bluuebunny/crossref_metadata_2025_split huggingface dataset:
Delayed spontaneous recanalization of the vas deferens
Authors: Sherlock D J , Holl-Allen R T J 
Published: March 2007

Abstract
Eight patients were identified who had undergone successful vasectomy a mean of 4·6 years previously and in whom all were microscopically shown to have recurrent motile spermatozoa in their ejaculate. All had been referred following a pregnancy in their wives, and all agreed to undergo repeat vasectomy. Histological examination of the excised portions revealed the presence of spermatozoa in the distal end of one side; but also the presence of a well formed sperm granuloma in continuity with both divided ends of the vas. There does not appear to be any correlation with the suture previously used, nor incidence of infections or injury. Although recanalization is a recognized complication of vasectomy, the majority have occurred within months of the operation. The association of the delayed recanalization with sperm granuloma formation in these cases suggests an aetiological link, it being previously reported that such granuloma can develop up to six years postoperatively.
Penetrating neck trauma with tracheal and oesophageal injuries
Authors: Shama D M , Odell J 
Published: March 2007

Abstract
Failure to recognize early that penetrating neck wounds include the cervical oesophagus greatly increases morbidity and mortality. From an analysis of experience over 5 years (1978–1983) it emerges that, while tracheal wounds are usually recognized early, cervical oesophageal injuries are not. It is empyema which complicates such oesophageal injury and which prompts referral to a Department of Thoracic Surgery, the patients by this time being mortally ill, with septicaemia and malnutrition. Neck penetration is usually left-sided, the injuring agent usually a knife, driven downwards and medially by a right-handed assailant. Empyema is usually right-sided. Early recognition and prompt referral are associated with a low morbidity and low mortality. Late recognition and late referral carry a high morbidity rate, prolonged convalescence in those who survive, and a mortality rate of nearly 25 per cent.
The effect of tetracyline lavage and trauma on visceral and parietal peritoneal ultrastructure and adhesion formation
Authors: Phillips R K S , Dudley H A F 
Published: March 2007

Abstract
The clinical efficacy of tetracycline lavage (1 mg/ml) in the management of abdominal sepsis has led to advocacy of its use in potentially contaminated cases. Yet at higher concentrations (6 mg/ml), tetracycline is a pleural sclerosant. The possibility of early ultrastructural peritoneal damage and later adhesion formation has been examined in syngeneic female Wag rats.
At high concentration (10 mg/ml), tetracycline caused adhesions in the absence of peritoneal trauma and there was an associated loss of serosal microvilli. Lavage with low concentration tetracycline (1 mg/ml) or saline after clean abdominal surgery led to more adhesions than if no lavage was employed. There was an unexplained paradoxically low incidence of adhesions if prior mild contamination of the peritoneal cavity with 1 ml 105 E. coli had been performed.
Postoperative peritonitis due to gastric and duodenal fistulas. Operative management by continuous intraluminal infusion and aspiration: Report of 23 cases
Authors: Levy Etienne , Cugnenc P H , Frileux P , Hannoun L , Parc R , Huguet C , Loygue J 
Published: March 2007

Abstract
A new surgical procedure is presented for the management of postoperative peritonitis due to a leak from a suture line in the stomach or the duodenum. At re-operation, an intraluminal unit made of three silicone tubes is inserted through the fistula into the bowel lumen. Extraluminal drains are placed near the fistula. A Witzel jejunostomy is constructed in order to provide continuous high energy enteral support. Intraluminal infusion and aspiration starts immediately after operation. Twenty-three patients have been treated according to this technique. Five died (22 per cent): one from mediastinitis and four from complications unrelated to the fistula. Three (13 per cent) patients developed recurrent abdominal abscesses and underwent re-operation for drainage with no mortality. In the first 2 weeks after operation, most of the discharge was collected by the extraluminal drains. Thereafter the intraluminal unit collected the majority of the fluid, thus allowing the extraluminal drains to be removed. At an average time of 27 days after operation the intraluminal unit was withdrawn. The external fistula created by this technique healed spontaneously in 15 of the 18 survivors, and was surgically closed in three, with no complication. This procedure prevents the recurrence of intra-abdominal sepsis and local complications due to the enzymatic action of the gastroduodenal secretions.
Large bowel cancer: Surgical pathology and its relationship to survival
Authors: Phillips R K S , Hittinger Rosemary , Blesovsky Lynda , Fry J S , Fielding L P 
Published: March 2007

