bluuebunny/crossref_metadata_2025_split huggingface dataset:
Exploration of the common bile duct—the relevance of the clinical picture and the importance of peroperative cholangiography
Authors: Cranley Brian , Logan Hume 
Published: March 2007

Abstract
A series of 500 cholecystectomies performed over a 7-year period was reviewed retrospectively. The reliability of preoperative clinical features such as jaundice and pancreatitis was assessed in determining the presence of choledocholithiasis, and was found to be of limited value. Investigations such as intravenous cholangiography and liver function tests were found also to be inaccurate in the detection of common duct stones as was the appearance of the duct at operation. The usefulness of the peroperative cholangiogram in the detection of common duct stones that would otherwise have been overlooked is emphasized. Common duct stones would have remained undetected in 25 per cent of patients with choledocholithiasis. Despite the use of routine peroperative cholangiography common duct stones were overlooked in 11·25 per cent of patients who underwent exploration.
Carcinoma of the hepatic duct junction
Authors: George Phyllis A , Brown Colin , Foley Robert T E 
Published: March 2007

Summary
A series of 54 patients with carcinoma of the hepatic duct junction is reviewed. The condition is probably less rare than previous publications would suggest as the condition is frequently missed at operation. An account of the presentation, investigation and treatment of these patients is given, as well as the results obtained. In the discussion that follows, it is pointed out that if systematic investigation is carried out, with particular regard to adequate radiological investigations, both prior to and during surgery, the correct diagnosis can be made, although histological proof may be difficult to obtain. These tumours are seldom resectable, but good and worthwhile palliation may be obtained.
Traumatic renal artery occlusion producing hypertension
Authors: Ernst David , Windsor Colin W O 
Published: March 2007

Summary
Traumatic renal artery occlusion is relatively rare. Prior to 1974 there were only 38 cases reported in the literature (1). The true incidence, however, is greater and the diagnosis is frequently missed at the time of the original injury. Less than 50 per cent of cases will develop hypertension. Early diagnosis is essential if this complication is to be avoided. Two cases of traumatic renal artery occlusion producing hypertension are described.
Solitary ulcer of the rectum—or is it? A report of 6 cases
Authors: Thomson G , Clark A , Handyside J , Gillespie G 
Published: March 2007

Summary
Solitary ulcer of the rectum is an unusual disorder which presents only occasionally to the individual clinician. While the histopathological features are characteristic, the wide variety of naked eye appearances of lesions which the syndrome produces may make for clinical confusion, particularly since the lesions may be neither solitary nor ulcerated. We present here an experience of six cases which presented to the Victoria Infirmary, Glasgow, over the period 1969–79 which illustrate the diagnostic dilemma and variety of lesions encountered.
The surgical treatment of radiation injuries after radiotherapy for uterine carcinoma
Authors: Cochrane John P S , Yarnold John R , Slack William W 
Published: March 2007

Summary
The outcome of serious radiation injuries to the pelvic viscera in 400 patients treated by radiotherapy for carcinoma of the uterus between January 1974 and December 1978 has been reviewed. Twenty-eight instances of serious radiation damage have been found, 13 of predominantly small bowel damage, 11 of predominantly large bowel damage and 4 of bladder damage. Many patients had involvement at multiple sites. Fourteen patients have died, and 9 survivors have artificial abdominal stomas. Leaking anastomoses and progressive sepsis were major problems in the postoperative period and could be related either to inadequate resection of irradiated bowel or to damage to other organs at operation. The possibilities of earlier diagnosis and better surgical procedures are discussed.
Tuberculous pyloric stenosis
Authors: Keenan Daniel J M 
Published: March 2007

Summary
A case of pyloric stenosis, caused by abdominal tuberculosis and presenting as an inoperable neoplasm in a member of the indigenous population of the British Isles, is reported. The need for histological confirmation of suspected inoperable malignant tumours is stressed. The pathogenesis and management of the condition are discussed.
Reoperation for recurrent peptic ulceration
Authors: Muscroft T J , Taylor E W , Deane S A , Alexander-Williams J 
Published: March 2007

