bluuebunny/crossref_metadata_2025_split huggingface dataset:
Depression and social stress among patients with benign breast disease
Authors: Hughes Jennifer E , Royle G T , Buchanan R , Taylor I 
Published: March 2007

Abstract
One hundred and forty women referred to the Southampton breast clinic had a psychiatric interview at home, before their first clinic attendance. The 107 subsequently diagnosed as having benign breast disease had a high rate of depressive symptomatology in comparison with women in published surveys of the general population. In the year before referral, 25 (23 per cent) had had definite depression and 19 (18 per cent) had had borderline depression: at the time of interview 9 (8 per cent) had major depression and 22 (21 per cent) had minor depression. Depression in these patients was associated with recent life events and social difficulties. Mood disturbance and psychosocial stress may lead to medical consultation about benign breast disease, or even contribute to its development. Severe depression was less common in the 33 patients who turned out to have breast cancer, though more of them had minor depression, and they reported fewer recent life events.
Increased dietary calcium and small bowel resection have opposite effects on colonic cell turnover
Authors: Appleton G V N , Bristol J B , Williamson R C N 
Published: March 2007

Abstract
Oral supplements of calcium reduce the mitogenic effects of fatty acids and bile acids on large bowel mucosa. The cytokinetic effects of intraluminal calcium were tested in normal and adapting colonic epithelium. Male Sprague–Dawley rats (n = 60) weighing 356·7 ± 24·9 g were submitted to either an 80 per cent jejuno-ileal resection or simple transection and resuture of the jejunum. Within each group, half the animals had 24 g/l calcium lactate added to the drinking water. Seven weeks postoperatively crypt cell production rate (CCPR) was determined in the lower descending colon. Among controls with transection CCPR was 4·49 cells crypt−1 h−1; calcium supplements reduced this figure by 26 per cent (P &lt; 0·05). As expected jejuno-ileal resection increased CCPR (by 51–61 per cent), but again calcium reduced this response by 31 per cent (P &lt; 0·02). Increased dietary levels of calcium thus inhibit colonic cell turnover and blunt the adaptive response to massive enterectomy, conceivably by binding tropic factors such as bile acids.
Rising detection rate of symptomatic Dukes' A colorectal cancers
Authors: Vellacott K D , Smith J H F , Mortensen N J McC 
Published: March 2007

Abstract
All 197 patients admitted to the Bristol Royal Infirmary during the 16 year period 1970--1985, and diagnosed as having Dukes' A colorectal cancers, were studied. The numbers diagnosed per year by 1985 were 20, compared with 9·4 per year for the period 1970–1979. This represented an increase in the percentage of Dukes' A cancers of all the colorectal cancers diagnosed from 8·3 to 15 per cent. The increase was largely due to better quality double contrast barium enemas and increased use of flexible sigmoidoscopy and colonoscopy. The operative mortality dropped from 17 to 3 per cent in the last 6 year period. The recurrence rate was 9·6 per cent of which 1 per cent were locally resected and crude 5 year survival was 90·4 per cent up to 1981.
Late results of mucosal proctectomy and colo-anal sleeve anastomosis for chronic irradiation rectal injury
Authors: Browning G G P , Varma J S , Smith A N , Small W P , Duncan W 
Published: March 2007

Abstract
Ten patients with severe chronic irradiation injury to the rectum were treated by mucosal proctectomy and colo-anal sleeve anastomosis. The indications were: recurrent rectal bleeding (five), stricture (three), fistula (one) and intractable pain (one). Overall follow-up has ranged from 8 to 77 months (mean 40 months). In the present survivors (n = 7) the follow-up ranges from 18 to 77 months (mean 52 months). Six patients have been followed up for more than 3 years and four for more than 5 years. There was no operative mortality. Three anastomotic strictures occurred but the protecting stoma could be closed in all but one patient. Continence was acceptable although urgency and frequency of defaecation were troublesome symptoms. The operation is recommended for life-threatening, haemorrhagic chronic irradiation injury to the rectum.
Nipple preservation during mastectomy
Authors: Kissin M W , Kark A E 
Published: March 2007

