bluuebunny/crossref_metadata_2025_split huggingface dataset:
Hereditary sacral agenesis associated with presacral tumours
Authors: Kenefick John S 
Published: March 2007

Abstract
This paper reports a family in which 6 females and 3 males have sacral agenesis. Four of the female members of the family have associated presacral tumours: 1 meningocele, 1 dermoid, and 2 of an undetermined nature at present. Similar sacral lesions associated with presacral meningoceles in 4 female members of a family of 29 have been reported by Cohn and Bay-Nielsen (1969).
Gastroduodenal ulceration and haemorrhage of neurogenic origin
Authors: Lewis Elizabeth A 
Published: March 2007

Abstract
The incidence, clinical experience, and management of gastroduodenal ulceration following intracranial disease over a 5-year period at the Royal Children's Hospital, Melbourne, are reported.
Usually the children present with a decline in the conscious state and falling blood-pressure. The maximum danger period is the first 7–10 days after an acute episode of brain-stem compression. The gastro-intestinal bleeding may not be overt, but the haemoglobin falls steadily. Small premonitory haemorrhages may herald torrential blood-loss. Early vagotomy and pyloroplasty with oversewing of the ulcer provide the best operation for these children, and there have been no major postoperative gastrointestinal symptoms in a short-term follow-up.
The outcome of treatment and changes in presentation of primary hyperparathyroidism
Authors: Britton D C , Johnston I D A , Thompson M H , Fleming L B 
Published: March 2007

Abstract
A review of 105 patients operated on over a 25-year period for primary hyperparathyroidism indicates that the diagnosis is now being made at an earlier stage of the disease. The incidence of bone disease is falling but renal symptoms remain the principal reason for presentation.
Hypertension in the presence of established disease persists after successful surgery and renal function frequently continues to deteriorate. Renal function is little affected in patients with minimal symptoms.
An accurate diagnosis can be made on the basis of persistent hypercalcaemia and elevated serum parathormone levels in peripheral or neck venous blood measured by sensitive immuno-assay.
Surgery is indicated as soon as the diagnosis is established with certainty even in the absence of any symptoms.
Highly selective vagotomy without a drainage procedure in the treatment of haemorrhage, perforation, and pyloric stenosis due to peptic ulcer
Authors: Johnston D , Lyndon P J , Smith R B , Humphrey C S 
Published: March 2007

Abstract
The good results of highly selective vagotomy (H.S.V.) in the elective surgical treatment of uncomplicated duodenal ulcer led to its use in the treatment of 30 patients who were suffering from complications of peptic ulcer, over a period of 21 months. In the emergency situation it is vital to select for H.S.V. patients who are fit enough to withstand a 1–2-hour operation.
Five out of a total of 9 patients with perforated duodenal ulcer were deemed to be suitable for H.S.V. In contrast, H.S.V. was used in the treatment of all 10 patients with haemorrhage (5 patients with duodenal ulcer and 5 with gastric ulcer), because definitive treatment for the ulcer is essential after haemorrhage has been arrested by direct suture.
Pyloric stenosis was diagnosed in 15 of 75 patients who came to elective surgery for duodenal ulcer. The diagnosis was made on clinical and radiological grounds and was confirmed at operation. Seven of the 15 patients had concomitant gastric ulceration. All 15 patients were treated by H.S.V. without a drainage procedure. The stenosis was simply dilated digitally. Seven patients who were followed up for at least a year underwent barium-meal examination, which showed that gastric emptying was normal in each case and that there was no sign of recurrent ulceration.
There was no operative mortality. None of the patients with haemorrhage bled again after operation. Only 1 of the 30 patients developed gastric retention, which was transient. Of the 14 patients who were reviewed more than 1 year after H.S.V., 11 had a perfect clinical result, 2 were very good, and 1 was ‘fair’ (Visick grade 3). The long-term prognosis should be the same as that of patients who have undergone elective H.S.V.
Granted a modicum of case selection, H.S.V. is a safe operation in the treatment of emergencies such as haemorrhage or perforation. In pyloric stenosis H.S.V. preserves and makes use of the stomach's compensatory mechanisms of hypertrophy and hyperperistalsis, whereas both gastrectomy and vagotomy with drainage destroy them. Vagotomy of the entire stomach makes necessary the addition of a drainage procedure. Vagotomy with drainage impairs the ability of the antrum to ‘mill’ food and to propel chyme onwards, and destroys or by-passes the pyloric sphincter. These surgical insults to normal gastric physiology harm the patient by producing dumping, diarrhoea, bilious vomiting, steatorrhoea, and gross elevation of serum gastrin. The main conclusion of this paper is that such harm can be avoided, because it is shown that even patients with pyloric stenosis can be treated by H.S.V. without a drainage procedure. The routine use of complete gastric vagotomy with a drainage procedure in the elective surgical treatment of duodenal ulcer is no longer justified.
Urinary hydroxyproline excretion in early and advanced breast cancer–a sequential study
Authors: Cuschieri A 
Published: March 2007

