bluuebunny/crossref_metadata_2025_split huggingface dataset:
Submucosal versus ligation excision haemorrhoidectomy: A comparison of anal sensation, anal sphincter manometry and postoperative pain and function
Authors: Roe A M , Bartolo D C C , Vellacott K D , Locke-Edmunds Jill , Mortensen N J Mcc 
Published: March 2007

Abstract
Submucosal (SM) and ligation excision (LE) haemorrhoidectomy were compared to establish whether SM is a less painful procedure and whether anal sensation is better preserved by SM, and, if so, how this relates to postoperative function. There were 18 SM and 22 LE patients. Anal sphincter manometry and anal mucosal electrosensitivity were measured pre-operatively and 6 weeks after surgery. Postoperative pain was assessed by linear analogue scale. Anal sphincter pressures which were high pre-operatively fell to normal after surgery. Neither operation affected functional sphincter length or the recto-anal inhibitory reflex. Forty per cent of patients showed ultraslow waves on sphincter motility studies. These were associated with the highest pressures and in all but three cases disappeared after surgery. There were no differences in postoperative pain scores between the two techniques but there was a wide range from no pain to very severe pain in both groups. Submucosal haemorrhoidectomy preserved anal sensation better than ligation excision but this was not reflected in improved function. There was minor leakage and soiling in 50 per cent of patients from both groups and two SM and LE patients had initial faecal incontinence. All these symptoms had resolved by 6 weeks.
Symptomatic submucosal lipoma of the large bowel
Authors: Creasy T S , Baker A R , Talbot I C , Veitch P S 
Published: March 2007

Abstract
Symptomatic large bowel lipomata may be of considerable size and usually present in middle age with symptoms of obstruction or bleeding. Although they are rare, their recognition is important so that patients may be spared unnecessary colonic resection for a presumptive malignant diagnosis. Colonoscopic removal may often be feasible. Six cases are reported together with a review of the literature emphasizing the characteristic features.
Effect of carotid endarterectomy on cerebral blood flow and its response to hypercapnia
Authors: Bishop C C R , Butler Lorraine , Hunt T , Burnand K G , Browse N L 
Published: March 2007

Abstract
Cerebral blood flow (CBF) was measured in 14 patients before carotid endarterectomy, 3 h after surgery and 2 days postoperatively using the intravenous xenon-133 technique. In 11 of the patients CBF was remeasured at 6 months and in 8 patients CBF and the response to hypercapnia (5 per cent CO2 in air) was measured pre-operatively and 6 months following surgery. All operations were performed using an intraluminal Javid shunt and internal carotid artery (ICA) ‘stump’ pressure was recorded. CBF measured at 3 h after endarterectomy revealed a postoperative cerebral hyperperfusion with significantly increased flows in both hemispheres. There was a significant correlation between carotid cross clamping time and ipsilateral hemispheric CBF increase which implied an ischaemic aetiology for the hyperperfusion and supported the routine use of an intraluminal shunt in carotid endarterectomy. Six months after surgery, CBF had returned to its pre-operative value but reactivity to CO2 was significantly improved, which suggested that the operation had increased cerebral reserve.
Popliteal vein entrapment caused by the third head of the gastrocnemius muscle
Authors: Iwai T , Sato S , Yamada T , Muraoka Y , Sakurazawa K , Kinoshita H , Inoue Y , Endo M , Yoshida T , Suzuki S 
Published: March 2007

Abstract
Three cases of the popliteal vein entrapment syndrome have been encountered during the past 3 years. The third head of the gastrocnemius muscle appeared to be the cause of this rare condition with the vessels in their normal position. Partial resection of the excess muscle was sufficient to relieve symptoms.
Prognostic significance of oestrogen and progestogen receptor activities in breast cancer
Authors: Hawkins R A , White Gillian , Bundred N J , Dixon J M J , Miller W R , Stewart Helen J , Forrest A P M 
Published: March 2007

