bluuebunny/crossref_metadata_2025_split huggingface dataset:
Surgical manpower, beds and output in the NHS: 1967–1977
Authors: Fowkes F G R , Page S M , Phillips-Miles D 
Published: March 2007

Abstract
The availability and use of surgical manpower and beds and certain measures of surgical workload were examined in the NHS in England and Wales from 1967 to 1977 using routine health statistics. Amongst the surgical specialties, there was no consistent relationship between changes in levels of manpower and beds and operating output. For example, ENT surgery and cardiothoracic surgery had more staff and fewer beds in 1977 than in 1967, but operating output in ENT surgery decreased by 18 per cent and in cardiothoracic surgery increased by 28 per cent. Although the efficiency of bed use may have improved (average length of stay was 10·5 days in 1967 and 8·8 days in 1977), the overall use of available beds in most specialties may have decreased. The number of operations performed in each specialty per consultant surgeon was less in 1977 than 1967 except for traumatic and orthopaedic surgery. Although interpretations of routine health statistics are rarely conclusive, the results of this study suggest the possibility of a less than optimum use in 1977 compared to 1967 of surgical beds and surgeons' operating potential which might be due to lack of other resources such as usable theatre time.
Current concepts in soft connective tissue wound healing
Authors: Forrest L 
Published: March 2007

Abstract
The strength and integrity of intact soft connective tissues are related to the forces which exist between collagen fibrils and these in turn appear to depend on collagen fibril size, density and architecture en masse. The genetic type of collagen, enzymic modifications to the collagen monomer and the proteoglycan environment all affect fibril size. Current evidence suggests that the restoration of tissue continuity and the early redevelopment of tissue strength following wounding are initially achieved by the formation of a myofibroblast–reticulin network which eventually disappears as the healing wound ages. The extent of this network defines the area in which repair tissue will be laid down and the network is equipped with the sensory apparatus to monitor the physical and chemical environment where healing is taking place and thus to direct the various facets of connective tissue synthesis outlined above. The maturation of the scar connective tissue matrix and the development of attachment between new and original connective tissues are simultaneous, related but independent processes. It takes some time before the weld is achieved by the same forces that hold connective tissue fibres together in intact tissues and the myofibroblast–reticulin network is replaced.
Prophylaxis of post-appendicectomy sepsis by metronidazole and ampicillin: A randomized, prospective and double-blind trial
Authors: Lau W Y , Fan S T , Yiu T F , Wong S H 
Published: March 2007

Abstract
Two hundred and eighty-three patients were admitted to a randomized, prospective and double-blind trial of the effect of the addition of ampicillin to metronidazole in the prophylaxis of post-appendicectomy wound sepsis. Nineteen out of 142 patients in the metronidazole and ampicillin group developed wound sepsis compared with 33 out of 141 patients in the metronidazole group. The difference is statistically significant. Early cases, including normal, acutely inflamed and gangrenous appendices, received 2 doses of antibiotics. In late cases with perforation and abscess formation, the antibiotics were continued for 1 week. The difference in wound infection in each of these 2 subgroups was also statistically significant. The commonest organisms isolated from the appendicular fossa and the infected wounds were Escherichia coli and Bacteroides fragilis.
Antiseptics in the treatment of bacterial peritonitis in rats
Authors: McAvinchey D J , McCollum P T , McElearney N G , Mundinger G , Lynch G 
Published: March 2007

Abstract
A controlled mixed peritoneal infection was produced by inoculation of bacteria into the peritoneum and peritonitis was allowed to become established. A laparotomy was performed and peritoneal toilet with a variety of agents was carried out. Local povidone-iodine in the inflamed peritoneum proved to be not only of no benefit but, in fact, to be toxic. In the standard concentrations recommended it proved lethal. Noxythiolin 2·5 per cent also had no beneficial effect. There was a significant difference between the effect of povidone-iodine when instilled into an inflamed peritoneum and instillation into the intact peritoneal cavity. We would advise caution in the use of these antiseptics in any situation in which local defence mechanisms have been compromised as a result of established infection.
The use of graduated compression stockings in the prevention of postoperative deep vein thrombosis
Authors: Allan A , Williams J T , Bolton J P , Le Quesne L P 
Published: March 2007

