bluuebunny/crossref_metadata_2025_split huggingface dataset:
Selective visceral angiography for unexplained acute gastrointestinal bleeding in a district general hospital
Authors: Athow Anna C , Sheppard Louise , Sibson D E 
Published: March 2007

Abstract
Eleven patients are reported with unexplained gastrointestinal haemorrhage (GIH) presenting over a 2 year period in whom selective visceral angiography (SVA) was carried out after a negative endoscopy. SVA revealed the anatomical source of bleeding in all eleven patients and the aetiology in six of them. The latter comprised two tumours of the small bowel, an A–V malformation of the jejunum, enlarged pancreaticoduodenal vessels, angiodysplasia of the caecum and carcinoma of the rectum. Of the remaining five patients, four were seen to have active bleeding into the large bowel and one into the duodenum. Local surgical resection was carried out in nine patients, only one of whom rebled. There was one pre-operative and one postoperative death. Experience with this technique has altered our management such that SVA is carried out sooner, saving the patient repeated admissions, investigations and transfusions. SVA is recommended as a pre-operative investigation for the surgeon managing acute unexplained GIH.
Truncal vagotomy and drainage: A comparison of elective and emergency operations
Authors: Clark C G , Fresini A , Araujo J G C , Moore F , Boulos P B 
Published: March 2007

Abstract
A comparison has been made between truncal vagotomy and drainage (TV+D) performed from 1968 to 1981 in 209 patients electively and in 68 patients as an emergency. The male:female distribution was 167:42 and 59:9 with a significant difference (P &lt; 0.001) in the mean ages of 49 years and 55 years respectively. Major postoperative complications following emergency TV+D (22 per cent) were significantly more common (P &lt; 0.001) than following elective TV+D (6.7 per cent) with seven (10.3 per cent) and one (0.5 per cent) deaths respectively. Of 163 patients in the elective and 54 in the emergency group followed up for an average of 5.7 and 5.9 years respectively, 132 patients (81 per cent) and 46 (82.5 per cent) had a good functional result graded as Visick I and II, but 31 (19 per cent) and 8 (14.8 per cent) patients respectively had a poor result due to recurrent ulceration in 23 (14.1 per cent) after elective TV+D and in all 8 (14.8 per cent) after emergency TV+D. These results are not statistically different. Thus emergency TV+D carries a higher mortality and morbidity than elective TV+D, but the long term results are similar. This conclusion substantiates the equivalent effectiveness of emergency and of elective TV+D.
The effect of a reversed ileal segment and artificial valve on intestinal transit and absorption following colectomy and low ileo-rectal anastomosis in the dog
Authors: Williams N S , King R F G J 
Published: March 2007

Abstract
The main problem facing patients with ulcerative colitis after mucosal proctectomy and ileo-anal anastomosis (MP + IAA) is severe frequency of bowel action. Although the addition of a pelvic reservoir can improve matters, some patients still complain of this problem. In an attempt to slow transit, enhance absorption and improve function, we investigated the effects on these parameters of (1) a reversed ileal segment, (2) an artificial valve in an animal model. Studies were conducted before and after operation. The dogs randomly underwent either colectomy and low ileorectal anastomosis (IRA) alone (control, n = 12), IRA with a 10 cm reversed loop (IRA + RL, n = 10) or IRA with an artificial valve (IRA + valve, n = 10). Operative mortality rates were similar in the groups. Mean transit time (MTT) was significantly reduced after the control operation and after IRA + RL but not after IRA + valve. In addition MTT after IRA + valve (21±s.d., 3.4 h) was significantly greater than in the other two groups (control = 12.1 ± 4.3 h, IRA + RL, 12.8±5.5 h, P&lt;0.04) and frequency of bowel actions seemed less. Measurements of absorption and nutritional state, however, did not differ significantly between the groups. Thus, although the artificial valve made no difference to absorption, it did prevent the reduction in MTT that occurred after the control operation whereas the reversed loop did not. This effect might thus benefit patients who undergo MP + IAA.
Proximal gastric vagotomy in patients resistant to cimetidine
Authors: Weaver R M , Temple J G 
Published: March 2007

