bluuebunny/crossref_metadata_2025_split huggingface dataset:
Frequency of infections in cirrhotic patients presenting with acute gastrointestinal haemorrhage
Authors: Bleichner G , Boulanger R , Squara P , Sollet J P , Parent A 
Published: March 2007

Abstract
The frequency of infection at the time of admission with upper gastrointestinal haemorrhage has been determined in 149 successive cirrhotic patients admitted to an intensive care unit. Infection status was investigated by clinical examination, chest X-ray, and blood, urine and ascitic fluid culture. At initial examination infection was present in 32 patients (22 per cent) and was often in the form of septicaemia or spontaneous peritonitis; the bacteria responsible were frequently digestive in origin. At endoscopy, acute lesions of gastroduodenal mucosa were more frequent among infected patients, whereas gastro-oesophageal varices and chronic gastroduodenal ulcers were more frequent among the non-infected patients. Acute mucosal lesions were observed in 70 per cent of infected patients and in 19 per cent of non-infected patients. The mortality rate was higher in infected patients. Infection and the frequency of acute mucosal lesions were related to the severity of the cirrhosis. It is suggested that these lesions could be due to stress secondary to infection.
Occult hepatic metastases in colorectal carcinoma
Authors: Finlay I G , McArdle C S 
Published: March 2007

Abstract
Occult hepatic metastases (OHMs) were detected by ultrasound and/or CT scanning in 17 of 71 (24 per cent) patients undergoing apparently curative resection for colorectal carcinoma. One of the patients with OHMs survived 5 years; in contrast, only 5 of 54 patients without evidence of OHMs at surgery died of disseminated disease. The presence or absence of OHMs at the time of surgery predicts the majority of deaths from disseminated disease following apparently curative resection for colorectal carcinoma.
Value of Tru-cut biopsy in the diagnosis of soft tissue tumours
Authors: Kissin M W , Fisher C , Carter R L , Horton L W L , Westbury G 
Published: March 2007

Abstract
The light microscopic appearances of Tru-cut needle biopsies from 50 consecutive soft tissue tumours were assessed by three pathologists and compared with the definitive histological diagnosis. Forty-four patients had soft tissue sarcomas and six had benign soft tissue lesions. A correct predictive diagnosis of sarcoma was made on 87–98 per cent of adequate Tru-cut specimens, the accuracy varying between pathologists. Three sources of diagnostic error were recognized: false positive cores (8 per cent), false negative cores (8 per cent), and cores inadequate for diagnosis (16 per cent). The major source of confusion related to difficulties in differentiating infiltrating fibromatosis from malignant fibrous histiocytoma. The high sensitivity of Tru-cut needle biopsy suggests that it could be a valuable aid in the diagnosis of clinically suspected soft tissue sarcomas.
Natural history of patients with recurrent parotitis and punctate sialectasis
Authors: Watkin G T , Hobsley M 
Published: March 2007

Abstract
The clinical features of 68 patients (26 children and 42 adults) who suffered recurrent attacks of parotitis and in whom sialography had revealed punctate sialectasis of the affected gland is described. The sex incidence was equal in those patients in whom symptoms commenced during childhood (younger than 15). When symptoms commenced later in life, however, there was a marked preponderance of females (female:male = 7.5:1). Bilateral sialography in 16 patients with unilateral symptoms revealed punctate sialectasis in the asymptomatic gland in 11 (69 per cent) of patients. Neither the presence of the sicca syndrome nor auto-antibodies had a significant predictive value as to the outcome of the disease. Five-year follow-up of 52 patients revealed that 56 per cent of adults and 64 per cent of children had shown spontaneous improvement of symptoms with symptomatic treatment alone. In 40 per cent of adults and 4 per cent of children, however, the persistence or worsening of symptoms necessitated parotidectomy. We believe that these results of conservative management indicate that, at least in the first instance and particularly in children, conservative management is justified and that the use of radiotherapy or steroids (with their attendant morbidity) is unnecessary.
Influence of endoscopic papillotomy on the management of bile duct stones
Authors: Thompson M H 
Published: March 2007

