bluuebunny/crossref_metadata_2025_split huggingface dataset:
Typhoid enteric perforation
Authors: Chouhan M K , Pande S K 
Published: March 2007

Abstract
A review of 344 patients with typhoid perforation of the intestine is presented. Patients with enteric perforations should be treated with antibiotics, by fluid and electrolyte replacement and blood transfusion. Surgery is necessary to close the perforated gut and drain the contaminated peritoneum with the minimum surgical interference which will achieve these objectives. Although better conservative management has significantly reduced the mortality of typhoid perforation, early limited surgery is most important if good results are to be obtained.
A study of cytoplasmic oestrogen receptors in patients with breast cancer in a district general hospital
Authors: Spencer G R , Prothero D L , Dawkins P D , Akehurst A C , Turner D R 
Published: March 2007

Abstract
The tumours of 61 patients suffering from primary adenocarcinoma of the breast were assayed for oestrogen receptors (ER), using the dextran-coated charcoal method. A statistically significant relationship (P &lt; 0.05) was found to exist between ER status and the histological grade of the tumour. No relationship was found between ER status and either tumour size or the pathological state of the axillary lymph nodes. It is concluded that it is a practical proposition to establish an ER assay service in a district general hospital, with subsequent benefits for the individual patient.
Primary hyperparathyroidism due to overactive intrathyroid parathyroid glands: A potential cause of failed exploration
Authors: Bainbridge E T , Barnes A D 
Published: March 2007

Abstract
The variable location of the parathyroid glands is a significant factor in unsuccessful cervical exploration for hyperparathyroidism. Particular difficulty may be experienced when an overactive parathyroid is concealed within the substance of the thyroid. Currently available methods of localizing abnormal parathyroid tissue may well fail to indicate an intrathyroid location. The latter possibility should always be considered whenever thorough cervical exploration has failed to reveal a parathyroid tumour as such awareness may obviate re-exploration or an unnecessary sternotomy. This report details the clinical features and operative findings in 6 patients whose primary hyperparathyroidism was due to an overactive intrathyroid parathyroid gland. Successful parathyroid surgery demands a strict routine exploration of the possible sites of overactive glands, virtually all of which are easily accessible through a standard collar incision.
Clinical trials of the efficacy and duration of antibacterial cover for elective resection in inflammatory bowel disease
Authors: Hares M M , Bentley Sandra , Allan R N , Burdon D W , Keighley M R B 
Published: March 2007

Abstract
A prospective double-blind placebo controlled trial was performed to test the value of 24-h cover with metronidazole and gentamicin in 57 patients requiring elective resections for inflammatory bowel disease (phase 1). The short term antimicrobial cover was not associated with a reduction in the incidence of postoperative sepsis. A further group of 30 patients who received metronidazole and gentamicin cover for 5 days (phase 2) was therefore studied and the results were compared with phase 1. There was a significant reduction in the incidence of sepsis in the patients receiving 5-day postoperative antibiotic cover compared with the placebo group.
Detection of carotid bifurcation disease: Comparison of ultrasound tests with angiography
Authors: Padayachee T S , Lewis R R , Gosling R G 
Published: March 2007

Abstract
Doppler-shift ultrasound with spectral analysis permits the measurement of the relative heights of systolic peaks (the A/B ratio) in blood velocity sonograms from supra-orbital and common carotid arteries, the temporal artery occlusion test, the common carotid resistance index and transit times of flow-velocity waves in the internal carotid pathway. The results are compared with 201 carotid angiograms and expressed in terms of sensitivity (true positive) and specificity (true negative).
Supra-orbital and common carotid A/B ratios, in combination with the temporal artery occlusion test, detected all grades of carotid artery disease with a sensitivity of 72 per cent and a specificity of 93 per cent. The corrected transit time gave a sensitivity of 57 per cent and a specificity of 89 per cent, whilst the Resistance Index gave a sensitivity of 60 per cent and a specificity of 80 per cent.
The values of ultrasound parameters associated with severe disease, defined as reductions in lumen diameter of 75 per cent or more, of the internal carotid artery are examined. The temporal artery occlusion test gave a sensitivity of 91 per cent and a specificity of 94 per cent. These results were more accurate than those obtained for the corrected transit time (sensitivity 83 per cent, specificity 92 per cent) and for the Resistance Index (sensitivity 75 per cent and specificity 92 per cent).
The results show that of the tests described the supra-orbital and common carotid artery A/B ratios, together with the temporal artery occlusion test, gave the best sensitivity and specificity for detection of both severe and minor carotid bifurcation disease.
Inflammatory bowel disease in the older patient
Authors: Carr N , Schofield P F 
Published: March 2007

