bluuebunny/crossref_metadata_2025_split huggingface dataset:
Achalasia-like syndrome in systemic sclerosis
Authors: Park R H R , McKillop J H , Belch J J F , Faichney A , MacKenzie J F 
Published: March 2007

Abstract
Two methods of quantifying oesophageal emptying for liquids have been used to assess the dysphagia of patients with systemic sclerosis: the oesophageal infusion scintiscan and the timed Gastrografin® swallow. Upper gastrointestinal endoscopy and oesophageal manometry were also performed. Thirteen patients with oesophageal symptoms were studied. Eight had dysphagia, and all of these had endoscopies with no evidence of oesophagitis or stricture. Four of these eight subjects had gross delay of oesophageal emptying for fluids, and manometry showed absence of oesophageal peristalsis and incomplete relaxation of the lower oesophageal sphincter. This abnormality is similar to achalasia. Two of these four patients have benefited from pneumatic dilatation with improvement in their severe dysphagia. We believe that pneumatic dilatation should be considered in patients with systemic sclerosis and severe dysphagia where reflux oesophagitis is not apparent.
Surgery for melanoma metastatic to the gastrointestinal tract
Authors: Klaase J M , Kroon B B R 
Published: March 2007

Abstract
Melanoma frequently disseminates to the gastrointestinal tract, being found post-mortem in 60 per cent of patients with disseminated disease, while during life it is diagnosed in only 4per cent. During the period 1981–87, 835 melanoma patients were referred and 30 developed complaints caused by gastrointestinal metastatic melanoma. Twenty-three patients were treated surgically. The interval between treatment of the primary melanoma and detection of intestinal involvement was a median of 34 months (range 2–87 months). In four patients recurrence in the gut was the first evidence of dissemination. Major complaints were nausea and vomiting, abdominal pain, signs of anaemia, and blood in the stools. Complications were bleeding (ten cases), ileus due to intussusception (five cases), bowel perforation (four cases) and cholecystitis (one case). The metastases, mainly localized in the small bowel, were removed by relatively simple procedures. Symptoms were reduced in 19 patients. Two patients died after operation: one from sepsis due to suture leakage, the other from pneumonia and a cerebrovascular accident. Of the remaining patients, 16 survived a median of 7·5 (range 0·7–32·0) months. Five patients are still alive 72, 72, 70, 7 and 2′ months after the metastasectomy, three of whom are tumour-free. The actuarial 5-year survival of all patients is 19per cent. These results support surgical intervention for patients with complaints andlor complications attributable to gastrointestinal metastatic melanoma.
Highly selective vagotomy 5–15 years on
Authors: MacIntyre I M C , Millar A , Smith A N , Small W P 
Published: March 2007

Abstract
Highly selective vagotomy for duodenal ulcer was performed on 307 patients between 1973 and 1983 without operative mortality. Of these, 283 (92·2per cent) were followed up prospectively for a minimum of 5 years. Recurrent ulcer was diagnosed in 49 (17·3per cent). The recurrent ulcer rate increased from 13·2per cent at 5 years to 19·4per cent at 12 years. Age, length of history, previous haemorrhage or perforation and preoperative acid output were not associated with increased risk of recurrent ulceration. The risk in men and smokers was higher but not significantly so. The recurrence rate for individual surgeons varied from 5·3 to 25·6 per cent. Failure of healing with H2-receptor antagonists was not associated with a higher recurrent ulcer rate. Patients with a strong family history (more than one first degree relative affected) had a significantly higher recurrence rate (33·2per cent at 10 years) than those without (13·5per cent at 10 years). Of the 49 recurrent ulcer patients, 30 (61·2per cent) required either an operation or regular H2-receptor antagonists. Of the 250 patients (81·4per cent) available in 1988 for review of symptoms 5–15 years after operation, 5·4per cent had dumping, 8·9per cent epigastric pain, and 11·8per cent heartburn every day or most days. H2-receptor antagonists were required by 10·7 per cent of patients on a frequent or regular basis. Of 239 patients who answered the question, 218 (91·2per cent) felt that their symptoms had been cured or greatly improved and 203 (84·9) considered the operation a success. Despite the high recurrence rate, the operation was successful in controlling ulcer symptoms in around 90 per cent of patients and produced postvagotomy symptoms - none severe - in around 5 per cent of patients.
Triad of anorectal stenosis, sacral anomaly and presacral mass: A remediable cause of severe constipation
Authors: Heij H A , Moorman-Voestermans C G M , Vos A , Kneepkens C M F 
Published: March 2007

