bluuebunny/crossref_metadata_2025_split huggingface dataset:
Restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial adenomatous polyposis: A comparison of three reservoir designs
Authors: Nicholls R J , Pezim M E 
Published: March 2007

Abstract
One hundred and four patients were treated by restorative proctocolectomy with ileal reservoir for ulcerative colitis and familial polyposis. Three different designs of reservoir were used (triple loop 68, double loop 13, quadruple loop 23). There were no postoperative deaths but six (5.8 per cent) had the reservoir removed. Rates for pelvic sepsis were 25, 15 and 13 per cent, and for intestinal obstruction requiring laparotomy 14.7,0 and 8.6 per cent. Function was assessed in 88 patients (58, 12 and 18) after mean intervals from closure of the ileostomy of 23.7, 12.7 and 4.5 months. Frequency of defaecation per 24 h was 3.7 ± 1.6, 5.5 ± 1.6 and 4.1 ± 1.3, being significantly greater for double loop reservoirs; night evacuation was more prevalent in the same group (26, 58 and 22 per cent). Significantly fewer patients with triple than with double loop reservoirs required antidiarrhoeal medication (19 and 58 per cent). Normal continence occurred in 67, 75 and 89 per cent of patients in the three groups. All patients with double or quadruple loop reservoirs defaecated spontaneously while only 41 per cent with triple loop reservoirs did so. Mean intra-operative reservoir volumes were 177 ± 64, 172 ± 58 and 325 ± 37 ml and volumes after closure of the ileostomy were 416 ± 176, 197 ± 69 and 322 ± 33 ml respectively. Double loop reservoirs were significantly smaller than the other two designs after ileostomy closure. There was an inverse relationship between reservoir volumes and frequency. A quadruple loop reservoir directly connected to the anal sphincter preserved spontaneous evacuation and resulted in function similar to that obtained with the triple loop reservoir.
Experience of posterior division of the puborectalis muscle in the management of chronic constipation
Authors: Barnes P R H , Hawley P R , Preston D M , Lennard-Jones J E 
Published: March 2007

Abstract
Nine women with severe chronic constipation who were unable to expel a water-filled rectal balloon underwent posterior division of the puborectalis muscle. Pre-operative concentric needle electromyography and measurement of the anorectal angle at rest and during straining suggested that the puborectalis muscle failed to relax during attempted defaecation in these patients. Two patients reported improvement after surgery and had normal balloon expulsion after operation. However seven patients reported no benefit from surgery and tests of defaecatory function and anorectal angle did not change. Incontinence for solid stool was not reported following puborectalis muscle division although five patients reported incontinence of flatus, liquid stool and mucus.
Meckel's diverticulum in the adult
Authors: Diamond T , Russell C F J 
Published: March 2007

Abstract
Meckel's diverticula were removed from 49 adult patients during a 15 year period. In 24 (49 per cent) of the patients the diverticulum was the cause of symptoms while in the remaining 25 it was an incidental finding at laparotomy. Of the symptomatic patients, 10 had acute inflammation of their diverticula, 8 presented with small bowel obstruction (in 4 cases due to fibrous bands) and 4 attended because of gross rectal bleeding; of the 2 remaining patients one was found to have intusssusception of Meckel's diverticulum into the terminal ileum whilst the other had a nodule of calcified material lying within a partly gangrenous vitellointestinal duct. There was no operative mortality in the series. Heterotopic tissue was noted histologically in six Meckel's diverticula, all of which produced symptoms. The importance of considering a diagnosis of Meckel's diverticulum in the young adult presenting with acute small bowel obstruction or rectal bleeding is emphasized.
Prolonged bandaging is not required following sclerotherapy of varicose veins
Authors: Fraser I A , Perry E P , Hatton Marion , Watkin D F L 
Published: March 2007

Abstract
Following sclerotherapy of varicose veins, 158 limbs of 154 patients were randomized to be bandaged with either crepe or Coban for 6 weeks each, or with Coban for 3 days only. Objective assessment of vein eradication and subjective evaluation of symptoms 3 months after completion of treatment showed no clear differences between these regimens. Significantly more discomfort was experienced with Coban than crepe when used for 6 weeks. It is suggested that, following sclerotherapy, 3 days is an adequate period of bandaging when using Coban. Such a policy would considerably reduce the inconvenience to patients during treatment.
Prospective study of the Angelchik anti-reflux prosthesis
Authors: Wale R J , Royston C M S , Bennett J R , Buckton G K 
Published: March 2007