Abstract
A sequential study of urinary hydroxyproline was performed in 47 patients with cancer of the breast. The results have shown that hydroxyproline excretion in the urine provides a sensitive index of the early development of secondary deposits in bone from primary breast cancer. Elevation of the urinary excretion of hydroxyproline may predate by several months the radiological demonstration of osseous deposits. Sequential estimations have shown that the elevated urinary hydroxyproline excretion is persistent in patients who subsequently develop deposits in bone.
The aetiology of hypertension after renal transplantation in man
Authors: Sampson D , Kirdani R Y , Sandberg A A , Murphy G P 
Published: March 2007

Abstract
The renin-angiotensin-aldosterone system was studied in renal allograft patients, 70 per cent of whom were hypertensive.
Plasma-renin levels were found to be normal, and a normal increase was observed when patients were changed from the supine to the erect posture (P&lt;0.01). However, aldosterone-secretion rates were found to be approximately four times normal, and a positive correlation between these values and diastolic blood-pressure was observed (r = 0-5, P = 0-05). In patients with intact kidneys a highly significant correlation between plasma-renin activity and aldosterone-secretion rate was observed (r = 0.8, P&gt;0.05), but this normal correlation was not apparent in the patients with transplanted kidneys (r = 0.1, P&gt;0.5). Thus the aldosterone-secretion rates in these patients was not under the control of the renin-angiotensin system.
Concurrent studies in adrenalectomized patients showed that they also had elevated aldosteronesecretion rates, and the injection of 14C-labelled cortisone acetate showed that they were capable of converting this steroid into aldosterone or an aldosterone-like metabolite. It is suggested that the hypertension seen after renal transplantation is related to the conversion of prednisone to a mineralocorticoid.
Further support for this hypothesis was obtained from studies in patients who had their therapy changed from daily prednisone to alternate-day methylprednisolone. They were found to secrete less aldosterone and all the patients became normotensive following this régime (P &gt;0.1). In addition, patients treated with an aldosterone antagonist, spironolactone, showed a prompt decrease in blood-pressure.
It is concluded that the denervated transplanted kidney is able to maintain normal blood-pressure homeostasis in man, and that hypertension Seen after renal allografting is largely due to the therapy with immunosuppressive steroids.
The role of cellular immunity in control of neoplasia
Authors: Bone G , Camplejohn R 
Published: March 2007

Abstract
Using assessment of the delayed hypersensitivity response to a new antigen–in this study 2–4-dinitrochlorobenzene–as a measure of cellular immunity in patients with rectal cancer has shown highly significant correlation with pathological staging. No relationship between cellular immunity and rate of proliferation of rectal tumours could be established. The significance of these results is discussed.
Measurement of stoma size following choledochoduodenostomy by transduodenal cholangiography
Authors: Ham J M , Sorby W 
Published: March 2007

