bluuebunny/crossref_metadata_2025_split huggingface dataset:
Towards a rational approach to the treatment of peritonitis: An experimental study in rats
Authors: McAvinchey D J , McCollum P T , Lynch G 
Published: March 2007

Abstract
Peritoneal infection progresses through defined stages: contamination, inflammation and abscess formation. An experimental model of established peritonitis without adjuvant in the rat was used to test the effect of various local and systemic agents on survival. There was significant improvement in all treatment groups except those treated with antiseptic lavage using PVP-I and noxythiolin. Intramuscular ampicillin improved survival from 40 to 60 per cent while intramuscular amikacin combined with local irrigation with metronidazole reduced mortality to nil (P &lt;0·001). Both cephradine and metronidazole used as peritoneal lavage solutions improved survival (P &lt;0·005) when compared with the controls but the difference was not significant when compared with irrigation with Hartmann's solution. Metronidazole given rectally also improved survival from 40 to 60 per cent but this difference was not significant. We conclude that survival in established peritonitis depends upon adequate antibiotic therapy.
Empyema following intra-abdominal sepsis
Authors: Ballantyne K C , Sethia B , Reece I J , Davidson K G 
Published: March 2007

Abstract
Over the past 9 years, ten patients have presented to the Thoracic Unit, Glasgow Royal Infirmary, with 12 empyemas secondary to intra-abdominal sepsis. In eight patients, the presenting signs and symptoms were wrongly attributed to primary intra-thoracic pathology. All were subsequently found to have intra-abdominal sepsis. The presence of empyema after recent abdominal surgery or abdominal pain strongly suggests a diagnosis of ipsilateral subphrenic abscess. Adequate surgical drainage is essential. In our experience, limited thoracotomy with subdiaphragmatic extension offers the best access to both pleural and subphrenic spaces and provides the greatest chance of eradicating infection on both sides of the diaphragm.
Prevention and treatment of intestinal dehiscence by an intraluminal bypass graft
Authors: Ger R , Ravo B 
Published: March 2007

Abstract
The most important cause of morbidity and mortality in the surgery of the colon, rectum and oesophagus is dehiscence. An experimental study to investigate a method of protecting intestinal anastomoses/dehiscences by an intraluminal bypass graft was carried out. This was accomplished by the implantation of a soft tube (graft) in the proximal intestine above the proposed anastomosis/dehiscence, which conducts the salivary, gastrointestinal secretion, food and faecal stream past the anastomosis/dehiscence into the distal intestine; these contents are thereby prevented from coming in contact with the anastomosis/dehiscence. Intestinal continuity is then completed. The graft is expelled spontaneously after a varying time. In the face of gross anastomotic dehiscences, faecal peritonitis and mediastinitis, primary healing without leakage occurs. A clinical study has been instituted.
Islet cell transplantation in diabetic dogs: Studies of graft function and storage
Authors: Alderson D , Walsh T N , Farndon J R 
Published: March 2007

Abstract
Islet cell transplantation is a potential treatment for insulin-dependent diabetes (IDD), assuming that physiological hormone release results in biochemical normality which, in turn, reduces the incidence of long-term diabetic complications. These experiments sought to create a metabolic model of IDD in a large animal and investigate the effects of insulin therapy and islet transplantation. After demonstrating the success of transplantation, further studies examined the feasibility of creating multiple grafts from a single donor and their long-term preservation. The totally pancreatectomized dog, treated with suboptimal insulin therapy was biochemically identical to human IDD and, when more appropriate doses of insulin were administered, metabolic improvements occurred without restoring normality. Islet cell autotransplants rendered such animals metabolically normal apart from persisting impairment of glucose tolerance. The isolation technique permitted the production of at least two recipient grafts and some success was achieved after graft cryopreservation. The experiments confirm the theoretical background to islet transplantation and demonstrate its applicability in a large animal model before allotransplantation.
What has happened to perforated peptic ulcer?
Authors: Watkins R M , Dennison A R , Collin J 
Published: March 2007

