bluuebunny/crossref_metadata_2025_split huggingface dataset:
Single dose antibiotic prophylaxis in high risk patients undergoing transurethral prostatectomy
Authors: McEntee G P , McPhail S , Mulvin D , Thomson R W 
Published: March 2007

Abstract
In a randomized controlled clinical trial single dose antibiotic prophylaxis (gentamicin 80 mg IV) was evaluated in 36 patients with indwelling urethral catheters undergoing transurethral prostatic resection. Prophylaxis resulted in a significant reduction in postoperative bacteriuria (P &lt;0·01), pyrexia (P &lt;0·001), bacteraemia (P &lt;0·01) and septicaemia (P &lt;0·05). During the same period there was one case of postoperative bacteriuria but no systemic infection in 25 consecutive patients undergoing elective prostatectomy with no local risk factors and in the absence of prophylaxis. A policy of selective antibiotic prophylaxis is justified and in high risk patients with in-dwelling catheters single dose prophylaxis is highly effective.
Endoscopic management of common duct stones without cholecystectomy
Authors: Martin D F , Tweedle D E F 
Published: March 2007

Abstract
Endoscopic sphincterotomy was attempted in 81 patients with gallbladders for the primary management of symptomatic common duct stones and was successful in 80. Immediate complications occurred in six (7 per cent) and one patient died (1 per cent). Clearance of the common duct was achieved in 70 (86 per cent). Eight patients required surgery for failed clearance of the duct and suffered no operative mortality. Of 70 patients with cleared ducts, 5 underwent elective cholecystectomy. Four other patients with persistent or recurrent symptoms have required cholecystectomy, also without mortality. Sixty-one patients were reviewed 12–44 months (mean 24; median 22 months) after endoscopic sphincterotomy. Eighteen have died, none from biliary disease. Forty-three patients remain alive and well, free of biliary symptoms since endoscopic sphincterotomy. When the surgical risk of cholecystectomy and choledocholithotomy is high, endoscopic sphincterotomy is effective and safe. Routine cholecystectomy is not indicated when the common duct has been cleared.
Carcinoma of the head of the pancreas: Bypass surgery in unresectable disease
Authors: La Ferla G , Murray W R 
Published: March 2007

Abstract
One hundred patients who underwent bypass surgery for unresectable, histologically proven carcinoma of the head of the pancreas were studied to determine: (1) the incidence of a second operation for duodenal obstruction in survivors who had a biliary diversion only; (2) whether the addition of a prophylactic gastroenterostomy is associated with increased mortality. Eighty-six patients (Group A) had a biliary diversion alone while fourteen (Group B) had a biliary diversion and a prophylactic gastroenterostomy. Both groups were comparable regarding sex, age, symptomatology and clinical findings. The postoperative mortality was similar for both groups (Group A, 27·9 per cent; Group B, 14·3 per cent). The mean surgically related hospital stay was 22·6·5 days (Group A) and 20·7 days (Group B). Of the 62 patients in Group A who left hospital, 8 (13 per cent) required a second operation for duodenal obstruction (mean interval 5·4 ± 2·7 months). The in-hospital stay for the second operation was 14·4·7·7 days. The overall survival for both groups was identical at 6 months (35·5 versus 33·3 per cent) and 12 months (19·3 versus 16·7 per cent). This study suggests that prophylactic gastroenterostomy adds no risk to patients requiring biliary diversion for carcinoma of the head of the pancreas. Its routine use is therefore justified since 13 per cent of the patients who survived the biliary diversion required further surgery for duodenal obstruction before death.
Preliminary results of the Nottingham breast self-examination education programme
Authors: Dowle C S , Mitchell Anna , Elston C W , Roebuck E J , Hinton C P , Holliday H , Blamey R W 
Published: March 2007

Abstract
Between June 1979 and December 1984, 49573 women (study population) between the ages of 45 and 64 years and living in one health district were invited to attend breast self-examination sessions as part of the DHSS ‘UK Trial of Early Detection of Breast Cancer’. Of the women invited 50·2 per cent attended for education. A total of 319 breast cancers were diagnosed in the study population during this period. The tumour characteristics, patient prognostic groups and survival have been compared with a control population consisting of the 319 consecutive breast cancers diagnosed immediately before the start of the DHSS trial, in women of the same age group and living in the same health district. There has been a significant reduction in the size at presentation of operable tumours (P &lt;0·01) and there has been a small (3·4 per cent) reduction in lymph node involvement, but this is not significant. The rates of presentation of both in situ and advanced carcinoma have not significantly changed following the introduction of a breast self-examination education programme. At this stage no overall survival difference has been identified between the two groups but the median follow up of the study population is limited (25 months).
Mitogenicity of human fibroblasts in vivo for human breast cancer cells
Authors: Horgan K , Jones D L , Mansel R E 
Published: March 2007

