bluuebunny/crossref_metadata_2025_split huggingface dataset:
Use of advisers in the diagnosis and management of abdominal pain in accident and emergency departments
Authors: Driscoll P A , Vincent C A , Servant C J , Audley R J 
Published: March 2007

Abstract
The performance of senior house officers (SHOs) and their advisers in accident and emergency departments was compared in the diagnosis of abdominal pain in 711 patients. Accuracy of diagnosis was 63 per cent for advisers and 54 per cent for SHOs. Overall, the adviser improves the diagnosis of the SHO in only 6 per cent of cases. The SHOs refer accurately in 94 per cent of cases, and the advisers improve the SHO referrals in only 1 per cent of patients. It is argued that the time-consuming process of calling a surgeon away from a ward or theatre to advise in the receiving room is of little value, and avoidance of this step would enable patients to be admitted more rapidly.
Pulmonary microembolization in experimental aortic surgery
Authors: Poskitt K R , Irwin J T C , Lane I F , Karacagil S , McCollum C N 
Published: March 2007

Abstract
Pulmonary dysfunction frequently follows major surgery and has many features identical to ‘shock lung’. A porcine model of aortic surgery is described in which 111In-labelled platelet kinetics were related to subsequent pulmonary function. In 14 pigs, standardized aortic surgery resulted in reproducible shock and a 50 per cent mortality at 3 days. Cardiac output fell from 22.3±0.2 to 1.0±0.1 litres min−1 following removal of the aortic clamp and mean platelet and leucocyte counts fell from 437±48 to 252±39×109 litres−1 and 21.7±1.5 to 12.9±1.2×109 litres−1 respectively (P&lt;0.01). Aggregate levels in inferior vena caval blood were maximal at this time and radiolabelled platelets accumulated in the lung with a rise in pulmonary vascular resistance. Alveolar—arterial oxygen difference subsequently increased from initial values of 13.7±2.0 to 23.4±3.5 mmHg (P&lt;0.01) following resuscitation and to 32.5±3.4 mmHg at 3 days following surgery (P&lt;0.01). This clear sequence suggests that pulmonary platelet microembolization occurs during surgical shock and may be responsible for subsequent pulmonary dysfunction.
Sex, Enterobius vermicularis and the appendix
Authors: Williams D J , Dixon M F 
Published: March 2007

Abstract
Examination of 182 appendices containing Enterobius vermicularis demonstrated that male pinworms are seen more commonly than female. There was no association between the sex of pinworms and inflammation in the appendix but inflammation was frequently seen in association with luminal ova. Ova release from female pinworms may be a feature of appendiceal obstruction.
Risk factors in onychocryptosis
Authors: Langford D T , Burke C , Robertson K 
Published: March 2007

Abstract
A study is described in which the normal toes of 50 patients with unilateral ingrowing toenails were compared with those of 50 healthy subjects matched for age and sex. Twenty-one potential risk factors were compared between the groups. All measurements on patients were derived from unaffected toes in order to avoid anatomical distortion due to the disease process. Statistical analysis revealed significant differences between the groups for three anatomical measures, namely nail fold width (P &lt; 0·001), medial rotation (eversion) of the great toe (P &lt; 0·02) and nail thickness (P &lt; 0·03). Possible discriminating variables were assessed using linear discriminant function analysis and a mathematical equation was derived based on these three factors. This equation was found to possess a potentially high predictive value in that it correctly classified 86 per cent of the patients and 77 per cent of the controls. A further group of 62 unselected patients presenting with unilateral onychocryptosis and 35 unaffected controls were assessed for these three parameters. Of these, 80 per cent of controls and 85 per cent of patients could be classified correctly by the equation. It is thus proposed that, in the majority of subjects with onychocryptosis, a discrete anatomical predisposition exists and that the other factors act only as triggers in the development of the condition. This study provides a rationale for less traumatic surgical approaches to ingrown nail than nail avulsion, with or without nail bed ablation and may also provide a means of identifying high-risk groups.
Computer-aided diagnosis: A review
Authors: Sutton G C 
Published: March 2007