Abstract
This paper presents a review of 64 patients in whom the first symptoms of inflammatory bowel disease occurred after the age of 60 years. Inflammatory bowel disease in older patients affects the large bowel much more commonly than the small bowel. The commonest variant is disease localized in the rectum and distal colon, and many of these patients have Crohn's disease (14 out of 28 patients). In 19 patients with localized left-sided colitis it was difficult to distinguish ischaemic colitis, acute diverticulitis and Crohn's disease. Patients with left-sided colitis or total colitis (15 patients) had a high incidence of acute complications, particularly colonic perforation. There should be an awareness of the risks associated with all types of colitis in the older patient.
A comparison of intravenous and oral metronidazole as prophylactic in colorectal surgery
Authors: Beggs F D , Jobanputra R S , Holmes J T 
Published: March 2007

Abstract
In a prospective randomized double-blind trial we have compared oral (n = 46) and parenteral prophylaxis (n = 51) with metronidazole in elective colonic resection. All patients received oral or intravenous metronidazole, together with oral neomycin. The overall infection rate was 11·3 per cent. Six out of 46 patients in the oral group (13 per cent) had a wound infection postoperatively compared with 5 out of 51 patients who received intravenous metronidazole (9·8 per cent). These results suggest that there is no significant difference whether metronidazole is administered intravenously or orally as a prophylactic in elective colonic surgery.
Surgery for primary hyperparathyroidism: Experience with 500 consecutive cases and evaluation of the role of surgery in the asymptomatic patient
Authors: Russell Colin F , Edis Anthony J 
Published: March 2007

Abstract
A group of 500 patients with a presumptive diagnosis of primary hyperparathyroidism (HPT) was operated upon at the Mayo Clinic between September 1974 and May 1980 using a standardized operative strategy. Clinical profiles, biochemical data, operative findings and pathological changes are reviewed. Of the 500 patients, 461 (92·2 per cent) were cured after primary cervical exploration. One patient died during the postoperative period, 1 had a permanent unilateral vocal cord paralysis and 10 (2 per cent) had protracted hypoparathyroidism. Owing to the continuing controversy regarding the appropriate therapeutic management of asymptomatic, uncomplicated and mild (‘biochemical’) primary HPT, we further evaluated this surgical experience by comparing the results of operation in two groups of patients: those with (‘biochemical’) HPT (serum calcium &lt; 11 mg/dl) and those with ‘non-biochemical’ HPT (symptomatic or complicated disease or serum calcium &gt; 11 mg/dl). The cure rate in each patient group was greater than 90 per cent. A statistically significant increase in the incidence of negative cervical exploration (4 normal parathyroid glands identified and biopsied) was noted in the ‘biochemical’ group. However, parathyroid disease was found at operation in 92 per cent of these patients. We conclude that cervical exploration in all patients with primary HPT, including those with ‘biochemical’ disease only, is safe and that such an aggressive management policy is justified.
Factors identifying the probability of further haemorrhage after acute upper gastrointestinal haemorrhage
Authors: Macleod I A , Mills P R 
Published: March 2007

Abstract
Ninety-five (24 per cent) of 389 admissions with acute upper gastrointestinal haemorrhage had further haemorrhage. An analysis of factors leading to further haemorrhage was undertaken by considering patients' clinical history, physical state on admission and endoscopic findings. The risk of further haemorrhage was significantly greater in patients bleeding from oesophageal varices or peptic ulcer and in those patients who were sober, shocked or anaemic on admission. Overall, those over 60 years of age were more likely to rebleed, but this difference was not apparent in relation to endoscopic source of blood loss.
Percutaneous transhepatic drainage in obstructive jaundice: Advantages and problems
Authors: McPherson G A D , Benjamin I S , Habib N A , Bowley N B , Blumgart L H 
Published: March 2007