Abstract
Fifty-seven patients, with chronic duodenal ulceration resistant to cimetidine therapy, underwent proximal gastric vagotomy during the period August 1979 to May 1984. Thirty-five failed to respond to cimetidine in a dose of 1 g/day, whilst 22 relapsed on reduction of dosage to 400 mg daily or on cessation of therapy. Forty have been followed up for a period of 12–53 months (median duration = 28.5 months), and assessed using the modified Visick system. Thirty-four patients (85 per cent) were graded Visick I or II. Four patients (10 per cent) had non-specific upper gastrointestinal symptoms (Visick III). In these patients endoscopy has shown no evidence of recurrent ulceration. Two patients (5 per cent) were graded Visick IV. One had recurrent ulceration on endoscopy. The other developed symptomatic gastro-oesophageal reflux, necessitating further surgery. These results support the view that cimetidine resistance is not a predictor of poor results following proximal gastric vagotomy.
Surgical pathology at early elective operation for suspected acute gallstone pancreatitis: Preliminary report of a prospective clinical trial
Authors: Mackie C R , Wood R A B , Preece P E , Cuschieri A 
Published: March 2007

Abstract
Fifty-five patients presenting with acute abdominal symptoms and found to be hyperamylasaemic underwent early biliary tract investigation, giving 31 patients in whom the presence of gallstones was suspected. In accordance with the protocol of a randomized controlled trial of early elective biliary tract surgery for patients suspected of having acute gallstone pancreatitis, 19 of these patients underwent laparotomy at a mean of 6.9 days after emergency admission. In this group operation showed that four patients had biliary tract stones and pancreatitis; ten patients had calculous cholecystitis (53 per cent) but no stigmata of pancreatitis; four patients had pancreatitis but no stones; one had a negative laparotomy. None of this group was found to have ampullary obstruction due to an impacted stone. Biliary tract investigations carried out during the first week following admission were unhelpful or misleading in 14 out of the whole group of 55 patients, and in all of those patients (11 per cent) who died or required surgical intervention during the same hospital admission. There appears to be a pathological heterogeneity among patients diagnosed as ‘gallstone pancreatitis’ on clinical and biochemical grounds alone.
Natural history of cystic disease: The importance of cyst type
Authors: Dixon J M , Scott W N , Miller W R 
Published: March 2007

Abstract
All breast cysts aspirated from a series of 100 patients followed for a minimum period of 2 years were classified on the basis of electrolyte composition as apocrine or flattened, this being the nature of the epithelium lining the two populations of breast cysts. Patients with single cyst were more than 3 times as likely to have a flattened rather than an apocrine cyst. Multiple cysts, whether simultaneous or sequential in any individual patient, were usually all of the same type, and were more commonly apocrine than flattened. A comparison of the frequency of subsequent cysts in patients whose initial cysts were of eithere apocrine than flattened. A comparison of the frequency of subsequent cysts in patients whose initial cysts were of either apocrine or flattened type showed further cysts were over 5 times more common in patients who presented with apocrine cysts. These observations suggest that the natural history of cystic disease is closely related to cyst type.
Bilateral gastric venous decompression by a modified Warren shunt
Authors: Nagasue N , Ogawa Y , Hirose S , Yukaya H 
Published: March 2007

Abstract
A new modification of the Warren shunt by which the coronary and short gastric venous systems can be simultaneously decompressed was carried out on two patients with oesophagogastric varices due to liver cirrhosis. One was an elective and the other an emergency operation. The left gastric vein entering the splenic vein was also drained through a Gore-Tex graft between the splenic and left renal veins. The proximal end of the splenic vein was ligated at its junction to the superior mesenteric vein. Porta-azygos disconnection was achieved by ligating the right gastric and gastro-epiploic veins. The shunt was patent and its effect on the varices was immediate with good decompression in both patients. The patients have had no recurrent variceal haemorrhage or postshunt encephalopathy. This modification may be indicated for selected patients with portal hypertension for both elective and emergency operations.
Determination of necrosis in necrotizing pancreatitis
Authors: Nordback I , Pessi T , Auvinen O , Autio V 
Published: March 2007

