bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical management of severe intractable postvagotomy diarrhoea
Authors: Cuschieri A 
Published: March 2007

Abstract
Experience with the surgical management of 23 patients with postvagotomy diarrhoea is outlined. The most common pre-operative abnormalities are rapid gastric emptying (14/23) and fast small bowel transit (23/23). Three patients were found to have steatorrhoea due to organic disease. Peptic ulcer surgery performed at a young age (x¯ = 29 years, range 21–37) appears to be the only identifiable risk factor. The results of medical treatment with bile salt binding agents were disappointing in the long term. In 10 out of 13 patients treated with antiperistaltic segments, the procedure had to be reversed because of episodes of severe postprandial colic, intestinal obstruction and bacterial overgrowth. A good result with relief of the explosive diarrhoea was obtained by the distal onlay reversed ileal graft in six out of seven patients. This procedure creates a passive non-propulsive segment, and has no undesirable sequelae. It should be considered in those patients in whom the diarrhoea is not controlled by conservative measures.
Incisional herniae following median sternotomy incisions: Their incidence and aetiology
Authors: Davidson B R , Bailey J S 
Published: March 2007

Abstract
A retrospective study was carried out of all patients undergoing cardiothoracic surgery through a median sternotomy incision under the care of a single surgical firm over an 8 year period in order to assess the incidence and aetiology of incisional epigastric herniae. Of the 582 procedures carried out, follow-up information was obtained in 475 (81·6 per cent) of which 20 (4·2 per cent) had developed incisional herniae (70 per cent of these within 3 months). Seven (35 per cent) of the herniae were symptomatic and required repair. The main predisposing factors were the male sex, the nature of surgery carried out (notably aortic valve replacement), obesity and the presence of postoperative complications of wound infection and left ventricular failure. Herniae were not found in those patients having wound closure using non-absorbable sutures.
Objective measurement by ultrasound to distinguish cyclosporin A toxicity from rejection
Authors: Parvin S D , Rees Y , Veitch P S , Bell P R F 
Published: March 2007

Abstract
Measurement of the cross-sectional area of the transplanted kidney with ultrasound has been used to differentiate between cyclosporin A toxicity and rejection both in the immediate post-transplant period and at the time of conversion from cyclosporin A to azathioprine. Of 40 patients studied 21 have been converted from cyclosporin A to azathioprine. There were 12 rejection episodes in 9 patients in the early post-transplant period, and 7 rejection episodes in 7 patients at the time of conversion from cyclosporin A to azathioprine. All of these episodes were correctly diagnosed by ultrasound. Eight episodes of drug induced toxicity in seven patients were, in all but one case, diagnosed correctly. In only 8 of the 19 rejection episodes was the diagnosis suspected clinically at the time ultrasound detected an increase in cross-sectional area.
Flap-Valve theory of anorectal continence
Authors: Bartolo D C C , Roe A M , Locke-Edmunds J C , Virjee J , Mortensen N J McC 
Published: March 2007

Abstract
The most important component of continence is considered to be the puborectalis muscle which is reputed to function by creating a flap-valve mechanism in which the anterior rectal wall occludes the upper anal canal. To elucidate this, anal and rectal pressures were measured simultaneously together with external anal sphincter and puborectalis electromyogram and synchronously superimposed on an image intensifier displaying the rectum outlined by barium. We studied 13 subjects at rest, and during a Valsalva manoeuvre. There was a significant rise in rectal and sphincter pressures (P &lt; 0·005) and external sphincter and puborectalis EMG (P &lt; 0·005). In a further 13 patients Valsalva manoeuvres were performed during proctography alone. In all subjects the anterior rectal wall was always clearly separated from the upper sphincter despite a maximal effort and a rectum filled with sufficient liquid to produce a desire to defaecate. These findings question the flap-valve theory of continence and suggest the puborectalis functions by sphincteric occlusion of the anal canal.
Alteration in colonic epithelial cell DNA associated with intestinal neoplasia: Selection of high risk patients
Authors: Matthews Joyce L , Glynn M , Parkins A , Cooke T 
Published: March 2007

