bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pre-operative infusion cholangiography compared to routine operative cholangiography at elective cholecystectomy
Authors: Alinder G , Nilsson U , Lunderquist A , Herlin P , Holmin T 
Published: March 2007

Abstract
Routine operative cholangiography (group 1) was compared with pre-operative intravenous infusion cholangiography and selective operative cholangiography (group 2) in 200 patients subjected to elective cholecystectomy. All patients were examined with pre-operative intravenous infusion cholangiography. In group 1 patients, this examination was not made available to the surgeon and not used in any way except for a later analysis. Thirteen patients had to be excluded for different reasons. In group 1, normal operative cholangiograms were obtained in 82/94 cases. Choledocholithotomy was performed in 7/12 cases, choledochotomy in 2/12 and no exploration in 3/12 cases. In group 2, pathological or inconclusive infusion cholangiograms were demonstrated in 17/91 cases. Choledocholithotomy was performed in 11/17 cases. One of 17 patients was subjected to choledochotomy only. In 5/17 patients, no exploration was carried out because of normal operative cholangiography. No residual or retained stone/s have been revealed during a follow-up period of 1 year. The general clinical outcome in the two groups of patients was similar. Significantly shorter operative time was an important advantage of the strategy in group 2 patients.
Staged below-knee amputations for septic peripheral lesions due to ischaemia
Authors: Desai Y , Robbs J V , Keenan J P 
Published: March 2007

Abstract
Preservation of the knee joint is of paramount importance in lower limb amputation for ischaemia. Clinical predictors of healing are unreliable in patients with septic peripheral lesions due to ischaemia. Seventy-three patients in whom a below-knee amputation was considered likely to heal, based on the temperature and appearance of the skin and bleeding from skin and muscle flaps, were divided into two groups. Twenty-nine (Group A) had a primary below-knee (BK) amputation at the site of election with delayed primary skin closure, while 44 patients (Group B) initially had a guillotine BK amputation below the site of election, with elective amputation at the appropriate level once infection had been eradicated (4–5 days later). The groups were similarly matched with regard to level of occlusive arterial disease, nature of ischaemic lesions and operative risk factors. There was no significant difference in the overall operative mortality in Group A (6.7 per cent) compared with Group B (11.4 per cent) (P &gt; 0.05). There was a significantly higher above-knee revision rate in Group A survivors (33.3 per cent) compared with Group B (7.7 per cent) (P &lt; 0.01) due to non-viability and uncontrolled sepsis of the BK amputation site. The presence or absence of a palpable femoral or popliteal pulse had no significant influence on healing in either group.
Ruptured abdominal aortic aneurysm
Authors: Jenkins A McL , Ruckley C V , Nolan B 
Published: March 2007

Abstract
Between 1974 and 1984, 174 patients with ruptured abdominal aneurysms have been treated by three vascular surgeons. The 11-year period showed a dramatic increase in the number of patients presenting with ruptured aneurysms. The overall operative survival, including patients who died before a graft could be inserted, was 67 per cent with improvement from 60 per cent in the first half of the period to 69 per cent in the second. The overall survival rate for the 162 who had a completed graft was 72 per cent. Reference to data from the Lothian area surgical audit showed that there has been a transfer of responsibility from general to vascular surgeons with an increase in the proportion of patients treated by operation. Concentration of care within a single specialized unit appears to have had a favourable effect on survival.
Para-ileostomy hernia: Failure of a local repair technique
Authors: Horgan K , Hughes L E 
Published: March 2007

Abstract
Different techniques of local repair of para-ileostomy herniae have been recommended by a number of authors, but without report of long-term outcome. Two patients presenting electively with symptomatic para-ileostomy herniae are reported. A local repair technique was used in each case because of severe (coexisting) medical disease, but both herniae recurred within 2 years. It is considered that local repair without stomal transposition cannot be recommended. The literature is reviewed.
Anal hypertonia in fissures: Cause or effect?
Authors: Gibbons C P , Read N W 
Published: March 2007

