bluuebunny/crossref_metadata_2025_split huggingface dataset:
Aortocaval fistula associated with ruptured aortic aneurysm
Authors: Burke A M , Jamieson G G 
Published: March 2007

Abstract
Seven cases of rupture of an abdominal aortic aneurysm into the inferior vena cava are reported. In the management of this rare condition it is important to make the diagnosis preoperatively. Most cases show evidence of a large arteriovenous fistula which can, on occasions, dominate the clinical picture, e.g. cyanosed lower extremities or cardiac failure, but abdominal pain is the major feature. Careful examination of all patients with a ruptured aneurysm, particularly listening for an abdominal bruit, will usually allow the diagnosis of aortocaval rupture to be made.
Abdominal aortic aneurysm with retroperitoneal fibrosis and ureteric entrapment
Authors: Sethia B , Darke S G 
Published: March 2007

Abstract
Eleven of 157 patients undergoing surgery for abdominal aortic aneurysm, with features of both aneurysm and periaortic retroperitoneal fibrosis, are presented. The clinical details, implications and management are reported. The possibility that this association may present with differing relative severity of these two conditions is discussed. Aortic replacement is advocated as the treatment of choice because the risk of rupture still exists and this procedure seems to halt, or even reverse, the inflammatory process. Synchronous ureterolysis is reasonably safe and can be undertaken if obstruction is present. Steroids represent an alternative option, where aortic replacement is too hazardous.
Fluorescent cytochemical oestrogen receptor assay: Is it valid in breast cancer?
Authors: Furnival C M , Chong K C , Watson L R , Visona A 
Published: March 2007

Abstract
The performance of a fluorescent cytochemical oestrogen receptor (ER) assay has been compared with an established dextran-coated charcoal ER assay in 85 cases of primary breast cancer. Both assays were performed on tissue samples from the same tumour, by independent observers in different laboratories. A good qualitative correlation between the two methods was found, with agreement in 92 per cent of cases (P &lt; 0·0005). Criticisms of the fluorescein-labelled oestrogen methods are discussed. It is concluded that such methods should be validated in each laboratory by comparison with a conventional, quantitative ER assay before being used for clinical decisions.
Management of faecal incontinence and results of surgical treatment
Authors: Keighley M R B , Fielding J W L 
Published: March 2007

Abstract
Ninety-five patients have been referred for the assessment and treatment of faecal incontinence. Incontinence was associated with previous anal trauma in 49 cases: 13 occurred after vaginal delivery, 32 were associated with anal operations and in 4 severe perineal trauma occurred after road accidents. Other causes were: idiopathic incontinence in 18, persistent incontinence despite successful rectopexy for prolapse in 10, diabetic neuropathy in 5 and in 13 the cause was not identified. Conservative treatment by control of diarrhoea, physiotherapy or electrical therapy was often successful in patients with minor incontinence. Fifty-six patients have been treated surgically. Complete continence was achieved in 67 per cent of patients treated by postanal repair and in 61 per cent by sphincter reconstruction. We believe that postanal repair is the treatment of choice for idiopathic incontinence and incontinence after rectopexy or anal dilatation. Sphincter repair should only be performed with a covering colostomy and is the treatment of choice for recent or long standing division of the external sphincter ring.
Prognostic factors in locally recurrent rectal carcinoma treated by radiotherapy
Authors: James R D , Johnson R J , Eddleston B , Zheng G L , Jones J M 
Published: March 2007

Abstract
An analysis has been made of the symptomatic response and survival of 143 patients following radiotherapy for locally recurrent rectal cancer. Computerized tomography (CAT) was performed on 45 patients. Of 119 evaluable patients, 54 had a good response to radiotherapy, 29 a moderate response and 36 no apparent response. Median response was 9 and 3 months respectively in the good and moderate groups. Median survival was 15, 9 and 5 months for the three groups. Latent interval between surgery and radiotherapy appeared to be of prognostic importance. When this exceeded 2 yr median survival was 12 months compared with 7 months for patients with a latent interval of less than 2 yr. Tumour volume measured by computed tomography may have prognostic importance. Radiotherapy should be considered for most patients with symptomatic recurrence. Surgery might be combined with radiotherapy for selected groups of patients with good prognosis.
Randomized trial of truncal vagotomy with either pyloroplasty or pyloric dilatation in the surgical management of chronic duodenal ulcer
Authors: Pringle R , Irving A D , Longrigg J N , Wisbey M 
Published: March 2007