Abstract
Fifteen years ago, computer-aided diagnosis of the acute abdomen promised much. Today it is little used. Studies have been flawed by poor trial design, bias, selective reporting of results, statistical naivety and spurious conclusions. The computer system lacks ‘common sense’ and is less accurate than clinicians. Yet its introduction has been associated with improved patient management and outcome. Much of the effect arisess from structured data collection methods and some from audit feedback to clinicians. It is on these innovations, not on the computer, that future work should focus.
A prospective randomized trial of Angelchik prosthesis versus Nissen fundoplication
Authors: Stuart R C , Dawson K , Keeling P , Byrne P J , Hennessy T P J 
Published: March 2007

Abstract
A total of 61 patients with gastro-oesophageal reflux, resistant to medical therapy, were entered into a prospective randomized trial comparing the Angelchik antireflux prosthesis with Nissen's fundoplication. Both groups had a similar age and sex distribution and their reflux profiles were comparable. An Angelchik prosthesis was inserted in 30 patients and 31 underwent fundoplication. The mean duration of postoperative follow-up was 38 months. At clinical assessment 23 (77 per cent) of the Angelchik group were graded Visick grade I or II, compared with 29 (94 per cent) of the Nissen group. Assessment by 24 h pH monitoring and manometry between 3 and 6 months after operation showed that both procedures were equally effective in reducing reflux and increasing lower oesophageal sphincter pressure. However, long-term endoscopic follow-up revealed grade III oesophagitis in seven patients in the Angelchik group. No patient in the fundoplication group had grade III oesophagitis. Three of eight patients with strictures in the Angelchik group reported persistent dysphagia. All seven patients with strictures in the Nissen group were relieved of their dysphagia. Migration or erosion of the prosthesis did not occur. Three prostheses (10 per cent) were removed, two for dysphagia and one because of sepsis.
Gastroplasty for morbid obesity: Technique, complications and results in 60 cases
Authors: Owen E R T C , Abraham R , Kark A E 
Published: March 2007

Abstract
A series of 60 gastroplasty operations based on Mason's vertical banded procedure are described. Details of technique, modifications, complications and results are discussed. Operative treatment results in a reduction to within 40 per cent of ideal weight in 80 per cent of patients between 12 and 18 months after surgery. The constricting band should not be greater than 5 cm; if it is most procedures will fail after 18 months. Pouch size should be measured and made no greater than 20 ml. The importance of nutritional counselling is emphasized. The surgical treatment should form part of a multidisciplinary approach with careful selection and long-term follow-up.
Effect of nutritional status on acute phase protein response to elective surgery
Authors: Cruickshank A M , Hansell D T , Burns H J G , Shenkin A 
Published: March 2007

Abstract
The aim of this study was to assess the effect of nutritional status on the acute phase protein response to elective surgery. Matched pairs of patients with gastric or colorectal cancer were studied. Undernourished patients (body-weight &lt; 80 per cent of ideal and triceps skinfold thickness &lt; 65 per cent of standard) were matched with controls (body-weight &gt; 95 per cent of ideal and triceps skinfold thickness &gt; 80 per cent of standard) for age, sex, type of pathology and surgery. Blood samples taken preoperatively and on days 1–5 after operation were analysed for C-reactive protein, α1-antitrypsin, α1-acid glycoprotein, albumin, prealbumin and transferrin. There was no significant difference in any of the preoperative protein concentrations between the two groups although undernourished patients tended to have lower transferrin concentrations (mean ± s.e.m., 2·2 ± 0·3 g/l) than the control group (2·9 ± 0·1 g/l). C-reactive protein response was significantly smaller in the undernourished group than in the control group (P = 0·05, Mann-Whitney U test). The responses of the other acute phase proteins did not differ between the two groups. There was no difference in the length of hospital stay after operation when undernourished patients (mean ± s.e.m., 17·7 ± 3·0 days) were compared with controls (14·3 ± 3·6 days). Undernourished patients therefore have an attenuated C-reactive protein response to elective surgery. The significance of this in relation to morbidity and mortality in severely ill patients requires further investigation.
Attitudes of operating theatre staff to inoculation-risk cases
Authors: Johnson C D , Evans R , Shanson D C , Wastell C 
Published: March 2007

