bluuebunny/crossref_metadata_2025_split huggingface dataset:
Transabdominal oesophageal transection for oesophageal varices: Experience in 101 patients
Authors: Umeyama K , Yoshikawa K , Yamashita T , Todo T , Satake K 
Published: March 2007

Abstract
The results of transabdominal oesophageal transection in 101 patients with oesophageal varices are reported. The primary diagnosis was liver cirrhosis in 65 patients, idiopathic portal hypertension in 29 and extrahepatic portal obstruction in 7. Twelve patients died postoperatively. The mortality rate for emergency operations was higher than that for elective and prophylactic procedures. The majority of patients died from hepatic failure. Improvement, judged by radiographic and endoscopic examination, was 100 per cent and 96 per cent, respectively. Post-transection rebleeding was observed in 14 of 89 patients during the follow-up period of 1–13 years. There were 25 late deaths, caused mainly by hepatic failure. The 5-year survival rate, including postoperative deaths, was 72 per cent in idiopathic portal hypertension and 55 per cent in liver cirrhosis. We suggest that transabdominal oesophageal transection is an acceptable operative procedure for oesophageal varices.
Preoperative urography in large bowel cancer: A useless investigation?
Authors: Phillips R , Hittinger Rosemary , Saunders Valerie , Blesovsky Lynda , Stewart-Brown Sarah , Fielding P 
Published: March 2007

Abstract
The utility of intravenous urography (IVU) in the preoperative assessment of patients with adenocarcinoma of the large bowel has been investigated in 4226 patients derived from a prospective multicentre study entitled the Large Bowel Cancer Project. An IVU was carried out in 956 of these patients (22·6 per cent), subsequent surgery revealing unsuspected direct urinary tract involvement in 75. However, 42 (56 per cent) had shown no IVU abnormality. Twenty patients having a clinical colovesical fistula had had a preoperative IVU. Only half showed an abnormality. In the entire study group, 10 nephrectomies and 40 other concomitant urinary tract resections were performed. Four of these nephrectomies were associated with right-sided tumours. A significantly higher number of patients with a rectal primary had a preoperative IVU. The value of routine preoperative urography before large bowel cancer surgery is questioned, and other methods of determining function in the other kidney before nephrectomy should be sought.
A physiological appraisal of polyethylene glycol and a balanced electrolyte solution as bowel preparation
Authors: Ambrose N S , Johnson Margaret , Burdon D W , Keighley M R B 
Published: March 2007

Abstract
Seventy-seven patients undergoing bowel preparation with either sennosides and rectal washout (S + RWO; n = 26) or polyethylene glycol and a balanced electrolyte solution (PEG + E) given orally (n = 25) or by nasogastric infusion (n = 26) have been studied. PEG + E was not associated with significant physiological change in electrolytes or blood gases. Patients tolerated PEG + E well and it provided a moderate to good bowel preparation in over 80 per cent of cases. PEG + E was not associated with a change in colonic microflora and was not associated with explosive mixtures of colonic gas due to hydrogen. It is therefore a safe, quick and efficient bowel preparation and provides a safer alternative to mannitol. The solution (PEG + E) may be used orally or by nasogastric infusion and does not require an accompanying intravenous infusion.
Influences of splanchnic nerve blockade on endocrine-metabolic responses to upper abdominal surgery
Authors: Tsuji H , Shirasaka C , Asoh T , Takeuchi Y 
Published: March 2007

Abstract
Twelve patients undergoing gastrectomy received combined epidural and splanchnic nerve blockade (Group E&S), and changes in plasma ACTH, cortisol, glucose and FFA were compared with those undergoing gastrectomy under general anaesthesia (Group G) or epidural analgesia alone (Group E). Plasma ACTH increased in all groups on the day of operation and was significantly higher in Group G than the other groups. Levels of ACTH in Group E&S were lower than Group E, but the differences were not significant. Cortisol response in Group G was most pronounced and prolonged. This cortisol response was significantly attenuated in Group E and was further inhibited in Group E&S. Blood glucose and FFA increased in Groups G and E during the operation but the increase was significantly less in Group E. In Group E&S, glucose and FFA concentrations showed practically no change throughout the study, being significantly lower than in Group E. The results indicated that the splanchnic nerve is responsible for producing endocrine-metabolic responses to gastric surgery even under epidural blockade.
The quality of life after rectal excision for low rectal cancer
Authors: Williams N S , Johnston D 
Published: March 2007