Abstract
High sphincter pressures recorded in patients with fissure-in-ano have been attributed to sphincter spasm induced by wide recording assemblies. To investigate this hypothesis, anal sphincter pressure was measured using a series of perfused probes of 0·4–2 cm diameter in six men with chronic anal fissure in whom digital examination was easily tolerated. The results were compared with those from 14 normal men. The resting pressure within the anal canal exceeded the normal range in all six patients irrespective of probe size. With the smallest (0·4 cm) probe, the resting pressure was 114 ± 17·1 cmH2O (mean ± s.d.) in patients with fissure and 73·1 ± 27·0 cmH2O (mean ± s.d.) in control subjects (P &lt; 0·01) even 10 min after introduction of the device. The minimum residual pressure attained during inflation of a rectal balloon with 100 ml of air was higher in patients with anal fissure than controls, reaching statistical significance with the 1·0 cm probe (80·8 ± 17·7 cmH2O versus 36·9 ± 19·0 cmH2O, P &lt;0·001). Maximum pressures recorded during a voluntary contraction of the sphincter were no higher than in control subjects. The results suggest that high resting pressures are recorded in patients with chronic anal fissures even when small probes are employed and are unlikely to be due to spasm, but probably represent a true increase in basal sphincter tone. It is proposed that elevated sphincter pressures may cause ischaemia of the anal lining and this may be responsible for the pain of anal fissures and their failure to heal.
Factors influencing bowel function after ileal pouch–anal anastomosis
Authors: Nasmyth D G , Johnston D , Godwin P G R , Dixon M F , Smith A , Williams N S 
Published: March 2007

AbstractSeventeen patients were studied 3–31 months (median 6·4 months) after mucosal proctectomy and ileal pouch–anal anastomosis for ulcerative colitis (n = 15) or adenomatous polyposis (n = 2). Seven had a triplicated pouch, and ten a duplicated pouch. Clinical bowel function was determined by detailed questionnaire, and correlations sought between clinical end-points such as frequency of defaecation, urgency of defaecation and continence, and the results of laboratory investigations, comprising anal manometry, capacity and compliance of the pouch, completeness of emptying, faecal bacteriology and mucosal inflammation. Frequency of defaecation was found to be inversely correlated with both the capacity (rs = −0·66, P &lt; 0·01) and the compliance (rs = −0·53, P &lt; 0·05) of the pouch. Patients who could postpone defaecation for &gt; 30 min had higher anal squeeze pressures (P &lt; 0·05) than patients who had greater urgency of defaecation. Patients with perfect anal continence had higher resting anal pressure (P &lt; 0·05) and emptied the pouch more completely (P &lt; 0·07) than patients who experienced minor leakage. The faecal flora of the pouches showed a greater predominance of anaerobes (P &lt; 0·01) and increased numbers of bacteroides (P &lt; 0·01) compared with the faecal flora of ileostomies, but the changes in the flora did not correlate with any aspect of bowel function. The best clinical results (i.e. perfect continence, low frequency of defaecation and little urgency) were associated with high anal pressure and with large volume, high compliance and complete emptying of the pouch. The completeness of emptying was similar for both designs of pouch, but the capacity and compliance of triplicated pouches were greater than the capacity and compliance of duplicated J pouches (P &lt; 0·05), and this was associated with a better clinical result in the triplicated pouches.
Effect of warfarin on formation and growth of pre-neoplastic lesions in chemically induced colorectal cancer in the rat
Authors: Goeting Nicola L M , Trotter G A , Taylor I 
Published: March 2007

Abstract
Anticoagulant drugs are known to have an effect on tumour growth. However, the mechanisms by which they act are poorly understood, and have therefore been investigated in this study. Wistar rats were given eight weekly subcutaneous injections of azoxymethane, at a dose of 10 mg kg−1 week−1. Following this they were randomized into two groups: a control group, which received no further treatment, and a warfarin treated group, which received warfarin at ‘non-therapeutic’ doses in their drinking water, for a further 8 weeks. Pairs of rats from each group were killed at 5-weekly intervals from 10 to 35 weeks after the first azoxymethane injection. At 40 weeks all remaining rats were killed. Samples of colonic mucosa from the descending colon and rectum were taken for scanning electron microscopy. The number of microadenomas per low power field was determined in both groups at each time interval. Tumour incidence and distribution were noted in animals killed at 40 weeks. The median number of microadenomas was significantly lower in warfarin treated animals than in controls at all time intervals. Tumour number was also significantly decreased by warfarin treatment (27 in azoxymethane treated animals, 10 in animals receiving azoxymethane and warfarin, P &lt; 0·05). The distribution of tumours along the colon was similar to that seen previously, following 12 weeks of azoxymethane. These effects occurred despite the non-concurrent administration of azoxymethane and warfarin.
Venous anatomy of the lower oesophagus in portal hypertension: Practical implications
Authors: Kitano S , Terblanche J , Kahn D , Bornman P C 
Published: March 2007

