bluuebunny/crossref_metadata_2025_split huggingface dataset:
The clinician and the vascular laboratory in the diagnosis of aortoiliac stenosis
Authors: Campbell W B , Cole S E A , Skidmore R , Baird R N 
Published: March 2007

Abstract
Two hundred and twenty-one lower limbs in 116 arteriopaths were examined for evidence of aortoiliac stenosis, by analyses of common femoral artery Doppler waveforms for pulsatility index (PI) Laplace δ, and principal components, pulse volume recordings (PVR) and thigh pressure measurements. Clinical assessment of the aortoiliac segment was also recorded in 124 limbs. The accuracy of prediction of aortoiliac stenosis, measured on biprojectional arteriograms, was calculated for the different methods, using multiple regression analysis.
Considering all grades of stenosis together, clinical judgement was the best predictor of severity (R2 — the correlation coefficient squared = 0.66): addition of non-invasive tests increased the accuracy of prediction to R2 = 0.70. For stenoses &gt; 50 per cent PVR amplitude- was the best non-invasive test (R2 = 0.39), but was no better than clinical assessment (R2 = 0.40). However, for stenoses &lt; 50 per cent clinical judgement was poor (R2 = 0.13), and derived most benefit from addition of Laplace δ (R2 = 0.20) or PVR upstroke time (R2 = 0.26).
In addition, common femoral PI and Laplace δ were compared in the arteriopaths, and in 146 limbs of normal control subjects, by calculation of sensitivity and specificity. PI was superior to Laplace δ for detecting severe stenoses and occlusions, but Laplace δ was more accurate in the detection of lesser degrees of disease.
These results suggest that conventional clinical assessment is the best method for detecting aortoiliac stenoses &gt; 50 per cent, but for less severe disease addition of vascular laboratory tests is helpful — especially PVR and Laplace waveform analysis.
Reconstructive renal vascular surgery for chronic renal failure
Authors: Jamieson G G , Clarkson A R , Woodroffe A J , Faris I 
Published: March 2007

Abstract
This paper reports the results of reconstructive renal arterial operations on 23 patients who underwent surgery because it was considered that renal artery disease was contributing to their chronic renal failure. The median pre-operative serum creatinine in this group of patients was 0·77 (range 0·15–1·14 mmol/l) and all patients had severe hypertension. In 10 cases there was evidence of other renal disease (analgesic nephropathy, 8; glomerulonephritis, 2). Operation performed was unilateral aortorenal reconstruction in 21 patients and bilateral reconstruction in 2 patients. There were four in-hospital deaths. In 15 patients operation was judged to have improved their renal function with a fall of median pre-operative creatinine from 0·34 mmol/l (0·15–0·84) to a median creatinine of 0·15 (0·05–0·52). There was one intra-operative death. There were 7 patients in whom operation led to no improvement in renal function. Their median pre-operative creatinine was 0·90 (0·32–1·14 mmol/l), and this pre-operative creatinine differs significantly from the group whose creatinine fell after surgery (P &lt; 0·002). Renal artery reconstruction should be considered in patients with chronic renal failure who have correctable arterial lesions.
A comparison between two types of waveform analysis in patients with multisegmental arterial disease
Authors: Junger M , Chapman B L W , Underwood C J , Charlesworth D 
Published: March 2007

Abstract
The results of an experiment to compare two different methods of analysing ultrasound signals are presented. Normal volunteers, both young and old, and patients with arteriosclerosis were examined with Doppler shifted ultrasound and the results of two forms of waveform analysis retrospectively compared with angiograms. The angiograms were used to divide the patients into groups with similar patterns of disease. The ability of the two methods of analysis, ‘pulsatility Index’ (PI) and ‘Laplace transform damping factor’ (LTD), to identify patients with haemodynamically significant disease in the aorta or iliac arteries was tested statistically (Mann–Whitney U test) and compared in receiver operator curves. The results showed that both tests were equally good in the identification of aortoiliac disease, even when the superficial femoral artery was occluded, and that, contrary to theoretical arguments, LTD was influenced by distal impedance.
Acalculous biliary pain: Diagnosis and selection for cholecystectomy using the cholecystokinin test for pain reproduction
Authors: Lennard T W J , Farndon J R , Taylor R M R 
Published: March 2007