Abstract
Stromal factors have been implicated in the regulation of mammary epithelial cell behaviour, but their influence on human breast cancer is unknown. Fibroblasts were grown in monolayer cell culture from explants of benign and malignant breast tissue and normal skin. MCF7 human breast cancer cells alone (2 × 106 cells) or in combination with live fibroblasts (MCF7 + F) were inoculated into the mammary fat pads of 6–8-week-old female nude mice. After 5 weeks tumours were excised, weighed and fixed for histological examination. Addition of live breast fibroblasts significantly increased the retrieval (127/135 versus 52/106, P &lt;0·01, χ2 test) and growth (tumour weight 174·11 versus 41·4 mg, mean ± s.e.m., P &lt;0·01, Mann—Whitney U test) of subsequent tumours. Histological examination did not reveal any morphological difference between the two tumour groups. Injection of fibroblasts alone did not produce tumours. Addition of skin fibroblasts was also stimulatory. Glutaraldehyde-killed fibroblasts increased tumour take but did not stimulate tumour growth. Mononuclear blood leucocytes were ineffective. The results demonstrate that, in this model, fibroblasts exert stimulatory influences on human breast cancer xenograft growth and development.
Random control trial of a short course of aspirin and dipyridamole (Persantin) for femorodistal grafts
Authors: Clyne C A C , Archer T J , Atuhaire L K , Chant A D B , Webster J H H 
Published: March 2007

Abstract
The effect of a short course of anti-platelet agents, started pre-operatively, on the patency of femorodistal bypass grafts is unknown. One hundred and forty-eight such grafts were randomized to act as controls or to receive dipyridamole 200 mg b.d. for 48 h pre-operatively and dipyridamole 200 mg b.d. with aspirin 300 mg daily for 6 weeks after surgery. Patients were well-matched and the mean pre-operative pressure index of 0·37 rose to 0·78 during the first postoperative week. No deaths were attributable to the treatment. Ninety-three grafts were autogenous vein and the remainder were prosthetic (GORE-TEX* (PTFE), human umbilical vein or externally supported Dacron). At 1 year autogeneous vein cumulative patency was 75 per cent. Overall results showed higher patency in the treated group (P = 0·012) which was entirely accounted for by the difference between prosthetic dipyridamole and aspirin group (85 per cent patency) and prosthetic control groups (53 per cent patency, P = 0·005) and arose during the first postoperative month. There were 11 deaths and 8 amputations in the dipyridamole and aspirin group and 8 deaths and 12 amputations in the control group. It is concluded that a six week perioperative course of dipyridamole and aspirin allows the patency of prosthetic femorodistal bypass to approach that of autogenous vein, and the regimen therefore is recommended for patients who may require a prosthetic graft.
Use of a gamma camera for measuring limb blood flow in peripheral vascular disease
Authors: Parkin A , Wiggins P A , Robinson P J , Vowden P , Kester R C , Ware Fiona M 
Published: March 2007

Abstract
A method for measuring limb blood flow during reactive hyperaemia is described. Pneumatic cuffs inflated to 300 mmHg are used to isolate the blood in the limbs from the rest of the circulation. The remaining blood is labelled with technetium. The increase in radioactivity in the limb following release of the cuffs is measured using a gamma camera. The mean rate of flow of blood to the limb (in ml (100 ml)−1 tissue min−1) is derived from the graph of radioactivity versus time and from the radioactivity in a sample of venous blood. The results of measurements carried out in patients with peripheral vascular disease (30 limbs) and normal controls (24 limbs) are presented. Repeated studies in 10 subjects (20 limbs) showed the method to be highly reproducible at high and low flow rates (r = 0·99). Case studies illustrating the use of the method as a screening test for peripheral vascular disease and to monitor the effects of treatment are presented.
Perforated duodenal ulcer managed by simple closure versus closure and proximal gastric vagotomy
Authors: Christiansen J , Andersen O B , Bonnesen T , Baekgaard N 
Published: March 2007

