bluuebunny/crossref_metadata_2025_split huggingface dataset:
Review of a hospital experience of breast abscesses
Authors: Scholefield J H , Duncan J L , Rogers K 
Published: March 2007

AbstractA retrospective review of breast abscesses during a 10-year period was performed. Only 8.5 per cent (6/72) of patients were in the puerperium. Peripherally sited abscesses were predominantly staphylococcal in origin, incision and drainage was effective treatment in all. By contrast, a subareolar abscess yielded a higher proportion of anaerobic bacteria and 46 per cent (13/28) of these patients had duct ectasia. We conclude that in present day practice a breast abscess is more likely to be related to duct ectasia than to the puerperium, and that patients with anaerobic infection or subareolar abscesses should be assumed to have duct ectasia and may require excision of the major duct system (Hadfield's procedure).
Digital ischaemia and palpable pedal pulses
Authors: Comerford J A , Broe P J , Wilson I A , Bouchier-Hayes D J 
Published: March 2007

Abstract
Digital ischaemia in the presence of an otherwise well-perfused foot in the non-diabetic patient presents diagnostic problems especially as the manifestations are frequently evanescent. Eighty such patients (sixty men and twenty women aged 55–84 years) who presented to St. Laurence's Hospital from 1982 to 1985 inclusive were evaluated. Micro-embolization was inferred from the demonstration of a cardiac (20) or an arterial source (42) in 62 of 80 patients. In 14 of the remaining 18 patients a malignancy was diagnosed, which was found to be visceral cancer in 11 cases. Indium platelet scanning revealed platelet aggregation in 14 of 26 patients examined. Laboratory evidence of abnormalities of platelet aggregation or blood coagulation was found in only 6 patients. There have been no further symptoms in 37 patients who have been treated surgically or in 17 of 21 patients who have been treated with either anticoagulation or antiplatelet therapy.
Asymptomatic carotid murmur: Ultrasonic factors influencing outcome
Authors: Aldoori M I , Benveniste G L , Baird R N , Horrocks M , Fairgrieve J 
Published: March 2007

Abstract
Sixty consecutive patients with an asymptomatic mid-cervical murmur on auscultation were identified amongst 1000 patients who underwent duplex scanning of the extracranial carotid arteries during 1981-83. They were classified according to the scan results into 12 high risk subjects with &gt; 75 per cent stenosis of an internal carotid artery, 37 low risk subjects with a &lt; 75 per cent stenosis and 6 with no detectable stenosis. The mean duration of follow-up was 3 years (minimum 2 years) or until stroke or death. One was lost to follow-up and four were excluded having undergone carotid endarterectomy during the study. Six of twelve subjects with &gt; 75 per cent stenosis suffered a stroke (five fatal and one non-fatal). There were no premonitory signs except in one patient with non-focal cerebral ischaemia for 2 months before an hemispheric stroke. There was one fatal stroke in the &lt; 75 per cent stenosis group and none in the control group. In all, 17 (28 per cent) patients died (myocardial infarction, 8; stroke, 6; malignant disease, 3). These results confirm that asymptomatic carotid murmurs are associated with increased mortality with most having non-severe carotid disease on duplex scanning and few strokes during follow-up. There is an important minority with tight carotid stenosis who carry a worrying risk of stroke if left untreated.
Effect of pre-operative blood transfusion on tumour metastases
Authors: Clarke Patricia J , Tarin D 
Published: March 2007

Abstract
The effects of allogeneic blood transfusion on the subcutaneous growth and metastatic spread of two types of mouse tumour (B16 melanoma syngeneic to the C57/BL6 mouse and UV-2237 fibrosarcoma syngeneic to the C3H/He mouse) were studied. The growth rates of the primary tumour were not altered by transfusing the animals with allogeneic blood 14 days before tumour inoculation, but spontaneous metastasis from tumours formed at the inoculation site was augmented and accelerated for both tumour types. This effect was dependent on the strain of the blood donor, metastases of B16 melanoma being augmented by transfusion with blood from Balb/c animals, and UV-2237 fibrosarcoma by transfusion with C57/BL6 blood, but not by blood from other donor strains tested.
Inhibition of intestinal carcinogenesis by dietary supplementation with calcium
Authors: Appleton G V N , Davies P W , Bristol J B , Williamson R C N 
Published: March 2007

