bluuebunny/crossref_metadata_2025_split huggingface dataset:
The acute treatment of haemorrhage from oesophageal varices: A comparison of oesophageal transection and staple gun anastomosis with mesocaval shunt
Authors: Osborne D R , Hobbs K E F 
Published: March 2007

Summary
Two matched groups of 20 patients with bleeding oesophageal varices were treated by the same surgical team by either oesophagogastric transection and anastomosis using a mechanical stapling instrument or by mesocaval portosystemic shunt operation. Five of the patients treated by transection died postoperatively, 2 of the survivors developed portosystemic encephalopathy (PSE). 2 died later and 5 rebled. Seven of the patients who had a mesocaval shunt died postoperatively, 8 developed PSE, 3 died later and 4 rebled. It is concluded that oesophagogastric transection and anastomosis using a mechanical instrument is preferable to portal decompression for managing bleeding oesophageal varices in the urgent situation.
Biliary surgery in the same admission for gallstone-associated acute pancreatitis
Authors: Osborne D H , Imrie C W , Carter D C 
Published: March 2007

Summary
The clinical course of 47 patients with gallstone-associated acute pancreatitis who had surgery during the same admission has been reviewed. In 37 patients, when the signs and symptoms of pancreatitis settled on conservative management, biliary tract surgery was safely performed during that admission without mortality. The 10 patients whose clinical condition failed to settle prior to surgery had a complicated hospital stay and a 50 per cent mortality. A revised prognostic factor grading system has been outlined in which the age factor is removed and serum transaminase levels are considered of prognostic significance only if greater than 200 u/l within 48 h of admission. This revised system gives a more accurate assessment of the severity of individual attacks of gallstone-associated acute pancreatitis.
Radionuclide biliary scanning in acute pancreatitis
Authors: Glazer Geoffrey , Murphy Frank , Clayden Gerald S , Lawrence Rosemary G , Craig Oscar 
Published: March 2007

Summary
Radionuclide biliary scanning with 99Tcm-labelled HIDA was performed in 36 patients with acute pancreatitis within 3 days of admission. Twenty had a non-visualized gallbladder on scanning and all were subsequently shown by cholecystography (n = 16) andlor operation (n = 16) to have underlying gallstones; 5 of the 16 cholecystograms revealed a ‘functioning’ gallbladder. Sixteen patients had normal HIDA scans with gallbladder visualization, and subsequently all were shown by cholecystography (n = 15) or operation (n = 1) to have a normal biliary tree; 15 of these had an alcoholic background. In the differentiation of gallstone from non-gallstone pancreatitis, biliary scanning was completely accurate and a better discriminant than the liver function profile or the clinical features, the latter being valueless.
Whether or not the gallbladder is visualized on biliary scanning depends on the presence or absence of cystic duct obstruction, a fact confirmed in two other groups: in 53 patients with acute cholecystitis and non-visualized gallbladders on scanning, 52 were subsequently shown to have ‘non-functioning’ gallbladders by oral cholecystography (1 having stones in a functioning gallbladder), whereas 9 other patients with normal biliary scans, all had ‘functioning’ gallbladders on oral cholecystography.
Thus, acute gallstone pancreatitis appears to be accompanied in the early stages by occlusion of the cystic duct, though this is a transient phenomenon in about one-third of the patients. The cause of this occlusion may be oedema in some cases but its relationship to the pathogenesis of acute pancreatitis is unclear.
Surgical decision making
Authors: Ruckley C V , Ferguson J B P , Cuthbertson C 
Published: March 2007

Summary
The decision-making process in a general surgical outpatient clinic has been studied by following the course of 2000 consecutive newly referred patients of whom 1045 were put on surgical waiting lists. Surgeons were asked to record their reasons for selection for each of four levels of care: main ward, 5-day ward, day bed unit or minor outpatient surgery. Selections were influenced by social and psychological factors in 12 per cent of patients, the remaining 88 per cent were determined by the medical history or physical condition.
The decision was assessed by monitoring the progress in hospital and the outcome at a follow-up clinic. In 84 per cent of patients arrangements had gone according to plan. Eleven (1·75 per cent) of 5-day or day care patients were transferred to a higher level of care and 13 (1·4 per cent) of the total series were re-admitted.
Surgeons were asked to forecast the duration of postoperative stay. Thirty-six per cent were discharged on the day forecast, 63 per cent within 24 h and 75 per cent within 48 h. Forrecasts of length of stay for hernias and varicose veins were accurate but were usually underestimated for major surgery.
It is concluded that for the majority of general surgical patients the selection of the level of care and the forecast of postoperative stay were sufficiently reliable to allow confident and definite advice to be given to the patient and to allow resources to be efficiently used.
Haemodynamic assessment following iliac artery dilatation
Authors: Gunn I G , Cowie T N , Forrest H , Quin R O , Sheldon C , Vallance R 
Published: March 2007