Abstract
Two neonates with intestinal obstruction and two children (aged 1 and 4 years) with severe constipation since birth are reported in whom stenosis of the distal rectum was found. In association with the rectal anomaly, three of them had a presacral tumour (teratoma in two, hamartoma in one) and all had a deformed sacrum. An embryological hypothesis to explain this association has been postulated by Currarino, after whom this triad has been named. Two patients were related (father and daughter). The role of hereditary factors in the occurrence of the syndrome has been reported before. Operative treatment of the rectal stenosis was necessary in all patients. Preoperative diverting colostomy was performed in three cases, followed by a posterior sagittal approach to excise the rectal stenosis and the presacral mass. In one case, persistent cerebrospinal fluid leakage required re-exploration for closure of a tear in a congenially abnormal dural sac. The fourth patient had undergone a low anterior resection in the past via the abdominal route and needed rectal dilatation afterwards for some time. The final result in all patients appears satisfactory, although follow-up is short. Most cases of this triad have been reported in children but a number of patients have been diagnosed only as adults. Recognition of this triad should imply a careful search for neural crest malformations. Operative treatment to correct all soft tissue anomalies leads to good results.
Selective postoperative radioactive iodine treatment of thyroid carcinoma
Authors: McHenry Christopher , Jarosz Harriet , Davis Melva , Barbate A L , Lawrence A M , Paloyan E 
Published: March 2007

Abstract
In a consecutive series of 234 patients with differentiated thyroid carcinoma of follicular cell origin (Hurthle cell tumors excluded), a radioactive iodine (131I) scan was obtained 3 to 6 months after thyroidectomy and 4 weeks after cessation of thyroid hormone treatments, only if extrathyroidal tumor extension or nodal or distant metastases were present. Twenty-one patients (9%) with 131I uptake of 3% or more (group 1) were treated with 150 to 200 mCi of 131I. Forty-four patients (19%) with less than 3% uptake (group 2) and 169 patients (72%) without evidence of metastases or extrathyroidal spread (group 3) were treated only with thyroid hormone. All patients initially underwent total thyroidectomy and modified neck dissection if cervical lymph node metastases were present. Three patients in group 1 and one patient in group 2 had recurrent tumor with a mean follow-up of 8.9 and 8.4 years. There were no recurrences in group 3 with a mean follow-up of 7.2 years. Death rate from thyroid carcinoma was 5% in group 1 (one patient) and 0% in groups 2 and 3. In conclusion, 1311 scanning and therapy may be omitted in patients with differentiated thyroid carcinoma in the absence of local tumor extension or regional or distant metastases. Therapy with 131I is not demonstrated to be of benefit in this population of patients. (Surgery 1989; 106:956-9.)
Pilonidal sinus: Finding the right track for treatment
Authors: Allen-Mersh T G 
Published: March 2007

Abstract
Management of pilonidal sinus is frequently unsatisfactory. No method satisfies all requirements for the ideal treatment - quick healing, no hospital admission, minimal patient inconvenience, and low recurrence -but greater awareness of the strengths and weaknesses of existing methods would lead to improved management. Early excision of the pilonidal pit at the time of treatment of pilonidal abscess reduces the high (40 per cent) risk of subsequent sinus. Treatments for pilonidal sinus that flatten the natal cleft halve the risk of recurrence. En bloc excision of pilonidal sinus with secondary healing should be abandoned and emphasis given to development of treatments, such as primary asymmetric closure, which have more potential. Some treatments are operator-dependent and, to achieve the best results, junior surgeons must be correctly trained and supervised. Future treatment studies must be prospective and randomized, and should compare healing time, recurrence rates beyond 3 years, nurse and hospital visits, patient inconvenience and loss of income.
Endoscopic transanal resection of rectal tumours - a preliminary report of its use
Authors: Berry A R , Souter R G , Campbell W B , Mortensen N J Mcc , Kettlewell M G W 
Published: March 2007

