bluuebunny/crossref_metadata_2025_split huggingface dataset:
Screening for breast cancer: some clinical aspects
Authors: Stockdale A D , Last P , Tucker A K , Thomas J Meirion 
Published: March 2007

Abstract
There is little doubt that screening by palpation and mammography will reduce the mortality from breast cancer. Most of the studies have been designed to test survival difference and, following diagnosis, patients were treated by a variety of surgeons and methods. We present clinical and pathological data on 32 asymptomatic patients who were screened and found to have breast cancer. Investigation and treatment was performed by one surgeon according to a defined protocol. We confirm that mammography is a more sensitive diagnostic tool than palpation and describe how a review of the patient with the suspicious mammogram will increase the incidence of palpable tumours. We stress the importance of fine-needle aspiration cytology as a diagnostic and localization method. The low incidence of axillary node metastasis in patients with invasive carcinoma is described. More importantly, no patient in this series required treatment by mastectomy. In our experience patients with breast cancer detected by screening are eminently suitable for treatment by breast conservation.
Role of adhesive wraps in the pathogenesis of complicated amoebic colitis
Authors: Luvuno F M 
Published: March 2007

Abstract
Ischaemic foci within the abdomen attract omental and peritoneal adhesions with neovascularization. Previously it has been shown that transmural amoebic colitis is an ischaemic process. An intra-operative evaluation of the peritoneal barriers in response to necrosis was undertaken during laparotomy in 82 patients with clinical transmural amoebic colitis. At operation the ischaemic colon was covered by adhesive wraps in all patients; peritonitis subsequently was absent in 23 patients (28 per cent), serous in 43 patients (52 per cent), purulent in only 9 patients (11 per cent) and faeculent in another 7 patients (9 per cent). The author regards wrapping as mechanically protective. Wrapping is also a source of neovascularization which was demonstrated on 10 angiograms of resected specimens with transmural disease. This is further supported by clinical finding of subsequent necrosis of colons in three patients whose wraps were disturbed at laparotomy without resection of the colons. Therefore, for both mechanical and vascular reasons, these wraps should not be disturbed.
Reproducibility of reactive hyperaemia test in the measurement of peripheral arterial disease
Authors: Fowkes F G R , Housley E , Macintyre C C A , Prescott R J , Ruckley C V 
Published: March 2007

Abstract
The reproducibility and sources of variation in ankle and brachial systolic pressures were determined for a reactive hyperaemia test used to assess peripheral arterial disease in the lower limbs. Thirty-six subjects had repeat measurements taken by four observers on two separate days using a Doppler probe and random zero sphygmomanometer. Ankle pressures were measured before and after 4 min of arterial occlusion above the knee. The 95 per cent confidence limits for a postocclusion reduction in pressure was approximately ±25 mmHg and for the postocclusion ankle-brachial ratio was ±20 per cent. The corresponding figures for the mean of four measurements taken by two observers on 2 days was approximately ±17 mmHg and ±13 per cent. In patients with vascular disease analysis of variance showed that the greatest sources of variation in the postocclusion ankle-brachial ratio were the ‘biological’ variations between subjects and between legs. But for postocclusion reductions in pressure, variability due to observers and repeat readings was as important as the ‘biological’ differences between subjects and legs. Thus, in respect of variability, the ratio may be a better parameter to detect differences between subjects.
Benign disease of the common bile duct
Authors: Saxena R , Pradeep R , Chander J , Kumar P , Wig J D , Yadav R V S , Kaushik S P 
Published: March 2007

Abstract
The incidence of common bile duct (CBD) pathology in a group of patients with benign biliary disease (n = 505) was found to be 23.2 per cent. The spectrum included 111 patients (90.2 per cent) with CBD stones, 37 of whom (33.3 per cent) had no symptoms or findings pre-operatively indicating CBD involvement. Five patients had papillary stenosis, three had postoperative CBD strictures, one had a choledochal cyst and one had an external biliary fistula. Of the 100 CBDs measuring more than 10 mm in diameter, 90 harboured calculi. In the remaining 23 CBDs measuring less than 10mm, calculi were present in 21. The presence of CBD calculi was demonstrated by intra-operative cholangiography in 49 patients. In the remaining patients (n = 74), the diagnosis of CBD pathology was made either by percutaneous transhepatic cholangiography, endoscopic retrograde cholangio-pancreatography, T-tube cholangiography or peroperative palpation. The surgical procedures performed included choledochotomy and T-tube drainage (n = 74), transduodenal sphincteroplasty (n = 27) and choledochoduodenostomy (n = 18). The overall mortality and morbidity of CBD exploration was 3.3 per cent and 24.4 per cent respectively, which was significantly greater than that for cholecystectomy alone (0.3 per cent and 8.6 per cent respectively). Transduodenal sphincteroplasty carried a much higher mortality (11 per cent) and morbidity (52 per cent) when compared with other procedures.
Standardization of the surgical technique in breast-conserving treatment of mammary cancer
Authors: Aspegren K , Holmberg L , Adami H-O 
Published: March 2007