Abstract
In a 12-month period, 177 patients at risk of infection with human immunodeficiency virus (HIV) or hepatitis B were operated on. Sixty-nine had HIV antibodies. The procedures used to identify these patients and minimize the risk of infection of hospital staff in the operating department are described. All staff working in the operating department were surveyed to determine their caseload, feelings of anxiety, and the incidence of high-risk exposure to infection. Anxiety was not related to workload, but was more common in those who had high-risk exposure. All members of staff who sustained a needlestick injury were tested for HIV antibodies at intervals after injury; 33 also volunteered to be tested in a screening session 3 months after the study period. None had HIV antibodies, suggesting that the risk of acquiring HIV infection in the operating department is low.
Liver transplantation for primary and secondary hepatic apudomas
Authors: Arnold J C , O'Grady J G , Bird G L , Calne R Y , Williams R 
Published: March 2007

Abstract
Four patients underwent liver transplantation in the Cambridge/King's College Hospital programme for malignant primary and secondary apudomas, secreting various peptide hormones and uncontrollable by standard treatment techniques. After transplantation all patients had excellent symptomatic relief and specific peptide hormone levels fell to normal ranges. Two patients remain alive and well after 38 and 22 months, the latter with recurrence of slight tumour-related symptoms and elevation of the specific secretory product. The other two patients died from chronic graft rejection 7 and 8 months after transplantation.
Changes in the hepatic perfusion index during the development of experimental hepatic tumours
Authors: Nott D M , Grime S J , Yates J , Day D W , Baxter J N , Jenkins S A , Cooke T G 
Published: March 2007

Abstract
A model of microscopic liver tumour has been developed in the Fisher rat by intraportal injection of 1·6 × 107 Walker 256 carcinosarcoma cells. Rats were studied at 2, 4 and 6 days after the inoculation of liver Walker cells. A control group received dead Walker cells. No tumour was visible in control groups at 2, 4 and 6 days after inoculation. Similarly in rats injected with live cells no tumour was visible at 2 days after inoculation but at 4 and 6 days the percentage hepatic replacement was (mean ± s.d.) 7·0 ± 2·3 and 27·9 ± 6·80 respectively. The hepatic perfusion index was significantly raised at 4 and 6 days after inoculation of live cells compared with control animals and those receiving viable cells after 2 days inoculation. Portal flow and portal venous inflow were significantly reduced when the hepatic perfusion index increased but hepatic arterial flow did not alter. Changes in the hepatic haemodynamics were accompanied by increases in the portal and splanchnic vascular resistance and an increase in the amount of arteriovenous shunting through the liver. These findings confirm studies that the hepatic perfusion index is useful in the detection of occult liver metastases but that the change is not a consequence of an increase in the hepatic arterial flow.
Adjuvant therapy of poor prognosis colon cancer with levamisole: Results of an EORTC double-blind randomized clinical trial
Authors: Arnaud J-P , Buyse M , Nordlinger B , Martin F , Pector J-C , Zeitoun P , Adloff A , Duez N 
Published: March 2007

Abstract
From 1978 to 1985, 297 patients were entered in a double-blind randomized trial comparing levamisole to placebo as adjuvant therapy of Dukes' C carcinoma of the colon. Therapy consisted of from two to five tablets of 50 mg levamisole (or placebo) twice a week, depending on bodyweight for 1 year. Levamisole was generally well tolerated, with only four reversible cases of agranulocytosis reported among 129 patients. The trial failed to show a benefit of levamisole on disease-free survival (P = 0·53) or on survival (P = 0·35). There was no difference between the two treatment groups in terms of number of disease relapses, sites of relapse, or time to relapse. The proportion of patients still alive at 5 years was 51 per cent (standard error, 5·5 per cent) in the levamisole group versus 39 per cent (standard error, 5·4 per cent) in the placebo group.
Major amputation in a defined population: Incidence, mortality and results of treatment
Authors: Kald A , Carlsson R , Nilsson E 
Published: March 2007

Abstract
Medical records of all patients, from a defined population of 88000 inhabitants, who underwent major lower limb amputation during 1980–82 were retrospectively scrutinized. The records showed 131 amputations were performed in 106 patients at the district hospital and 22 amputations on 17 patients at the local university hospital, referral centre, altogether 57 men and 66 women. This gave an amputation incidence of 46 per 105 inhabitants per year. Of the amputees 47 per cent were older than 80 years. Only two patients underwent reconstructive vascular surgery (at the university hospital) before surgery. Final amputation level was above-knee in 61 per cent of the patients treated at the district hospital. Mortality rates at 30 days and 2 years after the amputation were 23 and 56 per cent, respectively, and the age-corrected survival after 2 years was 55 per cent. For patients who came from and eventually returned to their own homes the mean hospital stay amounted to 184 days (postoperative deaths excluded). After amputation 26 patients were trained to wear a prosthesis and 16 of these used the prosthesis 2 years after amputation. The present study underlines the need for prospective and parallel studies of vascular surgery and amputation as well as analyses of the risk factors involved in lower limb ischaemia in defined populations.
Anastomotic suture materials and implantation metastasis: An experimental study
Authors: McGregor J R , Galloway D J , McCulloch P , George W D 
Published: March 2007