Abstract
Fifty patients with medically refractory gastro-oesophageal reflux were treated by the insertion of an Angelchik anti-reflux prosthesis. All patients had a pre-operative upper gastrointestinal endoscopy, 32 were investigated with 15 h overnight oesophageal pH studies combined with oesophageal bile sampling and 20 underwent oesophageal manometric studies. At pre-operative endoscopy 45 patients had evidence of oesophagitis and the 5 who did not had pathological reflux demonstrated on overnight pH testing. Postoperatively the main clinical problem was dysphagia which appeared to settle with time but left one-third of patients with mild dysphagia at the end of 12 months. A further 12 per cent had residual moderate to severe dysphagia which required the removal of the prosthesis in five patients (10 per cent). In only one patient was the dysphagia due to prosthetic migration and this was the first patient in the series. Subsequently, we have had no problems with prosthetic migration, disruption, or erosion into the oesophagus. The overnight pH studies confirmed the efficacy of the prosthesis in preventing reflux which correlated with symptomatic improvement. We conclude that, while the Angelchik anti-reflux prosthesis is an effective device, it has a disturbingly high incidence of postoperative dysphagia though this appears to settle with time, leaving around 10 per cent of patients with severe dysphagia which will necessitate removal of the prosthesis and one-third with mild dysphagia which may settle with the further passage of time.
Complications and hospital stay after surgery for breast cancer: A prospective study of 385 patients
Authors: Tejler G , Aspegren K 
Published: March 2007

Abstract
General complications, wound complications and hospital stay after surgery for operable mammary carcinoma were studied prospectively in 385 patients treated by either modified radical mastectomy (324 operations) or segmental resection with axillary dissection (71 operations). The overall infection rate was 3·6 per cent. Postoperative seromas were noted in 34·8 per cent of the wounds. Other complications were few. The average hospital stay was 7·2 days. Seventeen per cent of the total number of days in hospital for these patients were due to factors other than the mammary cancer.
The biliary tract in patients with acute gallstone pancreatitis
Authors: Armstrong C P , Taylor T V , Jeacock Julie , Lucas S 
Published: March 2007

Abstract
The biliary tract has been prospectively studied in a consecutive series of 769 patients undergoing surgery for gallstones to determine whether differences exist between subjects with and without a history of acute pancreatitis. The incidence of acute gallstone pancreatitis (AGP) was 7·7 per cent and men with gallstones were significantly more likely to develop pancreatic inflammation. Operations on patients with AGP were accompanied by a higher mortality rate which was almost entirely due to the severity of the disease at the time of surgery. The earlier operations were performed after the onset of pancreatitis the more often stones were found in the common bile duct and at the ampulla. Patients with AGP had smaller and more numerous gallbladder stones in association with a wider cystic duct than controls. The common bile duct diameter in patients with AGP was independent of the presence of choledochal calculi implying either previous temporary obstruction to the biliary tree or a dilated duct ab initio. Pancreatic duct reflux was far more commonly observed on the cholangiograms of patients with AGP and in these patients reflux occurred into a wider pancreatic duct, at a greater angle and was associated with a longer functioning common channel. No patient developed recurrent pancreatitis following biliary surgery. These features strongly support the concept of gallstone migration and suggest that patients with gallstones who develop acute pancreatitis have essential differences in their biliary tree which mechanically facilitate migration of calculi.
Metronidazole and Augmentin in the prevention of sepsis after appendicectomy
Authors: Drumm J , Donovan I A , Wise R , Lowe P 
Published: March 2007

Abstract
Two hundred and fifty patients were admitted to a prospective randomized trial to compare the efficacy of Augmentin with metronidazole in the prevention of sepsis after appendicectomy. Pre-operatively they received either 500 mg metronidazole or 1·2 g Augmentin intravenously. Those patients with gangrenous or perforated appendices received eight additional doses of the trial drug at 8 hourly intervals. Overall there were 13 wound infections in the Augmentin group (11 per cent) and 21 in the metronidazole group (18 per cent). The 90 per cent confidence limits for the overall 7 per cent difference in infection rates were ±8·5 per cent. There were high rates of wound infection in the gangrenous group (Augmentin 8 per cent versus metronidazole 19 per cent) and especially in the perforated group (Augmentin 33 per cent versus metronidazole 63 per cent). There was no statistically significant difference between the infection rates with the two antibiotics but our study suggests that Augmentin, which is active against both aerobes and anaerobes, may be more effective than metronidazole in reducing wound sepsis after appendicectomy.
Demonstration of a reduction in postoperative body protein breakdown using the Clinitron fluidized bed with an ambient temperature of 32°C
Authors: Jones Gwyneth A , Clague M B , Ryan D W , Johnston I D A 
Published: March 2007

