bluuebunny/crossref_metadata_2025_split huggingface dataset:
Influence of pancreatic resection on systemic complications in acute necrotizing pancreatitis
Authors: Teerenhovi O , Nordback I , Isolauri J 
Published: March 2007

Abstract
The influence of pancreatic resection on early systemic complications of acute necrotizing pancreatitis was evaluated in 84 patients. The aetiology of pancreatitis was alcohol 71 per cent, gallstones 13 per cent, alcohol plus gallstones 2 per cent, trauma 1 per cent and idiopathic 12 per cent. A total of 26 of 81 patients (32 per cent) had greater than 50 per cent pancreatic necrosis and 9 patients (11 per cent) considered to have parenchymal necrosis at operation had none shown histologically. The overall mortality was 38/84 (45 per cent) and mortality during the first postoperative week was 15/84 (18 per cent). The outcome after early and delayed operation did not differ significantly. Pancreatic resection had no beneficial effect on shock or respiratory or renal failure (respective pre-operative incidence 12 per cent, 11 per cent and 14 per cent).
Gallbladder non-filling: An indication for cholecystectomy after endoscopic sphincterotomy
Authors: Worthley C S , Toouli J 
Published: March 2007

Abstract
The place of endoscopic sphincterotomy in the treatment of common duct stones leaving the gallbladder in situ remains controversial. Over a 3-year period, 20 elderly high-operative-risk patients with stones in the common duct and intact biliary tree were treated by endoscopic sphincterotomy leaving the gallbladder in situ. Two patients underwent cholecystectomy for persistent symptoms after endoscopic sphincterotomy, and 18 patients were discharged from hospital, with the gallbladder intact. Of the 18 patients, 6 developed recurrent gallbladder problems, with 3 of the 6 dying as a result of these problems. On review of our data, these six patients were in a group of eight who, at the time of original endoscopic retrograde cholangiography (ERC), were shown to have an obstructed cystic duct. The other 10 patients, with a patent cystic duct and discharged with gallbladder in situ, remained symptom free over a median follow-up period of 9 (range 2–42) months. We conclude that if the gallbladder does not fill at ERC (indicating probable cystic duct obstruction), cholecystectomy is warranted. When the gallbladder fills, regular follow-up alone is justified in the absence of symptoms.
Application of mammary serum antigen assay in the management of breast cancer: A preliminary report
Authors: Tjandra J J , Russell I S , Collins J P , Stacker S A , McKenzie I F C 
Published: March 2007

Abstract
A monoclonal antibody (3E1.2) based serum test using an enzyme immunoassay has been used to determine circulating levels of the breast cancer associated antigen—mammary serum antigen (MSA). Of 157 patients with early breast cancer (stage I and II) and 199 patients with advanced breast cancer (stage III and IV), 73 per cent and 87 per cent respectively had elevated MSA levels (i.e. &gt; 300 inhibition units (IU). Furthermore, 40 of 44 patients (91 per cent) had a significant fall of MSA levels with reduction in tumour load by mastectomy. In addition, there was a correlation of MSA levels with the clinical course: changes in MSA levels correlated with changes in disease status (progressive disease, stable disease, disease regression) in 54 of 61 patients and antedated disease progression or recurrence by up to 8 months in some patients; and in 32 of 36 patients (89 per cent) with no clinical evidence of recurrence MSA levels did not vary by more than 25 per cent of the original MSA value over a period of 2–15 months. MSA is therefore a useful tumour marker in the diagnosis and staging of breast cancer. There is also evidence that serial estimations of MSA levels may be used to detect subclinical recurrence and the fluctuations in MSA levels might be useful in assessing response to therapy. Furthermore, it was also noted that surgical procedures such as fine needle aspiration biopsy or incisional biopsy could lead to a rise in MSA levels.
Bilateral spontaneous descent of the testis after the age of 10: Subsequent effects on fertility
Authors: Rasmussen T Bremholm , Ingerslev H J , Høstrup H 
Published: March 2007

