bluuebunny/crossref_metadata_2025_split huggingface dataset:
Role of pyloroplasty in the retrosternal stomach: Results of a prospective, randomized, controlled trial
Authors: Mannell A , McKnight A , Esser J D 
Published: March 2007

Abstract
A prospective, randomized, controlled trial comparing clinical outcome and emptying of a solid meal from the retrosternal stomach, with and without pyloroplasty is described. Forty consecutive patients with oesophageal cancer undergoing retrosternal gastric reconstruction of the oesophagus were studied. In 20 patients the pylorus was left intact (group 1) and 20 patients underwent an Aust1 pyloroplasty (group 2). Nine patients in group 1 suffered postoperative symptoms of gastric stasis compared with only one patient in group 2 (P = 0·0106). Three patients in group 1 died from aspiration pneumonia before discharge from hospital. A gastric emptying test was performed on 24 patients between 1 and 3 months after surgery. By this time, most survivors had recovered from symptoms attributed to gastric stasis and no significant difference in gastric emptying could be demonstrated between the two groups. Selection of patients, a wide range of emptying times and improvement in gastric emptying on follow-up may explain the lack of correlation between postoperative symptomatology and the gastric half-emptying times. A pyloroplasty is advised to prevent the potentially lethal effects of gastric stasis in the early postoperative period following retrosternal reconstruction of the oesophagus.
Intragastric balloons for morbid obesity: Results, patient tolerance and balloon life span
Authors: Mathus-Vliegen E M H , Tytgat G N J 
Published: March 2007

Abstract
Sixty morbidly obese patients were treated with 88 intragastric balloons. An air-filled intragastric balloon was used, which was permanently connected to an inflation catheter exiting through the nose. Patients were evaluated for loss of body weight and tolerance of the balloon; the balloon was inspected for efficacy and safety. A mean total loss of body weight of 21 kg was obtained after a mean of 39 weeks in 15 men (mean age 37·7 years) and 45 women (mean age 36·2 years), with a mean initial weight of 127·9kg. The maximum rate of weight loss occurred in the first 6 months, with a steady decrease of 1 kg per week; thereafter the rate declined. Subjective complaints were infrequent and consisted of nasal discomfort or abdominal symptoms. Intolerance in 12per cent of patients was due to enhanced hunger (one patient), nasal pulling sensation (four patients) and symptomatic ulcer (two patients). Fifteen patients asked for removal of the well functioning balloon after a mean of 169 days; 14 of the 15 balloons were still airtight. Forty balloons failed prematurely. Nine were retrieved orally and 31 were passed per anum, of which 28 passed with mild abdominal cramping, two patients required transabdominalpuncture undone neededlaparotomy. Even the 40 prematurely removed balloons remained in situ for a mean of 108 days; only one-third showed leakage. As yet, 33 well functioning balloons have been in situ for a mean of 167 days. Well functioning balloons deflated at a rate of 2·3 ml per day. Malfunctioning of the balloon was due to leakage in 12 cases and to clogging of the inflation catheter in three cases. Major complications (8per cent) included two gastric ulcers and three cases of mild ileus. One ileus patient required surgery (2per cent). The reported intragastric balloon model is effective and safe. We recommended this type of balloon as a weight reducing adjuvant therapy before bariatric surgery.
Electrically stimulated sartorius neosphincter: Canine model of activation and skeletal muscle transformation
Authors: Hallan R I , Williams N S , Hutton M R E , Scott M , Pilot M A , Swash M , Koeze T H , Watkins E S 
Published: March 2007

Abstract
The sartorius muscle was transposed into the abdominal cavity of six dogs, passed around a Thiry–Vella loop and sutured to itself to form a neosphincter. The muscle was activated by electrical stimulation and on contraction the neosphincter stopped or reduced the flow of saline through the Thiry–Vella loop in all animals until the onset of muscle fatigue. Continuous low frequency stimulation was used to transform the skeletal muscle, and when studied after a mean of 8 weeks of stimulation (range 6–11 weeks) the neosphincter stopped the flow for a significantly longer period of time (P = 0·027). Associated with the improved neosphincter function was a significant decrease in the fusion frequency (P = 0·003) and prolongation of the stimulus–peak tension time as assessed by a strain gauge sutured to the neosphincter muscle (P = 0·002). The changes in the contraction properties of the skeletal muscle suggest that continuous low frequency stimulation transformed the muscle fibres from type 2 to type 1, resulting in improved fatigue resistance and potential for continuous sphincter activity.
Pouch size: The important functional determinant after restorative proctocolectomy
Authors: Öresland T , Fasth S , Nordgren S , Åkervall S , Hultén L 
Published: March 2007

