bluuebunny/crossref_metadata_2025_split huggingface dataset:
The occult rectal prolapse syndrome
Authors: White C M , Findlay J M , Price J J 
Published: March 2007

Summary
Occult rectal prolapse is a condition of young adults which causes problems in diagnosis. Symptoms consist of tenesmus and the passage of blood and mucus associated with constipation and straining at stool. The rectal prolapse often remains unrecognized for a long time because demonstration of the prolapse is difficult. There are characteristic changes in the rectum on clinical examination and these should alert the clinician to the diagnosis. Treatment of the prolapse relieves the symptoms.
Tumour thickness and the site and time of first recurrence in cutaneous malignant melanoma (stage I)
Authors: Milton O W , Shaw H M , Farago G A , McCarthy W H 
Published: March 2007

Summary
A study was made of 326 patients first treated for clinical stage I cutaneous malignant melanoma by a wide excision (with or without split-skin graft) but no nodal dissection and who subsequently developed recurrence of their disease. Thick lesions recurred far more frequently than very thin lesions, although evidence of partial regression in very thin lesions conferred upon the latter a liability to metastasize. Thicker lesions first recurred predominantly in the vicinity of the scar of primary lesion excision whilst very thin lesions first recurred either at regional lymph nodes or at remote sites. The disease-free interval fell with increasing tumour thickness. As a result of this, local first recurrences developed more rapidly than remote first recurrences. The cumulative 10-year survival rate for patients with local first recurrences was, however, significantly higher than for patients with remote first recurrences, as the survival period after local first recurrence was considerably longer than after remote first recurrence.
We conclude that tumour thickness is an easily measured, objective predictor of the site and time of first recurrence from melanoma. Thus, by facilitating early detection of first metastastases, it may be possible to prolong survival time.
Removal of metronidazole by haemodialysis
Authors: Gabriel Roger , Page C M , Collier J , Houghton G W , Templeton R , Thorne P S 
Published: March 2007

Summary
The removal of the anti-anaerobic antibiotic metronidazole has been studied in oliguric patients. The drug and its principal metabolite are rapidly removed by haemodialysis so that the plasma concentration quickly falls below the therapeutic range. Hence a further dose of metronidazole would be needed after dialysis to restore an adequate plasma concentration.
Usefulness of transhepatic portal catheterization in the treatment of insulinomas
Authors: Pedrazzoli Sergio , Feltrin Giampiero , Dodi Giuseppe , Miotto Diego , Pasquali Claudio , Cevese Pier G 
Published: March 2007

Summary
Twenty-four per cent of β-cell tumours require more than one operation to control the hypoglycaemic syndrome. Almost all of them are small insulinomas undetectable by palpation of the pancreas. Arteriography is too insensitive to detect non-palpable tumours. Transhepatic catheterizaation of the splenic and portal veins (TPC) can detect the position at which there is an abrupt increase in insulin level indicating the site of the tumour. Routine use of TPC allowed us to locate all 9 insulinomas in which this technique was employed, whereas of 15 patients not studied by TPC only 12 tumours were located at first operation, 2 of which were found by blind resection of the tail of the pancreas. We believe that routine application of TPC to all cases of suspected insulinoma would reduce the incidence of surgical failures, unsuccessful blind resections and lengthy trials of medical therapy before laparotomy.
Fibrinogen in the ‘hepato-renal syndrome’: An experimental study
Authors: Sagar S , Shields R 
Published: March 2007

Summary
The pathogenesis of renal failure in jaundice is controversial. Several factors have been incriminated, including intravascular coagulation. We have investigated this hypothesis by studying the deposition of radioactive fibrinogen in the kidney of jaundiced rats. Fibrinogen labelled with 125I was injected into rats whose bile duct was subsequently ligated. The radioactivity in the kidney was compared to that in blood and the renal uptake ratio calculated. This ratio (mean ± s.e.mean) rose from 0·24 (± 0·04) to 2·93 (± 0·43) after ligation of the common bile duct. In contrast, in control rats who underwent a sham operation, the uptake ratio rose from 0·31 (± 0·03) to 0·96 (± 0·08). This deposition of 125I fibrinogen in the kidneys of jaundiced rats was significantly greater (P &lt; 0·001) than that in control rats. The deposition was specific to the kidney compared with that in the heart, bowel, muscle and liver. In the control animal the uptake of 125I fibrinogen by the kidney was not different from that by other viscera.
Penetrating injuries of the neck: A prospective study of 108 patients
Authors: Campbell F C , Robbs J V 
Published: March 2007

