bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of defibrinogenation on the early patency rate of experimental small calibre arterial grafts
Authors: Mahir M S , Hynd J W , Flute P T , Dormandy J A 
Published: March 2007

Abstract
The effect of defibrinogenation with Arvin1 was studied in a new animal model of early thrombosis of a 3 mm diameter polytetrafluoroethylene (PTFE) graft with a poor run-off. Fifteen control animals were compared with fourteen animals treated with subcutaneous Arvin 20 units kg−1 body weight day−1, starting 2 days before surgery and continuing for 2 days postoperatively. The peroperative fibrinogen level in the controls was 2·8 ± 0·9 g l−1 compared with 0·4 ± 0·3 g l−1 in the treated group. There was no significant difference in the peroperative or postoperative platelet count or haematocrit value between the two groups. Plasma viscosity and whole blood viscosity (at a low shear rate of 0·7 s−1) were significantly less during and after surgery in the defibrinogenated group. The degree of defibrinogenation in these animals produced no problems with haemostasis during surgery or in the postoperative period. The cumulative patency rates of the controls at 24 h, 48 h, and 4 days were 43 per cent, 28 per cent and 28 per cent compared with 86 per cent (P&lt;0·05), 73 per cent (P&lt;0·05) and 73 per cent (P&lt;0·05) respectively in the defibrinogenated group. In this model of a narrow PTFE graft with a poor run-off, defibrinogenation was a safe and effective method of improving early patency of small calibre arterial grafts.
Anorectal temperature sensation: A comparison of normal and incontinent patients
Authors: Miller R , Bartolo D C C , Cervero F , McC Mortensen N J 
Published: March 2007

Abstract
In the skin, temperature sensation plays an important role in discriminating between gas, liquid and solid. To elucidate the role of temperature sensation in idiopathic faecal incontinence we studied the minimum detectable temperature change in the lower, middle and upper zones of the anal canal anal rectum in 33 normal subjects, and 20 patients with idiopathic faecal incontinence. A water perfused thermode was used to vary anorectal temperature from 37°C down to 32.5°C and up to 41.5°C. The temperature change was reported by the patient as the thermode temperature varied from 37°C to each extreme and on return to base line. The anal canal in the control group was highly sensitive to temperature change, the lower rectum was significantly less sensitive (P&lt;0.0001). At each level in the anal canal and lower rectum the incontinent group were significantly less sensitive than their controls (P&lt;0.005). The mid-rectum had no appreciable sensation in either group. We consider that this sensory deficit may be an important factor in idiopathic faecal incontinence.
Five year results of a randomized trial of adjuvant 5-fluorouracil and levamisole in colorectal cancer
Authors: Windle R , Bell P R F , Shaw D 
Published: March 2007

Abstract
Following curative surgery for colorectal cancer 141 patients were randomized to receive a 6 month course of 5-fluorouracil (5FU) with or without postoperative levamisole or supportive treatment only. The patients have been followed up for a minimum of 5 years and 52 per cent of patients in the control group, 44 per cent of the 5FU group and 32 per cent of the 5FU/levamisole group have died of tumour recurrence. This represents a significant survival advantage in the patients receiving levamisole, even when other patient and tumour factors are allowed for.
Physiological study of pruritus ani
Authors: Allan A , Ambrose N S , Silverman S , Keighley M R B 
Published: March 2007

Abstract
Physiological abnormalities in the anorectum of 34 patients with pruritus ani, and 20 age and sex matched controls were assessed. A saline infusion (1500 ml) test showed that leakage started after infusion of 600 ml in patients with pruritus ani compared with 1300 ml in controls (median values: P&lt;0·001). There was an inverse relationship between the severity of the symptoms of pruritus ani and the volume of first leakage on the saline infusion test P&lt;0·02. Studies to assess anal sphincter function, rectal sensation to balloon distension, rectal compliance, and perineal descent did not show any significant differences between pruritic patients and controls. However, pruritic patients without co-existing anal pathology had a significantly greater fall of anal pressure when a rectal balloon was inflated (57 per cent) when compared with controls (40 per cent) P&lt;0·05.
Mechanical bowel preparation for colonic resection and anastomosis
Authors: Irving A D , Scrimgeour D 
Published: March 2007