Abstract
A randomized trial of 41 patients undergoing truncal vagotomy with pyloroplasty (TV + P) or truncal vagotomy with graded pyloric dilatation (TV + PD) for chronic duodenal ulcer is reported after mean follow-up of 34 months. There was no evidence of gastric stasis in patients who did not have a pyloroplasty. Liquid gastric emptying studies showed an increased rate of gastric emptying postoperatively in patients both with and without pyloroplasty. Overall clinical gradings at review were similar in both groups although there were more patients who were completely symptom free in the group with pyloric dilatation accompanying vagotomy.
Recurrent gastrointestinal bleeding of obscure origin: Report of 17 cases and a guide to logical management
Authors: Spiller R C , Parkins R A 
Published: March 2007

Abstract
Seventeen patients with chronic obscure gastrointestinal bleeding presenting over a 5-year period are described. While representing only 6 per cent of the total number of admissions due to gastrointestinal haemorrhage they required a disproportionate amount of medical attention, including 67 admissions, 73 radiological and 56 endoscopic procedures and transfusion of a total of 198 units of blood. The diagnoses included 5 cases of recurrent acute upper gastrointestinal erosions, 7 small bowel abnormalities and 4 colonic lesions, with 1 patient undiagnosed. Eight arteriovenous malformations (AVM) were demonstrated angiographically and one Meckel's diverticulum identified by a 99Tcm pertechnetate scan. There were 5 cases in which laparotomy yielded the final diagnosis and in one of these peroperative endoscopy of the small bowel was required. On the basis of our experience and a review of other series, a logical plan of investigation is described for such difficult cases.
Non-surgical management of post-cholecystectomy haemobilia
Authors: Kelley C J , Hemingway A P , McPherson G A D , Allison D J , Blumgart L H 
Published: March 2007

Abstract
Therapeutic embolization of the hepatic artery was performed in two patients actively bleeding from aneurysms resulting from previous surgical damage to the artery at cholecystectomy. The advantages of embolization over surgical ligation of the hepatic artery are discussed.
A definition of arteriomegaly and the size of arteries supplying the lower limbs
Authors: Callum K G , Thomas M Lea , Browse N L 
Published: March 2007

Abstract
A study has been made of the size of normal arteries supplying the lower limbs by measuring their circumferences at fixed points in cadavers and their diameters and lengths on aortographs. The arteriographs of a group of patients with dilated and elongated arteries have also been studied and a definition produced for the arteriographic condition known as arteriomegaly.
Prediction of risk in biliary surgery
Authors: Blamey S L , Fearon K C H , Gilmour W H , Osborne D H , Carter D C 
Published: March 2007

Abstract
To identify individual risk factors and to establish an index of risk in biliary tract surgery, data on 16 potential predictive factors were compiled from a series of 186 biliary tract operations excluding simple cholecystectomy. Eight factors had a significant association with postoperative mortality. Linear discriminant analysis showed that serum creatinine, serum albumin and serum bilirubin levels in the week before surgery had independent significance in predicting postoperative mortality. The discriminant function derived identified a high risk group of patients and the predictive value was confirmed in an independent series of 54 biliary tract operations carried out in another surgical unit. The discriminant function derived for patients jaundiced before surgery also defined a high and low risk group and was similarly validated. Identification of high risk patients undergoing surgery for obstructive jaundice may be useful in defining a group of patients to be considered for trials of preliminary biliary drainage.
Intramuscular pressure after revascularization of the popliteal artery in severe ischaemia
Authors: Qvarfordt P , Christenson J T , Eklöf B , Ohlin P 
Published: March 2007