Abstract
Endoscopic transanal resection (ETAR) of rectal tumours is a simple and inexpensive procedure, well tolerated in elderly patients or those undergoing palliation. We have performed 137 ETARs in 81 patients with a 30-day mortality rate of 11·1 per cent and a postoperative complication rate of 15·3 per cent. Thirty-one patients (38 per cent) had ETAR for palliation: in this group rectal bleeding was abolished or improved in 66 per cent of patients, altered bowel habit (diarrhoea) corrected in 77 per cent of patients, faecal incontinence improved in 50 per cent of patients and rectal pain (including tenesmus) improved in 50 per cent of patients. Twenty-three patients (28 per cent) were treated for large benign rectal polyps: in this group symptoms were universally abolished. The technique is particularly suited to the management of these patients. Twenty-seven elderly patients with theoretically ‘curable’ rectal cancer underwent ETAR with a 78 per cent crude survival rate at 1 year. While long-term results remain to be assessed, ETAR appears a useful technique for treating selected patients with rectal tumours.
Sutured posterior abdominal rectopexy with sigmoidectomy compared with Marlex® rectopexy for rectal prolapse
Authors: Sayfan J , Pinho M , Alexander-Williams J , Keighley M R B 
Published: March 2007

Abstract
Two treatment policies for rectal prolapse were prospectively assessed between April 1986 and January 1989. Sixteen patients had a Marlex® mesh posterior rectopexy alone and 13 underwent a sigmoidectomy combined with a sutured posterior rectopexy. Preoperative and post-operative assessment included manometry, a saline infusion test and video-proctography. Hospital stay, control of prolapse and complications were comparable in both groups. Restoration of continence occurred in nine of the 12 incontinent patients after Marlex rectopexy, compared with six of nine after sutured rectopexy and sigmoidectomy. Constipation persisted in three patients who were constipated before operation and in four of 13 who had previously normal bowel habits became constipated after Marlex rectopexy; constipation persisted in one of five previously constipated patients while none with previously normal bowel habits became constipated after sutured rectopexy and sigmoidectomy. Sigmoidectomy combined with sutured rectopexy was safe and as efficient as Marlex rectopexy in prolapse control and improvement of continence; significantly fewer patients were constipated (one of 13) after sigmoidectomy than following rectopexy alone (seven of 16). A randomized trial now seems justified.
Metabolism of body water and electrolytes after surgery for ulcerative colitis: Conventional ileostomy versus J pouch
Authors: Christie P M , Knight G S , Hill G L 
Published: March 2007

Abstract
Some authorities believe that patients with conventional ileostomies are chronically water and salt depleted but there are no data on the metabolism of body water and electrolytes after ileoanal J pouch. To clarify the situation we studied the body composition of 14 patients with well functioning ileostomies and 20 patients with well functioning J pouches. Both groups were compared with two closely matched control groups. Body weight, total body fat, fat-free mass, total body water and extracellular water were measured by neutron activation analysis, tritiated water and bromide dilution respectively; 24-h collections of urine and stool were analysed for volume and electrolyte content. The results show that the body content of water and extracellular fluid in ileostomy patients and J pouch patients is normal. The faecal volume and chemistry is similar in both groups resulting in a similar and significant degree of urinary sodium retention.
Effect of acute starvation on plasma fibronectin response to sepsis
Authors: Cheslyn-Curtis S , Aldridge M C , Dudley H A F 
Published: March 2007

Abstract
There is evidence that undernutrition may contribute to the reduction in plasma fibronectin concentration and the depression of the reticuloendothelial (RE) system associated with severe sepsis. We have investigated the effects of fasting, surgical trauma and sepsis on plasma fibronectin concentrations and RE function. In experiment 1, plasma fibronectin was measured in rabbits (n = 14) before and 48 h after fasting. In experiment 2, sepsis was induced by devascularization of the appendix in animals on a normal diet (sepsis group, n = 7) and in fas ted animals (fasting and sepsis group, n = 7). A third group of animals underwent only a laparotomy (laparotomy only group, n = 7). Plasma fibronectin concentrations and the blood clearance and organ distribution of 99mtechnetium tin colloid (TTC) were measured 24h after operation. Compared with pooled reference plasma, fasting in experiment 1 resulted in a reduction in mean(s.e.m.) plasma fibronectin concentration from 98(1·5) per cent to 86(3·7) per cent (T = 2, P &lt; 0·005). Mean(s.e.m.) plasma fibronectin concentration was raised in the sepsis group to 117(4·6)per cent, compared with 97(2·5)per cent in the laparotomy only group (U = 5, P &lt; 0·02), but there was no such increase in the fasting and sepsis group. There was a delay in the blood clearance and reduced hepatic uptake of TTC in both sepsis groups. The dissociation between fibronectin concentrations and RE function in animal models of sepsis casts doubt on the importance of fibronectin in RE function.
Effects of an amino acid solution enriched with either branched chain amino acids or ornithine-α-ketoglutarate on the postoperative intracellular amino acid concentration of skeletal muscle
Authors: Hammarqvist F , Wernerman J , Ali R , Vinnars E 
Published: March 2007