Abstract
The quality of life for patients with carcinoma of the lower two-thirds of the rectum (5–12 cm from the anal verge) treated by abdominoperineal resection (APER, n = 38) was compared with that of a similar group of patients treated by low sphincter saving resection (SSR, n = 40). Assessment was by questionnaire conducted a minimum of one year after operation. Thirty patients (75 percent) after SSR were entirely continent and ten patients (25 percent) had occasional episodes of incontinence. Each patient with a colostomy was incontinent and 25 (66 per cent) had leaks from their appliance (12 frequent; 13 occasional). Patients after APER avoided more items in the diet and took more medication to control their bowel habit than patients after SSR. Fifteen of the 18 patients (83 percent) who were employed before SSR returned to work after operation; only 6 of 15 patients (40 percent) returned to work after APER (P &lt; 0.05). Sexual function was impaired in 6 of 20 men (30 percent) after SSR and in 12 of 18 men (67 percent) after APER (P &lt; 0.06). Depression was significantly more prevalent after APER than after SSR. Patients with low rectal cancer who are treated by modern sphincter saving resection have a quality of life superior to those who are treated by APER.
Limitations of immune complex measurements in colorectal disease
Authors: Hobbiss J , Cooper K M , Moore M , Gowland E , Schofield P F 
Published: March 2007

Abstract
Three techniques (Clq, Raji and L1210 binding assays) alleged to measure circulating immune complexes (ICs) were applied to the sera of 101 patients with colorectal disease (54 carcinoma; 23 inflammatory; 13 benign tumour and 11 miscellaneous) at the time of diagnostic or definitive surgery, and 58 healthy adult controls. Elevated levels in the pathological sera were observed by all 3 methods in order of sensitivity: Raji &gt; Clq &gt; L1210. However, none of them differentiated between benign, inflammatory and neoplastic conditions nor, in the case of colorectal carcinoma, was there any correlation with stage of disease. With the exception of Raji v. L1210 (r = 0·43, P &lt; 0·001), correlations between the various assays were poor and levels of serum carcinoembryonic antigen (CEA) did not correlate with ICs measured by any of the techniques. Indeed, the IC assays were even less discriminatory than CEA, which was elevated mainly in the serum of carcinoma patients and which was positively correlated with serum γ-glutamyl transpeptidase (γ GT) (r = 0·42, P &lt; 0·005). The data suggest that the lack of concordance between the IC assays is a reflection of heterogeneity among ICs, interfering factors present in pathological sera, or both. Thus the IC assays deployed here have neither diagnostic nor prognostic utility in colorectal disease at this time, and immunochemical characterization of the serum reactive material detected by the different assays is required.
The role of percutaneous transhepatic cholangiography and grey-scale ultrasound in the investigation and treatment of bile duct obstruction
Authors: Gibbons C P , Griffiths G J , Cormack Anne 
Published: March 2007

Abstract
A total of 123 patients undergoing fine needle percutaneous transhepatic cholangiography (PTC) in Newport between 1977 and 1981 are reviewed. PTC was well tolerated with a 9 per cent complication rate, a 5 per cent failure rate and no mortality. Of 111 patients in whom a diagnosis of biliary obstruction was subsequently confirmed, PTC showed the presence of obstruction in 94 per cent, its site in 92 per cent and the correct cause in 87 per cent. Eighteen jaundiced patients were spared laparotomy on the basis of the PTC findings. Grey-scale ultrasound scanning was performed in 99 of these patients. Of 93 with subsequently verified biliary obstruction, ultrasound confirmed the presence of obstruction in 66 per cent, its site in 33 per cent and its cause in 29 per cent. It is concluded that PTC is the more useful investigation in the management of biliary obstruction and that its use may avoid unnecessary surgery.
Sequential bone scans and chest radiographs in the postoperative management of early breast cancer
Authors: Chaudary M A , Maisey M N , Shaw P J , Rubens R D , Hayward J L 
Published: March 2007