Abstract
A number of designations—for example excision, wide excision, lumpectomy, tylectomy, extended tylectomy, partial mastectomy, tumorectomy, segmental resection and quadrantectomy—have been applied to operative procedures aimed at treating mammary carcinoma with preservation of the breast. None of them, however, has been explicitly linked to a defined surgical technique and there is no consensus about the terminology. We propose a simple classification system for breast-conserving procedures, which can facilitate the communication between surgeons and the interpretation and exchange of scientific data. We also describe a strictly defined and locally radical partial mastectomy—a sector resection—which has been used at several centres in Sweden for more than 5 years with a favourable outcome so far in terms of local tumour control and the cosmetic result.
Pyogenic liver abscess: An improvement in prognosis
Authors: Farges O , Leese T , Bismuth H 
Published: March 2007

Abstract
Forty-six patients with pyogenic liver abscess have been treated at Paul Brousse Hospital between 1966 and 1986. The overall mortality was 24 per cent, all 11 deaths occurring in 24 patients seen prior to 1978 when there was often a considerable delay in the diagnosis of liver abscess (mean 90 ± 71 days). In seven patients the diagnosis was not made until post-mortem examination. The mainstay of treatment was surgical drainage. Since 1978 high resolution imaging techniques for the liver, and in particular ultrasound, have been available. The diagnostic delay has been significantly reduced (mean 28±20 days, P &lt; 0·01). Patients are receiving definitive treatment at an earlier stage in the evolution of the disease process, with fewer established complications prior to treatment (P &lt; 0&lt;05). Percutaneous drainage under ultrasound control is the preferred initial drainage procedure in high-risk patients. There have been no deaths in 22 patients treated for pyogenic liver abscess since 1978 (P &lt; 0·001).
Endoscopic removal of retained stones after biliary surgery
Authors: Lambert M E , Martin D F , Tweedle D E F 
Published: March 2007

Abstract
Seventy-three patients with retained stones in the common duct after biliary surgery underwent attempted endoscopic removal at a mean interval of 39 days after surgery. Endoscopic extraction was successful in 63 patients (86 per cent). Complications occurred in 14 patients (19 per cent). The most frequent complication was haemorrhage which occurred in nine patients, four of whom required surgery: two other patients required surgery for complications. The complication rate of endoscopic sphincterotomy in recently operated patients may be higher than in the non-operated patient. Less invasive methods, such as dissolution therapy or T tube track extraction, may be preferable as they are associated with less risk. Endoscopic sphincterotomy should be reserved for patients in whom these alternative techniques fail or are inappropriate.
Comparison of absorbable materials for surgical haemostasis
Authors: Blair S D , Backhouse C M , Harper R , Matthews J , McCollum C N 
Published: March 2007

Abstract
The haemostatic effect of two new materials has been compared with surgical gauze and oxidized cellulose using a standardized liver laceration in New Zealand White rabbits. Following excision of a 3 cm2 disc of tissue from the liver, 42 rabbits were randomized to the use of gauze swabs (n = 6), oxidized cellulose (Surgicel®) (n = 12), porcine collagen (Medistat®) (n = 12) or calcium alginate (Kaltostat®) (n = 12) to control the resulting haemorrhage. Blood loss and time to haemostasis were accurately recorded. The absorbable materials were left in situ and animals killed between 2 weeks and 6 months later to examine speed of absorption and resulting adhesions. Calcium alginate stopped bleeding in &lt;3 min in all animals compared with a mean (±s.e.m.) of 5.7 ± 0.75 min for porcine collagen, 12.5 ± 0.9 min for oxidized cellulose and &gt; 15min with gauze (P &lt; 0.001). Oxidized cellulose and calcium alginate reabsorbed within 3 months leaving a fibrous scar, but a vigorous foreign body reaction was seen with porcine collagen which caused intestinal obstruction in 5 out of 12 animals within 3 months.
Endocrine basis for the clinical presentation of hidradenitis suppurativa
Authors: Harrison B J , Read G F , Hughes L E 
Published: March 2007