Abstract
Sixty-seven patients with a J-shaped ileoanal pouch were studied over a 2-year period with regular recording of sphincter and pouch characteristics and analysis of their role in functional outcome. Although there was a 27 per cent permanent reduction in resting anal pressure (RAP) (P&lt;0–001), two-thirds of the patients still had a RAP within the normal range. The mean(s.d.) pouch volume increased during the first year from 132(46) ml to 282(85) ml. RAP was not related to functional outcome and preoperative RAP was not predictive of subsequent function. Large pouch volume and compliance correlated with low defaecation frequency (range of r = 0·27–0·36; P &lt;0·05) and good overall function (r = 0·37·0·56; P&lt;0·01). The initial pouch volume was predictive of subsequent overall function. The Heal length used for pouch construction predicted subsequent pouch volume (r = 0·48; P &lt; 0·001) and to some extent functional outcome (r = 0·28·0·37; P&lt;0·05). However, the studied variables accounted for only 21 per cent of the total variance of functional outcome.
Double contrast barium enema and flexible rectosigmoidoscopy: A reliable diagnostic combination for detection of colorectal neoplasm
Authors: Jensen J , Kewenter J , Asztély M , Lycke G , Wojciechowski J 
Published: March 2007

Abstract
The efficiency of double contrast barium enema and flexible rectosigmoidoscopy (to 60 cm) in the assessment of patients with a positive Hemoccult II® test in a randomized screening study for colorectal neoplasms was evaluated. A positive test was present in 625 patients, of whom 530 had a complete enema and rectosigmoidoscopic assessment. A carcinoma was diagnosed in 26 and an adenoma ⩾ 1 cm in diameter in 71. As a control, 323 patients with a negative assessment repeated the Hemoccult II test and of these 67 had a positive second test, of whom 55 underwent colonoscopy. One carcinoma (Dukes' A) and two adenomas ⩾ 1 cm in diameter were diagnosed. The efficiency of the assessment was also checked by rescreening the whole group 1–2 years after the first study and by continuing follow-up. It was found that two more carcinomas and one adenoma ⩾ 1 cm in diameter had been overlooked at the primary assessment. The sensitivity for neoplasms ⩾ 1 cm in diameter at the primary assessment was 72 per cent for double contrast barium enema and 86 per cent for rectosigmoidoscopy. The sensitivity for the combined methods was 94 per cent and the specificity was 99 per cent. The combination of double contrast barium enema and rectosigmoidoscopy in the primary assessment of patients with a positive Hemoccult II test gives an acceptable result and immediate retesting of those with a negative assessment is not necessary.
Indications for conservative management of acute scrotal pain in children
Authors: Hastie K J , Charlton C A C 
Published: March 2007

Abstract
Forty-three boys who presented with acute scrotal pain were studied retrospectively. Of these, 40 had torsion of scrotal contents. Torsion of testicular appendages, a self limiting condition, tended to present later than testicular torsion (P = 0·002). The testis was saved in all 11 cases of testicular torsion explored within 12 h of the onset of pain but orchidectomy was required in four who presented later. In 11 cases, a torted testicular appendage diagnosed as a tender nodule was found on examining the upper pole of the testis. The remaining 14 cases of torted appendage were diagnosed at operation because testicular torsion could not be excluded due to scrotal swelling. Most (12) of this operated group were not seen until 3 days after the onset of pain. This study suggested that urgent operation was unnecessary in those in whom a tender nodule was found (pathognomonic of a torted appendage) and in those presenting after more than 24 h of pain with scrotal erythema and oedema. The likely diagnosis in the latter case is a torted appendage and in cases of torsion of the testis there is no prospect of salvage at this stage. These guidelines were applied to a group of 20 boys studied prospectively. In eight, all with less than 24 h of pain, immediate exploration was undertaken and testicular torsion was confirmed in six. The remaining 12 fulfilled the criteria for conservative management and were observed. All had normal testes at late review. Careful clinical assessment in boys with scrotal pain indicates which cases may be treated by non-operative management without fear of losing a salvageable testis.
Effect of low dose recombinant interleukin 2 plus indomethacin on mortality after sepsis in a murine burn model
Authors: Morgan P G , Mannick J A , Dubravec D B , Rodrick M L 
Published: March 2007

