bluuebunny/crossref_metadata_2025_split huggingface dataset:
Changes in metabolism of major food components in patients with intrathoracic replacement of the oesophagus with the stomach
Authors: Lam K H , Lim T K , Wong J , Ong G B 
Published: March 2007

Abstract
In 19 patients in whom the stomach had been used as an intrathoracic replacement after oesophagectomy the absorption of fat, carbohydrate and protein was studied. There is no single pattern of disturbance of such absorption. Protein digestion and absorption occur earlier and more rapidly than in normal subjects, probably as a result of accelerated gastric emptying.
Muscle chemistry of critically ill surgical patients and the effects of a course of intravenous nutrition
Authors: King R F J G , Collins J P , Morgan D B , Hill G L 
Published: March 2007

Abstract
The water, electrolyte and nitrogen contents of muscle were measured in 15 critically ill surgical patients before and after a course (approximately 2 weeks) of intravenous nutrition and in 8 normal individuals.
The muscle from the surgical patients contained a significantly increased ratio of water to fat-free dry weight (P &lt; 0.01) due to an increase in the proportion of extracellular to intracellular water, and this was not corrected by intravenous nutrition. These changes could be due to an accumulation of extracellular fluid alone or to a loss of cell cytoplasm or a loss of whole muscle fibres. Intracellular chemistry was normal in the ill surgical patients and was not changed by intravenous nutrition.
Benign duodenocolic fistula
Authors: Howat John M T , Schofield Philip F 
Published: March 2007

Abstract
Benign duodenocolic fistula is a rare complication of a number of gastrointestinal diseases and it is seldom considered in diagnosis. Diarrhoea and weight loss are characteristic presenting features which may be masked by coexisting disease. Barium enema is the most useful diagnostic procedure. Prognosis is good if surgery is undertaken at an early stage after adequate correction of the metabolic consequences of the fistula, by administration of fluid, electrolytes and parenteral nutrition. This paper reports 4 cases of this condition and reviews the clinical features, investigation, aetiology and management.
Major arterial trauma: Review of experience with 267 injuries
Authors: Robbs J V , Baker L W 
Published: March 2007

Abstract
Experience with 267 arterial injuries treated over a 3-4 year period is reported. Vessels in the lower limb were involved most commonly (43 per cent), but there was also a relatively high incidence of carotid (13 per cent) and subclavian (9 per cent) injuries in this series. Penetrating wounds (stab and gunshot) were most comonly responsible. We found that serious distal ischaemia is uncommon in upper limb injuries, but expanding haematoma at the root of the limb is a cause of mortality and serious morbidity. Selective use of preperative angiography is recommended. Successful results follow liberal use of interpostion grafts after wide excision of doubtful vessel, rigorous wound excision, delayed primary closure and fixation of associated fractures. Repair of concomitant venous injuries should always be attempted but is more improtant in the lower than the upper limb. Late revascularization in the presence of critical ischaemia yields a 50 per cent limb salvage rate, but great care must be taken to avoid renal insufficiency and, if it occurs, energetic treatment is necessary for survival.
Intrathoracic rupture of the spleen
Authors: Hocking Margaret A , Bolton Paul M 
Published: March 2007

Abstract
The case is reported of a 15-year-old girl who presented following trauma and was found to have a massive congenital diaphragmatic hernia through the foramen of Bochdalek. The spleen, which was intrathoracic, had ruptured. No other similar cases have been reported in the literature hitherto.
Prediction of wound sepsis following gastric operations
Authors: Gatehouse David , Dimock Frances , Burdon D W , Alexander-Williams J , Keighley M R B 
Published: March 2007

