bluuebunny/crossref_metadata_2025_split huggingface dataset:
Parathyroid hormone levels, hyperparathyroidism and acute pancreatitis
Authors: Shearer M G , Imrie C W 
Published: March 2007

Abstract
Since 1971, in Glasgow Royal Infirmary 880 patients with acute pancreatitis (AP) have been prospectively studied. Only two (0·23 per cent) have been found with associated hyperparathyroidism (HPT), one of whom also had gallstones. During the period of study daily serum calcium levels were measured routinely in all patients with AP and, in addition, a consecutive series of 200 patients had daily mineral metabolism screening of blood and urine in an attempt to identify patients with hypercalcaemia as an aetiological factor. A separate group of 90 patients had sequential daily serum calcium and parathyroid hormone assays (PTH) performed for the first five days of their hospital admission and one of the patients described in this paper came from this group. She is the first patient, to our knowledge, documented in this manner. The overall pattern of the PTH and calcium response from all these patients is also recorded according to the severity of the AP. Hyperparathyroidism is uncommonly associated with AP and when it is other aetiological factors must be excluded.
Comparison of stapling and handsuture for left-sided large bowel anastomosis
Authors: Everett W G , Friend P J , Forty J 
Published: March 2007

Abstract
One hundred patients undergoing elective left-sided colonic or rectal resections were randomly allocated to have an anastomosis performed either with the EEA stapling gun or by hand suture using a single layer of interrupted sutures. In six patients the anastomosis could not be performed with the stapling gun. Clinical leakage occurred in two of the remaining 94 cases; both had hand-sutured anastomoses. Radiological leakage was demonstrated in 13 further cases (7 stapled, 6 sutured); there was no statistical difference in leakage rate with stapled and hand-sutured anastomoses.
Clinical results 1–10 years after highly selective vagotomy in 306 patients with prepyloric and duodenal ulcer disease
Authors: Enander L , Rydberg B , Adami H-O , Enander L K , Ingvar C 
Published: March 2007

Abstract
Overall clinical results were assessed 1–10 years after routinely performed highly selective vagotomy (HSV) in 326 consecutive patients suffering duodenal and prepyloric ulcer disease, operated on by 37 surgeons of varying seniority at a district general hospital. Three hundred and six (94 per cent) patients were followed up. No mortality was recorded after 326 primary and 50 reoperative procedures. Postoperative complications were few and diminished during the study period. Persistent moderate to severe dumping was found in 2.3 per cent of the patients; slight and periodic, but in no case disabling, diarrhoea in 11 per cent and gastric retention in 2.1 per cent. The overall clinical ulcer recurrence rate was 13.8 per cent, with a tendency towards better results during the second 5 year period. Significant differences were found between individual surgeons and groups of surgeons. Recurrences tended to be located more proximally than the primary ulcer. Fifty reoperations were performed in forty patients for ulcer recurrence (twenty-five), persistent ulcer-like symptoms (twelve) and gastric retention (three). When all recurrences and reoperations were classified as failures the symptomatic assessment according to Visick showed 67 per cent of the patients in grades I–II and 26 per cent in grade IV but the corresponding figures from the patients' own classification including the results of reoperations were 79 per cent and 7 per cent. It is concluded that for the time being HSV is the method of choice for the elective surgical treatment of duodenal and prepyloric ulcer disease.
Cement bezoars of the stomach
Authors: Visvanathan R 
Published: March 2007

Abstract
Cement ingestion resulting in the formation of concretions in the stomach is unusual in surgical practice. Cement bezoars that are retained in the stomach do not undergo degradation and attempts at chemical dissolution are not recommended. Early surgical removal is the only safe and effective method of treatment. Smaller concretions are excreted without incident but may cause intestinal obstruction which should be anticipated and surgically relieved.
Beneficial response to pituitary ablation following aminoglutethimide
Authors: Bundred N J , Eremin O , Stewart Helen J , Dale B A , Forrest A P M 
Published: March 2007