Abstract
A total of 241 patients with early breast cancer had serial bone scans and chest radiographs during the first two years of follow-up after primary treatment. Each patient had had a modified radical mastectomy and been found to have involved axillary nodes. They were part of a prospective randomized trial testing the use of l-phenylalanine mustard l-PAM as adjuvant chemotherapy. During the two years, these patients had a total of 832 serial bone scans and 1091 serial chest radiographs. Twenty-five patients (10·4 per cent) had bone metastases detected on sequential scanning, only 13 of whom, however, were asymptomatic at the time of the positive scan. Twelve (5 per cent) patients were found to have pulmonary metastases on routine sequential chest radiography of whom only 8 were asymptomatic at the time of the positive chest radiograph. It is concluded from this study that, apart from their usefulness in the monitoring of clinical trials, serial bone scans and chest radiographs cannot be recommended routinely in the follow-up of asymptomatic patients because of the low yield and high cost involved.
The mechanical properties of glutaraldehyde stabilized human umbilical vein measured in vivo
Authors: Chapman B L W , Charlesworth D 
Published: March 2007

Abstract
Vascular prostheses, when used to bypass the femoral and popliteal arteries, and particularly if the bypass is made to the distal part of the tibial arteries, seldom remain patent, or if they do then for only a limited period of time. Femorotibial bypass with modified human umbilical vein is relatively successful in selected patients and one explanation may be that it resembles human arteries more than other prostheses. We have developed a method of calculating the asymptotic phase speed, from the propagation constant and from this the characteristic impedance of a bypass (all of which characterize viscoelastic behaviour). Calculations were made on measurements of pressure made in vivo. Twenty patients who had a femorotibial bypass, using glutaraldehyde stabilized umbilical vein, were studied and, from measurements of pressure made at operation, we calculated the asymptotic phase speed and the characteristic impedance of the prostheses. Results show that the viscoelastic properties of newly implanted umbilical vein are comparable to those of autogenous saphenous vein.
Antibiotic concentration in the exudate of venous ulcers: The prediction of ulcer healing rate
Authors: Hopkins N F Gowland , Jamieson C W 
Published: March 2007

Abstract
We have designed a test to measure the local circulatory insufficiency in the base of chronic venous ulcers by measuring the concentration of Cefuroxime in the ulcer exudate following a single intravenous injection of the antibiotic at a dose of 500 mg/m2. We have studied 28 patients with 42 ulcers and shown that the concentration achieved increased with in-patient conservative treatment (P &lt; 0·01), decreased again on discharge from hospital if the ulcers had not healed (P &lt; 0·01) and correlated with observed healing rates (r = 0·72). This test may assist in the clinical management of these cases by predicting healing rates and the likely outcome of conservative treatment.
Bile acid receptors in colorectal cancer
Authors: Summerton J , Flynn M , Cooke T , Taylor I 
Published: March 2007

Abstract
Bile acids are thought to be involved in both the aetiology and development of colorectal cancer. In this study the existence of specific bile acid receptor proteins has been postulated. A receptor assay which involved labelling with 14C-deoxycholic acid was performed as well as autoradiography using 3H-deoxycholic acid. In an initial study resected colorectal cancer and adjacent histologically normal colorectal mucosa from 39 patients were studied, as were samples of normal gastric mucosa, cancers and benign colorectal tumours. Specific receptors to deoxycholic acid were detected in 12 (30·8 per cent) of the colorectal cancers, but in only 1 (2·6 per cent) of the samples from normal colorectal mucosa (χ2 = 11·16, P &lt; 0·005). No deoxycholic acid receptors were detected in any other tissue studied. Autoradiographs of colorectal cancers showed binding of 3H-deoxycholic acid in receptor-positive tumour tissue. These findings might provide some explanation for the evidence linking bile acids with the disease.
Oesophageal intubation for advanced oesophageal cancer: The Baragwanath experience 1977–1981
Authors: Diamantes T , Mannell Aylwyn 
Published: March 2007

Abstract
Oesophageal intubation was performed for 324 patients with advanced squamous cell carcinoma of the oesophagus. Peroral pulsion and traction techniques were used. There were 88 deaths in hospital (mortality rate, 27 per cent). The mortality rate did not appear to be directly related to the general condition of the patient or to the experience of the operator. Adequate palliation of dysphagia was achieved in 61 per cent of intubated patients, but a high rate of late complications impaired the quality of life following intubation. It is concluded that the insertion of an oesophageal tube was neither a safe nor satisfactory method for palliation of malignant dysphagia.
The value of operative pancreatography
Authors: Cooper M J , Williamson R C N 
Published: March 2007