Abstract
Gastric aspirates were obtained from 12 healthy volunteers, 49 patients with duodenal ulcer, 14 with gastric ulcer and 35 with gastric carcinoma. The mean total viable bacterial counts in these groups were as follows: volunteers 0, duodenal ulcer 3.8 × 101, gastric ulcer 6.95 × 104, carcinoma 1.9 × 107 organisms/ml.
The incidence of wound sepsis in patients without antibiotic cover was: duodenal ulcer 17 per cent, gastric ulcer 38 per cent, carcinoma 56 per cent. Regardless of the underlying pathology, patients with counts greater than 5 × 106 organisms/ml in the gastric aspirate had a 93 per cent in incidence of wound sepsis, compared with 16 per cent in patients with counts of less than 5 × 106 organisms/ml (P &lt;0.001). In the group with high counts all except one of the wound infections were caused by organisms present in the stomach at the time of operation.
There was a good correlation in the bacteriology of apirates obtained during preoperative endoscopy compared with operative nasogastric samples (n = 31) both for viable counts (r = 0.93) and for the counts of individual organisms. Therefore, preoperative endoscopy can be used to identify patients who are at risk of developing wound sepsis after gastric surgery.
Clinical experience with silicone rubber grafts as shunts in portal hypertension
Authors: Parr D C , Hopkinson B R 
Published: March 2007

Abstract
We report the use of a woven silicone rubber graft as an alternative prosthesis for a shunt in 8 patients with portal hypertension. Four patients were operated on as emergencies and 4 electively. In 4 cases the graft was used as a standard mesocaval H graft, in 2 as a portocaval H graft and in 2 cases it was used to simplify the Warren selective distal splenorenal shunt. The material has properties which make it a superior graft to existing prostheses and autogenous vein. Our results confirm the experience of others, that the poor risk patients do badly whatever form of shunt is performed, and of those who survive, the total portal shunt carries the risk of postoperative encephalopathy.
Aneurysms of the extracranial carotid arteries
Authors: Carrascal L , Mashiah A , Charlesworth D 
Published: March 2007

Abstract
Aneurysms of the extracranial carotid arteries are unusual; they present difficulties in diagnosis and may cause death or cerebrovascular accidents in a majority of patients. This report describes three different types of aneurysm of the carotid arteries and their presentation and discusses their management.
Popliteal artery entrapment syndrome: A case report
Authors: Inada K , Hirose M , Iwashima Y , Matsumoto K 
Published: March 2007

Abstract
A rare case of bilateral popliteal artery entrapment syndrome is reported. Pathological changes of the occluded lesion in this anomaly were investigated in 8 other cases. Abnormal longitudinal muscle in the media was noted in all. Development of these muscle bundles was considered to be due to chronic trauma inflicted by pressure on the arterial wall. Its significance is emphasized to assist in differentiation from other chronic arterial occlusive disease.
The fibrinogen uptake test after hip surgery
Authors: Loudon J R , McGarrity G , Vallance R , Baylis A C , Graham J 
Published: March 2007

Abstract
The fibrinogen uptake test has been used to detect deep vein thrombosis after total hip replacement in 90 patients. The upper third of the thigh in each leg was ignored and peripheral leg counting carried out distal to this. The results were directly compared with the findings of venography in the 170 legs of the 90 patients. There was a high false positive rate (30 per cent) with the fibrinogen uptake test which was associated with the presence of knee joint efusion or varicose veins, but not with the site of operation. There was a low false negative rate (less than 5 per cent), and the fibrinogen uptake test, used in this way, may fail to detect a percentage of small thrombi in the wound area that are probably produced by the local trauma of operation.
It is considered that the fibrinogen uptake test has a clinical use as a screening test for deep vein thrombosis after hip replacement, but venography is required in the interests of accuracy.
The management and prognosis of oesophageal perforation
Authors: Sandrasagra F A , English T A H , Milstein B B 
Published: March 2007