Abstract
Twenty-five postmenopausal women with advanced carcinoma of the breast, who were treated initially with aminoglutethimide alone (14 patients) or combined with tamoxifen (11 patients) had, on relapse or failure of treatment, a pituitary ablation performed. Initial therapy had produced a complete response in one patient, a partial response in 7, disease stasis in 6 but was without benefit in 8 patients. A further three patients were intolerant of aminoglutethimide therapy. Ten of these 25 patients benefited from subsequent pituitary ablation (1 complete response, 4 partial responses and 5 disease stasis), both local and distant sites of disease being influenced by this further therapy. Experience is also reported of 10 patients with advanced breast cancer who were treated initially by pituitary ablation and then subsequently received aminoglutethimide therapy. None responded. It is concluded that pituitary ablation should be considered for patients with progressive disease following aminoglutethimide therapy, irrespective of the therapeutic response to aminoglutethimide.
Circumumbilical incision for pyloromyotomy
Authors: Tan K C , Bianchi A 
Published: March 2007

Abstract
Forty infants with infantile hypertrophic pyloric stenosis had a Ramstedt pyloromyotomy through a circumumbilical incision. Delivery of the pylorus was relatively easy. Mild wound infection occurred in three infants and a further child developed a purulent discharge. There was one instance of abdominal wall dehiscence and all the resultant scars were hardly visible, thus achieving an apparently unscarred abdomen.
Second hepatic resection for recurrent hepatocellular carcinoma
Authors: Nagasue N , Yukaya H , Ogawa Y , Sasaki Y , Chang Y-C , Niimi K 
Published: March 2007

Abstract
During the last 5 years, radical hepatic resection was performed in 91 patients with hepatocellular carcinoma (HCC). Thirty-one of them had tumour recurrence in the remaining liver during the follow-up period. Second hepatic resection was carried out on nine of them 4–38 months after the first hepatectomy. The ages of these patients ranged from 39 to 65 years with an average of 53·7. There were six men and three women. Eight patients had underlying cirrhosis of the liver and one chronic active hepatitis. Six patients are alive, four being free of HCC and two with disease, for 15–45 months after the first operation. Two patients died of systemic cancer dissemination. The remaining patient had tumour recurrence in the liver again and died of hepatic failure after the third laparotomy. The survival rate of these nine patients was significantly better than that of twenty-two patients who were treated by other palliative methods. The present result shows that a second hepatic resection is a possible and meaningful method of treatment for the patients with recurrent HCCs in the liver remnant.
Randomized trial of oral adjuvant razoxane (ICRF 159) in resectable colorectal cancer: Five-year follow-up
Authors: Gilbert J M , Hellmann K , Evans Margaret , Cassell P G , Taylor R H , Stoodley B , Ellis H , Wastell C 
Published: March 2007

Abstract
Razoxane is one of the few agents which has shown activity in the treatment of advanced colorectal cancer. The drug has therefore been evaluated in a prospective randomized controlled trial as an adjuvant to surgery for resectable colorectal cancer. The results to median follow-up of 5 years are reported here. Accrual has ceased and a total of 272 patients entered the trial (133 control, 139 treatment). Treated patients received razoxane postoperatively on a continuous, long-term basis while control patients received identical clinical care but no adjuvant chemotherapy. Analysis of the results shows a significant prolongation of the time to recurrence for Dukes' C patients. All other groups including the overall analysis show no benefit although there is a consistent trend in favour of the treated patients except in Dukes' group ‘D’. Razoxane is tolerated well by patients and causes minimal side-effects. However acute leukaemia occurred in three patients (2·45 per cent) after prolonged exposure to the drug and further evaluation should be in patients who are at high risk of developing recurrent cancer, in whom such a risk may be acceptable. It is concluded that razoxane is suitable for further evaluation in colorectal cancer and for incorporation into combination chemotherapy regimens.
Endoscopic sphincterotomy for retained common bile duct stones in patients with T-tube in situ in the early postoperative period
Authors: O'Doherty D P , Neoptolemos J P , Carr-Locke D L 
Published: March 2007