Abstract
Clinical assessment of 134 patients with hidradenitis suppurativa revealed clinical evidence supporting an androgen-based endocrine disorder underlying the condition. Such features included postpubertal onset maximal during the third decade; female preponderance (13:5); premenstrual flare in 57 per cent of women; absence of this flare associated with irregular or anovulatory menstrual cycles; and an increased incidence of obesity and acne. Detailed hormone profiles in 36 female patients and 14 controls showed evidence of relative androgen excess and decreased progesterone levels in those patients without a premenstrual flare. Obesity and enhanced peripheral androgen conversion by apocrine tissue are possible explanations for normal serum androgen profiles in patients with a flare. Precise elucidation of the hormonal abnormality is a prerequisite for effective medical treatment of early disease.
Effects of low dose perioperative interferon on the surgically induced suppression of antitumour immune responses
Authors: Sedman P C , Ramsden C W , Brennan T G , Giles G R , Guillou P J 
Published: March 2007

Abstract
General surgical procedures are followed by a period of generalized immunosuppression that may favour the deposition of metastases seeded at operation in patients with malignant disease. In an attempt to prevent the suppression of host-antitumour immune mechanisms following surgery we have studied the immunological effects of low-dose perioperative interferon-α (r-HuIFNα). Patients were randomly allocated pre-operatively to the control (n = 15) or treatment group (n = 15). Patients in the treatment arm received a 1-week course of subcutaneous recombinant human interferon-α 2a (Roferon-A) at a dose of 2 megaunits daily starting on the evening before surgery. Natural killer cell, lymphokine activated killer cell cytotoxicities and endogenous interleukin 2 production were measured 1 day before surgery and on the first, third, fifth and tenth postoperative days. Treatment with r-HuIFNα did not prevent the postoperative impairment of interleukin 2 production or lymphokine activated killer cell cytotoxicity. However it prevented the fall in natural killer cell activity normally observed following surgery. This may have important consequences in controlling metastatic dissemination of tumour in this vulnerable period.
Cystic change and neoplasia in isolated thyroid swellings
Authors: Cusick E L , McIntosh C A , Krukowski Z H , Matheson N A 
Published: March 2007

Abstract
During a 6-year prospective study of clinically isolated thyroid swellings (ITS), 148 (37 per cent) of 395 swellings were cystic as defined by the aspiration of fluid during fine needle aspiration cytology (FNAC). In the 106 (72 per cent) patients operated upon, 47 per cent of the cystic swellings were neoplastic and 14 per cent were malignant. In men 29 per cent of cystic swellings were malignant and 11 percent in women. Only twelve cystic ITS were permanently abolished by aspiration and FNAC was inaccurate in predicting neoplasia. The incidence of malignancy in cystic ITS is higher than generally accepted and most cysts not abolished by aspiration should be removed.
Physiological parameters influencing function in restorative proctocolectomy and ileo-pouch-anal anastomosis
Authors: Keighley M R B , Yoshioka K , Kmiot W , Heyen F 
Published: March 2007

Abstract
Ileo-pouch-anal function has been assessed in 30 patients after restorative proctocolectomy and compared with age- and sex-matched controls. Median resting anal canal pressure was only 42 cmH2O (7–113 cmH2O) compared with 100 cmH2O (46–114 cmH2O) in controls (P &lt; 0.005). Maximum squeeze anal pressures were also significantly lower in pouch patients: 87 cmH2O (25–180 cmH2O) than controls: 143 cmH2O (114–171 cmH2O) (P &lt; 0.01). The recto-anal inhibitory reflex was absent in all pouch patients but was present in all controls. Maximum pouch or ileal pressures exceeded resting anal canal pressures in three patients. Median volume at first leak during saline infusion was 320 ml (60 ml-no leak) in pouch patients whereas the majority of controls had no leakage (median, none; 450 ml-no leak; P &lt; 0.05). Threshold pouch sensation (median, 50ml (0–250 ml)) did not differ from rectal sensation in controls (50 ml (0–180 ml)) but pouches were less compliant than a normal rectum, median 6.8 ml/cmH2O (2.1–17 ml/cmH2O) and 11.6 ml/cmH2O (4.7–16.2 ml/cmH2O) respectively (P &lt; 0.05). In patients who had an episode of pelvic sepsis (n = 8) the average number of abnormal physiological indices per patient was 3.8, compared with 1.3 in those with no sepsis (P &lt; 0.05). There was no difference in the number of abnormalities per patient with a J pouch (2.0; n = 19) or a W pouch (1.9; n = 11).
Sensory discrimination and dynamic activity in the anorectum: Evidence using a new ambulatory technique
Authors: Miller R , Lewis G T , Bartolo D C C , Cervero F , Mortensen N J McC 
Published: March 2007