Abstract
A prospective randomized trial of simple closure versus closure and proximal gastric vagotomy was conducted in 50 consecutive patients with perforated duodenal ulcer. There was one postoperative death in each group and no difference in postoperative morbidity. After a median follow-up of 54 months (24–96) the cumulative recurrence rate after simple suture was 52 per cent against 16 per cent after proximal gastric vagotomy and closure (P &lt;0·01). The recurrence rate after proximal gastric vagotomy for perforated duodenal ulcer was comparable to the recurrence rate seen after the electively performed operation.
Fine-needle aspiration biopsy and the diagnosis of thyroid cancer
Authors: Anderson J B , Webb A J 
Published: March 2007

Abstract
Conventional criteria for the evaluation of thyroid nodules are inaccurate in identifying the small proportion of malignant neoplasms. The diagnostic accuracy of fine-needle aspiration biopsy (FN AB) for cytology was therefore assessed in 562 patients with nodular thyroid disease, 373 of whom (66·4 per cent) had histological confirmation of the cytological diagnosis. Sixty-one aspiration biopsies were positive for malignancy, and the diagnosis was confirmed histologically in 59 of these (96·7 per cent). Thus, there were two false positive cytology results among 310 patients with proven benign disease (0·6 per cent). Four of sixty-three patients with proven carcinoma had a benign cytological diagnosis, a false negative rate of 6·3 per cent. In 57 of the 59 malignancies (96·6 per cent) correctly diagnosed by FNAB the histological type of tumour was successfully identified. Overall 367 of 373 patients received correct cytological discrimination between benign and malignant nodules, an overall accuracy of 98·4 per cent for FNAB. The sensitivity of the test was 93·7 per cent and the specificity 99·4 per cent. Besides being safe, cost-effective and reliable, FNAB directs the appropriate selection of patients for surgery and enables the correct operation to be performed for each type of tumour.
Blood viscosity in patients with bone fractures and long term bedrest
Authors: Ernst E , Schmidt-Pauly E , Mühlig P , Matrai A 
Published: March 2007

Abstract
Eighteen patients with bone fractures and without systemic disease were studied for blood rheology. Blood and plasma viscosities, haematocrit, red cell aggregation and filterability as well as plasma colloid oncotic pressure were measured. Results show that patients exhibit a substantial haemorheological deficit on admission. During bedrest this returns to normal, owing to marked ‘autohaemodilution’. It is concluded that trauma causes increased viscosity of blood in these patients. This change could predispose to deep vein thrombosis. However, such a risk is reduced by ‘autohaemodilution’ which is most probably an effect of immobilization.
Effect of topical and systemic antibiotics on bacterial growth kinesis in generalized peritonitis in man
Authors: Krukowski Z H , Al-Sayer H M , Reid T M S , Matheson N A 
Published: March 2007

Abstract
Quantitative bacteriology in peritoneal exudate was studied in 40 patients with generalized peritonitis of small intestinal, appendicular or colonic origin. Bacterial growth kinesis was measured in 28 of the patients. Systemic antibiotics given before operation resulted in a significant reduction in both the concentration and growth rate of viable bacteria in the peritoneal fluid. Lavage of the peritoneal cavity with saline resulted in a further reduction in growth rate in patients given pre-operative systemic antibiotics by an effect attributable to simple dilution. In contrast, peritoneal lavage with tetracycline (1 mg/ml) resulted in complete inhibition of bacterial growth in the residual peritoneal fluid. These observations support the policy of giving systemic antibiotics to patients with generalized peritonitis as soon as the diagnosis has been made and provide bacteriological evidence for the value of peroperative antibiotic peritoneal lavage.
Improved wound healing response in surgical patients receiving intravenous nutrition
Authors: Haydock D A , Hill G L 
Published: March 2007

