bluuebunny/crossref_metadata_2025_split huggingface dataset:
Out-patient treatment of haemorrhoids: A randomized clinical trial to compare rubber band ligation with phenol injection
Authors: Gartell P C , Sheridan R J , McGinn F P 
Published: March 2007

Abstract
A prospective randomized clinical trial comparing rubber band ligation (RBL) with phenol injection in 269 patients with symptomatic haemorrhoids presenting to one surgical clinic over a 6 year period, has been carried out. Questionnaires were completed by 215 patients (106 RBL and 109 injection) with an average follow up of 2.75 years. A successful outcome was achieved in 89 per cent of those receiving RBL compared with 70 per cent for injection (P &lt;0.001). All symptons tended to respond more favourably to RBL, the results achieving statistical significance in patients complaining of bleeding and prolapse (P &lt;0.01 and P &lt;0.05 respectively). Complications from either technique were minimal. It is concluded that RBL is superior to phenol injection in the out-patient treatment of haemorrhoids.
Postoperative pain and pulmonary complications: Comparison of three analgesic regimens
Authors: Cuschieri R J , Morran C G , Howie J C , McArdle C S 
Published: March 2007

Abstract
In a prospective study, patients undergoing cholecystectomy were randomly allocated to receive (a) intermittent intramuscular morphine (n = 25), (b) continuous intravenous morphine infusion (n = 25) or (c) epidural bupivacaine (n = 25) for postoperative pain relief. Morphine by intravenous infusion provided comparable pain relief to intermittent intramuscular morphine; there was no significant difference in the incidence of postoperative pulmonary complications. Patients receiving epidural bupivacaine for 12 h had better analgesia than patients receiving morphine (P &lt;0.001). Arterial oxygen tensions were also significantly higher in the epidural group for the first three postoperative days (P &lt;0.05). Epidural analgesia was associated with a significant reduction in the incidence of pulmonary complications (P &lt;0.01) and chest infection (P &lt;0.05).
Treatment of malignant melanoma by fast neutrons
Authors: Blake P R , Catterall Mary , Errington R D 
Published: March 2007

Abstract
Fast neutron therapy has been used to treat 87 tumours of primary, recurrent or metastatic melanoma in 48 patients. Complete regression has been obtained in 71 percent of tumours and 91 per cent of all tumours were controlled for the remainder of the patients, lives. Median survival was 14·5 months; 30 of the 34 deaths were due to metastases. Complications arose in 22 per cent of sites and were either fibrosis, which was related to large treated areas, previous surgery or a higher than standard dose, or necrosis which was related to sites with poor circulation, such as in the lower limb. It is suggested that for the treatment of advanced local disease fast neutron therapy is more effective than X-ray treatment and has a local control rate similar to that of surgery.
The value of perioperative Doppler ankle systolic pressure measurements in reconstructive arterial surgery
Authors: Wood D J , Bishara R , Darke S G 
Published: March 2007

Abstract
This study evaluates the use of ankle systolic Doppler indices for the detection of technical errors during reconstructive surgery. Measurements taken peroperatively, following declamping, are expressed as a ratio of brachial systolic pressure and compared with pre-operative and postoperative readings. A study has been made of 377 limbs in 272 patients, including patients undergoing surgery for aneurysm, claudication and limb salvage. In the majority of patients the peroperative ratios were similar to, or improved on, pre-operative levels. No technical errors or primary failures were apparent in those patients in which this was the case. In contrast, in the 27 limbs in which a pre-operative ratio had been measurable, but no peroperative signal obtained, 21 technical errors were identified and corrected immediately. There were 16 limbs with severe ischaemia, and neither pre-operative nor peroperative signals, in which the outcome was less certain. In ten, major amputation subsequently became necessary because of inadequate run-off which was demonstrated radiologically. Finally, there were four limbs in which failure occurred postoperatively in spite of a restored peroperative signal. It is concluded that this simple technique is useful and sensitive.
Carcinoid tumours of the appendix
Authors: Anderson J R , Wilson B G 
Published: March 2007