Abstract
In a retrospective study of 100 patients with operable breast cancer, microscopic involvement of the nipple-–areola complex was found in 16 cases. Each of these 16 cases occurred in patients with centrally situated tumours. In contrast, nipple involvement did not occur with peripherally situated tumours lying &gt;2 cm outside the areolar margin (P&gt;10−6, Fisher's exact test). Nipple involvement was more likely in patients with ≥ 4 positive axillary nodes (P &gt;0·01, χ2 test). From this study it appears that nipple preservation may be undertaken during mastectomy for small peripheral tumours, provided the nipple is clinically normal, and frozen section analysis of the sub-nipple area is shown to be free from tumour invasion. These criteria for nipple preservation were satisfied in 20 patients out of a prospective series of 60. In this group, nipple preservation on the skin flap improved the cosmetic result of breast reconstruction in 35 per cent, and facilitated skin closure in 20 per cent. After a mean follow-up period of 50·4 months, nipple preservation was not associated with any significant excess of local recurrences.
Peritoneal closure after lateral paramedian incision
Authors: Gilbert J M , Ellis H , Foweraker Sharon 
Published: March 2007

Abstract
The lateral paramedian incision has been advocated as the strongest incision for abdominal surgery. We have evaluated this incision and tested the necessity for closing the deep peritoneal layer by a prospective randomized trial. All 206 patients undergoing laparotomy in the Surgical Unit in 1984, both elective and emergency cases, were included. In patients undergoing laparotomy through unscarred tissue, a lateral paramedian incision was performed and they were randomized to have either the peritoneum closed (n = 77) or left open (n = 75). Patients in whom the laparotomy was performed through a previous incision (n = 51) and those in whom the abdomen had to be opened urgently (n = 3) were excluded from the trial but studied separately (n = 54). The rectus sheath was closed with monofilament nylon in all cases. Patients were assessed for wound integrity during the immediate postoperative period and at 1, 3, 6 and 12 months after operation. So far the patients have been followed up for between 1 and 2 years and follow-up is continuing as in some cases incisional hernia may not be detected until several years after operation. There have been no cases of burst abdomen. No incisional hernias have developed in patients in whom a lateral paramedian incision was performed and the peritoneum was closed, and one incisional hernia has occurred in the patients in whom the peritoneum was left open. Seven incisional hernias have occurred in patients excluded from the trial of the lateral paramedian incision (13 per cent). We conclude that the lateral paramedian incision successfully abolishes the burst abdomen and that incisional hernia is rare. It is not necessary to close the peritoneum with this incision.
Indium-111-labelled leucocytes in the diagnosis of abdominal abscess
Authors: Goldman M , Ambrose N S , Drolc Z , Hawker R J , McCollum Charles 
Published: March 2007

Abstract
The extensive morbidity and mortality of intra-abdominal abscess is mainly due to the delay in a diagnosis. The diagnostic accuracy of 111In-labelled mixed leucocytes with gamma imaging has been investigated in 100 consecutive patients including 34 following surgery and 36 with inflammatory bowel disease. White cell scans were performed 24 h following infection of autologous 111In-labelled leucocytes and were compared with clinical outcome where abscess was only diagnosed when pus either discharged or was drained at operation. Gamma images detected 28 of the 30 abscesses with no false positives giving 93 per cent sensitivity and 100 per cent specificity. Loculi of pus were identified in 11 of the 36 patients with inflammatory bowel disease with no errors in interpretation. Inflammation was reported in 15 of the remaining 25 patients with known but not necessarily active inflammatory bowel disease. 111In-labelled leucocyte imaging provides a rapid, safe and precise method for detecting intra-abdominal abscess even in the presence of inflammatory bowel disease.
Primary lymphoma of the breast
Authors: Dixon J M , Lumsden A B , Krajewski A , Elton R A , Anderson T J 
Published: March 2007

Abstract
Fifteen patients with primary lymphoma of breast are reported from a 30-year review. Eight of the patients were diagnosed in the last 5 years of this review, suggesting either an increase in the incidence or an increasing awareness of this condition. The age range was from 17 to 77 years. All patients presented with a breast mass and nine had histologically proven axillary node involvement. One patient had Hodgkin's disease and the remainder were non-Hodgkin's lymphoma. Treatment was by a combination of surgery, radiotherapy and chemotherapy. During follow-up which varied from 4 to 20 years (median 8 years) three patients developed metachronous involvement of the opposite breast and three died from their disease. Prognosis was related to tumour histology and stage of disease. The three who died all had high grade centroblastic lymphoma, the three largest tumours and nodal involvement. Five and ten-year survivals were 85 per cent and 73 per cent respectively, better than the survival of patients for either other non-disseminated extranodal lymphomas or breast cancer.
Predictive power of progesterone receptor status in early breast carcinoma
Authors: Sutton R , Campbell M , Cooke T , Nicholson R , Griffiths K , Taylor I 
Published: March 2007