Abstract
The proliferative activity of the colonic crypts of patients who are at high risk of developing colonic tumours has been assessed. Cells from the upper parts of the colonic crypts were collected at colonoscopy, and were stained for DNA by the Feulgen technique. Using a microdensitometer the DNA content of the cells was measured and a proliferative index calculated. Patients with single neoplasms had a proliferative index similar to controls although individual patients with hyperplastic mucosa could be identified. Patients with multiple neoplasms had an elevated proliferative index. These results may form the basis of a screening programme for colonic tumours.
Blood transfusion and recurrence of cancer of the colon and rectum
Authors: Francis D M A , Judson R T 
Published: March 2007

Abstract
Clinical and experimental studies indicate that transfusion of allogeneic blood has immunomodulating properties, and that the behaviour of some tumours may be influenced by the immune system of the host. Eighty-seven patients who had undergone ‘curative’ resection of cancer of the colon or rectum were studied retrospectively to determine whether blood transfusion adversely affected the rate of cancer recurrence. Fifty-three patients (61 per cent) were transfused and 34 were not. The transfused and non-transfused groups were comparable in terms of age, sex, duration of follow-up, mode of presentation, stage of disease and haemoglobin level at discharge from hospital, and differed in admission haemoglobin and distribution of tumour locations (right- or left-sided colonic or rectal tumours). Recurrent malignancy was detected in 36 per cent of transfused patients and 26 per cent of non-transfused patients (P &gt; 0·1). There was no association between the number of transfusions and recurrence for any tumour site or stage. The incidence of recurrence was significantly higher in those patients who received transfusions during surgery than in those who received transfusion either before or after surgery (χ2 = 7·01, d.f. = 1, P&gt;0·01) or no transfusions (χ2 = 4·23, d.f. = 1, P&gt;0·05). The study indicates that factors influencing the need for blood transfusion during operation had a greater bearing on prognosis than receipt of a blood transfusion per se and that future prospective studies investigating the association between transfusion and cancer recurrence need to determine accurately the indications for transfusion.
Duodenum-preserving total pancreatectomy for end stage chronic pancreatitis
Authors: Lambert M A , Linehan I P , Russell R C G 
Published: March 2007

Abstract
The classical Whipple procedure for chronic pancreatitis has been associated with significant long term postoperative morbidity. The pylorus-preserving procedure of Longmire has reduced but not eliminated the long-term morbidity. Preservation of the whole duodenum with total pancreatectomy has been introduced for the treatment of patients with end-stage chronic pancreatitis after favourable experience with this procedure in infants for nesidioblastosis. Fourteen patients with chronic pancreatitis have had a total pancreatectomy with preservation of the duodenum and the bile duct. All patients are still alive (median follow-up 9·5 months) and none suffered major complications in the perioperative period. One patient developed a biliary stricture at 3 months, requiring biliary reconstruction. Six of the patients have returned to full-time work; nine require no analgesia. All patients require pancreatic enzyme replacement, and all patients have gained weight postoperatively. Diabetic control is satisfactory with a twice daily insulin regime. Duodenum-preserving total pancreatectomy is feasible in the adult without mortality or high morbidity; early experience suggests that preserving the duodenum improves gastrointestinal function with easier control of the diabetes.
Primary sclerosing cholangitis: Biliary drainage and duct dilatation
Authors: Krige J E J , Terblanche J , Harries-Jones E P , Bornman P C 
Published: March 2007

Abstract
A further extension of the U-tube technique is described in the treatment of six patients with primary sclerosing cholangitis who developed progressive jaundice and recurrent biliary sepsis. All six patients had operative intrahepatic duct dilatation and U-tube placement. Three patients in addition had a Roux-en-Y hepaticojejunal anastomosis. Five patients are improved and are well after a median follow-up period of 56 months. Two patients have had the U-tube removed electively. Three patients with progressive disease required further percutaneous catheter dilatation of intrahepatic strictures via the U-tube tract. Application of the technique permits evaluation of the biliary system by tube cholangiography and provides access in complex cases for repeated therapeutic intrahepatic stricture dilatation.
Popliteal artery trauma: A high risk injury
Authors: Krige J E J , Spence R A J 
Published: March 2007