Abstract
Fertility after late spontaneous descent of the testes in 45 men with previous bilateral undescended testes was evaluated on the basis of seminal analysis and concentrations of follicle-stimulating hormone (FSH) in serum. Only 15 (33 per cent) were found to have a normal fertility as estimated from the results of the total semen analysis, whereas 21 (47 per cent) were classified as being sterile or having severely reduced fertility. Elevated serum FSH concentrations in the majority of men with subnormal sperm densities supported the results of the semen analysis, indicating impaired spermatogenesis. These findings suggest that the expectant attitude in the treatment of cryptorchidism does not seem to be justified in terms of fertility and combined with recent histomorphological studies favour a more active and early treatment of undescended testes.
Penetrating injuries of the diaphragm
Authors: Demetriades D , Kakoyiannis S , Parekh D , Hatzitheofilou C 
Published: March 2007

Abstract
This study involved 163 patients with penetrating injuries of the diaphragm (knife, 139; bullet, 24). Intra-abdominal injuries were present in 122 patients (75 per cent) and this resulted in early diagnosis and treatment of the associated diaphragmatic injury (mortality 3.2 per cent). In the remaining 41 patients (25 per cent) the injury was confined to the diaphragm, and the diagnosis was missed during the initial admission in 10 patients who returned at a later stage with diaphragmatic hernia. A diaphragmatic hernia was found in 24 cases (14.7 per cent). Fourteen of these were diagnosed during the initial admission (mortality 7.1 per cent) and the remaining ten were diagnosed during a subsequent admission (mortality 30 per cent). The initial chest radiograph was diagnostic of diaphragmatic injury in 13 per cent, abnormal but not diagnostic in 76 per cent, and completely normal in 11 per cent. The importance of early diagnosis in reducing mortality, morbidity and hospital stay is emphasized. A high index of suspicion, careful clinical examination, and serial chest radiographs remain the best way of making the diagnosis.
Use of fine needle aspiration cytology with immediate reporting in the diagnosis of breast disease
Authors: Nicholson S , Sainsbury J R C , Wadehra V , Needham G K , Farndon J R 
Published: March 2007

Abstract
Fine needle aspiration biopsy for cytological examination (FNAC) is becoming increasingly accepted as a means of tissue diagnosis in breast disease. This study examines the feasibility and accuracy of FNAC in ‘immediate reporting’ by a consultant cytopathologist in a busy breast clinic. Over a 2-year period, 884 cytology reports were analysed. An initial clinical report and subsequent final cytological diagnosis was made. Fine needle aspiration provided adequate material for cytological evaluation in 635 of the 884 biopsies (71·6 per cent) and this proportion was greater when discrete lumps were considered (463 of 562 biopsies = 82·4 per cent). In diffuse and cystic disease, however, the adequacy of specimens was reduced: 50 per cent and 65 per cent respectively. On immediate reporting the diagnostic sensitivity for all patients was 88 per cent (discrete lumps only, 92·5 per cent) and the specificity was 99·8 per cent (discrete lumps only, 100 per cent). FNAC retains its diagnostic accuracy when immediate reporting is employed and this study demonstrates that this technique can be used in making a diagnosis in patients with breast disease.
Role of Doppler ultrasound flowmetry in the diagnosis of breast lumps
Authors: Srivastava A , Webster D J T , Woodcock J P , Shrotria S , Mansel R E , Hughes L E 
Published: March 2007

Abstract
One hundred and five patients with discrete breast lumps were examined with a 10 MHz Doppler ultrasonic flowmeter. Doppler flow signals were analysed on an Angioscan spectrum analyser. Recordings from the opposite normal breast were taken as controls and signals from the two sides compared. In 23 patients signals from the normal breast could not be recorded and therefore results of the remaining 82 patients are reported. These included 39 patients with carcinoma, 20 with fibroadenoma, 12 with cyclical nodularity and 11 with cysts. Malignant lumps exhibited significantly higher peak systolic (S) and minimum diastolic frequencies (D) in comparison to the control breast. Fibroadenoma also had a higher S and D than those of the opposite normal breast. Signals over cysts and cyclical nodularity showed no significant difference from the recordings over the control side. Despite significantly higher systolic and diastolic frequencies in the cancer group in comparison to benign lumps and normal breast, considerable overlap in the values was seen between cancer and other groups. Therefore the patterns on 10 MHz Doppler sonography are not sufficiently specific to discriminate benign from malignant breast lumps.
Cholelithiasis: A serious complication after total gastrectomy
Authors: Hauters P , De de Roden A Neve , Pourbaix A , Aupaix F , Coumans P , Therasse G 
Published: March 2007