Abstract
Progesterone receptor status (PgR) and oestrogen receptor status (ER) were examined in 332 women with stage 1–11 breast carcinoma treated at a single centre either by simple mastectomy with (n=283) or without (n=6) axillary clearance, or by segmental mastectomy with (n=18) or without (n=25) axillary clearance and radiotherapy; median follow-up time was 40 (range 10–60) months. Neither the concentration nor the presence of PgR related to either disease-free interval or survival. However both the presence and the concentration of ER were found to be associated with a longer disease-free interval amongst patients with stage II tumours (P &lt;0·01). From this study it appears that progesterone receptor status does not predict outcome in early breast carcinoma.
Choledochoduodenostomy for intrabiliary rupture of hydatid cysts of liver
Authors: Alper A , Ariogul O , Emre A , Uras A , Ökten A 
Published: March 2007

Abstract
Frank intrabiliary rupture is an important complication of liver hydatid cysts and its incidence is between 5 and 25 per cent. The main principles of management are the surgical treatment of the cyst with removal of all cystic elements and drainage of the biliary tree. Accurate pre- and intra-operative diagnosis and permanent drainage of the biliary tree by a wide choledochoduodenostomy are important to reduce morbidity and mortality. In this report 28 cases of frank intrabiliary rupture of hydatid cysts treated by choledochoduodenostomy are presented.
Early diagnosis of femorodistal graft stenoses
Authors: Wolfe J H N , Lea Thomas M , Jamieson C W , Browse N L , Burnand K G , Rutt D L 
Published: March 2007

Abstract
Detection and early correction of stenoses following femorodistal bypass grafting may prevent graft occlusion. We studied 43 grafts (36 saphenous vein and 7 human umbilical vein) prospectively by peroperative angiography and then by clinical assessment, post-exercise Doppler ankle pressures and digital subtraction angiography at 1 week, 3 months, 6 months and 1 year. There were 11 grafts inserted for critical ischaemia, 16 for rest pain and 16 for disabling claudication. Four patients died within the year with five patent grafts and these were excluded from the final results. Eight grafts failed during the first year; four within 1 month and a further four subsequently, with no warning alteration of symptoms, ankle Doppler pressure or digital subtraction angiography. Four additional grafts were jeopardized by symptomatic stenoses. Six grafts developed an asymptomatic stenosis of &gt; 50 per cent without a change in exercising ankle Doppler pressure. Three symptomatic stenoses were successfully revised but the fourth occluded on conservative management. Three asymptomatic stenoses have also been successfully revised and three have been treated conservatively. Close surveillance of femorodistal grafts is justified by this study but a deterioration in ankle brachial Doppler index was only useful in the patients with recurrent symptoms and was unable to detect half the stenoses of &gt; 50 per cent. The detection of these by intravenous digital subtraction angiography might help to avoid graft failure.
Indicators of depressed fibrinolytic activity in pre-operative prediction of deep venous thrombosis
Authors: Sue-Ling H M , Johnston D , Verheijen J H , Kluft C , Philips P R , Davies J A 
Published: March 2007

Abstract
Euglobulin lysis time (ELT), tissue plasminogen activator (tPA), and the fast-acting inhibitor of tPA, were measured pre-operatively in 128 patients who underwent elective major abdominal surgery. Deep venous thrombosis (DVT) was detected by 125I-labelled fibrinogen scan in 37 patients (29 per cent) after operation. Pre-operatively, there was diminished euglobulin lysis activity (332 ± 197 versus 255 ± 156 min, mean ± s.d.; P &lt;0·025), and tissue plasminogen activator activity (4·2 ± 9·9 versus 7·7 ± 14·3 milliunits/ml, mean ± s.d.; P = 0·094) in patients who subsequently developed postoperative DVT compared with those who did not. There was no significant difference between the two groups in the level of inhibition of tissue plasminogen activator (160·6 ± 75·4 per cent versus 152·5 ± 77·5 per cent, mean ± s.d.; n = 47). Stepwise logistic discriminant analysis of the data obtained pre-operatively showed that tissue plasminogen activator, a more specific measure of fibrinolytic activity, was a weaker predictor of DVT than euglobulin lysis time. The results confirm other observations which indicate that lowered fibrinolytic activity is a risk factor for postoperative DVT. In addition, they suggest that this is not due entirely to low levels of activity of tissue plasminogen activator in plasma.
Major causes of intestinal obstruction in Libya
Authors: Kuruvilla M J , Chhallani C R , Rajagopal A K , Salem Rakas F 
Published: March 2007