Abstract
Dietary supplementation with calcium reduces colonic crypt cell production rates in both normal and hyperplastic mucosa. Calcium can bind intraluminally with bile salts and fatty acids thus reducing their mitogenic effect. The protective role of oral calcium on intestinal carcinogenesis (induced by azoxymethane) was tested in 60 male Sprague-Dawley rats submitted to either 80 per cent mid jejuno-ileal resection (n = 30) or jejunal transection (n = 30). Half the rats in each group received calcium lactate 24 g/l added to their drinking water. Rats were killed 25-27 weeks postoperatively. Enterectomy increased colonic tumour yield by 60–106 per cent (P = 0·002–0·005) and duodenal tumour yield by 70–86 per cent. Calcium abolished this effect at both sites, halving intestinal tumour yields in rats with both transection and resection (P&lt;0.05). Doubling the dietary intake of calcium inhibits experimental carcinogenesis.
New approach in the management of oesophageal varices
Authors: Ono J , Katsuki T , Kodama Y 
Published: March 2007

Abstract
Combined therapy consisting of sclerotherapy, embolization and splenopneumopexy was established for the treatment of oesophageal varices. These procedures were safely performed in 16 patients. No serious complications and no recurrent bleeding have been observed. The varices disappeared or were significantly improved as determined by periodic endoscopic evaluations. Portopulomonary shunt by splenopneumopexy is an alternative technique in the eradication of varices following sclerotheraphy.
Treatment of postoperative gastrointestinal atony
Authors: Verlinden M , Michiels G , Boghaert A , de Coster M , Dehertog P 
Published: March 2007

Abstract
One hundred and eighteen patients in whom postoperative gastrointestinal atony had lasted for 48–72 hours, were given one or two intravenous injections of different doses of cisapride (2, 4 or 8mg), or vehicle. The first occurrence of flatus was taken to mark the cessation of ileus. There was no significant difference in remission of ileus between the groups in the first hour following injection. All patients not responding to treatment in the first hour were given a repeat dosage and observed for the following 3 hours. Among this group, there was a significant remission of ileus in patients who had received 2 × 8 mg, which was particularly marked in those who had undergone intraperitoneal surgery. This study suggests that cisapride in repeated dosage may be of value in inducing remission in prolonged surgical ileus, particularly in patients who have undergone intraperitoneal operations.
Accuracy of identification of early gastric cancer
Authors: Ballantyne K C , Morris D L , Jones J A , Gregson R H , Hardcastle J D 
Published: March 2007

Abstract
Two hundred and nineteen patients underwent gastrectomy for cancer in Nottingham University Hospital between January 1978 and December 1985. Twenty of these patients had early gastric cancer (EGC). Barium meal was performed in 15 patients and upper gastrointestinal endoscopy in 15. In all cases, barium meal failed to define the early nature of this disease. Only two lesions were thought to be EGC endoscopically and at laparotomy three were considered to be EGC. As neither radiologist, endoscopist nor surgeon can reliably identify EGC, all patients with gastric cancer in the absence of proven metastases should undergo gastrectomy.
Prospective randomized controlled trial of urethral versus suprapubic catheterization
Authors: Sethia K K , Selkon J B , Berry A R , Turner Christine M , Kettlewell M G , Gough M H 
Published: March 2007

Abstract
Sixty-six patients requiring catheterization in the course of general surgical operations were randomly allocated into two groups. Of the 34 patients catheterized urethrally 16 developed urinary tract infections whereas of the 32 suprapubically catheterized patients only 2 developed an infection (P&lt;0.001). Five patients required recatheterization after removal of their urethral catheters. There were no major complications associated with the use of suprapubic catheters. We propose that, when catheterization is required during a general surgical procedure, the suprapubic route is to be preferred.
Neural control of internal anal sphincter function
Authors: Lubowski D Z , Nicholls R J , Swash M , Jordan M J 
Published: March 2007

Abstract
The effect on anal tone of electrical stimulation of the presacral (hypogastric) sympathetic nerves has been studied in eight patients during abdominal rectopexy or restorative proctocolectomy. A sharp fall in anal pressure occurred in seven patients (mean fall 59 cmH2O; range 35-80 cmH2O). In one patient given a β- and α-sympathetic blocking drug (labetalol 200 mg) intra-operatively, the anal pressure decreased by 15 cmH2O. These observations show that stimulation of the presacral sympathetic nerves causes relaxation of the internal anal sphincter and implies that these nerves may induce relaxation of the sphincter in vivo. The pathway of the recto-anal reflex has been studied intra-operatively in three patients undergoing rectal excision. The recto-anal reflex is present after presacral nerve blockade and after full mobilization of the rectum, but is abolished by circumferential rectal myotomy. The reflex has a local intramural pathway. This observation validates the assumption that absence of this reflex is a feature of aganglionosis, as in Hirschsprung's disease.
Unaltered risk of colorectal cancer within 14–17 years of cholecystectomy: Updating of a population-based cohort study
Authors: Adami H-O , Krusemo Ulla B , Meirik O 
Published: March 2007

