bluuebunny/crossref_metadata_2025_split huggingface dataset:
Paget's disease of the anal margin
Authors: Jensen S L , Sjolin K E , Shokouh-Amiri M H , Hagen K , Harling H 
Published: March 2007

Abstract
A follow-up study of 22 patients with Paget's disease of the anal margin was conducted to determine the prevalence of invasive disease and coexisting visceral carcinomas, cure and survival rates. Seventy-three per cent of the patients suffered from persistent pruritus ani. Seven (32 per cent) patients had malignancy (invasive Paget's disease (n = 5) and coexisting visceral carcinoma (n = 2)) and six (27 per cent) developed malignancy (invasive Paget's disease (n = 4) and coexisting visceral carcinoma (n = 2)) during follow-up, giving an overall occurrence of malignancies of 59 per cent (95 per cent confidence limits: 36–79). The median follow-up period was 9 (range 0.5–25) years. No difference in length of history could be found between patients with or without malignancy. The estimated cure rate by actuarial analysis among radically treated patients was 64 per cent (95 per cent confidence limits: 43–91) at 1 year and 45 per cent (95 per cent confidence limits: 18–72) at 8 years after primary treatment. The 5- and 10-year crude survival rates of 54 per cent and 45 per cent, respectively, were significantly lower than the corresponding values of 84 per cent and 60 per cent for the normal population (P&lt;0.01). Patients with persistent pruritus ani and a perianal skin lesion should be biopsied frequently. If Paget's disease is diagnosed, physical examination of the patient and anorectal region must be done carefully and repeatedly.
Surgical aspects of a district hospital combined gastroenterology clinic
Authors: Holmes K M , Cole T P , Salter R H 
Published: March 2007

Abstract
The surgical aspects of 12 years' involvement with a combined consultative gastroenterology clinic at a district general hospital are reviewed. In this time the overall number of patients subjected to surgery has gradually fallen and the average age of patient referral has gradually increased and the logistical implications are considered. Trends for the common diagnoses encountered are discussed and the educational benefit of the clinic is stressed.
Surgical treatment of acute necrotizing pancreatitis
Authors: Wilson C , McArdle C S , Carter D C , Imrie C W 
Published: March 2007

Abstract
Between January 1980 and June 1986, 21 patients required surgery for acute necrotizing pancreatitis. Four patients had been transferred from other hospitals: the remaining 17 patients had been treated from the outset at Glasgow Royal Infirmary, representing 3.7 per cent of the 456 patients treated for acute pancreatitis during this time. Necrosectomy was performed on 14 patients and 7 patients were treated by pancreatic resection, with 4 deaths in each group; thus 8 patients (38 per cent) died at a median time of 22 days from onset of their attack. Three of the four patients transferred to our care died, giving a mortality in our own patients of 29 per cent. Of the survivors, all but three had a prolonged and complicated hospital course. Our data confirm that acute necrotizing pancreatitis is still associated with a considerable mortality and morbidity. Early multi-organ failure, advanced age, underlying medical illness and the presence of infected necrosis were associated with a poor outcome. Necrosectomy delayed until the second or subsequent week appeared to be a suitable procedure for the majority of our patients, but shortcomings were apparent with the traditional methods of closed drainage of the pancreatic bed postoperatively. The many demands imposed by this small group of patients suggests that their management is best undertaken in centres in which there is special expertise and this should contribute to a further reduction in the mortality from this condition.
Hepatocellular pseudotumour (regenerating nodule) in the cirrhotic liver mimicking hepatocellular carcinoma
Authors: Nagasue N , Yukaya H , Chang Y-C , Kimura N , Ota N , Nakamura T 
Published: March 2007

