bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of transdermal glyceryl trinitrate on the survival of peripheral intravenous infusions: A double-blind prospective clinical study
Authors: Khawaja H T , Campbell M J , Weaver P C 
Published: March 2007

Abstract
Phlebitis is the commonest complication of intravenous infusion. It has been suggested that it is initiated by venoconstriction at the infusion site, hence treatment with a vasodilator may reduce its incidence. We carried out a prospective double-blind controlled study of the effect of transdermal glyceryl trinitrate on the survival of peripheral intravenous infusions in 340 patients. Fifty-five per cent (94 out of 170) of the infusions failed in the control group compared with 19 per cent (33 out of 170) in the treatment group (χ2 = 45, P &lt; 0.0005). The commonest cause of infusion failure was superficial phlebitis: 47 per cent in the control group and 17 per cent in the treatment group (χ2 = 46, P&lt;0.0005). The estimated median time of infusion survival was 74 h in the control group compared with 127 h in the treatment group (log rank χ2 = 143, P &lt; 0.0001). We conclude that infusion phlebitis is a common problem in hospitalized patients and its incidence can be effectively reduced by transdermal glyceryl trinitrate.
Definitive one-stage emergency large bowel surgery
Authors: Mealy K , Salman A , Arthur G 
Published: March 2007

Abstract
During a 30-month period, 126 operations for emergency large bowel conditions were performed: 57 were for colonic carcinoma, 26 for acute diverticulitis, 14 for colonic ischaemia, 13 for complications of inflammatory bowel disease, and 16 for other conditions. Sixty-eight patients had peritonitis. One hundred and ten patients (87.3 per cent) underwent immediate resection. Of these, 83 (65.9 per cent of the overall group) had colonic resection with primary anastomosis but without a colostomy, 56 of which were left-sided colonic resections. Excluding 9 of the 68 patients with peritonitis, who had a total colectomy, 66 per cent also underwent resection, anastomosis and no colostomy. Total group mortality was 14.3 per cent: 12.7 per cent in the immediate resection group, 9.6 per cent in those with primary anastomosis and no colostomy, 5.2 per cent in the group with peritonitis undergoing resection and anastomosis, and 25 per cent in those having non-resectional surgery. Complications included an overall wound infection rate of 10.3 per cent and a clinical anastomotic leak rate of 7.2 per cent in those who had anastomosis without colostomy. Our results suggest that resection and primary anastomosis can be performed with acceptable morbidity and mortality in a high proportion of cases of emergency large bowel conditions, irrespective of underlying pathology, site of disease or the presence of peritonitis.
Physiological changes after postanal repair and parameters predicting outcome
Authors: Yoshioka K , Hyland G , Keighley M R B 
Published: March 2007

Abstract
Nineteen patients have been studied before and 3 months after postanal repair. Physiological parameters have been compared with 16 age- and sex-matched controls. Twelve patients were substantially improved whereas seven obtained no clinical benefit. Pre-operative resting (P&lt;0.005), squeeze (P&lt;0.005) and strain (P&lt;0.005) anal pressures at 2 cm were significantly less than controls. Similarly, pressures during all three events at 4 cm were significantly less than controls (resting P&lt;0.05, squeeze P&lt;0.005, strain P&lt;0.025). Median volume of first leak during saline infusion was significantly less than controls (P &lt; 0.005) as was the total tolerable volume (P &lt; 0.005). Videoproctographic parameters which differed significantly from controls included pelvic floor descent at rest (P &lt; 0.005), during contraction (P &lt; 0.005) and straining (P &lt; 0.05); resting and squeeze perineal descent (P &lt; 0.005); and anal canal length at rest and straining (P &lt; 0.005). Anorectal angles, rectal compliance, rectal sensation and emptying did not differ from controls. None of these parameters was improved by postanal repair. Patients not improved by operation could be detected pre-operatively by low resting (P &lt; 0.05), squeeze (P &lt; 0.025) and strain (P &lt; 0.05) anal pressure at 2 cm as well as by videoproctographic evidence of increased pelvic floor descent at rest (P &lt; 0.01), during contraction (P &lt; 0.005) and straining (P &lt; 0.005), excessive perineal descent at rest (P &lt; 0.05), during contraction (P &lt; 0.05) and during attempted defaecation (P &lt; 0.05) and a short anal canal at rest (P &lt; 0.05) and during straining (P &lt; 0.025).
Choice of material for above-knee femoropopliteal bypass graft
Authors: Michaels J A 
Published: March 2007