Abstract
Patients managed at an elevated ambient temperature after major surgery have a less pronounced rise in postoperative urinary nitrogen excretion. To investigate the mechanism involved, body protein breakdown was assessed, using a tracer dose of labelled amino acid, in patients following aorto-bifemoral bypass surgery nursed on either a Clinitron fluidized bed at 32°C or a hospital bed at 22°C and correlated with urinary total nitrogen excretion. Results showed a small reduction in measured body protein breakdown on the second postoperative day in patients managed on the Clinitron fluidized bed at 32°C (2·92 ± 0·91 versus 3·23 ± 0·84 g protein kg−1 day−1; mean ± s.d.), which was equivalent to the mean protein sparing (0·29 g protein kg−1 day−1) demonstrated by the significant improvement in urinary total nitrogen excretion (9·20 ± 2·0 versus 12·48 ± 3·9 g N day−1; mean ± s.d.: P &lt; 0·05). Urinary total nitrogen excretion (N) and body protein breakdown (B) showed a weak though significant positive correlation (B = 1·25 + 13·13N; r = + 0·55 : P = 0·05), whereas no correlation existed between urinary total nitrogen excretion and the derived rate of body protein synthesis. There was also a significant decrease in postoperative stress, measured during the isotope infusion, in patients managed on the Clinitron fluidized bed at 32°C (12·3 ± 2·2 versus 16·1 ± 3·2 per cent activity incorporated into plasma proteins; mean ± s.d.: P &lt; 0·05). These results show the beneficial effect of managing postoperative patients on a Clinitron fluidized bed at 32°C in conserving body nitrogen through a reduction in body protein breakdown, probably as a consequence of decreased postoperative stress.
Heparin with and without graded compression stockings in the prevention of thromboembolic complications of major abdominal surgery: A randomized trial
Authors: Wille-Jørgensen P , Thorup J , Fischer A , Holst-Christensen J , Flamsholt R 
Published: March 2007

Abstract
One hundred and seventy-six patients scheduled for elective major abdominal surgery were randomized to two prophylactic regimens to prevent postoperative thromboembolism. All patients were screened with the 125I-labelled fibrinogen uptake test, and thromboembolism was verified by ascending phlebography and/or perfusion/ventilation lung scintigraphy. In the group of patients receiving low-dose heparin treatment (5000 units twice daily subcutaneously) 12 per cent developed thromboembolic complications. In the other group, where low-dose heparin treatment was supplemented with graded compression stockings only 2 per cent developed thromboembolism. It is concluded that the combination of low-dose heparin and the use of graded compression stockings is superior to heparin alone in preventing thromboembolism following major abdominal surgery.
Zinc deficiency and the prolonged accumulation of zinc in wounds
Authors: Senapati Asha , Thompson R P H 
Published: March 2007

Abstract
Zinc is required for protein synthesis and therefore for wound healing. Zinc levels were 50 per cent higher in muscle and skin from abdominal wounds of rats during the maturation phase of wound healing, but mild deficiency greatly reduced this accumulation. The results suggest that zinc takes part in the late stages of wound healing when protein is laid down, and that such extra local demands expose otherwise marginal zinc deficiency.
The results of surgical treatment of cancer of the rectum by radical resection and extended abdomino-iliac lymphadenectomy
Authors: Glass R E , Ritchie Jean K , Thompson H R , Mann C V 
Published: March 2007

Abstract
At St Mark's Hospital survival after radical surgery for cancer of the rectum has not changed significantly over the past 30 years. The technique of extended abdomino-iliac lymphadenectomy was developed in an attempt to improve prognosis in patients considered to have particularly unfavourable tumours. Between 1960 and 1981 the technique was used in 75 patients with a single adenocarcinoma of the rectum. Two patients died postoperatively and 52 patients developed complications; a mortality and morbidity similar to those seen after conventional surgery at this hospital. Five-year survival rate showed no improvement over that achieved by conventional techniques; disappointingly this was also the case for patients with Dukes' C1 tumours. The results of this study suggest that an improvement in survival in patients with cancer of the rectum is unlikely to be achieved by any extension of conventional radical surgery.
Colonic anastomotic healing and oxygen tension
Authors: Shandall A , Lowndes R , Young H L 
Published: March 2007

