bluuebunny/crossref_metadata_2025_split huggingface dataset:
Stimulus for vasopressin release during elective intra-abdominal operations
Authors: Melville R J , Forsling M L , Frizis H I , LeQuesne L P 
Published: March 2007

Abstract
In 12 patients undergoing an upper abdominal operation, blood pressure and peripheral venous blood samples were taken at intervals throughout the procedure. There was no significant increase in plasma vasopressin concentration after induction of anaesthesia or skin incision; within 3 min of opening the peritoneum and commencing intraperitoneal manipulation there was a highly significant rise (P &lt; 0.07), maintained with fluctuations until closure of the abdomen. There was no correlation between the changes of blood pressure and those in plasma vasopressin level. In 16 patients undergoing elective cholecystectomy similar observations were made to coincide with events believed, on the basis of the first study, to be related to changes in the concentration of vasopressin. There was a significant rise in vasopressin concentration (P &lt; 0.01) after incision of the peritoneum, 1 min after the start of intraperitoneal manipulation (P &lt; 0.01) and after deliberate traction on the stomach (P &lt; 0.01). During operative cholangiography, when there was no intraperitoneal manipulation, there was a significant fall in the vasopressin level. There was no correlation between changes in vasopressin concentration and blood pressure. These findings indicate that during an abdominal operation nervous stimuli, arising from within the peritoneal cavity and probably mediated via the autonomic system, are an important factor responsible for the increased secretion of vasopressin, and, at least in the absence of major changes in blood pressure and osmolality, the determinant factor.
Comparison of clinical scores and acute phase proteins in the assessment of acute Crohn's disease
Authors: Pettit S H , Holbrook I B , Irving M H 
Published: March 2007

Abstract
Fifty-two patients with Crohn's disease have been assessed using acute phase proteins and a scoring system. Thirty-nine underwent operation and intra-abdominal abscesses were found in seventeen. Both scores and acute phase proteins have been shown to reflect inflammation due to secondary sepsis in addition to that from active Crohn's disease. The scores were higher, and acute phase changes greater, in patients with sepsis than those without. By choosing a threshold for each variable that excludes patients without sepsis it has been found that a score &gt; 181, ESR &gt;45 mm/h, CRP &gt;33 mg/l, orosomucoid &gt;1.8g/l and albumin &lt; 26.7 g/l identify sepsis with a specificity &gt;95 per cent and sensitivity &gt; 35 per cent. Over 70 per cent of patients with abscesses exceeded one or more of these thresholds. We believe that operative management should be strongly considered if one or more of these criteria are positive as such patients have a greater than 90 per cent chance of having an intra-abdominal abscess. This will prevent these abscesses eroding into adjacent viscera or to the surface with resulting fistula formation.
Continuing experience with single layer appositional anastomosis in the large bowel
Authors: Matheson N A , McIntosh Carol A , Krukowski Z H 
Published: March 2007

Abstract
Results of continuing experience with single layer appositional anastomosis of the large bowel during 8 years (1977–84) were extracted from a prospective computerized audit of all abdominal operations under one consultant. After 204 elective operations mortality rate was 1.5 per cent: there were no deaths from anastomotic leakage. The total incidence of wound infection (including late infections) was 2.0 per cent. The median duration of postoperative stay was 9.7 days and the mode 8 days. Three clinical anastomotic leaks (total incidence 1.5 per cent) occurred in 140 patients (2.1 per cent) after elective colorectal anastomoses. A restorative anastomosis was made in 86 per cent of patients with rectal carcinoma 6–12 cm from the anus and in 29 per cent with tumours below 6 cm. The overall incidence of a permanent stoma for rectosigmoid carcinoma was 19 per cent. ‘Protective colostomy’ and anastomotic drains were not used. The safety and applicability of single layer anastomosis in the rectum are compared with those of stapling.
Evacuation proctography in obstructed defaecation and rectal intussusception
Authors: Bartolo D C C , Roe A M , Virjee J , McC. Mortensen N J 
Published: March 2007