Abstract
Under anaesthesia, 129 8-week-old male A/J mice were subjected to a 25 per cent scald or sham burn and then resuscitated. They were divided at random into two groups. Mice from the first group were allocated into two groups. Mice from the first group were allocated into four subgroups to receive 6 days intraperitoneal (I.P.) injections as follows: (i) recombinant human interleukin 2 (rhIL-2) (250 units day−1); (ii) saline; (iii) indomethacin (5 µg−1 day−1); or (iv)rhlL-2 (250 units) + indomethacin (5 µg). Sham burned mice served as no treatment controls. All animals were subjected to peritonitis induced by caecal ligation and puncture 10 days after the burn and mortality was assessed. Mice from the second group were allocated to two subgroups to receive 6 days intraperitoneal injections of: (i) rhIL-2 + indomethacin; or (ii) saline. Animals in this group did not undergo septic challenge. They were randomly killed on days 7, 9 or 10 after the burn. Their splenocytes were harvested and assayed for response to the mitogens phytohaemagglutinin (PHA) and concanavalin A (Con A), and for production of interleukin 2. Mortality rate in animals subjected to burn and septic challenge without treatment was 75 per cent; in mice receiving rhIL-2 alone it was 68 per cent, in mice receiving indomethacin alone it was 62 per cent (no significance) and in mice receiving rhIL-2 + indomethacin it was reduced to 38 per cent (P &lt; 0·02). Splenocytes from animals receiving combination therapy had markedly improved responses to PHA on days 7 (P = 0·01), 9 (P = 0·02), and 10 (P = 0·008), and to Con A on days 7 (P = 0·001), 9 (P = 0·002) and 10 (P = 0·001), after burn injury. Interleukin 2 production was also significantly (P = 0·004) improved by therapy with rhIL-2 + indomethacin. These data suggest that low dose rhIL-2 in combination with indomethacin may have potential use in the therapy of burn victims.
Quantification of duodenogastric reflux in gastroduodenal peptic ulcer and in gastric operation patients, using a 24-h gastric pH measurement as a quantification technique
Authors: Campos R Robles , Paricio P Parrilla , Mompeán J A Luján , Albasini J L Aguayo , Bueno F Sánchez , González J M Rodríguez , de Haro L F Marténez 
Published: March 2007

Abstract
Twenty-four-hour gastric pH measurement was used to study duodenogastric reflux. To differentiate between gastric hyposecretion and duodenogastric reflux, we also measured bile acid concentrations in the gastric juice, and regarded pH increases to above 4 as possible episodes of reflux. The procedure was used in 60 patients, divided into the following groups: (1) control group (ten patients); (2) duodenal ulcer (ten patients); (3) type 1 gastric ulcer (five patients); (4) type 3 gastric ulcer (five patients); (5) bilateral truncal vagotomy plus pyloroplasty (ten patients); (6) truncal vagotomy plus Billroth I partial gastrectomy (ten patients); and (7) truncal vagotomy plus Billroth II partial gastrectomy (ten patients). The amount of reflux (areas of pH &gt; 4) in the type I gastric ulcer and Billroth 1 and Billroth II groups was significantly greater than that found in the control, duodenal ulcer, type 3 gastric ulcer and truncal vagotomy plus pyloroplasty groups. The mean concentration of total bile acids was also greater in the gastrectomized patients than in the rest of the groups studied. In the type 1 gastric ulcer group the mean bile acid concentration was similar to that of the control group.
Back pain following general anaesthesia and surgery: Evaluation of risk factors and the effect of an inflatable lumbar support
Authors: Hickmott K C , Healy T E J , Roberts S P , Faraghert E B 
Published: March 2007

Abstract
Factors that contribute to postoperative lumbar back pain and the effect of an inflatable lumbar support on the incidence of postoperative backache were examined. The study consisted of two parts, a pilot study in which mathematical models for appropriate support pressures were produced and the main study to assess the role of an inflatable lumbar support. The use of a support reduced the incidence of back pain on the first postoperative day from 46 to 21 per cent (P = 0·007). The patient's sex, height, weight, and the presence or absence of obesity were not found to be significant factors in the incidence of postoperative back pain. Previous back pain or arthritis in any joint tended to be associated with an increase in the severity and incidence of postoperative back pain. Postoperative back pain was more severe after procedures lasting more than 40 min. Early mobilization reduced the amount of back pain. In conclusion, patients benefit from the use of an inflatable lumbar support if they have previously suffered from backache or if they are to be anaesthetized for more than 40 min.
Interaction of penetrating missiles with tissues: Some common misapprehensions and implications for wound management
Authors: Cooper G J , Ryan J M 
Published: March 2007

