bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experimental and clinical study of lactulose in obstructive jaundice
Authors: Pain J A , Bailey M E 
Published: March 2007

Abstract
The role of lactulose in preventing endotoxaemia in obstructive jaundice has been investigated. A prospective study was performed on 24 consecutive patients with obstructive jaundice undergoing surgery. Twelve patients were given oral lactulose before operation and were compared with twelve controls. Endotoxaemia was reduced in peroperative portal (P &lt; 0·05) and postoperative systemic (P &lt; 0·05) blood samples in the lactulose treated group, and a significant fall (P &lt; 0·05) occurred in the postoperative 24 h creatinine clearances in controls compared with the lactulose treated group. Results from animal experiments in which oral lactulose reduced endotoxin related mortality in obstructive jaundice (P &lt; 0·05), and the in vitro demonstration of a direct anti-endotoxic action of lactulose suggest that its beneficial action is due in part to an inactivation of endotoxin.
Effect of early blood transfusion on gastrointestinal haemorrhage
Authors: Blair S D , Janvrin S B , McCollum C N , Greenhalgh R M 
Published: March 2007

Abstract
The effect of citrated stored blood on coagulation was studied initially in a pilot study where 25 patients with acute severe gastrointestinal haemorrhage had their whole blood coagulation measured using the Biobridge Impedance Clotting Time (ICT). This demonstrated that there is a hypercoagulable response to haemorrhage which was partially reversed by blood transfusion. Similar changes were noted in Kaolin Cephalin Clotting Times (KCCT). A further 50 patients were then randomized to receive, during the 24h after admission, either at least 2 units of blood or no blood transfusion unless the haemoglobin fell below 8 g/dl or they were shocked. In the transfused group nine patients re-bled compared with only one in the non-transfused group (P &lt; 0·01, χ2 with Yates' correction). Early blood transfusion appears to reverse the hypercoagulable response to haemorrhage thereby encouraging rebleeding and hence the need for an operation.
Fluid sequestration: An early indicator of mortality in acute pancreatitis
Authors: Sauven P , Playforth M J , Evans Mary , Pollock A V 
Published: March 2007

Abstract
Complete daily intake and output charts were available for 218 patients with acute pancreatitis. The patients were divided into three groups according to the relation between fluid intake and output. In 105 patients in whom there was negligible fluid sequestration (daily output within 2 litres of intake) there were six deaths (5·8 per cent). In 69 patients the daily fluid intake exceeded the output by 2 litres or more but this imbalance lasted for 48 h or less; six patients died (8·7 per cent). The remaining 44 patients sequestered 2 litres or more of fluid per day for more than 48 h or until death. Thirty-eight patients in this group died (86·4 per cent). Fluid sequestration of 2 litres or more per day, and lasting longer than 48 h, is an accurate and simple predictor of mortality in acute pancreatitis. In this study it had a sensitivity of 76 per cent and a specificity of 96 per cent. The predictive value of a positive result was 86 per cent and of a negative result 93 per cent (efficiency 92 per cent).
Sialography in salivary gland disease
Authors: McEntee G P , Manners A R , Peel A L G 
Published: March 2007

Abstract
Ninety-six consecutive patients underwent sialography over a 10 year period at North Tees District General Hospital; there were 68 parotid and 28 submandibular examinations. Patients were divided into two groups: group 1, patients with symptoms but no clinical signs (n = 27); group 2, patients with swelling of the salivary gland (n = 69). Results showed that sialography was of considerable value in group 1 patients demonstrating pathology in 33 per cent (9/27 patients). In patients with a suspected, but unusually situated, parotid tumour (n = 20) sialography was confirmatory in 10 patients but the technique failed in four, gave a false negative result in four and would seem to be of limited value. In the remaining patients in group 2 with diffuse glandular swelling (n = 49) the main contribution of sialography was in demonstrating sialectasia (9), duct strictures (4) and non-opaque parotid calculi (2), but even in this group of patients 35 per cent (17/49 patients) of the examinations were normal. When submandibular calculi were demonstrable on plain radiography sialography contributed no further relevant information.
Outpatient varicose vein surgery under local anaesthesia
Authors: Bishop C C R , Jarrett P E M 
Published: March 2007