AbstractAutogenous saphenous vein is generally considered to be the best material for arterial bypass grafts below the inguinal ligament. Recent results have suggested that the advantage of vein over prosthesis is more pronounced in a distal situation, but it is not immediately apparent whether the difference is sufficient to justify a policy of using prosthesis for the initial above-knee graft to preserve the vein in case later surgery is required. An attempt has been made to answer this question. The literature has been reviewed to obtain estimates of the patency rates for grafts in different situations and a mathematical model has been set up using these figures to predict the outcome of different treatment policies. The model can be used to predict the result of alteration or inaccuracy in the data or to make use of the results of newly reported studies. The model predicts that the use of prosthesis for an initial graft will reduce the overall patency and substantially increase the requirement for reoperation, even if the present data give a substantial overestimate of the advantages of vein above the knee.
Risk of aortic aneurysm surgery as assessed by preoperative gated heart pool scan
Authors: Fletcher J P , Antico V F , Gruenewald S , Kershaw L Z 
Published: March 2007

Abstract
Gated heart pool scan measuring left ventricular ejection fraction (LVEF) was performed preoperatively in 72 patients presenting for elective repair of abdominal aortic aneurysm. Patients with a positive cardiac history were more likely to have a LVEF of ⩽45 per cent (P &lt; 0·001). The operative mortality rate was 4 per cent. Each of three patients who died had a LVEF ⩽35 per cent and developed cardiac failure which led to renal failure. Five other patients developed cardiac failure manifested by acute pulmonary oedema during the early postoperative period. There was no statistically significant association between a positive cardiac history and the occurrence of postoperative cardiac failure or death. However, patients with a LVEF of ⩽45 per cent were more likely to develop postoperative cardiac failure (P = 0·004) while patients with a LVEF of &gt;35 per cent had a greater chance of dying (P &lt; 0·001). No patient died with a LVEF &gt; 35 per cent. Preoperative evaluation of LVEF can select patients at high risk of cardiac death from repair of abdominal aortic aneurysm. Such patients could be followed conservatively if they remain asymptomatic and the aneurysm does not enlarge. If operation is considered mandatory, patients with a low LVEF should receive intensive perioperative monitoring with enhancement of ventricular performance.
Variceal haemorrhage after failed injection sclerotherapy: The role of emergency oesophageal transection
Authors: Jenkins S A , Shields R 
Published: March 2007

Abstract
In a planned sequential policy for the emergency control of continued bleeding from oesophageal varices, oesophageal transection was performed after failure of conservative treatment, including injection sclerotherapy. In 15 patients who underwent emergency oesophageal transection, bleeding was controlled by operation in the majority (87 per cent), but 11 of the 15 patients died in hospital. Mortality in patients with poor liver function (Child's C) was 100 per cent, the majority of deaths resulting from hepatic and renal failure. The results of this study suggest that emergency oesophageal transection to control acute variceal haemorrhage is associated with a poor prognosis in patients with poor liver function and questions its role in a sequential emergency treatment policy.
Timing of prophylactic antibiotics in abdominal surgery: Trial of a pre-operative versus an intraoperative first dose
Authors: Bates T , Siller G , Crathern B C , Bradley S P , Zlotnik R D , Couch C , James R D G , Kaye C M 
Published: March 2007

Abstract
When prophylactic antibiotics are used in abdominal surgery it is customary to give the first dose before the operation. Whilst intra-operative antibiotics may be effective in elective surgery, there may be an advantage to starting pre-operatively when there is already an infective focus such as appendicitis. Antibiotics started pre-operatively (group P) have been compared with antibiotics started after initial abdominal exploration (group T). Three intravenous doses of 500 mg metronidazole plus 1 g cephazolin were given in a randomized, double-blind study of 700 emergency and elective high-risk abdominal operations. Antibiotic plasma concentrations at the end of the operation were significantly lower in group P but lay well within the therapeutic range. Wound infection rates, which included minor and delayed infections, were similar in both groups (group P, 57 of 342, 16·7 per cent; group T, 55 of 358, 15·4 per cent; 95 per cent confidence intervals for the difference being −4·1 to +6·7 per cent. In appendicitis, wound infection rates were 12·1 and 13·9 per cent for groups P and T respectively. However, non-fatal deep sepsis was more common in group P (nine cases) than in group T (two cases) (χ2 = 4·9, P &lt; 0·05). Postoperative infection was twice as common in obese patients whose body mass index (BMI) was ⩾ 26 (39 of 132, 30 per cent) than in thin patients whose BMI was &lt;24 (41 of 288, 14 per cent; χ2 = 13·8, P &lt; 0·001). This study failed to show any advantage to starting antibiotics pre-operatively, even in appendicitis.
A study of the physiological variation in anal manometry
Authors: Pedersen I Krogh , Christiansen J 
Published: March 2007