Abstract
Previous reports, concerning the operation of choledochoduodenostomy have stressed the importance of an ‘adequate’ stoma. However, there does not appear to have been an attempt to measure the stoma size by some objective method.
The results with a new technique for the assessment of the stoma and duct system postoperatively are reported. The method involves the use of a transnasal guided catheter system with selective catheterization of the common bile-duct via the stoma. Accurate delineation of the stoma and ducts is then possible.
The stoma was successfully catheterized in 13 out of 16 attempts, and satisfactory radiographs were obtained in 1 other patient by a modification of the technique. The measurements of the maximum diameter of the stoma were considerably less than those reported previously; despite this the clinical result in the short term was good in all except the 2 patients in whom the stoma could not be demonstrated.
Selective or truncal vagotomy?: Five-year results of a double-blind, randomized, controlled trial
Authors: Kennedy T , Connell A M , Love A H G , MacRae K D , Spencer E F Anne 
Published: March 2007

Abstract
The 5-year results of a double-blind, randomized, controlled trial of selective versus truncal vagotomy, each with pyloroplasty, are reported. of 100 patients entering the trial, 95 are available for study. There were 4 suspected or proven recurrent ulcers in the truncal group and 1 suspected but no proven recurrence in the selective group. The incidence of episodic diarrhoea was significantly less in the selective group; 4 mild and no severe cases compared with 11 mild and 2 severe cases among the truncal vagotomies. There was no severe dumping; mild symptoms were more common in the selective group but not significantly so. Miscellaneous dyspeptic symptoms were a little more common in the truncal group. Taking all these symptoms into consideration, the Visick clinical status of the selective group was superior. Weight changes, haemoglobin levels, and calcium levels were similar and satisfactory in each group. Selective vagotomy is superior to truncal vagotomy when each is combined with pyloroplasty.
The effect of increased oxygen in prolonged acute limb ischaemia
Authors: Stalker C G , Ledingham I McA 
Published: March 2007

Abstract
Prolonged acute hindlimb ischaemia was produced in anaesthetized ventilated dogs. During ischaemia, oxygen extraction and consumption rose initially but later consumption fell towards normal in the least severely ischaemic limbs; a progressive fall to below normal occurred in the most severely ischaemic limbs. Hyperbaric oxygen (2 ATA) did not influence blood-flow or metabolic exchange in either of these groups; in the remaining 40 per cent of the animals blood-flow fell significantly but oxygenation of the perfused areas of the limbs appeared to improve.
Popliteal aneurysm: a review of 116 cases
Authors: Bouhoutsos John , Martin Peter 
Published: March 2007

Abstract
One hundred and sixteen cases of popliteal aneurysm have been studied. The condition most commonly represents a local manifestation of generalized degenerative arterial disease, either occlusive or dilating. In the latter instance the condition is more often bilateral and there is a higher incidence of aortic aneurysm.
Symptoms occur from complications irrespective of the size of the aneurysm.
The results of reconstructive operations in false aneurysrns are bad, and unless there is good cause to consider that some form of reconstruction would be successful a lumbar sympathectomy is probably the best treatment.
Operation should be advised in all cases with a patent aneurysm and in those with a thrombosed aneurysm and patent tibia1 vessels. In cases with tibial vessel obstruction due to embolism, clearance can often be effected by the use of an embolectomy catheter to allow distal anastomosis. When a popliteal aneurysm is a manifestation of generalized dilating disease the results of surgery are excellent and long lasting, but if there is generalized stenosing disease the results are the same as after operation for diffuse atherosclerosis.
In patients with bilateral popliteal aneurysms, one of which is complicated, the uncomplicated one should probably be operated upon first, although sometimes both may be done at the same session.
Sympathectomy seems a worth-while operation in patients in whom no distal vessel is available for anastomosis, and other proximal reconstructions may be indicated, particularly when diffuse stenosing disease is present.
The role of frozen section in the diagnosis and management of malignant melanoma
Authors: Davis Neville C , Little John H 
Published: March 2007