Summary
Fourteen patients with symptomatic atheromatous stenoses of common or external iliac arteries underwent percutaneous arterial dilatation. Twelve procedures were considered successful in terms of arteriographic and symptomatic improvement but the application of three haemodynamic indices (pressure index, pulsatility index and the papavarine test) indicated that only 8 patients had gained a significant improvement in blood flow. These results illustrate the need for quantitative measurements in the assessment of this new technique.
Propranolol in the surgical treatment of hyperthyroidism, including severely thyrotoxic patients
Authors: Feely John , Crooks J , Forrest A L , Hamilton W F , Gunn Andrew 
Published: March 2007

Summary
The perioperative course of 44 hyperthyroid patients prepared for surgery with propranolol alone, including 11 with severe thyrotoxicosis was compared to that of 20 euthyroid patients prepared for surgery with carbimazole. Conventional propranolol at a dosage of 160 mg/day was frequently insufficient to produce a high degree of beta-adrenergic blockade, particularly in severely thyrotoxic patients. A greater than 25 per cent reduction in sitting pulse rate was associated with a high degree of beta-blockade. The clinical course of patients with mild or moderate thyrotoxicosis was similar to that of the patients prepared with carbimazole. In contrast, the course of severely thyrotoxic patients was complicated and, in addition to a higher preoperative propranolol dosage, these patients commonly required supplemental propranolol after operation. Although thyroid crisis did not occur in any patient, we cannot recommend the use of propranolol alone for the severely thyrotoxic patient.
The value of preserving the anal sphincter in operations for ulcerative colitis and polyposis: A review of 22 mucosal proctectomies
Authors: Johnston David , Williams Norman S , Neal David E , Axon Anthony T R 
Published: March 2007

Summary
Ulcerative colitis and polyposis are both diseases of the mucosa. They can be cured by colectomy combined with selective mucosal proctectomy, without sacrifice of the anal sphincters or damage to bladder or sexual function. Terminal ileum, either as a straight tube or in the form of a pouch, is drawn down through the denuded tube of anorectal muscle and anastomosed to the mid-anal canal. A temporary defunctioning ileostomy is always used. Caecum has also been used as a neorectum after mucosal proctectomy, but without long term success.
Twenty-two patients, 20 with ulcerative colitis and 2 with polyposis, have been treated by mucosal proctectomy in the past 4 years, with no mortality. The caeco-anal procedure proved a failure because of recurrence of colitis, although the early functional results were good. After ileo-anal anastomosis, continence was perfect by day, but 2 patients had occasional lapses at night. The disadvantage of straight ileo-anal anastomosis is frequency of bowel action (6–9 times a day), even with codeine medication, although the patients considered the operation a success. Some form of pelvic reservoir is therefore desirable and our early experience with the triplicated ileal pouch is encouraging.
Surgical approach to corrosive injuries of the stomach
Authors: Di-Costanzo J , Cano N , Martin J , Noirclerc M 
Published: March 2007

Summary
The surgical management of corrosive injuries of the stomach has not yet been clearly defined. This work analyses the results achieved with a surgical protocol included in a new therapeutic approach. This approach applied to 111 consecutive patients was based upon three points: (a) early fibroscopic examination, (b) protection of severe burns by total parenteral nutrition and (c) reparative surgery in the complete healing phase. The stomach was involved in 89 per cent of the 93 cases with proved gastrointestinal lesions; gastric lesions were isolated in 42 per cent of cases. The frequency of gastric involvement is partly related to the type of product ingested; the intensity of lesions is correlated with the quantity and the concentration of corrosive products. After a 3-month total parenteral nutrition period, reparative surgery can be performed without local complications in severe cases. Limited resections of the stomach must then be preferred when possible. In cases with total involvement bypass techniques can be carried out. Indications for early surgery are not yet well defined.
The treatment of pleomorphic adenomas by formal parotidectomy
Authors: Stevens K Lindsey , Hobsley M 
Published: March 2007