Abstract
The anal canal in health is extremely sensitive to thermal stimuli. If temperature sensation plays a part in sensory discrimination two conditions must be fulfilled: there must be a temperature gradient along the anorectum and rectal contents must be able to come into contact with the sensitive anal mucosa. In a study of 53 normal subjects we demonstrated this temperature gradient with a median temperature difference between the rectum and lower, mid and upper anal canal of 0.4, 0.2 and 0.1°C respectively. The second condition was examined in 15 normal ambulatory subjects by measuring mid-anal sphincter (SP) and rectal pressures (RP) with a microtransducer catheter. The signals were digitalized and recorded in a portable electronic memory for later computer display, and analysis. Marked spontaneous sphincter relaxation resulting in equalization of RP and SP occurred 7 times per hour (1–4). The conscious sensation of the presence of flatus was associated with an SP reduction of 30 mmHg (20–50 mmHg) and an RP increase of 7 mmHg (0–15 mmHg), such that RP ⩽ SP in 80 per cent of 144 recorded events. Using this new technique we have demonstrated the highly dynamic nature of the anal sphincter. Several times an hour the sphincter relaxes with subsequent equalization of rectal and anal pressures, allowing entry of rectal contents into the anal canal so that its presence and nature can be determined.
Abdominoperineal and anterior resection of the rectum with retrocolic omentoplasty and no drainage
Authors: Smith S R G , Swift I , Gompertz H , Baker W N W 
Published: March 2007

Abstract
Forty consecutive patients scheduled for either low anterior resection or abdominoperineal resection of the rectum have been studied. After standard procedures, carried out by all grades of surgeons, the omentum was mobilized as a pedicle graft based on the left gastro-epiploic arcade and transposed to the pelvis or perineum. All wounds were closed primarily without drainage. Twenty-six patients had anterior resection, 11 abdominoperineal resection and 3 an extended Hartmann's operation. Patients were assessed clinically and radiographically by Gastrografin® enema and ultrasound for evidence of anastomotic leakage, pelvic collections and wound healing. After anterior resection there were three radiological leaks and no overt clinical leaks. One patient had a collection related to a leak. Of 11 perineal wounds 8 healed primarily in 2 weeks and all healed by 4 weeks. There was no frank wound breakdown. The three patients who had Hartmann's operations all healed without complication. There were no unavoidable complications of the procedure. Retrocolic omentoplasty is a simple, safe and effective adjunct to rectal surgery. The additional time taken (15–20 min) is well rewarded by sound healing of these operations.
Endoluminal ultrasound and computed tomography in the staging of rectal cancer
Authors: Holdsworth P J , Johnston D , Chalmers A G , Chennells P , Dixon M F , Finan P J , Primrose J N , Quirke P 
Published: March 2007

Abstract
Pre-operative staging of rectal cancer might define patients with disease confined to the rectal wall without lymph node metastases, in whom local excision might be appropriate, or patients with extrarectal spread, who might benefit from pre-operative radiotherapy. With these objectives, 36 consecutive patients with rectal cancer were studied by endoluminal ultrasound: 17 of them also underwent computed tomography (CT) of the pelvis. The results were correlated with the findings at operation and subsequent pathological examination. Endoluminal ultrasound correctly predicted invasion of the tumour through the rectal wall in 86 per cent of patients, with a sensitivity of 96 per cent and specificity of 50 per cent, but correctly identified lymph node metastases in only 61 per cent of patients (sensitivity 57 per cent; specificity 64 per cent). CT correctly predicted invasion through the rectal wall in 94 per cent of cases, with a sensitivity of 100 per cent and specificity of 67 percent and correctly identified lymph node metastases in 70 per cent of patients (sensitivity 25 per cent; specificity 85 per cent). These findings indicate that both endoluminal ultrasound and CT may be helpful in selecting patients for pre-operative radiotherapy. Neither technique, however, can reliably identify lymph node metastases and therefore cannot be used to select patients who would be suitable for local excision.
Preventing wound infection after appendicectomy: A review
Authors: Krukowski Z H , Irwin S T , Denholm S , Matheson N A 
Published: March 2007