Abstract
The efficacy of graduated compression stockings in the prevention of postoperative deep vein thrombosis was studied in a randomized, prospective, controlled trial of 200 patients, aged 40 years and over, undergoing abdominal surgery (100 for benign disease, 100 for malignant conditions). Deep vein thrombosis was diagnosed by the 125I-fibrinogen test. The incidence of deep vein thrombosis was 35·9 per cent in the control group (103 patients) and 15·5 per cent in the stockinged group (97 patients) (P &lt; 0·025). In the patients with benign disease, deep vein thrombosis developed in 24·5 per cent of the control limbs and 6·1 per cent of stockinged limbs (P &lt; 0·005); in patients with malignant disease the similar figures were 27·9 and 11·5 per cent (P &lt; 0·05). Increasing age did not alter the efficacy of the stockings. It is concluded that graduated compression stockings provide a safe and effective method of prophylaxis against deep vein thrombosis.
The conservative treatment of fissure-in-ano
Authors: Gough M J , Lewis A 
Published: March 2007

Abstract
A randomized clinical trial assessed the value of regular anal dilatation in combination with a topical local anaesthetic in the treatment of 82 patients with a posterior fissure-in-ano. One month after treatment the fissure had healed in 43·6 per cent of patients using 2 per cent lignocaine gel alone and in 41·9 per cent of patients who also used a St Mark's Hospital anal dilator. Thus the regular use of such a dilator did not contribute to the success of conservative therapy in patients with a posterior anal fissure. A review of patients who presented with anterior or lateral anal fissures during the trial period revealed that healing was achieved in 73·3 per cent of patients without operation within 1 month of diagnosis.
Cicatrial cancer in the South-West of England: A regional plastic surgery unit's experience over a 20-year period
Authors: Nancarrow J D 
Published: March 2007

Abstract
Historical aspects of cicatrial cancer are presented and 18 cases of cicatrial cancer reviewed. The incidence of cicatrial cancer is increasing, paralleling other skin tumours. Survival is better than many series have suggested. Prevention and treatment is discussed in relation to the biological behaviour of scars and their tumours. A high index of suspicion for chronic non-healing lesions in scarred areas will increase survival.
Neurological deficit and injuries involving the neck arteries
Authors: Robbs J V , Human R R , Rajaruthnam P , Duncan H , Vawda I , Baker L W 
Published: March 2007

Abstract
The management of 85 patients with penetrating injuries involving the external (n = 19), internal (n = 6) and common carotid (n = 46), vertebral (n = 10) and brachiocephalic (n = 4) arteries over a 5-year period in one hospital is reviewed. Sixty-three patients had no peroperative neurological deficit; 22 presented with localizing neurological signs. Where there was no deficit, the external carotid (n = 19) and vertebral (n = 10) arteries were ligated without adverse sequelae. Arterial reconstruction was performed of the internal carotid (n = 2), common carotid (n = 25) and brachiocephalic (n = 4) which resulted in a temporary neurological deficit in 7 patients and death in 3. Among the 22 patients with a preoperative neurological deficit, arterial reconstruction was performed in 18, which involved the common carotid in 17 patients and the internal, carotid in 1 patient. There was complete neurological recovery in 11 patients and 2 patients died. Four comatose patients had cerebral revascularization performed without fatality and with complete recovery in 3 of them. CT head scanning was not routinely employed for logistic reasons but has proved of limited value. No intraluminal arterial shunts were used in this series. It would seem that arterial reconstruction is not harmful and may well be beneficial to the young patient with extracranial cerebral arterial injury associated with a neurological deficit. Shunts are probably unnecessary for routine use.
Two methods of skin closure in abdominal operations: A controlled clinical trial
Authors: Pickford I R , Brennan S S , Evans Mary , Pollock A V 
Published: March 2007

Abstract
Operative bacterial contamination of surgical wounds is common. The ability of the host to eradicate these bacteria and prevent subsequent wound infection is affected by a number of factors; one of these has been shown experimentally to be the presence of suture material in the subcutaneous tissues. In a prospective randomized controlled clinical trial in 341 abdominal operations we compared the primary infection rates after two methods of skin closure: either vertical mattress monofilament nylon sutures (182 patients) or steel clips which penetrated only the dermis (159 patients). All patients received a single dose of a cephalosporin intravenously at induction of anaesthesia and neither sutures nor drains were placed in the subcutaneous plane. The overall wound infection rate in the sutured wounds was 17·0 per cent, compared with 6·3 per cent in those closed by clips (χ2 = 9·26, P &lt; 0·01). We conclude that skin closure with clips reduces the incidence of wound infection in patients in whom operative parietal contamination has occurred.
Endogenous prostaglandin F2α in the hyperdynamic state of severe sepsis in man
Authors: Oettinger W K E , Walter G O , Jensen U M , Beyer A , Peskar A 
Published: March 2007