Abstract
We reviewed 100 patients who underwent formal parotidectomy. Seventy-two were new patients in whom a parotid lump proved to be a pleomorphic adenoma. Twenty-eight were patients in whom a tumour had recurred after treatment for pleomorphic adenoma by local excision (with or without irradiation) elsewhere. After a follow-up of 1–15 years (median 4 years), there were no recurrences in the primary group but 5 recurrences among the secondary cases. Permanent facial nerve damage was not seen in the primary group, but 11 patients undergoing secondary parotidectomy were left with some permanent facial weakness. Malignant change occurred in 4 patients in the secondary group.
The role of abdominal surgery in the treatment of advanced testicular germ cell tumours
Authors: Jones B M , Newlands E S , Begent R H J , Rustin G J S , Bagshawe K D , Johnson A G , Reynolds K W 
Published: March 2007

Abstract
Twenty patients with advanced testicular teratoma and 1 with advanced seminoma have undergone abdominal surgery for the removal of residual disease following treatment by sequential chemotherapy (1). Fourteen out of the 21 patients (66 per cent) have achieved complete remission with a follow-up period of 6–41 months. In 12 patients (57 per cent) the tumour had undergone histological maturation or necrosis following chemotherapy, those patients in whom the tumour remained histologically active having a worse prognosis. Raised preoperative serum levels of the tumour markers human chorionic gonadotrophin (hCG) and alpha-fetoprotein (AFP) indicating active disease, forecast a particularly poor prognosis, 5 out of 9 such patients (55 per cent) having died. Computerized tomography gave false negative results in 3 patients (14 per cent). Postoperative complications were few, and only 2 patients (9 per cent) suffered with failure of ejaculation. At present our policy is surgical removal of any residual mass after chemotherapy to determine the histology, and, wherever possible, to achieve complete clinical and biochemical remission. Six patients with an apparently poor prognosis have benefited directly from surgery and remain in long term remission. The selection of patients who benefit most from surgery can only be determined by more experience and longer follow up.
Late results of proximal gastric vagotomy without drainage for duodenal ulcer: 5–9-year follow-up
Authors: De Miguel Jacinto 
Published: March 2007

Abstract
From 1970 to 1974 proximal gastric vagotomy without drainage was performed in 158 patients for duodenal ulcer. One patient died, giving an operative mortality of 0·6 per cent. Nine unrelated deaths occurred during the period of survey and 5 other patients were lost to follow-up. The remaining 143 patients were followed-up for a minimum of 5 years and a maximum of 9 years.
The most frequent symptoms were epigastric fullness and intolerance to milk. Early dumping, detected in 6·7 per cent of the patients, was always mild. Diarrhoea, also very slight and often only related to the ingestion of milk, was seen in 9·6 per cent. Recurrent duodenal ulcer was proved in 7·7 per cent and strongly suspected in 0·7 per cent and the presence of a new gastric ulcer was also proved in 1·4 per cent of patients, making a total incidence of recurrence of 9·8 per cent. Approximately 89 per cent of the patients were classed as having a satisfactory result and 11 per cent were classed as unsatisfactory.
Proximal gastric vagotomy is clearly effective in reducing the side-effects of gastric surgery, while the incidence of recurrent ulceration in the long term is similar to the incidence of recurrence after truncal or selective vagotomy with a drainage procedure. For these reasons, consideration should be given to the wider use of proximal gastric vagotomy in the elective surgical treatment of duodenal ulcer.
Hospital admissions for acute cholecystitis: Changes in the age and sex distribution in Oxford in the post-war period
Authors: Mitchell Andrew , Morris Peter J 
Published: March 2007