Summary
One hundred and eight patients were admitted to King Edward VIII Hospital, Durban, with a penetrating wound of the neck and were managed by a conservative policy. Intervention was undertaken if, and only if, there was an indication of damage to deep structures. Data were collected prospectively. Significant sequelae were seen in only 50 patients (46 per cent) and 26 underwent surgery. Three patients died from their neck injuries (2·8 per cent), 2 after operative intervention and 1 after conservative management. Morbidity was higher after surgery, though local sepsis in wound haematomas was more common in those treated conservatively.
A selective policy for surgical intervention is safe and justifiable. A minimum mortality and morbidity can be obtained by adequate preoperative evaluation which includes the use of contrast radiography and angiography.
Faecal bile acid excretion in diverticular disease
Authors: Flynn M , Hyland J , Hammond P , Darby C , Taylor I 
Published: March 2007

Summary
Faecal bile acid excretion and sigmoid myoelectrical activity were measured on three separate occasions over a 12-month period in 21 patients with diverticular disease and the results were compared with those of 17 age-matched normal subjects. Statistically significantly lower faecal concentrations of both deoxycholic and lithocholic acid were found in patients with diverticular disease (96·7 ± 11·3 mg/100 g, 59·6 ± 6·0 mg/100 g respectively) when compared with normal subjects (219 ± 32·0 mg/100 g and 117·6 ± 14·6 mg/100 g respectively P &lt; 0·001). These values persisted throughout the period of study. Patients with diverticular disease were found to have an abnormally rapid myoelectrical rhythm (frequency 0·2–0·3 Hz [12 – 18 c/min]) which returned towards normal after 1 year's bran treatment. Significant correlatzons were found between lithocholic acid concentrations and activity of 0·2–0·3 Hz (r = 0·67) and deoxycholic acid concentrations and activity of 0·1–0·15 Hz (6–9 c/min) (r = 0·62). It is suggested that increased colonic absorption of bile acids may occur in diverticular disease which may influence the myoelectrical activity.
Comparison of skin closure using continuous and interrupted nylon sutures
Authors: McLean N R , Fyfe A H B , Flint E F , Irvine B H , Calvert M H 
Published: March 2007

Summary
Skin closure using continuous nylon sutures was compared with closure using interrupted nylon sutures in 105 consecutive patients undergoing laparotomy. Particular note was made of wound healing and wound infection.
The incidence of wound infection was similar (3·9 per cent and 3·7 per cent respectively) and all wounds healed satisfactorily. The continuous method was quicker and cheaper.
Factors determining outcome of reversed saphenous vein femoropopliteal bypass grafts
Authors: Sonnenfeld Tomas , Cronestrand Ruben 
Published: March 2007

Summary
This investigation was designed to study factors that might be of predictive value in femoropopliteal vein bypass grafting. A series of 146 grafts had a cumulative 5-year graft patency of 82·5 per cent. Five-year limb survival rate in salvage cases was 77·9 per cent. These results are encouraging. However, taking certain factors into account, the patency rates varied. In limbs with claudication, the 5-year graft patency rate was significantly higher than in salvage procedures (P &lt; 0·05). Basal and maximal (during pharmacological vasodilalation) intraoperative graft flow rates were also significantly higher in claudicating limbs (P &lt; 0·01). Reconstructions in limbs with a good run-off had better patency and flow rates than in limbs with a poor run-off (P &lt; 0·001). This suggests that progression of distal atherosclerosis is a major factor for late graft thrombosis. The incidence of graft thrombosis was correlated with the flow rates (P &lt; 0·01). Age, the presence of diabetes, graft diameter and the site of the distal anastomosis did not affect patency.
Aorto-duodenal and subsequent aorto-colonic fistula following operation for ruptured aortic aneurysm
Authors: Cranston D , Vowles K D J 
Published: March 2007

