bluuebunny/crossref_metadata_2025_split huggingface dataset:
Outpatient flexible fibreoptic sigmoidoscopy, diagnostic yield and the value of glucagon
Authors: Foster G E , Vellacott K D , Balfour T W , Hardcastle J D 
Published: March 2007

Summary
One hundred patients had flexible fibreoptic sigmoidoscopy in an outpatient clinic after preparation with a phosphate enema but without sedation. Patients were randomized to receive 1 mg of glucagon intravenously or a matching placebo. The discomfort of the patients and the ease of the procedure were similar in both groups. Nine patients were excluded from the final analysis as they had low rectal or anal lesions. In the remaining 91 patients, abnormalities were found in 27 (29·6 per cent) including 16 adenomatous polyps and 1 carcinoma. Only 3 lesions were below 20 cm and might have been easily visualized using a rigid sigmoidoscope.
Identification of risk factors for acute pancreatitis from routine radiological investigation of the biliary tract
Authors: McMahon M J , Playforth M J , Booth E W 
Published: March 2007

Summary
The size and shape of gallstones, the diameter of the common bile duct and the presence of reflux into the pancreatic duct were studied by examining routine contrast investigations of the biliary tract in 174 patients with gallstones. Patients were divided into two groups: 69 who had been admitted to hospital with an attack of acute pancreatitis (group 1) and 105 patients with gallstones who had not had a known attack of pancreatitis (group 2).
Four or more gallstones were present in 38 (78 per cent) of 49 visualized gallbladders in group 1 compared with 45 (52 per cent) of 87 in group 2 (P &lt; 0·005). The smallest gallbladder stone was less than 4 mm in diameter in 69 per cent of group 1 and 44 per cent of group 2 gallbladders (P &lt; 0·005). Twenty-nine per cent of gallbladder stones in group 1 were clearly faceted compared with 20 per cent in group 2.
There were no significant differences in the diameter of the common bile duct or the presence of stones in the common bile duct, although the latter were more common in group 1. Reflux of contrast into the pancreatic duct (on operative or T tube cholangiogram) was more common in group 1 (50 per cent) than group 2 (25 per cent) (P &lt; 0·025).
This study supports the role of numerous small stones and a ‘common channel’ at the ampulla as aetiological factors in patients who develop acute pancreatitis as a complication of gallstones.
Long term follow-up of interposition mesocaval shunting in portal hypertension
Authors: Fletcher M S , Dawson J L , Williams Roger 
Published: March 2007

Summary
The long term results of 28 interposition mesocaval shunts performed between 1971 and 1975 are analysed over a follow-up period of 5–9 years. There were 6 emergency operations and 22 elective operations, with an overall operative mortality of 14·3 per cent and a 5-year survival for the complete series of 31·5 per cent (class A patients 55·5 per cent, class B 33 per cent and class C 0 per cent). Shunt patency at 7 months was 95 per cent but by 5 years this had fallen to 53 per cent. Further variceal bleeding occurred in 6 patients (31·5 per cent) in 4 of whom shunt occlusion was confirmed.
Whole-body nuclear magnetic resonance imaging: The first report of its use in surgical practice
Authors: Pollet J E , Smith F W , Mallard J R , Ah-See A K , Reid Anne 
Published: March 2007

Summary
This is the first report of whole-body nuclear magnetic resonance (NMR) imaging being of value in clinical surgery. Following aortobifemoral grafting, a 54-year-old man developed a pyrexia and hypotension which did not respond to antibiotic therapy and which was thought to be caused by early graft infection. Whole-body NMR imaging showed the graft and iliac arteries to be normal and an empyema of the gallbladder to be present. NMR imaging is a safe, non-invasive technique for imaging the body in transverse sections and specifically measures the water concentration of tissues, enabling normal and inflamed tissues to be differentiated.
Aerobic and anaerobic bacteriology of subcutaneous abscesses
Authors: Ghoneim A T M , McGoldrick J , Blick P W H , Flowers M W , Marsden A K , Wilson D H 
Published: March 2007