Abstract
Appendicular carcinoid tumours in 147 patients are presented. Two patients had evidence of metastatic spread at the time of presentation. Both patients had primary tumours &lt; 2 cm in diameter. Size remains the most reliable guide to the malignant potential of these tumours. If, after simple appendicectomy, a carcinoid tumour is found with a post-formalin fixation diameter &gt; 1·5 cm then a subsequent right hemicolectomy should be considered.
Influence of rectal washout on bacterial counts in the rectal stump
Authors: Scammell B E , Phillips R P , Brown R , Burdon D W , Keighley M R B 
Published: March 2007

Abstract
Forty-three patients undergoing a restorative colorectal resection were randomized to have their rectal stump washed out with either 0·9 per cent saline, 2·5 per cent povidone—iodine or 0·3 per cent sodium hypochlorite. The bacterial counts before and after washout for Escherichia coli and Bacteroides fragilis were compared using the Mann—Whitney U test. There was no significant difference in the counts for E. coli before and after washout with saline (log 9·7–log 9·7 organisms/ml) and saline had no influence on the counts of B. fragilis (log 7·9–log 6·5 organisms/ml). Hypochlorite was associated with a significant reduction in E. coli counts (log 6·1–log 1·1 organisms/ml, P &lt; 0·005) and the counts of B. fragilis (log 8·1–log 0·0 organisms/ml, P &lt; 0·005). The counts of B. fragilis were significantly reduced by povidone—iodine (log 8·1–log 1·1 organisms/ml, P &lt; 0·005) but there was no significant reduction in counts of E. coli (log 5·6–log 5·3 organisms/ml). The data suggest that sodium hypochlorite is better than povidone—iodine or saline as a rectal washout for colorectal anastomosis.
Acral (volar—subungual) melanoma
Authors: Gutman M , Klausner J M , Inbar M , Skornick Y , Baratz M , Rozin R R 
Published: March 2007

Abstract
Acral melanoma occurs in the volar surface of the hands, feet, fingers, toes and subungual sites. Recently it has been recognized as a distinct entity with characteristic clinical and pathological features. Of our 340 patients with malignant melanoma, 24 (7 per cent) had acral melanoma. Sixteen were in the plantar skin, two in the palms and six in the nailbed. The delay in diagnosis was 6 months to 5 years and most of the patients presented with large neglected tumours. Fourteen lesions had histological features consistent with acral lentiginous melanoma — a unique pattern to this area. Fourteen patients were in clinical stage I at diagnosis, seven in stage II and three had distant metastases (stage III). The treatment was mainly surgical. Palmar—plantar lesions were widely excised. One patient underwent below-knee amputation. Lesions of the digits were treated by amputation of the affected toe. Fourteen of the patients underwent either prophylactic or therapeutic lymph node dissection. In 9 of them, regional metastases were found. In patients with advanced disease chemotherapy was added. Three patients had isolated limb perfusion. Fourteen patients died of metastatic disease within 1–5 years. Four are alive but have metastatic spread. Six patients are disease-free, one to 4·5 years following diagnosis.
Partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after Nissen fundoplication
Authors: Salo J A , Lempinen M , Kivilaakso E 
Published: March 2007

Abstract
The results of partial gastrectomy with Roux-en-Y reconstruction in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication in six patients were analysed. There were no postoperative deaths. Postoperative complications (pneumonia and atelectases, postoperative ileus) developed in three patients. The results were evaluated by clinical and endoscopic examination 1 to 3·5 years after the operation. Clear clinical and endoscopic improvement was observed in five of the six patients. In the remaining patient the procedure failed to prevent progression of the oesophagitis with development of a Barrett's oesophagus. The results suggest that a partial gastrectomy with Roux-en-Y reconstruction is an effective and safe procedure in the treatment of persistent or recurrent oesophagitis after failed Nissen fundoplication.
Management of retroperitoneal haematoma following penetrating trauma
Authors: Costa M , Robbs J V 
Published: March 2007