Abstract
Admissions for acute cholecystitis to the Radcliffe Infirmary, Oxford, during the period 1974–1978 have been reviewed and compared with figures previously published for the period 1953–1962 (I).
There was a small overall increase in the annual rate of female admissions for acute cholecystitis between the two periods and this increase can be accounted for by population changes in all age groups above the age of 40 years. However, there was a significant increase in the admission rate of women under the age of 40 which could not be accounted for by changes in population alone. This apparent increase in acute gallbladder disease in young women coincides with the growth between 1960 and 1970 of the number of women taking oral contraceptives, and is further evidence of a causal relationship between the use of the contraceptive pill and the development of gallstones. Women taking oral contraceptive steroids had a higher rate of common bile duct exploration and of sphincteroplasty than did those not taking oral contraceptives.
The annual rate of male admissions almost doubled between the two periods and this increase cannot be accounted for by population changes. There has also been a virtual disappearance of acute cholecystitis in children over the same time.
Report of a prospective trial of dextranomer beads (Debrisan) and silicone foam elastomer (Silastic) dressings in surgical wounds
Authors: Young Howard L , Wheeler Malcolm H 
Published: March 2007

Abstract
A prospective randomized controlled trial of dextranomer beads (Debrisan) and silicone foam elastomer (Silastic) dressings in open infected surgical wounds has been performed. The results indicate that the healing time for wounds treated by Debrisan (n = 25) and elastomer (n = 25) is similar, being 40·92 ± 3·98 and 36·90 ± 3·18 days respectively. The time taken for wounds to become pain-free was similar in both treatment groups, as was the persistence of signs in the wounds of erythema, oedema and slough. Comparison of cost reveals the elastomer dressing to be considerably cheaper than Debrisan.
Difficulties in the diagnosis and management of pyogenic liver abscess
Authors: Northover J M A , Jones B J M , Dawson J L , Williams Roger 
Published: March 2007

Abstract
Thirty patients with pyogenic liver abscess were admitted to King's College Hospital between 1967 and 1978. The overall mortality was 43 per cent (13 patients). The diagnosis was often difficult and in 10 patients the correct diagnosis was not made until post-mortem. Of the 20 patients diagnosed and treated, 17 had a unilocular abscess, of whom 16 survived. The remaining 3 had a multicentric abscess, and only 1 of them survived. Difficulty in diagnosis was sometimes increased by misleading results from special investigations. Clinical awareness leading to early diagnosis, drainage and broad spectrum antibiotic treatment remain the prerequisites for cure.
Injection sclerotherapy for oesophageal varices in children
Authors: Stamatakis J D , Howard E R , Psacharopoulos H T , Mowat A P 
Published: March 2007

Abstract
Oesophageal varices in 21 children with portal hypertension (intrahepatic 13, extrahepatic 8) were treated with sclerotherapy using ethanolamine oleate injected via a fibreoptic endoscope. Repeat endoscopy confirmed variceal obliteration in 18 children with a mean of 3·5 (range 1–8) injections. No patient has bled since obliteration of varices. Complications were oesophageal stricture (2 patients), oesophageal ulcer (5 patients) and haemorrhage within 30 days of injection (5 patients). The early results suggest that this is a satisfactory method for the treatment of oesophageal varices in children.
Parathyroid function during acute pancreatitis
Authors: McMahon M J , Heyburn P J , Playforth M J , Woodhead J S 
Published: March 2007

Abstract
The renal handling of calcium and phosphate, which normally reflects parathyroid hormone (PTH) activity, was studied during the first 5 days after admission to hospital in 18 patients with acute pancreatitis. The ionized calcium level in plasma was calculated from the total calcium, albumin, total protein and pH. Hypocalcaemia (Ca &lt; 1·08) was found in 6 patients and was associated with low urine calcium concentrations, hypophosphataemia and lower renal tubular reabsorptions of phosphate. Although these changes were all consistent with an appropriate renal response to increased PTH production in the hypocalcaemic patients, measured levels of PTH were very variable. In one patient who developed tetany, calcium infusion resulted in a rise in plasma calcium and a reversal of renal changes, but had little influence upon PTH levels. We found no evidence that hypomagnesaemia or proteolytic degradation of PTH were factors in the aetiology of hypocalcaemia.
The discrepancy between evidence of PTH activity from renal function and immunoassayable levels of PTH in plasma might indicate that the parathyroid response, although present, was inadequate to mobilize enough skeletal calcium to prevent hypocalcaemia; it underlines the need for caution in the interpretation of data from radioimmunoassay techniques when taken in isolation in situations where they have not been fully evaluated.
Cholecystoduodenocolic fistula following abdominal trauma
Authors: Griffith C D M , Saunders J H 
Published: March 2007