Summary
Direct communication between aorta and intestinal lumen. whether spontaneous (primary) or postoperative (secondary), is a rare and frequently lethal cause of gastrointestinal haemorrhage. This paper records what is believed to be a unique occurrence in the survival of a patient who, following surgery for ruptured aortic aneurysm, not only developed an aorto-duodenal but subsequently an aorto-colonic fistula over a span of 5 years.
Is continued anal dilatation necessary after a Lord's procedure for haemorrhoids?
Authors: Vellacott K D , Hardcastle J D 
Published: March 2007

Summary
Forty patients with symptomatic haemorrhoids had a Lord's procedure performed under general anaesthetic. Anal pressures were recorded before and after the dilatation. The patients were then randomly allocated to one of two regimens. Group I was given only a bulk laxative and group 2 was given a bulk laxative and a large anal dilator to use over the next few months according to Lord's regimen. When reviewed at 3 months and 12 months there was no difference in the results between the two groups. We conclude that the use of an anal dilator does not improve the results after a Lord's procedure.
Isolated limb perfusion with melphalan in the treatment of malignant melanoma
Authors: Bulman Andrew S , Jamieson Crawford W 
Published: March 2007

Summary
Seventy patients with invasive malignant melanoma confined to one limb were treated by isolated perfusion with 1-phenylalanine-dihydrochloride (melphalan) and regional lymphadenectomy between 1959 and 1979. Five patients were perfused twice.
This treatment did not modify the results of appropriate local excision in early melanoma. Twenty-one patients with stage I disease have had 76 per cent 5-year survival.
Forty-eight per cent of 29 patients with extensive local recurrent tumour showed marked tumour regression. Nine of these had subsequent local recurrence with a mean remission of 7 months. Survival in those who responded was 2 years longer than in those who did not. In 6 patients with slight local recurrence, and 19 patients with regional node metastases, response could not be assessed directly. Their 5-year survival was 52 per cent.
There have been no deaths as a result of the procedure and no amputations. Mean postoperative hospital stay was 25 days. We conclude that this technique has a useful place in the palliation of extensive local recurrent melanoma.
The presentation and progress of macroscopic breast cysts
Authors: Jones B M , Bradbeer J W 
Published: March 2007

Summary
A total of 322 cases of macroscopic breast cysts presenting at a district general hospital has been studied with a minimum follow-up period of 5 years. In almost half the patients (44·18 per cent) a further cyst occurred following aspiration, and in two-thirds of these, more than one subsequent cyst developed. There was a 50-year age span from the youngest to the oldest patient at presentation; however, the majority of cysts (61·80 per cent) occurred in the perimenopausal age group (40–50 years). The subsequent incidence of carcinoma was more than twice that which would be expected in the population at large, but no case of carcinoma that was not suspected clinically was revealed by cytology.
Intestinal complications of endometriosis
Authors: Pillay S P , Hardie I R 
Published: March 2007

Summary
Five patients with intestinal endometriosis are presented. Two patients had appendiceal involvement, and 3 with sigmoid colon involvement presented with clinical features indistinguishable from carcinoma of the colon. It is important for surgeons to be aware of the possibility of intestinal endometriosis when treating patients with polypoidal colonic masses, strictures of the pelvic colon and atypical rectal bleeding.
Association of Surgeons of Great Britain and Ireland
Authors: Lawrence D , Kakkar V V 
Published: March 2007

Summary
Foot volumetry is a simple, non-invasive technique for functional assessment of the venous system of the lower limb. The results of foot volumetry and venous pressure measurements were compared in 28 patients who were allocated to one of three groups—normal, uncomplicated superficial venous incompetence and deep venous incompetence—on the basis of clinical examination and ascending phlebography. Volumetry was found to differentiate more accurately between the three groups. Volumetry was also used in 113 patients who had suffered from phlebographically proved deep vein thrombosis (DVT). Seventy-seven per cent of 34 patients who sustained a major DVT and 16 per cent of 79 patients with calf vein thrombosis had evidence of severe haemodynamic impairment equivalent to that seen in the established post-phlebitic syndrome. The clinical significance of these findings is discussed.
The recovery of intestine after ischaemic injury
Authors: Gorey Thomas F 
Published: March 2007

