bluuebunny/crossref_metadata_2025_split huggingface dataset:
Haematuria after blunt trauma: the role of pyelography
Authors: Demetriades D , Rabinowitz B , Sofianos C , Landau A 
Published: March 2007

Abstract
This study is a combined prospective and retrospective review of 208 patients presenting with haematuria after blunt abdominal trauma. One hundred and twelve patients had an urgent intravenous pyelogram (IVP) with cystogram performed, while the remaining ninety-six were observed with serial urinalysis without any further investigation. Nineteen of the twenty-three patients with a positive IVP had gross haematuria and the remaining four had microscopic haematuria. Twenty-two of the patients with an abnormal IVP had positive abdominal signs, whilst only one case (with severe head injury) had no abdominal signs. In the 96 cases who were observed without IVP no complications occurred. It is suggested that if certain clinical criteria are observed most patients with post-traumatic microscopic haematuria can safely be spared an IVP. Indications for emergency IVP should include: gross haematuria or microscopic haematuria associated with abdominal signs or severe head injury or fracture of pelvis or spine. Had these criteria been observed during this study, 130 patients (62 per cent) would have avoided the risks and expenses of an IVP, and no significant urological injury would have been missed.
Influence of diabetes mellitus on operative risk
Authors: Hjortrup A , Sørensen C , Dyremose Elly , Hjortsø N-C , Kehlet H 
Published: March 2007

Abstract
In a retrospective study postoperative morbidity was compared between 224 patients with diabetes mellitus and 224 non-diabetic control patients matched with regard to operative procedure (major vascular, abdominal and acute surgery for hip fracture), sex, age, complicating cardiovascular disease and weight. Forty-six patients in each group had complications, without any trend towards specific morbidity in the diabetic group. Incidence of morbidity was similar in diabetic patients treated with insulin, oral antidiabetic agents or diet. Diabetic patients with complications had significantly (P&lt;0·01) lower blood glucose pre- and postoperatively than those without complications. The risk of overlooking (type II error) a 25 per cent increase in complication rate in the diabetic patients was less than 10 per cent and the risk of overlooking a 50 per cent increase in morbidity less than 0·5 per cent. These results do not support the common belief that diabetes per se may increase surgical risk.
Conservative pancreatectomy
Authors: Cooper M J , Williamson R C N 
Published: March 2007

Abstract
By convention, resection of the proximal pancreas includes the distal stomach (and duodenum) and resection of the distal pancreas includes the spleen. In 28 patients the stomach and spleen were preserved to minimize functional disability. In 13 patients with proximal pancreatectomy (7 men, median age 39 years) the pylorus and first 3 cm of duodenum were preserved. Indications were chronic pancreatitis (n = 9) and localized neoplasia (ampulla 2, duodenum 1, insulinoma 1). One patient died (aged 81 years), and 2 required re-operation for a pancreatic abscess or stenosed choledochojejunostomy. The 12 survivors are well at a median of 1·25 years (range 0·25–3·25 years) In 15 patients with distal pancreatectomy (6 men, median age 44 years) the spleen was preserved. Indications were islet cell tumour in 2 and chronic abdominal pain in 13, 9 of whom had an isolated dorsal pancreas and 6 of whom had histological evidence of chronic pancreatitis. Recovery was uneventful apart from 2 patients with a fluid collection in the lesser sac, 1 needing percutaneous aspiration. In the absence of gross inflammatory adherence, partial pancreatectomy need not entail removal of the adjacent stomach or spleen.
Pyloric reconstruction
Authors: Koruth N M , Krukowski Z H , Matheson N A 
Published: March 2007

Abstract
Fourteen patients with persistent and severe postcibal symptoms following vagotomy and pyloroplasty for duodenal ulcer had the pylorus reconstructed. A dumping provocation test was useful in patient selection and evaluation of results. When assessed between 6 months and 3 years after operation, nine patients had an excellent or good result and three were improved. Surgical technique is relatively simple and the operation should be considered and practised more often than it seems to be from documented experience.
Hypovolaemia and healing in colonic anastomoses
Authors: Foster M E , Laycock J R D , Silver I A , Leaper D J 
Published: March 2007