Abstract
The diagnosis of necrosis and its extent in acute necrotizing pancreatitis is one main problem in establishing criteria for possible pancreatectomy. With this in mind a clinicopathological analysis was carried out on 54 patients who had undergone pancreatic resection for acute necrotizing pancreatitis. The macroscopic appearance of the gland correlated poorly with its histology. Parenchymal necrosis varied from 0 to 100 per cent of the resected specimen though all the glands were considered totally or subtotally necrotic. In the clinicobiochemical status no criteria were found determining the extent of necrosis. Obesity, hypotension, hypocalcaemia and elevated serum creatinine in severely ill patients (as determined by Ranson criteria) strongly supported extensive peripancreatic and septal necrosis; however, 38 per cent of patients developed necrosis without those stigmata. While waiting for new methods to determine necrosis we prefer conservative treatment. In contrast to our previous tactics we think that resection should be limited to extreme cases in order to avoid resection of glands with limited necrosis and thus mainly reversible parenchymal damage.
Acute appendicitis in the over-sixty age group
Authors: Sherlock D J 
Published: March 2007

Abstract
58 (37 per cent) of the 155 patients over the age of 60 years presenting with appendicitis at East Birmingham Hospital from 1970 to 1982 were found to have perforated appendices; the corresponding proportion under the age of 60 was 346 out of 3608 patients (10 per cent), the difference being statistically significant (P&lt;0·001). The delay before surgery and the length of in-patient treatment were significantly longer in the group who perforated, and the mortality was greater, although not achieving significance. Examination of the yearly incidence reveals neither an increasing trend of appendicitis in elderly patients, nor an increase in the perforation rate over the period studied. Delay, at all stages, appears to be the major factor responsible for the higher rate of perforation in this age group; only by an increased awareness of appendicitis in the elderly can this risk be minimized.
A score system for evaluating random control clinical trials of prophylaxis of abdominal surgical wound infection
Authors: Evans Mary , Pollock A V 
Published: March 2007

Abstract
We devised 33 rules for the evaluation of random control trials (RCT) and used them to assess 56 RCTs listed in Index Medicus during 1980–82 on antibiotic prophylaxis of surgical wound infection. We asked 15 questions about design and conduct, 10 about analysis and 8 about presentation. Out of a maximum score of 100 only 16 papers scored over 70, the highest being 89 and the lowest 34. Defects in presentation were not common, and 17 papers scored over 90 per cent. Defects in analysis included the incorrect use of statistical tests and ignoring the Type II error in ‘negative’ trials; only 13 papers scored over 70 per cent. Defects in design and conduct included transgressions of ethical principles, inappropriate regimens, ill-defined end points and biased randomization or assessment; only 20 papers scored over 70 per cent. We conclude that there is room for improvement in the performance of RCT and that the application of the 33 rules would be helpful not only to researchers but also to editors and referees of scientific journals, and to their readers.
Antibiotic treatment during surgery for diffuse peritonitis: A prospective randomized study comparing the effects of cefuroxime and of a cefuroxime and metronidazole combination
Authors: Törnqvist A , Forsgrent A , Leandoer L , Ursing J 
Published: March 2007

Abstract
In a prospective randomized open study of patients operated upon for diffuse peritonitis, the effects of two different antibiotic regimens were evaluated. Cefuroxime given as a single drug (Group I; n = 59) was compared with a combination of cefuroxime and metronidazole (Group II; n = 63). Bacteriological cultures, both aerobic and anaerobic, were obtained peroperatively and in the event of any complication. The antibiotic sensitivities of isolated bacteria, and the serum and tissue concentrations of cefuroxime were determined. Postoperative infectious complications occurred in 22 per cent of Group I patients (cefuroxime), and in 17±5 per cent of Group II (cefuroxime plus metronidazole). The mortality rates were 5 per cent for Group I and 8 per cent for Group II. Tissue concentrations of cefuroxime were well above the MIC (minimal inhibiting concentration) values for most of the bacteria isolated. From a few patients in Group I, however, cultures were obtained with isolates sensitive to metronidazole but resistant to cefuroxime. Our findings suggest that, in the antibiotic treatment of patients operated for diffuse peritonitis, an agent which is primarily effective against aerobic bacteria (but not entirely without effect on anaerobes) is as effective as combination therapy covering both aerobic and anaerobic bacteria.
Atypical claudication
Authors: Tait W F , Charlesworth D , Lemon J G 
Published: March 2007