Abstract
Modifications of Dukes' (1932) classification of rectal tumours have led to confusion. From the data of 2518 patients who had undergone curative colorectal surgery the interrelationships between tumour penetration, grade, vascular invasion and pattern of lymph node involvement have been examined and their individual relevance to survival determined. Subdivision of Dukes' A cases into those confined to the muscularis mucosae (A) and those penetrating into, but not through, the bowel wall (B1) should be abandoned. Despite interrelationships between lymph node status, grade of tumour and vascular invasion, they all contribute prognostic information independent of each other. Apical lymph node involvement, more than four lymph nodes involved and extensive primary tumours with nodal involvement all carry a bad prognosis. Although interrelated each variable is individually relevant. However, subgroups of patients with Dukes' C tumours have an observed survival significantly better than expected. When few lymph nodes are involved or the primary tumour is confined to the bowel wall but lymph nodes are involved, the expectation of life is equivalent to Dukes' B.
Faecal incontinence after anal dilatation
Authors: Snooks S , Henry M M , Swash M 
Published: March 2007

Abstract
We have studied 10 patients with faecal incontinence occurring after anal dilatation. Abnormalities were found in the external anal sphincter in clinical and manometric tests in five patients and in single fibre EMG tests in four patients. Internal anal sphincter function was impaired in eight patients. These findings have implications for prevention of faecal incontinence after this procedure.
A prospective study of end-to-side vs. side-to-side arteriovenous fistulas for haemodialysis
Authors: Wedgwood K R , Wiggins P A , Guillou P J 
Published: March 2007

Abstract
In an attempt to determine the optimum configuration of arteriovenous (A–V) fistulas for haemodialysis, 71 patients were prospectively randomized to undergo either a side-to-side or end-of-vein to side-of-artery A–V fistula. Nine months after operation, the patency rates on dialysis were almost identical in the two groups (79.2 per cent and 78.6 per cent respectively). However, 7 of the 32 side-to-side fistulas developed hyperaemia of the hand, three of which required revisional surgery. Hyperaemia of the hand has not been seen with end-to-side fistulas. In addition, peroperative measurements of fistula flow appeared to have prognostic value with end-to-side but not with side-to-side fistulas. It is suggested that the end-to-side configuration is the one of choice for the formation of A–V fistulas for haemodialysis.
Randomized prospective trial of the Angelchik anti-reflux prosthesis
Authors: Gear M W L , Gillison E W , Dowling B L 
Published: March 2007

Abstract
Fifty-two patients with reflux oesophagitis resistant to medical treatment were randomized at operation to receive either the Angelchik prosthesis or a fundoplication. All patients were assessed postoperatively by a physician unaware of the nature of the operation. Forty-two patients have been followed up for 1–2 years; ten patients for 3–9 months. Ninety-six per cent of the Angelchik patients had satisfactory or excellent results compared with 81 per cent with a fundoplication. There were no failures to control reflux with the Angelchik prosthesis whereas 6 patients (23 per cent) of the fundoplication group have persisting reflux. Operating times for insertion of the prosthesis averaged a little over half that recorded for fundoplication. Complication rates were similar. The results of the trial encourage the use of the prosthesis in patients with gastro-oesophageal reflux, where medical treatment has failed. The prosthesis should not be used if the gut is opened during operation either inadvertently or deliberately, as in making a suture line or anastomosis, because of the risk of sepsis.
Pancreatic abscesses
Authors: Shi E C P , Yeo B W , Ham J M 
Published: March 2007