AbstractColonic anastomotic leakage is more common following emergency resections than after elective operations. Transient hypovolaemia, which is more likely to occur during emergency surgery, has been shown to impair collagen metabolism in abdominal and skin wounds but its effect on colonic anastomotic healing has not been previously examined. Acute intra-operative loss of 10 per cent circulating blood volume in rats significantly impaired collagen concentration in both ileocolic (P&lt;0·02) and colocolic (P&lt;0·05) anastomoses measured on the third postoperative day. This degree of blood loss did not significantly affect early anastomotic strength. Hypovolaemia leads to tissue hypoxia, and this in turn may lead to impaired anastomotic healing. Measurement of tissue oxygen tension may predict poor healing by identifying inadequate intestinal perfusion. Colonic pTO2 measured in rabbits was significantly lower than in small bowel (37±18 mmHg versus 42±18 mmHg; P&lt;0·001), and fell significantly in colon following 10 per cent blood loss (P&lt;0·001): We conclude that adequate intra-operative fluid replacement during colonic resection and anastomosis is a prerequisite for successful healing.
Sphincter of Oddi motility disorders in patients with idiopathic recurrent pancreatitis
Authors: Toouli J , Roberts-Thomson I C , Dent J , Lee J 
Published: March 2007

Abstract
Motor disorders of the sphincter of Oddi (SO) may play a role in the pathogenesis of idiopathic recurrent pancreatitis. We have compared manometric records from the SO in 28 patients with idiopathic recurrent pancreatitis with those from 10 control subjects. Patients with idiopathic recurrent pancreatitis had presented with episodes of upper abdominal pain associated with abnormal serum levels of amylase on at least two occasions, in the absence of alcohol abuse and biliary disease. Retrograde pancreatography was either normal or showed only minor changes in pancreatic ducts. A triple lumen low compliance manometric system was used to obtain a 5 min recording of spontaneous SO motor activity. From this recording were determined the SO basal pressure, SO phasic contraction amplitude, SO wave frequency and direction of wave propagation. The SO response to intravenous cholecystokinin-octapeptide (CCK-OP) 20 ng/kg was then recorded for at least 3 min. Twenty-five of the twenty-eight patients demonstrated one or more manometric abnormality when compared with data from the ten controls. The most frequent abnormality was an elevated SO basal pressure in 16 patients. In addition, excess of retrograde contractions in nine patients, high frequency of SO phasic contractions in nine patients, absence of phasic contractions in three patients, and paradoxical response to CCK-OP administration in two patients were recorded. This study has demonstrated a spectrum of sphincter of Oddi manometric disorders in patients with idiopathic recurrent pancreatitis and suggests that motility disorders of the sphincter of Oddi may be associated with episodes of pancreatitis.
Correlation of clinical and manometric abnormalities of rectal function following chronic radiation injury
Authors: Varma J S , Smith A N , Busuttil A 
Published: March 2007

Abstract
Continuous fluid-inflation proctometrograms were performed in men with the symptoms of chronic radiation proctitis and in age and sex-matched control subjects (n = 10). Rectal volumes and compliance were measured. There was a significant reduction in the rectal volumes at sensory threshold, constant sensation and maximal tolerance and in rectal compliance (P&lt;0.01). Comparable pressure measurements did not demonstrate significant differences. The maximum tolerable volume, symptomatic and sigmoidoscopic scoring correlated to rectal compliance (r = 0.77, −0.8, −0.73; P&lt;0.01, &lt;0.01, &lt;0.02, respectively). Reduction in volume and compliance is often not obvious radiologically. Histological evidence suggests that smooth muscle hypertrophy and myenteric plexus damage are contributory.
Assessment of myocardial function before aortic surgery by radionuclide angiocardiography
Authors: Mosley J G , Clarke J M F , Eii P J , Marston A 
Published: March 2007

Abstract
A consecutive series of 41 patients undergoing elective aortic surgery had pre-operative assessment of cardiac function by radionuclide angiocardiography. Their subsequent progress was monitored. There were 4 patients whose pre-operative left ventricular ejection fraction was &lt;30 per cent and 3 of these patients died of cardiac failure postoperatively. There was only 1 death from cardiac failure amongst the 37 patients whose pre-operative left ventricular ejection fraction was &gt; 30 per cent. Radionuclide angiocardiography is an accurate indicator of myocardial function of patients before major aortic surgery.
Isotope lymphography: a new method of investigating the role of the lymphatics in chronic limb oedema
Authors: Stewart G , Gaunt Judith I , Croft D N , Browse N L 
Published: March 2007