Abstract
In a 4 year period two hundred and seventy-nine patients were treated for gallstones in a single surgical unit. One hundred and thirteen were treated for stones in the bile duct, of them 49 patients were treated surgically and 64 endoscopically. Twenty-three patients had papillotomy without previous cholecystectomy. There were two deaths, both after surgery following failure of endoscopic treatment. Morbidity was greater in the surgically treated group. It is concluded that a large proportion of patients with bile duct stones can be treated by endoscopic papillotomy.
The 15-minute dumping provocation test
Authors: Linehan I P , Weiman J , Hobsley M 
Published: March 2007

Abstract
Following gastric surgery, the diagnosis of the dumping syndrome (DS) has never been precise. The importance of diagnosis is not only in deciding management, but also in comparing series of incidences. The mainstay of diagnosis has been the gastric emptying and dumping provocation test (DPT); however it requires expensive equipment and the interpretation of the results is subjective and therefore variable. In 38 DPTs the percentage plasma volume and pulse rate changes, 15 min after the ingestion of 150 ml of hypertonic glucose, were expressed as percentages of the maximum values encountered and summed to form a score. The tests were independently interpreted by the authors and where they disagreed the result was defined as equivocal. The score was used with the symptoms provoked to follow a simple algorithm to divide the patients into those with and those without DS. There were six suffering from DS on our current interpretation; the new method identified all of these. Three tests were positive on the scoring scheme only and on review the interpreters agreed that all of these patients were suffering from the dumping syndrome. An accurate test using only the baseline and 15 min samples is simple, cheap and has definite rules of interpretation; the only laboratory measurement needed is the haematocrit estimation of three blood samples.
Post-Mastectomy breast reconstruction using the inflatable tissue expander
Authors: Chisholm E M , Marr Sheelagh , Macfie J , Broughton A C , Brennan T G 
Published: March 2007

Abstract
Breast reconstruction following mastectomy has previously relied on the insertion of a silicone gel implant or the use of a myocutaneous flap. We report the use of an innovation, the inflatable tissue expander, for both immediate and delayed breast reconstruction in 26 patients where soft tissue cover was inadequate to permit the use of the silicone implant. By serial inflation of the tissue expander with saline, sufficient tissue cover was achieved for a second operative placement of a silicone prosthesis of appropriate volume to match the normal breast. To date, 10 patients undergoing delayed reconstruction and 5 of 16 patients with immediate reconstruction have had their final prosthesis inserted, while 3 women are satisfied with the result of the expandable implant and desire no further surgery. Only two technical complications have arisen with loss of the expander in one patient who had had recent radiotherapy and in another the tissue expander was placed much too high on the chest wall. Mechanical failure occurred in three cases where disruption of the seam led to sudden deflation in two and a slow leak from the injection port developed in one. One patient also attempted self-inflation leading to deflation of the tissue expander. The cosmetic results were subjectively and objectively very good with capsular distortion present in only one case. We feel that the inflatable tissue expander is simple and safe to use, may be used for immediate reconstruction without compromising the ablative surgery and should be a choice available to general surgeons for providing safe and cosmetically acceptable reconstructive surgery.
Pattern of spread of bloodborne tumour
Authors: Murphy P , Alexander P , Kirkham N , Fleming J , Taylor I 
Published: March 2007

Abstract
The pattern of bloodborne tumour spread has been studied experimentally in syngeneic rats. A variety of tumour types has been injected intravenously, intraportally and also intra-arterially via the left ventricle. Tumour cell arrest as a factor in the localization of metastases in the lung following intravenous injection of cells, and in the liver following intraportal injection, is emphasized. Once tumour cells have entered the arterial circulation they disseminate to almost all organs in similar proportions to the distribution of cardiac output. The dissemination and arrest of cells is not found to correlate with the later distribution of metastases. For example, certain organs (especially the adrenals) which receive only low fractions of injected cells, are always preferred sites for bloodborne metastasis. A strikingly similar pattern of ‘arterial metastasis’ is also seen for all the tumours used despite their very different histological and biological natures.
Impaired spermatogenesis in testes at risk of torsion
Authors: Anderson J B , Cooper M J , Thomas W E G , Williamson R C N 
Published: March 2007