Summary
Pus from 84 patients with subcutaneous abscesses was examined for aerobic and anaerobic bacteria: organisms were recovered from 70 (83·3 per cent). In 13 no organisms were seen in the Gram-stained smears and the cultures showed no bacterial growth. Staphylococcus aureus was the most prevalent organism (n = 44), isolated in 43 in pure culture, in marked contrast to the anaerobic organisms which almost invariably were associated with mixed cultures. All patients were treated by the primary suture method. Half of them were not given preoperative antibiotics and 3 developed bacteraemia and 1 septicaemia. Blood isolates were of S. aureus of the same phage type as pus isolates. The other patients received one injection of 300 mg of clindamycin phosphate 30 min to 1 h before surgery. From this group only one patient, with a perianal abscess, developed Escherichia coli bacteraemia. The levels of clindamycin in the abscess aspirate were inhibitory for S. aureus, bacteroides, streptococci and other Gram-positive bacteria but not for E. coli.
Muscular abnormalities affecting the popliteal vessels
Authors: Bouhoutsos J , Daskalakis E 
Published: March 2007

Summary
Forty-five cases in 33 patients of congenital muscular abnormalities causing vascular compression in the popliteal fossa are reported. Three main types of abnormality were distinguished. In the first, one muscle, either the medial head of gastrocnemius or the plantaris, is abnormal. In the second, both these muscles contribute to the problem, whereas in the third type, the semi-membranosus also is abnormal. In some cases an abnormal course of the popliteal vessel(s) is also found. With only a few exceptions, cases reported in the literature fit into this classification. Twelve patients in this series were affected bilaterally but only 5 had the same anatomy in both legs. In only 14 instances, either with thrombosis or with characteristic shifting of the artery, was routine arteriography sufficient for diagnosis; loss of distal pulses during active plantar flexion was necessary in the majority to demonstrate the abnormality. It is suggested that the condition is more common than has been thought.
Influence of oral mannitol bowel preparation on colonic microflora and the risk of explosion during endoscopic diathermy
Authors: Keighley M R B , Taylor E W , Hares M M , Arabi Y , Youngs D , Bentley S , Burdon D W 
Published: March 2007

Summary
Oral mannitol has been widely accepted as the bowel preparation of choice for colonoscopy and elective colorectal operation because it is well tolerated by patients. Recent concern has been expressed regarding the risk of explosion and sepsis using oral mannitol because it may provide a nutrient for certain gas-producing bacteria in the colon. Samples of colonic contents aspirated at operation were compared in patients prepared by oral mannitol, by whole bowel irrigation, mannitol preceded by 48 h of oral antibiotics (neomycin with metronidazole) and in patients who did not undergo any preparation. Significantly higher counts of gas-producing Escherichia coli were recovered from patients prepared with mannitol alone compared with whole bowel irrigation or mannitol preceded by oral antimicrobials. These data are consistent with the hypothesis that fermentation of mannitol by Escherichia coli is responsible for the production of potentially explosive gas mixtures after oral mannitol preparation and may also explain the increased incidence of sepsis when oral mannitol is used for bowel preparation.
Cimetidine and the potential risk of postoperative sepsis
Authors: Muscroft T J , Youngs Denise , Burdon D W , Keighley M R B 
Published: March 2007

Summary
The gastric microflora of patients receiving cimetidine for duodenal ulceration has been investigated and the results compared with those from a group of untreated patients. Cimetidine-induced hypochlorhydria allows bacterial proliferation in the stomach; 75 per cent of aspirates from 44 fasting patients taking cimetidine 1 g daily were found to contain bacteria 2–4 h after the last dose. Of 41 patients taking cimetidine 400 mg at night, 34 per cent still had bacteria in their aspirates 12–13 h later. Patients treated with cimetidine are likely to be at an increased risk of postoperative sepsis. The drug should either be withdrawn before gastric surgery is undertaken or patients with gastric contents of pH 4 or above should receive antibiotic cover.
Smoking and arterial reconstruction
Authors: Greenhalgh R M , Laing Susan P , Cole P V , Taylor G W 
Published: March 2007