Abstract
To establish the incidence of cholelithiasis after total gastrectomy patients operated on between 1979 and 1985 were reviewed. The study group consisted of 30 patients, all free of gallstones at the time of their gastrectomy. The median age of the patients was 56 years, the average follow-up 40 months. Cholelithiasis developed in 47 per cent of patients (14/30) and always within 2 years of total gastrectomy. The incidence of cholelithiasis was not related significantly to the sex or age of the patients. Morbidity from cholelithiasis was not negligible. Three of the fourteen patients presenting with gallstones required medical treatment in hospital and later came to cholecystectomy because of specific biliary symptoms. Cholelithiasis appears to be a significant complication after total gastrectomy. It may be related to the vagotomy which is performed at the time of gastrectomy.
Definitive radiation therapy for selected cancers of the rectum
Authors: Sischy B , Hinson E J , Wilkinson D R 
Published: March 2007

Abstract
During the last 15 years, over 400 patients with adenocarcinoma of the rectum have undergone a course of endocavitary irradiation for cure or palliation of Dukes' A and B disease. This treatment method makes use of an unconventional fractionation scheme, by which the tumour receives 10000–12000 cGy in approximately four fractions over a period of about 60 days. The treatments are separated by an interval of 2 or 3 weeks. This method of definitive irradiation allows suitable patients to avoid abdominoperineal resection and its drawbacks. Hospitalization is avoided and the patients maintain a normal daily life. Approximately 15–20 per cent of all rectal cancer patients may be expected to fulfil the criteria for selection, which are sufficiently strict that the local control (95 per cent) and 5-year survival rates (94 per cent) can exceed those of surgery for comparable disease.
An aetiology for fistula in ano
Authors: Pople I K , Ralphs D N L 
Published: March 2007

Abstract
Four cases of superficial peri-anal fistula occurring in early infancy are described. They were all successfully treated by complete excision of the fistula. Histological examination of the excised fistulae revealed a mixture of columnar, transitional and stratified squamous epithelium lining the tracts in three cases and non-specific connective tissue in the fourth. It is postulated that the presence of these inappropriate types of epithelium (columnar and transitional) along the length of the fistulous tract is evidence of a congenital origin for peri-anal fistulae presenting in the first few months of life.
Villous tumours of the large bowel
Authors: Pollard S G , Macfarlane R , Everett W G 
Published: March 2007

AbstractA series of 110 patients with villous tumours of the colon and rectum treated by a single surgeon over an 18-year period is reported. Multiple lesions were present in 15 per cent of patients and 24 per cent of cases contained invasive malignancy, of which 83 per cent were Dukes' A. The major lesion was in the rectum in 84 per cent of patients and in the sigmoid colon in 12 per cent. Rectal bleeding and diarrhoea were the most common presenting symptoms; 6 per cent of patients were asymptomatic. Digital assessment proved a more reliable indicator of the presence of malignancy than either random biopsy or barium enema. In all, 70 of 76 (92 per cent) benign rectal lesions and 15 of 22 (68 per cent) malignant rectal lesions were successfully removed by peranal submucous excision or snaring and none of the malignancies so treated has developed a recurrence to date. Benign recurrence has developed in 13 per cent of all patients; the majority appeared within 4 years and were at the same level as the initial lesion. Of the 79 patients with benign tumours 7·6 per cent have subsequently developed large bowel carcinomas, after 2–16 years; all were symptomatic, half were at the same level as the previous benign lesion, and half were suitable for peranal removal.
Preduodenal mechanisms in initiating gallbladder emptying in man
Authors: Ellenbogen S , Jenkins S A , Grime J S , Critchley M , Mackie C R , Baxter J N 
Published: March 2007