Abstract
Using a Clark oxygen electrode and a 133Xe clearance technique, tissue oxygen tension (To2) and blood flow have been determined in the small and large bowel of a rabbit experimental model. The predictive value of perianastomotic To2 in colonic anastomoses was determined, healing being assessed by leakage rate, tensile strength and hydroxyproline content. The effect of suture technique on colonic perianastomotic To2 has also been studied. Colonic and small intestinal To2 correlated with blood flow (r = 0·93). Basal colonic blood flow and oxygen tension were significantly lower than in the small intestine (P&lt;0·01). Interrupted and continuous suture techniques decreased colonic perianastomotic To2, although mean To2 in the continuous group was significantly lower than in the interrupted group (P&lt;0·01). The leakage rate was 10 per cent (1/10) for anastomoses constructed with a perianastomotic To2 above 55 mmHg compared with 100 per cent (10/10) if less than 25 mmHg (P&lt;0·001). Perianastomotic To2 correlated with breaking energy (P&lt;0·001), breaking strength (P&lt;0·01) and hydroxyproline content (P&lt;0·05).
Retroperitoneal tumour infiltration detected by bone scanning in patients with infiltrating lobular carcinoma of the breast
Authors: Wilkinson M J S , Howell A , Harris M , Adam N M , Lupton E , Johnson R J , Sellwood R A 
Published: March 2007

Abstract
Radionuclide bone scans performed in some patients with carcinoma of the breast showed abnormal retention of isotope in the renal pelvis which developed and progressed during the period of follow-up after mastectomy. This phenomenon was seen in 15 of 30 patients with infiltrating carcinoma of the breast (ILC) but in none of 29 with infiltrating duct carcinoma (IDC). Autopsies were performed in eight of the patients with ILC and three of those with IDC. Diffuse retroperitoneal and ureteric infiltration was seen in seven (88 per cent), with ILC and none with IDC. These data suggest that this scan abnormality is an indicator of retroperitoneal spread by ILC.
Risk factors and clinical data related to oestrogen receptor status in women presenting with breast cancer
Authors: Montgomery A C V , McClelland R A , Skilton R A , Easton D , Cancer Breast 
Published: March 2007

Abstract
Oestrogen receptor (ER) content was measured in 257 patients presenting with ‘operable’ breast cancer. Difference in age, menopausal status, parity, age at first pregnancy, breast feeding habit and details of past and family history were compared with oestrogen receptor status. The symptoms and their duration together with the extent of the disease both clinically and pathologically were also compared with receptor status. Association both for increasing age and postmenopausal status was found when oestrogen receptors were present in the primary tumours in significant quantities. No separation between the effect of age and menopausal status on oestrogen receptor status could be distinguished. No relationship was demonstrated between oestrogen receptor status and the other clinical and pathological factors examined.
Management of splenic trauma: The Durban experience
Authors: Chadwick S J D , Huizinga W K J , Baker L W 
Published: March 2007

Abstract
In a retrospective survey of splenic trauma managed at a teaching hospital, the data of 127 patients during a 2 year period have been analysed. Splenic conservation was achieved in 47 laparotomies (38·8 per cent). Six patients with blunt abdominal trauma (4·7 per cent of all patients) were managed non-operatively. Splenic conservation by suture with or without packing with omentum or oxidized cellulose was successful in 27 out of 37 attempts. Failure of this technique was easily recognized during laparotomy and no patient required re-operation for continued splenic bleeding after splenorrhaphy. There was no significant difference between successful conservation of the spleen at laparotomy of patients below the median age (28 years) and older patients. Wound sepsis was increased after splenectomy (P &lt; 0·05). Splenic conservation is not appropriate for all types of splenic injury. Where conservation is not possible splenectomy and re-implantation is recommended.
Pilonidal sinus excision — healing by open granulation
Authors: Marks J , Harding K G , Hughes L E , Ribeiro C D 
Published: March 2007