Abstract
The symptoms of obstructed defaecation may present as a number of different syndromes including descending perineum, solitary rectal ulcer, irritable bowel and mucosal or complete rectal prolapse. In order to clarify the pathophysiology of obstructed defaecation we carried out dynamic and static radiological investigations together with manometric and electrophysiological measurements in ten patients with severe, intractable obstructed defaecation. Results were compared with a total of 35 control subjects. There were no significant differences in sphincter pressures or the recto-anal inhibitory reflex between patients and controls. Mean motor unit potential duration was prolonged in patients compared with controls (P&lt;0.02) in the puborectalis and external sphincter indicative of neuropathic changes. X-ray measurements of the anorectal angle and perineal descent at rest showed no differences. However, obstructed defaecation patients had a greater increase in anorectal angle on straining (P&lt;0.02) and significantly more descent on straining (P&lt;0.002). Fast film sequence evacuation proctography showed that the anal canal was occluded by anterior rectal wall in four patients and five patients had variants of recto-rectal intussusception without overt rectal prolapse, which explained the obstructive symptoms. This information should allow the surgeon to follow a rational treatment programme based on the anatomical abnormality.
Intussusception and intestinal malrotation in infants: Waugh's syndrome
Authors: Brereton R J , Taylor B , Hall Christine M 
Published: March 2007

Abstract
The position of the duodenojejunal flexure was determined in 37 out of a group of 49 consecutive infants presenting with intussusception. The flexure was in a normal position in 19, at the midline in 3, and in an abnormal position in 15. The caecum was unfixed in all of the 41 infants subjected to operation. It is concluded that lack of normal rotation and fixation of the intestine is an important factor in the aetiology of idiopathic intussusception of infants.
Restorative rectal resection: An audit of 220 cases
Authors: Tagart R E B 
Published: March 2007

Abstract
Two hundred and twenty consecutive, unselected cases of restorative rectal resection are reported. The operative mortality was 8.3 per cent; 3.5 per cent in patients less than 70 years old and 13 per cent over that age. Leakage at the colorectal suture line was an intractable problem, uninfluenced by anastomotic technique, but the introduction of antimicrobial prophylaxis as a routine was followed by a statistically significant reduction in the leak rate. Postoperative rectal function was satisfactory but temporary stenosis at the suture line was not uncommon. In only one case was it permanent, requiring regular dilatation. Recurrence of malignant disease occurred in 50 per cent of cases followed for at least 2 years; 35 per cent general disease, 15 per cent localized to the pelvis. These figures do not differ significantly from those following total rectal excision, which is now necessary in only 1 in 10 cases where the growth lies within 10 cm of the anus.
Influence of local surgery and radiotherapy on the natural history of pleomorphic adenomas
Authors: Watkin G T , Hobsley M 
Published: March 2007

Abstract
We have analysed the interval between first treatment and tumour recurrence in 65 patients with parotid pleomorphic adenomas which had recurred following local excision. Our results indicate that 5 years is an inadequate period of follow-up and that 10–20 years may be more realistic. Radiotherapy given to 17 patients after local excision of their tumours was found to have had no significant advantageous effect in terms of recurrence-free interval either before or following formal parotidectomy or in limiting the ultimate surgery required. Major complications directly attributable to radiotherapy developed in at least 3 of these 17 patients. Malignant transformation of the pleomorphic adenoma has occurred in three patients, two of whom had been subjected to radiotherapy. We advise that caution is exercised in the interpretation of results of local excision and radiotherapy in this disease. In view of the fact that an alternative and apparently superior treatment is available in the form of formal parotidectomy, we urge that this should be universally adopted for the management of both primary and recurrent pleomorphic adenomas.
Monitoring middle cerebral artery blood velocity during carotid endarterectomy
Authors: Padayachee T S , Gosling R G , Bishop C C , Burnand K , Browse N L 
Published: March 2007