Abstract
A prospective double blind placebo controlled study was conducted on 41 patients with a clinical diagnosis ofacalculous biliary pain (ABP) and 10 healthy volunteers. Cholecystokinin (CCK) (Kabivitrum, Uxbridge) was given intravenously (1 Ivy Dog Unit/kg) over 5 min in a randomized crossover study using normal saline as a placebo infusion. All referred patients had undergone at least one normal oral cholecystogram, abdominal ultrasound and upper gastrointestinal endoscopy before infusions. Twenty-six patients developed pain in response to the CCK infusion and not the placebo, and the pain did not differ from their spontaneous pre-infusion pain as measured by the McGill Pain Questionnaire and a Visual Analogue Pain Scale. Fourteen patients developed no pain with either infusion, and one developed pain with both placebo and CCK. All patients whose pain was reproduced (CCK-positive) underwent cholecystectomy and peroperative cholangiography. Operative findings were normal in all of the CCK-positive group except one in whom a small common bile duct stone was found. Histopathology of resected gallbladders was abnormal in 24 out of 26 cases, but all patients operated on remained pain-free at follow-up (mean 11 months, range 2-24 months). Repeat CCK infusion postoperatively failed to bring on pain in any of the postoperative group.
The CCK infusion test is a simple, cheap, bedside or out-patient procedure which will identify true acalculous biliary pain which will respond well to cholecystectomy.
Pre-operative percutaneous transhepatic biliary drainage: The results of a controlled trial
Authors: McPherson G A D , Benjamin I S , Hodgson H J F , Bowley N B , Allison D J , Blumgart L H 
Published: March 2007

Abstract
The operative mortality for biliary tract obstruction due to malignancy is high. In 1981 a controlled clinical trial of pre-operative percutaneous drainage was started at the Royal Postgraduate Medical School. At the time of percutaneous transhepatic cholangiography patients were randomized either to laparotomy or to pre-operative percutaneous transhepatic biliary drainage (PTBD) followed by laparotomy. Only patients with malignant biliary tract obstruction and serum bilirubin greater than 100 μmol/l were included. Seventy patients entered the trial, and five were withdrawn. Of the 65 remaining, 31 underwent laparotomy and 34 had pre-operative PTBD followed by laparotomy. The median duration of drainage was 18 days and during this time the median bilirubin fell from 305 to 115 m̈mol/l. Five patients required early surgery for complications of PTBD and two died within 30 days of surgery. The mortality for laparotomy was 19 per cent (6/31) compared with 32 per cent (11/34) for drainage plus laparotomy. This trial highlights the hazards of PTBD in high risk patients and has failed to demonstrate a reduction in mortality with the use of pre-operative PTBD.
The localization of an anti-tumour monoclonal antibody (791T/36) in gastrointestinal tumours
Authors: Armitage N C , Perkins A C , Pimm M V , Farrands P A , Baldwin R W , Hardcastle J D 
Published: March 2007

Abstract
Fifty-six patients with gastrointestinal cancers and four patients with benign colorectal tumours have been injected with radiolabelled anti-tumour monoclonal antibody (791T/36) to assess the degree of localization of the antibody by external scintiscanning and measurements on resected specimens. Twenty-nine patients with primary colorectal cancer showed increased uptake of the radiolabelled antibody in the resected tumours, with a tumour to normal tissue (T:NT) ratio of 2·5:1. All but two of fifteen patients with recurrent or metastatic tumour showed positive images of the deposits on external scintiscanning. Twelve patients with noncolonic gastrointestinal malignancy were studied and in only two patients were tumours demonstrated by external scanning. There were no positive images in four patients with benign colonic disease nor could increased uptake of radiolabelled antibody be demonstrated in the resected specimens. Immunohistology and autoradiography have shown that the antibody can be demonstrated in the pseudoacini and stroma of colon cancer. There are indications that this may represent localization to a cell surface antigen which becomes detached in the processing of the histological sections. It seems that in the gastrointestinal tract the monoclonal antibody 791T/36 is consistently taken up by colorectal cancer. Only a few noncolonic cancers and no benign colonic tumours take up the antibody. This antibody uptake may prove of value in the detection of occult metastases and in the targeting of antitumour agents.
A frequency-duration index (FDI) for the evaluation of ambulatory recordings of gastro-oesophageal reflux
Authors: Branicki F J , Evans D F , Jones J A , Ogilvie A L , Atkinson M , Hardcastle J D 
Published: March 2007