Abstract
In a series of 72 consecutive elective and emergency colectomies with primary anastomosis, all pre- and perioperative mechanical preparation of the bowel was omitted and the patient covered only by a single peroperative intravenous dose of cefuroxime and metronidazole. No anastomotic dehiscence was clinically apparent and wound infection was noted in only 8.3 per cent of patients.
Diseases of the breast in Nigeria
Authors: Oluwole S F , Fadiran O A , Odesanmi W O 
Published: March 2007

Abstract
For the purpose of defining the distribution of breast diseases in Nigeria, a review of 671 cases seen in Ife over a 10 year period was undertaken. Twenty-six (3·9 per cent) of the patients were males. The frequency of breast diseases in this population was fibro-adenoma, 48 per cent; carcinoma, 21 per cent; breast abscess, 8·6 per cent; fibrocystic disease, 5·5 per cent; sclerosing adenosis. 5·4 per cent and gynaecomastia, 2·7 per cent. The other breast lesions were the same type of disease as documented in white patients. The most striking difference was the relatively high incidence of fibro-adenoma, especially in nulliparous adolescent females, while carcinoma and fibrocystic disease were fewer than expected. Breast carcinoma presented a decade earlier in Nigerian women and was usually advanced at presentation and of aggressive histological type. Of the breast carcinomas, 4·3 per cent were associated with pregnancy.
Carcinoma of the breast in women aged 35 or less
Authors: Backhouse C M , Lloyd-Davies E R V , Shousha S , Burn J I 
Published: March 2007

Abstract
Breast cancer in young women is an unusual problem which has acquired a poor prognostic reputation in the eyes of many clinicians. We have reviewed all 59 patients with malignant disease of the breast aged 35 years or less managed in the Breast Unit at Charing Cross Hospital between 1974 and 1984. After exclusion of 5 patients (2 with lymphomas, I with fibrosarcoma, and 2 with inadequate available data), 54 patients were available for analysis. More than 3 months delay from first symptoms to presentation was seen in 45 per cent and 36 per cent were considered ‘late’ at initial clinical staging (T3–4, N2–3 or M1). Nevertheless, a 5-year survival of 66 per cent was seen among the 29 patients with sufficient length of follow-up. Distribution among the main histological types was very similar to that found in a consecutive series of 264 breast cancers of all age groups in our unit. We conclude that breast carcinomas in young patients do not significantly differ in type or behaviour from other age groups and that with treatment similar to other premenopausal patients, a prognosis comparable to older patients can be expected.
Prospective randomized trial comparing two injection techniques for sclerosing oesophageal varices: Over-tube and free-hand
Authors: Kitano S , Koyanagi N , Iso Y , Iwanaga T , Higashi H , Sugimachi K 
Published: March 2007

Abstract
The safety, efficacy and complications of two techniques of endoscopic injection sclerotherapy were examined in 102 consecutive patients, using either a totally transparent over-tube or the free-hand technique. The choice of treatment was at random. There was a significantly higher control of variceal bleeding when the over-tube technique was used (100 per cent versus 77 per cent, P&lt;0·05). The frequency of re-bleeding before the eradication of oesophageal varices was significantly less in the over-tube group than in the free-hand group (P&lt;0·01), although all re-bleedings were well controlled with additional injections of 5 per cent ethanolamine oleate. There was no significant difference between the two techniques with regard to the frequency of endoscopic injection sclerotherapy for eradication of oesophageal varices. The over-tube technique is safer than the free-hand technique and takes less time to accomplish; at the initial session of treatment, time and bleeding during these techniques were 11·5 ± 2·3 mm (mean ± s.d.) and 7·3 ± 5·9 ml in the over-tube technique, and 20·4 ± 4·1 min and 45·1 ± 30·0 ml in the freehand technique (P&lt;0·001, in both time and bleeding).
Acute idiopathic scrotal oedema: Incidence, manifestations and aetiology
Authors: Najmaldin A , Burge D M 
Published: March 2007