Abstract
Swelling is known to occur after peripheral revascularization. In this study of 14 patients undergoing revascularization of the popliteal artery for severe ischaemia, leg swelling and intramuscular pressure were recorded before and after operation. Calf circumference increased with a maximum swelling of 3·9 ± 1·1 cm on postoperative day 6. There was a gradual increase in intramuscular pressure from 9±2 mmHg on the day before operation in the anterior tibial compartment to a maximum pressure on postoperative days 6–7 of 26±4 mmHg. Similar intramuscular pressure changes were seen in the superficial posterior compartment. These high intramuscular pressures may lead to a compartment syndrome and perhaps graft failure, which was actually observed in one case. Deep-vein thrombosis in the postoperative course may contribute to the high intramuscular pressures. Phlebography revealed a deep-vein thrombosis in 2 patients. In conclusion popliteal revascularization causes leg swelling and increased intramuscular pressure which may lead to a compartment syndrome and graft failure. Therefore followup of intramuscular pressure in patients with marked swelling after distal revascularization procedures and early fasciotomy may be considered on wide indications.
Risk of gastric cancer after Billroth II resection for duodenal ulcer
Authors: Fischer A B , Græm N , Jensen O M 
Published: March 2007

Abstract
In a follow-up study of 1000 patients, who were subjected to Billroth II resection for duodenal ulcer, the incidence and mortality of gastric carcinoma in a 22–30 year follow-up period were determined. Among the 423 survivors traced, 196 underwent gastroscopy and biopsy but carcinomas of the gastric remnant were not seen. Thus the prevalence was 0, not significantly different from the expected prevalence of 0·3. From all 1000 patients only 13 cases of gastric carcinoma were identified. This is not significantly different from the expected number of 10·6 calculated by the life table method and indirectly standardized for age, sex, place of residence and time. Even more than 15 years after operation the gastric cancer risk was only slightly increased (observed/expected = 7/4·8 ± 1·48), but this was not significant statistically. Of 522 deaths 13 were due to gastric carcinoma, which was not significantly different from the expected number of 10·2. These epidemiological data show that individuals subjected to Billroth II resection for duodenal ulcer hardly have a higher risk of gastric carcinoma than the general population within the first decades after operation. Thus proplylactic endoscopical monitoring will be unrewarding.
Management of malignant obstructive jaundice at The Middlesex Hospital
Authors: Leung J W C , Emery R , Cotton P B , Russell R C G , Vallon A G , Mason R R 
Published: March 2007

Abstract
A total of 180 patients with malignant obstructive jaundice have been treated by 5 different methods: surgical resection; surgical by-pass; percutaneous prosthesis; endoscopic prosthesis; and endoscopic sphincterotomy (for papillary tumours). The spectrum of patients is unusual, because many elderly and ill patients were referred for non-operative management. Operative by-pass, percutaneous and endoscopic prostheses gave similar overall results, with a mean survival of about 6 months. Patients with tumours of the papilla of Vater treated by endoscopy or surgery fared well; 11 of 18 were alive at follow-up. Median survival after resection of other tumours was 17 months. These results underline the need for randomized clinical trials, which are now in progress.
Prevention of postoperative renal failure in patients with obstructive jaundice—the role of bile salts
Authors: Cahill C J 
Published: March 2007

Abstract
Preoperative administration of the simple bile salt sodium deoxycholate has been shown in this study to prevent postoperative endotoxaemia and renal failure in patients with obstructive jaundice. Fifty-four per cent of jaundiced patients not given the salt were found to have systemic endotoxaemia, associated with renal impairment in two-thirds of the cases. No patient given sodium deoxycholate 500 mg 8 hourly for 48 hours before operation had portal or systemic endotoxaemia, and none had evidence of renal impairment (P &lt; 0·02, χ2 with Yates' correction). The incidence of endotoxaemia in untreated jaundiced patients was very significantly greater than in non-jaundiced patients undergoing elective upper abdominal surgery (P &lt; 0·005), but this difference is abolished by the prophylactic administration of the oral bile salt. The mechanism of action of bile salts in preventing endotoxin absorption from the small bowel has been investigated, and the lack of any significant alteration in the small bowel microbial flora in obstructive jaundice suggests that a direct effect on the endotoxin molecule is involved. Nearly 20 per cent of patients with obstructive jaundice still develop postoperative renal insufficiency, but preoperative prophylactic use of sodium deoxycholate should reduce this very significantly.
Mammary duct ectasia
Authors: Dixon J M , Anderson T J , Lumsden A B , Elton R A , Roberts M M , Forrest A P M 
Published: March 2007