Abstract
This study is a critical prospective assessment of 37 patients with obstructive jaundice, treated by percutaneous transhepatic biliary drainage. The median duration of drainage was 18 days (range 44–56), and during this period clearance of bilirubin and improvement in creatinine clearance were obtained. Only 10 patients gained weight. Three patients required early laparotomy. Thirty-three patients underwent definitive surgery. Of these, 8 died without leaving hospital. The incidence of infection rose during drainage, and infected bile was clinically significant. Two deaths were associated with infection, arising in the drainage system, producing intrahepatic abscesses around the drain track.
While the evidence for a staged approach in the severely ill patient with obstructive jaundice is substantial, the procedure of percutaneous transhepatic tubal drainage carries significant hazards, under-emphasized in previous reports. Further controlled assessment is required before this technique is accepted as the initial best option for decompression of the obstructed biliary tract.
The use of jejunal interposition for intractable symptoms complicating peptic ulcer surgery
Authors: Ramus N I , Williamson R C N , Johnston D 
Published: March 2007

Abstract
Ten patients severely disabled by post-gastrectomy syndromes were allocated to two treatment groups. Those with predominant dumping received a 10-cm antiperistaltic jejunal interposition; those with predominant bile vomiting received a 20-cm isoperistaltic interposition. After follow-up for a minimum of 3 years, 6 patients remained virtually asymptomatic (Visick grades 1 and 2). There were 2 deaths from myocardial infarction, 6 months and 2 years after remedial surgery. One patient developed a stomal ulcer after successful treatment of dumping. Jejunal interposition appears to be a safe and relatively successful procedure. A short antiperistaltic loop is recommended for early dumping; for bile vomiting a longer isoperistaltic segment is a satisfactory alternative to Roux-en-Y conversion.
Active trypsin and reflux oesophagitis: An experimental study in rats
Authors: Mud H J , Kranendonk S E , Obertop H , Van Houten H , Westbroek D L 
Published: March 2007

Abstract
In order to clarify the role of active trypsin, bile acids and pepsin in reflux oesophagitis, a comparable series of experiments was performed in rats before and after reflux-inducing operations. Three control procedures were used—laparotomy (n = 10), oesophageal transection and reanastamosis (n = 7) and a Roux-en-Y reconstruction (n = 9)—and seven experimental procedures in order to produce gastric, bile and pancreatic reflux (G + B + P) (n = 9), gastric and pancreatic reflux (G + B) (n = 8), bile and pancreatic reflux (B + P) (n = 10), pancreatic reflux alone (P) (n = 9), gastric reflux alone (G) (n = 8), bile reflux alone (B) (n = 9) and gastric with bile reflux (G + B) (n = 9). Macroscopic and histologically confirmed oesophagitis was produced in groups G + B + P, G + P, B + P and P. The trypsin levels were significantly elevated in these groups, compared to both the control and other experimental groups (P &lt; 0·01). Bile acid levels were insignificantly different between the groups. Because these experiments involved vagal transection, no oesophagitis was found in the gastric juice reflux group.
This study has shown for the first time a correlation between the presence of active trypsin in the oesophagus and the occurrence of oesophagitis. It is possible that active components of duodenal juice may contribute to the development of reflux oesophagitis in man.
Resection and sutured colo-anal anastomosis for rectal carcinoma
Authors: Parks Alan G , Percy John P 
Published: March 2007

Abstract
Resection with preservation of the anal sphincters is now widely accepted as providing satisfactory treatment for carcinoma of the upper rectum. However, restorative resection is less widely performed for tumours of the lower rectum because anastomosis can be technically difficult when performed low in the pelvis. Between 1973 and 1980, 76 patients with rectal carcinoma underwent rectal resection and restoration of bowel continuity by means of a sutured anastomosis between colon and anal canal. The pathological characteristics of these tumours were similar to those of all cases of carcinoma of the rectum treated at St Mark's Hospital between 1948 and 1972. Two patients developed pelvic sepsis following colonic necrosis and anastomotic breakdown. Eight developed pelvic sepsis without major anastomotic breakdown. No patient died as a result of pelvic sepsis. Sixty-nine of the 70 patients who were able to be assessed were either completely normal functionally or had only minor deficiencies of bowel function.
Six patients have been observed to develop recurrent pelvic tumour, localized to the pelvis in 4 patients and concurrent with the development of widespread metastases in 2. Twenty-one of 32 patients are alive 3 years and 12 of 19 patients are alive 5 years after a curative operation for rectal carcinoma. These results are comparable with those seen following total excision of the rectum and pelvic floor for similarly sited tumours.
Results of extended surgery for cancer of the rectum and sigmoid
Authors: Bonfanti Giuliano , Bozzetti Federico , Doci Roberto , Baticci Fabio , Marolda Raffaele , Bignami Paola , Gennari Leandro 
Published: March 2007