Abstract
Oesophageal pH monitoring has been undertaken in 20 symptomatic patients and 20 normal subjects for periods of 24 hours at work and in the home using a pH sensitive radiotelemetry capsule and a portable receiving system.
There was no correlation between symptoms and endoscopic findings in symptomatic patients. The number and duration of reflux episodes was greater in symptomatic patients than normal subjects during 24 hour ambulatory study (P &lt; 0·002). A frequency-duration index for the evaluation of recordings is described which was significantly greater in symptomatic patients than in normal subjects during both day (P &lt; 0·002) and night (P &lt; 0·008) periods of recording. Discrimination between the two groups was more clearly seen using the frequency-duration index compared to either the frequency of reflux episodes or the cumulative duration of acid reflux.
The thoracic stomach: A study of gastric emptying, bile reflux and mucosal change
Authors: Mannell Aylwyn , Hinder R A , San-Garde B A 
Published: March 2007

Abstract
The clinical progress, histological state of the gastric mucosa, gastric emptying of a liquid meal and duodenogastric reflux were studied postoperatively in 15 patients with a vagotomized intrathoracic stomach without a drainage procedure. The intact though denervated pylorus did not impede the emptying of liquids. Bile reflux into the thoracic stomach in both the erect and supine positions was significantly greater than that measured in control subjects. While posture did not affect duodenogastric reflux in the normal adult, bile reflux across the denervated pylorus was significantly increased in the supine position. Chronic active gastritis was noted in 12 patients but could not be correlated with the degree of bile reflux. Nine patients had evidence of pulmonary aspiration and gastric food residue was a common finding at endoscopy. The vagotomized intrathoracic stomach may need a drainage procedure to facilitate solid emptying.
A high macrophage content in human breast cancer is not associated with favourable prognostic factors
Authors: Steele R J C , Eremin O , Brown M , Hawkins R A 
Published: March 2007

Abstract
The macrophage contents of 40 human primary breast cancers were ascertained using three separate macrophage membrane markers. Four prognostic factors (lymph node status, tumour size, histological grade and oestrogen receptor status) were determined concurrently in these mammary carcinomas. No significant relationship was found between the macrophage content of the mammary carcinomas and any individual prognostic factor. When the patients were grouped according to whether they had 0–2 or 3–4 high risk factors, however, the macrophage content was significantly greater in those tumours with the poorer prognosis, regardless of the marker used to enumerate the cells. A high macrophage content, therefore, is not associated with favourable prognostic factors in breast cancer. Indeed, the present study has revealed the reverse to be the case.
Prognostic evaluation in node-positive breast carcinoma: Stage versus growth rate
Authors: Hartveit F , Thoresen S , Mæhle B O 
Published: March 2007

Abstract
The range in survival time in operable node-positive breast carcinoma is considerable. Postoperative management is thus dependent on accurate prognostic assessment. This involves the choice of relevant prognostic factors. Theoretically these should include measurements of both stage and growth rate. In a series of 96 cases it is demonstrated that the diameter of the primary (3 cm and under/over 3 cm) can be used as a measure of tumour stage; the histological grade of the primary as one of tumour growth rate; and the presence/absence of tumour cells in the efferent nodal vessels (EVI status) as a measure of nodal stage. The latter is proposed as an alternative to the number of tumour-bearing nodes recovered from the axilla. Division of the cases on this basis was sufficient to assess high or low risk using routine histological methods.
Ruptured aortic aneurysms: Postoperative complications and their aetiology
Authors: Fielding J W L , Black J , Ashton F , Slaney G 
Published: March 2007