Abstract
Patients undergoing elective cholecystectomy provide a highly reproducible model of the effects of trauma on intermediary metabolism. Three parenteral nutrition regimens were given to groups of eight such patients. An isonitrogenous total parenteral nutrition, including a commercially available amino acid solution, an amino acid solution enriched with branched chain amino acids or one supplemented with ornithine-α-ketoglutarate, was given after operation. The intra cellular free amino acid concentrations of skeletal muscle were determined in tissue specimens obtained before operation and on the third postoperative day using a percutaneous needle biopsy technique. The mean(s.e.m.) decrease in the concentrations of free intracellular glutamine on the third postoperative day was less pronounced (P &lt; 0·05) in the ornithine-α-ketoglutarate group (18·8(7·5) per cent) than in the control group (39·4(5·1)per cent) or the branched chain amino acid group (45·3(6·1) per cent). In conclusion, in the immediate postoperative period total parenteral nutrition supplemented with ornithine-α-ketoglutarate countered the decline in the muscle free glutamine. No difference in this parameter was seen between the control group and the branched chain amino acid group.
Strength of the colon wall in diverticular disease
Authors: Watters D A K , Smith A N 
Published: March 2007

Abstract
Studies of the aetiology of diverticular disease of the colon have been focused on intraluminal pressure for almost three decades. It is only relatively recently that the mechanical properties of the wall of the colon have been examined. The tensile strength and elasticity of the colon decline with age and this is most marked in the left colon which is the narrowest and thickest part. This review discusses the case that the mechanical properties of the bowel wall are key factors in the development of diverticular disease. The potential role of high fibre diets in reducing the pressure changes which may stress the colon wall in this disease is also considered.
Current hypotheses on synergistic microbial gangrene
Authors: Kingston D , Seal D V 
Published: March 2007

Abstract
We have reviewed spreading infections of the dermis, with special reference to the importance of synergy in their causation. Evidence for this is accumulating from both clinical studies and from studies in laboratory animals. Necrotizing fasciitis (rapid spread over 24 h) can be caused by β-haemolytic streptococci, sometimes with Staphylococcus aureus, or by mixed infections of aerobes and anaerobes, often of gut origin. Animal studies provide good evidence that S. aureus can potentiate the β-haemolytic streptococcal infection in necrotizing fasciitis. There is also evidence that mixtures of aerobes and anaerobes can act synergistically, but animal models for necrotizing fasciitis have not been developed. Anaerobic cellulitis (variable rate of spread from hours to days) can be caused by mixed aerobes and anaerobes or by mixed clostridia. Animal studies provide good evidence for synergy in the former. Meleney's synergistic postoperative gangrene (slow spread over weeks) may be cutaneous amoebiasis: the animal model of Brewer and Meleney relates to the more rapid infections of anaerobic cellulitis.
Association of congenital hypertrophy of the retinal pigment epithelium with familial adenomatous polyposis
Authors: Iwama T , Mishima Y , Okamoto N , Inoue J 
Published: March 2007

Abstract
Ophthalmological examinations were performed in 49 people (43 patients) from 24 families affected by familial adenomatous polyposis (FAP). No features of congenital hypertrophy of the retinal pigmented epithelium (CHRPE) were noted in six first-degree relatives without colonic polyps. Patients with Gardner's syndrome exhibited CHRPE more frequently than those without exostosis or desmoid tumour (91 per cent versus 45 per cent). In addition the prevalence of CHRPE was slightly higher in the patients with gastric or duodenal polyps (68 per cent compared with 50 per cent) in those who had a normal gastroduodenal examination. There were 11 families in which two or more patients underwent ophthalmological examinations. In five of these 11 families, all 12 patients were negative for CHRPE. In four of the remaining six families, all 11 patients had CHRPE. CHRPE is one of the pleiotropy of FAP and ophthalmological examination is an important screening test for the family of patients with CHRPE associated with FAP.
Management of gastric variceal haemorrhage
Authors: Greig J D , Garden O J , Anderson J R , Carter D C 
Published: March 2007