Abstract
Experience with the management of 106 consecutive patients found to have a retroperitoneal haematoma (RH) at laparotomy for penetrating trauma over a 2-year period is reviewed. Three types of retroperitoneal haematoma are recognized: Type I (central), Type II (flank) and Type III (pelvic). Type I RH was present in 22 patients as a result of injuries to the inferior vena cava (9), the aorta (5), the pancreas and duodenum (5), the portal vein (2), and to both aorta and inferior vena cava (1). Fourteen patients died (63·8 per cent) representing 70 per cent of all deaths in the series. Type II RH was seen in 73 patients. Thirty-two were stable and the perinephric fascia was not opened with no morbidity or mortality. Forty-one were explored: 15 on pre-operative evidence of renal injury which was confirmed at laparotomy. In the remaining 26 a stable haematoma was explored and no significant lesion found. It is considered that in 45 of 73 Type II RH (61·0 per cent) exploration was unnecessary. Five patients died (6·8 per cent). Type III RH was found in 11 patients and was due to iliac vessel injuries. Two patients died. In conclusion Type I and III RH should be routinely explored. Stable Type II RH discovered at laparotomy should be explored selectively based on pre-operative clinical and radiological assessment of renal injury.
Changes in colonic motility 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 colonic motility was studied in six mini-pigs. Motility was detected in vivo during the development of obstruction with chronically implanted Ag/AgCl electrodes using an impedance technique. When the obstruction was complete the segments of bowel were resected and spontaneous contractile activity and response to cholinergic stimulation were studied in an organ bath. Any hypermotility resulting from obstruction was shortlived and a gradual state of hypomotility supervened proximal to the obstruction. Decompression of the bowel did not result in the immediate return of motility and the resected bowel was unresponsive to carbachol. These results suggest that spontaneous resolution of large bowel obstruction is unlikely and that motility disturbances are unlikely to be a cause of anastomotic dehiscence.
Intra-operative colonic irrigation in the management of left-sided large bowel emergencies
Authors: Koruth N M , Krukowski Z H , Youngson G G , Hendry W S , Logie J R C , Jones P F , Munro A 
Published: March 2007

AbstractIn a consecutive series of 93 patients who required emergency surgery for distal colonic lesions, 61 had primary bowel resection with immediate anastomosis after intra-operative antegrade colonic irrigation. The operative mortality was 8 per cent, anastomotic leakage rate 7 per cent and superficial wound infection occurred in 3 per cent of patients. The mean hospital stay was 13 days. Of the remaining 32 patients, 3 did not have a resection and 29 had a primary resection and end colostomy without anastomosis: bowel continuity was later restored in 17 of 28 survivors (61 per cent) but 11 (39 per cent) were left with a permanent colostomy. The hospital mortality in this group was 6 per cent, superficial wound infection rate 14 per cent and the mean hospital stay 26 days. The results of this study suggest that intra-operative colonic irrigation is an effective method enabling the surgeon to perform a primary anastomosis with reasonable safety after emergency resection of selected distal colonic lesions.
The results of surgery for epidermoid carcinoma of the anus
Authors: Pyper P C , Parks T G 
Published: March 2007

Abstract
A series of 89 cases of anal carcinoma presenting over a 20-year period is reviewed. The majority were epidermoid carcinomas, 57 arising in the anal canal and 13 at the anal margin. The remainder were melanomas and basal cell carcinomas, and these were not considered further. The main presenting symptoms of epidermoid anal carcinomas were bleeding and pain. Tumours arising in the anal canal were commoner in women whilst those at the margin were more frequent in men. The majority (51/70) had a clinical diagnosis of malignancy made but in 19 cases this was not considered initially. The necessity for routine early histological diagnosis is stressed. Treatment was mainly surgical, either abdominoperineal resection (37 canal, 2 margin) or wide excision (8 canal, 11 margin). The 5 year survival of patients with anal margin tumours was better than those with canal lesions (50 per cent compared with 36 per cent).
Peculiarities of mucinous colorectal carcinoma
Authors: Umpleby H C , Ranson D L , Williamson R C N 
Published: March 2007

Abstract
The clinical and pathological features of 54 mucinous carcinomas of the large intestine were compared with those of 576 non-mucinous carcinomas. Tumours were only categorized as mucinous if they contained at least 60 per cent of mucin by volume. Those with a moderate mucin content (60–80 per cent) were indistinguishable in behaviour from ‘non-mucinous’ tumours. By contrast, those with a high mucin content (&gt; 80 per cent) showed several differences from non-mucinous cancers: they had a more proximal distribution through the large intestine, they comprised a greater fraction of cancers in the under 50 age group (24 versus 7 per cent: P &lt; 0·01), they were more likely to be Dukes' stage ‘D’ (58 versus 31 per cent: P &lt; 0·01) and local fixity was commoner (70 versus 37 per cent: P &lt; 0·001). Consequently the overall resection rate was reduced from 90 to 73 per cent (P &lt; 0·01), the curative resection rate from 69 to 42 per cent (P &lt; 0·01) and the 5-year survival rate from 37 to 18 per cent (P &lt; 0·05). Colorectal carcinomas of high mucin content require wide excision, tend to recur locally and carry a poor prognosis.
Patterns of flap recurrence following mastectomy
Authors: Blacklay P F , Campbell F C , Hinton C P , Blamey R W , Morgan D A L , Elston C W , Haybittle J L 
Published: March 2007