Abstract
Local anaesthesia has been used for 186 varicose vein operations performed in a day surgical unit. The long saphenous vein was stripped in 87 legs using a femoral nerve block. All patients went home on the day of operation and none required readmission. Complications were minimal and included six wound infections, six episodes of thrombophlebitis and one case of saphenous neuritis; 35 patients had minor residual varices at 6 weeks of which 29 required injection sclerotherapy. The technique has been shown to be both safe and acceptable to patients, and reduced the waiting time for surgery to a mean of 3·1 months during the period studied.
Haemodynamics of the interposition vein cuff
Authors: Beard J D , Benveniste G L , Miller J H , Baird R N , Horrocks M 
Published: March 2007

Abstract
It has been suggested that the use of an interposition vein cuff for anastomosing PTFE grafts to small calibre arteries confers a haemodynamic advantage. Pulsatile blood flow through a standard anastomosis was compared, in vitro, to that incorporating a vein cuff. 6 mm PTFE was anastomosed end-to-side to 10 pairs of cadaver internal mammary arteries matched for length and internal diameter (median 1·8 mm, range 1·6–2·4). Blood flow was significantly higher through the vein cuff anastomosis than the standard anastomosis (comparison of regression analysis, P &lt; 0·001) when the arterial diameter was &lt; 2·0 mm (five pairs). These results suggest that the vein cuff does confer a significant haemodynamic advantage when PTFE is anastomosed to arteries &lt; 2·0 mm diameter and this may be because the compliant vein cuff allows more distension of the anastomosis thus reducing anastomotic resistance.
Diagnosis and surgical management of intractable constipation
Authors: Roe A M , Bartolo D C C , Mortensen N J McC 
Published: March 2007

Abstract
Seventy-four patients with intractable constipation, of whom thirty-three had slow and forty-one normal intestinal transit, were investigated to determine the aetiology of their disorder and plan treatment. Patients with slow transit had a greater incidence of abdominal pain and distension (P &lt; 0·001) and only 9 per cent had a normal call to stool compared with 71 per cent of those with normal transit (P &lt; 0·001). Internal anal sphincter function as assessed by sphincter pressures, length and the recto-anal inhibitory reflex did not reveal any difference between the groups and normal controls; similarly anal sensation and rectal compliance were normal. However, those with normal transit had a higher threshold of rectal sensation than controls (P &lt; 0·05), Slow transit patients failed to show a postprandial increase in rectosigmoid motility compared with controls (P &lt; 0·05). Whilst the majority failed to inhibit the external sphincter on bearing down, half of those with normal transit produced either partial or complete inhibition. Both groups were able to increase the anorectal angle on straining. Twenty-two normal transit patients had abnormal perineal descent compared with controls (P &lt; 0·0005). Patients with perineal descent exhibited abnormal rectal morphology. Rectal intussusception was observed in 13 of 35 evacuation proctograms. On the basis of the data presented, we could not justify internal sphincterotomy of puborectalis division. Our policy in severe slow transit constipation was to offer colectomy and ileorectal anastomosis. In five out of seven to date, a successful result has been achieved. Eight patients with rectal intussusception have undergone an abdominal rectopexy with significant improvement in three. In our hands, the evacuation proctogram and transit studies were the most useful preoperative investigations.
Results of surgical treatment for iliofemoral venous thrombosis
Authors: Swedenborg J , Hägglöf R , Jacobsson H , Johansson J , Johnsson H , Larsson S , Nilsson E , Zetterquist S 
Published: March 2007

Abstract
The long-term results after venous thrombectomy combined with a temporary arteriovenous fistula were evaluated in 19 patients. Clinical status, isotope phlebography, venous occlusion plethysmography and foot volumetry were performed after a mean follow-up time of 38 months (range 13–75). The primary operation was successful in 17 of the 19 patients; the 2 remaining had chronic occlusions of their iliac veins. At the time of closure of the arteriovenous fistula, i.e. 3 months after thrombectomy, 14 patients had a patent iliac vein. At follow-up eight patients were considered to have a patent iliac vein, eight had a partial restitution and three had an occluded iliac vein. The group as a whole had no impaired venous emptying of the leg, but the small group of patients with occlusion at follow-up according to isotope phlebography seemed to have an impaired venous emptying. Foot volumetry showed only minor signs of valvular insufficiency, mainly in limbs with distal extension of the initial thrombus or only partial restitution of venous patency. A good long-term result can be expected after venous thrombectomy with a temporary arteriovenous fistula particularly in younger patients where the thrombosis is limited to the iliofemoral segment. This emphasizes the importance of early operation before distal extension of the thrombus occurs.
Carcinoma of the thyroid: Differential behaviour in solitary and multinodular tumours
Authors: Kapur M M , Sarda A K , Bal S , Sood S 
Published: March 2007