Abstract
From March 1979 to April 1988 nine patients with hepatic cirrhosis have presented with acute variceal haemorrhage from gastric varices. Of six patients who underwent emergency laparotomy those with modified Child's grade C (n = 3) died within 30 days of surgery. Six patients have been followed for 2 years or longer. In the three patients who underwent under-running of gastric varices alone, two patients developed oeosophageal varices at 3 and 14 months, respectively, and in the third patient gastric varices recurred 3 years after surgery. In the remaining three patients, additional left gastric vein ligation was not associated with recurrence of gastric varices or the development of oesophageal varices.
Fine-wire localization and biopsy of non-palpable breast lesions
Authors: Tresadern J C , Asbury D , Hartley G , Sellwood R A , Borg-Grech A , Watson R J 
Published: March 2007

Abstract
We have undertaken fine-wire localization and biopsy of 130 impalpable breast lesions identified by mammography and considered suspicious of malignancy. Histologically 22 of these lesions were invasive carcinomas and 24 were in situ carcinomas (35 per cent malignant). Twenty-nine per cent of the lesions were identified during the screening of asymptomatic women. In the remainder, the presenting symptoms bore no relation to the eventual histological diagnosis. Clusters of micro-calcification were more often malignant than were abnormal soft-tissue masses. Malignancy in the absence of microcalcification was almost always invasive.
Measurement of serum thyroglobulin is of value in detecting tumour recurrence following treatment of differentiated thyroid carcinoma by lobectomy
Authors: Harvey R D , Matheson N A , Grabowski P S , Rodger A B 
Published: March 2007

Abstract
Serum thyroglobulin was measured in 243 samples from 84 patients (20 men and 64 women, with a mean age of 48·9(14) years) with differentiated thyroid carcinoma treated by lobectomy, and in 58 patients treated by total thyroidectomy. Both groups were given thyroxine to suppress thyroid stimulating hormone (TSH). Three patients in the lobectomy group and eight in the thyroidectomy group had evidence of tumour recurrence. Serum thyroglobulin concentration was elevated in the presence of known recurrent tumour (P &lt; 0·001) irrespective of the type of operation, and in its absence tended to be higher in the lobectomy than in the thyroidectomy group (median 4 μg/l versus 2 μg/l, P &lt; 0·05). Serum thyroglobulin levels of less than 10 μg/l could confirm the absence of otherwise known tumour recurrence in both groups with a specificity of 100 per cent, and sensitivities of 80 per cent and 86 per cent in the lobectomy and thyroidectomy groups respectively. Exclusion of samples liable to spurious elevation of thyroglobulin improved the sensitivity in the lobectomy group to 92 per cent. Despite the presence of residual thyroid tissue, measurement of serum thyroglobulin can exclude the presence of significant metastases in most patients following lobectomy for thyroid carcinoma.
Infected false aneurysms in the groin of intravenous drug abusers
Authors: Welch G H , Reid D B , Pollock J G 
Published: March 2007

Abstract
The hazards of dealing with infected false femoral aneurysms resulting from intra-arterial narcotic injection are highlighted in six patients. Two patients were human immunodeficiency virus positive and three patients were hepatitis B surface antigen positive. Because of these infections exploration of groin swellings as presumed soft tissue abscesses is potentially hazardous without proper proximal vascular control. All patients underwent reconstruction following arterial ligation and five grafts became infected, with life threatening haemorrhage occurring in four patients. Five grafts have subsequently occluded or have been removed without loss of limb viability, although two patients have been regrafted. A high index of suspicion and assessment by a vascular surgeon, with angiography if indicated, is required in any intravenous drug abuser presenting with a groin swelling following injection. Because of the great risk of graft infection, it is suggested that ligation and debridement alone be carried out, with immediate arterial reconstruction only for non-viability.