Abstract
Twenty-four children with a total of 31 episodes of acute idiopathic scrotal oedema (AISO) were assessed during a 5 year period. AISO accounted for 30 per cent of all admissions with acute scrotal pathology in this period and was the final diagnosis in 69 per cent of cases in those presenting under the age of 10 years. Although presentation was with unilateral (48 per cent) or bilateral (52 per cent) AISO, considerable overlap between these two groups occurred. Five patients (21 per cent) had recurrent attacks. Fourteen boys (60 per cent) had a history of aliergy or had allergic manifestations at presentation compared with an incidence of allergy of 28 per cent in 42 controls (P &lt; 0.05). AISO is the commonest cause of the ‘acute scrotum’ in boys under the age of 10 years and is probably allergic in origin.
Model of TPN-associated hepatobiliary dysfunction in the young pig
Authors: Truskett P G , Shi E C P , Rose Margaret , Sharp P A , Ham J M 
Published: March 2007

Abstract
Gallbladder ‘sludge’ and cholestasis are two common complications associated with total parenteral nutrition (TPN), but the aetiology of each is uncertain. An animal model has been developed in the young pig which demonstrates these two complications. Five female piglets, of Landrace Large White Cross variety weighing 4.5–5.9 kg, received nutritional support for 2 weeks with a continuous infusion of TPN solution at a dose of 150 kcal kg−1 day−1. The solution was 35 per cent dextrose, 5 per cent L-amino acids with conventional electrolyte, mineral and vitamin additives. No lipid was used in the solution. Five weight-matched animals were used as controls. All animals in the TPN group developed ‘sludge’ in their gallbladders, decreased basal bile flow, decreased bile salt excretion and a diminished response to bile salt stimulated bile flow, as compared with controls. There was no abnormality in routine liver function tests or liver histology. It is concluded that TPN therapy in this animal model is associated with the appearance of gallbladder ‘sludge’, and cholestasis as demonstrated by direct bile flow studies. It is suggested that this bile flow abnormality is due to a decrease in bile salt dependent and bile salt independent fractions of canalicular bile flow. The model provides the opportunity to investigate TPN related hepatobiliary dysfunction in an animal that has similar liver function to man and comparable mutritional requirements.
Results of proctocolectomy for Crohn's disease
Authors: Scammell B E , Andrews H , Allan R N , Alexander-Williams J , Keighley M R B 
Published: March 2007

Abstract
Seventy-four patients have had a one-stage proctocolectomy for the management of Crohn's disease. Indications for operation were: acute colitis 28 percent, chronic colitis 39 per cent, perianal disease 13 per cent, proctitis and perianal disease 8 per cent, bleeding 5 per cent, coexisting colonic malignancy 7 per cent. There were two hospital deaths (2·7 per cent), both associated with sepsis. Late deaths (n = 13) were most commonly associated with reoperations for recurrent disease (n = 3), cardiovascular disease (n = 4) and colorectal carcinoma (n = 1). Postoperative complications were principally associated with sepsis. Cumulative reoperation rates at 5 and 10 years were 19 and 24 per cent respectively. Recurrence was unrelated to the age of the patients, the duration of disease, or the presence of ileal disease at the time of colectomy.
Thrombosis of the superior mesenteric vein
Authors: Umpleby H C 
Published: March 2007

Abstract
Four patients under 45 years old presented with small bowel infarction secondary to superior mesenteric venous thrombosis. Diagnosis was not made pre-operatively in three patients and delay to operation of over 4 days occurred in two patients. In each case infarcted bowel was resected and a primary anastomosis fashioned. A further resection of infarcted small bowel was necessary in three patients. Each patient was discharged on long-term warfarin therapy. Two patients required permanent total parenteral nutrition, one of whom died of liver failure at one year. The remaining patients remain well.
Use of a lipid containing medium chain triglycerides in patients receiving TPN: A randomized prospective trial
Authors: Clarke Patricia J , Ball Madeleine J , Hands Linda J , Dennison A R , Tunbridge Anne , White K , Kettlewell M G W 
Published: March 2007