Abstract
It is apparent from review of published papers and books that misunderstanding and confusion exists in the minds of many authors describing the interaction of penetrating missiles with tissues. These misapprehensions may influence the management of wounds by suggesting didactic approaches based upon a preconceived notion of the nature and severity of the wound for different types of projectiles. This review considers the biophysics of penetrating missile wounds, highlights some of the more common misconceptions and seeks to reconcile the conflicting and confusing management doctrines that are promulgated in the literature - differences that arise not only from two scenarios, peace and war, but also from misapprehensions of the wounding process. Wounds of war and of peacetime differ both in the nature of the wound and in the propensity for wound infection. Additionally, the limitations imposed by war dictate the type of management that may be practised and result in procedures that would be considered inappropriate by some in civilian clinical practice. Many of the procedures described in civilian peacetime settings, such as reliance on antibiotics alone for the control of infection in penetrating wounds, or minimal excision and debridement, can yield good results but would herald disaster if transposed to a war setting.
Tamoxifen therapy in unresectable adenocarcinoma of the pancreas and the papilla of Vater
Authors: Bakkevold K E , Pettersen A , Arnesjø B , Espehaug B 
Published: March 2007

Abstract
Between 1984 and 1987, 176 Norwegian patients with histologically verified unresectable pancreatic adenocarcinoma were randomized to double-blind treatment with oral tamoxifen (30 mg daily; 48 men and 44 women) or placebo (47 men and 37 women). Analysis of oestrogen receptor activity in the carcinomas was not performed. There were no statistically significant differences between the two groups according to age, Karnofsky performance index, tumour node metastasis (TNM) stage, operative treatment or other patient characteristics. The tamoxifen or placebo treatment continued to death or to 10 months after accrual into the trial was stopped. In the tamoxifen group, the mean and median survivals were 205 and 115 days, respectively. These values did not differ statistically from the 192 and 122 days, respectively, observed in the placebo group. Additional retrospective analyses of sex and stage revealed no beneficial effect of tamoxifen upon survival. For women in stage III (any TN1 M0), mean and median survivals were 255 and 191 days, respectively, compared with values of 84 and 45 days, respectively, in the placebo group (P = 0·011). After 2·5 years, three (7 per cent) women in the tamoxifen group were still alive compared with no survivors in the placebo group. No male patients survived beyond 2·5 years. This therapeutic result in a small subgroup of women is probably incidental and not an effect of tamoxifen.
Manovolumetric and sensory characteristics of the ileoanal J pouch compared with healthy rectum
Authors: Öresland T , Fasth S , Åkervall S , Nordgren S , Hultén L 
Published: March 2007

Abstract
Pouch volume, motility, sensory function and integrated pouch-anal mechanisms during graded isobaric distension of the pouch were prospectively studied in 67 patients with a J pouch-anal anastomosis. The findings were related to functional outcome. Thirty-six normal controls were studied for comparison. In contrast with normal rectum, the Heal pouch exhibited pronounced motility, and pouch contractions were frequent even at a high distension pressure. The presence of high pressure motility was associated with a poor functional outcome. The threshold pressure and threshold volume for eliciting first sensation of filling and urge to defaecate were significantly higher in the Heal pouch. The pressure threshold levels were not related to the functional outcome. Sphincter inhibition on pouch distension reappeared in 25 per cent of the patients. The distension pressure required to elicit the inhibition was considerably higher than in the control subjects. The functional result was similar irrespective of whether sphincter inhibition was present or not. The motor and sensory function of this artificial setting appear to be controlled by nervous mechanisms that are different from those in the healthy anorectum.
Colon wound management and prograde colonic lavage in large bowel trauma
Authors: Baker L W , Thomson S R , Chadwick S J D 
Published: March 2007