Summary
Fasting levels of serum triglyceride, serum cholesterol, lipoprotein, uric acid, fibrinogen and carboxy-haemoglobin (COHb) were measured in 64 patients with stenosing arterial disease before reconstructive surgery, and were compared with those for normal, age- and sex-matched controls. All except fibrinogen were significantly higher in the patients with arterial disease than in the controls. The outcome of arterial reconstruction, assessed both clinically and by Doppler pressure measurements, was compared in terms of these risk factors.
The reconstructions of 12 patients failed between 3 months and 5 years, leaving 52 patients with patent reconstructions at the end of the follow-up period. There was no difference between the two groups in terms of any of the risk factors, except for COHb. The COHb level (associated with inhalation of cigarette smoke) was significantly higher in the reconstruction failure group than in the reconstruction success group. We believe that patients should stop smoking cigarettes before reconstructive arterial surgery is undertaken.
Compression suture of the abdominal wall: A controlled trial in 302 major laparotomies
Authors: Mayer A D , Ausobsky J R , Evans Mary , Pollock A V 
Published: March 2007

Summary
Monofilament nylon suture material undergoes both plastic and elastic elongation when stretched. Nylon inserted as a continuous suture for approximation of the abdominal musculo-aponeurosis may, therefore, allow early separation of the cut edges, which may predispose to the later development of an incisional hernia.
This hypothesis was tested in a consecutive series of 302 major laparotomies randomized to be sutured with continuous mass nylon either to approximate or to compress the deep layers. The incidence of incisional hernia at 6 months in the group sutured with normal tension was 10.0 per cent, compared with 5.5 per cent in those tightly sutured. There was, however, an increased rate of minor wound infection in the latter group.
Admission policy for patients following head injury
Authors: Weston P A M 
Published: March 2007

Summary
In the 2 years following a change in the policy of admission following head injury in Nottingham, the number of patients admitted fell from 941 in 1977 to 536 and 460 in 1978 and 1979 respectively. No detrimental effects resulting from this change in policy have been noted. Previously, all patients who had been unconscious (however briefly) had been admitted. The changed policy stated that:
1. Patients who had been briefly unconscious or amnesic would only be admitted if one of the following factors was also present: abnormal neurological signs or obtunded consciousness on arrival at hospital, fits, vomiting, severe headaches or clinical or radiological evidence of a fracture of the skull.
2. Such patients would only be allowed home if instructions issued to the patients on a ‘head injury instruction card’ could be implemented satisfactorily.
It is suggested that the implementation of such an admission policy will avoid the unnecessary admission of large numbers of patients, thus freeing beds for other purposes. The article leaves unanswered the question ‘Which patients should have a skull X-ray?’.
Reconstructive gastric surgery
Authors: Kelly Keith A , Becker James M , van Heerden Jonathan A 
Published: March 2007

Summary
Among 173 patients undergoing reconstructive gastric operations, including 115 patients who received Roux-en-Y gastrojejunostomy, 25 with jejunal interpositions, 11 with conversion of Billroth II to Billroth I, 8 with closure of gastroenterostomy, 5 with pyloric reconstruction and 9 with other operations, only 2 immediate postoperative mortalities occurred. A perfect or good result was obtained in 108 of 156 patients (69 per cent) at long term follow-up, while a fair result was achieved in 35 patients (22 per cent) and a poor result in 13 patients (9 per cent). We concluded that reconstructive gastric operations were safe and had clearly improved 7 of 10 patients in this series.
Five years' experience in stapling the oesophagus and rectum
Authors: Graham H K , Johnston G W , McKelvey S T D , Kennedy T L 
Published: March 2007

Summary
In the 5-year period from 1976 to 1980, 143 anastomoses were performed using circular stapling devices. In 2 further cases, anastomosis was attempted but failed and operation was completed by orthodox methods. There were 101 oesophageal anastomoses; 70 of these were transections in patients with oesophageal varices and 31 were either oesophagogastric or oesophagojejunal in nature, mainly following excisional cancer surgery. The remaining 42 patients had colorectal anastomoses following anterior resection of the rectosigmoid. Initial results in a follow-up period from 2 months to 5 years have been encouraging. There were 3 cases of complete anastomotic deniscence and 4 cases of leakage. Stricture formation occurred in 10 per cent of patients but was easily controlled in the majority of cases.
Imaging of 111In-labelled platelets—a new method for the diagnosis of deep vein thrombosis
Authors: Grimley R P , Rafiqi E , Hawker R J , Drolc Z 
Published: March 2007