Abstract
During a recent 6-year period we have encountered 10 patients with ‘hepatocellular pseudotumour in the cirrhotic liver’ (regenerating hyper-plastic nodule). The patients were all male, aged 40–82 years. Seven were chronic alcohol consumers. None was positive for HBs-Ag but seven had either anti-HBs or anti-HBc. Serum AFP level ranged from 4 to 28 ng/ml in six patients who did not have hepatocellular carcinoma at the time of the diagnosis of the pseudotumour. The lesions were depicted by ultrasonography in seven, by computed tomography in two, and by angiography in one case. Liver scan was negative in all five cases investigated. The pre-operative diagnosis was definitely or highly suspicious of hepatocellular carcinoma in three, of pseudotumour in the cirrhotic liver in three, and of recurrent carcinoma in one. In another three patients, pseudotumour was coincidentally discovered in resected specimens with hepatocellular carcinoma. The histopathological and follow-up studies demonstrated synchronous or metachronous development of carcinoma in seven patients. Whether or not these lesions in the cirrhotic liver are premalignant remains to be elucidated.
Parotid tumours: A review of parotid tumour surgery in the Northern Regional Health Authority of the United Kingdom 1978–1982
Authors: Gunn A , Parrott N R 
Published: March 2007

Abstract
A review of inpatients treated for parotid tumours during the 5-year period 1978 to 1982 in the Northern Regional Health Authority of the United Kingdom revealed 376 new parotid tumours and 28 recurrent tumours. The incidence of new parotid tumours was 2.4 per 100000 and of pleomorphic adenomas 1.5 per 100000 per annum. Local excision was the most common operation and was employed to remove 156 (67.2 per cent) of the 232 pleomorphic adenomas but there was evidence of incomplete excision in 60 (38.5 per cent) of these tumours. Incomplete excision also occurred in 12 (15.8 per cent) of the 76 pleomorphic adenomas removed by conservative parotidectomy. Global temporary facial nerve palsy was more common after conservative parotidectomy for benign tumours (21.8 per cent) than after local excision (3.7 per cent) but global permanent nerve palsy only occurred after local excision (0.9 per cent). The widespread use of local excision resulted in its use in 12 (27.3 per cent) of the 44 malignant tumours. The low incidence of parotid tumours and their treatment by a relatively large number of surgeons resulted in limited experience for surgeons and few opportunities for training in parotid surgery.
Endoscopic biliary endoprosthesis in the palliation of malignant obstruction of the distal common bile duct: A randomized trial
Authors: Shepherd H A , Royle G , Ross A P R , Diba A , Arthur M , Colin-Jones D 
Published: March 2007

Abstract
A total of 52 jaundiced elderly patients who had malignant obstruction of the distal common bile duct and who required palliative biliary decompression were randomized to receive either an endoscopically placed biliary endoprosthesis (10 French gauge) or conventional surgical bypass. Patients within the two treatment groups were well matched and 51 were followed until their death. Patients treated with endoprosthesis had a significantly shorter initial hospital stay than those treated surgically. In the long term, overall survival in the two groups was similar and jaundice was relieved in over 90 per cent of patients. Despite more re-admissions to hospital for those patients treated endoscopically, the total time spent in hospital still remained significantly shorter in this treatment group compared with those subjected to surgery. The endoscopically placed biliary endoprosthesis is a valuable alternative to conventional surgical bypass in the palliation of extrahepatic biliary obstruction.
Current practice in biliary surgery
Authors: Cahill C J , Pain J A 
Published: March 2007

Abstract
A questionnaire enquiring about current practices in biliary surgery was sent to over 25 per cent of consultant general surgeons in the UK; 90 per cent replied. Only 56 per cent use antibiotic prophylaxis for elective cholecystectomy, and 84 per cent for emergency cholecystectomy. Duration of use, choice of agent and absence of prophylaxis for high-risk cases were inappropriate in up to 20 per cent of cases. Of the respondents 84 per cent routinely perform operative cholangiography and use T tubes, and 75 per cent routinely place a peritoneal drain after cholecystectomy. Despite controversies in the literature, most UK surgeons still follow traditional practices in biliary surgery.
Amputation for peripheral vascular disease: The case for level selection
Authors: McCollum P T , Spence V A , Walker W F 
Published: March 2007