Summary
A reproducible model of reversible segmental ischaemia was used to evaluate methods of predicting intestinal viability after the release of strangulation. Visual assessment in the immediate period after reperfusion and at ‘second-look’ 24 hours later was inaccurate in identifying recoverable bowel. A Doppler probe used to detect the return of pulsatile blood flow was overpredictive of necrosis. The pattern of surface fluorescence after injection of the supravital dye fluorescein increased the accuracy of predicting intestinal recovery.
A series of silicone rubber injections was carried out to investigate whether the patency of the microvessels influenced the outcome. It was shown that as the ischaemic period increased there was progressive failure of the microcirculation.
It was concluded that the fluorescein injection test correctly identifies recoverable bowel and that the outcome after ischaemic injury is related to microvascular patency.
The effect of vibration on digital blood flow
Authors: Welsh C L 
Published: March 2007

Summary
The effect on digital blood flow of an acute exposure to vibration has been assessed. Vibration in the frequency range 40–200 Hz reduces digital blood flow, the effect being maximal at 120 Hz. Increasing the amplitude of vibration reduces digital blood flow. The results have implications in the formulation of industrial vibration standards and in the pathophysiology of vibration-induced white finger.
The value of laparoscopy under local anaesthesia in 250 medical and surgical patients
Authors: Hall T J , Donaldson D R , Brennan T G 
Published: March 2007

Summary
This study reports our experience of laparoscopy under local anaesthesia in 250 patients; the procedure was safe, quick and easy to perform with minimal inconvenience to the patient. We advocate the early use of laparoscopy in patients with ascites and when there is difficulty in the diagnosis of patients with jaundice and hepatomegaly, an accurate histological diagnosis being obtained in the majority. In patients with intra-abdominal malignancy, in whom surgery is planned, laparoscopy can detect disseminated disease and so avoid an unnecessary laparotomy. Laparoscopy may also provide a diagnosis in patients presenting with a variety of vague symptoms such as abdominal pain, weight loss, lethargy etc. We have found laparoscopy an excellent investigation if positive but, as it only allows the surface inspection of viscera, when negative, we recommend caution in its interpretation.
A prospective study of sexual function after major colorectal surgery
Authors: Williams J T , Slack W W 
Published: March 2007

Summary
Excision of the recto-sigmoid and rectum for cancer or inflammatory disease frequently damages the autonomic nerve supply. The anatomy and function of the autonomic nervous system in the pelvis is reviewed.
Thirty-two patients who underwent excision of the rectum have been studied: 28 operations were for carcinoma, 4 for ulcerative colitis. A detailed history of sexual function was obtained preoperatively together with a neurological examination of the genitalia and perineum. Biopsies were taken from the surgical specimens and examined for the presence of nerve tissue. A further sexual history was taken 3 months postoperatively.
Ten sexually active men (ages 46–74) who had anterior resections or abdominoperineal excisions for carcinoma tended to show impaired sexual activity if there was excessive nerve tissue in the specimen. Two out of 3 sexually active women (ages 53–68) who had cancer operations had satisfactory sexual function postoperatively.
Four patients (ages 28–66) all had satisfactory sexual function after panproctocolectomy for ulcerative colitis.
The advantages of avoiding damage to the pelvic autonomic nerves at operation are discussed.
The anal reflex in idiopathic faecal incontinence; an electrophysiological study
Authors: Henry M M , Parks A G , Swash M 
Published: March 2007

Summary
We have recorded the latency of the anal reflex, using a simple electrophysiological method, in 22 patients with anorectal incontinence and in 33 control subjects without anorectal disease. The mean latency in the control subjects was 8·3 ms (range 5–11·3 ms). In the patients with faecal incontinence the mean latency of the anal reflex was 13·0 ms (range 6·5–22·0 ms). The reflex latency was within the normal range in only three incontinent patients. These findings support our concept, based on histological examination of the external anal sphincter musculature, that a major cause of this syndrome is denervation of these muscles due to damage to the innervation of the external anal sphincter and puborectalis muscles.
Cancer of the oesophagus—how should tumour biology affect treatment?
Authors: Roberts John G 
Published: March 2007

Summary
An analysis of the biology of cancer of the oesophagus suggests that significant dissemination may not have taken place at the time of diagnosis in approximately one-third of cases. Positive nodal histology in the mediastinum or abdomen is the best available evidence of disseminated disease. Patients without such nodal involvement there-fore represent a group in whom the disease is most likely to be localized. It is suggested that only these patients be subjected to aggressive local therapy. The effects of no treatment, ortho- and megavoltage radiotherapy, surgery and combinations of surgery and radiotherapy are reviewed. The need for cooperative randomized clinical trials to test the biological hypothesis outlined is discussed. Megavoltage radiotherapy as a primary treatment for oesophageal cancer followed by radical surgery in those patients without evidence of dissemination from nodal histology is proposed as a basis for such clinical trials.
Single dose intra-rectal metronidazole as prophylaxis against wound infection following emergency appendicectomy
Authors: Tanner W A , Ali A E , Collins P G , Fahy Ann M , Lane B E , McCormack T 
Published: March 2007