Abstract
A method of investigating the lymphatic system by radionuclide imaging in patients with chronic lower limb oedema is described. The clearance of 99mTc rhenium sulphur colloid from the interdigital space of 55 limbs and its appearance in the ilio-inguinal lymph nodes 30 min, 1, 2 and 3 h later has been measured using a gamma camera in 34 limbs (26 patients) with the clinical and radiological features of primary lyphoedema, 10 limbs (8 patients) with venous oedema and 12 control limbs (6 volunteers). On visual interpretation the sensitivity of this technique in diagnosing lymphoedema was 97 per cent and its specificity 100 per cent, while it clearly differentiated between lymphoedema and venous oedema. Estimation of the percentage uptake of the colloid in the ilio-inguinal lymph nodes at 1/2, 1, 2 and 3 h showed a markedly decreased lymph flow in the 34 lymphoedematous limbs and an increased flow in the 10 limbs with venous oedema. The results suggest that this technique can be used as a simple diagnostic outpatient technique in the investigation of chronic limb oedema.
The place of laparoscopy in the management of the impalpable testis
Authors: Boddy Su-Anna M , Corkery J J , Gornall P 
Published: March 2007

Abstract
In a four-year period 46 boys have been laparoscoped in the search for 55 impalpable testes. Thirty-three per cent of the testes were located intra-abdominally. Another 53 per cent were absent. This could be diagnosed by laparoscopy alone in 35 per cent. Laparotomy was needed in only 3 boys to locate the testes.
Intramural rupture and intramural haematoma of the oesophagus
Authors: Yeoh N T L , McNicholas T , Rothwell-Jackson R L , Goldstraw P 
Published: March 2007

Abstract
We report on two cases of spontaneous intramural rupture and haematoma formation in the oesophagus. This is an unusual and often misdiagnosed condition. Its diagnosis relies on the history and a barium swallow. Instrumentation can result in further damage to the oesophagus and should be avoided. Treatment is conservative and results in resolution of the haematoma and a return to normal swallowing.
Early discharge despite postoperative pyrexia after inguinal herniorrhaphy in unselected patients
Authors: Belham G J , Emery R J , Cheslyn-Curtis Sarah , Ralphs D N L 
Published: March 2007

Abstract
Although shown to be suitable for selected patients with subsequent community medical and social support early discharge from hospital after inguinal hernia repair is apparently not well established. The application of such a policy may also be inhibited by postoperative pyrexia even though the cause of this is not evident. We report a series of 103 unselected patients presenting consecutively to an inner London hospital for hernia repair in whom early discharge was proposed in 95 per cent and achieved in 79 per cent irrespective of clinically unaccountable postoperative pyrexia and without special community health provision. This discharge policy placed no additional burden on the community health services and did not affect adversely patients' welfare, satisfaction or time off work.
Intrarectal ultrasound and computed tomography in the pre- and postoperative assessment of patients with rectal cancer
Authors: Romano G , De Rosa P , Vallone G , Rotondo A , Grassi R , Santangelo M L 
Published: March 2007

Abstract
The ability of intrarectal ultrasound to recognize the local extent of disease was investigated in 23 patients with histologically proven adenocarcinoma of the lower two-thirds of the rectum before operation. Two probes, 12cm long, working at a frequency of 3.5 and 7.5 MHz, were used. The results were compared with those of pre-operative computed tomography (CT) and with the pathological report of the resected specimens. Sonography correctly staged 20 of 23 tumours with two false negatives and one false positive, while CT correctly staged 19 of 23 tumours with two false negatives and two false positives. The results of ultrasound were found to be as accurate as those of CT; the low cost and simple use of ultrasound makes it preferable in the pre-operative assessment of the depth of invasion of rectal cancer. In addition, intrarectal ultrasound was routinely performed in 42 patients, operated on for rectal cancer by means of sphincter-saving procedures, at variable intervals in the first 2 years postoperatively. Eight local recurrences were recognized and confirmed by CT. Based on the low cost, reliability and simple use, intrarectal ultrasound is proposed as first examination for local recurrence detection in the follow-up of patients with low anterior resection for rectal cancer.
Carotid body tumour: 30 years experience
Authors: Dickinson P H , Griffin S M , Guy A J , McNeill I F 
Published: March 2007