Summary
A radionuclide method for detecting established thrombi at all sites in the lower limb would have several advantages. Autologous platelets were labelled with 150 μCi (5.5 MBq) indium-111-oxine and re-injected into patients who were imaged with a gamma camera and data processed by a medical computer. Areas of increased uptake on imaging were correlated with the sites of thrombi identified by bilateral ascending venography.
Venography in 27 patients identified 12 unilateral and 5 bilateral thrombi. On the day following the re-injection of labelled platelets, imaging identified thrombi at 13 sites in 24 limbs giving an overall correlation with venography of 84.4 per cent, correlation for the calf and thigh being 79.5 per cent and 89.1 per cent respectively. In the thigh 57.1 per cent of thrombi were identified by imaging and 52.9 per cent in the calf. Activity over thrombi was at least 20 per cent higher than in adjacent areas or at similar sites in the contralateral leg. Herapin therapy is considered to affect the detection of deep vein thrombus adversely by this technique. The technique offers a useful method for the diagnosis of both early and established thrombi at any site in the lower limb.
Laparoscopy in general surgery
Authors: Lewis Adam , Archer T J 
Published: March 2007

Summary
The results of diagnostic laparoscopy under general anaesthetic in 81 general surgical patients have been reviewed. A tissue diagnosis was achieved in 25 of 42 patients (60 per cent) suspected to have widespread intra-abdominal malignancy with minimal preoperative investigation. Extensive investigation, excluding only computerized tomography, failed to achieve a diagnosis in 25 patients with an intra-abdominal mass. Subsequent laparoscopy allowed diagnosis of 22 of these patients (92 per cent). Severe persistent and unexplained abdominal pain in 14 patients was diagnosed at laparoscopy in only one patient (7 per cent) and the procedure did not influence the subsequent course of events in the remainder. There was no mortality and the morbidity (4·9 per cent) compares well with that of laparotomy in similar patients. Laparoscopy failed in 5 patients (6·2 per cent) due to the presence of dense intraperitoneal adhesions.
The use of dermal antigen testing in predicting the outcome of renal transplantation
Authors: Wedgwood K R , Guillou P J , Leveson S H , Giles G R 
Published: March 2007

Summary
The responses to dermal antigen testing to a variety of antigens were measured in patients on regular dialysis. Forty-eight patients have received renal allografts and graft survival was assessed at 6 months. The antigens used were mumps, monilia, streptokinase/streptodornase, tuberculin and dinitrochlorobenzene (DNCB). The responses to these antigens were recorded using standard methodology. The responses failed to correlate with graft survival in these patients when compared singly or in combination. Matching at the HLA-B locus was also correlated with graft survival. Of 31 patients with a match at this locus, 22 (71 per cent) have functioning grafts at 6 months, compared with only 4 of 13 (31 per cent) of patients with no match at the B locus (P &lt; 0·05). When matching at the B locus and DNCB scores were taken in combination, it became evident that those patients with no match at the B locus and low DNCB reactivity all rejected their kidneys within 4 months of transplantation.
Assessment of aorto-iliac disease by non-invasive quantitative Doppler waveform analysis
Authors: Demorais Domingas , Wayne Johnston K 
Published: March 2007

SummaryThe results of this study demonstrate that frequency analysis recordings of the femoral artery waveform are of value in the quantitative analysis of the severity of aortoiliac disease. In 45 patients, pulsatility index measurements were found to correlate (r = 0·82) with the pressure gradient measured directly across the aortofemoral segment. The implications and the limitations of this technique are discussed.
A retrospective review of 89 stab wounds to the abdomen and chest
Authors: Donaldson L A , Findlay I G , Smith A 
Published: March 2007

Summary
This study compared the admission findings in 89 stab victims with the subsequent severity of their injury. The majority of patients were young males who arrived at hospital after 2300 h on a Friday, Saturday or Sunday and had consumed alcohol prior to admission. The presence of ‘clinical shock’ or absent bowel sounds was invariably associated with significant injury. However, 64 of the 89 patients in this study had a normal blood pressure and audible bowel sounds at the time of admission. Thirty of these 64 patients had also suffered significant injury, which frequently was a perforated viscus. A diagnostic laparotomy should be readily performed in such patients in view of the high incidence of occult injury. Experienced anaesthetic support is necessary to ensure a low mortality from the actual laparotomy.
Benign oesophageal strictures: Historical and technical aspects of dilatation
Authors: Earlam Richard , Cunha-Melo J R 
Published: March 2007