Abstract
The incidence of colorectal cancer after cholecystectomy was analysed in a historical population-based cohort study comprising 16439 patients who were completely followed up for 14-17 years after operation. The observed number of colorectal cancers (150) was lower than the expected number of 166·3 (relative risk (RR) = 0·90:95 percent confidence limits 0·77-1·05) and the overall risk for colon cancer (RR = 0·95) did not differ significantly from that of rectal cancer (RR = 0·82). Separate analyses by sex, age at operation and duration of follow-up revealed relative risks close to or lower than unity. Some deviations indicating a substantially reduced risk might have been due to the play of chance alone. Our results contradict the idea both of a causal and of a non-causal association—through common aetiological factors—between surgically confirmed gallbladder disease and colorectal cancer.
Natural history of anterior mucosal prolapse
Authors: Allen-Mersh T G , Henry M M , Nicholls R J 
Published: March 2007

Abstract
Case notes of 250 patients (M:F, 1:2·7; age 48·7±16·5 years) in whom anterior mucosal prolapse had been diagnosed, at one hospital between 1974 and 1976, were reviewed. The commonest symptoms were bleeding (56 per cent), pain (32 per cent) and a sense of prolapse (32 per cent). The prevalence of constipation was significantly higher among women (47 per cent) than men (29 per cent). Perineal descent was present in 20 per cent of cases and was significantly more frequently associated with excessive straining at defaecation (28 per cent) compared with patients in whom there was no history of excessive straining (12 per cent). Sixty-six patients (26 per cent) experienced recurring symptoms over the 10 year period following presentation but did not deteriorate, while 28 patients (11 per cent) deteriorated. Deterioration was associated with a history of symptoms for longer than 1 year at the time of presentation, female sex, and the presence of perineal descent on clinical examination. The risk of developing perineal descent was &lt; 10 per cent over the 5 years after presentation while that of developing sphincter laxity among patients who had already developed perineal descent was 30 per cent over this period. Complete rectal prolapse occurred in 20 per cent (3/15) of patients with clinical perineal descent and sphincter laxity but was not seen in the absence of these signs. The results of treatment by submucosal phenol injection, mucosal rubber banding, or glycerine suppositories were the same.
Role of computed tomography in selecting patients for hindquarter amputation
Authors: Watkins R M , Thomas J Meirion 
Published: March 2007

Abstract
Nine patients with soft tissue sarcomas close to the pelvic girdle and one patient with a primary malignant bone tumour of the pelvis were referred for consideration of hindquarter amputation. Patients were considered unsuitable for hindquarter amputation on clinical grounds if malignant disease infiltrated into the perineum or across the sacro-iliac joint. If disease in the femoral triangle extended above the inguinal ligament the tumour's operability was seriously questioned. Buttock tumours which had passed through the greater sciatic notch to become palpable on pelvic examination were also considered likely to be inoperable. On computed tomographic (CT) examination, tumours were considered inoperable if the psoas muscle was involved above the inguinal ligament, or if malignant disease involved the sacro-iliac joint, sacrum or perineal structures. Soft tissue tumours of the buttock extending significantly through the greater sciatic notch were also considered likely to be inoperable. Five patients thought suitable for hindquarter amputation on clinical assessment had no excluding features on CT; four undergoing hindquarter amputation were proven on histological examination to have good clearance of their tumours. In another patient, considered suitable for hindquarter amputation on clinical grounds, CT suggested that en bloc wide excision of the tumour was feasible enabling the affected limb to be preserved. Four patients after clinical examination were considered unsuitable for hindquarter amputation and in all cases inoperability was confirmed by CT. CT complements clinical examination and provides an objective and reliable means of selecting patients for hindquarter amputation which should avoid unnecessary surgical exploration.
Natural history and surgical management of radiation enteritis
Authors: Galland R B , Spencer J 
Published: March 2007