Abstract
Transcranial pulsed Doppler ultrasound and spectral analysis were used to monitor blood velocities in the middle cerebral artery of nineteen patients (mean age 61 ± 9 years) during carotid endarterectomy. A Javid shunt was used in all patients. The intensity weighted mean Doppler frequency for each spectral sweep (at 5 ms intervals) was time-averaged over the cardiac cycle to obtain a mean value for blood velocity in the middle cerebral artery. The range of such values found in the 19 patients was: 12–38 cm s−1 after anaesthesia (baseline); 12–69 cm s−1 during diathermy; 0–30 cm s−1 during carotid clamping; 16–32 cm s−1 during shunting and 18–60 cm s−1 in the recovery room. The average change in middle cerebral artery blood velocity from baseline values showed significant increases during diathermy (P&lt;0.005), shunting (P&lt;0.05) and in the recovery room (P&lt;0.005). Clamping of the internal carotid artery showed a significant decrease in middle cerebral artery blood velocities of all patients (P&lt;0.005), three of whom showed no flow in the middle cerebral artery during clamping. Abnormally high amplitude Doppler signals at the commencement of shunting were detected in 17 of the 19 patients. Such Doppler signals are consistent with turbulent blood flow or the introduction of micro-air bubbles by the shunt. Backbleeding in the internal carotid artery before insertion of the shunt was associated with diminished flow in the ipsilateral middle cerebral artery of ten patients, oscillatory forward/reverse flow in three patients and cessation of flow in the remaining six patients.
Seat belt injury to the female breast
Authors: Dawes R F H , Smallwood J A , Taylor I 
Published: March 2007

Abstract
Six women who sustained injury to a breast from seatbelt straps during road traffic accidents are presented. In three the breast contained a carcinoma. In view of the overlap of the appearance of fat necrosis and carcinoma by clinical and radiological examination all such lesions should be biopsied to exclude carcinoma as the history of the lesion can be dangerously misleading.
Drainage in uncomplicated thyroid and parathyroid surgery
Authors: Kristoffersson A , Sandzén B , Järhult J 
Published: March 2007

Abstract
A randomized study of the value of drainage in thyroid and parathyroid surgery is presented. Fifty patients were provided with surgical drains and another fifty patients were allocated to a control group without drainage. Complications were few in either group and the rate of subjective discomfort from the collar incision was equally low in both groups. The observations suggest that the provision of drainage is not necessary after uncomplicated neck surgery.
Effects of a long-acting somatostatin analogue in patients with severe ileostomy diarrhoea
Authors: Cooper J C , Williams N S , King R F G J , Barker M C J 
Published: March 2007

Abstract
Proctocolectomy (PC) with small bowel resection may lead to profuse ileostomy diarrhoea which can be difficult to treat. The effect of a recently developed long acting somatostatin analogue (SMS 201-995) on ileostomy output was investigated in 5 patients who had undergone PC and ileal resection (median 120 cm) and who suffered severe diarrhoea (4–7 litres/24 h). Gastric emptying, transit of a standard meal through the small bowel and the amounts of nutrients excreted were simultaneously determined during double blind infusion of SMS (25 fig/h) and placebo (isotonic saline 125 ml/h). SMS 201–995 significantly reduced ileostomy output (P &lt; 0.05) and water excretion (P &lt; 0.05) and prolonged small bowel transit time (P &lt; 0.05). Whilst having little effect on gastric emptying, or on the excretion of glucose or nitrogen, fat excretion was significantly increased (P &lt; 0–05). In two patients subcutaneous administration of SMS 201-995 (50 μg b.d.) has maintained a reduced ileostomy output for 4 and 6 months respectively.
Gastric secretory responses to modified sham feeding (MSF) and insulin after vagotomy
Authors: Athow Anna C , Lewin M R , Sewerniak Anna T , Clark C G 
Published: March 2007

Abstract
Modified sham feeding (MSF) and insulin tests were carried out in 28 patients after vagotomy. Basal and pentagastrin collections were also performed. Using the secretory data from 9 of the patients with endoscopically proven recurrent ulcer as a reference, 20 gastric secretory indices were studied and critical levels were chosen to provide the maximum sensitivity and specificity. The eleven most discriminating indices were then used to evaluate the remaining 19 patients. There was agreement between the responses to MSF and insulin as to the adequacy of vagotomy in 16 of the patients (84 per cent) and contradictory responses in 3 patients (16 per cent). Overall, MSF responses were as discriminating as the responses to insulin. A simplified ward test, based on crude volume measurements in response to MSF is proposed.
Resection and colo-anal anastomosis with colonic reservoir for rectal carcinoma
Authors: Parc R , Tiret E , Frileux P , Moszkowski E , Loygue J 
Published: March 2007