Abstract
Flap recurrence after mastectomy is divisible into three distinct entities: spot recurrence, multiple spot recurrence and field change. Spot recurrence and multiple spot recurrence are usually controlled by local measures and are not associated with any particular characteristics of the primary tumour. The field change type of flap recurrence is difficult to control and is associated with aggressive primary tumours (grade III, node positive, oestrogen receptor negative) and a very poor prognosis. The appearance of field change type of flap recurrence is an indication for systemic therapy.
The prediction of local or regional recurrence after simple mastectomy for operable breast cancer
Authors: Williams M R , Hinton C P , Todd J H , Morgan D A L , Elston C W , Blamey R W 
Published: March 2007

Abstract
Both the histological grade of the primary tumour and lymph node status have been found to contribute significantly towards the development of a local or regional recurrence after simple mastectomy for operable breast cancer. No other factor, from a series of seven studied, has been found to be of independent significance. A small group of patients with grade III tumours, lymph node positive at mastectomy, has been identified in whom more than 40 per cent of all symptomatic local or regional recurrences occurred. The chance a patient in this group has of developing a local or regional recurrence requiring treatment within 4 years approaches 50 per cent.
A retrospective study of male breast cancer in Holland
Authors: van Geel A N , van Slooten E A , Mavrunac M , Hart A A M 
Published: March 2007

Abstract
A retrospective study has been undertaken of 104 men with breast cancer, all of them having a follow-up period of at least 5 years. In 78 cases a histological diagnosis was obtained. The preferred treatment for operable cases was radical mastectomy, in which 60 per cent positive axillary nodes were found. Five-year survival is 54 per cent and the disease-free interval is 42 per cent. Local recurrence occurred in 26 per cent and 16 per cent had developed distant metastases. The overall results are similar to those in the literature with the exception of those for stage III who did better in this series. The generally held beliefs that Klinefelter's syndrome is the strongest predisposing factor to developing male breast cancer and that gynaecomastia is not a premalignant condition are supported by this study. Comparison of results from this series, with those of women of the same age having breast cancer leads to the conclusion that the prognosis in male breast cancer is no worse than for women with comparable disease.
Sigmoid exclusion: a new technique in the management of radiation-induced fistula
Authors: Aitken R J , Elliot M S 
Published: March 2007

Abstract
Colovesical and colovaginal fistulas following irradiation for pelvic malignancy represent a formidable surgical problem. Although complex surgical procedures to close the fistulas and restore continence have been described, often a defunctioning colostomy with an associated urinary conduit is the only feasible option. Three patients who have successfully undergone an original procedure (sigmoid exclusion) are presented. Sigmoid exclusion restores continence but avoids a permanent stoma. The involved sigmoid colon was isolated on its mesentery ensuring that the area incorporating the fistulas was not disrupted. The ends of the isolated sigmoid colon were closed and bowel continuity then restored by a colorectal or colo-anal anastomosis. Following closure of a temporary colostomy the patients were continent with no ill effects or sepsis from the excluded colon. This procedure has the dual advantage of restoring continence yet avoiding both an urinary conduit and a permanent colostomy, and represents a useful advance in the surgical management of radiation induced colonic fistulas.
Maydl's hernia: report of a series of seven cases and review of the literature
Authors: Ganesaratnam M 
Published: March 2007