Abstract
The clinical records of 61 patients who underwent extended surgery, including resection of parietes or other viscera, from 1965 to 1977 for cancer of the rectum and sigmoid were reviewed. Abdominoperineal resection was performed in 41 patients, anterior resection in 18 and Hartmann's resection in 2. The postoperative mortality rate was 8·2 per cent, the non-lethal morbidity rate 30·3 per cent, but 4 patients presented multiple complications. The 5-year survival rate was evaluated separately for patients with and without microscopic evidence of neoplastic involvement of the simultaneously excised structures; in the first group it was 32 per cent, in the second 75 per cent. Local or distant recurrence occurred in 66 per cent of patients with microscopic infiltration and in 24 per cent of patients without microscopic infiltration. These results compare favourably with those reported after ordinary resections of Dukes' C cancers of the rectum and sigmoid, and seem to justify the use of extended surgery when cancer of the rectum and sigmoid has invaded contiguous structures.
The management of post-traumatic intrahepatic cutaneous biliary fistulas
Authors: Smith E E J , Bowley N , Allison D J , Blumgart L H 
Published: March 2007

Abstract
Three cases of post-traumatic intrahepatic cutaneous biliary fistulas are presented, and some of the techniques available for the surgical management of persistent fistulas are described: simple suture, fistulo-jejunostomy and fistulo-cholecystostomy. All 3 patients achieved good clinical and biochemical results from their operations.
Stapling instruments in upper gastrointestinal surgery: A retrospective study of 362 cases
Authors: Lowdon Ian M R , Gear Michael W L , Kilby John O 
Published: March 2007

Abstract
A retrospective review of 362 upper gastrointestinal operations performed over a 6-year period was undertaken. The incidences of complications following the use of stapling instruments (Autosuture) or the use of conventional anastomotic techniques were compared. Complications considered to be related to anastomotic techniques were: leak or bleeding from the suture line or the development of intra-abdominal or wound sepsis. The complication rates were 21 per cent for operations using conventional suturing techniques and 16 per cent for operations in which the stapling instruments were employed.
Malignant phaeochromocytoma: Report of a case and a critical review
Authors: Dow C Jean , Palmer M K , O'Sullivan J P , Kirkham J S 
Published: March 2007

Abstract
A right adrenal phaeochromocytoma is described in a 64-year-old man. Metastases to bone and subsequent death following cord compression occurred within 2 years of diagnosis. Twenty-seven cases in the English literature have been reviewed since 1968. In three of these, the pathological proof was unsatisfactory for the diagnosis of malignancy, and one further case was inadequately documented. The variation in incidence of malignancy found in large retrospective series may relate to inconsistency in pathological criteria, as well as to selective reporting of cases.
Endoscopic retrograde cholangiograms of the normal and post-cholecystectomy biliary tree
Authors: Hamilton I , Ruddell W S J , Mitchell C J , Lintott D J , Axon A T R 
Published: March 2007

Abstract
The diameter of extrahepatic and intrahepatic bile ducts was measured on 50 normal retrograde cholangiograms and on the cholangiograms of 109 post-cholecystectomy patients undergoing endoscopic retrograde cholangiopancreatography: 70 of the post-cholecystectomy patients had a normal cholangiogram and 39 had retained stone or biliary stricture, of whom 17 were jaundiced. Biliary diameter at all points measured was greater in the post-cholecystectomy patients with no biliary lesion than in normals, and further increased in the presence of pathology (e.g. retained stone). The extent of overlap in biliary diameter between all these three groups is so great that measurement of bile duct calibre cannot separate patients with retained stone from post-cholecystectomy patients without retained stone, or from patients with an entirely normal biliary tree, even in the presence of obstructive jaundice. Methods of evaluating the biliary tract which rely on the measurement of bile duct diameter (e.g. ultrasound) are therefore of limited value in the investigation of post-cholecystectomy patients.
Delayed hypersensitivity testing for the prediction of postoperative complications
Authors: Ausobsky J R , Bean P , Proctor J , Pollock A V 
Published: March 2007