Abstract
Sphincter-saving operations are now generally accepted for the treatment of mid-rectal cancers. Many techniques have been described: low colorectal anastomosis, pull-through procedures, and colo-anal anastomosis. The functional results following these operations are impaired by loss of the reservoir function of the rectum. In order to improve these results, a modification of Parks' colo-anal anastomosis is proposed. A J-shaped colic reservoir is constructed and its end is anastomosed to the anal canal. We have operated upon 31 patients using this technique. Mortality was 3.3 per cent. Functional results were evaluated in 24 patients having a follow-up of more than 3 months. All were continent; mean number of bowel movements was 1.1 per day. Defaecation was spontaneous in 75 per cent of cases; in the remaining 25 per cent, evacuation of the reservoir was elicited by a small enema each two days. This technique, creating a neo-rectum, can achieve an important place among the sphincter-saving operations.
Clinical investigations of lymphadenopathy, including lymph node biopsies, in 24 homosexual men with antibodies to the human T-cell lymphotropic virus type III (HTLV-III)
Authors: Farthing C F , Henry Kristin , Shanson D C , Taube M , Lawrence A G , Harcourt-Webster J N , Gazzard B 
Published: March 2007

Abstract
The findings of 27 lymph node biopsies performed on 24 homosexual patients with lymphadenopathy are presented. Six had acquired immune deficiency syndrome (AIDS) and 18 lymphadenopathy only, of whom one subsequently developed AIDS. All these patients had antibodies to the human T-cell lymphotropic virus type III (HTLV-III) suggesting that HTLV-III is currently the commonest cause of lymphadenopathy in homosexual men. The histopathological findings of six of seven nodes from AIDS patients showed either follicular depletion alone or follicular and paracortical lymphocyte depletion. Nodes from four patients showed Kaposi's sarcoma, three of which also showed follicular hyperplasia. In two of these patients there were no cutaneous manifestations of this condition. One lymph node from a patient with persistent generalized lymphadenopathy (PGL) showed Mycobacterium tuberculosis. Six nodes from six other patients have had features oftoxoplasmosis although there was no serological or clinical evidence of recent toxoplasma infection. The remaining 11 lymph nodes from patients with PGL and one node from a patient with transient lymphadenopathy, showed reactive follicular hyperplasia only. We conclude that homosexuals with lymphadenopathy who are HTLV-III antibody positive do not need a routine node biopsy unless an alternative diagnosis is strongly suspected.
Major amputation compared with graft occlusion as the end point for assessing results of bypass surgery in lower limb ischaemia
Authors: Mikulin T , Hopkinson B R , Makin G S 
Published: March 2007

Abstract
Cumulative graft patency rates calculated using graft occlusion as the end point are the standard method of presenting results of bypass surgery for lower limb ischaemia. The problems of using graft occlusion as the end point are that this is not easily documented and it gives no indication of the condition of the patient's limb after the graft occludes. The date of amputation is a well defined end point and it means treatment has failed. It is used to calculate cumulative limb salvage rates. Using the two techniques to assess different risk factors (age, calf vessel run-off, diabetes, position of distal anastomosis and hypertension), it was found that the limb salvage rate was a better indicator of patient progress. Whereas graft patency rates for diabetics and non-diabetics were similar (χ2 = 0·8, P &gt; 0·1), diabetics had a higher amputation rate and the limb salvage rate was significantly worse (χ2 = 5·0, P &lt; 0·05). Cumulative survival is rarely presented in vascular series but it could be used as an indicator of the general condition of patients being selected for bypass surgery. The cumulative survival of diabetics was 23 per cent (s.e.m. ± 12 per cent) at four years, while for non-diabetics this was 55 per cent (s.e.m. ± 15 per cent), (χ2 = 10.6, P &lt; 0.001). Diabetic patients have such different limb salvage and survival rates compared with non-diabetic patients that their results should be presented separately. A better indication of patient progress following bypass surgery is obtained if limb salvage rates and survival rates are reported as well as graft patency rates.
Emergency presentation and mortality from colorectal cancer in the elderly
Authors: Waldron R P , Donovan I A , Drumm J , Mottram S N , Tedman Susan 
Published: March 2007