Abstract
We report on thirty-nine patients who underwent endoscopic sphincterotomy (ES) and stone extraction for retained common bile duct calculi with a T-tube in situ. Sixteen of the patients had undergone unsuccessful attempts at removal by flushing or dissolution by cholesterol solvents. A total of 76 stones were present: 53 distal to the T-tube and 23 proximal to the T-tube. ES and clearance of the common bile duct was achieved in 37 patients (95 per cent) and complications occurred in three patients (7·7 per cent). This method is an effective and relatively safe method in the early postoperative period allowing rapid treatment during the same admission as for the original operation and early hospital discharge.
Changing epidemiology, diagnosis, and treatment of Clostridium difficile toxin-associated colitis
Authors: Talbot R W , Walker R C , Beart R W 
Published: March 2007

Abstract
One hundred and ninety patients with Clostridium difficile toxin-associated colitis (CTAC) or pseudomembranous colitis (PMC) were identified, from microbiology records, disease index and proctoscopy service records, and studied retrospectively. CTAC was associated with cephalosporin antibiotic administration in 70 per cent of the patients. CTAC developed postoperatively in 108 patients after all types of surgery with no preponderance for abdominal surgery. Identification of cytotoxin in stool samples was the primary diagnostic test in 81 per cent of patients but cytotoxin was isolated in 98 per cent of all patients. Pseudomembranes visible on proctoscopy established the diagnosis in 19 per cent of patients and were more commonly seen in severe colitis (71 per cent) than in mild colitis (23 per cent). CTAC responded similarly to oral vancomycin and metronidazole with a relapse rate of 20–23 per cent, respectively. With its association with cephalosporin administration, CTAC is likely to occur with increasing frequency in surgical practice. Oral metronidazole is an effective, cheap, alternative to vancomycin therapy.
Endoluminal ultrasound in the assessment of local invasion in rectal cancer
Authors: Beynon J , Foy D M A , Roe A M , Temple L N , Mortensen N J McC 
Published: March 2007

AbstractA new method for staging local invasion in rectal cancer has been assessed. Thirty-eight patients with primary rectal cancers have been examined pre-operatively with endoluminal rectal ultrasound and results compared with histological analysis of resected specimens in 33 cases. Three patients who also underwent laparotomy but not resection had good evidence of both stage T3 (1) and T4 (2) disease. The coefficient of correlation between ultrasonic and histological staging was 0·93 (P &lt; 0·001). Invasion beyond the muscularis propria was predicted with a sensitivity of 96 per cent, specificity of 92 per cent and a predictive value of 96 per cent.
Diagnostic yield of endoscopic retrograde cholangiopancreatography in carcinoma of the pancreas
Authors: Gilinsky N H , Bornman P C , Girdwood A H , Marks I N 
Published: March 2007

Abstract
The results of 117 consecutive endoscopic retrograde cholangiopancreatographic (ERCP) examinations in patients with adeno-carcinoma of the pancreas, performed over a six year period, are reported. The diagnostic accuracy of this procedure (80.3 per cent) was higher than that of computed tomography (63.6 per cent) and ultrasonography (54.0 per cent). Fewer false negative diagnoses were made by retrograde cholangiopancreatography (7.7 per cent) than with the other procedures (28 per cent each). Analysis of the total ERCP experience during the study period revealed a false positive rate for malignancy of 5.6 per cent. In situations where investigations are performed by individuals with a broad spectrum of expertise, ERCP is superior to other methods in diagnosing pancreatic carcinoma, even in areas with a high prevalence of chronic pancreatitis.
Stapled ileo-anal anastomosis: A technique to avoid mucosal proctectomy in the ileal pouch operation
Authors: Heald R J , Allen D R 
Published: March 2007

Abstract
Ten patients have undergone abdominal proctocolectomy with the formation of an ileal reservoir anastomosed onto the anal canal using a stapling device. This technique avoids stripping of the rectal mucosa from the muscle tube (mucosal proctectomy) which is time consuming and often difficult. One patient is awaiting closure of her ileostomy. The remaining seven are continent and are passing between one and six motions a day.
Surgical management of ‘lymphangioma circumscriptum’
Authors: Browse N L , Whimster I , Stewart G , Helm C W , Wood J J 
Published: March 2007