AbstractOne hundred major lower limb amputations were performed for end stage peripheral vascular disease over a 15-month period. Selection of amputation level was made on the basis of laboratory criteria using skin blood flow and infrared thermography data. Eighty-one amputations were performed at the below-knee level with six failures. This resulted in a final below-knee:above-knee amputation ratio of 3:1. It is clear that there are still many centres in the UK where above-knee amputation is the accepted operation, despite the inherent drawbacks to this procedure. We recommend that more attention is given to achieving higher below-knee amputation rates to improve the chances of amputee mobility and therefore quality of life.
Complications of intravenous feeding catheters
Authors: Mughal M M 
Published: March 2007

Abstract
Complications of intravenous nutrition are uncommon but may prove problematic in patients requiring long-term nutritional support. This article reviews the complications associated with intravenous catheters with particular emphasis on problems associated with insertion, catheterrelated sepsis, venous thrombosis, catheter occlusion, endocarditis and intracardiac thrombus formation.
Carotid body tumours and other cervical paragangliomas: Diagnosis and management in 25 patients
Authors: McPherson G A D , Halliday A W , Mansfield A O 
Published: March 2007

Abstract
This report of a series of 25 patients with cervical paragangliomas reviews the experience of one surgeon over a period of 13 years. A total of 26 resections were performed with no mortality and no hemiplegia. Two patients required carotid reconstruction. Eight patients had a permanent cranial nerve palsy but in seven this was due to involvement of the nerve by the tumour. Lymph node involvement occurred in two patients. Only one patient has developed recurrent tumour. These tumours are locally malignant and resection offers a chance of cure.
Viscoelastic properties and collagen content of the long saphenous vein in normal and varicose veins
Authors: Psaila J V , Melhuish J 
Published: March 2007

Abstract
Veins taken from patients undergoing surgery for varicose veins were compared with those obtained from patients undergoing other surgical procedures (‘normals’). Varicose veins had a lower breaking strength and breaking energy than normal veins. Elastic stiffness was less in normals (tan θ = 41 (24)) than in varicose veins (tan θ = 55 (18); P &lt; 0·01). There was no difference in viscoelastic behaviour between samples taken above, at, or below the valve leaflet insertion. In normals, perivalvular vein wall exhibited a 50 per cent lower breaking strength and elastic stiffness than vein from other sites. Collagen content was significantly higher in normal vein specimens in all sites examined (mean collagen content = 70 (21) μg/mg, versus 51 (20) μg/mg for varicose veins; P &lt; 0·001). We conclude that significant structural changes are seen in varicose veins. In normal veins, the perivalvular vein wall has distinct viscoelastic features when compared with vein wall from other sites. This difference was not found in veins which became varicose.
111In-labelled leucocyte imaging in vascular graft infection
Authors: Berridge D C , Earnshaw J J , Frier M , Perkins A C , Wastie M L , Hopkinson B R , Makin G S 
Published: March 2007

Abstract
Twelve patients with a clinical diagnosis of possible vascular graft infection have been studied over the last 3 years. All patients had their leucocytes labelled with indium-111 and γ-camera imaging after 24 and 48h. Subsequent management was according to established surgical techniques. Eight patients proved to have vascular graft infection and indium uptake was seen along the length of the graft in six. Two patients with open wound infections and synthetic grafts had localized uptake only on leucocyte scanning. Four patients, all of whom had negative scans were not thought to have infected grafts after further investigation using digital subtraction angiography and computed tomography scanning. These patients have been followed up for a median period of 19 months (range 5–25 months) and have remained symptom free. Initial experience with 111In-labelled leucocyte scanning has been encouraging, both in diagnosis and in planning the management of patients with graft infections.
Air-filled microballoon manometr for use in anorectal physiology
Authors: Miller R , Bartolo D C C , James D , Mortensen N J McC 
Published: March 2007