Abstract
Thirty-eight patients undergoing reoperation for recurrent peptic ulceration have been reviewed after at least 3 years. All were considered to be in Visick grade IV before reoperation. There were no operative deaths. Thirty-three of the patients ended with both a vagotomy and antral resection. After reoperation 17 patients (45 per cent) remained in Visick grades III and IV. Eight patients have had further operations and, after 47 procedures in 38 patients, 14 (37 per cent) were still in Visick grades III and IV. Vagotomy and antrectomy has a high non-ulcer mobidity rate and we conclude that other methods of treatment for recurrent ulceration require evaluation.
The clinical relevance of isolated ventral pancreas
Authors: Thompson M H , Williamson R C N , Salmon P R 
Published: March 2007

Abstract
An isolated ventral pancreas results from failure of fusion of the dorsal and ventral pancreatic ducts. Until the advent of endoscopic retrograde cholangiopancreatography (ERCP), the clinical significance of this abnormality was not known. A series of 11 such patients in 850 consecutive ERCP examinations is described. No other cause for their symptoms was discovered. Secretory studies showed a low volume of pancreatic juice with normal concentration of bicarbonate and trypsin. In 5 cases operative dorsal pancreatography was performed: it was normal in all cases. In 3 cases the pancreatic tail was amputated and found unexpectedly to be the seat of pancreatitis in 2. Isolated ventral pancreas may be associated with pancreatitis, but this is not proved.
Surgical treatment for Graves' disease: A long term follow-up of 325 patients
Authors: Noguchi Shiro , Murakami N , Noguchi A 
Published: March 2007

Abstract
Postoperative thyroid status was classified into 6 categories on the basis of serum free thyroxine index (FTI), serum triiodothyronine (T-3) and serum TSH concentration. Review of 325 patients who underwent thyroidectomy for Graves' disease more than 4 years previously showed that 25 patients (7·7 per cent) had recurrent hyperthyroidism. Six patients (1·8 per cent) were classified as equivocal hyperthyroid since either FTI or T-3 was above the normal range. Two hundred and twenty-two patients (68·3 per cent) were unequivocally euthyroid and 33 patients (10·3 per cent) were euthyroid with elevated TSH levels. Twenty patients (6·2 per cent) were equivocal hypothyroid since either their FTI or T-3 values were below the normal range and TSH were increased. Hypothyroidism was present in 19 patients (5·8 per cent), of whom 11 had no clinical manifestation of thyroid dysfunction. The incidence of hypothyroidism did not correlate with the intervals between operation and review.
The second review, performed in 189 patients 18 months after the first, showed that there was a change in thyroid functional status in 46 patients, of whom 32 had an increased level of function, including one hypothyroid and 7 equivocal hypothyroid patients who became euthyroid spontaneously.
Thus postoperative hypothyroidism in some patients can recover without medication. Also thyroid function in some postoperative patients is not maintained at a fixed level but may fluctuate.
The wound fibroblast and macrophage. I: Wound cell population changes observed in tissue culture
Authors: Stewart Richard J , Duley John A , Rosman Ingrid , Fraser Robin , Allardyce Randall A 
Published: March 2007

Abstract
The number and type of cells which migrated from sequential explants of wounded fascia in rats reflected the dense and changing cell populations observed in healing wounds. Macrophages appeared in large numbers from explants taken in the 5 days following injury, thereafter fibroblast-like cells predominated. The results support the hypothesis that the fibroblast-like cell of tissue culture is the same as the wound fibroblast. The technique can be used to obtain wound cells and provides a useful bridge between in vivo and in vitro means of investigating wound repair.
Lymphoscintigraphy cannot diagnose breast cancer
Authors: Black R B , Merrick M V , Taylor T V , Forrest A P M 
Published: March 2007

Abstract
Axillary lymphoscintigraphy was performed by the technique of Agwunobi and Boak (1) in 68 patients with operable cancer of the breast and 11 patients with benign disease. Contrary to their previous report, scans were found to be indistinguishable from normal in the majority of breast cancer patients with interpretable scans, and no pattern of uptake was found which was typical of carcinoma in the corresponding breast.
Scintiscanning of the breast with 99Tcm−diethylene triamine penta-acetic acid—a prospective blind evaluation
Authors: Cuschieri A , Hutchinson F , Neill G D S , Wisbey M L , Wood R A B , Preece P , Clark J 
Published: March 2007