Abstract
The venous anatomy of the lower oesophagus and upper stomach in man was studied using high resolution resin casts obtained from ten fresh cadavers. Four layers of veins were identified in the oesophagus of both normal and portal hypertension patients. Intra-epithelial channels drained into a superficial venous plexus which connected to larger deep intrinsic veins. Both the superficial plexus and the deep intrinsic veins communicated directly with their counterpart veins in the stomach. Perforating veins connected the deeper veins with the adventitial plexus, the fourth layer. In patients with portal hypertension all of these veins were significantly dilated. Typical large oesophageal varices arose from the main trunks of the deep intrinsic veins which communicated directly with gastric varices. This study clarifies the anatomy of oesophageal varices and may explain why sclerotherapy is usually effective. The venous communications are probably partly responsible for the recurrence of varices after sclerotherapy.
Impact of vascular surgery on community mortality from ruptured aortic aneurysms
Authors: Ingoldby C J H , Wujanto R , Mitchell J E 
Published: March 2007

Abstract
The workload of aortic surgery in a district increased fourfold over 10 years as the incidence of aneurysm rupture rose from 7 to 17/100 000. Of 260 patients with ruptured aneurysms 101 reached hospital alive (38 per cent) of which 52 (52 per cent) survived, an overall survival rate of 19.8 per cent. Despite increasing experience, mortality after emergency surgery did not improve, suggesting outcome was largely determined by the patient's condition and age. Only 5 of 90 patients aged over 75 survived aortic rupture at home. In consequence overall community mortality did not improve in the period studied. Survival after elective surgery was 95 per cent, suggesting that efforts to improve survival should be directed towards identifying and treating the disease before rupture occurs. The commonly stated figure of 50 per cent survival for ruptured aortic aneurysms is an overestimate, due to neglect of patients dying at home.
Abdominal aneurysms in a black population: Clinicopathological study
Authors: Costa M , Robbs J V 
Published: March 2007

Abstract
With exclusion of vascular trauma 2182 patients (1302 black and 880 white) have been treated in our Vascular Service over a period of 3 years. Sixty black patients (4.6 per cent) and 260 white patients (29.5 per cent) presented with aneurysms of the aorta and its abdominal branches. The aneurysms in the black group were distributed as follows: 50 aortic (9 suprarenal, 41 infrarenal), 6 common iliac artery, 2 superior mesenteric and 2 renal artery aneurysms. None of the 260 aneurysms seen in white patients involved arteries other than the aorta (16 suprarenal, 244 infrarenal). In the black group there was an almost equal distribution among sexes, whereas in the white group there was a male to female ratio of 2:1. The mean age was 49.4 years among the black patients, and 67.1 years among the white patients. Surgery was performed on 47 black patients and 245 white patients. Among the black patients 16 aneurysms were atherosclerotic (34 per cent), 22 were of non-atherosclerotic origin (47 per cent) and 9 were of uncertain nature (19 per cent). Of the 22 non-atherosclerotic aneurysms 14 were due to non-specific aorto-arteritis, 4 were due to tuberculous arteritis, 2 were due to intimomedial mucoid degeneration, 1 was due to syphilitic aortitis and 1 was a mycotic aneurysm. In the white group 243 aneurysms were atherosclerotic and 2 had changes of intimomedial mucoid degeneration. All aneurysms were treated along standard surgical lines, antituberculous treatment was initiated when appropriate. It was concluded that abdominal aneurysm is an uncommon disease in black patients. When it occurs a more heterogeneous pathology can be expected with an unusually high prevalence of aorto-arteritis compared with the white population.
Risk of lymphoedema following the treatment of breast cancer
Authors: Kissin M W , Della Rovere G Querci , Easton D , Westbury G 
Published: March 2007