Summary
A prospective placebo controlled randomized trial was carried out in 104 patients with a presumptive diagnosis of acute appendicitis. A single dose of 1 g of metronidazole was given intra-rectally 1 h preoperatively. There were 16 wound infections, 15 (out of 50) in the placebo group, 1 (out of 54) in the metronidazole group. This study supports the already accepted value of metronidazole but suggests that a single intra-rectal dose regimen is adequate for prophylaxis.
Incidence of postoperative venous thromboembolism in South India
Authors: Shead G V , Narayanan Ramji 
Published: March 2007

Summary
The development of postoperative deep vein thrombosis (DVT) was determined in 50 South Indian patients aged 50 years or more using the 125I-fibrinogen uptake technique. The overall incidence was 28 per cent. In patients with malignancy the incidence was 47·6 per cent. Predisposing factors such as varicose veins, oral contraceptives and obesity did not appear important.
A retrospective analysis of post-mortem examination performed on 432 patients dying after operation showed major pulmonary embolism to have occurred in only 1·9 per cent. The disproportion between the frequent ocurrence of postoperative DVT and the infrequence of fatal pulmonary embolism warrants further study.
Use of an extracorporeal glucose monitor for the diagnosis and surgical treatment of an insulinoma
Authors: Buysschaert M , Lambotte L , Reynaert M , Kestens P J , Ketelslegers J M , Lambert A E 
Published: March 2007

Abstract
An extracorporeal glucose monitor (EGM) has been used in a patient with an insulinoma. This system, which continuously measures blood glucose, can be used in combination with a feedback-controlled glucose infusion to maintain glycaemia at any preselected level. It prevents the risk of severe hypoglycaemia during diagnostic tests (total fast, tolbutamide and insulin tolerance tests) as well as during surgery. It also helps in determining whether all the insulin-secreting tumour tissue has been removed. The EGM is thus helpful in the diagnosis and surgical treatment of insulinomas.
The management of pancreatic and pancreaticoduodenal injuries
Authors: Campbell Robert , Kennedy Terence 
Published: March 2007

Abstract
From 1969 to 1979 39 injuries of the pancreas and duodenum were treated at the Royal Victoria Hospital, Belfast. The mortality was 31 per cent. Twenty-six injuries were due to stab, bomb or bullet. Two of the 17 with low velocity gunshot wounds died, whereas all 5 cases of high velocity missile injury died (P &lt; 0·001). Ten of the 13 cases of blunt trauma were due to road traffic accidents. In 21 cases the body and tail of the gland were injured, and in 13 the head and neck. There were 5 isolated duodenal injuries and in 7 a combined pancreaticoduodenal injury. The mortality was directly related to the number of other organs damaged.
Three main methods of treatment were used—simple drainage, suture and drainage, and primary distal pancreatic resection. Serious complications, pancreatitis, fistula, secondary haemorrhage and sepsis were frequent after the first two methods but rare after distal resection.
Diagnosis was delayed in 4 cases of closed injury and 1 of these patients died. Pancreatic injury was missed 6 times at operation; in 4 cases retroperitoneal haematoma was not explored and 2 of these patients died.
Five of the 12 deaths were due to overwhelming bomb and bullet injury. In one case resuscitation was inadequate. The remaining 6 died of the complications of the original pancreatic injury, either because operation was delayed or because the injury was missed.
Our management was deficient in three areas: awareness of the need for laparotomy, recognition of the injury at operation and inadequate surgery. All open abdominal injuries must be explored; suspicion and careful assessment are essential in closed trauma. At operation the pancreas must be carefully examined; an upper retroperitoneal haematoma is an absolute indication for this. Simple drainage is only sufficient for trivial injury; for major injury of the body and tail we prefer distal resection. Roux loop drainage is suggested for injury to the head and neck, especially when associated with duodenal injury.