Abstract
Our experience with the management of 28 patients with oesophageal perforation is reviewed. The majority of perforations followed oesophageal instrumentation. The occurrence of pain, fever or cervical crepitus following endoscopy should raise the suspicion of oesophageal perforation. Plain radiographs of the neck, chest and abdomen provided confirmatory evidence of the presence of a perforation in 89 per cent of our cases. Contrast studies of the oesophagus demonstrated the site and extent of the leak in 21 of the 26 cases in which they were performed. The overall mortality for the series was 32 per cent. The mortality for thoracoabdominal perforations was nearly three times that for the cervical segment. Instrumental perforations were associated with a lower mortality than spontaneous perforations or those following paraoesophageal surgical procedures. The coexistence of an oesophageal obstruction with a perforation did not have an adverse effect on the outcome. The time lapse between the occurrence of the perforation and surgical intervention had a profound influence on the morbidity and mortality. Early closure of the perforation with drainage was associated with a 25 per cent mortality for thoracoabdominal perforations and no complications in the survivors. A delay of over 24 h, on the other hand, was associated with a high incidence of septic complications in both cervical and thoracoabdominal perforations, a longer period of drainage and a 50 per cent mortality in the latter group. A plea is therefore made for early surgical intervention in both cervical and thoracoabdominal perforations.
Diets and stoma function
Authors: Gazzard B G , Saunders B , Dawson A M 
Published: March 2007

Abstract
Fifty ileostomy and 50 colostomy patients were questioned as to which foods upset their stoma function. Most patients had no problem in finding a suitable diet and 70 per cent would eat any food on occasions, although half the patients found that side effects with particular foods were a nuisance. Only a small range of foodstuffs seemed to produce symptoms in a significant proportion of patients.
We feel that no particular foodstuff should be eliminated from a diet without an adequate trial as most patients are able to eat entirely normally.
Sigmoid motility and clinical results after transverse taeniamyotomy for diverticular disease
Authors: Pescatori M , Castiglioni G C 
Published: March 2007

Abstract
The purpose of our investigation was to evaluate the effect of multiple transverse taeniamyotomy on sigmoid motility and on the clinical picture of 8 patients affected by symptomatic, uncomplicated diverticular disease of the sigmoid, selected for the operation after the failure of medical therapy. We recorded rectosigmoid intraluminal pressures and the manometric tracings were correlated with the corresponding photofluorograms before and after the operation for 1 year.
Motility indices were computed and a significant decrease after meals and Prostigmin was found in patients who underwent transverse taeniamyotomy. These functional changes were accompanied by a marked clinical recovery, expressed in terms of relief from lower abdominal pain and improvement in bowel movements.
Considering the functional and clinical disadvantages reported after colectomy and longitudinal myotomy, and observing our results after transverse taeniamyotomy, even though they are short term results, we conclude that the latter operation is an effective procedure for the treatment of diverticular disease with muscular hypertrophy and high intracolonic pressure which has not responded to a medical and dietetic regimen.
The long term sequelae of deep vein thrombosis
Authors: Mudge Marjorie , Hughes L E 
Published: March 2007

Abstract
Five hundred and sixty-four patients undergoing abdominal surgery, who were carefully assessed at the time of operation for evidence of venous thrombosis, have been followed up to determine the incidence of legsymptoms, varicose veins and post-thrombotic syndrome.
Patients are frequently troubled by pain, swelling and phlebitis, which can persist for up to a year after operation. New varicose veins developed by 1 year in 20 per cent of patients. These occurred with increased frequency in patients who also developed a deep vein thrombosis, but they were also seen in patients who showed no clinical or isotopic evidence of thrombosis. The post thrombotic syndrome was present in 26 patients by 3 years after the operation; half of these patients had suffered the syndrome before the definitive operation.
Assessment of the long term effects of venous thrombosis must be carried out against the background of similar effects seen in patients without thrombi, and the development of the post-thrombotic syndrome may best be considered as the summation of a number of incidents, overt or occult, occurring throughout a lifetime.
The clinical and economic effects of early return to work after elective inguinal hernia repair
Authors: Bourke J B , Taylor M 
Published: March 2007