Abstract
Between 1983 and 1987 prograde colonic lavage was prospectively evaluated in 389 patients with colon trauma. Predefined high risk patients had exteriorization of the primarily sutured colon. Intra-peritoneal primary closure was otherwise used. Patients received prograde colonic lavage by random allocation. The healing exteriorized colon was interiorized 5–10 days after the initial surgery. The median age was 29 years and only 28 patients were women. Injuries were due to stab (316), gunshot (54), shotgun (10) or blunt trauma (9). Exteriorization of the primarily sutured colon was carried out in 217 patients of whom 101 had prograde colonic lavage. Twenty (9 per cent) died. Of the survivors, 150 (76 per cent) had their colon successfully interiorized and this rate was unaffected by prograde colonic lavage. Intraperitoneal primary closure was performed in 172 patients of whom 91 had prograde colonic lavage. Seven (4 per cent) died. Mortality was directly related to the number of associated injuries. Prograde colonic lavage, irrespective of the type of colonic wound management used, did not reduce the mortality rate, which was 7·2 per cent for those who had such lavage and 6·6 per cent for the rest. Prograde colonic lavage cannot therefore be recommended in colon trauma.
Asymmetrical nature of the muscular anatomy of the infantile pylorus: A possible consideration in pyloromyotomy
Authors: Cass D T , Bond G 
Published: March 2007

Abstract
Post-mortem studies of the normal infantile pylorus have demonstrated an asymmetrical structure with the mucosa protruding under the circular muscle at the lesser curve but not on the anterior surface. In addition the circular muscle was often discontinuous at the pyloroduodenal junction with only longitudinal fibres or even fibrous tissue separating the mucosa from the serosa. In a further specimen in which a pyloromyotomy had been performed 10 weeks previously, this asymmetry was more pronounced. This anatomy suggests that inpyloric stenosis it may be safer to site the caudal part of the pyloromyotomy incision on the anterior surface, rather than on the anterosuperior surface as most authors recommend. Perforation of the mucosa is predicted to be less likely.
Failure of nutritional recovery after total gastrectomy
Authors: Curran F T , Hill G L 
Published: March 2007

Abstract
Malnutrition is reported to be an inevitable consequence of total gastrectomy, although there are few data to support this contention. Six patients of median age 63 years underwent total gastrectomy for malignancy. At follow-up (median 45 months, range 25–60 months) each patient was clinically tumour-free and underwent dietary assessment, faecal fat and nitrogen measurement and routine haematological testing. Protein and fat stores, measured by neutron activation analysis and the tritiated water dilution technique, were compared with the same measurements made before operation and with predicted values. Mean(s.d.) dietary intake (2224(381) kcal day−1 and 81(15)g protein day−1) met the patients' estimated requirements. Mean(s.d.) serum albumin and faecal nitrogen values were normal but there was notable steatorrhoea (21(17) g day−1). Body composition measurements revealed profound deficiencies of body-weight (P &lt; 0·02), protein (P &lt; 0·01) and fat (P &lt; 0·02) before operation which were not corrected by an apparently curative total gastrectomy (P &lt; 0·05), although further deterioration was prevented.
Bile acids and the increased risk of colorectal tumours after truncal vagotomy
Authors: Mullan F J , Wilson H K , Majury C W , Mills J O M , Cromie A J , Campbell G R , McKelvey S T D 
Published: March 2007

Abstract
An association between colorectal cancer and previous peptic ulcer surgery is reported. In a prospective screening study, 100 asymptomatic patients (80 men and 20 women) who had undergone truncal vagotomy at least 10 years previously were investigated by barium enema, colonoscopy and gallbladder ultrasonography. Control data were obtained from forensic autopsy subjects. The incidence of neoplasms ≥1.0 cm in the vagotomized group was 14 per cent (11 adenomas, 3 carcinomas) and 3 per cent in controls (P = 0.01). Duodenal bile obtained at endoscopy from 21 vagotomized patients with normal gallbladders and from 21 control patients undergoing endoscopy was analysed by high performance liquid chromatography. The mean percentage of cholic (CA), chenodeoxycholic (CDCA), deoxycholic (DCA) and lithocholic (LCA) acids in the bile of vagotomized patients was 32.3, 45.6, 20.7 and 1.4 per cent respectively compared with 45.3, 36.2, 17.9 and 0.7 per cent respectively in controls. The increased proportions of CDCA and LCA and decreased proportions of CA in the duodenal bile of vagotomized patients were significant (P &lt; 0.001; P = 0.02; P = 0.007). Abnormalities in bile acid metabolism may help to explain the increased risk of colorectal neoplasia 10 years after truncal vagotomy.