs; these patients had fast-growing tumours. Group B, to which nearly 60 per cent of patients belonged, was made up of menopausal women (46–50 years) with advanced disease, a history of from 3 months to 1 year and poor prognostic signs; their tumour growth rate was intermediate. Group C made up slightly more than 10 per cent of cases and consisted of postmenopausal women (50 years and above) who gave a long history (1 year or more), and had resectable tumours without poor prognostic signs. Thus, although advanced breast cancer in tropical Africa is due to late presentation in the majority of cases, a small but significant proportion of women have advanced disease in spite of early presentation, attributable to fast tumour growth rate.
Follow-up after treatment of primary breast cancer
Authors: Rutgers E J Th , van Slooten E A , Kluck H M 
Published: March 2007

Abstract
This study evaluates the usefulness of routine follow-up of breast cancer patients. In all, 416 patients who were treated with curative intent for breast cancer were followed according to a fixed follow-up schedule for a minimum of 2·5 years and a maximum of 13·5 years (mean about 5 years). During the 4533 routine out-patient visits, 41·16 chest radiographs, 3889 pelvic radiographs and about 17000 laboratory tests were carried out routinely. In the follow-up period, 148 patients were found to have distant recurrence of whom 34 (23 per cent) had asymptomatic metastases and 114 symptomatic metastases. Of the 8005 routinely performed radiographs, 24 (0·3 per cent) revealed asymptomatic metastases, and the 17000 laboratory tests led to the discovery of six asymptomatic bone and four asymptomatic liver recurrences. Screening for metastases did not result in a reduction of the lead time to the diagnosis of asymptomatic metastases; the disease-free interval was equal in both symptomatic and asymptomatic patients. Of the 46 locoregional recurrences 42 were found by physical examination during a routine follow-up visit and 37 had not been noticed by the patient. Seventeen second primary breast cancers were diagnosed, six of which were in stage I (&lt; 2 cm). Mammography was not a part of the routine follow-up scheme. It is concluded that routine follow-up of breast cancer patients by history and physical examination is sufficient to detect local recurrence and a second primary tumour as well as giving the opportunity to track signs and symptoms of distant recurrence at an early stage. Performing annual or biannual mammography is advisable, but the use of other costly routine investigations in the follow-up is not justifiable, as no therapeutic advantages can be expected.
Intraperitoneal rupture of amoebic liver abscess
Authors: Sarda A K , Bal S , Sharma A K , Kapur M M 
Published: March 2007

Abstract
A retrospective analysis of 23 cases of amoebic liver abscess with intraperitoneal rupture is presented. Group I consisted of 16 patients with clinical features of generalized peritonitis. Eight of these patients were treated surgically, and four died. Group II consisted of seven patients with features of localized peritonitis and all were treated conservatively. In all cases the diagnosis of liver abscess was established by liver scan or ultrasound examination; peritonitis was established either at operation or, in the conservatively managed group, by aspiration of pus from the peritoneal cavity. Amoebiasis was diagnosed by serology. Eight group I and all group II patients were managed conservatively by aspiration of the liver abscess, antibiotics and amoebicides. There were no deaths in this group. It is suggested that, if the diagnosis can be made early, conservative treatment offers the best chance of cure for patients of amoebic liver abscess with intraperitoneal rupture.