Abstract
Lipid emulsions which contain long chain triglycerides (LCTs) provide a valuable energy source for patients requiring total parenteral nutrition (TPN). We have investigated the use of a new lipid emulsion containing both long and medium chain triglycerides (MCTs) in a randomized prospective trial. Sixty patients received TPN including 500 ml of either 20 per cent Lipofundin S (LCT) or Lipofundin 10 per cent MCT/10 per cent LCT for at least 6 days. Patients with renal or hepatic impairment, or major trauma, were excluded from the study. The MCT/LCT emulsion was found to be as safe and as effective a source of calories as LCT but the differences in metabolic parameters did not differ significantly between the two groups of patients. A lipid emulsion containing MCTs may have important advantages for seriously ill patients, but appears to have no obvious advantages for the majority of patients receiving TPN who are not severely stressed.
Relative contribution of bile and pancreatic juice duodenogastric reflux in gastric ulcer disease and cholelithiasis
Authors: Eyre-Brook I A , Smythe Anne , Bird N C , Mangnall Yvonne , Johnson A G 
Published: March 2007

Abstract
Bile acid concentrations, phospholipase A2 activity and pH in the stomach were measured in the fasting state and for 2 h after a fat-containing test meal in patients with an active gastric ulcer (GU), in patients with gallstones before and after cholecystectomy and in normal subjects. Fasting and peak postprandial bile acid concentrations in the stomach were low in all normal controls. Although high concentrations were found in many patients with GU (P&lt;0·01), similar concentrations were found in many patients with radiologically non-functioning gallbladders containing gallstones (NFG) (P&lt;0·01) and also after cholecystectomy (AC) (P&lt;0·01). Fasting intragastric phospholipase A2 activities were similar, and very high in GU and NFG patients compared with control subjects (P&lt;0·01). High values were not found after cholecystectomy. There was no difference in pH profile or in postprandial phospholipase A2 between patient groups. Since patients with cholelithiasis or after cholecystectomy are not known to have an increased incidence of gastric ulceration, the significance of duodenogastric reflux in the aetiology of gastric ulcers must be questioned. If reflux does produce ulcers in GU patients then factors in addition to bile acid are probably involved. However, neither patterns of phospholipase A2 reflux nor pH profiles can explain the absence of gastric ulceration in those patients with gallstones who reflux large quantities of bile acid.
Lateral paramedian incision
Authors: Brennan T G , Jones N A G , Guillou P J 
Published: March 2007

Abstract
Prospective randomization of 360 patients undergoing abdominal surgery determined whether a standard lateral paramedian incision was made (group A) or one of two modifications in which the anterior sheath was incised medially and posterior sheath incised laterally (group B) or vice versa (group C), in order to determine the necessity for incising both layers laterally to provide the shutter mechanism which is held responsible for the integrity of this wound. Medial incision of the anterior rectus sheath significantly reduced the time required to perform the incision (P&lt;0·02) and tended to reduce wound sepsis rate. However, this was achieved at the cost of a higher incisional hernia rate (0 per cent, 2·9 per cent and 4·6 per cent in groups A, B and C respectively, P&lt;0·02). We conclude that lateral incision of both anterior and posterior rectus sheath is necessary to obviate the risk of wound hernia with the lateral paramedian incision.
Role of Enterobius vermicularis in the aetiology of appendicitis
Authors: Budd J S , Armstrong C 
Published: March 2007

Abstract
An evaluation was made of the histological material obtained from all 1529 appendices removed during the last 5 years at Southmead Hospital. Bristol, in order to elucidate possible relationships between the incidence of Enterobius vermicularis and the origin of inflammation in the appendix. In total, 1419 appendices were removed as cases of clinical appendicitis and 110 in the course of another surgical procedure. E. vermicularis was identified in 2·7 per cent of patients with clinical appendicitis and was most commonly seen in appendices with either chronic inflammation or where the appendix was histologically normal. E. vermicularis was rarely associated with histological changes of acute appendicitis. No cases of E. vermicularis infestation occurred in appendices removed during the course of other surgical procedures. The results suggest that, although E. vermiculans may have a causal role in appendicular pain and chronic inflammation, it is rarely related to acute appendicitis.
Comparison of the local and systemic effects of sepsis in predicting survival
Authors: Ponting G A , Sim A J W , Dudley H A F 
Published: March 2007