Abstract
A review of 198 ruptured aortic aneurysms has been undertaken, this being 36–3 per cent of all the aneurysms treated during the period 1960–81. The overall mortality rate was 42·9 per cent. The peroperative mortality was 6·6 per cent and the mortality of the patients who survived the operation was 38·9 per cent. Factors which influenced postoperative mortality were the age of the patient, the distance travelled to hospital, the presence of an intraperitoneal bleed, the duration of the operative procedure and the volume of blood transfused, but only the amount of blood transfused had a statistically significant influence on mortality. However, as the highest mortality associated with any of these risk factors was 54·9 per cent, no single factor alone can be considered a contra-indication to operation. As there are no reliable predictive factors, we believe that all cases with clinically ruptured aortic aneurysms should have a laparotomy and resection. The most common postoperative complications were varying degrees of renal and respiratory insufficiency and the occurrence of these was significantly associated with the volume of blood transfused.
Primary adenocarcinoma of the vermiform appendix: Report of a series of ten cases, and review of the literature
Authors: Gilhome R W , Johnston D H , Clark J , Kyle J 
Published: March 2007

Abstract
Ten cases of primary adenocarcinoma of the vermiform appendix are presented. The condition is rare and usually presents after middle age as acute appendicitis. It is seldom recognized during appendicectomy. The tumours resemble colonic adenocarcinomas but, because of peculiarities in the anatomy of the appendix, there is a tendency to early local spread. Right hemicolectomy performed as soon as the true nature of the lesion is recognized is the treatment of choice and has been shown to improve survival. Even after hemicolectomy the prognosis must be guarded, as local spread of disease may not be controlled in many cases.
Obstructing/perforated carcinoma of the left colon treated by resection and the formation of a double colostomy
Authors: Day T K , Bates T 
Published: March 2007

Abstract
Forty patients presenting with obstructing left colon tumours between 1975 and 1980 were treated by a modified Paul-Mikulicz resection. The hospital mortality was 5 per cent. Subsequent mortality was largely related to the stage of the tumour at presentation and was not higher than that to be expected after an elective resection. In 21 patients the procedure was palliative and 16 of these patients later died. The quality of palliation was reasonable in 80 per cent and poor in 20 per cent. Despite the need for a second hospital stay to close the colostomy, time in hospital accounted, on average, for less than one-tenth of the remaining lifespan in those having a palliative resection.
Partial closure and other techniques in pilonidal surgery: An assessment of 157 cases
Authors: McLaren C A 
Published: March 2007

Abstract
The report is a retrospective study of 157 patients with pilonidal disease. The period in hospital, the healing time, and the rates of wound breakdown and sinus recurrence were documented following four different methods of management. After incision and drainage of the pilonidal abscess, later excision was necessary in less than 40 per cent of patients. Elective excision of the granulation tissue and skin, with partial closure of the defect, gave better results than excision and primary suture.
Hypocalcaemia after subtotal thyroidectomy for thyrotoxicosis
Authors: Ramus N I 
Published: March 2007

Abstract
Eighty-one patients who underwent subtotal thyroidectomy for thyrotoxicosis had a 10 per cent incidence of symptomatic hypocalcaemia (corrected calcium &lt;2.0mmol/l) but only a 1.2 per cent incidence of prolonged hypocalcaemia. In the same patients only one had a transient right sided recurrent laryngeal nerve palsy. These results would seem to confirm the wisdom of lateral ligation of the inferior thyroid arteries to protect the recurrent laryngeal nerve. They lend no support to the suggestion that in order to protect parathyroid function this teaching be abandoned in favour of a policy of ligation of the arteries on the surface of the gland. Nevertheless, injury, devascularization or inadvertent removal of parathyroid tissue must still be the first practical consideration.
Smooth muscle neoplasms of the rectum and anal canal
Authors: Walsh T H , Mann C V 
Published: March 2007

Abstract
Forty-eight patients who presented to St. Mark's Hospital, London between 1948 and 1979 with smooth muscle neoplasms of the rectum or anal canal have been reviewed. Twenty-six tumours arose from the muscularis mucosae of the rectum. These lesions were small, asymptomatic and did not recur after local removal. Eighteen tumours arose from the muscularis externa of the rectum. Local excision of these resulted in a high local recurrence rate regardless of the degree of differentiation of the tumour but long-term survival figures were similar whether the tumours were treated by local or radical techniques. However, the prognosis did relate to the degree of tumour differentiation, being worst in the poorly differentiated group. In four cases the smooth muscle tumour arose from the internal sphincter of the anal canal.
Anorectal myectomy in adult Hirschsprung's disease: A report of six cases
Authors: Hamdy M H , Scobie W G 
Published: March 2007