Abstract
The wound healing response was assessed in 90 surgical patients by measuring the accumulation of hydroxypyroline that occurred over a 7 day period, in fine tubes of thin walled GORE-TEX placed in the subcutaneous layers of the arm. In 47 patients presenting for intravenous nutrition, the wound healing response was less (0·34 ± 0·23 μg hydroxyproline/cm of tubing) than that of 36 normally nourished patients (0·49·0·30 μg/cm; P &lt;0·01). However, it was higher when measured after intravenous feeding had commenced (0·88 ± 0·62 μg/cm; P &lt;0·005). In 29 patients two sequential studies of wound healing were conducted over a 14-day period of intravenous nutrition. The mean accumulation of hydroxyproline during the first week of intravenous nutrition was 0·36 ± 0·24 μg/cm and this was increased significantly over the second week of feeding to 0·78 ± 0·67 μg/cm; P &lt;0·005. The wound healing response that occurred in wounds made after a period of pre-operative nutrition was better than that which occurred when only postoperative nutrition had been given (P &lt;0·02). These results show that the wound healing response in surgical patients requiring intravenous nutrition is improved by this treatment. This improvement is seen after only one week of therapy and before there is an obvious change in nutritional status. It also appears that the improved wound healing response is more marked when intravenous nutrition is given before, rather than after the surgical procedure.
Major hepatic resection for colorectal liver metastases
Authors: Bradpiece H A , Benjamin I S , Halevy A , Blumgart L H 
Published: March 2007

Abstract
A 6 12 year experience in the management of hepatic colorectal metastases in a specialist unit is reviewed. During the period studied, 48 patients were referred of whom only 24 actually came to resection. There were two in-hospital deaths, at 20 and 60 days, and six patients had non-fatal complications. Although the extent of resection was greater than in most reported series (13 right hepatectomies and 6 extended right hepatectomies), the results of resection were broadly the same as those of others, with a median survival of 30 months and 2 and 3 year survivals of 50 and 44 per cent respectively. A number of factors which others have considered to be of prognostic significance were examined. Tumour clearance was the only important prognostic indicator, where a 5 mm clear margin between the tumour and cut surface produced a significant difference in survival. It is suggested that a much larger number of patients in the UK with hepatic colorectal metastases might be considered for resection.
Carcinoid tumours of the rectum and anus
Authors: Burke M , Shepherd N , Mann C V 
Published: March 2007

Abstract
Carcinoid tumours of the anorectum comprise only 0·1 percent of all rectal tumours. Their behaviour and treatment are still debatable. We identified 35 cases from the records of St Mark's Hospital; 31 were benign and 4 were malignant. Benign tumours were of three distinct histopathological patterns. All benign tumours were cured by local treatment. Malignant tumours can be identified clinically; the only consistent microscopic feature was invasion of the muscularis propria. All patients with malignant tumours died, despite radical surgical treatment; lymph node metastases were invariably present in the operation specimens. Because radical treatment for malignant carcinoid tumours of the anorectum is largely unsuccessful, a flexible surgical approach is advocated.
Anorectal myectomy for outlet obstruction
Authors: Yoshioka K , Keighley M R B 
Published: March 2007

Abstract
Anorectal myectomy has been evaluated in 29 patients with chronic constipation associated with outlet obstruction. Eight patients had histological evidence of aganglionosis. No patient was able to defaecate spontaneously more than once a week before operation. Eighteen (62 per cent) patients were able to defaecate spontaneously more than 3 times a week after operation (good results) whereas 11 patients were not. There was a significant fall in maximum resting anal pressure after operation in the patients having a good result (102·7±16·7 to 79·5 ± 27·8 cm H2O) whereas there was no significant fall in those having a poor result (118·4±25·0 to 108·8±28·5 cm H2O). The operation had no influence on squeeze pressures, length of the high pressure zone, rectal sensation or the anorectal angle. These results seem to indicate that the therapeutic effect of anorectal myectomy is merely due to reduced resting anal canal pressures.
Acute pancreatitis associated with carcinoma of the ampulla of Vater
Authors: Robertson J F R , Imrie C W 
Published: March 2007

Abstract
Acute pancreatitis associated with pancreatic carcinoma or tumour metastases in the pancreas is well documented. In this paper we show a similar association between acute pancreatitis and ampullary carcinoma. Of 41 patients with ampullary carcinoma seen at a single centre over a 25 year period (1959–83), 6 developed acute pancreatitis. Three other patients with a history of obstructive jaundice were noted to show mild transient hyperamylasaemia. Endoscopic retrograde choledochopancreatography is mandatory in the investigation of such patients.
Alcohol induced pancreatitis: Social and surgical aspects
Authors: McEntee G P , Gillen P , Peel A L G 
Published: March 2007

