bluuebunny/crossref_metadata_2025_split huggingface dataset:
Colonic carcinoma at the site of ureterosigmoidostomy: What is the risk?
Authors: Thompson P M , Hill J T , Packham D A 
Published: March 2007

Abstract
A case of colonic carcinoma arising 27 years after urinary diversion by ureterosigmoidostomy is reported. This late complication is now well recognized and increasing numbers of cases are being reported. The implications of this aptient and the 31 previously reported cases are considered.
Postoperative hypoxaemia: Oesophagectomy with gastric replacement
Authors: Bishop D G M , McKeown K C 
Published: March 2007

Abstract
Pre- and postoperative arterial blood samples were analysed for oxygen partial pressure (Pao2) and carbon dioxide partial pressure (Paco2) in a consecutive series of 21 patients subjected to two- or three-stage oesophagectomy for carcinoma of the oesophagus. The forced vital capacity (FVC) was measured at the same time.
On the second postoperative day the Pao2 showed a fall to 65 per cent of the preoperative value followed by a gradual recovery to 78 per cent on the tenth postoperative day. After 13 weeks the Pao2 had recovered to 95 per cent of the preoperative value.
The Paco2 decreased in the early postoperative period but had returned to the preoperative level by the tenth day. The FVC showed a trend similar to the Pao2 with a reduction to 33 per cent of the preoperative value on the second postoperative day, 52 per cent on the tenth day and 85 per cent after 13 weeks.
The preoperative detection of internal mammary lymph node metastases in breast cancer
Authors: Osborne M P , Jeyasingh K , Jewkes R F , Burn Ian 
Published: March 2007

Abstract
The internal mammary lymph node chain has been studied in patients with breast cancer by radioiosotope imaging. The technique enabled the study of lymph node function in an area inaccessible to clinical examination or lymphography.
Thirty-four patients with breast cancer have been studied by injecting the posterior sheath of the rectus abdominis muscle, in the subcostal region, with technetium-99m-labelled stannous phytate and subsequently imaging the anterior thorax. Lymph node metastases were diagnosed in 13 patients (38 per cent) in whom a suppressed uptake of the isotope by the internal mammary lymph nodes was observed. Eighteen patients (53 per cent) had normal scans and in 3 patients (9 per cent) the examination was technically unsatisfactory. Histopathological correlation of internal mammary node biopsy with the preoperative scan confirmed the scan findings in all but one case in which this was carried out. Radioassay of internal mammary lymph nodes confirmed that the agent was localized in them and that uptake was suppressed in the presence of metastases.
Twenty-three patients in this study underwent sequential scanning using first 99Tcm-labelled stannous phytate and subsequently 99Tcm-labelled antimony sulphide colloid. The latter agent was able to demostrate the anatomical presence of nodes when a suppressed uptake had initially been observed using 99Tcm-labelled stannous phytate.
Internal mammary lymphoscintigraphy may be of value in the preoperative of breast cancer.
Anticoagulant activity and operative blood loss after intrapulmonary heparin
Authors: Wright Charles J , Mahadoo Jaysen , Jaques Louis B 
Published: March 2007

Abstract
The safety and efficacy of heparin given by the intrapulmonary route are further assesed in this study. A single dose of heparin (2000 units/kg) was given by intratracheal instillation in dogs and measurements of plasma heparin concentration, whole blood clotting time and partial thromboplastin time made at intervals for 48 h. These values rose progressively and in parallel for 7 h and remained elevated for 48 h.
A series of operations was performed on dogs within 3 h of a single dose of intrapulmonary heparin (1500 units/kg). Operations involving minimal dissection (small bowel resection) and extensive dissection (resection of muscle) were performed in two separate groups. Within each group the animals were randomly given heparin or saline. In the limited dissection group there were no differences in operative blood loss, wound healing, or sequential haemoglobin and haematocrit measurements. In the group subjected to muscle resection there was increased postoperative wound drainage and a slightly greater fall in haemoglobin and haematocrit in those given heparin.
It is concluded that heparin is absorbed from the lung causing significant changes in coagulation parameters. Even with the relatively high dose of 1500 units/kg, operations were performed with minimal hazard. Intrapulmonary heparin may have important clinical applications after further investigation.
Non-operative removal of bile duct stones by duodenoscopic sphincterotomy
Authors: Cotton Peter B 
Published: March 2007