Abstract
The results of surgery in 29 patients with ‘lymphangioma circumscriptum’ have been reviewed 2–8 years after operation. They show that in regard to management there are two varieties: small lesions, &lt; 7 cm diameter, in favourable sites of the body, which are potentially curable; and large lesions, &gt; 7 cm diameter on the skin with an even larger area of subcutaneous cysts, in which complete excision of all the skin and subcutaneous vesicles would require skin grafting. Nine patients had small lesions excised. Seven have had no recurrence. Twenty patients had large lesions treated by a radical excision of all or as much of the cyst bearing subcutaneous tissues and skin as possible, but leaving enough skin to permit a primary suture, even though it meant leaving skin vesicles. The lesion was controlled and the cosmetic appearance improved in 16 patients. Subsequent regression of many of the vesicles not excised supports the aetiological hypothesis of the skin lesions proposed by Whimster.
Oesophageal emptying in patients with gastro-oesophageal reflux
Authors: Maddern G J , Jamieson G G 
Published: March 2007

Abstract
A reproducible radionuclide technique for measurement of oesophageal emptying of a solid bolus has been used to study normal control subjects, patients with gastro-oesophageal reflux and a subgroup of these patients before and after fundoplication. The number of swallows to empty the oesophagus was significantly delayed in the gastro-oesophageal reflux group compared to controls (P &lt; 0.001). As a group, patients describing dysphagia had slower oesophageal emptying than patients without dysphagia (P &lt; 0.001). The presence or absence of pre-existing oesophagitis did not influence oesophageal emptying significantly. Following fundoplication patients did not show any significant alteration in their oesophageal emptying compared with their pre-operative studies, although individually changes were noted in two patients. The solid bolus oesophageal emptying test is easily performed, well tolerated by patients and is a useful method for studying oesophageal dysfunction.
Distal splenorenal (Warren) shunt in the management of actively bleeding oesophageal varices
Authors: Peterson K , Giles G R 
Published: March 2007

Abstract
Distal splenorenal shunts have been performed on 53 patients during or soon after variceal haemorrhage. In 38 patients active haemorrhage was occurring at the time of operation or was controlled by tamponade and 12 of these patients died. There was no mortality in the semi-elective group. A higher mortality was found in patients with poor liver reserve and in whom prolonged conservative management had been attempted. Rebleeding occurred in 20 per cent of patients in the early postoperative period and this was a significant factor in the death of three patients. Of 39 patients with longer term follow-up, 8 suffered minor encephalopathy. Subsequent mortality could be related to the progression of liver disease and was no worse than that seen in a population of cirrhotic patients.
A randomized clinical trial of oral ursodeoxycholic acid in obstructive jaundice
Authors: Thompson J N , Cohen J , Blenkharn J I , McConnell J S , Barr J , Blumgart L H 
Published: March 2007

Abstract
Forty patients with obstructive jaundice (bilirubin &gt; 100 μmol/l) were entered into a randomized trial of oral ursodeoxycholic acid for 48 h before surgery versus no additional therapy. Pre-operative venous and operative portal total bile salt concentrations were higher in the bile salt treated patients (P &lt; 0·001). Portal endotoxaemia during operation was reduced in ursodeoxycholic acid treated patients (P &lt; 0·05). There was no significant difference in systemic venous endotoxaemia, renal function or postoperative morbidity or mortality. This study suggests pre-operative oral bile salt therapy may be of no clinical benefit in patients with obstructive jaundice.
Surgical aspects of pancreatic abscess
Authors: Stricker P D , Hunt D R 
Published: March 2007

Abstract
In a retrospective study of all patients admitted with acute pancreatitis to a single hospital over the 10 year period 1975–1984, 22 patients operated upon for pancreatic abscess complicating acute pancreatitis were identified. The accuracy of the assessment by the surgeon of the extent of the abscess and the results of treatment by either local or wide drainage have been reviewed. The surgeon underestimated the extent of the abscess in 5 of the 22 patients. Four of these five patients were assessed as having a localized abscess presenting in the lesser sac and, in the other, the abscess was thought to be confined to the tail of the pancreas. Local exploration and drainage were performed in 13 patients and resulted in a high morbidity and mortality (54 per cent). Wide exploration was performed in nine patients with only two deaths, despite the greater extent of abscess formation. Improvement in outcome seen in the second 5 year period appears to be due to a more aggressive approach to exploration and drainage. The surgeon must be aware that abscesses in the lesser sac often signify more widespread abscess formation. Without wide exploration of the pancreas, assessment at laparotomy is likely to be unreliable. There appears to be additional benefit from wide drainage, even where abscess formation appears localized.
Leg ulcers: Epidemiology and aetiology
Authors: Cornwall Julia V , Doré Caroline J , Lewis J D 
Published: March 2007