Abstract
In this blind prospective study of breast scintiscanning with 99Tcm−diethylene triamine penta-cetic acid (DTPA) in 67 female patients presenting at a primary breast referral clinic, we have observed that this investigation has a high diagnostic accuracy in distinguishing benign from malignant lesions of the breast. The predictive value of the test when positive in establishing the presence of cancer is 94 per cent with a false negative rate of 6 per cent. The predictive value of the test when negative in excluding cancer is 97 per cent with a false positive rate of 3 per cent. Initial studies also indicate the potential value of DTPA breast scintiscanning in delineatingthe activityof painful benign lesions of the breast.
The effects of caerulein and a meal stimulus on gallbladder intraluminal pressure and bile flow in the pig
Authors: Mitchenere P , Adrian T E , Hobbs K E F , Bloom S R 
Published: March 2007

Abstract
The intraluminal gallbladder pressure has been measured in a conscious unsedated pig model by the use of a radiotelemetry pressure capsule. A loop fistula was incorporated to measure bile output simultaneously. Mean fasting intraluminal gallbladder pressure was found to be 15±4 mmHg above atmospheric pressure, and mean fasting bile output 7·5±0·8 ml/10 min.
Following intravenous caerulein pressure peaked at 2 min with a mean rise of 17±3 mmHg above basal (P&lt;0·005). Bile output was increased for 30 min following caerulein with a total mean increase for this period of 13·5±2·2 ml (P&lt;0·005).
Gallbladder pressure rose significantly 5 min after commencing a meal by 6·0±1·9 mmHg (P&lt;0·025) reaching a peak pressure 65 min after the meal with a mean rise of 14·8±2·3 mmHg (P&lt;0·005). Bile output was significantly increased for 50 min following the ingestion of food. The total increments above basal values for bile output being 15·9±2·7 ml (P&lt;0·005) in the first 30 min post-randially and 11·6±2·4 ml (P&lt;0·005) in the 30–60 min period.
This model re-emphasizes the rapidity of the hormonal response and may be valuable for further studies on the physiology of post-randial gallbladder emptying.
Carcinoma of the gallbladder
Authors: Koo Jarley , Wong John , Cheng Frank C Y , Ong G B 
Published: March 2007

Abstract
A retrospective study of 100 proved cases of primary carcinoma of the gallbladder admitted to the University Surgical Unit, University of Hong Kong, over a 20-year period was undertaken. The female to male ratio was 1·4 to 1. The peak incidence was in the seventh decade for the females and the sixth decade for the males. Preoperative diagnosis was made in 10 patients. ‘Curative’ cholecystectomy was performed in 20 patients with a 5-year survival rate of 10 per cent. Palliative procedures were performed in 44 patients with a median survival of 8 weeks, which was notsignificantly different from that in the 30 patients who were not operated upon or had laparotomy and biopsy only. Radical resection was carried out in 6 patients, all of whom died in hospital. Gallstones were found in only 26 patients. The gallbladders of 3 patients had associated benign tumours, one of which had malignant transformation at multiple sites. One patient had chronic typhoid infection. The incidence of clonorchis infestation and primary pyogenic cholangitis in these 100 patients was not different from that of our general hospital population.
Management of diabetes during open heart surgery
Authors: Gill G V , Sherif I H , Alberti K G M M 
Published: March 2007

Abstract
The management of 5 insulin-dependent diabetics following open heart surgery was studied and compared with a group of 5 similar diabetics who had undergone urological or orthopaedic operations. The patients were all treated with a glucose/insulin/potassium infusion regimen, but the cardiac group needed much greater amounts of insulin (1·0 unit/g of glucose) than the non-cardiac group (0·3 units/g) to achieve a similar level of control. The high requirements of the cardiac patients are probably related to trauma, hypothermia and glucose loading when cardiopulmonary bypass begins. Diabetics undergoing such surgery need suitably modified insulin regimens from the outset.
The influence of an intact pylorus on postprandial enteroglucagon and neurotensin release after upper gastric surgery
Authors: Sagor G R , Ghatei M A , McGregor G P , Mitchenere P , Kirk R M , Bloom S R 
Published: March 2007