Abstract
Provided that the pathologist is experienced, frozen section diagnosis of suspected malignant melanoma of the skin is remarkably accurate. Not only can the pathologist diagnose malignancy but he can often indicate the level of invasion of the dermis by the tumour cells. This is a most important prognostic sign and guides the surgeon in his further management of the patient. The use of a cryostat is considered essential to allow better study of the cytological changes. The main indications for the technique are to make a precise diagnosis when there is suspicion of a malignant melanoma, and to confirm the clinical diagnosis before deciding on the extent of surgery. Its use in small tumours and for the detection of lymph node metastases is not advocated.
A series of 329 frozen sections from 316 patients with an accuracy rate of 98·8 per cent is reported.
Secondary carcinoma of the thyroid gland
Authors: Thomson John A , Kennedy J S , Browne M K , Hutchison J 
Published: March 2007

Abstract
Two patients are described who presented with clinically solitary thyroid nodules which were found to be due to metastatic disease from the kidney and colon respectively. Removal of the solitary metastatis in one patient resulted in disease-free survival for over 5 years.
A classification of fistula-in-ano
Authors: Parks A G , Gordon P H , Hardcastle J D 
Published: March 2007

Abstract
A classification of anal fistulas is presented, which is the result of an analysis of 400 cases treated over the past IS years, based on the pathogenesis of the disease and the normal muscular anatomy of the pelvic floor. Four main types were found but numerous variations of each occur, which are described. It is hoped that this will alert the surgeon to the various complex situations that he may encounter.
Fissure-in-ano: The initial management and prognosis
Authors: Lock M R , Thomson James P S 
Published: March 2007

Abstract
The results of treatment of 188 consecutive new patients with a primary diagnosis of fissure-in-ano presenting to the Outpatient Department of St Mark's Hospital are reviewed. One-third underwent operation as the primary treatment and were not studied further. Of the remaining patients who underwent non-operative treatment only, one-half were initially cured. Follow-up at 4 years showed that this cure was maintained in half of these-cases, suggesting that there is aplace for treatment with a dilator in the correctly selected case.
The presence of a sentinel skin tag or a fibrous anal polyp is shown to have a statistically significant association with operative treatment. The use of a paediatric sigmoidoscope ro diagnose a fibrous anal polyp is recommended.
Appendicectomy: An assessment of the advisability of stump invagination
Authors: Sinha A P 
Published: March 2007

Abstract
Seven hundred and thirty-two cases of appendicectomy performed over a period of 5 years are reviewed to compare the incidence of complications and the length of the postoperative stay in hospital, depending on whether the appendix stump was simply ligated or was invaginated by purse string suture following ligation. No detrimental effects are noted following simple ligation, whereas patients who had stump invagination remained in hospital on average more than a day longer, mainly owing to a higher incidence of wound infection (16 per cent as against 6 per cent).
The Horsley–Clarke stereotaxic apparatus
Authors: Schurr Peter H , Merrington W R 
Published: March 2007

Abstract
Robert Henry Clarke was responsible for the application of mathematical principles to neurophysiology and the invention and construction of an apparatus which would allow Sir Victor Horsley to make electrolytic lesions in the roof nuclei of the cerebellum. In order to be able to make lesions at any other desired point of the brain of a cat or monkey, Clarke and Horsley constructed an atlas based on photographs of sections to be used in conjunction with the instrument. The original apparatus was made in 1905 and papers on its use and on the atlas were published in 1908, 1911 and 1914. This advance was the basis of modern stereotaxic surgery and of a very large part of the work on neurophysiology that is carried out today.
Clarke gave his original apparatus to F. J. F. Barrington, genitourinary surgeon at University College Hospital and neurophysiologist. It was lent to various other workers in Oxford and elsewhere and was last used by Barrington in 1953 or 1954. It then disappeared following his sudden death in 1956. Various other pieces of apparatus were built, some of which are of historical importance in their own right, and these are referred to in the paper.
Some parts of Clarke's apparatus, including a special grid for trnsferring measurements from the atlas to the instrument and a spinal stereotaxic instrument, were found and described by E. R. Hitchcock in 1960. One of us (W. R. M.) succeeded in locating the original apparatus in 1970. It is now in the museum of University College Hospital, London.
Colour lymphography in clinical surgery
Authors: Leaper D J , Evans Mary , Pollock A V 
Published: March 2007