Abstract
The oligospermia observed after unilateral torsion of the spermatic cord could reflect immunological damage to the opposite testis. An alternative explanation, that there may be a pre-existing defect in spermatogenesis, was tested in 20 post-pubertal males with acute torsion. In a prospective study the contralateral testis was biopsied at operation and the histological appearances were related to subsequent testicular function as assessed by seminal analysis 3 months later. Thirteen patients had biopsy evidence of partial maturation arrest in spermatogenesis which was either mild (6), moderate (4) or severe (3), and ten of these were oligospermic (&lt; 20 × 106/ml). By contrast all seven patients with normal histology had a sperm concentration gt; 25 × 106/ml. Histological grading of spermatogenesis by the Johnsen technique gave a higher score in patients with a normal biopsy (median 9·01, semi-quartile range 8·96–9·21) than in those with abnormal histology (median 8·28, semi-quartile range 7·98–8·45, P &lt; 0·001) and correlated with the log of the sperm concentration 3 months later (r = 0·79, P &lt; 0·001). There was minimal anti-sperm and no anti-testis antibody formation following torsion. Serum FSH levels were raised in 6 of 10 oligospermic patients, while all those with a normal sperm count had FSH concentrations within the normal range. Thus many patients who develop testicular torsion have an underlying defect in spermatogenesis, which correlates closely with poor postoperative exocrine function.
Successful autotransplantation of isolated islets of Langerhans in the cynomolgus monkey
Authors: Gray D W R , Warnock G L , Sutton R , Peters M , McShane P , Morris P J 
Published: March 2007

Abstract
A recently described method for isolation of islets of Langerhans from the human pancreas has been adapted to the cynomolgus monkey pancreas. The mean yield of islets obtained from 13 monkey pancreata was 1319 islets per gram of pancreatic tissue (range 533–1800) and the usual purity of the preparation varied from 5 to 15 per cent islet tissue. Twelve cynomolgus monkeys underwent total pancreatectomy, preparation of islets from the excised pancreas and autotransplantation to either the spleen or the liver. Three animals received no transplant and became immediately diabetic, surviving 4–8 days. Four animals became normoglycaemic after intrasplenic islet transplantation, and survived 6 weeks, at which time splenectomy was performed with immediate onset of diabetes. Splenic vein insulin sampling confirmed the spleen as the source of insulin, and histological examination showed implanted islet tissue in all cases. Five animals became normoglycaemic after intrahepatic islet implantation. Three animals subsequently became diabetic at 4 and 5 months and two animals still have functioning grafts, the longest function being 9 months. These results suggest that in the cynomolgus monkey sufficient islets can be extracted from a single donor pancreas to reverse diabetes.
Oxygen inhalation induced changes in the skin as measured by transcutaneous oxymetry
Authors: McCollum P T , Spence V A , Walker W F 
Published: March 2007

Abstract
Transcutaneous oxygen (P tcO2) measurements were made on 46 patients with severe ischaemia of the lower limbs and on 17 age-matched controls. Values breathing air, 100 per cent oxygen and the rate of change of P tcO2 breathing oxygen were recorded. Of 29 below knee amputations there were 4 failures; 16 had P tcO2 values &lt; 35 mmHg, but 12 of the 16 healed. When the rate of change of P tcO2 during oxygen inhalation was greater than 9 mmHg/min all below knee amputations healed; all 4 failures were found to have values &lt; 9 mmHg/min while only one patient with a value of &lt; 9 mmHg/min healed a below knee amputation. This study shows that low P tcO2 values are a poor indication of healing potential. A more reliable index of skin viability is provided by the dynamic measurement PtcO2 changes during oxygen inhalation. The addition of an oxygen inhalation test, when making P tcO2 measurements, greatly enhances the applicability of the technique in the assessment of the oxygen supply to the skin.
Venous muscle pump function in patients with primary lymphoedema: Assessment by ambulatory strain gauge plethysmography
Authors: Struckmann J , Strange-Vognsen H H , Andersen J , Hauch O 
Published: March 2007