Abstract
The clinical presentation and management of 28 popliteal artery injuries following penetrating and blunt trauma during a 6 year period is reviewed. Clinical and Doppler evaluation identified an arterial injury in 24 (85 per cent) patients. In eight (29 per cent) patients with arteriovenous fistulae or false aneurysms, pedal pulses were palpable during initial assessment. Three (10·7 per cent) patients had limb amputation attributable to delayed vascular repair, crush injury and sepsis. End-to-end arterial repair following blunt trauma resulted in early failure with thrombosis in two patients. Autogenous vein grafting was used in 12 patients and is advocated in all blunt popliteal arterial injuries. Routine repair of associated venous injuries and liberal criteria for early fasciotomy were used. Exoskeletal fixation or skeletal traction for compound and comminuted fractures is recommended for simplicity of application and wound management. The significant functional orthopaedic disability following blunt arterial trauma at the knee is emphasized.
One hundred patients ten years after parietal cell vagotomy
Authors: Von Holstein C Staël , Graffner H , Oscarson J 
Published: March 2007

Abstract
One hundred patients with duodenal or pyloric/prepyloric ulcer disease were operated with parietal cell vagotomy (PCV) and followed for a minimum of 10 years. At 6 weeks, 1,5 and 10 years postoperatively gastric secretory tests, haematological work-up and clinical examination or telephone interview were performed. There was no operative mortality and the frequency of postoperative sequelae was minimal. The cumulative ulcer recurrence rate was 18 per cent and another 14 per cent had slight to moderate symptoms of epigastric pain without any signs of ulcer. Upper gastrointestinal endoscopy was used to reveal recurrences but was performed only if the patient had symptoms of recurrence. A rise in basal acid secretion and in pentagastrin-stimulated secretion was observed the first year postoperatively, whereas insulin-stimulated peak acid output increased during the first 5 years. We conclude that PCV has a low rate of per- and postoperative complications and an acceptable recurrence rate. Therefore, it seems that PCV is the method of choice in chronic duodenal ulcer disease.
Effect of cimetidine on prognosis after simple closure of perforated duodenal ulcer
Authors: Simpson C J , Lamont G , Macdonald I , Smith I S 
Published: March 2007

Abstract
A prospective controlled study in 60 patients undergoing simple closure of perforated duodenal ulcer demonstrated a significant (P &gt; 0·05) benefit following postoperative cimetidine treatment, in terms of avoiding subsequent dyspeptic symptoms and complications of peptic ulcer disease. Thus cimetidine is recommended in the follow-up management of perforated duodenal ulcers.
Maximal gastric secretion and duodenogastric reflux in patients with gastric or duodenal ulcer and in control subjects
Authors: Frizis H I , Whitfield P F , Hobsley M 
Published: March 2007

Abstract
Maximal gastric secretion was studied in 41 unoperated patients with gastric ulcer, 201 patients with duodenal ulcer, and 122 control subjects. The patients with a gastric ulcer were divided into high, body and prepyloric, according to the site of the ulcer. Both high and body gastric ulcers secreted significantly less than the controls, and the duodenal ulcer patients secreted significantly more. However, the patients with gastric ulcer were older and lighter than the controls and, since these factors are known to influence maximal gastric secretion, the controls and patients with duodenal ulcer were standardized to the mean weight (and age, for the controls) of the gastric ulcer group. After this standardization, there was no significant difference in secretion between the patients with body ulcers and normal controls. Pyloric loss was a similar percentage of maximal gastric secretion in all groups, but duodenogastric reflux was higher in the gastric ulcer group compared to the controls. The mean volume of duodenogastric reflux was greatest in the patients with a prepyloric gastric ulcer. It is commonly accepted that hyposecretion in patients with a gastric ulcer is due to gastritis consequent upon increased duodenogastric reflux. However, in this study, no gastric hyposecretion was evident in the body and prepyloric gastric ulcer groups, both of whom had greater than normal levels of duodenogastric reflux.
Perisplenitis and perinephritis in the Curtis–Fitz-Hugh syndrome
Authors: Gatt D , Jantet G 
Published: March 2007