Abstract
Manometry is fundamental to anorectal physiology but the water-filled manometric systems commonly used have several disadvantages. to investigate the ‘new’ air-filled microballoon system, we compared it with a standard water-filled equivalent by measuring sphincter length, maximum resting pressure (MRP) and maximum voluntary contraction pressure (MVC) in 44 patients using the station pull-through technique. A good correlation was found for all three parameters (Spearman correlation coefficient rs: sphincter length = 0·86, MRP = 0·86 and MVC = 0·94, P &lt; 0·001). Repeat studies in 15 patients showed excellent reproducibility (rs: sphincter length = 0·97, MRP = 0·96 and MVC = 0·97, P &lt; 0·001). Air-filled microballoon manometry gives results similar to a water-filled microballoon system and has many advantages.
Experience of restorative proctocolectomy with ileal reservoir
Authors: Everett W G 
Published: March 2007

Abstract
The experience gained with restorative proctocolectomy and ileal reservoir in 60 patients is presented. Fifty-two patients had W reservoirs and the operative technique of the procedure is described in detail. Forty patients had a defunctioning ileostomy and 20 had a single stage procedure. There was no perioperative mortality. The main complications were sepsis (28 per cent), intestinal obstruction (18 per cent) and reservoir ileitis (20 per cent). There was a significant improvement in sepsis rate (from 20 to 4 per cent) and hospital stay (from 31·8 to 15·6 days) with increased experience. The functional results of 48 patients with W reservoirs was assessed. The mean number of evacuations per 24 h (±s.d.) was 3·8 ± 0·2. Sixty-five per cent of patients did not evacuate at all, or rarely, at night and none evacuated more than once at night. Forty-four per cent of patients took antidiarrhoeal agents. Continence was normal in 50 per cent of patients. Minor leakage occurred in 46 per cent of cases, frequent leakage in 4 per cent and incontinence in none. Sexual function in 29 men was normal. Ninety-four per cent of patients considered the result of their operation to be good or excellent.
Anastomotic leakage: An avoidable complication of Lewis-Tanner oesophagectomy
Authors: Paterson I M , Wong J 
Published: March 2007

Abstract
Data were collected prospectively from 159 patients undergoing Lewis-Tanner oesophagectomy for carcinoma of the lower two-thirds of the oesophagus and analysed with regard to anastomotic leakage. The 30-day mortality rate was 3·8 per cent and none of these deaths was due to anastomotic leakage. In hospital, mortality was 7·5 per cent. Six patients (3·8 percent) had evidence of a leak. In four patients this was from the suture line, but in the remaining two it was due to patches of gangrene in the fundus of the transposed stomach and was separate from the anastomosis. Two patients died with an unhealed leak. Anastomotic leaks were minor in three instances and healed with conservative treatment but the fourth required exploration. Gangrene of the oesophageal substitute resulted in gross leakage with mediastinitis and required exploration in both cases. An apparent predisposing cause was evident in five of the six cases with leakage and some of these might have been avoidable. Transthoracic oesophagectomy can be performed with acceptably low mortality and leak rates and may therefore be considered as the treatment of choice for most patients with oesophageal cancer.
Delayed return of gastric emptying after gastroenterostomy
Authors: Woods S D S , Mitchell G J 
Published: March 2007

Abstract
A retrospective study of patients having gastroenterostomies was undertaken to identify predictive factors for the development of postoperative delayed return of gastric emptying (DRGE). A total of 322 consecutive patients underwent 324 gastroenterostomies; 35 experienced delayed return of gastric emptying. Regression analysis demonstrated preoperative obstruction to be the most significant factor (P &lt; 0·001). Vagotomy was not an independent variable. Age, sex, size of stoma, anastomotic technique, albumin and experience of the operator were not significant factors. Gastroenterostomy in the presence of ‘gastric atony’ was likely to produce DRGE. In all, 86 per cent of cases resolved spontaneously. Only one case of DRGE was found to have a mechanical cause. Most patients were supported by parenteral nutrition but, with a knowledge of the identified risk factors, more thought could be given to establishing a route for jejunal feeding at the time of surgery.
Pylorus-preserving pancreatectomy: Functional results
Authors: Hunt D R , McLean R 
Published: March 2007