Abstract
A prospective study is reported of 100 pilonidal sinus excisions healing by open granulation. Delays in healing appeared to be due to infection, particularly by anaerobic bacteria. Comparisons are made between three groups studied consecutively — 30 wounds not treated with antibiotics, 20 given a fixed two-week course of metronidazole and 50 managed flexibly. In this last group, wound management was determined by clinical appearance; 24 wounds were clinically healthy throughout and received no antibiotic while 26 looked unhealthy initially or after an interval and were treated with metronidazole, supplemented in some cases with erythromycin. The best results were obtained in the group managed flexibly. It is considered that the problems of delayed healing are due to excisions which leave a wound of a shape ill-designed to maintain good drainage. Unhealthy wounds should be re-shaped if possible and treated early with a combination of metronidazole and erythromycin.
Oxygen tension on the skin of the gaiter area of limbs with venous disease
Authors: Clyne C A C , Ramsden W H , Chant A D B , Webster J H H 
Published: March 2007

Abstract
We examined the levels of oxygen on the skin of the gaiter areas of limbs with venous disease using a Roche Transcutaneous pO2 Monitor to determine whether hypoxia contributes to the skin changes and ulceration associated with severe venous disease. We studied patients with superficial varicose veins and no skin changes (Group 1: n = 25), patients with skin changes and healed ulcers (Group 2: n = 15), and an age matched normal control group (controls: n = 25). TcpO2 measurements were taken 5 cm above the medial malleolus with the limb both horizontal and vertical using a Roche Transcutaneous pO2 Monitor. A standard heel-raising test using a Medisonics Photoplethysmograph indicated the degree of venous insufficiency present. Results show that Group 1 patients and controls have similar skin oxygen levels (Group 1: TcpO2 66·48 + 14·12 mmHg; controls: TcpO2 61·60 ± 11·02 mmHg) whereas those with skin changes and ulceration have significantly lower oxygen levels (Group 2: TcpO2 46·57 ± 9·70 mmHg, t = 4·29, P&lt;0·001). Group 2 patients did not show a significant rise in TcpO2 levels in the standing position whereas Group 1 patients and controls did (t = 2·6, P &lt; 0·02). PPG post-exercise recovery times confirmed differences between the three groups. These findings show that significant skin hypoxia occurs on the gaiter area of limbs with severe venous disease and support the concept of an oxygen diffusion block.
Effects of a selective β2-blocker (ICI 118,551) on hepatic haemodynamics in the cirrhotic and non-cirrhotic rat
Authors: Jenkins S A , Baxter J N , Johnston J N , Devitt P , Shields R 
Published: March 2007

AbstractThe effects of a selective β2-blocker (ICI 118,551) on hepatic haemodynamics were studied in cirrhotic and non-cirrhotic rats. Infusions of 10 and 20 μg (kg body wt)−1 min−1 β2-blocker (in cirrhotic and non-cirrhotic rats) significantly reduced portal pressure, portal venous flow and liver blood flow without altering heart rate. Splanchnic vascular resistance was significantly increased following infusions of 10 and 20 μg (kg body wt)−1 min−1 β2-blocker. An intraportal injection of β2-blocker (10 μg body wt)−1 or hepatic artery ligation lowered portal pressure by approximately the same magnitude. Intraportal injection of β2-blocker after hepatic artery ligation did not further reduce portal pressure. The results indicate that a selective β2-blocker reduces portal pressure by a combination of increased splanchnic vascular resistance and hepatic arterial resistance. It is concluded that a selective β2-blocker may be of clinical value in the long-term managements of portal hypertension.
Malignant masquerade at the hilum of the liver
Authors: Hadjis N S , Collier N A , Blumgart L H 
Published: March 2007

Abstract
Eight patients with biliary obstruction and a pre-operative diagnosis of a neoplastic lesion at the confluence of the hepatic ducts were found postoperatively to have benign disease. Cholangiography was highly suggestive of a malignant stricture in all patients. Angiography performed in six patients indicated that the lesions were potentially resectable. Seven patients underwent elective surgery; in six the ductal confluence including the lesion was removed, without mortality. Six patients are alive, five of them totally asymptomatic, in a median follow-up of 32 months. Many patients with hilar strictures are treated for what appears radiologically to be a neoplastic lesion. Since treatment often involves the placement of an endoprosthesis or palliative surgery, without histological diagnosis, some of these patients with benign disease are likely to be treated inappropriately, unless they are considered for a curative resection.