Abstract
This paper presents the clinical features and problems in the management of 34 patients with pancreatic abscesses. In the majority of patients the abscesses developed following an attack of pancreatitis due to alcohol or gallstones. The abscesses were usually multilocular, and often had spread widely in the retroperitoneal space. Invasion into surrounding viscera or the peritoneal cavity occurred in 12 instances, and eight patients developed major bleeding into the abscess cavity. Obstructive complications (affecting bowel, common bile duct and large veins) occurred in eight patients. Twelve of the 34 patients (35 per cent) died, most deaths being due to failure to control sepsis (seven patients) or to massive bleeding from the abscess cavity (three patients). The mortality of this condition is likely to remain high, but may be reduced by better drainage techniques at the initial exploration. The importance of the inframesocolic approach for drainage is emphasized.
Choledochoscopy: Are stones missed? A controlled study
Authors: Gartell P C , McGinn F P 
Published: March 2007

Abstract
Although the choledochoscope has been available for several years, its use has not achieved universal acceptance. Enthusiasts claim that the incidence of retained stones in the common bile duct would be reduced by using the instrument, but no controlled study by the same team has been reported. Patients undergoing biliary surgery by one surgical team in Southampton were operated upon in one of three hospitals. The choledochoscope was available for use at only one hospital, but the other two were otherwise fully equipped, and no selection of patients was made for any particular hospital. Over a period of 7 years, 707 patients underwent elective or emergency cholecystectomy. Routine choledochography was performed and stones were found or suspected in the bile ducts in 103 (14.6 per cent). The choledochoscope was used in 54 of the bile duct explorations and in 10 patients residual calculi following routine exploration were identified by the instrument. Postoperative T-tube choledochography was performed in 35 patients following choledochoscopy, 31 with choledocholithiasis at operation, and no unsuspected retained stones were demonstrated. In the 49 patients undergoing duct exploration by the same team without the choledochoscope, 32 were found to have choledocholithiasis. Thirty-six postoperative choledochograms were performed and six patients were found to have retained stones. There were no additional complications attributed to the use of the instrument. We conclude that the use of the choledochoscope should reduce the incidence of retained bile duct stones.
The four to eight year results of the Sheffield trial of elective duodenal ulcer surgery—highly selective or truncal vagotomy?
Authors: Stoddard C J , Johnson A G , Duthie H L 
Published: March 2007

Abstract
In a prospective randomized trial between June 1973 and July 1978 highly selective vagotomy (HSV) was compared with truncal vagotomy and pyloroplasty (TVP) in 137 male patients undergoing elective surgery for chronic duodenal ulceration. Ninety per cent of patients were followed up for between 49 and 102 months (mean 77). A good result was obtained in 49 of 59 patients (83 per cent) after HSV compared with 41 of 64 (64 per cent) after TVP (P &lt; 0.02). The recurrent ulcer rate was 8.8 per cent after HSV and 9.4 per cent after TVP. Dumping and diarrhoea were significantly commoner after TVP (P &lt; 0.05). We believe that HSV is a better operation than TVP for the treatment of uncomplicated duodenal ulcer.
Are bile bacteria relevant to septic complications following biliary surgery?
Authors: Willis R G , Lawson W C , Hoare E M , Kingston R D , Sykes P A 
Published: March 2007

Abstract
Bile bacteriology, wound sepsis and the effect of prophylactic antibiotics have been studied in a controlled prospective double blind randomized trial on 375 patients undergoing elective cholecystectomy at a district general hospital. We have examined the overall prevalence of bacteria in bile and have identified several factors associated with an increased incidence. The identity of organisms isolated from a total of 21 patients with infected wound swabs was compared with isolates from the bile at operation, and in only two instances was there a correlation. Cephazolin, given either pre-operatively, or into the wound, reduced wound infection rates compared with a control group (from 11·8 to 2·4 per cent, P &lt; 0.005). We conclude that the majority of wound infections in this series were caused by organisms from the patients' skin or exogenous sources, rather than by bacteria from the biliary system.
Mediastinal parathyroid adenoma: A new method of localization
Authors: Ubhi C S , Hardy J G , Pegg C A S 
Published: March 2007