Abstract
A total of 108 patients with mammary duct ectasia have been reviewed. Patients who presented with breast pain or a lump were significantly younger than those with nipple retraction. A histological review of the 88 patients who underwent biopsy showed severe periductal inflammation around non-dilated ducts occurred in younger patients and was associated with the symptom of breast pain or a lump, whereas older patients had duct dilatation as the most prominent feature, frequently associated with nipple retraction. These findings suggest periductal mastitis precedes duct dilatation and is the initial disorder in this condition. Data on parity and breast feeding for the 108 patients with duct ectasia were compared with age-matched groups of 505 patients with breast cancer, 199 with fibroadenoma, 240 with cysts and 912 ‘normals’. There were no differences in parity or breast-feeding history between the patients with duct ectasia and any other group, indicating that neither parity nor breast feeding is an important aetiological factor in this condition.
Management of acute brachial artery occlusion due to trauma or emboli
Authors: Lambert M , Ball C , Hancock B 
Published: March 2007

Abstract
Out of 37 patients requiring emergency surgery for upper limb ischaemia, 9 were due to spontaneous embolus, 7 to arterial laceration and 21 followed cardiac catheterization. Eleven of the initial operations (30 per cent) failed to relieve ischaemic symptoms though 6 were corrected by further operations. Success at the initial operation was associated with (i) repair with end-to-end anastomosis after resection, saphenous vein bypass or interposition graft, or generous vein patch, (ii) exposure of the radial/ulnar bifurcation, (iii) instillation of heparinized saline locally or (iv) restoration of the radial pulse at the end of the operation. In the cases studied in whom all the above recommendations were followed, the operation was entirely successful and all patients have a radial pulse and are currently symptom free.
An assessment of long saphenous venography to evaluate the saphenous vein for femoropopliteal bypass
Authors: Mosley J G , Manhire A R , Raphael M , Marston J A P 
Published: March 2007

Abstract
A long saphenous venogram was performed on a consecutive series of 42 patients (5 bilateral) though in 4 the vein was not satisfactorily demonstrated. In all cases the long saphenous vein was dissected out and its suitability for use for a femoropopliteal bypass compared to the radiological findings. Eleven veins were unusable for a bypass and radiologically these were narrower (mean diameter 2·8 mm) than the veins which functioned satisfactorily (mean diameter 5·0mm), and had more tributaries (mean 5) than the suitable veins (mean 2). Preoperative venography is a useful technique to identify veins that will be unsuitable for a femoropopliteal bypass and thereby save an unnecessary dissection.
Glutamine
Authors: Hall J C , Heel K , McCauley R 
Published: March 2007

Abstract
Glutamine is the most abundant free amino acid in the circulation. It is a primary fuel for rapidly dividing cells and plays a key role in the transport of nitrogen between organs. Although glutamine is absent from conventional regimens aimed at nutritional support, glutamine deficiency can occur during periods of metabolic stress; this has led to the reclassification of glutamine as a conditionally essential amino acid. Experiments with various animal models have demonstrated that the provision of glutamine can result in better nitrogen homoeostasis, with conservation of skeletal muscle. There is also considerable evidence that glutamine can enhance the barrier function of the gut. This review concludes by discussing the clinical evidence that supports the inclusion of stable forms of glutamine in solutions of nutrients.
Role of cytokines and growth factors in promoting the local recurrence of breast cancer
Authors: Reid S E , Scanlon E F , Kaufman M W , Murthy M S 
Published: March 2007

Abstract
The pathogenesis of local recurrence in breast cancer is not well understood. Breast-conserving surgery is particularly prone to local recurrence as it leaves behind breast tissue that may harbour occult cancer, and lends itself to enhanced intraoperative shedding of cancer cells due to narrower resection margins and transection of lymphatic channels. A review of clinical breast cancer studies as well as experimental research strongly suggests that these persisting cancerous cells are unlikely to develop into clinically evident disease if their environment remains unstimulated. However, an inordinately high local recurrence rate occurs at the surgical scar, and such recurrence must be triggered by the release of growth factors and cytokines into the healing wound. These factors can stimulate any available cancer cells which express the proper growth factor receptors. Perioperative strategies to neutralize this tumour cell-growth factor interaction should maximize local control.
Long-term outcome after surgery for asymptomatic small hepatocellular carcinoma
Authors: Lee C-S , Sheu J-C , Wang M , Hsu H-C 
Published: March 2007