Abstract
The number of elective operations for chronic peptic ulceration has decreased substantially with the widespread use of H2-receptor antagonists. We have reviewed all cases of perforated peptic ulcer in Oxford over the last 18 years (1965–82) to see if a similar change in the incidence of this major complication of peptic ulceration has occurred. Since 1976 there has been a fall in the incidence of perforated peptic ulcer from 8.7 to 6.9 cases per 100 000 population per year. The male to female ratio decreased over the review period from 4.9:1 to 1.9:1 owing to a reduced incidence of perforation in men and an increased incidence in women. The mean age of men with perforated duodenal ulcer increased from 52.3 years in 1965–70 to 59.0 years in 1977–82. One hundred and sixty-six patients treated between 1977 and 1982 have been reviewed in detail. The overall mortality in this 6 year period was 12.7 per cent with an operative mortality rate of 8.9 per cent. The majority of perforations (65 per cent) are now of acute ulcers and therefore are unlikely to be prevented by improved therapy for chronic peptic ulceration.
Transurethral ureteroscopic stone extraction
Authors: Ford T F , Wickham J E A 
Published: March 2007

Abstract
Transurethral ureteroscopy has now been used for stone retrieval in 31 patients with ureteric calculi. Four stones were located in the upper third, nine in the middle third and eighteen in the lower third of the ureter. The stones varied in size from 4 to 10 mm in diameter. Successful retrieval of the stones was achieved at the first attempt in 17 and at a second attempt in 3. Of the 11 failures (due to impaction, dislodgement into the pelvis or failed instrumentation), 4 have required open ureterolithotomy, 2 percutaneous nephroscopy and 2 ureteric meatotomies; 3 have been successfully disintegrated in situ. There have been no significant complications to date. Transurethral ureteroscopy appears to offer an alternative to existing therapeutic options.
The effect of malignant and inflammatory fixation of rectal carcinoma on prognosis after rectal excision
Authors: Durdey P , Williams N S 
Published: March 2007

AbstractFixity of colorectal carcinoma at operation seems an important prognostic indicator, perhaps equally as significant as lymph node invasion. A proportion of tumours are, however, tethered by inflammatory adhesions only and, although patients with these tumours should fare better than those with tumours fixed by extramural malignant spread, available data is contradictory. With the recent interest in pre-operative radiotherapy for patients with fixed rectal tumours and in order to clarify the above points we studied 625 patients who had undergone rectal excision a minimum of 10 years previously. Excluding those with disseminated disease, 169 (27 per cent) were fixed, 124 (20 per cent) by direct malignant spread, 45 (7 per cent) by inflammatory tissue. Survival and recurrence rates in these patients were compared with an equivalent number who had mobile lesions. The groups were matched for age, sex and Dukes' stage. The degree of differentiation and height of the lesion above the anal margin were similar. Corrected 5 year survival rates were 28.5 per cent in patients with malignant fixation, 68.9 per cent (P &lt; 0.01) in those with mobile tumours and 64.6 per cent (P &lt; 0.01) where the lesion was tethered by inflammation. The incidence of local recurrence in the three groups was 41.3, 15.1 and 20.0 per cent respectively. Five year survival rate in patients with fixed Dukes' B lesions was 43.5 per cent and in patients with mobile C lesions was 62.9 per cent (P &lt; 0.01). Thus, patients with fixed carcinomas of the rectum have a poor prognosis but only if contiguous spread of the tumour has occurred. These findings have important implications for patients in whom fixity is used as an indication for adjuvant therapy.
Polyamines in colorectal cancer
Authors: Kingsnorth A N , Lumsden A B , Wallace Heather M 
Published: March 2007

Abstract
Polyamine levels (putrescine, spermidine and spermine) in colorectal cancers (n = 25) were measured in order to assess their importance as markers of cellular proliferation. Colonic mucosa from healthy resection margins of patients with diverticular disease (n = 5) was used as control material. Polyamine levels (expressed as nanomoles per 100 mg tumour) in cancers ranged from 0.8 to 7.9 for putrescine (mean: 2.3±0.7), from 6.5 to 22.8 for spermidine (mean: 13.9±0.9) and from 13.0 to 37.5 for spermine (mean: 22.1±1.3). Mean spermidine and spermine content of cancers was more than three times mean spermidine (3.92±0.8), and more than four times mean spermine (5.0±1.2), content of normal colonic mucosa (P &lt; 0.01). Polyamine content of colorectal cancers was independent of tumour site, Dukes' stage, histological grade and the presence of palpable liver metastases at laparotomy. Because colorectal cancers contain such high levels of spermidine and spermine, polyamines may play an essential role in the regulation of their growth.
Changes in intestinal blood flow during the development of chronic large bowel obstruction
Authors: Coxon J E , Dickson Caroline , Taylor I 
Published: March 2007