Abstract
The incidence of lymphoedema was studied in 200 patients following a variety of treatments for operable breast cancer. Lymphoedema was assessed in two ways: subjective (patient plus observer impression) and objective (physical measurement). Arm volume measurement 15 cm above the lateral epicondyle was the most accurate method of assessing differences in size of the operated and normal arm. Arm circumference measurements were inaccurate. Subjective lymphoedema was present in 14 per cent whereas objective lymphoedema (a difference in limb volume &gt; 200 ml) was present in 25.5 per cent. Independent risk factors contributing towards the development of subjective late lymphoedema were the extent of axillary surgery (P &lt; 0.05), axillary radiotherapy (P &lt; 0.001) and pathological nodal status (P &lt; 0.10). The risk of developing late lymphoedema was unrelated to age, menopausal status, handedness, early lymphoedema, surgical and radiotherapeutic complications, total dose of radiation, time interval since presentation, drug therapy, surgery to the breast, radiotherapy to the breast and tumour T stage. The incidence of subjective late lymphoedema was similar after axillary radiotherapy alone (8.3 per cent), axillary sampling plus radiotherapy (9.1 percent) and axillary clearance alone (7.4 per cent). The incidence after axillary clearance plus radiotherapy was significantly greater (38.3 per cent, P &lt; 0.001). Axillary radiotherapy should be avoided in patients who have had a total axillary clearance.
Is operative cholangiography always necessary?
Authors: Wilson T G , Hall J C , McK Watts J 
Published: March 2007

Abstract
To determine whether operative cholangiography could be performed on a selective basis, 272 consecutive patients undergoing cholecystectomy and routine operative cholangiography were studied prospectively. Appropriate clinical, biochemical and operative data were recorded and the surgeon was asked to estimate the likelihood of common bile duct stones. These factors were correlated with the subsequent cholangiographic and operative findings. From this information, four criteria were selected as indications for performing an operative cholangiogram: an abnormal common bile duct, a wide cystic duct, or elevated levels of alkaline phosphatase or bilirubin documented in the previous six months. Operative cholangiograms would have been indicated by the presence of one or more of these criteria in only 139 of the 272 patients in the study (51 per cent). Only one unsuspected stone would have been missed. It is concluded that a policy of selective cholangiography could have been safely adopted in this series of patients.
Pancreatoduodenectomy with pylorus preservation for adenocarcinoma of the head of the pancreas
Authors: Grace P A , Pitt H A , Longmire W P 
Published: March 2007

Abstract
For many years, the classical Whipple procedure has been the standard operative treatment for resectable periampullary cancer. Recently, the pylorus preservation operation has also been applied to periampullary tumours. This newer procedure has potential advantages in terms of ease of performance and postoperative physiology, but has yet to be proved as an adequate cancer operation. We, therefore, undertook the present retrospective analysis to compare the outcome following the pylorus preservation operation (n = 13) with that of the classical Whipple resection (n = 13) in 26 patients with histologically proved adenocarcinoma of the head of the pancreas. The two groups of patients were comparable for age, sex, pre-operative laboratory data, and resected margins free from tumour. More patients undergoing the classical Whipple resection had Stage I disease (10 versus 4, P &lt; 0.05). However, this difference would not be significant if the two patients in the pylorus preservation group with carcinomas in situ were considered to have stage I disease. Mean tumour diameter in the pylorus preservation patient group (3·2±0·6 cm) was smaller (P &lt;0·05) than in the classical Whipple group (4·1±1·0 cm) but more patients in the pylorus preservation group also had metastases to the regional lymph nodes (54 versus 23 per cent). Overall operative morbidity (31 per cent) and mortality (4 per cent) was acceptable and did not differ between the two groups. Five year actuarial survival for pylorus preservation (25 per cent) was comparable to that observed for the Whipple procedure in this and other series.
Perineal and pelvic morbidity following perimuscular excision of the rectum for inflammatory bowel disease
Authors: Berry A R , De Campos R , Lee E C G 
Published: March 2007