Abstract
The existence of preduodenal phases of gallbladder emptying in normal volunteers was investigated by evaluating the effect of sham feeding a sandwich (chew and spit) (n = 15), the sight and smell of food followed by sham feeding a cooked meal (n = 15), and gastric distension (intragastric balloon tube) (n = 9) on gallbladder emptying and comparing these responses with those after ingestion of a standard meal (n = 14). A control group given no intestinal stimuli were studied to determine the frequency of spontaneous emptying during fasting (n = 18). 99mTc-EHIDA (2,6 diethylphenylcarbamoylmethyliminodiacetic acid) was used as the biliary tracer. The frequency of gallbladder emptying during fasting was 0.0045/min. Thus, in any 20 min period emptying occurred spontaneously in only about 1 in 11 volunteers. Significant emptying (&gt; 5 per cent over 20 min) occurred in 8 out of 15 volunteers after sham feeding a sandwich (P &lt; 0.001 versus control), in 8 out of 15 volunteers after sham feeding a cooked meal (P = 1.0 versus sandwich sham feed, n.s.), in 6 out of 9 volunteers after gastric distension (P &lt; 0.001 versus control) and in 14 out of 14 volunteers after meal ingestion. The rate of emptying was significantly greater in the gastric distension and meal ingestion groups compared with other groups (P &lt; 0.05). However, the emptying rate after sham feeding was not significantly different from spontaneous gallbladder emptying (P &gt; 0.05, n.s.). These was no significant difference in time to onset of emptying between the four stimulus groups (P &gt; 0.05, n.s.). These results suggest that pre-duodenal stimuli can evoke gallbladder emptying in man, although the precise physiological significance of this phenomenon remains to be established.
Surgical treatment of hepatic hydatid disease
Authors: Dawson J L , Stamatakis J D , Stringer M D , Williams R 
Published: March 2007

Abstract
The results of surgery in 48 patients with hepatic hydatid disease are described. In 26 out of 32 patients with uncomplicated cysts, conservative surgery with obliteration of the cyst cavity by omentoplasty gave satisfactory results. In contrast, 16 patients with cysts complicated by pyogenic infection or cholangitis required a variety of surgical procedures, including prolonged tube drainage, exploration of the common bile duct, sphincterotomy/plasty and hepatojejunostomy to achieve a satisfactory outcome. The group with complicated cysts also had a much longer postoperative stay (median 30 days) than those with uncomplicated cysts (median 14 days). Two patients died: in one, post-mortem examination revealed carcinoma in the wall of the cyst.
Surgical glove perforation
Authors: Dodds R D A , Guy P J , Peacock A M , Duffy S R , Barker S G E , Thomas M H 
Published: March 2007

Abstract
In a study to investigate the incidence and significance of surgical glove perforation, bacterial contamination of surgeons' hands and gloves before and after operation was measured and the gloves tested for damage. Perforations were found in 74 of 582 gloves (12.7 per cent) and occurred in 34–5 per cent of operations. Glove perforation did not influence bacterial counts on the surgeons' hands or on the outside of their gloves. A separate clinical study of 100 adult hernia repairs gave no evidence that perforation increased wound sepsis. After standard pre-operative hand preparation, glove perforations are of no clinical significance to the patient, but their high incidence should alert surgeons to the need for protection against pathogens transmissible during surgery, such as hepatitis B and the human immunodeficiency virus. Protection of the surgeon is the main indication for peroperative change of damaged gloves.
Thrombosis prophylaxis with low molecular weight heparin in total hip replacement
Authors: Eriksson B I , Zachrisson B E , Teger-Nilsson A-C , Risberg B 
Published: March 2007

Abstract
In a randomized prospective trial, the efficacy of low molecular weight heparin (LMWH) (Fragmin®) and dextran 70 (Macrodex®) in preventing deep vein thrombosis (DVT) in the legs was evaluated in 98 consecutive patients undergoing elective total hip replacement. The patients were randomly allocated to receive either 2500 anti-factor Xa units LMWH twice daily for 7 days, with the first dose given 2 h before surgery; or 500 ml dextran 70 twice during the day of operation, followed by a single infusion of 500 ml on the first and again on the third postoperative day. DVT was assessed by 125I-fibrinogen test for 2 weeks postoperatively, a positive test being followed by phlebography. DVT developed in 22 (45 per cent) of 49 patients receiving dextran 70 and in 10 (20 per cent) of 49 patients in the LMWH group (P &lt; 0.01). LMWH was thus statistically significantly better than dextran 70 in preventing DVT in the legs. It was not firmly established whether this benefit was also valid in the high ileofemoral region. Two patients with non-fatal pulmonary embolism were found in each group. Per- and postoperative blood loss and blood transfusion requirements were significantly lower in the LMWH group.
Erythrocyte membrane stearic and oleic acid ratios in breast cancer
Authors: Thomas B S , O'Dea J , Fentiman I S 
Published: March 2007

Abstract
A case control study has been conducted to determine the value of stearic/oleic acid ratios in the erythrocyte membranes of women at the time of presentation with breast cancer. No difference was found between the stearic/oleic acid ratio of cases and that of controls with benign breast condition or normal volunteers. Furthermore, within clinical stages of breast cancer, no differences were detected. This ratio does not appear to be of value as a marker of malignancy, or of tumour burden.
A new non-operative approach to fistula in ano
Authors: Misra M C , Kapur B M L 
Published: March 2007