Abstract
The effect of chronic progressive distal large bowel obstruction on intestinal blood flow was studied in 12 mini-pigs. Blood flow was measured by the techniques of xenon133 clearance and intracardiac injections of radiolabelled microspheres. Intestinal blood flow was increased in the left colon and ileum but decreased in the caecum. Blood was shunted from the mucosa to the muscle layers. The results suggest that primary anastomosis of the obstructed left colon is not contraindicated by haemodynamic considerations.
Does a water soluble contrast enema assist in the management of acute large bowel obstruction: A prospective study of 117 cases
Authors: Stewart J , Finan P J , Courtney D F , Brennan T G 
Published: March 2007

Abstract
We have performed a prospective study on 117 patients in order to assess the value of a single contrast water soluble enema in acute large bowel obstruction. In 99 cases where the plain films suggested a diagnosis of mechanical obstruction, the Diodone enema confirmed its presence in 52, and relocated its site in 11. There was free flow of contrast to the caecum in the remaining 35, 11 of whom were shown to have idiopathic pseudoobstruction. The plain films suggested a diagnosis of pseudo-obstruction in 18 patients. The Diodone enema confirmed this diagnosis in 15, but revealed an unsuspected mechanical obstruction in two. The examination failed in two cases. We conclude that the water soluble single contrast enema is of value in the management of large bowel obstruction. It will confirm the diagnosis of mechanical obstruction and prevent unnecessary surgery in patients with pseudo-obstruction.
Infusion cholecystography in the early diagnosis of acute gallbladder disease
Authors: Dykes Evelyn H , Stewart I , Gray H , Simpson C , Davidson S , McArdle C S 
Published: March 2007

Abstract
The value of infusion cholecystography 99mTc HIDA cholescintigraphy and ultrasonography was compared in 51 patients presenting with a clinical diagnosis of acute cholecystitis. Of the 35 patients with proven gallbladder disease, the presence of gallstones was correctly predicted in 31 (88 per cent) by infusion cholecystography, 32 (90 per cent) by 99mTc HIDA cholescintigraphy and 27 (77 per cent) by ultrasonography. There were no false positive investigations. Infusion cholecystography may be of particular interest to surgeons with no ready access to isotope scanning techniques.
Incidence and prognosis of N4 node involvement in gastric cancer
Authors: Keighley M R B , Moore Janet , Roginski Claudia , Powell Jean , Thompson H 
Published: March 2007

Abstract
We have undertaken a prospective study of the frequency and prognosis associated with N4 node metastases in gastric cancer in 136 patients referred for surgical treatment between 1976 and 1983. N4 node metastases (pre-aortic or hepatic hilar nodes) were present in 20 of 31 patients who had a laparotomy without resection (64 per cent), in 2 of 8 patients who had a ‘palliative’ resection in the presence of distant metastases (25 per cent) and, in 19 of 85 patients who had a ‘curative’ resection (22 per cent). The median survival in patients having a “curative” resection with N4 nodes was 4.5 months which was only marginally longer than in patients having a ‘palliative’ resection (median survival 3 months). In view of these findings and since immediate imprint cytology can be used to detect nodal metastases at operation, involvement of N4 nodes might be a contra-indication to extensive gastric resection in non-obstructing gastric cancer.
CAPD—a risk factor in renal transplantation?
Authors: Guillou P J , Will E J , Davison A M , Giles G R 
Published: March 2007

Abstract
Theoretical considerations suggest that patients undergoing continuous ambulatory peritoneal dialysis (CAPD) may fare less well after renal transplantation than their haemodialysed (HD) counterparts. Review of 121 consecutive cadaveric renal allografts performed in this centre indicate this to be the case with graft survival rates at 1 year of 63·5 per cent in the HD group compared with 35·5 per cent in the CAPD-treated patients. This difference appeared to be independent of the duration of dialysis and, although a significant blood transfusion effect was seen in the HD group, no such trend was evident in the CAPD group. Studies of T cell subsets (using monoclonal antibodies) in the two groups suggests that, in part at least, the differences in graft survival rates may be attributable to the maintenance or restoration of immunological integrity in the CAPD group.
A controlled trial of bipolar electrocoagulation in patients with upper gastrointestinal bleeding
Authors: Kernohan R M , Anderson J R , McKelvey S T D , Kennedy T L 
Published: March 2007