Abstract
Radiation enteritis is an increasing problem. The effect of ionizing radiation is due to a direct effect on proliferating cells and due to a progressive obliterative vasculitis. Predisposing factors include the dose of radiation, combination with chemotherapy, previous operations and vascular disease. Management is related to the stage of disease at presentation, and tailored to the clinical problem. Surgical management must take into account the poor healing associated with irradiated intestine.
Adhesion obstruction following Nissen fundoplication in children
Authors: Wilkins Barbara M , Spitz L 
Published: March 2007

Abstract
The incidence of postoperative adhesion intestinal obstruction among 156 children who had undergone Nissen fundoplication for intractable gastro-oesophageal reflux was determined. There were 18 episodes of obstruction in 16 patients (10·3 per cent). The mean interval between fundoplication and adhesion obstruction was 10 months (range 10 days-4 years). Additional procedures performed at the original laparotomy substantially increased the risk of developing obstruction. Re-laparotomy for adhesion obstruction was required by 21 per cent of patients who had a Ladd's procedure and 12 per cent who had appendicectomy. Presenting symptoms were not typical of intestinal obstruction because many of these children were unable to vomit. Only three did vomit but all had radiological appearances suggestive of small bowel obstruction. There were two deaths directly related to adhesion obstruction.
Outcome of surgery for Graves' disease re-examined
Authors: Cusick Eleri L , Krukowski Z H , Matheson N A 
Published: March 2007

Abstract
The outcome of surgery for Graves' disease in terms of early and late morbidity was studied in 161 patients undergoing subtotal thyroidectomy in the 10-year period 1976–1985. Eighty of these patients had a minimum follow-up of 5 years. There was a low operative morbidity and a zero mortality. The weight of thyroid tissue preserved (in the range 5–10 g) influenced the prevalence of hypothyroidism at one year and at five years. There was a cumulative incidence of hypothyroidism which could not be reliably predicted from biochemical results during the first year. Over 60 per cent of patients with subclinical hypothyroidism at 4 months (63 per cent) or 1 year (70 per cent) did not subsequently need thyroxine replacement within 5 years. Patients remained at risk of developing recurrent toxicity indefinitely and the risk was significantly greater in patients with small goitres (&lt; 50 g). Our results may be improved by leaving larger remnants (9–10 g) in most patients and smaller remnants (2–4 g) in those with small glands in whom alternative treatment, which is to be preferred, is not acceptable. After subtotal thyroidectomy for Graves' disease lifelong follow-up is necessary.
Conservative management of bleeding duodenal ulcer without a visible vessel: Prospective randomized trial
Authors: Saperas E , Piqué J M , Ayuso R Pérez , Bordas J M , Terés J , Pera C 
Published: March 2007

Abstract
Between January 1983 and December 1985, 305 patients were admitted to our hospital because of bleeding duodenal ulcer. A subgroup of 69 patients aged 50 or above in whom emergency endoscopy showed non-arterial bleeding or signs of recent haemorrhage without a visible vessel entered a prospective therapeutic trial. The patients were randomized to receive either (1) early surgery, implying immediate operation, or (2) expectant management, with surgery reserved only for patients with further haemorrhage. The two groups were homogeneous with respect to age, sex, prior ingestion of ulcerogenic drugs, mode of bleeding, admission haematocrit, number with hypovolaemic shock and number with active bleeding on initial endoscopy. Overall mortality was 8·6 per cent. Mortality in patients submitted to early surgery was five times higher than that in those allocated to expectant therapy (14·7 per cent versus 2·9 per cent; risk ratio 5·07). The results suggest that expectant management is advisable in patients with bleeding duodenal ulcer not bleeding massively and in whom endoscopy does not disclose spurting arterial bleeding or a visible vessel.
Surgical treatment of pancreatic pseudocysts
Authors: Köhler H , Schafmayer A , Lüdtke F E , Lepsien G , Peiper H-J 
Published: March 2007