Abstract
One hundred and sixty-six patients undergoing elective major laparotomy were skin tested preoperatively with four common recall antigens in an attempt to correlate preoperative cell-mediated immune status with postoperative septic complications. Nineteen patients were anergic, 22 relatively anergic and the remaining 125 reacted to two or more of the antigens and were regarded as normally reactive. No significant differences in morbidity or mortality were found between patients who had depressed delayed cutaneous hypersensitivity reactions and those who reacted normally. We conclude that identification of those patients with depressed cell-mediated immunity preoperatively does not help in predicting postoperative problems.
The long term effects of proctectomy on bladder function in patients with inflammatory bowel disease
Authors: Neal David E , Parker Andrew J , Williams Norman S , Johnston David 
Published: March 2007

Abstract
The effect on bladder function of protectomy for colitis or Crohn's disease was studied by means of a questionnaire and by pressure/flow cystometry. Thirty-seven patients who had undergone protectomy for inflammatory bowel disease were compared with 34 control patients who had undergone bowel resection without protectomy. Symptoms of urinary dysfunction were found to be significantly more common in patients after protectomy than in controls (P &lt; 0·05). Straining at micturition (P &lt; 0·05) and a sensation of incomplete emptying of the bladder (P &lt; 0·02), in particular, were significantly more common after protectomy. Evidence of denervation of the bladder, as shown by the finding of capacious bladders with poor detrusor function, was found in 6 patients after protectomy but in none of the controls (P &lt; 0·05). The residual volume of urine in the bladder after micturition was significantly greater in patients after proctectomy than in controls (P &lt; 0·02). Thus, the bladder is at risk of denervation in the course of proctectomy for inflammatory bowel disease even when dissection is kept close to the rectum.
Delayed hepatic resection for major liver injury
Authors: Smadja C , Traynor O , Blumgart L H 
Published: March 2007

Abstract
Seven patients with major liver injury initially assessed and managed elsewhere, and then referred to the Hepatobiliary Unit at Hammersmith Hospital, London, are reported. Six of the 7 patients had been operated upon and 4 had undergone two laparotomies before referral. All were seriously ill as a result of bleeding or liver necrosis and infection. Further laparotomy was carried out for the control of bleeding, débridement of dead tissue and drainage of infected material. Hepatic resection was performed in all patients and 3 of the 7 died in the postoperative period.
Liver resection is necessary for the control of bleeding and removal of dead tissue in severe shattering injuries. Should temporary packing be instituted in order to obtain control, then early referral for definitive treatment is necessary. Delay is dangerous and extension of necrosis with secondary infection is inevitable.
The P3 iso-enzyme of serum amylase in the management of patients with acute pancreatitis
Authors: Collins R E C , Frost S J , Spittlehouse K E 
Published: March 2007

Abstract
The concept of the P3 index and its use in separating acute pancreatitis from other causes of hyperamylasaemia is described. The mean P3 index of 12 healthy volunteers was 94·8 per cent. All 69 patients with acute pancreatitis had a P3 index below 80 per cent with a mean value of 67·9 per cent. The P3 index is abnormal longer than the raised serum amylase, which increases diagnostic accuracy. Causes of hyperamylasaemia other than acute pancreatitis have been studied and most patients have a P3 index above 80 per cent, although certain false positive values have been obtained. No patient with acute pancreatitis has had a P3 index above 80 per cent on admission. Five cases of acute pancreatitis have been studied in whom the P3 index remained abnormal; all had continuing pancreatic disease, usually with pseudocyst formation. The test has proved most valuable in identifying those patients at risk of developing subsequent problems. To date, the test cannot be relied upon to help in deciding upon the severity of an attack of acute pancreatitis.