Abstract
Progress in the study of sepsis has been hampered by the lack of a suitable system for grading its severity. Systems suggested for scoring sepsis have been based either on its systemic effects (APACHE II) or on a mixture of local and systemic variables (sepsis score). The APACHE II and sepsis scores were applied to patients with intra-abdominal sepsis of more than 3 days' duration, to determine if local or systemic factors were more important in predicting survival. Of 45 patients studied, 14 died. The sepsis score for non-survivors (median 21·5, range 11–32) was significantly higher than for survivors (median 14, range 10–26, P&lt;0·05). There was overlap between the two groups, such that an individual score had no predictive value. The local component of the sepsis score was not significantly increased in non-survivors (P&lt;0·05), but the systemic component was (P&lt;0·05). The APACHE II score for non-survivors (median 24, range 15–38) was significantly higher than for survivors (median 12, range 3–21), and correctly identified 13 of the 14 fatalities. Both the systemic and non-systemic components (age and chronic disease) were significantly higher among the latter. The APACHE II was more effective than the sepsis score in predicting survival. We conclude that any system used for scoring sepsis should be based on systemic rather than local effects. At present the APACHE II score is preferred.
Evaluating surgical risk: The importance of technical factors in determining outcome
Authors: Pettigrew R A , Burns H J G , Carter D C 
Published: March 2007

Abstract
A total of 113 patients having elective resection of the alimentary tract were studied prospectively to examine the relationship of pre-operative clinical and nutritional assessment to the development of major postoperative complications. In addition, the operating surgeon made a risk assessment on a linear analogue scale before and immediately after operation. Major complications developed in 28 patients (25 per cent). Age, weight loss and relative weight did not select high risk patients, but patients with a serum albumin of 29 g/l developed significantly more complications than those with higher levels (60 versus 22 per cent, P &lt; 0·05). Clinical assessment also selected some high risk patients but patients selected by the surgeon's pre-operative assessment did not develop significantly more complications than those not selected (38 versus 21 per cent). However, the surgeon's postoperative assessment did select patients at significantly increased risk, especially when compared with his pre-operative assessment. Of 38 patients who were selected pre-operatively as high risk or who increased their risk ranking postoperatively, 20 (53 per cent) developed complications, as opposed to only 6 of 65 patients (9 per cent) who were low risk or decreased their risk ranking (P &lt; 0·001). The surgeons changed their ranking postoperatively in 44 patients and in 36 (82 per cent) the reason given was the technical ease or difficulty of the procedure. Using receiver-operating characteristic curves, immediate postoperative assessment was superior to any pre-operative method of selecting high risk patients. Of 15 patients with normal serum albumin levels whose risk ranking increased postoperatively 6 (40 per cent) developed complications while none of the 7 patients with low serum albumin (high risk) who decreased their risk ranking developed complications. It is concluded that operative performance is the main factor in the development of postoperative complications and should be assessed in future studies of outcome.
Renal impairment following biliary tract surgery
Authors: Thompson J N , Edwards W H , Winearls C G , Blenkharn J I , Benjamin I S , Blumgart L H 
Published: March 2007

Abstract
Postoperative mortality has been directly attributed to renal failure in approximately 5 per cent of patients after surgery for obstructive jaundice. An analysis of 334 patients undergoing biliary tract surgery was undertaken to identify the perioperative factors associated with the development of renal impairment, and to estimate the contribution of renal failure to mortality. Thirty-eight patients (11 per cent) developed postoperative renal impairment (a two-fold increase in serum creatinine postoperatively or a rise of &gt; 100 μmol/l). Ninety-three factors were examined in these and 196 control patients. Stepwise logistic regression analysis identified only three factors which were significantly associated with renal impairment: postoperative sepsis (P &lt; 0·0005), pre-operative serum bilirubin (P &lt; 0·0005), and pre-operative urea (P &lt; 0·05). Renal impairment developed at a median 4 days after surgery and was associated with a median of two additional major postoperative complications, particularly sepsis and haemorrhage, for which 17 patients underwent reoperation. Twenty-eight (74 per cent) of the patients with renal impairment died in hospital, but in only one case was the cause of death directly related to renal failure. Twenty patients received specific therapy for renal failure, but only one of these survived. Pre-operative obstructive jaundice and postoperative infection are the major factors associated with renal impairment after biliary tract surgery. Renal impairment appears to be related to postoperative complications rather than directly to the surgical procedure itself. The development of postoperative renal impairment predicts a low chance of survival but appears to be an indicator, rather than a direct cause of a poor prognosis.