Abstract
Four cases of the Curtis–Fitz-Hugh syndrome diagnosed laparoscopically and with microbiological or serological evidence of chlamydial pelvic infection are reviewed. The case histories emphasize the part played by renal angle and left upper quadrant symptoms. In one patient the surface of the spleen was affected by the same classical imflammation normally seen on the surface of the liver. In 3 patients bilateral or left-sided renal angle pain and tenderness constituted the presenting features, or a major manifestation, and in all patients renal tract investigations were entirely normal. The patient with laparoscopic perisplenitis also had perihepatitis and pelvic inflammation, the latter being florid in all cases. Perisplenitis and perinephritis are proposed as possible additional manifestations of this syndrome.
Present status of pharyngogastric anastomosis following pharyngolaryngo-oesophagectomy
Authors: Lam K H , Choi T K , Wei W I , Lau W F , Wong J 
Published: March 2007

Abstract
Pharyngolaryngo-oesophagectomy with pharyngogastric anastomosis was described more than 25 years ago. Since then it has been employed for the treatment of cancers of the hypopharynx, cervical oesophagus and larynx. Results of recent reports showed a wide variability. Our previous report of 157 such operations gave a significant morbidity and overall hospital mortality rate of 31 per cent. In the 6-year period between 1980 and 1985, 91 patients underwent this operation. The morbidity and mortality rates gradually decreased to 30 and 5 per cent respectively. Changes in the indications for the operation resulted in a reduction in the number of procedures performed in recent years. Resection of the oesophagus for cancers of the pharyngolaryngeal region is indicated only when there is actual oesophageal involvement, and would be the prime indication of pharyngogastric anastomosis.
Arrow wounds to the heart and mediastinum
Authors: Fingleton L J 
Published: March 2007

Abstract
Wooden tipped arrows are still used in tribal fighting in the Highlands of Papua New Guinea. Thirteen cases of arrow injury to the heart and mediastinum, presenting at Mt. Hagen Hospital in a 2-year period, are described. Ten cases presented early (within 3 days) while the remaining 3 cases presented late and suffered from mediastinal abscesses. Removal of the arrow, after full visualization with repair where possible, was performed in all cases with two deaths and little morbidity. Most of the 13 patients arrived in a stable condition, withstood surgery well and made a rapid recovery (average stay in hospital 20 days). Unstable presentations included 2 cases of mild shock, one with early cardiac tamponade and one case of acute aortic incompetence. Survival figures justify attempted salvage of these patients, even with the limited facilities available.
Kinetics of intra-operative pH of the canine corpus fundal mucosa before and after truncal vagotomy
Authors: Larsson J O , Hjelmquist U 
Published: March 2007

Abstract
The intra-operative surface pH of the corpus fundic mucosa in anaesthetized dogs was studied with a glass electrode during stimulation with graded doses of pentagastrin. The mucosal pH could be related to the dose of pentagastrin by a hyperbolic curve. With intact vagus ED50 averaged 0·67 µg kg−1 h−1 of pentagastrin and maximum effect corresponded to an average pH of 1·9. Immediately after truncal vagotomy there was a significant shift of the curve to the right corresponding to an average ED50 of 3·77 µg kg−1 h−1, an effect that could be described as that of a competitive inhibitor. Two weeks after vagotomy the value of ED50 had returned to the prevagotomy level. The high ED50 immediately after vagotomy is ascribed to the sudden fall in the subthreshold release of acetylcholine previously supplied by the intact vagus. The return to the low ED50 2 weeks later could be explained by denervation supersensitivity. The relation between the curves before and immediately after vagotomy suggests that the dose of the agonist be as low possible, when testing the completeness of a vagotomy intraoperatively.
Management of caustic ingestion in adults
Authors: Sarfati E , Gossot Dominique , Assens P , Celerier M 
Published: March 2007

Abstract
The treatment of 484 adults with caustic ingestion injury is discussed. Signs and symptoms are an unreliable guide to injury and a chest X-ray and fibreoptic endoscopy should be performed as soon as possible. All of the 250 patients who developed superficial lesions of the oesophagus, stomach or duodenum experienced healing without sequelae. Forty-four patients required emergency surgery of whom twenty-four died and oesophagectomy without thoracotomy is now advocated for this group, followed by interval surgery to restore continuity. The remaining 190 patients suffered gastric or oesophageal ulceration without necrosis: 92 recovered without complication, 3 succumbed to aorto-oesophageal fistula, 12 survived following delayed surgery for complications and 83 developed oesophageal and/or gastric stenosis which subsequently required endoscopic or surgical treatment.
Survival after resection for carcinoma of the oesophagus
Authors: Schattenkerk M Eeftinck , Obertop H , Mud H J , Eijkenboom W M H , Van Andel J G , Van Houten H 
Published: March 2007