Abstract
One hundred and sixty-three cases of thyroid carcinoma were treated between 1979 and 1983. The cancers were classified as solitary nodules or carcinomas in multinodular goitres according to their clinical presentation. Analysis revealed a significantly higher incidence of T0/T1 in the solitary nodular carcinoma group (P &lt; 0·001) and a lower incidence of metastatic disease (P &lt; 0·05) compared with multinodular carcinoma. Survival for the T0/T1 subgroup of solitary nodular carcinoma was significantly better compared with the same subgroup of multinodular carcinoma (P &lt; 0·05).
Insulin infusion (GIK) in the treatment of type 2 (non-insulin dependent) diabetes during the perioperative period
Authors: Thomas D J B , Platt H S , Alberti K G M M 
Published: March 2007

Abstract
The effect of surgery on intermediary metabolism has been studied in six non-diabetic subjects, eleven type 2 diabetic subjects untreated during surgery, and nine type 2 diabetic subjects treated by glucose–insulin–potassium (GIK) infusion during surgery. Plasma glucose results were studied in all subjects and other metabolites whenever possible. Initial glucose concentrations were similar in both groups of diabetic subjects. Four hours postoperatively the plasma glucose was lower in the GIK group (10·1 ± 1·0 mmol/l) than in untreated subjects (14·2 ± 1·3 mmol/l, P &lt; 0·05) but still far above levels found in non-diabetic subjects. Lactate concentration was higher in the GIK treated diabetic subjects than in both non-GIK treated diabetic and non-diabetic patients 15 min after induction (1·32 ± 0·07 compared with 0·93 ± 0·09 and 0·89 ± 0·08 mmol/l, P &lt; 0·02). Non-esterified fatty acid (NEFA) was lower one hour postoperatively in the GIK treated diabetic group than in the non-GIK diabetic patients (0·47 ± 0·09 mmol/l compared with 1·09 ± 0·22 mmol/l, P &lt; 0·05). All NEFA concentrations were lower in GIK treated diabetic subjects than in non-diabetic subjects for the time of insulin infusion. Blood 3-hydroxybutyrate was also lower in GIK treated (0·04 ± 0·02) than in untreated diabetic subjects 4h postoperatively (0·25 ± 0·07 mmol/l, P &lt; 0·05). The levels of non-esterified fatty acid and 3-hydroxybutyrate found in the untreated diabetic did not differ from those found in non-diabetic controls. Plasma cortisol levels had risen in all groups 4 h postoperatively (P &lt; 0·01).
Abolition of postprandial alkaline tide after vagotomy and its use as a screening test in the assessment of vagotomy
Authors: Ahmad A 
Published: March 2007

Abstract
Assessment of completeness of vagotomy has always been an irksome and time-consuming affair. The commonly employed test of insulin-induced hypoglycaemia (Hollander) is tedious, risky and associated with practical limitations and theoretical objections, which have resulted in its being replaced by the modified sham feed technique in some centres. The postprandial alkaline tide is attributed to HCO3− release consequent to H+ secretion. Any procedure which reduces acid secretion is expected to affect the postprandial urinary pH. This study was performed to evaluate the effect of vagotomy on the postprandial alkaline tide by measuring prevagotomy and postvagotomy fasting and postprandial urinary pH. The results show that postprandial urinary pH falls after vagotomy and this method may be used to assess the completeness of vagotomy. The proposed test is convenient and may be used as a screening method in the assessment of vagotomy and other acid reducing operative procedures, if further validated, by comparison with already established tests.
Diagnostic accuracy of double-contrast enema and rectosigmoidoscopy in connection with faecal occult blood testing for the detection of rectosigmoid neoplasms
Authors: Jensen J , Kewenter J , Haglind Eva , Lycke G , Svensson Christina , Åhrén C 
Published: March 2007