Abstract
Nine surgical patients underwent haemodynamic and respiratory monitoring during the course of severe sepsis. Endogenous PGF2α levels in mixed venous and arterial plasma were measured. Results indicate pulmonary net release of PGF2α, since arterial levels (1252±119pg/ml) are significantly higher than mixed venous ones (824 ± 89 pg/ml) in full-pronounced hyperdynamic septic shock. By contrast, the inactive metabolite KH2PGF2α was found in lowest concentrations during shock (368±72pg/ml) which suggests impaired pulmonary degradation. It is concluded that circulating PGF2α is a marker of stimulated prostaglandin production in severe human sepsis.
Acute emphysematous thyroiditis
Authors: Gigot J F , Mannell Aylwyn 
Published: March 2007

Abstract
Acute emphysematous thyroiditis is a severe pyogenic infection of the thyroid gland characterized by the production of gas. Although earlier writers of the pre-antibiotic era had referred to ‘gangrene of the thyroid with gas formation’ (1–3), only 5 cases of gas-forming or emphysematous thyroiditis have been specifically documented.
In this report, the sixth case of acute emphysematous thyroiditis is presented and the clinical features of this rare but potentially lethal infection of the thyroid gland are described. The pathogenesis and management of the disease are discussed.
A Silastic stent for palliation of extrinsic tracheal compression or unresectable tracheobronchial obstruction
Authors: Westaby S 
Published: March 2007

Abstract
A silicone rubber stent has been used successfully in the treatment of patients with unresectable major airways obstruction. Silicone rubber does not generate secretions in the tracheobronchial tree and may be left in situ for long periods without complications. With effective relief from asphyxia, radiotherapy can be employed safely.
Radical surgery following radiotherapy for advanced parotid carcinoma
Authors: Corcoran M O , Cook H P , Hobsley M 
Published: March 2007

Abstract
We have reviewed the surgical treatment of 12 consecutive patients with advanced carcinoma of the parotid gland at this hospital. Ten patients received immediate preoperative radiotherapy to a mean total dose (TD) of 4000 cGy (rad), range 2600–6500 cGy. Two patients with recurrent carcinoma had previously been treated with local radiotherapy (TD 6500 cGy) at 1 year and 2 years respectively prior to referral. A radical parotidectomy with block dissection of the neck was performed on all 12 patients. After a follow-up period ranging from 6 months to 8 years, 6 patients have remained disease free including 3 patients who have died from unrelated causes within this period. Three patients have developed local recurrent disease (interval 9 months–3 years), 3 further patients with residual microscopic disease have been observed postoperatively (follow-up interval 6 months–2 years) without developing overt local recurrence.
The influence of ultrasonic duplex scanning on the management of carotid artery disease
Authors: Breslau P J , Knox R A , Greep J M , Strandness D E 
Published: March 2007

Abstract
In order to assess the influence of a non-invasive test such as Duplex scanning on the management of patients with suspected carotid artery disease, we reviewed the data on all new referrals (n = 491) during a year. The patients were grouped according to the reason for the referral: 1, patients with focal neurological symptoms lasting less than 24 h (n = 156); 2, patients with focal neurological symptoms lasting longer than 24 h (n = 107); 3, patients with non-focal neurological symptoms (n = 147); 4, patients with asymptomatic bruits (n = 81). For all four groups there was a statistically significant relationship (χ2; P &lt; 0·005) between the reporting of the presence of a high grade stenosis (more than 50 per cent diameter reduction) and the likelihood that the patient would undergo arteriography. The finding of a high grade stenosis on the arteriogram resulted in a greater number of patients undergoing carotid artery surgery. The results of this study indicate that the report of the non-invasive test influenced the decision-making process in the management of patients with suspected carotid artery disease.
Effect of postoperative total parenteral nutrition (TPN) as an adjunct to gastrectomy for advanced gastric carcinoma
Authors: Yamada N , Koyama H , Hioki K , Yamada T , Yamamoto M 
Published: March 2007