Abstract
In a regional Health District with a population of 198900, 357 patients with 424 ulcerated legs were documented, an overall prevalence of 0.18 per cent. The prevalence of ulceration in the 92 100 aged &gt; 40 years was 0.38 per cent. Fifty per cent of the lesions had been present for more than one year, and 62 per cent of patients had never attended any hospital. The patients were stratified by history of peripheral arterial disease. A random sample (100 patients, 193 legs) was examined by ultrasound and photoplethysmography to assess the venous and arterial circulation; 38 per cent had evidence of deep vein involvement and 43 per cent had superficial vein incompetence. An ischaemic element was present either in isolation (9 per cent) or combined with venous disease (22 per cent) in a total of 31 per cent, with a mean pressure index of 0.62 (s.d. 0.14). Simple objective methods of assessment together with dedicated community staff with ready access to specialized facilities can enhance the service provided to patients with leg ulcers.
Low molecular weight heparin plus dihydroergotamine for prophylaxis of postoperative deep vein thrombosis
Authors: Sasahara A A , Koppenhagen K , Häring R , Welzel D , Wolf H 
Published: March 2007

Abstract
In a prospective, double-blind investigation of the prophylaxis of deep vein thrombosis (DVT) in patients undergoing elective major abdominal surgery, 269 patients were randomized into two groups. One hundred and thirty-two patients received a fixed combination of heparin sodium 5000 units plus dihydroergotamine mesylate 0.5 mg (H/DHE) twice a day and 137 patients received a fixed combination of low molecular weight heparin 1500 units plus dihydroergotamine mesylate 0.5 mg (LMWH/DHE) once a day as well as one injection of placebo per day. Treatment was initiated 2 h pre-operatively in both groups and continued for 7–10 days. The frequency of DVT determined by the 125I-labelled fibrinogen uptake test and phlebography was 10.3 per cent in patients receiving H/DHE and 10.4 per cent in those receiving LMWH/DHE. DVT of the femoral vein was detected in four patients of the H/DHE group and in none of the LMWH/DHE group. Intra- and postoperative blood loss did not differ significantly between both groups. Also no difference in the development of wound haematoma and injection site haematoma was found. While intra-operative volume substitution was comparable in both groups, significantly more patients under H/DHE prophylaxis received volume substitution during the postoperative phase. These results show that once-daily prophylaxis with the combination of low molecular weight heparin and dihydroergotamine is equally as effective and as safe as the twice-daily regimen using a combination of unfractionated heparin and dihydroergotamine in patients undergoing elective, major abdominal surgery. The advantages of the once-daily regimen of LMWH/DHE include greater patient acceptance, less nursing time and greater cost effectiveness, provided the new combination can be sold at a cost which maintains this advantage.
Plasma fibronectin and complement activation in coronary bypass surgery
Authors: Chadwick S J D , Stanbridge R De L , Mowbray J F , Dudley H A F 
Published: March 2007

Abstract
In patients with severe sepsis, plasma fibronectin concentrations are reduced and complement is activated. It is not known whether complement activation interferes with plasma fibronectin. Cardiopulmonary bypass is known to activate complement. We have therefore used this operation to study the effect of complement activation on plasma fibronectin in the absence of sepsis. After 15 min of bypass the percentage changes of plasma fibronectin and haematocrit were similar (65.9 ± s.e.m. 4.8 and 67.0 per cent ± s.e.m. 2.3, respectively), but the changes in C3 and C5 (58.4 ± s.e.m. 4.8 per cent and 52.5 per cent ± s.e.m. 2.1) were significantly greater than those of the haematocrit, indicating complement consumption. During the first 60 min of bypass there was a significant increase in the neutrophil count which is compatible with complement activation. It is unlikely that complement activation alone, in the absence of sepsis, contributes to the reduction of plasma fibronectin concentrations.