Abstract
Between 1978 and 1982 operative pancreatography was undertaken in 39 patients (mean age 47 years) using 1 of 4 different techniques. Final diagnoses were chronic pancreatitis (15), isolated dorsal pancreas (10), carcinoma head of pancreas (3), acute pancreatitis (3) and miscellaneous pancreatic conditions (8). Retrograde (transduodenal) pancreatograms were successfully obtained in 10 of 12 patients, including 3 via the minor papilla. Prograde cannulation was achieved after distal pancreatectomy in 15 of 16 patients, 10 of whom had an isolated dorsal pancreas. ‘Ambigrade’ pancreatography was performed after direct puncture of a palpable duct in 6 patients and cystography in another 5 patients with pseudocysts. No complications of pancreatography were seen and the radiological findings modified the operative procedure in 16 patients (41 per cent).
Localization and excision of occult breast lesions
Authors: Chetty U , Kirkpatrick A E , Anderson T L , Lamb J , Roberts M M , Humeniuk V , Forrest A P M 
Published: March 2007

Abstract
Between 1976 and 1982, 190 non-palpable mammographic abnormalities considered to be suspicious of malignancy were excised using a needle localization technique. The indications for biopsy, technique for localization, method for confirmation of excision and histopathological preparation are presented. The histopathological diagnosis of these lesions were 150 benign and 40 malignant. There was no clear correlation between the mammographic appearances and the occurrence of cancer. Compared with 100 consecutive women with palpable breast cancer the impalpable and mammographically detected tumours were smaller, more often non-invasive and associated with negative axillary nodes.
The role of protease in immunoregulation
Authors: Donnelly P K , Shenton B K , Alomran A M , Francis D M A , Proud G , Taylor R M R 
Published: March 2007

Abstract
Whilst immunodepression is widely recognized in patients subject to trauma or chronic disease, the mechanism of this process is poorly understood. We found that most of the lymphocyte suppressive activity of plasma from severely ill patients was attributable to the protein α2-macroglobulin (α2M) and low molecular weight peptide (&lt;10 000). The only major variation in α2M concentration was found in patients subject to trauma, when it was depressed at times of high plasma suppressive activity. In order to explain qualitative immunosuppressive differences in α2M we studied its functional role as the main route for binding and degrading proteolytic enzyme (protease). In normal plasma minor degrees of protease complex formation to α2M caused greatly increased suppressive activity due principally to α2M and the abnormal appearance of low molecular weight peptide (≤10 000). Study of protease inhibitor function in patients suffering from acute or chronic illness suggested that in these patients their plasma becomes immunosuppressive due to inadequate handling of protease, resulting in α2M-protease complexes or inhibitory peptides persisting in the circulation. Opportunities for background immunoregulation by altering protease metabolism are considered.
The effective management of venous ulceration
Authors: Negus D , Friedgood Anne 
Published: March 2007

Abstract
The importance of the direct perforating veins of the lower leg in the aetiology of venous ulceration is supported by the results of a 6-year study of 77 patients with 109 ulcerated legs. Incompetent perforating veins were demonstrated by examination and Doppler ultrasound, and confirmed at operation, in 108 legs. Subfascial ligation of these veins, with stripping of incompetent saphenous veins when necessary, was followed by elastic compression stockings in 44 legs (40 per cent) in which deep vein incompetence was demonstrated by non-invasive methods and phlebography. Some 91 ulcers (84·3 per cent) remain healed (76 per cent &gt; 3-year follow up). Eight patients with rheumatoid arthritis in addition to venous incompetence had a 75 per cent failure rate. If these patients are excluded, 88 (92 per cent) of 96 ulcerated legs remain healed. It is submitted that these results support the argument for the importance of perforating vein incompetence in the aetiology of venous ulceration. They also suggest that a more optimistic attitude towards treatment is justified.
Long term results of 66 femoral-to-femoral by-pass grafts: a 9-year follow-up
Authors: Mosley J G , Marston A 
Published: March 2007