Abstract
During the period 1977–1985, 38 patients with alcohol related pancreatitis (37 men, 1 woman) were referred to a specific pancreatic follow-up clinic; their mean age was 42·4 years (range 20–69 years). At initial presentation 14 patients were unemployed (37 per cent) and 11 worked as unskilled labourers (29 per cent). Twenty-seven patients (71 per cent) required more than one hospital admission. Surgery was indicated in 14 patients (37 per cent): 4 diagnostic laparotomy, 3 cholecystectomy, 3 drainage of pancreatic pseudocyst and 1 pancreatic abscess, 3 biliary bypass and 4 pancreatic resection. Four patients required more than one operative procedure. Five deaths occurred during the study period: one following biliary bypass, one following total pancreatectomy and three not directly related to pancreatitis. Follow-up attendance rates at 1, 3 and 5 years were 76, 47 and 34 per cent respectively. Alcohol induced pancreatitis in Teesside, UK, is a disease of young adult males of lower socio-economic status with a recurring pattern leading to repeated hospital admissions and an unexpectedly high incidence of surgery. The study demonstrates the problem of ascertaining data related to long term follow-up in a condition where, despite intensive efforts, patient compliance is poor.
Effects of epidural administration of local anaesthetics or morphine on postoperative nitrogen loss and catabolic hormones
Authors: Tsuji H , Shirasaka C , Asoh T , Uchida I 
Published: March 2007

Abstract
To examine the effects of postoperative epidural analgesia with local anaesthetics or morphine on the excess nitrogen loss after upper abdominal surgery and to assess the roles of catabolic hormones in the nitrogen loss, urinary excretion of nitrogen and catecholamines and plasma concentrations of cortisol and glucagon were measured in three groups of patients undergoing elective gastrectomy. Group G patients received the operation under general anaesthesia, and their postoperative pain was relieved by intermittent injections of analgesics. Group PE received prolonged epidural analgesia with local anaesthetics during and after surgery. Group EM received epidural analgesia intra-operatively and epidural morphine postoperatively. Urinary nitrogen excretion during the first three postoperative days was significantly less in the PE and EM groups than in the G group, and the PE group excreted slightly less nitrogen than the EM group. In the G group, urinary excretion of adrenaline increased mainly on the day of operation, and noradrenaline chiefly on postoperative days. These catecholamine responses were almost completely abolished in the PE group, and significantly inhibited in the EM group. Plasma cortisol response was most remarkable shortly after the operation and then decreased in all groups, but was significantly lower in the two epidural groups than in the G group throughout the study. Plasma glucagon increased postoperatively in all groups, and the increase was less pronounced in both epidural groups than in the G group. These results suggested that an elevated sympathic activity, represented by increased noradrenaline excretion and elicited by painful nociceptive and sympathetic nervous afferents, is responsible for the postoperative nitrogen loss which is mediated by glucagon and cortisol.
Value of nutritional parameters in the prediction of postoperative complications in elective gastrointestinal surgery
Authors: Leite J F M S , Antunes C F , Monteiro J C M P , Pereira B T V 
Published: March 2007

Abstract
The following nutritional parameters were assessed in 117 patients before major gastrointestinal surgery: percentage recent weight loss; percentage ideal body weight; tricipital skinfold; arm muscular area; grip strength dynamometry; serum albumin (ALB); serum transferrin (TFN); delayed hypersensitivity skin tests (DH); total lymphocyte count; prognostic nutritional index (PNI) and clinical assessment of malnutrition. Comparing the results in patients without complications (n = 99) with those in patients with complications (n = 18) and the results in patients who survived (n = 109) with those who died (n = 8), we found that only ALB, DH, TFN and PNI showed significant differences in both comparisons. Correlations of complications with combined parameters was made by multiple linear regression analysis; a modified PNI (mPNI), including these three single variables, has emerged. Considering its risk values, the nutritional parameters showed the following sensitivity and specificity, respectively: ALB&lt;3·2 g/dl (72 and 71 per cent), anergy (67 and 64 per cent), TFN &lt;205 mg/dl (67 and 55 per cent) and mPNI &lt;20 (72 and 70 per cent). Using Bayes' theorems, ALB, DH and calculated indices showed the same predictive capacity and we conclude that single or multiple association of nutritional parameters have no additive effect. To predict complications of nutritional origin it seems only necessary to consider ALB, taking into account the type of operation and the normal duration of postoperative hospital stay without oral intake.