Abstract
The physiological variation in anal manometry using a perfused catheter with radiating sideholes was studied in 78 healthy volunteers. The maximum intraindividual variation in the length of the anal high pressure zone, resting pressure and squeeze pressure was 10 mm, 26 mmHg and 68 mmHg respectively. The median 95 per cent confidence interval for length of the pressure zone was 4 mm; for resting pressure it was 15 mmHg and for squeeze pressure it was 48 mmHg. Day-to-day variation did not exceed the intraindividual variation. Constant recording with the catheter fixed in the high pressure zone revealed slow waves and ultraslow waves with amplitudes of 6–24 mmHg which could account for most of the intraindividual variation. No sex difference was found in the length of the high pressure zone whereas resting pressure and squeeze pressure were higher in men than in women. Although a tendency towards a decrease in the length of the high pressure zone, resting pressure and squeeze pressure was observed with increasing age, no significant age-related difference could be demonstrated.
Near-total thyroidectomy for carcinoma of the thyroid
Authors: Sarda A K , Bal S , Kapur M M 
Published: March 2007

Abstract
There is controversy about the most appropriate treatment for patients with thyroid cancer. This study analyses our experience with 206 cases of thyroid cancer from an endemic goiterous area. There were 100 males and 106 females; patients presented at an earlier age with a short history. Thyroid cancers demonstrated an aggressive biological behaviour with an advanced stage at presentation (overt cancers in 51 per cent) and a relentless course with a mortality rate of 24·2 per cent for the well-differentiated tumours. Near-total thyroidectomy was performed in 126 patients. Multicentric foci of tumour were seen in 17·2 per cent of the well-differentiated cancers and 25·2 per cent of the cases of well-differentiated cancers who underwent near-total thyroidectomy developed loco-regional recurrence. Hemithyroidectomy was performed in 35 patients who refused completion total thyroidectomy at a second stage; 16·7 per cent of these patients developed a recurrence in the remaining contralateral lobe. Thus in our patients from an endemic goiterous area, near-total thyroidectomy is the treatment of choice particularly because of the frequent occurrence of follicular and anaplastic cancers (in 44·2 per cent) and because the course of the disease is more virulent.
Prediction of outcome in patients with acute variceal haemorrhage
Authors: Jacobs S , Chang R W S , Lee B , Al Rawaf A , Pace N C , Salam I 
Published: March 2007

Abstract
Prediction of outcome in 87 patients following acute bleeding oesophageal and gastric varices due to portal hypertension from chronic liver disease was studied at our hospital over a 30-month period. The overall mortality rate was 26 per cent (23/87), with the operative mortality rate (50 per cent) being more than triple the non-operative mortality rate (14 per cent). The initial prothrombin time ratio (PTR) alone was significantly different in survivors and non-survivors both in the operated and non-operated patients. The only survivor in the whole material with a PTR ⩾ 2·2 was a patient who was transferred and underwent successful liver transplantation elsewhere. Among operated intensive care unit (ICU) patients, the Glasgow predictor gave a mean probability of discharge of 0·81 (s.d. 0·15) in 13 survivors and of 0·35 (s.d. 0·35) in the 15 non-survivors (P &lt; 0·001). In the 11 non-operative ICU patients, who had failed sclerotherapy, the Glasgow predictor could not be validated. Fourteen ICU deaths were associated with significant hypotension defined as a systolic blood pressure &lt; 90 mmHg for &gt; 1 h.
Cardia carcinoma considered as a distinct clinical entity
Authors: Huseman B 
Published: March 2007