Abstract
Upper partial gastrectomy for carcinoma of the gastric cardia or fundus is unavoidably accompanied by truncal vagotomy, so it is orthodox practice to carry out pyloroplasty with this procedure. In order to assess the effect of leaving an intact pylorus in this operation, 21 patients were investigated with an oral hypertonic load (200 ml 50 per cent glucose solution), and blood was taken at intervals during the test, for the ileal gut hormones, enteroglucagon and neurotensin, as well as for measurements of haematocrit and blood glucose. Clinical features of dumping during the test were sought. There were 7 patients with upper partial gastrectomy, truncal vagotomy and an intact pylorus, 7 patients without a pylorus(total or near total gastrectomy) and 7 patients not subjected to gastric surgery.
No significant difference was found in any of the measurements between gastrectomy patients with an intact pylorus andthose draining through an enterostomy. However, both these groups differed significantly from normal controls in havinggreater rates of rise and higher peak values of enteroglucagon, neurotensin, haematocrit and blood glucose, together witha more frequent occurrence of dumping symptoms during the test.
As the above measurements probably reflect transit of glucose into the small intestine, the findings in this study suggest that leaving an intact unstenosed pylorus is unlikely to lead to gastric stasis following upper partial gastrectomy.
Gallstone ileus complicating terminal ileal Crohn's disease
Authors: Highman L , Jagelman D G 
Published: March 2007

Abstract
Two cases are reported of gallstone ileus complicating terminal ileal Crohn's disease. Both patients had a prolonged history of Crohn's disease without the need for surgical intervention. They were admitted with small bowel obstruction which failed to resolve on conservative management as is usually the case. The features of these two cases that may lead to the development of this complication and the pointers in diagnosis are discussed.
Body temperature after accidental injury
Authors: Little R A , Stoner H B 
Published: March 2007

Summary
Core and mean skin temperatures have been measured in 82 patients shortly after accidental injuries of different severity in order to study the effects of injury on thermoregulation. Skin temperature fell after injury and core temperaturealso when the injury was severe. After severe injuries both core and mean body temperatures were negatively related to theseverity of the injury, measured by the Injury Severity Score. The fall in skin temperature was attributed to vasoconstriction and that in core temperature to decreased heat production due to reduced oxygen transport to the tissues. These changes in temperature should have stimulated shivering which was not observed in the severely injured. This suggests thatthermoregulation is affected after injury, and possible mechanisms are discussed.
Postoperative changes in coagulation and fibrinolysis independent of neurogenic stimuli and adrenal hormones
Authors: Rem J , Feddersen C , Brandt M R , Kehlet H 
Published: March 2007

Summary
Postoperative changes in various haemostatic parameters (capillary bleeding time, platelet count, fibrinogen, fibrinmonomers, prothrombin, antithrombin III, factor VIII procoagulant, factor VIII antigen, euglobulin clot lysis time, streptokinase lysis time, fibrinogen related antigens, α1−antitrypsin and α2−macroglobulin) plasma glucose and cortisol were studied in 12 female patients undergoing elective abdominal hysterectomy during either general anaesthesia or epidural analgesia (T4−S5). General anaesthesia and epidural analgesia on their own had only negligible influence on haemostatic parameters. Hysterectomy during general anaesthesia caused activation of coagulation and fibrinolysis, followed by depression of fibrinolysis. Epidural analgesia prevented the cortisol and glucose response to surgery, but did not influence the coagulation and fibrinolytic response to surgery, except for an inhibition of the postoperative increase in factor VIII antigen. It is concluded that postoperative changes in the coagulation and fibrinolytic systems are mediated by factors other than neurogenic stimuli and adrenal hormones.
Ionized calcium in acute pancreatitis and its relationships with total calcium and serum lipase
Authors: Croton Roger S , Warren Richard A , Stott Anthony , Roberts Norman B 
Published: March 2007