Abstract
201Tl-thallous chloride/99mTc sodium pertechnetate subtraction scanning is a simple and accurate means to demonstrate enlarged parathyroid glands. We report a case in which the intra-operative location of a mediastinal adenoma was greatly facilitated by using a probe radiation detector following intravenous injection of201Tl-thallous chloride. We believe this is the first reported use of this technique in parathyroid surgery.
Altered responses of prolactin, luteinizing hormone and follicle stimulating hormone secretion to thyrotrophin releasing hormone/gonadotrophin releasing hormone stimulation in cyclical mastalgia
Authors: Kumar S , Mansel R E , Scanlon M F , Hughes L E , Edwards Catherine A , Woodhead J S , Newcombe R G 
Published: March 2007

Abstract
A generalized abnormality of hypothalamopituitary function was found in 17 patients with cyclical pronounced mastalgia compared with 11 controls by using a combined thyrotrophin releasing hormone and gonadotrophin releasing hormone test. The release of prolactin, luteinizing hormone and follicle stimulating hormone was significantly greater in cyclical mastalgia patients than in controls. Basal thyrotrophin, T3 and T4 levels were within the normal range in both groups indicating normal thyroid status in benign breast disease. The single measurement of oestrogen and progesterone in the luteal phase was not abnormal. These data demonstrate an alteration in lactotroph and gonadotroph function in patients with cyclical mastalgia. It is unknown at present whether this represents an appropriate cellular response to altered central or peripheral signals. There is no evidence to suggest, however, that the anterior pituitary cell types are abnormal per se.
Prognostic factors and in vitro cytotoxic sensitivity in colorectal cancer
Authors: Trotter G A , Morgan G R , Goeting Nicola , Cooper A J , Taylor I 
Published: March 2007

Abstract
The poor response rates to chemotherapy for colorectal cancer justify attempts to rationalize selection of patients for treatment, and the development of systems to evaluate new cytotoxic agents. Refinement of prognostic indices may identify colorectal cancer patients at a higher risk of recurrence who merit more aggressive treatment. We report our experience with the stem cell assay and pulse thymidine labelling in 43 primary colorectal cancers. Thirty-six tumours were evaluable, and clonogenic growth was obtained in 30 (83 per cent). In 24 tumours (67 per cent) growth was adequate for meaningful interpretation of a cytotoxic drug assay. Frequency of growth and colony forming efficiency did not correlate with histopathological grade, Dukes' stage or tumour cell kinetic indices. Thymidine labelling indices correlated with Dukes' stage (A and B versus C and D, P&lt;0·01, Mann–Whitney U test). Cytotoxic assays with 5-fluorouracil and 5′-deoxy-5-fluorouridine were undertaken in 18 cases (14 primary carcinomas, 4 malignant ascites), of which 14 were evaluable and 3/14 (21·5 per cent) were chemosensitive in vitro. Both drugs were equally effective in vitro at clinically attainable plasma concentrations. This is in accordance with the response rates observed clinically with 5-FU chemotherapy in colorectal cancer.
Iatrogenic biliary stricture: Presentation and management
Authors: Collins P G , Gorey T F 
Published: March 2007

Abstract
Repair of iatrogenic biliary stricture was carried out in 38 patients of whom five are now dead, three causally related. Thirty-one patients were followed up between August 1983 and March 1984 (mean time since repair 7·9 years). Fifty reparative operations were carried out, six patients first having a temporary end fistula performed. Cholangiography during cholecystectomy had been performed in only eight patients (21 per cent). All but one patient had gastroscopy and barium meal examination and the incidence of duodenal ulceration was 6·7 per cent and of oesophageal varices 5·6 per cent. Liver biopsies taken during the first reparative operation were normal in 5 per cent, obstructive in 65 per cent and cirrhotic in 30 per cent. Intra-operative cultures were mainly coliforms (66·7 per cent). Liver function tests were normal in 19 (61·3 per cent) but there was no correlation between abnormal values and clinical status. Twenty-nine patients (93·5 per cent) are now completely well. 99mTc HIDA scans, liver ultrasonography, intravenous cholangiography and BSP excretion were of limited value in planning further surgery. The most useful investigation before reoperation was transhepatic cholangiography.
Prediction of recurrence after mastectomy for operable breast cancer
Authors: Nixon S J , Steele R J C , Hawkins A R , McGregor J , Forrest A P M 
Published: March 2007

