bluuebunny/crossref_metadata_2025_split huggingface dataset:
Vitamins in intravenous feeding: A study of watersoluble vitamins and folate in critically ill patients receiving intravenous nutrition
Authors: Bradley J A , King R F J G , Schorah C J , Hill G L 
Published: March 2007

Abstract
Red cell B vitamins, folate and white cell vitamin C were measured in a group of critically ill surgical patients before and following a course of intravenous nutrition.
Patients received a widely used vitamin supplementation regimen in the form of one ampoule of watersoluble vitamins daily and recommended doses of intramuscular folate, vitamin B12 and vitamin K weekly. This regimen was adequate to maintain tissue levels of the water-soluble vitamins and folate. Patients with initially low values had normal values at the end of the treatment period.
Effect of gastrointestinal hormone infusions on lower oesophageal competence of Rhesus monkeys
Authors: Moossa A R , Hall A W , Hughes R G , Moraldi A , Moossa D E , Skinner D B 
Published: March 2007

Abstract
The lower oesophageal high pressure zone (HPZ) was studied in 5 non-refluxing and 3 refluxing Rhesus monkeys. The changes in HPZ and reflux status in response to infusion of various doses of secretin, cholecystokinin and glucagon were measured in all animals, and, in the 5 non-refluxing monkeys, after oesophagogastrectomy with replacement of the lower oesophagus by a stomach tube. All three hormones consistently produced a transient decrease in the HPZ pressure. The only change in response following oesophagogastrectomy and gastric tube replacement was a significant delay in the response to each hormone. Neither hormone infusion nor operation altered gastro-oesophageal reflux status.
It appears that lower oesophageal competence in primates is more dependent on the presence of a narrow, muscular, intra-abdominal tube than on a specialized segment of the lower oesophagus.
Heterotopic mediastinal goitre
Authors: Nwafo D C 
Published: March 2007

Abstract
The unusual coexistence in a woman of 34 years of a cervical thyroid and a heterotopic mediastinal thyroid is recorded. Both thyroids had undergone non-toxic nodular enlargement. Recurrent enlargement was noted in the cervical gland 12 months after transpleural thoracic removal of the mediastinal goitre, whilst no corresponding change has so far been noted in the mediastinum. The literature on heterotopic thyroid is briefly reviewed and the diagnosis discussed.
Diagnosis and management of a gastric carcinoid tumour with hepatic metastases
Authors: Maempel F Zammit , Modlin I 
Published: March 2007

Abstract
The gastric carcinoid tumour is a rare variety of carcinoid characterized by atypical production of 5-hydroxytrytophane rather than serotonin. In our case it is likely that other polypeptides are the source of symptoms, though these are as yet unidentified. Since surgery was not feasible in the management of the hepatic metastases, we have used a non-operative technique of embolization to destroy the carcinoid secondaries and ameliorate symptoms. The patient tolerated this procedure well and improved dramatically, with remarkable diminution of liver size and the disappearance of all carcinoi symptoms. Destruction of hepatic secondaries without recourse to surgery has obvious advantages in severly ill patients. Careful attention should, however, be paid to the large quantities of pharmacologically active compounds released from the liver by the procedure.
The injuries of terroist bombing: A study of 1532 consecutive patients
Authors: Hadden W A , Rutherford W H , Merrett J D 
Published: March 2007

Abstract
Of 1532 explosion victims only 9 died in hospital Injury to the chest or abdominal organs was rare (10 patients of whom 5 died). Primary blast lung was apparent in only 2 patients. Major limb amputations occurred in 16 patients of whom 4 died). Primary blast lung was apparent in only 2 pateints. Major limb amputations occurred in 16 pateints of whom 4 died. None of the 50 patients with burns required skin grafts.
Injuries were predominantly to the head and neck and limbs, suggesting the protective effect of clothing. Half of the patients suffered from emotional shock, most with no physical injury and 82 per cent of whom were female.
Eighty-three per cent of patients arrived at hospital between 10.00 a. m. and 7.00 p. m.
Isolated complete transection of the common bile duct by blunt abdominal trauma
Authors: Shorthouse A J , Singh M P , Treasure T , Franklin R H 
Published: March 2007