Summary
Serial measurements of serum amylase, lipase and ionized calcium were made in a prospective study of 17 patients withacute pancreatitis. The mean serum ionized calcium was significantly below the normal range for the first 24 h and had returned to normal after 48 h. There was no correlation between serum ionized calcium and paired calcium corrected for albumin during the first 36 h of the study, but they were correlated for the remainder of the investigation. Serum lipase andionized calcium levels were just significantly correlated over the first 3 days (r= −0·44;t = 2·3; P&lt;0·05; d.f. 22), but failed to reach correlation over the whole period of study (r= −0·34; t= 2·0; d.f. 31). These data establish a significant drop in directly measured ionized calcium early in an attack of pancreatitis, which is not seen in the paired corrected calcium values. Furthermore, the drop is correlated with serum lipase, although this is weak and other factors must be involved in the hypocalcaemia.
Diagnostic peritoneal lavage in acute pancreatitis—the value of microscopy of the lavage fluid
Authors: Bradley J Andrew , Bradley Paul , McMahon Michael J 
Published: March 2007

Summary
In only 2 of 98 cases with a clinical diagnosis of acute pancreatitis submitted to peritoneal lavage in order to assess severity was the diagnosis found to be wrong. These two cases (one was biliary peritonitis and the other mesenteric infarction) were not differentiated from severe pancreatitis by clinical examination, measurement of plasma amylase, the appearance of the lavage fluid or its amylase or white cell count. One case was exceptional in that the lavage fluid had a faecal odour, and both cases were found to have large numbers of intestinal organisms which were clearly visible on routine microscopy. Scanty commensals (? contaminants) were seen in the lavage fluid of 2 of the 96 patients with acute pancreatitis but no intestinal organisms were found. If peritoneal lavage is used in the management of acutepancreatitis, microscopy of the lavage fluid, carried out as an emergency investigation, might help to detect the occasional case with a false diagnosis.
The effect of increased motility on absorption from the canine colon
Authors: Grandison A S , Hyland J , Darby C , Shields R , Taylor I 
Published: March 2007

Summary
The absorption of water and electrolytes and intraluminal pressure were measured from Thiry-Vella loops in 4 dogs under basal conditions and during electrical stimulation of the colonic smooth muscle. Pulse wave electrical stimulation via serosal silver | silver chloride electrodes gave rise to significant increases in both intraluminal pressure and percentage motility. Absorption of water, sodium and chloride was significantly increased during stimulation but the transport of ammonia, bicarbonate and potassium was not significantly affected. It is suggested that motility changes result in altered absorption irrespective of transit time.
The effect of surgical operation upon monocytes
Authors: Everson N W , Neoptolemos J P , Scott D J A , Wood R F M , Bell P R F 
Published: March 2007

Summary
The effect of surgical operation upon monocyte numbers and function was studied in patients with both benign and malignant disease. In patients with benign disease a significant increase in the phagocytosis of 99Tc latexlabelled particles by monocytes was observed at 24 h postoperatively (P&lt;0·01 compared with preoperatively) and also a significant increase in monocyte numbers (P&lt;0·001 compared with preoperatively). In patients undergoing surgery for malignant disease no significant increase in phagocytic activity of monocytes was found postoperatively. A significantdecrease in monocyte numbers was shown to follow surgery in this group (P&lt;0·001). The implications of these findings are discussed.
The social, emotional and financial implications of adjuvant chemotherapy in breast cancer
Authors: McArdle C S , Calman K C , Cooper A F , Hughson A V M , Russell A R , Smith D C 
Published: March 2007

Summary
The incidence and severity of toxicity, the extent of emotional disturbance and cost of adjuvant chemotherapy were assessed in patients with early breast cancer randomized to receive either radiotherapy, chemotherapy (CMF) or radiotherapyfollowed by chemotherapy. Nausea and vomiting occurred in 85 per cent of patients receiving chemotherapy and contributed significantly to distress. Over one-third of patients required a wig or developed mucosal ulceration. Nevertheless, most patients were able to return to work during treatment. Leucopoenia was more commonly encountered in those patientswho received radiotherapy prior to chemotherapy. Twelve months after mastectomy, psychiatric morbidity was present in 13 of 34 patients receiving chemotherapy with or without radiotherapy, compared with only 1 of 18 receiving radiotherapy alone. Anxiety was common in both groups. This trend was still present 6 months after the completion of chemotherapy. The cost of chemotherapy is discussed.