Abstract
The pylorus-preserving technique is reported as improving the functional results of pancreatectomy but it is complicated in the early postoperative period by delayed recovery of gastric function in a proportion of patients. We have examined early and late gastrointestinal function in a prospective study of 16 patients having this procedure. The late results appear better than reported results for conventional Whipple resection and the delay in early recovery does not appear to have any late sequelae, provided that it does not require gastric bypass for relief.
C-reactive protein, antiproteases and complement factors as objective markers of severity in acute pancreatitis
Authors: Wilson C , Heads A , Shenkin A , Imrie C W 
Published: March 2007

Abstract
In a series of patients with acute pancreatitis we have studied complement factors, antiproteases (α2-macroglobulin and α2-antiprotease) and C-reactive protein to determine the value of their sequential measurement in the prediction of outcome relative to clinical assessment and current multiple factor scoring systems. Complement factors were unhelpful in predicting the severity of an attack. α2-Macroglobulin levels were significantly lower in complicated attacks during days 3–8 and α1-antiprotease levels were significantly higher during days 4–8. C-reactive protein concentrations showed the best discrimination between mild and complicated attacks, levels rising higher and persisting for longer in complicated attacks; these differences were highly significant from day 2 (the morning after admission) to day 8. The concentrations providing the best discrimination were found to be ⩾ 210 mg/l for the peak C-reactive protein (on the second, third or fourth day) and ⩾ 120 mg/l for the C-reactive protein at the end of the first week. Analysis demonstrated both the peak or seventh-day C-reactive protein concentration to be of similar accuracy to either the Ranson or Glasgow multiple factor scoring systems and slightly better for attacks associated with gallstones. The C-reactive protein assay is simple, quick to perform, provides useful clinical information and is more likely to be of value and to be adopted into routine clinical practice than multiple factor scoring systems.
Surgical anatomy of the human spleen
Authors: Redmond H P , Redmond J M , Rooney B P , Duignan J P , Bouchier-Hayes D J 
Published: March 2007

Abstract
Post-splenectomy sequelae are now well recognized, and conservative splenic surgery is widely advocated. However, controversies exist regarding splenic surgical anatomy. We studied 127 human spleens using anatomical dissection and a sequential injection method involving both radiology and corrosion casting, with the primary aim of examining segmental splenic anatomy and blood supply. The existence of well-defined splenic segments was confirmed and these ranged in number from 3 to 7 with a mean of 4·3. Each segment had its own arterial supply and venous drainage. The segments were separated from each other by avascular planes. Subsegments with independent blood supply were also identified. The splenic artery was found to divide into two branches; in all cases these further divided into segmental arteries supplying the central segments of the spleen. The polar segments were supplied by segmental vessels of highly variable origin and size. This study aims to highlight the importance of identifying these segmental vessels at operation when splenic conservation is considered.
Endoscopic haemostasis for non-variceal upper gastrointestinal haemorrhage
Authors: Steele R J C 
Published: March 2007

Abstract
Endoscopic haemostasis can be effective in non-variceal upper gastrointestinal haemorrhage, and should be regarded as potential front-line treatment. Diverse methods are available, and although no single technique has become firmly established, current evidence favours thermal coagulation and injection therapy.
Repeat selective visceral angiography in patients with gastrointestinal bleeding of obscure origin
Authors: Lau W Y , Ngan H , Chu K W , Yuen W K 
Published: March 2007

Abstract
In the past 9 years, we have operated on 56 patients with gastrointestinal bleeding of obscure origin. Selective visceral angiography demonstrated the bleeding lesions in 24 of the 30 patients who underwent this investigation. Six of these 24 patients, however, had a negative angiogram initially and the lesions were only demonstrated on a repeat angiogram. The negative initial angiograms were due to: (1) slow bleeding from lesions in two patients; (2) a small bleeding tumour that caused only intermittent jejunojejunal intussusception in one patient; (3) technical fault in one patient; and (4) spasm of the bleeding vascular lesions and their feeding arteries in two patients. We advocate repeat angiography the following day in all patients in whom profuse bleeding continues, and during the next intestinal bleeding in those whose bleeding stops after the initial negative angiography. In patients who have repeated episodes of massive bleeding, and in whom full investigations fail to reveal the bleeding source, repeat angiography carried out 4 weeks after the bleeding has stopped can sometimes demonstrate the vascular lesions.