Abstract
In a prospective study the incidence, causes and management of atypical claudication have been investigated. All patients had a clinical assessment, Doppler ultrasound studies and X-rays of the lumbosacral spine, some had epidural injections, myelography with computerized axial tomography and arteriography. The incidence of atypical claudication was low, 13 per cent of all claudicants referred to our department, and although difficulties in diagnosis were encountered an approximately equal incidence of spinal and arterial causes was found. Only one patient had a definite central spinal stenosis. The need for invasive investigations was low (18 per cent) and even lower for surgery (7 per cent); the majority of patients' symptoms responded to conservative management.
Achalasia of the cardia in children
Authors: Buick R G , Spitz L 
Published: March 2007

Abstract
Fifteen children with achalasia treated surgically over a period of 21 years are reported. All had a modified Heller's myotomy as a primary treatment. The thoracic approach was used in five and the abdominal route in ten. In three patients the myotomy was confined to the oesophagus. Six patients had antireflux procedures at the time of initial myotomy. The mean follow-up period was 6.2 years. Nine patients had excellent results, three had good results, two had fair results and one had a poor result. Of the nine children who did not have an antireflux procedure, three developed symptomatic and radiologically proven gastro-oesophageal reflux. The results of myotomy in children with achalasia are satisfactory but a significant number may develop gastro-oesophageal reflux. We believe that a modified Heller's myotomy combined with a short loose Nissen fundoplication should be the primary treatment of achalasia in children.
Surgical treatment of perforated duodenal ulcer: A prospective trial between simple closure and definitive surgery
Authors: Tanphiphat C , Tanprayoon T , Na Thalang A 
Published: March 2007

Abstract
Seventy-eight patients with perforated duodenal ulcer were prospectively studied between 1977 and 1982. Patients were alternately allocated to receive simple closure (Group I, 33 patients) and definitive surgery (Group II, 32 patients). High-risk patients and those whose conditions dictated a definitive operation were excluded. All patients in Group II had a truncal vagotomy and drainage except one who had a proximal gastric vagotomy. There was no death in Group I or Group II; the complication rate and postoperative course were similar. Twenty-seven patients in Group I and 26 patients in Group II were available for follow-up 12 to 80 months after operation, mean 39 months. Good/excellent results were achieved in 30 per cent of Group I compared with 81 per cent of Group II (P&lt;0.01). Eighty-five per cent of Group I patients developed recurrent ulcer symptoms and 33 per cent had already had a second definitive operation. Two patients (8 per cent) in Group II were reoperated upon for recurrent ulcer due to an incomplete vagotomy. In a population of patients where long-term follow-up and medical treatment for duodenal ulcer is unsatisfactory, truncal vagotomy with drainage should be the treatment of choice for perforation. Simple closure should be reserved for high-risk patients or when the surgeon is inexperienced.
Transcutaneous Doppler ultrasound measurement of coeliac axis blood flow in man
Authors: Qamar M I , Read A E , Skidmore R , Evans J M , Williamson R C N 
Published: March 2007

Abstract
Transcutaneous Doppler ultrasound was used to measure coeliac axis blood flow in 42 normal subjects in the fasting state and in 10 subjects following a liquid meal. A Duplex scanner was used and coeliac axis blood flow was estimated by calculating the instantaneous average velocity of blood flow over the cardiac cycle. Both the diameter of the vessel and the angle between the vessel and the beam were measured from real time imaging. The mean (±s.e.m.) of coeliac axis blood flow was 703± 24 ml/min. There was no difference in the results between the sexes nor any correlation between flow and age. The mean coefficient of variability was 7.8 per cent in a 1 day test and 9.2 per cent in a 2 day test. Coeliac axis blood flow increased by 38 per cent immediately after the end of ingestion of the meal and declined to 29 per cent 5 min and 24 per cent 10 min later.
Sump syndrome following choledochoduodenostomy and its endoscopic treatment
Authors: Baker A R , Neoptolemos J P , Carr-Locke D L , Fossard D P 
Published: March 2007