Abstract
The object of this study is to focus attention on the causes of intestinal obstruction in Libya. In this study, spread over 30 months and involving 114 patients, the most common cause was the entrapment of bowel in an external hernia. Postoperative adhesions accounted for obstruction in a third of our patients, and 59 per cent of them followed appendicectomy. Biliary lithiasis is the most common surgical disease in Libya, yet there was only one instance of gallstone ileus in this series. Sigmoid volvulus and intestinal lymphoma were also rare, and tubercular stricture and Crohn's disease were remarkable by their absence. There were no cases of idiopathic intussusception during or immediately following Ramadan.
Splenectomy for massive splenomegaly
Authors: Bickerstaff K I , Morris P J 
Published: March 2007

Abstract
Splenectomy was performed on 47 patients with massive splenomegaly (spleen weight &gt; 1·5 kg). With one exception, all patients had a haematological malignancy. The indications for splenectomy were for the diagnosis of unknown cause (n = 5), for the relief of pain (n = 8). as the initial treatment of hairy cell or prolymphocytic leukaemia (n = 8), and for the correction of a haematological cytopenia (n = 26). Splenectomy was completely successful in relieving pain and in establishing a diagnosis, and provided effective palliation in patients with hairy cell and prolymphocytic leukaemia. An immediate correction of a haematological cytopenia was achieved in 24 patients, and the correction was maintained for over 1 year in 11 patients. There were no postoperative deaths and morbidity was acceptably low. We conclude that patients with massive splenomegaly can derive considerable benefit from splenectomy and that massive splenomegaly should not be regarded as a contra-indication to splenectomy.
Management of colovesical fistula
Authors: Rao P N , Knox R , Barnard R J , Schofield P F 
Published: March 2007

Abstract
The clinical presentation and management of 24 patients treated for colovesical fistula were reviewed. It is concluded that an aggressive investigative approach in the management of patients with suspected colovesical fistula is rewarding. Cystoscopy and barium enema appear to be the most useful investigative tools. Once found the fistulae should be managed surgically. Radical excision of the sigmoid colon with primary anastomosis is the treatment of choice and is accompanied by no mortality and a very low complication rate.
New technique for pancreaticojejunostomy using a biological adhesive
Authors: Tashiro S , Murata E , Hiraoka T , Nakakuma K , Watanabe E , Miyauchi Y 
Published: March 2007

Abstract
A new technique of pancreaticojejunostomy using a fibrin glue biological adhesive system (BAS) after pancreaticoduodenectomy is reported. Pancreaticojejunostomy was performed on 112 patients between 1971 and 1985. Forty-two of the patients received BAS application (Group I), but the remaining seventy did not (Group II). To evaluate more precisely the effectiveness of BAS, 22 patients in Group I (Group I–ST) and 26 patients in Group II (Group II–ST) who were operated upon by the same surgeon during the same period were reviewed retrospectively. The selection of patients for the use of BAS was randomized. In Group I–ST, one patient had a minor leak; no major leaks or operative deaths occurred. Two of the twenty-six patients in Group II–ST had minor leaks and one patient had a major leak causing death. This new technique for pancreaticojejunostomy using a biological adhesive system may be useful for preventing anastomotic leaks, especially in a patient with a normal pancreas.
Prediction of postoperative pulmonary complications in oesophagogastric cancer surgery
Authors: Fan S T , Lau W Y , Yip W C , Poon G P , Yeung C , Lam W K , Wong K K 
Published: March 2007

Abstract
In a series of 102 patients with cancer of the oesophagus or gastric cardia in whom surgery had been performed, postoperative respiratory infection, respiratory failure and mortality secondary to respiratory complication occurred in 55·8, 34·3 and 21·6 per cent respectively. The incidence of complications correlated well with the pre-operative peak expiratory flow rate when it was &lt;65 per cent of the predicted normal value. However, the predictive ability of peak expiratory flow rate was much less than the patient's age, pre-operative serum albumin level, pre-operative Pa,O2 and number of surgical wounds when all risk factors were considered. Significantly more complications occurred when the patient was &gt;65 years old, Pa,O2 was &lt;10 kPa, serum albumin was &lt;39 g/l and when the operation required three incisions. These findings may serve as guidelines for identification of high-risk patients in the future.
Role of urokinase in colorectal neoplasia
Authors: Gelister J S K , Jass J R , Mahmoud M , Gaffney P J , Boulos P B 
Published: March 2007