Abstract
A case of cholecystoduodenocolic fistula following trauma is reported. It is unusual in that the majority of such fistulas are seen in relation to gallstones. The patient was managed initially by total parenteral nutrition and drainage followed by successful operation.
HLA antigens in relationship to duodenal ulceration, gastric acid secretion and the clinical result following vagotomy
Authors: Gough M J , Rajah S M , Giles G R 
Published: March 2007

Abstract
The distribution of 20 HLA antigens was measured in 100 patients with a duodenal ulcer. An increase (P &lt; 0·05) in the incidence of the HLA-BW35 antigen was identified which conferred an increased risk factor of developing a duodenal ulcer of 2·7. The preoperative acid output in patients who had the BW35 antigen was significantly lower than that found in all other patients prior to surgery. The clinical outcome from definitive surgical treatment did not appear to be influenced by the HLA status of the patients.
Adjuvant tamoxifen therapy for early breast cancer: An experimental study with reference to oestrogen and progesterone receptors
Authors: Wilson Alan J , Tehrani F , Baum M 
Published: March 2007

Abstract
There is very little known about the subsequent behaviour of breast cancer following adjuvant endocrine therapy or the effect of this therapy on the oestrogen and progesterone receptor content of recurrent disease. Mammary tumours were induced in Sprague–Dawley rats using n-nitrosomethylurea. In two experiments animals were treated with tamoxifen at different doses prior to the appearance of tumours. Tamoxifen prolonged the induction time and reduced the total number of tumours. Subsequent treatment of established tumours exposed to tamoxifen in the induction period demonstrated a reduced response to further tamoxifen therapy. There was no difference in the oestrogen receptor content of the tumours previously exposed to tamoxifen, but there was a significant reduction in the progesterone receptor content. The results suggest that: (a) patients treated with adjuvant tamoxifen therapy will show a delay in the appearance of recurrent disease with a reduced response to further tamoxifen therapy; (b) the model may provide an in vivo method to examine the relationships between oestrogen and progesterone receptors and response to endocrine therapy.
Randomized controlled trial of colestipol in antibiotic-associated colitis
Authors: Mogg G A G , George R H , Youngs Denise , Johnson Margaret , Thompson H , Burdon D W , Keighley M R B 
Published: March 2007

Abstract
Thirty-eight patients with severe antibiotic-associated postoperative diarrhoea were entered into a randomized controlled trial to compare colestipol (an ion exchange resin) in 17 patients with placebo (sherbet) in 21 patients. Clostridium difficile or its toxin was present before treatment in 12 of the colestipol group, compared with only 5 in the placebo group. Because of the low incidence of Cl. difficile or its toxin, the placebo group data from 22 patients receiving placebo in a previous trial (9 of whom had Cl. difficile or toxin) were included for comparison. Neither colestipol nor placebo had any influence on the faecal excretion of Cl. difficile or its toxin. Colestipol was clinically no better than placebo. In view of the persistent faecal excretion of Cl. difficile toxin, ion exchange resins cannot be recommended for the treatment of antibiotic-associated colitis.
Effect of surgery on monocyte function
Authors: Oladimeji M , Grimshaw A D , Baum M , Patterson K G , Goldstone A H 
Published: March 2007

Abstract
In vitro monocyte lysozyme production (IVMLP) was assessed in 10 male patients preoperatively and at intervals postoperatively. A similar procedure was carried out in 6 sex- and age-matched controls. In contrast to the control group where the IVMLP was constant, the IVLMP levels in the surgical group showed a marked increase at 6–10 h postoperatively, falling to control levels after 10 days. In addition, peripheral monocyte counts were carried out using a Technicon Hemalog D counter which produces accurate reproducible counts for cells such as monocytes which occur at low frequency. The peripheral monocyte counts were stable in the control group, whilst in the surgical patients there were significantly higher readings at 36–48 h, which persisted for up to 10 days compared with preoperative counts. This study suggests that surgery has both a qualitative (IVMLP) and quantitative (monocyte counts) effect on the mononuclear phagocytes. These data may be relevant when considering factors that influence the early stages of wound healing.