Abstract
Thirty-two patients with 37 carotid body tumours, seen in the Vascular Unit at the Royal Victoria Infirmary, Newcastle upon Tyne between 1956 and 1985 are reviewed. Twenty-six of the tumours were treated by surgical excision. There were no peri- or postoperative deaths, but one patient developed a permanent hemiplegia following surgery (3.8 per cent); cranial nerve palsy occurred in five patients (19.2 per cent). There were no malignant tumours although in one patient, histology of the resected specimen showed the presence of local lymph node invasion (3.8 per cent). In the 7 patients who did not undergo surgery, 3 have been lost to follow-up; the remainder have not shown any significant increase in the size of the tumour. One patient was treated by radiotherapy. It is concluded that surgical excision is the treatment of choice, though observation may be preferred for the older patient with a symptomless, slow-growing tumour. To help reduce the risk of hemiplegia (the most serious complication of surgery) a meticulous surgical technique is necessary and heparin, intraluminal shunting and facilities for arterial repair and grafting must be at hand.
Small bowel necrosis after aorto-iliac reconstruction
Authors: Bergqvist D , Bowald S , Eriksson I , Lannerstad O , Takolander R 
Published: March 2007

Abstract
Small bowel ischaemia causing necrosis is a rare complication after aorto-iliac reconstructive surgery. During a 14-year-period we have seen 6 cases out of 1343 reconstructions, making a frequency of 0.4 per cent. Diagnosis was difficult, causing a delay until re-exploration. Thrombocytopenia was a constant finding, and should raise suspicion. Pathogenesis was multifactorial. In two of our cases diagnosis was made at autopsy and in four at operation. Two patients survived extensive bowel resection but had a long stormy postoperative course.
Role of catabolic hormones in the hypoketonaemia of injury
Authors: Watters J M , Wilmore D W 
Published: March 2007

Abstract
Adaptation to fasting results in ketosis, protein conservation, and diminished energy requirements. To determine whether the attenuation of these responses following injury is due to an altered hormonal environment, we infused the catabolic hormones cortisol, glucagon, and adrenaline into seven fasting subjects for 72 h. Saline alone was administered during a comparable control period. Hormone infusion achieved blood levels typical of moderate injury and resulted in hypermetabolism, hyperglycaemia, hyperinsulinaemia, and marked suppression of fasting ketosis. The hypoketonaemia could not be accounted for by decreased precursor availability, accelerated ketone utilization or increased urinary excretion. The altered hormonal environment associated with critical illness attenuates fasting ketosis by limiting hepatic ketogenesis.
Selective venous sampling for localization of hyperfunctioning parathyroid glands
Authors: Granberg P-O , Hamberger B , Johansson G , Lindvall N , Luthman Marguerite , Öhman U 
Published: March 2007

Abstract
Selective venous sampling with parathyroid hormone assay was used in 46 patients with primary hyperparathyroidism. All patients had previously been operated on in the neck region. In 80 per cent of the patients the method correctly located the position of the hyperfunctioning gland(s). No complications were observed. The method was found to be of great value when evaluating patients with persistent or recurrent hyperparathyroidism.
Short stay surgery for inguinal hernia: Experience of the Shouldice operation, 1970–1982
Authors: Devlin H B , Gillen P H A , Waxman B P , Macnay R A 
Published: March 2007

Abstract
Between mid 1970 and mid 1982, 696 patients underwent 718 operations for primary inguinal hernias by the Shouldice surgical technique. Follow-up to 31 December 1983 revealed 6 recurrences, 40 patients died during the follow-up period and 37 were lost to the study. Five patients required re-operation for complications of the suture material. Polypropylene was the most efficacious of the suture materials used during the study. Duration of hospital stay and age at operation do not influence the probability of recurrence. The operation gave consistently good results when performed by either a consultant surgeon or a surgeon in training. Using the Shouldice surgical technique the probability of recurrence of the inguinal hernia at 10 years is only 1 per cent.
Resection of the rectum with construction of a colonic reservoir and colo-anal anastomosis for carcinoma of the rectum
Authors: Lazorthes F , Fages P , Chiotasso P , Lemozy J , Bloom E 
Published: March 2007