Abstract
From 1 January 1969 until 31 December 1985, gastric resections were performed in 937 patients with carcinoma of the stomach and 422 patients with carcinoma of the cardia. During this period, the general frequency of cardia carcinoma increased continuously from 6·6 per cent (1969–71) to 37·5 per cent (1984–85) and a corresponding decrease of carcinomas in other sites was observed. Early carcinomas (pT1) of the oesophageal margin (n = 10, 2·4 per cent) were diagnosed less often than early carcinomas in other sites (n = 177, 18·9 per cent). Whereas 51·4 per cent of all resected carcinomas of the stomach showed no lymph node metastases (pN0), only 14·1 percent of cardia carcinomas belonged to this category. With respect to operative treatment. Lauren's classification which defines the required margin of clearance according to diffuse type (frequency in cardia carcinoma 43 per cent, in other stomach sites 51 per cent), is of great significance. We believe that extensive oesophageal resection is necessary for patients with such difficult tumours. The pattern of metastasis in cardia carcinoma is similar to that of cancer in other stomach sites, the preferred area is the regional lymph nodes on the lesser curve (83 per cent). Histological classification and metastasis pattern show that cardia carcinoma is a type of carcinoma of the stomach which must be treated according to the criteria of stomach cancer surgery.
Branched chain amino acids as the protein component of parenteral nutrition in cancer cachexia
Authors: Hunter D C , Weintraub M , Blackburn G L , Bistrian B R 
Published: March 2007

Abstract
A prospective randomized trial was conducted to determine the effects of branched chain amino acids (BCAA) as the protein component of total parenteral nutrition (TPN) on protein kinetics in patients with intra-abdominal adenocarcinoma. Nine malnourished patients were given both conventional TPN containing 19 per cent BCAA (AA) and isocaloric, isonitrogenous TPN containing 50 per cent BCAA (BCAA-TPN), in random order. Both [13C]leucine and [14C]tyrosine were employed as tracers to avoid the potential bias due to the different amino acid composition of the two TPN solutions. With BCAA-TPN, leucine and tyrosine flux increased significantly from (mean ± s.d.) 158·0 ± 37·2 to 243·5 ± 75·8 μmol kg−1 h−1 (P &lt; 0·025) and from 35·0 ± 8·4 to 42·6 ± 11·0 μmol kg−1 h−1 (P &lt; 0·05) respectively. Leucine oxidation was significantly higher on BCAA-TPN (24·1 ± 6·3 on AA versus 68·3 ± 37·1 μmol kg−1 h−1, P &lt; 0·025) while tyrosine oxidation was significantly lower (3·7 ± 1·8 μmol kg−1 h−1 on AA versus 2·5 ± 2·0 μmol kg−1 h−1 on BCAA-TPN, P &lt; 0·05). Whole body protein synthesis and breakdown was significantly higher on BCAA-TPN by the tyrosine tracer (31·3 ± 7·3 on AA versus 40·1 ± 9·3 μmol kg−1 h−1, P &lt; 0·025 and 33·0 ± 8·4 on AA versus 41·3 ± 11·1 μmol kg−1 h−1, P &lt; 0·05) respectively. Using the leucine tracers both synthesis and breakdown were increased, but not significantly, from 133·8 ± 40·0 to 175·3 ± 65·1 μmol kg−1 h−1 and from 127·9 ± 33·6 to 167·7 ± 71·2 μmol kg−1 h−1 respectively. The fractional albumin synthetic rate increased significantly on BCAA-TPN from 4·3 ± 2·9 on AA to 8·0 ± 5·1 per cent per day (P &lt; 0·05). The reduction in tyrosine oxidation, suggesting improved protein utilization, coupled with an increase in protein and albumin synthesis, strongly support a positive benefit from BCAA-TPN in cancer cachexia.
Isotopic studies during surgical convalescence
Authors: Humberstone D A , Shaw J H F 
Published: March 2007

Abstract
We have performed paired isotopic studies in four patients undergoing resection of early colorectal cancer and four having removal of parathyroid adenomas. Kinetic measurements of protein and glucose metabolism were made before resection and at home 10 weeks after surgery. During convalescence there were major changes in both groups in glucose metabolism and the hormonal milieu despite no alterations in protein kinetics or metabolic rate. In particular, the rate of glucose production doubled from (mean±s.e.m.) 14·8 ± 1·3 to 28·1 ± 2·5 μmol kg−1 min−1 (P &lt; 0·01), the percentage of available glucose undergoing oxidation decreased from 35·5 ± 3·9 to 21·5 ± 2·9 per cent (P &lt; 0·05) and the percentage of glucose undergoing recycling to lactate increased from 20·1 ± 10·0 to 52·9 ± 2·3 per cent (P &lt; 0·05). During convalescence the basal plasma insulin concentration was significantly higher (P &lt; 0·05) and there was a proportionately smaller response to glucose infusion. The convalescent state was also associated with an elevation in serum cortisol from 291 ± 54 to 496 ± 75 nmol litre−1 (P &lt; 0·05). The values for resting energy expenditure were not significantly different from the predicted energy expenditure in either the preoperative or the convalescent groups. We conclude that (a) there is a marked increase in both glucose production and glucose recycling to lactate in convalescence from clean uncomplicated surgery, and this is associated with a decrease in the percentage of glucose uptake oxidised; (b) a relative hyperinsulinaemia is seen in convalescent patients and is associated with decreased responsiveness to a glucose load; (c) the plasma cortisol level is significantly elevated after 10 weeks of convalescence; and (d) convalescent patients do not have elevated rates of protein catabolism or energy expenditure.
Anergy in patients with biliary lithiasis
Authors: Caínzos M , Potel J , Puente J L 
Published: March 2007