Abstract
The results of a new out-patient approach to fistula in ano are presented. The technique involved passing a multi-strand stainless steel wire through the fistulous tract and has been used in 56 patients with low fistulae as well as high horseshoe anal fistulae. Recurrence was seen in only 2 patients and none of the patients experienced temporary or permanent incontinence of flatus or faeces.
Total duodenal diversion in the treatment of complicated peptic oesophagitis
Authors: Perniceni T , Gayet B , Fékété F 
Published: March 2007

Abstract
Total duodenal diversion (TDD) has been carried out in 59 patients with complicated forms of peptic oesophagitis (acquired short oesophagus, columnar lined oesophagus, previous oesophagogastric surgery, stenosis). A standard procedure (truncal vagotomy, antrectomy and gastrojejunal anatomosis using a 70 cm Roux-en-Y loop) was performed in 41 patients, and some technical adjustments were required in 18 patients previously operated on. One patient died from postoperative pulmonary embolism. Bowel movements were resumed before the fifth postoperative day in 93 per cent of patients (54/59). Early postoperative complications (gastroparesis, 5; fistula, 1; subsequent operation, 1) occurred in 12 per cent of patients. Stabilization of the oesophagitis was achieved in less than 3 months in 95 per cent of cases (55/58). There were two cases of regression of columnar lined oesophagus. A 3-h postprandial pH assessment showed that the reflux had been controlled in 92 per cent of cases (47/51). One patient who still had an acid reflux died subsequently of a perforated oesophageal ulcer. Three anastomotic ulcers occurred in eight patients who did not have vagotomy. Digestive side-effects have been observed in nine patients, but only in one case were they crippling. Our results suggest that TDD is a suitable form of treatment for complicated forms of peptic oesophagitis.
Relaparotomy for postoperative intra-abdominal sepsis in jaundiced patients
Authors: Mäkelä J , Kairaluoma M I 
Published: March 2007

Abstract
During the period 1979–84, 30 abdominal re-explorations were performed for postoperative intra-abdominal sepsis and single or multiple organ failure in jaundiced patients. Postoperative sepsis was caused by intra-abdominal abscess in 16 cases (53 per cent), by suture line leakage in 9 cases (30 per cent) and by technical error in 5 cases (17 per cent). Abscesses occurred most commonly in the subphrenic space (6 cases), in the subhepatic space (6 cases) and in the lesser sac (5 cases). Sepsis was associated with single organ failure in 20 cases and with multiple organ failure in 10 cases. The overall mortality rate was 50 per cent (15/30). Factors that were statistically associated with fatal outcome were: serum bilirubin &gt; 100 μmol/l (P&lt;0·008), positive blood culture (P&lt;0·013), malignant disease (P&lt;0·02), multiple organ failure (P&lt;0·02) and age &gt; 60 years (P&lt;0·031). Mortality rose with the number of failed organs. Autopsy revealed continuing sepsis in 12 of the 15 fatal cases. Because mortality was high in spite of adequate operative drainage at relaparotomy, it is concluded that earlier definitive diagnostics are needed to lower the mortality rate.
Management of symptomatic gallstones in the elderly
Authors: Irvin T T , Arnstein P M 
Published: March 2007

Abstract
In a study of 544 patients with symptomatic gallstones 158 subjects were aged &gt; 70 years. Elderly patients had a significantly higher incidence of emergency presentation, jaundice, cholangitis, ductal stones, biliary drainage procedures, and acute complications requiring urgent or emergency surgery (P &lt; 0·001); they had more than twice the incidence of postoperative complications in comparison with patients aged &lt; 70 years. There was an increased perioperative mortality in the elderly (1·3 per cent after cholecystectomy and 2·9 per cent after bile duct exploration, P = 0·039). Conservative treatment in 11 per cent of elderly patients resulted in no mortality due to gallstones, but 3 of 17 patients had recurrent biliary symptoms. It was estimated that 38 per cent of the bile duct explorations in the elderly might have been avoided by referral for endoscopic sphincterotomy, but surgical treatment of gallstones in the district general hospital is relatively safe and specialist referral should be considered only in the relatively small number of ‘high risk’ cases.