Abstract
The prognostic significance of the tumour activities of 2 steroid receptors, those for oestrogen (ER) and for progestogen (PgR), has been studied in 372 patients with breast cancer, in whom follow-up was available for 2-6 years (median 41 months). Of 252 patients with operable disease, 75·8 per cent had ER-positive tumours and 46·4 per cent had PgR-positive tumours, though a small additional fraction (6·3 per cent) had an equivocal PgR assay result. For the 236 patients with unequivocal receptor status, the relationships between disease-free interval or overall survival and receptor activity and other factors were evaluated by univariate and multivariate analyses. The latter revealed that only tumour size, node status, menstrual status and ER status related significantly to both disease-free interval and survival, though adjuvant therapy also related to disease-free interval, and tumour grade related to survival. It is concluded that measurements of PgR activity do not add to the prognostic significance of ER status.
Consultations for breast disease in general practice and hospital referral patterns
Authors: Maureen Roberts M , Elton R A , Robinson S E , French K 
Published: March 2007

Abstract
As part of the evaluation of a health education campaign about breast disease, consultations for breast problems were monitored in five general practices over an 18-month period in Edinburgh. No increase was found as a result of the campaign, nor was there any increase in the number of biopsies performed. On average, each GP saw 13 women with breast problems each year, a rate of 1·6 per cent; 29 per cent were referred to hospital, regardless of their age. The most common presenting symptom was pain (47 per cent), with 35 per cent complaining of a lump. The reasons for hospital referral are discussed. It is suggested that GPs may refer too many young women to a specialist clinic, although this may be inevitable.
Prognostic factors related to survival and groin recurrence following therapeutic lymph node dissection for lower limb malignant melanoma
Authors: Kissin M W , Simpson D A , Easton D , White H , Westbury G 
Published: March 2007

Abstract
A retrospective analysis was carried out of 133 patients undergoing therapeutic lymph node dissection for malignant melanoma of the lower limb. A radical ilio-obturator dissection (RID) was performed in 106 patients and a superficial femoral dissection (SFD) in the remaining 27. On univariate analysis five factors were found to be significant indicators of prognosis. These were: Clark level of the primary (P = 0·02); primary melanoma thickness (P = 0·04); total number of positive nodes (P&lt;0·001); number of positive femoral nodes (P &lt; 0·001); and number of positive ilio-obturator nodes (P&lt;0·001). On multiple regression analysis only the number of positive nodes in each compartment remained a significant independent factor (P&lt;0·001). The morbidity associated with RID was not significantly greater than after SFD. RID was, however, associated with a reduction in subsequent groin recurrence. Radical nodal clearance is the operation of choice. This technique provides maximum prognostic information, reduces the likelihood of local untreatable disease and possibly improves overall survival rates—especially when only one iliac node is involved.
Changes in the plasma sodium concentration after minor, moderate and major surgery
Authors: Guy A J , Michaels J A , Flear C T G 
Published: March 2007

Abstract
The plasma sodium concentration, [Na]P, falls following major surgery and this fall is exacerbated by the administration of sodium-free or sodium-low intravenous fluids in the postoperative period. As a prelude to prospective, but controlled, studies we observed the range of [Na]P on admission for surgery in 477 patients. In 309 patients the extent of the change in [Na]P by the first postoperative day (Δ[Na]) was related to the severity of the operation undergone (minor, moderate or major) and the volume of potentially hypo-osmolar intravenous fluid given. The mean admission [Na]P was significantly lower with increasing severity of proposed operation. A highly significant fall occurred in [Na]P following surgery of every grade; such falls in [Na]P were seen even when no potentially hypo-osmolar fluids were administered. A significant inverse relationship between admission [Na]P and Δ[Na] was demonstrated. We conclude that [Na]P falls following surgery of any severity and that such falls occur even when exogenous dilution cannot be implicated as a cause.
Thermogenesis after major elective surgical procedures
Authors: Carli F , Aber V R 
Published: March 2007

Abstract
Sequential changes of body temperature have been measured for 48 h in 147 patients after major elective abdominal, cardiac, orthopaedic and pelvic surgery. Core temperature (aural canal) started to increase immediately after surgery reaching a mean peak value of 37·5°C 14 h (range 8-16) after the end of surgery. Subsequently, a second peak of 37·4°C was shown 18 h (range 16-20) later. The time interval between these two peak temperatures was constant for all types of surgery studied. A close examination of core temperature oscillations during a 72-h postoperative period and a comparison with a pre-operative 24-h cycle in a group of 14 patients who underwent cardiac surgery did not show any circadian rhythm. In the third part of the study, analysis of postoperative body temperature and metabolic rate showed a similar pattern of increase for core and mean skin temperatures, and oxygen consumption.
Kinetic changes in experimental colonic urinary diversion
Authors: Strachan J R , Matthews Joyce , Rees H C , Cooke T 
Published: March 2007