Abstract
Seven cases of Maydl's herniae with two patients needing resection of bowel are presented. This condition is rare and may be lethal if unrecognized. The hernial sac contains two loops of bowel with another loop of bowel being intra-abdominal. The intra-abdominal loop of bowel may become strangulated, either alone or in combination with bowel in the hernial sac. It is more often seen in men, and predominantly on the right side. Maydl's hernia should be suspected in patients with large incarcerated herniae and in patients with evidence of intra-abdominal strangulation or peritonitis. Postural or manual reduction of the hernia is contra-indicated as it may result in non-viable bowel being missed.
Peripheral resistance measurement in the assessment of severe peripheral vascular disease
Authors: Parvin S D , Evans D H , Bell P R F 
Published: March 2007

AbstractThirty-seven patients undergoing femoropopliteal, fifteen undergoing femorodistal reconstruction and seven below knee amputees were subjected to prospective measurement of peripheral resistance. Resistance was significantly higher in the amputation and femorodistal groups than in the femoropopliteal group (P &lt; 0.03 and P &lt; 0.005 at 76 ml/min). In the femoropopliteal group patients with three vessel runoff had a significantly lower resistance than those with two or single vessel runoff (P &lt; 0.01). In the femoropopliteal group resistance of patent grafts at four months was significantly less than thrombosed grafts (P &lt; 0.006). Patients with a resistance&lt;1200 mPRU had a significantly better patency than those in whom the resistance was &gt; 1200 mPRU (P &lt; 0.05). Taking all the failed grafts there was a significant correlation between graft patency and resistance (P &lt; 0.003). Resistance measurement has been shown to correlate with the severity of the disease, with runoff defined radiographically and with graft patency. In a simplified form it may prove a useful adjunct to other methods of assessment in patients with distal disease.
Study of cardiothoracic wound infection at St. Thomas' Hospital
Authors: Farrington M , Webster Margaret , Fenn A , Phillips I 
Published: March 2007

Abstract
Wound infection occurred after 14.3 per cent of 433 open heart operations. In 309, saphenous veins were harvested for coronary artery bypass grafting (CABG) and 8.7 per cent of sternal wounds and 12.9 per cent of leg wounds were infected. Only 1.6 per cent of the remaining 124 patients who had open heart operations without leg surgery suffered sternal wound infections. In the CABG group sternal infection was theatre-related and significantly associated with length of pre-operative stay, diabetes and re-operation. Similar organisms were isolated from both leg and sternal wounds which suggest that organisms were transferred from legs to sternum with the veins. No clinically relevant cross infection was demonstrated. Skin disinfection and surgical technique seem more important than antibiotic prophylaxis in the control of these infections.
The influence of surgical operations on components of the human immune system
Authors: Lennard T W J , Shenton B K , Borzotta A , Donnelly P K , White M , Gerrie Linda M , Proud G , Taylor R M R 
Published: March 2007

Abstract
Surgical operations have been shown to cause a variety of immunological disturbances in man both in vivo and in vitro. With few exceptions the overall picture is one of a generalized state of immunodepression in the postoperative period. The implications of these observations are that host defences may be compromised by surgical procedures, thus providing a ‘fertile soil’ for bacterial invasion and tumour cell metastasis at the very time when risks from invading pathogens and viable tumour cells are maximal. We have studied the effects of surgical operations on the immune system in 35 patients with benign disease. Surgical procedures were classified as either minor (n = 15) or major (n = 20). A panel of monoclonal antibodies was used to identify peripheral blood lymphocyte subpopulations and analysis was performed using flow cytometry. Simultaneous estimations of plasma alpha-1 proteinase inhibitor (alphal-PI), alpha-2-macroglobulin (alpha-2-M), alpha-2-pregnancy-associated glycoprotein (alpha-2-PAG) and plasma suppressive activity (PSA) on stimulated allogeneic lymphocytes were performed before operation and on postoperative days 1, 3, 7, 14 and 21. Circulating numbers of all lymphocyte subpopulations fell significantly following surgery, except for B lymphocytes which did not change. The magnitude, and duration of the reduction in cell numbers and the subpopulation affected was significantly related to the degree of surgical trauma, and returned to pre-operative values by postoperative day 7. Changes in alpha-1-PI, alpha-2-M, alpha-2-PAG and PSA were also significantly related to the degree of surgical trauma, and these plasma changes persisted longer than the cellular disturbances. Surgical operations induce a reversible depression of cellular immunity which precedes plasma suppressive activity in its return to pre-operative levels. Immunostimulating agents such as interferon and the interleukins deserve evaluation as prophylactic agents pre-operatively.