Abstract
Surgical exploration of the common bile duct carries considerable risks in elderly and frail patients. Peroral, fibreoptic duodenoscopy allows access to the papilla of Vater in sedated patients and the opportunity to perform a diathermy sphincterotomy for removal of bile duct stones. We have attempted sphincterotomy in 134 patients, most of whom had previously undergone cholecystectomy and had some contraindication to a further operation. Sphincterotomy was technically successful in 129 patients (96 per cent), and all duct stones were removed in 119 patients (92·5 per cent of successful sphincterotomies). The technique failed only once in 95 patients with stones less than 14 mm diameter. Immediate complications occurred in 10 patients, 3 of whom required emergency surgery; 1 patient died.
Endoscopic diathermy sphincterotomy is a major therapeutic advance in the management of elderly and high risk patients with bile duct stones. No significant adverse effects have yet been revealed in follow-up studies. However, the possibility of long term complications dictates the need for caution in offering this procedure to young patients who are fit for reoperation.
Physical characteristics of gallstones and the calibre of the cystic duct in patients with acute pancreatitis
Authors: McMahon Michael J , Shefta Jahan R 
Published: March 2007

Abstract
Forty-six gallbladders were examined for the number, weight, size and shape of their gallstones, and for the volume of flow, under conditions of constant pressure, that was transmitted by the cystic duct. Eighteen gallbladders were from patients who had previously suffered an attack of acute pancreatitis, and the other 28 were from control patients who had not had a known attack of pancreatitis.
Cystic duct flow rates, which we assumed were related to cystic duct calibre, were greater in the pancreatitis group (mean = 282 ml/min) than in the controls (mean = 134 ml/min) (P &lt; 0·01). There were more stones in the gallbladders of the pancreatitis patients, and the mean stone weight was lower in this group (0·31 g compared with 0·74 g; P &lt; 0·02). Large stones were more frequently seen in the control gallbladders. Small, irregular or mulberry-shaped stones were the dominant stone type in 78 per cent of the pancreatitis group but in only 43 per cent of the controls (P&lt;0·05).
Thus a large-calibre cystic duct and numerous small stones with an irregular shape appeared to be more common in patients who had suffered acute pancreatitis, and may be factors in the pathogenesis of the attack.
Iatrogenic choledochoduodenal fistula: An unsuspected cause of post-cholecystectomy symptoms
Authors: Hunt D R , Blumgart L H 
Published: March 2007

Abstract
In the investigation of 90 patients referred with severe post-cholecystecomy problems, 8 patients were found at ERCP to have choledochoduodenal fistula. The clinical feature associated with the fistula included pain with fever, jaundice or hyperamylasaemia. Reviewing the details of the original surgery and the endoscopic findings, it is suggested that most, if not all, of these fistulas are iatrogenic. Treatment by biliary bypass is recommended.
What is involved in endoscopic sphincterotomy for gallstones?
Authors: Slooff M , Baker R , Lavelle M I , Lendrum R , Venables C W 
Published: March 2007

Abstract
This study reports our first year's experience of endoscopic sphincterotomy for common bile duct stones. Forty patients were considered for the procedure and it was attempted in 37. An effective endoscopic sphincterotomy was eventually achieved in 32 (86 per cent), 7 after a ‘pre-cut’. Twenty-three patients passed stones spontaneously (72 per cent), 6 could not be reassessed and 3 still had stones present (9 per cent). Bed occupancy was 9·5±5·9 days.
Complications occurred in 30 per cent, the most common being pancreatitis in 6 cases with 1 death.
It is concluded that endoscopic sphincterotomy offers a valuable alternative to surgery in the management of common bile duct stones.
Present concept of the Belsey mark IV procedure in gastro-oesophageal reflux and hiatus hernia
Authors: Singh S V 
Published: March 2007