Abstract
A prospective study was carried out in 428 subjects (212 controls and 216 patients) to evaluate the delayed cell-mediated immune response preoperatively in patients with biliary lithiasis. The delayed hyper-sensitivity response was assessed by a Multitest and subjects were classified as immunocompetent, relatively anergic or anergic. Significant differences were found between control subjects and patients with cholelithiasis compared with those with acute cholecystitis (P &lt; 0·01), non-icteric choledocholithiasis (P &lt; 0·01) and choledocholithiasis with jaundice (P &lt; 0·05). There were also differences between patients with icteric and non-icteric choledocholithiasis (P &lt; 0·02). Seven possible causative factors for anergy were evaluated: a haemoglobin concentration of ⩽ 12 g/l and a haematocrit of ⩽ 35 per cent were related to the appearance of anergy and relative anergy in patients with acute cholecystitis. Bilirubin levels ⩾ 34 μmol/l were found in 60 per cent of patients with choledocholithiasis and relative anergy and in 80 per cent of those who were anergic (P &lt; 0·001). These results show a high incidence of failure of the cell-mediated immune response in patients with acute cholecystitis (71 per cent) and icteric choledocholithiasis (82 per cent). In the latter, jaundice appears to be associated with this failure. A close correlation between relatively anergic and anergic state and the development of postoperative septic complications was found.
Residual tumour after biopsy for non-palpable ductal carcinoma in situ of the breast
Authors: Wobbes Th , Tinnemans J G M , van der Sluis R F 
Published: March 2007

Abstract
In a group of 40 patients with non-palpable ductal carcinoma in situ (DCIS) of the breast, 41 breast specimens were available for studying residual tumour after biopsy. In one group of ten patients seen before 1977, simple histological examination revealed a 9 per cent incidence of residual tumour. However, after thorough examination residual foci of DCIS were found in 77 per cent of a subsequent group of 30 patients. This means that the majority of patients would have had to undergo reoperation if a breast-saving procedure had been performed. This fact must be taken into account when planning treatment of patients with non-palpable DCIS.
Prior renal transplantation does not facilitate subsequent canine islet allograft survival
Authors: Guy A J , Griffin S M , Alderson D , Farndon J R 
Published: March 2007

Abstract
Successful islet allografts can be established in rats bearing long surviving renal allografts, without additional immunosuppression, when kidney and islet donor animals are of the same strain. The applicability of such a scheme to clinical practice has been investigated in a large animal model of diabetes: the pancreatectomized dog. Eight dogs with previously established renal allografts and immunosuppressed with cyclosporin A received islet allografts from their respective original kidney donors. The median islet graft functional survival was only 10·5 days, significantly less than for six similarly immunosuppressed dogs receiving islet allografts alone (48·5 days, P &lt; 0·05). Three of the sequentially transplanted dogs had had no renal graft rejection episodes before islet transplantation, yet their islet grafts were all rejected within 19 days. In the pancreatectomized dog, prior donor specific renal transplantation has an adverse effect upon subsequent islet graft survival.
Need for surgical wound dressing
Authors: Chrintz H , Vibits H , Cordtz T O , Harreby J S , Waaddegaard P , Larsen S O 
Published: March 2007

Abstract
The need for dressings on clean and clean contaminated surgical wounds was investigated. A total of 1202 patients with 1202 clean or clean contaminated surgical wounds were randomized into two groups: 633 wounds were covered by dressings up until the time of suture removal, and 569 wounds were treated without dressings after the first postoperative day. In the group characterized by long dressing time, the rate of postoperative wound infections was 4·9 per cent. The rate was 4·7 per cent in the group represented by short dressing time. Using short dressing time not only reduces the number of nursing hours but also limits the need for costly dressing material. In addition, both wound observation and patients' personal hygiene are made easier.