Abstract
The musculovenous pump function was assessed by ambulatory strain gauge plethysmography in 11 patients with primary lymphoedema. The venous function was within the normal range regarding both venous reflux and expelled volume. The values were compared with ten patients with chronic venous insufficiency and oedema. The values for venous function were clearly abnormal for the patients with venous insufficiency and different from those with primary lymphoedema. Ambulatory strain gauge plethysmography may be a useful non-invasive method in distinguishing between oedema of lymphatic or venous origin.
Admission guidelines for head injuries: Variance with clinical practice in accident and emergency units in the UK
Authors: Fowkes F G R , Ennis W P , Evans R C , Roberts C J , Williams L A 
Published: March 2007

Abstract
Guidelines for the initial management of head injuries were formulated by neurosurgeons and a multidisciplinary group of clinicians and administrators attending a seminar convened by the UK Department of Health and Social Security (DHSS). Analysis of data collected previously by the Royal College of Radiologists in nine accident and emergency units in the UK shows that admitting practice varied between centres and was very different from that recommended subsequently in the guidelines. Only 49 per cent (range 22 to 71 per cent) of patients who had skull X-rays and possessed symptoms and signs warranting admission were admitted to hospital and 14 per cent (range 1 to 20 per cent) of those without appropriate symptoms and signs were admitted. Rates of admission for patients with a history of unconsciousness, which according to the guidelines is not a criterion for admission, were up to ten-fold higher than for comparable patients with no such history. Implementation of the guidelines could have a substantial effect on clinical practice and could reduce admissions of patients who had skull X-rays by up to 46 per cent.
Refashioning of phallus stumps and phalloplasty in the treatment of carcinoma of the penis
Authors: Parkash S , Ananthakrishnan N , Roy P 
Published: March 2007

Abstract
The surgical management of 41 patients with carcinoma of the penis is presented. Conservative surgery in the form of a circumcision or a glansplasty was done in eight patients with one recurrence. Circumcision as an adequate procedure is advocated for lesions near the apex of the preputial sac permitting a 2 cm clearance; glansplasty after local excision requires further evaluation. The details of technique of lengthening and refashioning of the residual phallic stump after partial amputation in a further 20 patients is described using a technique which leaves a satisfactory penile stump in patients who would normally be candidates for a total amputation. In a third group of patients requiring a total amputation of penis, reconstruction was done in two stages using scrotal flaps in four with satisfactory results. The reconstructed phallus was adequate as a urinary conduit but was unsuitable for sexual function. A one stage procedure involving covering of the urethra with scrotal flaps appears an attractive alternative to the staged procedure. Conventional multistage reconstructions are not recommended.
Morbidity, mortality and local recurrence following regional node dissection for melanoma
Authors: Bowsher W G , Taylor B A , Hughes L E 
Published: March 2007

Abstract
Eighty-six patients who underwent regional node dissection (RND) for melanoma were reviewed with respect to short and long term postoperative morbidity, mortality and local recurrence rate. Twenty-eight per cent of dissections were prophylactic and seventy-two per cent therapeutic. There were significant wound related complications which tended to delay hospital discharge, in particular following axillary and groin dissections, but symptomatic long term complications were infrequent. The postoperative mortality rate was 1·2 per cent. Local recurrence in RND scars was particularly common in the neck (33 per cent). RND for melanoma is a safe procedure, with significant short term but relatively little long term morbidity. Both recurrence and morbidity should be borne in mind when considering patients for prophylactic RND. Surgeons should be prepared to use axial or myocutaneous flaps where extensive skin resection is necessary. A controlled trial of prophylactic antibiotics would be useful to try to reduce the incidence of wound infection.
Enteric bacteriology, absorption, morphology and emptying after ileal pouch–anal anastomosis
Authors: O'Connell P R , Rankin D R , Weiland L H , Kelly K A 
Published: March 2007