AbstractOver an 8-year period, 66 femoral-to-femoral grafts were performed for unilateral iliac artery disease. The grafts were inserted retropubically with an operative mortality of 4·5 per cent. The minimum follow-up has been 12 months and cumulative patency 80 per cent at 6 years. Sixteen patients had critical ischaemia (preoperative Doppler ankle pressure &lt; 40 mmHg) and 50 patients had severe ischaemia (preoperative ankle pressure &gt; 40 mmHg). The graft significantly improved initial ankle pressures and this improvement was maintained at late follow-up (average 45 months). There was no evidence of a detrimental effect on the donor limb. Long term patency was adversely affected if there was preoperative critical ischaemia, a woven Dacron prosthesis was used or the patient continued to smoke.
Early results of subcutaneous mastectomy with immediate silicone prosthetic implant for carcinoma of the breast
Authors: Ward D C , Edwards M H 
Published: March 2007

Abstract
Surgery for carcinoma of the breast is becoming less radical even to the extent of breast conservation. Subcutaneous mastectomy and implant offers itself as an alternative, retaining a breast shape and removing almost all breast tissue. Forty-four consecutive patients who had this procedure for breast carcinoma were studied with a follow-up of 5–44 months (mean 25·3 months). Only 4 patients (9 per cent) had local recurrences, i.e. recurrence in the skin flap or scar. This compares favourably with other series and other forms of treatment. Removal of the prosthesis was necessary in 10 patients due to local factors. The cosmetic result as assessed by the patients was almost universally pleasing. Twenty-six of 27 patients with prostheses in situ who were interviewed in person or by postal questionnaire were pleased with the results of their surgery. The absence of high recurrence rates locally and high patient acceptance makes this a definite surgical alternative.
Central breast carcinoma treated by simultaneous mastectomy and latissimus dorsi flap reconstruction
Authors: Nash A G , Hurst P A E 
Published: March 2007

Abstract
Simultaneous mastectomy with latissimus dorsi flap reconstructions have been performed on 15 women with primary central breast cancer and on 5 women with local recurrence after local excision and deep X-ray treatment. The indications and technique are discussed. There was no mortality and no initial morbidity. No prosthesis has become infected. One prosthesis has slipped laterally, requiring removal and re-insertion at the time of nipple reconstruction. In all patients an acceptable cosmetic result, as assessed by the patient and the surgeon, has been achieved. Follow-up is very brief, 1–18 months, but there is as yet no sign of local recurrence.
The cutaneo-anal reflex: A useful index of neuropathy?
Authors: Bartolo D C C , Jarratt J A , Read N W 
Published: March 2007

Abstract
Recent studies have suggested that the latency of the cutaneo-anal reflex is prolonged in idiopathic faecal incontinence, suggesting neuropathic damage to the external anal sphincter. Electrical responses were recorded from the external anal sphincter following stimulation of the ipsilateral and contralateral perianal skin in normal subjects and patients with idiopathic faecal incontinence. Ipsilateral stimulation gave rise to shorter latencies of the earliest responses to stimulation compared with contralateral stimulation (P &lt; 0·001). When care was taken to compare results obtained by stimulating the skin on corresponding sides of the sphincter, the latency of both the early and late components of the cutaneo-anal reflex in incontinent patients was not significantly different from that in control subjects. The durations of the motor unit potentials, obtained by conventional electromyography, were prolonged in incontinent patients, indicating that they have external sphincter neuropathy. The data support the suggestion that external sphincter neuropathy in idiopathic faecal incontinence is due to a stretch injury to the pudendal nerve, and indicate that measurement of the latency of the cutaneo-anal reflex may be an inadequate means of demonstrating nerve damage in patients with idiopathic faecal incontinence.
Single dose metronidazole with and without cefuroxime in elective colorectal surgery
Authors: Mitchell N J , Evans D S , Pollock D 
Published: March 2007

Abstract
Seventy patients undergoing elective colorectal surgery for malignant and inflammatory bowel disease were allocated randomly to one of two groups. Patients in group 1 were given, after induction of anaesthesia, a single dose of metronidazole 500 mg i.v. Patients in group 2 were given in addition a single dose of cefuroxime 1·5 g i.v. of 34 patients in group 1, 4 (11·8 per cent) developed postoperative infection. of 36 patients in group 2, 5 (13.6 per cent) developed postoperative infection. No significant difference was noted in the incidence of postoperative sepsis between the two treatment groups.