Abstract
An exponential increase in the number of published prospective studies reflects both a continuing interest in, and a lack of consensus on, the optimal prophylaxis of wound sepsis after appendicectomy. Review of the literature over the last 25 years leads us to emphasize both the importance of adequate study size and of stratification of the severity of the sepsis found at operation. For critical comparison of prophylactic regimens the high percentage of wound infections disclosed after discharge from hospital must be taken into account. Antibiotics reduce the frequency of wound sepsis and although low wound sepsis rates have been reported with systemic antibiotics active against only anaerobes, the cumulative evidence favours a spectrum of antibacterial activity against both aerobic and anaerobic organisms. Topical antiseptics have no significant effect but topical antibiotics are beneficial. Wide variations in outcome for similar antibiotic regimens reflect the importance of technical factors in determining the frequency of wound sepsis.
Murine monoclonal antibodies in breast cancer: An overview
Authors: Tjandra J J , McKenzie I F C 
Published: March 2007

Abstract
Monoclonal antibody technology has been an important development in breast cancer research. Monoclonal antibodies do not detect ‘breast cancer specific’ antigens but, rather, they react with normal or modified tissue antigens which are either preferentially or inappropriately expressed upon malignant cells. Thus far a number of monoclonal antibodies that have a preferential reaction with breast cancer tissue have been developed. They have a potential value in immunohisto-pathology as diagnostic tools and in the recognition of small quantities of malignant cells, in the development of serum assay for tumour markers in breast cancer and in the radio-immunodetection of metastases. There has been success in effecting selective targeting of anticancer agents (cytotoxic drugs, toxins, radionuclides) to tumour deposits and encouraging results are obtained in preclinical in vivo studies. Various clinical studies are now in progress to evaluate the role of monoclonal antibodies in the management of breast cancer.
Temperature gradient between the rectum and the anal canal: Evidence against the role of temperature sensation as a sensory modality in the anal canal of normal subjects
Authors: Rogers J , Hayward M P , Henry M M , Misiewicz J J 
Published: March 2007

AbstractTemperature difference between the rectum and anal canal is a fundamental requirement for the hypothesis that temperature sensation is of physiological importance in discrimination of anorectal contents occurring during the ‘sampling reflex’. The temperature gradient between the rectum and the anal canal was measured in 47 normal subjects (mean age 51.6 years ± 16.8 s.d., 24 men). The maximum mean difference in temperature between the rectum and the anal canal was 0.13°C (0.06-0.19, 95 per cent confidence intervals) and occurred 4 cm from the anal verge. This difference is too small to be detected by the anal canal mucosa. Under normal physiological circumstances the conscious appreciation of temperature of faeces passing from the rectum to the anal canal is impossible during the anorectal sampling reflex.
Faecal incontinence associated with reduced pelvic sensation
Authors: Lubowski D Z , Nicholls R J 
Published: March 2007

Abstract
Eight patients with faecal incontinence associated with high threshold of rectal sensation are described. All had a normal anal sphincter on clinical and physiological assessment including anal manometry, pudendal nerve latency estimation and single fibre electromyography. In each case however rectal sensation was abnormal. The threshold of rectal sensation was 143 ± 33 ml (range 110–200 ml) compared with control values of 39 ± 14 ml (range 25–65 ml) (P &lt; 0.005) in 12 normal age-matched individuals. The degree of rectal distension required to initiate the recto-anal reflex was no different in the incontinent patients (19 ml, range 15–25 ml, compared with 22ml, range 15–30 ml, in the controls). There was also no difference in the maximal tolerated volume of rectal distension between the groups (291 ± 87 ml and 279 ± 91 ml respectively). These observations may have defined a small group of patients with incontinence in whom an abnormality of rectal sensation rather than sphincter incompetence could be a part of the pathophysiological disorder.