Abstract
The presentation and management of six adult patients with proven aganglionosis of the rectum are reported. Rectal mucosal biopsy combined with enzyme histochemistry was used to establish the diagnosis and it is recommended as the first investigative procedure. Conservative surgery either with anterior resection and anorectal myectomy or myectomy alone was found to be simple and relatively complication-free and to give very satisfactory results.
Slowed conduction in the pudendal nerves in idiopathic (neurogenic) faecal incontinence
Authors: Kiff E S , Swash M 
Published: March 2007

Abstract
We have studied 30 patients with idiopathic (neurogenic) faecal incontinence using anorectal manometry and concentric needle and single fibre electromyographic methods. We have measured the terminal motor latency in the pudendal nerves of these patients using a new digitally directed transrectal stimulation and recording technique (right mean (±s.d.) 3.2±0.9 ms, left mean (±s.d.) 3.0±0.9 ms) and compared the results with those obtained from 28 normal subjects (right mean (±s.d.) 2.0±0.5 ms, left mean (±s.d.) 1.9±0.3 ms). These differences between normal and incontinent patients were significant (P = 0.01) using the Wilcoxon Rank Sum Test. The findings support the hypothesis that idiopathic (neurogenic) faecal incontinence is due to damage to the nerve supply of the pelvic floor musculature.
The aetiology and significance of distal choledochoduodenal fistula
Authors: Martin D F , Tweedle D E F 
Published: March 2007

Abstract
Thirteen patients undergoing investigation for biliary or pancreatic disease were found at endoscopic retrograde cholangiopancreatography to have unsuspected choledochoduodenal fistula. In only one patient could the presenting symptoms be directly attributed to the fistula. Ten of the thirteen patients had previously undergone exploration of the common bile duct and instrumentation at surgery is postulated as being the most likely cause of these fistulae. Treatment of the uncomplicated fistula appears unnecessary.
Clinicopathological staging of gastric cancer
Authors: Fielding J W L , Roginski C , Ellis D J , Jones B G , Powell J , Waterhouse J A , Brookes V S 
Published: March 2007

Abstract
13175 patients with gastric carcinomas have been staged with reference to the TNM staging system. This has confirmed the poor overall prognosis (5·5 per cent and 3·8 per cent age-adjusted survival rates at 5 and 10 years respectively). However, it has demonstrated the significant survival associated with the treatment of Stage I disease (70·0 per cent at 5 years and 63·2 per cent at 10 years). This study demonstrates that 72·9 per cent of cases are unresected and that interpretation of resectability rates must be related to the population base of the study.
Blunt thorax oesophageal stripping: An emergency procedure for caustic ingestion
Authors: Brun J G , Celerier M , Koskas F , Dubost C 
Published: March 2007

Abstract
We report our experience with an original procedure which we have applied to the management of acute necrotic caustic burns of the upper gastro-intestinal tract. Blunt thorax oesophageal stripping is performed through a cervicotomy and a laparotomy, thus avoiding a wide pleural exposure and the frequent and often fatal respiratory complications of a thoracotomy. The stripping method permitted survival of 13 of 17 patients and is thus considered to be a safer and more successful technique than open thoracic oesophagectomy.
Early aneurysmal degeneration of human umbilical vein bypass grafts
Authors: Layer G T , King R B , Jamieson C W 
Published: March 2007

Abstract
Three cases of early aneurysmal degeneration of modified human umbilical vein (HUV) grafts in the femorodistal segment are described. One such graft is the first reported with multiple true aneurysms. The pathology and management of this complication is discussed.
Hydatid thrill: An explanation of the phenomenon
Authors: Sukumar A 
Published: March 2007

Abstract
The hydatid thrill is a rare but pathognomic sign of hydatid disease. The physical basis of the thrill was studied in two patients with the disease. The thrill occurs when a mother cyst packed with unruptured daughter cysts is gently percussed. The consistency of the wall of the daughter cyst and the tension of the fluid inside it are responsible for making the cysts vibrate and produce the sensation of a thrill. Free fluid from ruptured daughter cysts dampens the vibrations. It is extremely rare for a mother cyst to have all the daughter cysts in an intact condition.