Abstract
We have assessed the value of the BICAP electrocoagulation probe in reducing the incidence of further bleeding in patients with upper gastrointestinal haemorrhage. One hundred and twenty-nine patients were studied in a prospective randomized controlled trial. There were 85 male and 44 female patients, age range 16–92 years. Forty-five patients had stigmata of recent haemorrhage (visible vessel or spot) and were randomized during endoscopy to 24 control and 21 treatment patients. Seven control patients rebled compared with nine treated patients (Fisher's exact probability test P = 0·44). The transfusion requirements of control patients (3·9±3·2 units) was not different from that of treated patients (5·7 ± 3·7 units): Mann Whitney U test, P = 0·06. In the treatment group there was no difference in the operation rate. Also, the number of probe applications between patients with further bleeding and those with no further bleeding was similar (11·6 ± 5·5 and 11·0 ± 5·75 respectively). Access with the probe was considered inadequate in 50 per cent of lesions, but this did not correlate with the incidence of rebleeding. Stigmata of recent haemorrhage were significant in predicting rebleeding (P = 0·0019 Fisher's exact probability test). Overall mortality rate of 3·2 per cent was low and was not influenced by electrocoagulation or presence of stigmata of recent haemorrhage. We have not shown that BICAP bipolar electrocoagulation reduces the incidence of rebleeding in upper gastrointestinal haemorrhage.
The surgical management of typhoid perforation in children
Authors: Keenan J P , Hadley G P 
Published: March 2007

Abstract
Typhoid perforation still has a high mortality rate (19–59 per cent) and controversy regarding the management of patients with this complication still abounds. We report our experience of 26 children with histologically proven typhoid perforation with an operative mortality of 9·0 per cent. Timed surgery with ulcer excision, simple two-layer closure of the defect and copious peritoneal lavage were used.
Surgical approaches to thrombo-embolism
Authors: Greenfield L J , Langham M R 
Published: March 2007

Abstract
Management of angiographically confirmed pulmonary thrombo-embolism in 313 patients has been based on a physiological classification system. Patients in shock (Class IV) are managed either by catheter embolectomy (26 patients) with 27 per cent mortality rate or by open embolectomy during active resuscitation (6 patients) with a 33 per cent mortality rate. High-risk patients with transient hypotension (Class III) are managed by anticoagulation and filter insertion. The most common indication for filter placement is a contra-indication to anticoagulation (37 per cent). Filter placement was infrarenal in 268 patients (86 per cent) and intentionally suprarenal in 19 patients (6 per cent). Misplacement has occurred into the iliac veins, renal veins and the heart but has not been seen since the guide wire technique for insertion was developed. The 30 day mortality for patients receiving filters was 14 per cent and due to other disorders. Only one death was suspected from recurrent embolism. One hundred and thirteen venacavagrams at intervals up to 99 months in 110 patients showed long-term patency in 97 per cent. Recurrent embolism was seen in five patients (2 per cent) but caused no deaths.
Surgical management of reflux-induced oesophageal stenoses: Results in 101 patients
Authors: Payne W S 
Published: March 2007

Abstract
One hundred and one patients with benign, reflux-induced oesophageal stenosis were surgically treated at the Mayo Clinic during a recent 6 year period by the author. In 71 patients, the stenosis was readily dilated and treated by a variety of antireflux procedures, depending on presence or absence of oesophageal peristalsis or acquired shortening of the oesophagus. Thirteen additional patients were managed by gastric secretion suppression with duodenal diversion using the Roux-Y principle. Seventeen patients with undilatable stenoses were managed by resection and a variety of reconstructions. The modified Ivor–Lewis procedure with or without thoracotomy was the procedure employed in 12 of the 17 with the remainder managed with either substernal colon or upper digestive secretion suppression-diversion. These 101 operations were accomplished without mortality and all but one patient have resumed an oral diet and returned to their usual occupation. While 91 per cent of the 101 patients are free of reflux symptoms or demonstrable stenosis and are considered improved, only 83 per cent of all patients have ‘excellent’ to ‘good’ late results in terms of both oesophageal and gastrointestinal symptoms.
A review of treatment of spinal cord injury
Authors: Collins W F 
Published: March 2007