Abstract
Four hundred and fifty-eight consecutive subjects with a positive faecal guaiac test when screened for early detection of colorectal neoplasms were investigated with double-contrast enemas and rectosigmoidoscopy (60 cm). The results of these two methods were compared. The radiologists and endoscopists were unaware of the result of each others' examination at the time of their own investigation. Altogether ten subjects with carcinoma in the rectosigmoid area were found. The radiologists and endoscopists each overlooked four of these ten carcinomas and only four of the carcinomas were diagnosed with both methods. Fifty-six of one hundred and seven adenomas were 1 cm or larger in diameter and located in the rectum or the sigmoid colon. Thirteen of the fifty-six adenomas were missed by double contrast enema and ten by endoscopy and only thirty-three adenomas were diagnosed with both methods. Neoplasms in the rectum and the sigmoid colon are sometimes difficult to diagnose with both radiology and endoscopy. Rectosigmoidoscopy (60 cm) should therefore be used as a complement to double contrast enemas if this method is chosen for investigation of a patient with rectal bleeding.
Laparoscopy as an adjunct to decision making in the ‘acute abdomen’
Authors: Paterson-Brown S , Eckersley J R T , Sim A J W , Dudley H A F 
Published: March 2007

Abstract
When patients are admitted to hospital with acute abdominal pain, clinicians, irrespective of a specific diagnosis, intuitively select three diagnostic classes: operation definitely required (Group A); operation definitely not required (Group B); need for operation uncertain (Group C). The last is followed either by a precautionary laparotomy or a variable period of observation/investigation. We have studied prospectively the influence of laparoscopy on the distribution between these classes and particularly on outcome in group C. One hundred and twenty-five consecutive patients with abdominal pain severe enough for emergency admission have been classified by one of two admitting surgeons (SHO/registrar), who also expressed in group C a view on how they would proceed – operation or observation. Group C were then laparoscoped. The procedure confirmed a provisional view that laparotomy was needed in 11 of 15 patients. In the ‘observation’ sub-group the provisional decision was confirmed in 14 of 16 and early discharge followed in most. Six inappropriate decisions were thus avoided. Seven management decisions in group A and 4 in group B proved incorrect (11/94: 12 per cent). The majority were potentially recognizable by laparoscopy. Though relatively high rates of successful decision making are achieved with conventional clinical techniques, they can be further improved by laparoscopy. This procedure is particularly applicable in the management of patients with acute abdominal pain without a definite diagnosis, or when appendicitis is regarded as an established diagnosis.
Orthotopic liver transplantation: Postoperative complications and their management
Authors: Kirby R M , McMaster P , Clements D , Hubscher S G , Angrisani L , Sealey M , Gunson B K , Salt P J , Buckels J A C , Adams D H , Jurewicz W A J , Jain A B , Elias E 
Published: March 2007

Abstract
The Birmingham liver transplant programme started in 1982. Forty-six patients have been transplanted with a follow-up of 3 months or longer. Twenty-seven patients are still alive, of whom sixteen have lived for more than one year. The 30 day hospital mortality was 30·4 per cent and the actuarial predicted one year survival 55·5 per cent. Four patients have been regrafted for chronic rejection and graft failure. Thirteen patients have required surgery in the postoperative period for: bleeding (two), removal of abdominal packs (four), biliary leaks and obstruction (five), duodenal perforation (one) and small bowel obstruction (one). Acute rejection was common, occurring in 30 patients and progressing to chronic rejection in 4. Ten patients developed renal failure with an 80 per cent mortality and eleven patients developed grand mal fits. Severe bleeding (&gt;70 units) was associated with previous abdominal surgery and a high mortality (88·9 per cent). Opportunistic fungal infection carried a 100 per cent mortality. Although more than half of all transplanted patients will survive for more than one year, the postoperative period is still one of high morbidity and mortality.
Dysplasia of the colon after jejuno-ileal bypass
Authors: McFarland R J , Talbot R W , Woolf N , Gazet J-C 
Published: March 2007

Abstract
Colonoscopic biopsies were performed on 38 patients, 10–13 years after jejuno-ileal bypass. No significant dysplasia or premalignant change was seen in 371 biopsies. In one patient two tubulovillous adenomata were found in an otherwise normal colon, which is likely to be a chance finding. Although it will take another 10–20 years to establish whether jejuno-ileal bypass is associated with an increased risk of large bowel cancer in humans, there is at present no indication for regular colonoscopic surveillance.
Intraduct enterokinase is lethal in rats with experimental bile-salt pancreatitis
Authors: Terry T R , Grant D A W , Hermon-Taylor J 
Published: March 2007