Abstract
Since 1 January 1976 male patients of four consultant surgeons undergoing elective repair of a unilateral inguinal hernia have been included in a trial to see if ‘early’ return to work or normal activity is associated with an increased recurrence rate and also to investigate any economic consequences. To date 295 patients have been entered into the trial and the first 150 have been reviewed at 1 year. There was a complete follow-up at 1 year. There was 1 recurrence (0·7 per cent) at 1 year, and this had occurred by the time the patient came to the clinic to be included in the trial. Patients supervised by their general practitioner were off work for 78·5 days, while those advised to return to work early were off work for 52·1 days. This difference of 25·4 days is significant at the 0·1 per cent level. Loss of earnings while off work was reported by 36·7 per cent of patients, and the average sum lost was £19·86 per week. Thus, patients lost £72·06 on average. If patients went back to work at 52 days instead of at 78 days, the benefit to the economy would be of the order of £7 m., and this ‘early’ return to work is not associated with an increase in the recurrence rate at 1 year.
Assessment of the nutritional state of patients with an intestinal fistula
Authors: Gross E , Holbrook L B , Thornton Margaret 
Published: March 2007

Abstract
The arm muscle area, derived fat-free mass, urinary excretion of 3-methylhistidine and creatinine were measured serially in a group of patients with an intestinal fistula receiving prolonged nutritional support. While the two anthropometric tests appeared reasonable indicators of changes in muscle mass in these patients, the marked intra-individual variability in excretion of 3-methylhistidine and creatinine created problems in interetation.
It is suggested that more use be made of serial anthropometry in district general hospitals as an alteranative, simple, measure of nutritional status.
Early breast cancer: Part I: Surgical pathology and preoperative assessment
Authors: Hughes L E , Forbes J F 
Published: March 2007

Abstract
The management of early breast cancer is showing a growing tendency to move away from radical surgery back towards conservative surgery and systemic adjuvant therapy. This paper and the one that follows review the data that underly this trend and consider the clinical and biological principles that are presently used to make a decision regarding the optimal primary treatment for breast cancer. The conclusion is reached that conservatism is based on a false understanding of the disease and on false conclusions drawn from premature analysis of data from clinical trials.
Optimal management can be determined by appropriate preparative investigation. Breast cancer patients can be divided into three groups: early cases, with a good prognosis, late, incurable cases and an intermediate group. Radical therapy by surgery or surgery combined with radiotherapy gives better results than a conservative approach in the early and intermediate groups. The intermediate group should be seen as having a poor, but not necessarily hopeless prognosis. These cases may benefit particularly from adjuvant chemotherapy, but this should not be used as an excuse to deny the patient adequate local measures, which alone (at present) offer hope of cure. The problem posed by the third group should be seen as one of optimal palliation.
Adjuvant systemic therapy raises hope of improving results, but no patient with breast cancer has yet been cured by chemotherapy or the application of immunological principles. Future improvements are most likely to derive from optimal use of each modality, and not at the expense of the most effective method at present available–radical surgery. The many remaining questions regarding management can best be answered by careful, controlled clinical studies, and every effort should be made to include patients with a poor prognosis in appropriate clinical trials.
99Tcm-polyphosphate uptake by breast tumours
Authors: Clyne Charles A C , Perry P M , Gibson A , MacLeod M A 
Published: March 2007

Abstract
Technetium polyphosphate uptake by breast tumours has been investigated in 69 patients. Although 70 per cent (38 out of 54) of malignant tumours took up the isotope in comparison with 45 per cent (5 out of 11) of benign lesions, this technique would be unreliable for diagnostic purposes.
Relief of lymph obstruction by use of a bridge of mesentery and ileum
Authors: Kinmonth J B , Hurst P A , Edwards J M , Rutt D L 
Published: March 2007

Abstract
The background to the use of a bridge of ileum with its associted mesentery in the relief of lymphatic obstruction is described. A case report of the successful use of this method in a 22-year-old patient with lymphedema praecox is presented. Following experience with further cases. It is suggested that. Provided changes in lymph channels and in the tissues of the affective drainage through small gut lymphatics may be achieved.
Common bile duct perfusion combined with operative cholangiography
Authors: Hopton David 
Published: March 2007