Abstract
Between 1966 and 1980, 54 patients (40 men and 14 women) with a mean age of 38 years were operated on for a pancreatic pseudocyst at the Department of General Surgery, University of Göttingen. The aetiology of the cysts was alcohol abuse in 35 patients, biliary diseases in 8, blunt abdominal trauma in 4, virus-induced in 2 and unknown in 5. With the exception of those who had had trauma, all patients were suffering from chronic pancreatitis. Surgical therapy included in all cases a cystojejunostomy (52 with a Roux-Y-limb and 2 with an omega loop). The mean follow-up period was 13 years (range 6 to 20 years). The late mortality was 15 per cent (8 of 52 patients). Recurrent cysts occurred in two patients (5 per cent) and relapse of pancreatitis in one third of the patients. Deterioration of carbohydrate metabolism was observed in 20 per cent of the patients. After drainage operation stool fat content became normal in 20 per cent and deteriorated in 13 per cent. Persistence or cessation of alcohol intake influenced the long-term results. From these data we conclude that both alcohol withdrawal and sufficient drainage of the pseudocyst are important factors in the prognosis of pseudocyst.
Polydioxanone or polypropylene for closure of midline abdominal incisions: A prospective comparative clinical trial
Authors: Krukowski Z H , Cusick Eleri L , Engeset J , Matheson N A 
Published: March 2007

Abstract
Seven hundred and fifty-seven consecutive patients undergoing a midline abdominal incision were stratified according to age, sex, type of operation and degree of operative contamination and were randomly allocated to mass closure of the abdominal wall with continuous 4 metric polydioxanone (PDX; 374 patients) or continuous 4 metric polypropylene (PPL; 383 patients). Wound infection was less common with PDX (PDX 3·5 per cent; PPL 7·0 per cent; P &lt; 0·05) and there was one dehiscence in each group. The incidence of defective wounds in patients surviving 1 year was similar (7·7 per cent PDX; 9·7 per cent PPL) but the PPL suture had to be removed because of persisting wound pain or sinus formation in five patients. PDX is the preferred suture material for closure of midline abdominal incisions.
Prospective assessment of carotid endarterectomy by clinical and ultrasonic methods
Authors: Aldoori M I , Baird R N 
Published: March 2007

Abstract
Sixty-three carotid endarterectomies in 60 patients were followed by clinical and duplex scanning at 2 weeks postoperatively and at 3-monthly intervals for 3 years (mean 18 months). Four patients died (two of stroke, two of myocardial infarction) and four survivors had recurrent ipsilateral symptoms. Two had an immediate mild hemiparesis which recovered completely within 36 h; in both, the endarterectomized arteries were patent on scanning. The other two experienced amaurosis fugax for 2–3 weeks at 2 and 24 weeks; scanning showed that the sites of both endarterectomies had become occluded. Ultrasound assessment at 2 weeks showed that 43 of 61 (70·5 per cent) endarterectomized arteries were widely patent. There were three occlusions, one stenosis of &gt; 75 per cent, three stenoses of &gt; 50 per cent and eleven stenoses of &lt; 50 per cent. At 6 months a total of five vessels were occluded, with &gt; 75 per cent stenosis in three and &gt; 50 per cent stenosis in eight. At latest follow-up, six of eight arteries with &gt; 50 per cent stenosis shown earlier had scans which had reverted to normal. Tacking down of the distal intima was associated with higher incidence of restenosis and occlusion (P &lt; 0·01). Women were more predisposed to restenosis by neointimal hyperplasia (P &lt; 0·05). All restenosis occurred within the first 6 months postoperatively (26·2 per cent) and fell to 16·4 per cent at the end of the study.
Synchronous and ‘early’ metachronous carcinomas of the colon and rectum
Authors: Finan P J , Ritchie Jean K , Hawley P R 
Published: March 2007

Abstract
In a review of cases of colorectal cancer presenting to St. Mark's Hospital over the 16-year period 1970–85, 59 patients were found to have a synchronous carcinoma (3·4 per cent). Although 82 per cent of these synchronous tumours were distal to the splenic flexure (and hence within reach of a 60 cm flexible sigmoidoscope) only 42 per cent were detected pre-operatively: the remaining tumours were noted at surgery (24 per cent) or found incidentally on pathological examination of the resected specimen (34 per cent). Histological examination of these synchronous lesions revealed a high proportion with favourable stage (Dukes' A — 75 per cent) and grade (well or moderate differentiation - 90 per cent). Over the same 16-year period, 10 patients presented with an ‘early’ metachronous lesion (&lt;3 years from initial surgery). Review of these cases noted negative findings on the initial barium studies in four patients and a failure to conduct full examination of the colon at initial presentation in the remaining six. It is concluded that full examination of the colon in all patients presenting with primary colorectal cancer is mandatory and that, in the light of this experience and recent reports in the literature, this should be by pre- or peroperative colonoscopy.