Abstract
Isolated complete transection of the common bile duct due to blunt trauma is rare. Its occurrence and successful treatment in an 8-year-old boy are described.
Initial minor peritonism resolved quickly, followed by a deceptive asymptomatic period and insidious development of jaundice, anorexia, vomiting, pain, acholic stools and progressive abdominal distension due to sterile biliary ascites. A preliminary cholecystostomy was followed by construction of a Roux-en-Y chole-cystojejunostomy.
Influence of bowel preparation and antimicrobials on colonic microflora
Authors: Arabi Y , Dimock F , Burdon D W , Alexander-Williams J , Keighley M R B 
Published: March 2007

Abstract
The influence of three types of preoperative mechanical bowel preparation on colonic microflora has been studied in 88 patients undergoing elective bowel resection and compared with 21 controls. Neither conventional bowel preparation (CBP) using oral magnesium sulphate, enemas and rectal washouts nor whole bowel irrigation (WBI) via a nasogastric tube influenced the type or number of organisms in the colon at the time of operation. The administration of an elemental diet (ED) was associated with only a small reduction in the numbers of Escherichia coli (P &lt;0.02). The addition of oral neomycin and metronidazole for 48 h before operation to all three methods of bowel preparation was associated with a highly significant reduction in the counts per ml of E. coli (P&lt;0.001) and Bacteroides fragilis (P&lt;0.001) in the colon. There was no correlation between the diameter of the lesion being resected with the numbers of bacteria in the colon even when oral neomycin and metronidazole were added to the bowel preparation.
Primary suture of the perineal wound following rectal excision for inflammatory bowel disease
Authors: Marks C G , Ritchie Jean K , Todd I P , Wadsworth Jane 
Published: March 2007

Abstract
Delay in healing of the perineal wound is a major cause of disability in patients after excision of the rectum.
The outcome of primary suture in 76 patients treated at St Mark's Hospital between 1967 and 1976 was correlated with a number of factors describing the patients, their preparation for surgery and details of surgical technique and management.
The perineal wound healed by first intention in 33 patients. The remaining 43 patients regarded as failures included 7 with delayed breakdown after initial healing.
The results showed that women fared better than men. Excision of the rectum following colectomy and ileostomy was associated with failure of the perineal wound to heal in 9 out of 10 patients. Treatments with peroperative ampicillin and topical antibacterial agents were both correlated significantly with success. Preoperative sepsis and operative contamination were followed by perineal sepsis and wound breakdown on 16 out of 21 occasions.
Discriminant analysis showed that topical and peroperative antibacterial treatments, sex, preoperative sepsis and finally ACTH were the most important variables in descending order of importance. The prediction of success and failure by this procedure was 72.4 per cent correct.
An isotope clearance method for measurement of liver blood flow during portasystemic shunt in man
Authors: Leiberman D P , Mathie R T , Harper A M , Blumgart L H 
Published: March 2007

Abstract
The clearance from the surface of the liver of krypton 85 following its injection into the portal vein was measured in 10 patients. Six control patients (i.e. those not suffering from portal hypertension) averaged flow values of 142 ml per 100 g liver weight per min. A repeat flow estimation in these patients was not significantly different.
Four patients with portal hypertension were studied. In 2 with congenital hepatic fibrosis the portal vein was temporarily occluded to allow prediction of the degree of hepatic perfusion likely to be achieved by the hepatic artery alone after portal deviation. The flow after portal venous clamping was unaffected in one of these cases but reduced by 45 per cent in the other. In a patient undergoing a Warren distal splenorenal shunt there was no change in flow after the procedure.
If measurements are performed before and during temporary portal vein occlusion, an assessment of the flow reduction to be expected after a shunt procedure can be made. We suggest that a knowledge of liver tissue perfusion might influence the choice of operative procedure.
Post-amputation pneumatic walking aid
Authors: Redhead R G , Davis B C , Robinson K P , Vitali M 
Published: March 2007