AbstractThe aim was to determine whether changes in enteric bacteriology, absorption, morphology, and emptying occur after ileal pouch–anal anastomosis for ulcerative colitis, and to relate any changes to the clinical result. Twenty patients were studied 26 ± 2 months (mean ± s.e.m.) after operation. Eight patients had a good result, six a poor result, and six a history of recurrent pouch ileitis. Anaerobic and aerobic overgrowth occurred in the jejunum of patients with a poor result, but not in those with a good result or with pouch ileitis. In contrast, ileal pouch bacterial overgrowth occurred in all patients regardless of the clinical result. Patients with jejunal overgrowth had increased 24 h stool volume and stool nitrogen, but other patients did not. The larger the stool volume, the greater the anaerobic overgrowth. Pouch biopsies showed chronic inflammation in all patients, while 45 per cent had colonic metaplasia. Neither the inflammation nor the metaplasia correlated with the clinical result, nor did the clinical result correlate with the efficiency of pouch emptying. In conclusion, jejunal bacterial overgrowth after ileal pouch–anal anastomosis was associated with an increased stool output, azotorrhoea, and a poor clinical result. A distinguishing bacterial, absorptive, morphological, or emptying abnormality was not found in patients with a history of recurrent pouch ileitis.
Internal sphincterotomy for chronic anal fissure: Long term effects on anal pressure
Authors: Chowcat N L , Araujo J G C , Boulos P B 
Published: March 2007

Abstract
In 28 patients with chronic anal fissure the median anal canal pressure was 98 cmH2O, significantly higher than in control subjects (P &lt; 0·001). After lateral internal sphincterotomy the pressure dropped by 50 per cent to normal levels and the fissures healed with no change in pressure over 12 months. Ten patients also had normal anal pressures and were asymptomatic 4–6 years after internal sphincterotomy. Adequate internal sphincterotomy appears to reduce permanently anal canal pressure, suggesting that abnormal activity in the sphincter contributes to the development of a fissure.
Blind total gastrectomy for massive bleeding from the stomach
Authors: Primrose J N , Gledhill T , Quirke P , Johnston D 
Published: March 2007

Abstract
The source of massive haemorrhage from the stomach cannot always be identified even with the use of fibreoptic endoscopy and angiography. Six patients with massive, continuing, non-variceal haemorrhage from the stomach are described in whom total gastrectomy was eventually required. Three patients were shown to have bled from submucosal arteriovenous malformations, two from erosive gastritis and one from a vessel in an ulcer at the oesophagogastric junction. One patient died as a result of surgery and another died later of disseminated malignant disease. The functional results in the remaining patients were surprisingly good and rebleeding has not occurred. Total gastrectomy is a satisfactory ‘last resort’ treatement for life-threatening gastric haemorrhage for which no cause can be found.
Endoscopic treatment of inoperable colorectal cancers with the Nd YAG laser
Authors: Bown S G , Barr H , Matthewson K , Hawes R , Swain C P , Clark C G , Boulos P B 
Published: March 2007

Abstract
Seventeen patients with cancers of the rectum or distal sigmoid and considered inoperable because of old age, severe concomitant disease or advanced stage of malignancy, were treated endoscopically with the Nd YAG laser. Symptoms included rectal bleeding, obstruction, diarrhoea and incontinence. Significant improvement was achieved in 15 (88 per cent) and there were no complications. The procedure was carried out with simple bowel preparation and minimal sedation and, for otherwise fit individuals, the mean total hospital stay was 6·8 days, with day case therapy sometimes possible. Three patients required further therapy for recurrent symptoms 6–8 weeks after treatment. Fourteen patients died 1–39 weeks after therapy (mean survival 15 weeks). Three are alive and free of bowel symptoms after 39–54 weeks. This technique is the only non-surgical therapy that can be used safely for lesions above the peritoneal reflection and provides palliation at least as good as electrocoagulation, cryotherapy and radiotherapy with minimal upset to these seriously ill patients.
Re-routing procedures for ectopic anus in the adult
Authors: Keighley M R B 
Published: March 2007

Abstract
Four cases of adult ectopic anus are described. All patients presented with incontinence; in two there was a history of constipation. Electromyography correctly identified the site of the anal sphincters pre-operatively. The anorectum was mobilized and re-routed through the sphincter ring with repair of the perineal body. There was improvement in anal canal pressures on voluntary contraction after operation in all three cases studied. Continence was restored in three patients but results were poor in one patient because of persistent constipation. Severe constipation may be a contra-indication to this procedure.