Abstract
Rectal resection with colo-anal anastomosis was performed in 65 patients with carcinoma of the lower rectum. In 20 a pelvic colonic reservoir was constructed while in 45 a direct anastomosis was carried out. There were no postoperative deaths and morbidity was comparable in the two groups. Functional results were determined by clinical examination and manometry. The frequency of bowel movements was inversely related to the maximum tolerated volume (P &lt; 0.001). During the first year 60 per cent of the patients with a reservoir and 33 per cent of the patients without had one or two stools per day (P &lt; 0.05). After one year, 86 per cent of the patients with a reservoir and 33 per cent of the patients without had one or two bowel movements per day (P &lt; 0.01). The maximum tolerated volume was increased by the reservoir (P &lt; 0.05). The loss of reservoir capacity of the rectum increases frequency of bowel movements in colo-anal anastomosis. The creation of a colonic reservoir improves function by increasing the maximum tolerated volume without any increase in mortality or morbidity.
Role of the splanchnic nerves in endocrine and metabolic response to abdominal surgery
Authors: Shirasaka C , Tsuji H , Asoh T , Takeuchi Y 
Published: March 2007

Abstract
The splanchnic nerves are inevitably stimulated during upper abdominal surgery and this may produce various responses. To assess the role of splanchnic nerve stimulation on the endocrine–metabolic responses to abdominal surgery, intra-operative splanchnic nerve blockade was carried out in 12 patients undergoing elective gastrectomy under general anaesthesia and the results compared with those of patients undergoing gastrectomy under general anaesthesia or epidural analgesia alone. In the splanchnic blockade group, intra-operative increase in plasma cortisol, glucose, FFA (free fatty acids) and urinary adrenaline excretion were significantly less than that of the general anaesthesia group. This inhibitory effect of splanchnic blockade on these endocrine–metabolic responses was almost the same as, but slightly less remarkable than, that of high spinal epidural blockade. Urinary noradrenaline excretion reached the highest level on the first postoperative day in the general anaesthesia group. This noradrenaline response was significantly inhibited in the splanchnic group as well as in the epidural group. These results appeared to indicate that mechanical stimulation to the splanchnic nerve due to operative manipulation is largely responsible for the endocrine–metabolic responses in abdominal surgery. The results also suggested that, in addition to the splanchnic nerve stimulation, conscious pain perception is responsible for catecholamine release.
Delayed perineal wound healing after proctectomy for Crohn's colitis
Authors: Scammell Brigitte E , Keighley M R B 
Published: March 2007

Abstract
The rate of perineal wound healing was assessed in a series of 112 patients undergoing proctectomy for Crohn's colitis. Healing was impaired in patients with a high fistula-in-ano or a rectovaginal fistula pre-operatively, faecal contamination and postoperative perineal sepsis. Early healing (within 12 weeks) occurred in 63 per cent of the patients. Healing was delayed by over one year in 21 patients, and in 10 patients the perineal wounds never healed.
The presentation and management of presacral tumours
Authors: Stewart R J , Humphreys W G , Parks T G 
Published: March 2007

Abstract
Twenty cases of presacral tumours are presented, nine males and eleven females being affected. Malignancy occurred in 50 per cent of adults and was commoner in men than in women. Diagnosis depends on a careful rectal examination. Computerized axial tomography is the single most useful investigation; however, should it not be available, plain X-rays and ultrasonography give considerable information. For lesions &lt; 10 cm in size a local parasacral approach is often feasible but for larger lesions an abdominal approach or combined approach should be considered.
Surgical biopsy for persistent generalized lymphadenopathy
Authors: Rashleigh-Belcher H J C , Carne C A , Weller I V D , Smith A M , Russell R C G 
Published: March 2007

Abstract
Lymph node biopsy was performed in 39 homosexual men with unexplained persistent generalized lymphadenopathy (PGL). Thirtyseven (95 per cent) of these patients had antibodies to human Tlymphotropic virus type III (HTLV-III), at the time of biopsy. Histology in all but one showed only follicular hyperplasia, the exception showed caseating granulomata typical of tuberculosis. Clinical differentiation between lymphadenopathy associated with HTLV-III and other causes of generalized lymphadenopathy is difficult; however, the presence of antibodies to HTLV-III probably identifies patients in whom surgical biopsy will only occasionally reveal a specific histological diagnosis. It is suggested that the presence of antibodies to HTLV-III in patients with PGLjustifies a more selective approach to lymph node biopsy.