Abstract
A patient's risk of early recurrence after mastectomy for breast cancer has been estimated by using a combination of four prognostic factors. A computer program, designed to calculate the exact probability of recurrence within 2 years of mastectomy, was accurate when tested on 240 patients. A simple scoring system could identify patients at lower and greater risk than any single factor alone.
Survival following local skin recurrence after mastectomy
Authors: Fentiman I S , Matthews P N , Davison O W , Millis R R , Hayward J L 
Published: March 2007

Abstract
Seventy-three patients with breast cancer, treated by radical mastectomy, who subsequently developed a local skin recurrence without clinical evidence of disseminated disease, have been reviewed. There were significant differences between the survival of patients with single and multiple recurrences. Only 10 per cent of those with multiple lesions survived 5 years, and none was alive at 10 years, whereas 42 per cent of those with single lesions survived 5 years and 22 per cent were alive and well at 10 years’ postrecurrence. Adequate local treatment of a single skin nodule may enable a subset of patients to survive without subsequent development of breast cancer metastases.
Electrically evoked activity in the human external anal sphincter
Authors: Wright A L , Williams N S , Gibson J S , Neal D E , Morrison J F B 
Published: March 2007

Abstract
Following electrical stimulation of perianal skin, short latency evoked electromyographic (EMG) responses from the external and sphincter have been interpreted as the electrophysiological correlate of the anal reflex. Delayed responses in patients with idiopathic faecal incontinence have been interpreted as evidence for denervation of the external anal sphincter. Electrically evoked responses were studied in normal subjects, either before and during spinal anaesthesia (n = 8), or before and during competitive neuromuscular blockade (n = 4), instituted for operative purposes. Short latency responses persisted unchanged in either latency or duration during spinal anaesthesia whereas long latency responses were completely abolished. Both short and long latency responses were abolished during competitive neuromuscular blockade. Short latency responses are not spinal reflex in nature, but due to stimulus activation of α-motoneuronal terminal branches. Delayed responses in incontinent patients cannot be interpreted as evidence for pudendal neuropathy. Long latency (i.e. &gt; 40 ms) responses demand a functional sacral spinal cord and represent the true anal reflex. Their wide range of latency in normal subjects suggests this measurement will be of little use in confirming the presence or absence of pudendal neuropathy, and that other measures of neuropathy may be more appropriate.
Catheter-related sepsis in patients on intravenous nutrition: A prospective study of quantitative catheter cultures and guidewire changes for suspected sepsis
Authors: Pettigrew R A , Lang S D R , Haydock D A , Parry B R , Bremner D A , Hill G L 
Published: March 2007

Abstract
One hundred and ninety-five central venous catheters used for intravenous nutrition in 113 patients were studied prospectively. Catheter-related sepsis (CRS), defined by recovery of the same organism from the catheter tip and peripheral blood cultures, occurred with only 3.3 per cent of catheters or 2.3 per 1000 days of therapy. In contrast, CRS was suspected with 30 per cent of catheters and catheter contamination occurred in 37 per cent. Contamination was defined by a positive catheter tip culture without recovery of the same organism from the blood. CRS was present in 4 of 12 cases (33 per cent) with &gt; 1000 colony forming units on the catheter tip but in only 2 of 54 (4 per cent) with fewer organisms. Thirty-eight cases suspected of having CRS were randomized to have catheter removal and later replacement, or replacement over a guidewire. There were no significant differences in the catheter contamination rate but there were significantly fewer problems of insertion in the guidewire group. However, transfer of Klebsiella sp., during the guidewire procedure, resulted in subsequent sepsis in one case. It is concluded that replacement of catheters over a guidewire is a safe and convenient way of establishing whether sepsis is catheter-related. Because organisms may be transferred, the procedure is not an appropriate treatment for catheter-related sepsis.