Abstract
Spinal cord injury remains a devastating event to the person sustaining the injury. Not only the cost of acute and rehabilitation care, but also the loss of productivity of the victims who are often young men injured at a highly productive period of their lives are a costly illness for society as a whole. In the past 20–30 years, there has been continual improvement in the morbidity and mortality from spinal cord injury with the improvement in prevention of a second injury, prevention of secondary renal, pulmonary and cutaneous complications, better techniques for stabilization of the spinal column, and more effective utilization of remaining neurological function with improved rehabilitation therapy. It remains, however, difficult to demonstrate an effect from a wide range of ‘acceptable’ medical or surgical care on the resultant loss of spinal cord function. The lack of improvement in preventing or reversing the loss of spinal cord function in spite of marked variations in acute spinal cord injury care indicate that acceptable data are still lacking to determine the role of aggressive and conservative management. The need for a more organized approach to the problem is obvious.
Current achievements and challenges in adrenal surgery
Authors: Hunt T K , Roizen M F , Tyrrell J B , Biglieri E G 
Published: March 2007

Abstract
Adrenal surgery is now done in almost ideal circumstances. Mortality and complications are rare except in Cushing's syndrome. All major adrenal hormones and their stimulators are measurable and discriminating tests abound. Imaging techniques detect small masses. Inhibitors of hormone synthesis and cell receptors allow amelioration of metabolic hazards pre-operatively. Primary aldosteronism is first medically controlled, and patients are selected for operation if difficult to control and if the type of disease is responsive to adrenalectomy. Cushing's disease usually requires pituitary adenomectomy, but some of the 15–30 per cent failures, those with ectopic adrenocorticotrophic hormone (ACTH) producing tumours, or adrenal adenomas warrant adrenalectomy. Metabolic hazards are controlled pre-operatively by aminoglutethimide. Benefits of adrenalectomy are uncertain and many challenges remain. Hazards of phaeochromocytomectomy are avoided by pre-operative adrenergic blockade. Myocardial disease warrants delay. Small unilateral lesions of all types are best removed through unilateral approaches. Small masses found on imaging and without apparent effect can be observed.
Towards the Belfast immunosuppressive regimen: A prospective trial of low versus high dose steroids and once versus twice daily immunosuppression
Authors: Griffin P J A , Salaman J R 
Published: March 2007

Abstract
The Transplant Unit in Belfast achieves the highest survival rates in Great Britain for renal transplants. The immunosuppression used comprises azathioprine and very low doses of steroids administered just once a day. The importance of these features has been examined in two clinical trials using (a) high or low dose steroids with azathioprine, (b) low dose steroids with azathioprine given once or twice daily following cadaveric renal transplantation. Low dose steroids were no more effective than were high dose steroids in preventing graft rejection and there was no advantage in administering immunosuppression once daily in the morning as opposed to twice daily in divided doses. None the less, with low doses of steroids the complications of cushingism and obesity were markedly reduced. Neither trial achieved the degree of success in transplant survival that has been usual in Belfast.
Non-seminomatous germ cell testicular tumours: Residual masses after chemotherapy
Authors: Levitt M D , Reynolds P M , Sheiner H J , Byrne M J 
Published: March 2007

Abstract
Twenty-three consecutive patients with metastatic non-seminomatous germ cell testicular tumours were treated with a combination of cisplatinum, vinblastine and bleomycin. Nineteen had elevated serum tumour marker levels (α-fetoprotein and βT-subunit HCG) prior to chemotherapy. In 11 of the 19, residual masses were present on the completion of induction chemotherapy despite normal serum tumour marker levels (residual mass after chemotherapy). The management of these 11 patients was based on a policy of observation rather than routine resection of residual deposits and all are currently alive (32-58 months) with ten free of active disease. Two of the eleven required additional chemotherapy when serial tumour marker levels became elevated during follow-up. Another six have been observed without further intervention and have remained well with stable or diminishing deposits. The remaining three have required resection of residual masses, in each case because of mass enlargement despite persistently negative tumour marker levels. None of the masses showed histological evidence of malignancy. A more selective approach to resection of residual masses after chemotherapy is advocated.