Abstract
A pneumatic walking training aid is described that has been developed by the Biomechanical Research and Development Unit, Roehampton, from the original design by Little. The new design has been used in the management of 87 amputations, including 44 patients over the age of 70. Ninety-four per cent of these patients were rehabilitated to walking independently on a pylon or prosthesis.
Acute abdominal complications of systemic lupus erythematosus
Authors: Stoddard C J , Kay P H , Simms J M , Kennedy A , Hughes P 
Published: March 2007

Abstract
Four patients with acute abdominal complications of systemic lupus erythematosus requiring laparotomy are presented. The complications consisted of intestinal ischaemia, without perforation, in 3 patients and omental infarction in the fourth. In 2 patients the abdominal emergency was the first manifestation of the collagen disease. Tissue removed from 3 patients showed a marked vasculitis on histological examination. The pathogenesis and management of acute obdominal complications of systemic lupus erythematosus are discussed and the literature reviewed.
Kock's continent ileostomy: Results of 51 operations and experiences with correction of nipple-valve insufficiency
Authors: Palmu A , Sivula A 
Published: March 2007

Abstract
Fifty-one Kock's continent reservoir ileostomies were performed over a 4-year period. Immediate postoperative complications included 2 perforations of the reservoir, causing the death of 1 patient, 4 faecal fistulas and 8 intestinal obstructions. After a follow-up of more than 3 years in 22 cases, of 1-3 years in 21 cases and of less than 1 year in 8 cases an excellent functional result was attained after the first operation in 31 cases. Fifteen patients had to undergo reoperation owing to leakage of gas and bowel contents and difficulties in catheterization. Reoperation revealed three different causes of nipple insufficiency: total or partial sliding of the invaginate in 6 cases, dislocation of the nipple out of the reservoir in 6 cases and a fistula at the base of the nipple in 3 cases. Correction of the nipple-valve was performed using a modified invagination technique. After reoperation an excellent functional result was attained in 12 out of 15 cases. Thus, the functional result in the whole series was excellent in 43 patients.
The symptoms of nipple-valve insufficiency appeared in most of the cases during the first 3-6 months post-operatively. Since there is a good chance that reoperation will correct the failure, the procedure should be carried out without delay after the appearance of disturbance in nipple-valve function.
The prognostic and therapeutic implications of the positive radionuclide bone scan in clinically early breast cancer
Authors: McKillop J H , Blumgart L H , Wood C B , Fogelman I , Furnival C M , Greig W R , Citrin D L 
Published: March 2007

Abstract
Seventy-five women with clinical stage I or stage II carcinoma of the breast have had radionuclide bone scans at the time of presentation and at 6-monthly intervals during a mean follow-up period of 39 months. Patients with evidence of metastases on bone scan, either at the time of presentation or during follow-up, had significantly higher mortality and morbidity rates than those with persistently negative scans.
Whatever the clinical stage, breast cancer patients with a positive bone scan have a very poor short term prognosis and local therapy to the breast is inadequate. A plan is outlined which incorporates the patient's bone scan status into the decision to introduce endocrine therapy or chemotherapy.
The plasma clearance of fructose and glucose during and after surgical operation
Authors: McCarthy D O B , Wright P D , Johnston I D A 
Published: March 2007

Abstract
Fasting blood glucose is elevated and the rate of disappearance of a glucose load is reduced after major surgery. Resistance to insulin is considered to play a part in post-traumatic glucose intolerance. Fructose metabolism is partly independent of insulin.
Glucose and fructose clearance were compared in two groups of 6 matched male patients with normal glucose tolerance who were studied before and after major vascular surgical operations of the same severity. Fructose or glucose (25 g) was given intravenously over a 2-min period before, during and at intervals for 8 days after surgery.
The rate of clearance of fructose increased significantly during operation (P&lt;0.01), but returned to the preoperative level by the first postoperative day. Glucose clearance, in contrast, was reduced during and throughout the 8 days of the study.
The fructose load produced a brisk insulin response before operation which was diminished and delayed during surgery. These findings suggest that administered fructose may be removed more rapidly than glucose during and immediately after surgical operation.
Laparoscopic assessment of the jaundiced patient: A review of 53 patients
Authors: Irving A D , Cuschieri A 
Published: March 2007