Abstract
Suture implantation of viable exfoliated malignant cells may be responsible for local recurrence (implantation metastasis) of colorectal cancer. In this study, four anastomotic materials (braided polyamide, braided polyglycolic acid, monofilament polypropylene and monofilament stainless steel) were compared with respect to their ability to entrap and transfer free Mtln3 carcinoma cells from the colonic lumen of a rat. The braided materials transferred greater numbers of cells than did the monofilament sutures (P&lt;0·001), but significant differences were also observed between polyglycolic acid and polyamide (P&lt;0·001) and between polypropylene and stainless steel (P&lt;0·05). Secondly, the firm adherence of tumour cells to the suture materials was assessed by an in vitro technique. The Mtln3 cells were found to adhere in significantly greater quantities to the braided sutures than to the monofilaments (P&lt;0·001) and this was supported by in vivo tumour growth studies. These findings may have implications for colorectal cancer surgery in man.
Sutureless large bowel anastomosis: European experience with the biofragmentable anastomosis ring
Authors: Cahill C J , Betzler M , Gruwez J A , Jeekel J , Patel J-C , Zederfeldt B 
Published: March 2007

Abstract
Sutureless colonic anastomosis using a biofragmentable anastomosis ring (BAR) has been evaluated in a prospective randomized comparison with sutures and staples for elective colorectal surgery. One hundred and one patients underwent BAR anastomosis, 85 a sutured anastomosis, and 16 a stapled anastomosis. There were two anastomotic leaks in the patients undergoing BAR anastomosis, seven in patients having a sutured anastomosis, and one in a patient who had a stapled anastomosis. Wound infection occurred in ten BAR patients, ten sutured patients and no stapled patient. There was no statistically significant difference in these or in other postoperative complications between the groups. The BAR was easy to use and is a safe alternative to sutures and staples for large bowel anastomosis.
Colonic complications of severe acute pancreatitis
Authors: Aldridge M C , Francis N D , Glazer G , Dudley H A F 
Published: March 2007

Abstract
Colonic complications are rare in acute pancreatitis. Over the last 9 years at St. Mary's Hospital, London, UK, we have managed severe acute pancreatitis by intensive supportive therapy followed by sub-total pancreatic resection and/or debridement in those who fail to improve. Of the 22 patients who have undergone this form of surgery, nine were found to have colonic involvement in the form of either necrosis or perforation. In addition, one patient presenting at West Middlesex University Hospital, Isleworth, UK, had severe acute pancreatitis and almost total colonic necrosis as an unexpected finding at emergency laparotomy. These ten patients comprised seven men and three women of median age 59 years and with a median of four Ranson criteria. In seven patients, colonic involvement was discovered at the time of pancreatic surgery or laparotomy for pancreatitis and in the remainder it presented between 1 and 3 weeks later as either a faecal fistula (n = 2) or persistent abdominal sepsis (n = 1). The ascending colon was involved in one patient, the splenic flexure and descending colon in one, the transverse colon in three, the splenic flexure alone in four, and one patient had almost total colonic involvement. All patients underwent resection of the involved colon and exteriorization with either a proximal colostomy (n = 7) or ileostomy (n = 3) and a distal mucous fistula. Pathological examination of the resected colons revealed a spectrum of changes from pericolitis through to ischaemic necrosis suggesting at least two possible mechanisms. Six patients died from overwhelming sepsis between 1 day and 4 weeks (median 11 days) after colonic resection. Severe acute pancreatitis must be recognized as a cause of colonic ischaemia and necrosis; this complication is associated with a very poor prognosis despite surgical intervention.
Appendicitis and appendicectomy in a Melanesian population
Authors: Foster H Mca , Webb S J 
Published: March 2007