Abstract
A series of 223 patients undergoing cholecystectomy has been studied. In 204 patients the common bile duct was perfused with saline at a pressure of 30 cm. The rate of flow has been analysed as a means of determinaing the presence of common bile duct stones, this being confirmed on the evidence of operative cholangiography or exploration of the duct. The results suggest that flow studies can be more consistently obtained than cholangiograms, which were not available for technical reasons in 8·0 per cent of patients in this series. The results of flow studies are comparable with those of cholangiography in confirming the normality of the common bile duct but are less reliable in detecting stones. The reliability is such that if radiological facilities are not available, flow studies are an acceptable alternative.
In none of these patients was stenosis of the sphincter of Oddi detected. If this clinical entity does exist, it is rare and of little significance.
Cryosurgery in the management of rectal tumours
Authors: Osborne D R , Higgins A F , Hobbs K E F 
Published: March 2007

Abstract
Ten patients with rectal tumours were treated by cryosurgery. Good palliation without local complications was achieved in the cases of rectal carcinoma and a complete cure followed treatment of benign rectal tumours. Low rectal carcinomas with clinical evidence of dissemination are ideally suited for cryosurgery and complications are minimal. Cryosurgery is a simple, safe procedure which can be performed without a general anaesthetic, and this study indicates that it has a place in the management of rectal tumours.
Cancer of the rectum following colectomy and ileorectal anastomosis for ulcerative colitis
Authors: Baker W N W , Glass R E , Ritchie Jean K , Aylett S O 
Published: March 2007

Abstract
The case notes of all patients treated for ulcerative colitis by colectomy and ileorectal anastomosis at the Gordon Hospital under the care of Mr S. O. Aylett from 1952 to 1976 have been reviewed. Three hundred and seventy-four patients left hospital with an ileorectal anastomosis and have been followed for periods up to 23 years. Twenty-two patients are known to have developed a carcinoma of the rectum. Within 10 years of the onset of the disease, no rectal carcinoma was found in 3534 patient-years. The risk was 1 in 185 patient-years between the tenth and twentieth years and 1 in 115 patient-years between the twentieth and thirtieth years. The cumulative risk was 6 per cent (± 2 per cent) at 20 years and 15 per cent (± 4 per cent) at 30 years.
The need for meticulous follow-up is emphasized. The finding of dysplasia in rectal mucosal biopsies will, it is hoped. identify the patient at particularly high risk and enable rectal excision to be undertaken before carcinoma develops.
The medical management of renal artery stenosis in transplant recipients
Authors: Jachuck S J , Wilkinson R , Uldall P R , Elliott R W , Taylor R M R , Hacking P M 
Published: March 2007

Abstract
The investigation, management and clinical course of 12 patients developing stenosis of the renal artery following transplantation are described. The possible aetiology of the three arteriographic patterns of stenosis is discussed. Surgical correction of graft arterial stenosis is difficult and may lead to graft loss, whereas the outcome with antihypertensive drug treatment with or without anticoagulants is good. Surgery should only be contemplated if medical treatment is failing or if renal function is deteriorating.
Arteriovenous grafts for vascular access in haemodialysis
Authors: Kester R C 
Published: March 2007

Abstract
The outcome of 68 arteriovenous grafts placed in 46 patients requiring haemodialysis was studied over a period of 3.5 years. The biological grafts included autogenous saphenous vein, modified bovine carotid artery and human umbilical cord vein allograft, whereas the synthetic grafts comprised Sparks Dacron mandril, expanded reinforced polytetrafluoroethylene and knitted Dacron velour. These subcutaneous grafts were arranged as looped or straight configurations in the forearm or thigh. Of 59 grafts evaluated in patients with end-stage renal failure, only 48 per cent of the forearm grafts performed well, compared with 85 per cent of the thigh grafts. Although only 38 per cent of the looped grafts were successful, 78 per cent of the straight grafts functioned satisfactorily. Synthetic grafts suffered less serious complications than the commercial biological grafts.
Pyeloduodenal fistula: A case report and review of the literature
Authors: Batch A J G , Amery A H , Reddy E R 
Published: March 2007

Abstract
A case of the rare condition of pyeloduodenal fistula is presented—the thirty-second case so far recorded in the literature. The authors consider that this instance shows some of the features typical of the cases so far reported.
The literature is reviewed and the aetiology, presentation, diagnostic methods and treatment are briefly discussed.