Abstract
The subjects of this study were 48 asymptomatic patients who had surgery for small hepatocellar carcinoma (HCC). There were 42 men and six women with mean(s.d.) tumour size of 3·31(1·46) cm and age 55·0(7·4) years. Follow-up was for a minimum of 10 years. The main concern of this study was a univariate analysis of factors that might affect long-term survival after surgery, which was 50 per cent at 5 years and 31 per cent at 10 years. A high incidence of recurrent HCC (37 of 48 patients) was observed but reoperation further prolonged life in some cases. The significant prognostic factors detected by multivariate analysis were: histological classification, functional liver reserve and histology of the resection margin. Tumour size, gross appearance of tumour, presence of liver cirrhosis, serum α-fetoprotein level, age or sex did not affect the prognosis.
Serum concentrations of inflammatory mediators related to organ failure in patients with acute pancreatitis
Authors: de Beaux A C , Goldie A S , Ross J A , Carter D C , Fearon K C H 
Published: March 2007

Abstract
Leucocyte activation and proinflammatory cytokine release (tumour necrosis factor (TNF) and interleukin 6 (IL-6)) are thought to contribute to the induction of a systemic inflammatory response, an acute-phase response and multiple organ failure in patients with acute pancreatitis. The serum concentration of TNF, soluble TNF receptors (sTNFR55 and sTNFR75), IL-6 and Creative protein (CRP) in 58 patients with acute pancreatitis was assessed during the first 2 days of admission. Thirty patients had mild disease and 28 severe disease, of whom 18 developed local pancreatic complications alone (Atlanta classification) and ten developed organ failure (a Goris score of 1 or more). TNF was detected in only 17 patients on the first day of admission, while soluble TNF receptors were detected in all patients and IL-6 in 34. On the first and second days of admission there was a progressive and significant (P &lt; 0·03) increase in the median concentration of sTNFR55, sTNFR75 and IL-6 in patients eventually classified into those with mild disease, a local pancreatic complication alone, or organ failure. This pattern was also evident in CRP levels from the second but not the first day of admission. These findings suggest that proinflammatory cytokines or their soluble receptors may be more accurate early predictors of outcome than CRP. Moreover, markers of inflammation in the sera of patients with acute pancreatitis are highest in those who subsequently develop organ failure.
Randomized study of antibiotic prophylaxis for general and gynaecological surgery from a single centre in rural Africa
Authors: Reggiori A , Ravera M , Cocozza E , Andreata M , Mukasa F 
Published: March 2007

Abstract
In a district rural hospital in Uganda, 850 surgical patients were evaluated prospectively over a 3-year period to compare the clinical efficacy of conventional postoperative penicillin therapy with single-dose ampicillin prophylaxis for hernia repair and ectopic pregnancy, and with single-dose ampicillin-metronidazole prophylaxis for hysterectomy and caesarean section. The high rate of postoperative infection usually encountered in African hospitals after conventional treatment with penicillin for 7 days was significantly reduced with the new regimen: from 7·5 to 0 per cent in hernia repair and from 10·7 to 2·4 per cent in ectopic pregnancy; from 20·0 to 3·4 per cent in hysterectomy and from 38·2 to 15·2 per cent in caesarean section. Length of hospital stay and postoperative mortality rates were also significantly reduced. Single-dose ampicillin prophylaxis with or without metronidazole, although rarely used in developing countries, is more cost effective than standard penicillin treatment.
Perineal excision of the rectum
Authors: Poppen B , Svenberg T , Bark T 
Published: March 2007

Abstract
An intersphincteric and perimuscular approach was employed for perineal excision of the rectum in 33 patients who had previously undergone total colectomy with preservation of the rectum. Laparotomy was avoided in 28 of the 29 patients who had had closure of the rectal stump with ileostomy. Of the lour patients (two with ileorectal anastomoses and two with sigmoid mucous fistulas) for whom laparotomy was planned, this was considered to be much less extensive than would otherwise have been required. It is concluded that in patients who have previously undergone total colectomy for inflammatory bowel disease, subsequent perineal excision of the rectal stump without laparotomy is frequently possible.