Abstract
Clinical staging and immune reactivity were correlated in 39 patients who underwent gastrectomy for primary gastric cancer. Cellular immunity was depressed as the stage of cancer advanced, whereas humoral immunity was unaffected. Gastrectomy for advanced cancer in stage 3 and 4 suppressed cellular immunity.
The cellular and humoral immune systems in relation to total parenteral nutrition (TPN) versus non-TPN were evaluated in 57 patients who underwent gastrectomy for stage 3 and 4 advanced cancer. Cell-mediated immunocompetence was restored in all 29 patients who received postoperative TPN, while serum immunoglobulins were unaffected by TPN. Improvement of impaired cell-mediated immunity was also obtained in patients treated with a TPN–5-FU combination as an adjunct to surgery. Treatment with TPN during 5-FU administration restored immunocompetence, increased tolerance for 5-FU and gave a satisfactory 3-year survival rate. There were significant differences in the 3-year survival rates of patients who underwent non-curative gastrectomy (54 per cent for TPN–5-FU v. 0 per cent for non-TPN–5-FU; P &lt; 0·05).
It is concluded that TPN during chemotherapy as an adjunct to surgery leads to diminished morbidity, and possibly to prolonged survival time, in patients undergoing gastrectomy for gastric cancer. A possible mechanism responsible for the gratifying results of TPN treatment may be the increased tolerance for 5-FU resulting from improved nutrition and increased cell-mediated immunity.
Splenectomy and infection in Hodgkin's disease
Authors: Keel Aileen , Bennett B , Sarkar T K , Forman K M , Dawson Audrey A , Jones P F 
Published: March 2007

Abstract
The incidence of infection in 56 patients with Hodgkin's disease who had undergone staging laparotomy with splenectomy was compared with that of 28 non-splenectomized patients with Hodgkin's disease treated concurrently. The results suggest that splenectomy does not result in a major change in the incidence of infection experienced by such patients with stage II or stage III disease. Aggressive therapy may be of greater importance in increasing the susceptibility to infection in Hodgkin's disease.
The hourly pattern of urine solute and electrolyte excretion following standard surgical trauma
Authors: Kapadia C R , Chan S T F , Johnson A W , Radcliffe A G , Dudley H A F 
Published: March 2007

Abstract
Although urine volume (and, less frequently, concentration) is often measured in the perioperative period, little attempt has been made to separate temporal phases of the intra- and postoperative response to surgery. In 7 patients undergoing standard severe single trauma and managed by a conventional regimen which included intraoperative Hartmann's solution, we have investigated the hourly pattern of urine solute and electrolyte excretion over the first 48 h. Contrary to expectation, in the first 5 h Na+ excretion increases in association with overall solute excretion, and thereafter progressively diminishes. K+ excretion increases 4 h postoperatively and remains elevated for 24 h, after which it returns to normal, even though Na+ excretion remains low. Free water excretion is negative for the first 24 h, though urine osmolality does not suggest a maximal antidiuretic response by the kidney—the highest concentration achieved being just below 800 mosmol/kg. In order to distinguish between the physiological adaptive changes due to starvation and those due to injury, the hourly pattern of urine solute and electrolyte excretion was further investigated in 12 healthy volunteers mimicking postoperative conditions. Apart from the early postoperative period, the hourly pattern of Na+, K+ and osmolar excretion shows no discernible difference from the operated group. These results show that, particularly in relation to Na+, the changes seen in the post-injury patient, even after major uncomplicated surgery, are largely adaptive, and this is especially striking at 24 h after surgery.
Carcinoma of the anus in Crohn's disease
Authors: Preston D M , Fowler E Fiona , Lennard-Jones J E , Hawley P R 
Published: March 2007

Abstract
The incidence of gastrointestinal cancer in patients with Crohn's disease may be slightly increased. We report 2 cases of squamous cell carcinoma of the anus occurring in patients with distal Crohn's disease.
A clinical evaluation of postoperative peritoneal lavage in the treatment of perforated appendicitis
Authors: Udén P , Eskilsson P , Brunes L , Mätzsch T 
Published: March 2007