Abstract
One hundred patients with gastro-oesophageal reflux and hiatus hernia were treated at the North Middlesex Hospital, Regional Cardiothoracic Centre, between 1968 and 1969. All patients received surgical treatment by the Belsey mark IV technique with no significant complications. The 9–10 year follow-up has shown a recurrence rate of 10 per cent. The majority of recurrences occurred within 2 years of the initial operation. Seven of these recurrences had excellent results after a second mark IV repair. The improved quality of life in the successful cases was dramatic. This series indicates that a left transthoracic mark IV type of repair is a safe and reliable procedure and gives excellent results with relief of symptoms.
Clinical results of 229 patients with duodenal ulcer 1–6 years after highly selective vagotomy
Authors: Adami H O , Enander L K , Ingvar C , Rydberg B 
Published: March 2007

Abstract
The aim of this study was to assess the clinical results after highly selective vagotomy (HSV) when used routinely at a district general hospital. A total of 229 patients with chronic duodenal or prepyloric ulcers was included in a 92 per cent complete follow-up 1–6 years after an elective HSV without drainage. There was no postoperative mortality, and the frequency of postoperative complications was low. Transient dysphagia and early fullness each occurred in about a quarter of the patients, whereas persistent dumping was found only in 1·3 per cent and diarrhoea in 2·2 per cent of the patients. Recurrent ulcer was diagnosed in 12·7 per cent of the patients, but this figure decreased to 9·3 per cent after exclusion of one of the 24 surgeons involved. The overall clinical results according to the modified Visick classification were recorded as excellent or very good in 70 per cent and unsatisfactory in 20 per cent. The failures were almost exclusively due to a proved or suspected recurrence or to gastric retention, and further operations have been performed on 27 of these patients. After reoperation only 8 patients (3·5 per cent) remained failures according to the patient's own judgement at the time of follow-up.
The recurrence rate in this study was considered disquietingly high with regard to the short observation time. However, other obvious advantages of the method and the possibility of improved results after adjustment of the surgical technique were considered to justify continued use of HSV as a routine procedure.
The management of childhood intussusception in a district hospital
Authors: Thomas D F M 
Published: March 2007

Abstract
Fifteen out of 34 infants with intussusception admitted to a district hospital were found to require resection of gangrenous bowel or an anatomical lead point. This resection rate (44 per cent) is considerably higher than those reported from specialist centres which rely on hydrostatic reduction as their primary form of treatment. The difference is probably a reflection of the greater proportion of late cases seen in a district hospital. Complications were virtually confined to those children who had undergone resection and it is concluded that earlier referral to hospital is the single factor most likely to reduce morbidity. Operative management is advocated, although barium enema is a safe valuable adjunct to surgery.
Intramural haematoma of the duodenum
Authors: Vellacott K D 
Published: March 2007

Abstract
Five cases of traumatic intramural haematoma of the duodenum occurring in children are presented. Four of the cases were treated conservatively with nasogastric aspiration and intravenous fluids and it is suggested that this should be the treatment of choice in the majority of cases. Two of the cases were diagnosed initially as having appendicitis and during the exploratory procedure in one of these cases the haematoma was evacuated.
The clinical significance of the pattern of elevated serum carcinoembryonic antigen (CEA) levels in recurrent colorectal cancer
Authors: Wood C B , Ratcliffe J G , Burt R W , Malcolm A J H , Blumgart L H 
Published: March 2007

Abstract
Serial serum carcinoembryonic antigen (CEA) assays were performed in 148 patients after potentially curative surgery for colorectal cancer. Thirty-seven patients developed proved recurrent tumour in a follow-up period of 2–5 years. Elevated CEA levels recorded in 36 of these patients and in 27 rising levels preceded clinical symptoms of recurrent tumour. Two distinct patterns of CEA rise were observed: a ‘fast’ rise in which serum concentrations reached 100 μg/l within 6 months of the first elevation and a ‘slow’ rise in which concentrations remained less than 75 μg/l for at least 12 months. The majority of patients with the ‘fast’ rise had metastatic spread, whereas most patients with a ‘slow’ rise had local recurrence alone. This differential pattern may help to predict the site of recurrent tumour.
Operative mortality following excision of the rectum
Authors: Hughes E S R , McDermott F T , Masterton J P , Cunningham I G E , Polglase A L 
Published: March 2007