Abstract
An experimental model of colonic urinary diversion was performed on male Wistar rats to see if faeces, urine or a faeces and urine mixture produces tumours. Cell kinetic techniques, including the crypt cell production rate, and cellular DNA measurement were used to examine the effect of urine and of faeces on the colonic mucosa. Urinary diversion into the colon significantly increased colonic crypt activity. Tumours were found at the anastomosis when urine and faeces were mixed at 4 months, and at 6 months with urine alone.
Discrimination is not impaired by excision of the anal transition zone after restorative proctocolectomy
Authors: Keighley M R B , Winslet M C , Yoshioka K , Lightwood R 
Published: March 2007

Abstract
Anal sensation has been assessed using a constant current stimulator in 21 patients after restorative proctocolectomy (15 J pouch, 6 W pouch). The anal transition zone (ATZ) has been excised in 15 patients but preserved in 6. Results were compared with 14 age- and sex-matched patients with ulcerative colitis (UC) and 14 controls. Median threshold values in the lower, mid and upper zones of the anal canal in pouch patients were: 6·8 mA, &gt; 15·0 mA and &gt; 15·0 mA respectively compared with 3·9 mA (P&lt;0·01), 5·7 mA (P&lt;0·01) and 11·4 mA (P&lt;0·01) in UC and 3·5 mA (P&lt;0·01), 4·2 mA (P&lt;0·01) and 11·4 mA (P&lt;0·01) in controls. The mid and upper zone threshold anal sensation was significantly lower when the ATZ had not been removed and except in the lower zone did not differ from UC or controls (median threshold sensations when ATZ was preserved were: lower zone, 5·8 mA; mid zone, 5·5 mA; upper zone, 7·5 mA). Paired studies in eight patients showed that excision of the ATZ was associated with a significant impairment in anal sensation (mid zone: 5·7 versus &gt; 15·0 mA, P&lt;0·05; upper zone: 7·5 versus &gt; 15·0 mA, P&lt;0·05) whereas no change in anal sensation was recorded when the ATZ was preserved. Despite these physiological changes, no clinical benefit could be identified in patients in whom the ATZ was preserved. Discrimination was normal in all except one patient. The incidence of soiling, nocturnal incontinence and failure to defer defaecation for more than 1 h was recorded in 3/15 patients (20 per cent) whose ATZ had been removed, compared with 1/6 patients (17 percent) in whom the ATZ had been preserved. We conclude that excision of the ATZ does not eliminate the ability to discriminate and does not increase the risk of impaired continence after ileo-pouch anal anastomosis.
The solid bolus oesophageal egg transit test: Its manometric interpretation and usefulness as a screening test
Authors: Eriksen C A , Holdsworth R J , Sutton D , Kennedy N , Cuschieri A 
Published: March 2007

Abstract
The standardized 99mTc-labelled solid bolus oesophageal egg transit test (OET) was developed for assessing oesophageal motility. Its value in detecting oesophageal motility disorders was compared with oesophageal manometry in 102 symptomatic patients. Of 32 patients with normal OET, 22 (68·8 per cent) had normal manometry, whereas of 61 patients with abnormal manometry, 51 (84 per cent) had abnormal OET (χ2 = 15·82, P&lt;0·001). The computer-generated condensed image of the OET clearly defined five transit patterns: normal (n=32); oscillatory (n=21); non-clearance (n=16); ‘step’ delay (n=16) and non-specific delay (n=17). The oscillatory pattern occurred in only one patient with normal manometry, but in all six with manometrically defined achalasia and two with diffuse oesophageal spasm. The predictive value of a positive (abnormal) OET test in detecting abnormal motility (both specific and non-specific disorders) was 73 per cent, and for specific motility disorders was 100 per cent. The predictive value of a negative (normal) test in excluding specific motor disorders was 94 per cent. Manometric tertiary contractions and low amplitude waves occurred in 6/32 and 1/32 patients with normal OET but in 31/70 and 21/70 with abnormal OET (χ2 = 5·14, P&lt;0·02; χ2 = 7·85, P&lt;0·001 respectively). Patients showing oscillation demonstrated significantly more tertiary contractions (17/21) and low amplitude waves (12/21) compared with 20/81 and 10/81 patients without oscillation (χ2 = 20·47, P&lt;0·001; χ2 = 17·22, P&lt;0·001 respectively). The solid bolus oesophageal transit test provides an objective screening test of specific oesophageal motility disorders and should be performed before oesophageal manometry.
Recurrence of varices after oesophageal transection: Intra-operative and postoperative assessment by endoscopy
Authors: Koyanagi N , Iso Y , Higashi H , Kitano S , Sugimachi K 
Published: March 2007