Abstract
A prospective study of patients with appendicitis has been conducted over a 3-year period in the Melanesian population of the North Solomons. Patients presented with suspected appendicitis at an annual rate of 39 per 100 000 population. Appendicitis was confirmed at operation at an annual rate of 22 per 100000 population. The disease was considerably more frequent in male than in female patients. The annual appendicectomy rate was 29 per 100 000 population. Thirty per cent of patients presented with signs of late or complicated appendicitis, while 37 per cent of patients submitted to operation were found to have advanced appendicitis. The incidence and pattern of appendicitis in the North Solomons are quite different from those seen in the urbanized populations of developed countries.
Low power interstitial Nd YAG laser photocoagulation: Studies in a transplantable fibrosarcoma
Authors: Matthewson K , Barr H , Tralau C , Bown S G 
Published: March 2007

Abstract
The effects of interstitial delivery of low power (1·2-2 W), long exposure (600–1200 s) Nd YAG laser light on a transplantable fibrosarcoma in rats have been studied. Three cohorts of ten animals were treated either by 1·2 W for 600 s, 1·2 W for 1200 s or 2 W for 600 s to each tumour nodule. An additional untreated cohort served as controls and a further cohort was treated by radical surgical resection. A partial response as evidenced by ulceration was seen in all laser-treated tumours. In the cohort treated by 2 W for 600 s there was complete loss of palpable tumour, and in five out of the ten animals there was no evidence of local recurrence following a prolonged period of observation. Three of these eventually died from metastatic disease and two were cured. There was a significant prolongation of survival in this cohort compared with the controls (median 70 days versus 30 days, P &lt; 0·05), but not in any of the other cohorts. Histological assessment of tumours 2 days after laser treatment showed a central area of degeneration with shrunken and densely staining nuclei and disorganized cytoplasm, the boundary between the degenerate zone and surrounding viable tumour being well defined. The technique might be used to induce necrosis of intrahepatic and other solid organ tumours.
Reduced human peritoneal plasminogen activating activity: Possible mechanism of adhesion formation
Authors: Thompson J N , Paterson-Brown S , Harbourne T , Whawell S A , Kalodiki E , Dudley H A F 
Published: March 2007

Abstract
A unifying pathophysiological hypothesis states that the plasminogen activating activity (PAA) of the peritoneal mesothelium determines whether the fibrin which forms after peritoneal injury is either lysed or organized into permanent fibrous adhesions. The PAA of human peritoneal biopsies was measured using a fibrin plate lysis technique to assess the changes that occur in inflammation and ischaemia, conditions which both produce fibrous adhesions. Activity was found in all biopsies from normal parietal and visceral (appendix, bowel and omentum) peritoneum with no significant site-to-site variation. Inflamed peritoneum (parietal, appendicular and mesenteric) had significantly less PAA compared with normal peritoneum; visceral ischaemia also resulted in a significant decrease of PAA. These reductions in human peritoneal PAA observed in inflammation and ischaemia support the view that mesothelial PAA plays a key part in the prevention of events leading to the production of fibrous adhesions.
Fibroadenoma of the breast: A follow-up of conservative management
Authors: Wilkinson S , Anderson T J , Rifkind E , Chetty U , Forrest A P M 
Published: March 2007

Abstract
This report details the outcome after clinical diagnosis of mammary fibroadenoma in 110 women aged under 35 years. After fine needle aspiration cytology, and subsequent exclusions and failures of follow-up, 92 lesions were observed for a mean of 47 weeks (range 13–90 weeks), with regular measurements until removal of persisting lesions at 12 months. Fifteen lesions disappeared and 56 had the classical histology of fibroadenoma, mean size 2·5 cm; 30 of the latter continued to grow throughout the study. Cytology is essential to exclude malignancy if conservative treatment is considered, and is helpful in identifying a benign lesion. A period longer than 12 months may be required for resolution of a fibroadenoma and removal under local anaesthesia as a day case offers a simple alternative.
Surgical significance of non-toxic iodine-avid goitre
Authors: Kalra M , Khanna S K 
Published: March 2007

Abstract
During the period 1970–87, of 1580 patients operated on for non-toxic nodular goitre, 17 satisfied the laboratory criteria for iodine avidity. All of these goitres were non-endemic, with no evidence of enzymatic deficiency. Preoperative thyroxine markedly reduced the surgical morbidity by decreasing the size and vascularity of the gland.