Abstract
In 38 patients undergoing femoral artery profundaplasty and in 18 having simple mastectomy with pectoral node biopsy, a 6.2 per cent solution of sodium sulphan blue was injected peripherally to outline the lymph nodes in the groin or axilla. Nodes and vessels were easily seen and the technique is now in routine use.
Conservative surgery in reflux stricture of the oesophagus associated with hiatal hernia
Authors: Moghissi K 
Published: March 2007

Summary
During a 7-year period, 130 patients with oesophageal stricture resulting from long-standing reflux oesophagitis and hiatal hernia were referred for surgery. Eighty-seven of these patients underwent conservative surgery consisting of intraoperative transgastric retrograde dilatation combined with one of two types of anti-reflux operation: in 34 patients (group 1) an Allison-type operation for hiatal hernia was undertaken, and in the remaining 53 patients (group 2), a Nissen-type fundoplication was carried out. In 22 patients in this latter group the oesophagogastric junction could not be brought down into the abdomen in spite of extensive oesophageal mobilization and the fundoplication was finally placed above the diaphragm.
From the successful results in both groups (particularly in group 2), it is concluded that conservative surgery should be considered in cases of hiatal hernia with a reflux stricture that yields to intraoperative dilatation.
Bilio-pancreatic bypass for obesity: II. Initial experience in man
Authors: Scopinaro Nicola , Gianetta Ezio , Civalleri Dario , Bonalumi Umberto , Bachi Virgilio 
Published: March 2007

Summary
After a successful trial of bilio-pancreatic bypass in dogs, a clinical study has been completed in 18 patients followed for more than 1 year. The operation has been modified to achieve the best weight reduction, and forming the bilio-pancreatic tract of equal length to the alimentary tract with a short common ileal tract, the average weight loss as a percentage of the preoperative body weight was 24·1 ± 5·4 per cent (mean ± s.d.) at 6 months and 33·7 ± 4·1 per cent at 12 months. The only immediate complication was a wound dehiscence, and there were no late complications. Liver function studies showed the absence of hepatic deterioration and liver biopsies showed improvement of liver morphology 1 year after the operation. It is suggested that this procedure may be an alternative to jejuno-ileal bypass in the management of obesity.
The distribution, size and density of the apocrine glands in hidradenitis suppuritiva
Authors: Morgan W P , Hughes L E 
Published: March 2007

Abstract
The distribution, size and density of the apocrine glands in hidradenitis suppuritiva as compared with those in axillary hyperhidrosis and normal controls have been studied. There are no significant differences in the size or density of the apocrine glands in hidradenitis suppuritiva as compared with normal controls. The apocrine glands in axillary hyperhidrosis are significantly larger than those in axillary hidradenitis and in normal controls.
A simple method that can be used to demonstrate the distribution of the apocrine glands preoperatively is described. This has proved useful in delineating the area which it is necessary to excise to obtain complete apocrine gland excision in the diseased area. The apocrine gland-containing skin in the diseased region does not always correspond exactly to the hair-bearing area in that region.
Prophylactic metronidazole in appendicectomy: A controlled trial
Authors: Bates T , Touquet V L R , Tutton M K , Mahmoud S E , Reuther J W A 
Published: March 2007

SummaryProphylactic metronidazole was compared with no treatment in a randomly allocated study of patients undergoing appendicectomy. A 1-g suppository of metronidazole was given with the premedication and 200 mg t.d.s. orally for 7 days thereafter.There were 4 hospital wound infections in the 87 patients receiving metronidazole and 11 out of 83 in the no-treament group (P &lt; 0·05). However, 60 per cent of wound infections occurred at home and the overall infection rates were not significantly different.The duration of postoperative hospital stay was longer in the control group (5·8 days ± 3·0 s.d.) than in the treated group (4·8·2·3; P &lt; 0·01).Only one anaerobic infection occurred in a patient receiving metronidazole but late infection was not prevented. Blood levels of metronidazole taken at the end of operation showed a wide variation but there was no correlation with subsequent infection. Culture of the appendix showed aerobic organisms in 88 per cent of cases and anaerobes in 72 per cent.It is suggested that an antibiotic which is effective against both aerobic and anaerobic organisms might have an advantage over metronidazole in appendicitis.