Abstract
Intra-operative and postoperative endoscopy were used in 16 patients with portal hypertension to investigate whether intra-operative elimination of oesophageal varices by oesophageal transection with devascularization leads to prevention of variceal recurrence and rebleeding. Intra-operative elimination of the varices was achieved in 12 patients. In ten patients the varices recurred and in two cases rebled, during the follow-up period of 6-43 months (average 25 months). of the ten patients with recurrent varices, eight (including the two who bled acutely in the postoperative period) successfully underwent endoscopic injection sclerotherapy. Postoperative endoscopy was performed at 5-monthly intervals. It is concluded that intra-operative elimination of the varices will not prevent recurrence and that a closer follow-up using endoscopy more than three times a year is a significant aid in the management of these patients.
Surgical management of bleeding gastric ulceration
Authors: Rogers P N , Murray W R , Shaw R , Brar S 
Published: March 2007

Abstract
In a nine-year period from 1977 to 1985 sixty-one patients underwent surgery for bleeding gastric ulceration in the Western Infirmary, Glasgow. Nineteen patients were treated by partial gastrectomy, twenty-two had undersewing of the ulcer plus vagotomy and drainage and twenty had undersewing alone. Mortality in the three groups was 26, 45 and 10 per cent respectively. All groups of patients were similar in terms of age, severity of haemorrhage, delay before surgery and grade of surgeon performing the procedure. Out-patient follow-up (mean: 37 months) of patients treated by undersewing alone revealed that 73 per cent were symptom free. Treatment of bleeding gastric ulceration by undersewing alone is effective and should be considered in patients who require surgery.
Assessment of microtransducers in anorectal manometry
Authors: Miller R , Bartolo D C C , Roe A M , McC Mortensen N J 
Published: March 2007

Abstract
It has been reported that microtransducer-tipped catheters (transducer) produce reliable reproducible measurements which correlate well with water-filled balloon systems. Maximum resting pressure (MRP) and maximum voluntary contraction pressures(MVC) were compared using a standard station pull-through technique in 12 patients. There was a poor correlation for both MRP: microballoon, 115 cmH2O (60–160 cm H2O); transducer 60 (20–110), r = 0.62, P &lt; 0.05, and MVC: microballoon, 202 (60–375); transducer, 175 (60–210), r = 0.42, n.s. To determine whether this was due to radial variation in pressures measured by the transducer, we studied a further 39 patients with both systems. At each station, transducer measurements were made at each of four quadrants. We found better correlation for MRP: microballoon, 100 (40–175); transducer, 66 (34–120), r = 0.72, P &lt; 0.001, and MVC: microballoon, 225 (55–650); transducer, 180 (50–470), r = 0.87, P &lt; 0.001, but a significant radial variation for the transducer where rotation reduced MRP pressure measurements by 21 per cent (0–600 per cent), and MVC 17 per cent (0–76 per cent). Moreover there was a significant difference between anterior and posterior MRP in the upper anal canal, anterior 35 (5–80) versus posterior 25 (10–60), P &lt; 0.05. These results account for the poor correlation between random positioning of the microtransducer-tipped catheter and indicate that radial orientation must be taken into account.
Use of myocutaneous flaps for primary cover following lymph node dissection for malignant melanoma
Authors: Morgan R H , Horgan K , Hughes L E 
Published: March 2007