Abstract
Controlled intraduct infusion and peri-acinar dispersal of 100 µl buffer containing sodium glycodeoxycholate (GDOC) at concentrations of 8·5, 17 and 34 mmol/l in rats caused a progressively severe acute pancreatitis from which none of the animals died over the experimental period. Infusion of affinity-purified active human enterokinase in buffer did not cause pancreatitis, presumably because of the inability of the macromolecule to gain access to its specific intracellular substrate trypsinogens. The addition of enterokinase 200 ng to GDOC 34 mmol/l in the infusate resulted in a severe systemic disturbance and a form of acute necrotizing pancreatitis which was uniformly and rapidly lethal. This effect was not seen when equimolar trypsin was substituted for enterokinase. These findings show that enterokinase specifically increases the lethality of experimental bile salt pancreatitis and suggest that this bile-borne enzyme may in some cases pose a significant clinical threat.
Mechanism of the haemostatic effect of ethanolamine oleate in the injection sclerotherapy for oesophageal varices
Authors: Kang J H , Kambayashi J , Sakon M , Shiozaki H , Ogawa Y , Ohshiro T , Mori T 
Published: March 2007

Abstract
Changes in coagulation and fibrinolysis were investigated in 20 patients with oesophageal varices, who underwent endoscopic injection sclerotherapy (EIS) with 5 per cent ethanolamine oleate (EO), by means of serial determination of plasma fibrinopeptide A (FPA) and fibrinopeptide β15–42 (β15–42). One hour after the completion of EIS, the value of FPA was significantly increased to 38·1 ± 11·1 ng/ml (mean ± s.e.m.) from a pre-EIS value of 7·1 ± 1·4 ng/ml (P&gt;0·01) and it gradually returned to normal range by 48 h after EIS. A very similar change was observed in the value of Bβ15–42 (P&gt;0·01). These observations indicated that EIS provokes transient activation of coagulation and fibrinolysis. In vitro studies, however, revealed that EO inhibits fibrin clot formation because of the Ca2+-chelating ability of its constituent ethanolamine, although oleate or benzyl alcohol exhibited procoagulant activity in FPA formation in vitro. Nevertheless, an external application of EO or oleate over decapsulized kidney of rat resulted in a significant accumulation of 125I-labelled fibrin(ogen). From these results it was suggested that intravascular injection of EO, which exerts an inhibitory effect on coagulation in vitro, activates the local coagulation system. The activation may be accelerated by an acute inflammatory process provoked by oleate, which is supported by such clinical manifestations as mild fever, retrosternal pain leukocytosis and an increase in plasma fibrinogen level which was observed in all during the period.
Staphylococcal infection of open granulating wounds
Authors: Marks J , Harding K G , Hughes L E 
Published: March 2007

Abstract
The significance of staphylococcal infection has been studied prospectively in 250 wounds healing by open granulation. In a series of 50 axillary skin excisions, 17 became infected with Staphylococcus aureus with consequent pain and delay in healing. The infections responded well to Fucidin ointment. Nasal carriers of the organism may be especially liable to this complication. In contrast, although S. aureus was not infrequently found in deep granulating wounds, there was no clear evidence of harm resulting in the 50 laparotomy wounds and 150 pilonidal sinus excisions studied. The susceptibility of superficial wounds to the infection is ascribed to friction from dressings. Deep granulating wounds are occasionally affected similarly when the cavity has filled.
Surgical staging of gastric carcinoma: Sources and consequences of error
Authors: Madden M V , Price S K , Learmonth Genevieve M , Dent D M 
Published: March 2007

Abstract
Macroscopic ‘TNM’ staging was performed during 78 consecutive operations for gastric carcinoma and compared with subsequent pathological staging. Surgical assessment was correct for tumour (T) in 60 per cent when depth of invasion was assessed, for nodes (N) in 61 per cent, for liver metastases (M) in 92 per cent but for all aspects in only 21 per cent. Curability (conservatively defined as T1–3, N0–1, M0) was correct in 8 of 18 patients thus assessed at surgery and incurability was pathologically correct in 58 of 60 patients. Despite inaccurate surgical staging, no patient was denied a resection although 10 patients had unduly radical procedures for their stage and 2 had inappropriately conservative procedures for their stage (but without evidence of residual disease). Staging errors did not jeopardize conventional surgical management substantially and use of intra-operative microscopic sampling of nodes would have improved surgical treatment only minimally.