Abstract
One hundred and fifteen patients who were treated by a proctocolectomy in Oxford between 1972 and 1984 for inflammatory bowel disease have been studied. All the patients had the rectum removed by the technique of perimuscular dissection which was introduced in 1972 in an attempt to overcome the problems associated with the previous types of proctectomy. The method has been shown to be safe; the operative mortality was 1·7 per cent. The most worrying potential complications due to permanent autonomic nerve damage (i.e. impotence and urinary incontinence), which previously have been recorded as occurring in a significant percentage of patients, were completely prevented by the method of dissection. One man suffered transient impotence which responded to psychiatric treatment. There were no long term urinary tract or sexual problems. Postoperative complications occurred in 37 per cent of patients, perineal wound infections being the most common (25·7 per cent). Perineal healing, however, was achieved in 75 per cent of patients by the time of their discharge from hospital. The mean length of postoperative hospital stay was 19 days in patients with ulcerative colitis and 15 days in patients with Crohn's disease. Our rate of perineal healing is better than has been recorded using other operative techniques.
Changing pattern of lower limb amputation for vascular disease
Authors: Sethia K K , Berry A R , Morrison J D , Collin J , Murie J A , Morris P J 
Published: March 2007

Abstract
In 1980 a review of lower limb amputation over a 3.5 year period between 1974 and 1978 was reported from our centre. More recently 193 amputations were performed for peripheral vascular disease over a similar 3.5 year period, representing an increase of 33 per cent in the amputation rate during the last 6 years. This cannot be explained by the increasing age of the population alone. Fewer below-knee amputations (BKA) (33.0 per cent) and more Gritti—Stokes amputations (GSA) (32.0 per cent) were performed and the overall incidence of re-amputation for stump breakdown was 13.5 per cent. Twenty-eight per cent of below-knee amputation stumps required re-amputation at higher levels, but when successful were associated with a 75 per cent incidence of rehabilitation with an artificial limb. Eight per cent of GSA stumps required re-amputation and were associated with a twenty-eight per cent incidence of successful rehabilitation. Thirty-seven per cent of patients had undergone reconstructive vascular surgery before amputation. Of the 26 patients requiring re-amputation 58 per cent had undergone arterial reconstruction in an attempt to salvage the limb (χ2 = 5.65, P &lt; 0.02) and in 26.9 per cent of cases this was performed within the week before amputation. We feel that injudicious attempts at arterial reconstruction, when amputation appears inevitable, may adversely affect the subsequent level of amputation and jeopardize rehabilitation.
Ischiopagus tetrapus conjoined twins
Authors: Somasundaram K , Wong K S 
Published: March 2007

Abstract
Two sets of ischiopagus conjoined twins were successfully operated on at the University Hospital, Kuala Lumpur in 1981 and 1982. The anatomy of the organ and system malformations are discussed which determined the technique of reconstruction after surgical separation to obtain optimum cosmetic and functional results. Permanent colostomy was not required in any of the four twins and in only one twin was there a need for urinary diversion.
Survival patterns in hormone treated advanced breast cancer
Authors: Williams M R , Todd J H , Nicholson R I , Elston C W , Blamey R W , Griffiths K 
Published: March 2007

Abstract
This study investigates a series of factors, all recordable by the time of presentation of distant metastases from primary breast cancer and relates these to survival after the initiation of endocrine therapies. One hundred and ninety-one patients have received endocrine therapy as initial treatment for distant metastases. In all patients both the histological grade and oestrogen receptor (ER) status of primary tumour tissue; the lymph node stage and menopausal status at mastectomy and the disease-free interval and sites of initial metastases are available for analysis. Four of these factors have been found to contribute independently towards prolonged survival after the initiation of treatment: tumour grade, ER status, disease-free interval and sites of metastases. Employing a multivariate analysis incorporating these four factors, three groups of patients have been identified with survivals of 67, 37 and 0 per cent at 18 months on therapy. These three groups of patients contain 37, 41 and 22 per cent of the patient population respectively.