Abstract
We report seven patients undergoing palliative surgery for advanced malignant melanoma, who required wide excision of skin and underlying tissue in association with lymph node dissection. In each case, primary closure of the wound was facilitated by the use of a myocutaneous flap. Four ilio-inguinal lymph node dissections were closed with rectus abdominis flaps, two cervical dissections were closed with a pectoralis major flap, and a limited latissimus dorsi flap was used for one axillary clearance. Primary healing was achieved in all cases; morbidity was low, with one wound infection and two limited lymphatic collections. All donor sites were closed primarily and healed well. We conclude that in selected patients the use of a myocutaneous flap procedure gives excellent coverage of large defects with low morbidity. In particular, there is rapid convalescence and return of good function after palliative resections, while the wide excision minimizes local recurrence where the tumour is in proximity to overlying skin.
Randomized comparison of R1 and R2 gastrectomy for gastric carcinoma
Authors: Dent D M , Madden M V , Price S K 
Published: March 2007

Abstract
The contention that the R2 radical gastrectomy for localized and potentially curable gastric carcinoma may be superior to gastrectomy without lymphadenectomy (R1) was assessed by randomized trial. Five years after commencement 403 patients have been evaluated at surgery and only 43 (11 per cent) found eligible (S0–2, P0, H0, N0–1), 22 of whom underwent R1 and 21 R2 gastrectomy. Seven patients had final histological stages in excess of the protocol. The R2 group had a longer operating time (P&lt;0.005), a greater blood transfusion requirement (P&lt;0.005), a longer hospital stay (0.05&gt;P&gt;0.025) and required reoperation in four cases. There were no postoperative deaths. Four patients have died from the disease in the R1 group and five in the R2 group, there being no difference in the probability of survival at a median follow-up of 3.1 years. The small proportion of patients suitable for radical R2 surgery, the high associated morbidity and the fact that survival advantage has yet to be proven in trial suggest that this procedure should not yet be performed outside of controlled clinical trials.
A rational technique for surgical operation on Borrmann type 4 gastric carcinoma: Left upper abdominal evisceration plus Appleby's method
Authors: Furukawa H , Hiratsuka M , Iwanaga T 
Published: March 2007

Abstract
Borrmann type 4 gastric carcinoma, including linitis plastica, is difficult to detect at an early stage and the results of surgical treatment remain poor. We have used ‘left upper abdominal evisceration plus Appleby's method (LUAE + Apl.)’ as a radical surgical procedure for this disease. During the period 1983–86, 30 cases of Borrmann type 4 gastric carcinoma underwent this procedure (Group A). These cases were compared with 30 patients who underwent total gastrectomy with pancreaticosplenectomy (Group B) during the period 1980–82. Although this is not a randomized study and the extent of resection was greater in Group A, the operation time, amount of blood loss, and number of complications were similar for both methods. When the survival rates were compared, the 3-year survival rate in stage II-III cases was higher for Group A (83.3 per cent) than for Group B (42.2 per cent) (P&lt;0.05). One patient in Group A and 12 patients in Group B died with peritoneal metastasis within 3 years of operation in stage II-III. The LUAE + Apl. method is a rational and useful technique for the surgical treatment of Borrmann type 4 gastric carcinoma.
Non-invasive treatment for retained common bile duct stones in patients with T tube in situ: Saline washout after intravenous ceruletide
Authors: Tritapepe R , Di Padova C , Di Padova F 
Published: March 2007

Abstract
The combination of ceruletide-induced relaxation of the sphincter of Oddi plus flushing with saline has recently been proposed as a novel procedure for the treatment of residual common bile duct (CBD) stones. In this study we have administered intravenous ceruletide (2 ng kg−1 body weight min−1 for 1 h) plus intraductal saline (800–3000 ml, infused at a rate that kept biliary pressure below 30 cmH2O) to a group of 14 patients. The treatment induced the passage of residual stones in 11 subjects (79 per cent) with complete clearance in 7 (50 per cent). The majority of the cleared concretions (11/15) had a diameter &lt; 10 mm. No severe side-effects were recorded during the treatment. Four of the seven subjects who exhibited incomplete CBD clearance underwent a short cycle of mono-octanoin administration in order to reduce the size of residual radiolucent stones. This course of treatment was followed by another attempt with intravenous ceruletide and saline washout which gave a successful response in an additional three cases. These data indicate that the combination of ceruletide and flushing is a safe and inexpensive method for treatment of residual stones. The procedure is feasible for both radiolucent and radio-opaque stones and is mainly eligible for small concretions of diameter &lt;10 mm. Larger (&gt;10 mm) radiolucent stones may be partially dissolved with mono-octanoin and then eliminated by the washout technique.