Abstract
Laparoscopy in the investigation of patients with jaundice allows visualization of intra-abdominal pathology, target biopsy of intra-abdominal lesions and percutaneous fine-needle cholangiography, all to be carried out at the one procedure. Formal laparotomy can then be planned electively or avoided completely in appropriate cases.
In our experience we have found laparoscopy with percutaneous fine-needle cholangiography and biopsy to be a useful procedure in the diagnosis and management of jaundiced patients.
The role of ultrasound scanning in the diagnosis of thyroid swellings
Authors: Lees W R , Vahl S P , Watson L R , Russell R C G 
Published: March 2007

Abstract
This study has determined the ability of grey scale ultrasound to assess if a thyroid is normal or abnormal, if the appearances of the gland are specific for one disease and if the probability of malignancy can be determined. One hundred patients were studied, 65 with histologically confirmed diagnoses. It was found that the normal gland was distinguished from the abnormal with 99 per cent accuracy, simple cysts were diagnosed with 100 per cent accuracy and a specific disease diagnosis was given with 84 per cent accuracy. It was correctly stated in 87 patients that the disease was definitely benign, but in the remaining 12 patients (3 with cancer) it was stated that malignancy could not be excluded.
The clinical scope and potential of isotope angiology
Authors: Hurlow R A , Strachan C J L 
Published: March 2007

Abstract
Arterial imaging using a gamma-camera to follow an intravenously injected bolus of 99Tcm has been performed in over 200 patients. The technique has been found useful in the evaluation of emergency vascular problems, in routine cases where arteriography cannot be performed or is inadvisable and in the assessment and follow-up of patients with intermittent claudication and digital vessel disease.
The indications for simple closure of perforated duodenal ulcers
Authors: Playforth M J , McMahon M J 
Published: March 2007

Abstract
One hundred and sixty-one patients undergoing simple suture of a perforated duodenal ulcer are reviewed retrospectively. Nine patients (6 per cent) suffered a complication of their ulcer during the postoperative period and 3 (2 per cent) of them died.
The mean length of follow-up was 26 months and during this period a total of 14 complications was seen in 12 patients. Five of these patients died after a complication of their ulcer.
Analysis of the data from patients who had complications of their ulcers indicates that the operation of simple suture of a duodenal ulcer is indicated only in young and middle-aged women.
A double blind trial of the prolactin inhibitor bromocriptine in painful benign breast disease
Authors: Mansel R E , Preece P E , Hughes L E 
Published: March 2007

Abstract
A double blind crossover trial of the prolactin inhibitor bromocriptine in painful benign breast disease is reported. Twenty-nine women with cyclical mastalgia and 11 with non-cyclical pain were treated with bromocriptine, 5 mg daily, and placebo over six menstrual cycles. Assessment of response to treatment was made by a linear analogue system and clinical examination together with plasma prolactin estimations. Bromocriptine produced a significant improvement in breast symptoms and a significant improvement in breast symptoms and a significant fall in prolactin levels in the cyclical pain group, but had no effect in the non-cyclical group. These results suggest that bromocriptine offers a new and effective approach in the management of cyclical breast pain.
A new method for the rapid measurement of body composition in critically ill surgical patients
Authors: Hill G L , McCarthy I D , Collins J P , Smith A H 
Published: March 2007

Abstract
A rapid, non-invasive method for the measurement of obsolute amounts of fat, protein, minerals and water in the body has been developed which is applicable to very ill patients. The patients is weighed and skinfold thickness is measured with calipers. The body contents of potassium, nitrogen, sodium, chlorine, calcium and phosphorus are measured in a whole-body radiation counter after irradiation with fast neutrons. From these values absolute amounts of body fat, protein, minerals and water are calculated. The procedure, which takes about 40 min, is carried out with the patient lying supine on a couch. The errors in the absolute measurement of the components expressed as percentages of body weight are: for fat, 4·5 per cent; for protein, 1·6 per cent; for minerals, 0·8 per cent; and for water, 4·9 per cent. The radiation dose is equivalent to that of a chest radiograph (50 mrem).
We have used this technique (a) to determine the tissue composition of the weight lost in 16 patients after excision of the rectum: (b) to establish that the weight gained by 16 patients receiveing intravenous nutrition was mainly water; and (c) to show that in 10 patients who received a simple solution of amino acids for 2 weeks after rectal excision body protein was preserved as efficiently as in 10 similar patients who received a full course of intravenous nutrition.
This is the first time body weights of living persons have been broken down into terms of fat, protein, minerals and water, and the method should help to solve a number of metabolic and nutritional problems in clinical surgery.
The aldosterone response to surgery and the relationship of this response to postoperative sodium retention
Authors: Cochrane J P S 
Published: March 2007