Abstract
Resection of the rectum was performed in 1395 patients. There were 94 (6·7 per cent) operative deaths. The operative mortality was similar in the three types of excision. Mortality was high in the male, in the older age groups and in those having palliative resection. Cardiopulmonary complications and sepsis were the two chief causes of the operative deaths.
Clinical and manometric evaluation of rectal prolapse and incontinence
Authors: Keighley M R B , Makuria T , Alexander-Williams J , Arabi V 
Published: March 2007

Abstract
The clinical presentation and manometric findings in 46 patients with rectal prolapse and/or incontinence are reported. Basal and maximal squeeze pressures in the anal canal of patients with prolapse alone did not differ from the pressures in age- and sex-matched controls whereas anal pressures in both groups of patients with incontinence were significantly lower than in controls. Physiotherapy and faradism had no therapeutic value in rectal prolapse but gave improvement in 30 per cent of patients with incontinence. Rectopexy gave satisfactory results in all the patients with prolapse and improved incontinence in 70 per cent. Post-anal repair cured 87 per cent of patients with idiopathic anorectal incontinence or with persistent incontinence after rectopexy. No form of treatment was associated with any signicant elevation of anal pressures.
The effect of bile salts on the pancreatic duct mucosal barrier
Authors: Reber Howard A , Mosley John G 
Published: March 2007

Abstract
The effects of various bile salts on the permeability of the pancreatic duct in cats have been investigated. The sodium salts of cholic, glycocholic, taurocholic, chenodeoxycholic, glycochenodeoxycholic, deoxycholic and glycodeoxycholic acids were perfused through the main duct in concentrations similar to those found in the duodenal contents (15–42 mM). HCO3− and Cl− fluxes were determined before and after perfusion. The unconjugated dihydroxy bile salts increased permeability to these anions to a greater degree than the trihydroxy bile salt, but all were damaging to the duct when they were perfused at an alkaline pH (8·4–9·1). The glycine conjugates of the bile salts were as damaging as the unconjugated form, but 42 mM taurocholate was more damaging than 42 mM glycocholate. When 25 mM glycocholate was perfused at pH 2·4 there was potentiation of the damage produced during perfusion of glycocholate at pH 8·7. Sterile cat bile did not damage the duct, but infected bile did. The ability of bile salts to increase the permeability of the pancreatic ducts must be considered as a possible aetiological factor in the pathogenesis of inflammatory and malignant diseases of the pancreas.
The saline dilution test—a preoperative predictor of DVT
Authors: Heather Brian P , Jennings Stella A , Greenhalgh Roger M 
Published: March 2007

Abstract
In vitro dilution of blood with normal saline produces an increase in coagulability which can be accurately measured by the thrombelastograph. The degree to which the coagulability of an individual patient's blood is increased by such dilution appears to be directly related to that patient's risk of developing a postoperative deep venous thrombosis. In a small group of patients undergoing major abdominal surgery, a preoperative test based on the coagulability increase after in vitro saline dilution successfully predicted all those who subsequently developed a postoperative deep venous thrombosis on 125I-fibrinogen scanning.
The insertion of prostheses at mastectomy for carcinoma of the breast—a preliminary report
Authors: Logan Hume 
Published: March 2007

Abstract
There has been a move away from radical surgery for carcinoma of the breast to more conservative measures. However, even simple mastectomy causes considerable mutilation and is psychologically very upsetting for most patients. This has led to attempts at reconstruction of the breast and more recently to prostheses being inserted at the time of mastectomy (1). The early results of this procedure in 30 patients—the total experience of a general surgeon—are reported in this paper.
Upper thoracic sympathectomy by transthoracic electrocoagulation
Authors: Weale Felix E 
Published: March 2007

Abstract
Transthoracic electrocoagulation (TTEC) of the upper thoracic sympathetic chain is described. In 10 patients the technique was relatively simple and denervation was satisfactory in 9. One temporary Horner's syndrome was produced. The merits of this technique in a preliminary series are compared with other forms of treatment.
The effect of hypovolaemia on colonic blood flow in the dog
Authors: Gilmour D G , Aitkenhead A R , Hothersall A P , Ledingham I Mca 
Published: March 2007