Abstract
We have assessed the influence of age on the mode of presentation and perioperative mortality in 1033 patients with colorectal cancer. There were 522 patients (51 per cent) over 70 years (group I) and 511 patients (49 per cent) under 70 (group II). In group I, 301 patients (58 per cent) were admitted as emergencies compared with only 222 (43 per cent) in group II (P &lt; 0·001). Perioperative mortality was especially high in the elderly emergencies, 38 per cent, compared with 18 per cent for elective operations. Of the patients presenting as emergencies in either age group 66 per cent had localized ‘potentially curable’ disease. The incidence of colorectal cancer is highest in the elderly. A larger number of these elderly patients present as emergencies and die from the consequences of complications of localized disease. Earlier diagnosis by pre-symptomatic screening is therefore especially desirable in these old patients.
Colonic healing: A role for polymorphonuclear leucocytes and oxygen radical production
Authors: Shandall A A , Williams G T , Hallett M B , Young H L 
Published: March 2007

Abstract
Using a model of ‘reperfusion injury’ as a mechanism of oxygen radical (OR) production in vivo, we have demonstrated that superoxide (O2-) is the major source of damage. Inhibition of its production from polymorphonuclear leucocytes (PMNs) by aprotinin, a protease inhibitor, or by scavenging with superoxide dismutase (SOD), resulted in reduced oxidation of of tissue glutathione (P &lt; 0·002). Colonic healing after anastomosis was also improved by aprotinin as measured by histology (P &lt; 0·05), breaking energy (P &lt; 0·001), breaking strength (P = 0·02), and by hydroxyproline content (P = 0·01). Allopurinol, although inhibiting glutathione oxidation, had no effect on PMN leucocyte OR production and did not protect against histological damage. These data demonstrate that PMNs endogenous to the tissue or attracted there as a result of trauma are the source of OR production in ‘reperfusion’. Their inhibition improves colonic healing.
Comparison of the mortality, morbidity and incidence of local recurrence in patients with rectal cancer treated by either stapled anterior resection or abdominoperineal resection
Authors: Gillen P , Peel A L G 
Published: March 2007

Abstract
One hundred patients with rectal cancer treated by one surgeon over a 7 year period are reviewed. Fifty-five patients were treated by stapled anterior resection (SAR) and 45 by abdominoperineal resection (APR). Dukes' classification, degree of differentiation and local spread were similar in both groups. Operative mortality was 7.2 per cent for SAR and 2.2 per cent for APR. Anastomotic leakage following SAR occurred clinically in two patients (3.6 per cent), one of which proved fatal, and radiologically in five patients. Morbidity after SAR and APR was otherwise similar. There was no significant difference in local recurrence rates after SAR (14.7 per cent) and APR groups (25.0 per cent). The results of this study suggest that for patients with rectal cancer radical excision with sphincter preservation using the circular stapler has a mortality, morbidity and risk of local recurrence comparable with radical excision with a permanent colostomy.
Incidence of locally metastatic(‘recurrent’) cutaneous malignant melanoma following conventional wide margin excisional surgery for invasive clinical stage I tumours: Importance of maximal primary tumour thickness
Authors: Griffiths R W , Briggs J C 
Published: March 2007

Abstract
In a minimum 5-year follow-up study of 638 primary clinical Stage I invasive cutaneous malignant melanomas (excluding lentigo maligna melanomas) excised with conventional wide normal tissue margins, the incidence of local tumour metastasis was 48/638 (8 per cent). The incidence of locally metastatic tumours rose from 2 per cent for tumours &lt; 0.99 mm thick, to 14 per cent for tumours between 5 and 6 mm in thickness. The rate of local metastasis was significantly greater for tumours &gt; 2.0 mm compared with tumours &lt; 2.0 mm thick (P &lt; 0.01). Despite the anatomical restrictions to wide resection margins in the head and neck, these areas had the lowest regional incidence for local tumour metastasis (2 per cent). Over the prolonged postoperative follow-up period (median 11 years) 67 per cent (32/48) of patients with locally metastatic disease died of disseminated malignant melanoma, compared with a 31 per cent mortality (180/590)for those without local disease metastasis. The term ‘local recurrence’ is unhelpful in our attempts to understand the pathology of malignant melanoma, and the term ‘local metastasis’ could replace it with benefit.
The ‘sandwich technique’ in the management of the open abdomen
Authors: Schein M , Saadia R , Jamieson J R , Decker G A G 
Published: March 2007

Abstract
A management technique of the open abdominal wound is described. It consists of a ‘sandwich’ composed of a Marlex mesh and an Op-Site wound dressing with interposition of suction tubes. Such a technique prevents evisceration, protects the skin, decreases evaporation, allows accurate fluid replacement, facilitates nursing and adds to the patient's comfort.