Abstract
The clinical features of eight patients with sump syndrome following side-to-side choledochoduodenostomy are reported. The syndrome is defined and its aetiology discussed with special reference to debris in the common bile duct, bacterial overgrowth and the clinical picture of acute cholangitis, which does not appear to be necessary for the diagnosis to be made. Five patients were successfully treated by endoscopic sphincterotomy and a sixth by endoscopic removal of food debris from the sump. The other two patients had further surgery.
Significance of positive bacterial cultures from aortic aneurysm contents
Authors: Buckels J A C , Fielding J W L , Black J , Ashton F , Slaney G 
Published: March 2007

Abstract
Aneurysm contents were cultured in 275 patients out of a series of 546 cases undergoing infrarenal aortic aneurysm repair between 1961 and 1981. The incidence of positive cultures was 8 per cent. Cultures were more likely to be positive if taken from ruptured (16.7 per cent) and acute (9.1 per cent) aneurysms than from elective (4.2 per cent) cases (χ2 = 6.69, P &lt; 0.01). Gram-positive organisms predominated with Micrococcus being the commonest isolate. Positive cultures were seen at an annual rate of 1–3 cases up to 1976 since which time all have been negative and we believe this may be due to prophylactic antibiotics being given preoperatively rather than postoperatively. The incidence of subsequent graft sepsis was greater in patients with positive aneurysm contents cultures (7 out of 22) than in those with negative cultures (6 out of 253) (χ2 = 32.7, P &lt;0.001). We recommend the routine culture of aneurysm contents to identify patients who are at high risk of developing graft sepsis and suggest that those cases with positive cultures receive prolonged organism-specific antibiotic therapy. In addition, there is evidence that pre-operative antibiotics may eliminate organisms from aneurysms, thus reducing the subsequent risk of graft sepsis.
Fine bore jejunostomy feeding following major abdominal surgery: A controlled randomized clinical trial
Authors: Smith R C , Hartemink R J , Hollinshead J W , Gillett D J 
Published: March 2007

Abstract
A randomized controlled prospective clinical trial has been undertaken to examine the efficacy of the technique of early postoperative feeding using a fine bore catheter jejunostomy. Fifty patients undergoing surgery for gastrointestinal malignancy were randomly allocated into treatment and control groups. A low residue liquidized diet (IsocalR) was administered to the patients in the treatment group. Control patients received routine intravenous therapy. Nutritional parameters (serum albumin, serum transferrin, serum prealbumin, weight, body fat and fat free mass) were measured pre-operatively and on the tenth postoperative day. Postoperative surgical complications were similar in both groups. There were 20 catheter complications and one death directly attributable to the jejunal catheter feeding. Postoperative stay was significantly longer (P &lt;0.01) in the treatment group patients. Evaluation of the nutritional parameters showed no advantage for either the treatment group or a selected complication-free, successful treatment, subgroup. It is concluded that no significant clinical or nutritional advantage for jejunal catheter feeding has been demonstrated and because of the related complications, its routine use cannot be recommended.
Serum dependent variability in the adherence of tumour cells to surgical sutures
Authors: Dwyer P O' , Ravikumar T S , Steele G 
Published: March 2007

Abstract
Five commonly used surgical sutures were tested for their abilities to adhere tumour cells by an in vitro adherence assay. Adherence was quantified in vitro using radiolabelled tumour cells after standard incubation with a set length of the differing sutures. Tumour cells consistently adhered least to Prolene. All suture materials tested adhered significantly more tumour cells than Prolene (P &lt;0.002 for chromic and &lt;0.0001 for nylon, silk and Vicryl when compared with Prolene, with increasing cell numbers adhering to the sutures tested in that order). These differences in adherence were dependent upon an as yet unidentified macromolecule(s) in serum. All of the suture materials supported tumour growth in vivo after pre-incubation with tumour cells. Rapidity of in vivo tumour growth, however, correlated well with the in vitro tumour adherence characteristics of the different suture materials. The clinical significance of these findings is discussed.