Abstract
In a comparative investigation, 369 patients operated upon for perforated appendicitis were studied retrospectively. During the period 1973–1979 181 patients with perforated appendicitis, treated at Sundsvall Hospital, were all given postoperative peritoneal lavage, whereas 188 patients with the same diagnosis treated at Skövde Hospital received no such treatment. Appendicectomy was performed in all patients and all were given systemic antibiotic therapy. Complications recorded were postoperative deaths, intra-abdominal abscesses, wound infections, postoperative ileus and lavage catheter complications. Postoperative peritoneal lavage did not diminish the frequency of these postoperative complications.
In situ femoropopliteal and distal vein bypass for limb salvage—experience of 50 cases
Authors: Denton M J , Hill D , Fairgrieve J 
Published: March 2007

Abstract
The aim of this paper is to assess the in situ technique of saphenous vein femoropopliteal (and femorotibial) bypass for limb salvage, and to compare it with the reversed vein method of bypass. In our 3-year study, we have operated on 50 cases resulting in a graft patency and limb salvage rate of 78 per cent at 18 months and 72 per cent overall. There was a 2 per cent perioperative and 10 per cent overall mortality. Graft thrombosis was associated with a variety of factors, mostly notably a small vein (&lt; 4 mm), a low calf vessel anastomosis, wound sepsis and progressive proximal (inflow) disease. However, the strongest correlation was that between graft thrombosis and the extent of distal disease, as 11 of 12 cases with thrombosed grafts had grade 2 or 3 run-off. In our experience the in situ technique offers haemodynamic and technical advantages over the reversed vein method of performing straightforward femoropopliteal bypass. Moreover, the in situ technique has wider application in that it allows a smaller vein (&gt; 2·5 mm) to be used and also makes anastomosis to a small calf vessel easier. In this series, 16 per cent of cases would have been considered unsuitable for the reversed vein method if 4 mm was accepted as the lower limit of size for a reversed vein graft.
Dynamic preoperative assessment of cardiac reserve in elective aortic surgery
Authors: Knight D G , Lane B , McGowan S M , Metcalf M J , Walker M G 
Published: March 2007

Abstract
Myocardial infarction accounts for over 50 per cent of mortality following elective abdominal aortic surgery. Previous history of ischaemic heart disease and abnormal ECGs, common in vascular patients, are unreliable parameters for predicting myocardial response to stress. Exercise ECGs are often valueless, as claudication may mask myocardial insufficiency. Myocardial performance was studied preoperatively in 29 consecutive patients undergoing elective aortic bifurcation grafting, using a Swann-Ganz catheter to measure the rise in pulmonary artery wedge pressure (PAWP) produced by rapid intravenous infusion of plasma (200–400 ml). A Frank-Starling Curve was obtained by plotting LVSWI against PAWP. Two important values were obtained: (a) ‘Upslope’ or gradient of the ascending portion of the curve. Low values identify patients most at risk from cardiac complications. Six patients who suffered from postoperative cardiac complications had a mean ‘upslope’ value of 1·568 ± 0·681 (1 s.e.m.), whereas the 23 who did not, had a mean value of 7·094 ± 0·745 (1 s.e.m.), a significant difference (P &lt; 0·001); (b) ‘PAWPmax’, the ventricular filling pressure above which work output dropped. Infusion beyond this may precipitate pulmonary oedema. PAWP was observed at levels greater than PAWPmax in all 6 patients who developed either pulmonary oedema or myocardial infarction. The myocardial performance curve can reliably identify high risk patients and permit control of intravenous therapy within individual safety limits, thereby preventing pulmonary oedema.
Cranial and cervical nerve damage associated with carotid endarterectomy
Authors: Dehn T C B , Taylor G W 
Published: March 2007

Abstract
Carotid endarterectomy may be complicated by damage to the adjacent cranial and cervical nerves. The true incidence and severity of these complications is rarely reported. In a prospective study of 43 carotid endarterectomies there was a 25 per cent incidence of temporary vocal cord palsy, 5 per cent incidence of hypoglossal nerve damage and anaesthesia of the greater auricular and transverse cervical nerves was found in 60 per cent and 69 per cent of patients respectively 1 week postoperatively. There was some recovery of these nerve injuries over a 6-month period.