Abstract
The biofunctional activity of the plasminogen activators urokinase and tissue plasminogen activator has been measured in extracts from 50 colorectal carcinomas and 21 adenomas using a bioimmunoassay. Compared with control mucosa urokinase activity was significantly-elevated in adenomas (P&lt;0.001) and carcinomas, levels being significantly higher in carcinomas (P&lt;0.05). In contrast tissue plasminogen activator activity was reduced in adenomas (P&lt;0.01) and carcinomas, levels being significantly lower in carcinomas (P&lt;0.01). Although enzyme activity did not relate to Dukes' stage or histological grade urokinase activity was higher in carcinomas with venous invasion (n = 17, P&lt;0.05), in those with moderate or extensive local spread (n = 27, P&lt;0.05) and in cases where a palliative resection only was feasible because of advanced disease (n = 8, P&lt;0.05). Urokinase has been implicated in tissue degradation as well as fibrinolysis and may play a role in tumour invasion and metastasis in human colorectal neoplasia.
Primary gastric lymphoma
Authors: Hockey M S , Powell Jean , Crocker J , Fielding J W L 
Published: March 2007

Abstract
This is a population-based review of 153 cases of primary gastric lymphoma. Sixty-seven (43 per cent) were histologically reviewed using the Kiel classification. There were no significant differences between reviewed and unreviewed cases. Ninety-seven per cent of all cases were of the non-Hodgkin's type. The annual incidence was constant at 1.2 per cent of gastric malignancies. The mean age was 60 years and the male to female ratio 1:8. Presenting symptoms were similar to those of gastric cancer. Twenty-one per cent had a palpable mass but one-third of these were amenable to a potentially curative resection. Some 66 per cent were resectable and 58 per cent had a macroscopic clearance of tumour. TNM stage and absolute tumour size were significant prognostic factors (P&lt;0.005 and P&lt;0.05 respectively) but the Kiel classification was not. The overall 5 year survival was 24 per cent. Apart from 10 patients whose only anti-tumour treatment was radiotherapy (5 year survival 36.9 per cent) no patient who did not have curative surgery survived 5 years. The 5 year survival for curative resection was 34 per cent and for curative resection plus radiotherapy was 43.5 per cent (45 and 73.4 per cent for the node negative cases respectively). A laparotomy is essential; ‘curative’ surgery possibly with adjuvant radiotherapy offers the best hope for cure.
Early results of low dose intra-arterial streptokinase therapy in acute and subacute lower limb arterial ischaemia
Authors: Earnshaw J J , Gregson R H S , Makin G S , Hopkinson B R 
Published: March 2007

Abstract
Thirty-two patients with acute and subacute limb-threatening peripheral arterial ischaemia were treated with low dose intra-arterial streptol ase infusions. The mean duration of infusion was 38 h. Six patients developed pericatheter thrombosis and two had distal embolization of fragments of thrombus but in all cases these responded to repositioning the catheter and continuing the infusion. Five patients developed groin haematomata and in three of these there was evidence of a systemic fibrinolytic effect from the streptokinase with plasma fibrinogen reduced below 1 g/l. The most serious complication was perforation of the popliteal and tibial arteries which occurred on two occasions and required cessation of the infusion. Twenty-two patients (69 per cent) achieved limb salvage, eight (25 per cent) suffered a major amputation and two (6 per cent) died. The outcome was not related to the site, nature or duration of the arterial occlusion but patients with loss of sensation or paralysis of the affected limb were significantly less likely to obtain limb salvage (P = 0.001). For occlusions greater than 30 cm in length a new technique was used where the thrombus was lysed from distal to proximal in short lengths by gradual catheter withdrawal. This was successful in five out of six cases. Low dose intra-arterial streptokinase has been confirmed as an effective, relatively safe method of treatment in recent arterial ischaemia and can be recommended in situations where the results of surgery may not be favourable. In particular, patients with arterial thromboses and no distal run-off, distal and late arterial emboli, thrombosed popliteal aneurysms and patients after a failed embolectomy, have all been shown to respond to thrombolytic therapy with intra-arterial streptokinase.