Summary
A review of the different bougies used over the years confirms that the dilators presently available are adequate for the conservative management of cesophageal benign strictures. Most of these are of an old but well-tested design. Several additional techniques may have to be tried in difficult patients. Dysphagia can be relieved by the passage of size 39 FG bougies but many will wish to increase this to 60 FG, if it is possible. Failure of conservative management by dilatation only can be defined as (a) technical impossibility to dilate sufficiently to relieve the dysphagia, which is rare, or (b) when the patient or the surgeon considers the procedure is being done too frequently, which must be measured in FG for the bougie and weeks for frequency. The more expert the surgeon becomes at dilatation, the safer it will become, and the necessity for surgical intervention will be less frequent.
Basal cell carcinoma of the anus—a clinical study of 34 cases
Authors: Nielsen Ole Vagn , Jensen Steen Lindkær 
Published: March 2007

Summary
Thirty-four patients with basal cell carcinoma of the anus were treated in Denmark between 1943 and 1974. The tumours were usually between 1 and 2 cm in diameter and localized to the anal margins. Three tumours had a diameter of 10 cm and extended into the anal canal. In one case the tumour had spread to the regional lymph nodes. Modes of treatment were wide local excision (27 patients), abdominoperineal excision of the rectum (4 patients), colostomy combined with radiotherapy (1 patient) and radiotherapy alone (2 patients). Local recurrence was observed in 8 cases. After retreatment (re-excision: 5 patients), excision of the rectum (1 patient) and radiotherapy (2 patients), no recurrences were observed in the follow-up period (&gt;5 years). The crude 5-year survival rate was 72·6 per cent. The death rate was not higher than in the normal population of the same age and sex and no death was due to the basal cell carcinoma.
Trophic effect of short chain fatty acids on mucosal handling of ions by the defunctioned colon
Authors: Roediger W E W , Rae D A 
Published: March 2007

Abstract
Sodium and water absorption were measured in defunctioned loops of colon of dogs either in the presence or in the absence of the bacterial fatty acid, n-butyrate.
In freshly defunctioned colonic loops n-butyrate enhanced sodium absorption twofold (P &lt; 0·05) and promoted sodium absorption for 48 h. In the absence of n-butyrate, defunctioned loops lost the ability to absorb sodium and water within 48 h. Pre-treatment of colonic loops with fatty acids for 3 h significantly diminished (P &lt; 0·05) sodium and water losses into the colonic lumen compared with loops pre-treated with saline only. Butyrate was absorbed at a steady rate even when no sodium was aborbed.
Results suggest that fatty acids act on the colonic mucosa to exert a trophic effect on absorption of sodium. This trophic effect determines the efficiency of absorption of ions and could have clinical implications in the genesis of postoperative diarrhoea.
Neurovascular traction injuries of the upper limb root
Authors: Batey N R , Makin G S 
Published: March 2007

Abstract
Eight cases of injury to the subclavian and axillary arteries are described. All were accompanied by injury to the brachial plexus. Arterial continuity was restored in all cases. Six young patients sustained high velocity injuries and they showed no neurological improvement. Two elderly patients with low velocity injuries recovered neurological function in the limb. Primary amputation should be considered when nerve damage is obviously very severe.
The effect of sustained venous hypertension on the skin capillaries of the canine hind limb
Authors: Burnand K G , Clemenson G , Whimster I , Gaunt J , Browse N L 
Published: March 2007

Abstract
An increased number of skin capillaries has been found in human skin subjected to sustained venous hypertension. To investigate this observation, venous hypertension was produced in the hind limb of Greyhounds by fashioning an arteriovenous (AV) fistula between the femoral vessels. This caused an increase in the number of capillaries in the skin of the lower leg.
The capillary permeability of normal legs and legs subjected to chronic venous hypertension was then studied by observing the movement of radioactive molecules from the plasma to the fluid within Guyton capsules. Fibrinogen, a large molecule, leaked out of the capillaries significantly faster in the limbs with a high venous pressure and an enlarged capillary bed. It is suggested that the increase in the size and permeability of the dermal skin capillaries secondary to prolonged venous hypertension is the cause of lipo-dermatosclerosis and venous ulceration.