Summary
The effects of a minor degree of hypovolaemia on colonic blood flow and on systemic haemodynamics have been studied in nine greyhound dogs.
A loss in blood volume of 10 per cent over 20 min produced no change in blood pressure and only a 7 per cent rise in heart rate. Cardiac output, however, fell by 26 per cent and central venous pressure also fell significantly. Colonic blood flow fell by 28 per cent and oxygen availability by 29 per cent. All these changes were statistically highly significant. Retransfusion of shed blood resulted in a slow and incomplete return to pre-bleed status.
Since colonic blood flow and oxygen availability during and after surgery may be important for colonic healing, it is suggested that even the slightest degree of hypovolaemia should be avoided in cases involving colonic anastomosis. Systemic blood pressure may be an inadequate index of the need for transfusion in these cases.
Asymptomatic hyperparathyroidism: An assessment of operative intervention
Authors: Graham J J , Harding P E , Hoare L L , Thomas D W , Wise P H 
Published: March 2007

Summary
The incidental finding of hypercalcaemia during multichannel screening was the initiating event in 33 (45 per cent) of 79 consecutive cases of surgical treated primary hyperparathyroidism. This subgroup was asymptomatic as defined. Altough significant biochemical differences existed between symptomatic and asymptomatic cases, a range of metabolic indices of bone turnover fell postoperatively in almost all asymptomatic subjects, although initially abnormal in only 35 per cent. Achievement of normocalcaemia was significantly surgeon-dependent.
How long do compression bandages maintain their pressure during ambulatory treatment of varicose veins?
Authors: Raj T B , Goddard M , Makin G S 
Published: March 2007

Summary
Compression bandages are normally applied for 6 weeks after sclerotherapy. The changes in pressure exerted by such bandages have been measured over 8 h. The results show that different surgeons applied bandages over a wide range of pressures but the range for each individual surgeon was surprisingly narrow. The pressure falls with time and approaches zero at 6–8 h of normal activity by the subject, but more slowly if the knee and ankle joints are excluded from the bandage. The initial pressures were higher when STD compression pads were used, although the rate at which the pressure fell was the same.
Tuberculosis of the breast
Authors: Alagaratnam T T , Ong G B 
Published: March 2007

Summary
Sixteen cases of tuberculosis of the breast are presented. The clinical features were a firm mass or a recurring abscess of the breast, sometimes associated with discharging sinuses. Diagnosis relied on histological appearance, acid-fast bacilli being present in only 3 specimens and positive cultures obtained in 4 patients. Local excision of the mass and chemotherapy proved effective treatment.
The delayed treatment of wounds of the hand and forearm under antibiotic cover
Authors: Morgan W J , Hutchison D , Johnson H M 
Published: March 2007

Summary
In wounds of the hand and forearm treated within 4 h of injury, prophylactic clindamycin, in a dose of 150 mg 6-hourly for 5 days, did not reduce the infection rate. In wounds treated after 4 h the infection rate was reduced, but not significantly so. There was a significant reduction in the infection rate comparing all wounds treated within 4 h with those treated after 4 h. Early treatment of wounds is more important than prophylactic antibiotics, although these may have a part to play where late treatment is unavoidable.
A clinical trial in the management of operable cancer of the breast
Authors: Langlands Allan O , Prescott Robin J , Hamilton Thomas 
Published: March 2007

Summary
The results of a randomized controlled clinical trial in the management of operable breast cancer are given. Between 1964 and 1971 498 women, aged 35–69 years, were treated within the trial protocol. Those under 60 years of age on entry underwent ovarian ablation, usually by surgery, and were allocated randomly to treatment by either radical mastectomy (RM) or simple mastectomy and postoperative radiotherapy (SM). Follow-up data for the first 12 years are presented and show that survival in the radical mastectomy group is significantly better (P &lt; 0·05), particularly in clinical stage 1 disease.
The pattern of survival once recurrence was detected also showed interesting differences between the two treatment groups. Overall there was a significantly prolonged survival after detection of recurrence in the RM group (P &lt; 0·05) which was most marked when local recurrence and distant metastases coincided (P &lt; 0·01). The duration of survival once recurrence had taken place was independent of tumour size, clinical stage of the disease or menstrual status at the time of presentation, but was directly proportional to the duration of the disease-free interval (P &lt; 0·01).