Abstract
To investigate whether the aldosterone response to surgery is ‘inevitable’ and whether it is the prime cause of postoperative sodium retention, 30 patients undergoing uncomplicated cholecystectomy were givaen four different postoperative intravenous intakes (either ‘low’ or ‘high’ sodium, with and without dextran). Patients on the low sodium intake–a conventional intake of approximately 75 mmol of sodium daily – had a sixfold increase in their plasma aldosterone levels on the day of operation, which slowly declined to the preoperative level by the fifth day after operation, Patients on a high sodium intake, which was between two and three times the low sodium intake, showed only a modest rise (two-fold), which returned to the preoperative level within 8 h of operation. These aldosterone responses appeared to be caused by at least two stimuli, with the evidence suggesting that ACTH and renin were both involved.
Patients on the high sodium intake had the highest positive sodium balance, amounting to approximately 400 mmol of sodium retained by day 4 after operation, despite the fact that the plasma aldosterone level had returned to the preoperative level within 8 h of operation, and thereafter remained below it. No clear evidence was found to show that the plasma aldosterone level had any significant relationship to the amount of sodium each patient retained. The sodium retained was found to be a similar proportion of the sodium intake whether the intake was low or high, the addition of dextran making no consistent difference.
Analysis of the data produced the incidental finding of an increasingly significant correlation, over the 5 postoperative days studied, between the proportion of sodium retained and the patient's preoperative systolic blood pressure. It has long been known that patients with a raised blood pressure excrete a sodium load more rapidly than normotensive patients, but this effect on sodium balance after operation has not previously been recorded.
Amoebic perforation of the bowel: Experiences with 26 cases
Authors: Eggleston F C , Verghese M , Handa A K 
Published: March 2007

Abstract
Over a period of 14½ years, 26 instances of amoebic perfoation of the bowel occurring in 25 patients were treated surgically. Nineteen perforations occurred in males and 7 in females, whose ages ranged from 3 to 74 years. The duration of symptoms varied from 12 h up to 5 months (average 15 days). All patients were toxic and a right lower quadrant mass was present in 14. The correct diagnosis was made or suspected in 14 (54 per cent).
Amoebic perforation of the bowel should be suspected in patients presenting with an acute abdomen if a past history of fever, pain and diarrhoea is obtained, particularly if a large tender mass is present in the right iliac fossa.
Resctional surgery was performed in 7 patients, with a mortality of 71 per cent, whereas procedures designed to divert the faecal stream were carried out in 19, with a mortality of 43 per cent. All 6 patients with concomitant liver absesses died. If these patients are excluded, the mortality from resections was 60 per cent and from faecal diversion 27 per cent.
Faecal diversion with wide drainage is the treatment of choice for amoebic perforation of the colon.
Postoperative external small bowel fistulas: A study of a consecutive series of patients treated with intravenous hyperalimentation
Authors: Blackett R L , Hill G L 
Published: March 2007

Abstract
A consecutive series of 25 patients who developed external small bowel fistula within 2 weeks of abdominal surgery is described. Half the patients had a primary diagnosis of inflammatory bowel disease and the fistula arose usually as a result of direct trauma to the bowel or the breakdown of an anastomosis.
All the patients were treated conservatively with total bowel rest and intravenous hyperalimentation. In 15 (60 per cent) spontaneous fistula closure occurred, in an average period of 32 days. In 8 patients the fistula failed to close and surgery was performed, but was effective in only 3 cases. Thus the fistula eventually closed in 18 patients. Five patients died, all from intra-abdominal sepsis. of the 8 patients with a primary diagnosis of Crohn's disease, 3 died, 2 have a persistent fistula, 1 has a permanent ileostomy and spontaneous closure occurred in only 2.