Abstract
During the period 1978–1984, 525 patients referred with cancer of the oesophagus or gastro-oesophageal junction were assessed for operation and cure. After investigation, 276 patients were selected and operaten upon, as a rule, 4 weeks after radiotherapy (40 Gy/4 weeks). In 224 patients (81 per cent) the oesophagus and cardia were resected and reconstructed with stomach (69 per cent), colon (21 per cent), free ileal graft (7 per cent) or Roux-en-Y-oesophagojejunostomy (3 per cent). The postresectional hospital mortality was 14 per cent in all patients and decreased to 5 per cent in 1983. Mortality was higher when the colon was used for reconstruction than when the stomach was used. By postresection staging, 82 patients were found to have stages I and II tumours and 14. patients stage III tumours. Estimated 3-year survival after resection for all male patients was 28 per cent and for all female patients was 42 per cent. Estimated 3-year survival for all patients treated for adenocarcinoma was 31 per cent. Survival was better for stages I and II patients with adenocarcinoma (52 per cent) than for stage III patients (18 per cent) (P &lt;0·01). Estimated 3-year survival for all patients treated for squamous cell carcinoma was 33 per cent. Estimated 3-year survival was better for stages I and II patients with squamous cell carcinoma (48 per cent) than for stage III patients (25 per cent) (P &lt;0·001). It can be concluded from this study that resection of oesophagus and cardia after radiotherapy offers hope for cure in a subgroup of patients with non-advanced oesophageal cancer. The operation can be performed with acceptable mortality by experienced surgeons, especially when the stomach is used for reconstruction.
Management of traumatic rupture of the diaphragm
Authors: McCollum C , Anyanwu C H , Umeh Beatrice U O , Swarup A S 
Published: March 2007

Abstract
Traumatic rupture of the diaphragm is a potentially serious injury which presents in different forms depending on the mechanism of the causative trauma. Over a 7 year period, 20 patients (17 male and 3 female) with traumatic rupture of the diaphragm were seen in our unit; their mean age was 25·6 years. Automobile accidents caused the diaphragmatic injuries in 65 per cent of cases while falls from trees were the cause of injury in 10 per cent. Ten patients (50 per cent) were seen within 7 days of the injury and 95 per cent within 3 months. The left hemidiaphragm was ruptured in 85 per cent and the right in 15 per cent of cases. Fifty ribs were fractured in fourteen patients (70 per cent) but there were no pelvic fractures. Fourteen patients (70 per cent) had gastrointestinal visceral herniation into the thorax, the stomach, omentum, colon and spleen being the commonest herniating organs. Successful surgical repair was achieved in 18 patients, 4 of whom also had splenectomy; 2 patients were treated conservatively. A high index of suspicion and early surgical treatment are the mainstay of successful management of traumatic rupture of the diaphragm with or without herniation of abdominal organs.
Absorptive and motor function of orthotopically vascularized segmental ileal autografts
Authors: Dennison A R , Collin J , Watkins R M , Millard P R , Morris P J 
Published: March 2007

Abstract
In 24 dogs a 100 cm length of terminal ileum was autografted as an orthotopically vascularized Thiry—Vella segment. In six dogs absorption, motility and histology were studied in detail and in two intestinal myo-electrical activity was recorded. At a second operation 5 weeks after autotransplantation the Thiry—Vella segment was returned to its normal anatomical position in the intestinal stream and 2 months later all the non-transplanted intestine was resected. Eighteen grafts were technically successful. Intestinal myo-electrical activity was normal by the second day after transplantation while intestinal transit and contractile activity recovered within 10 days. Mucosal morphology and intestinal absorption had largely recovered by 10 days after grafting but absorption of oleic acid was impaired for 4 weeks. Ten dogs with severe short bowel syndrome but intact ileocaecal valve were maintained in good health for more than 7 months by a 100 cm ileal autograft.