bluuebunny/crossref_metadata_2025_split huggingface dataset:
Prediction of prognosis in axillary lymph node positive breast cancer patients: A statistical study
Authors: Mæhle B O , Skjærven R 
Published: March 2007

Abstract
This work has identified variables of importance to short- and long-term prognosis in 97 node positive breast cancer patients followed for a minimum of 98 months. The diameter of the primary tumour (⩽3 cm/&gt;3 cm) is shown to be an important prognostic variable. Its addition to the presence/absence of tumour cells in the efferent nodal vessels and the mean nuclear area of the tumour cells gave correct prediction of the disease outcome, 60 and 98 months after the operation, in 83 and 80 per cent of the patients respectively. Although the number of tumour-bearing nodes is shown to be a strong variable, more information was gained from the tumour diameter. Histological grade was only of value for 5-year prognosis. Factors that did not add information of prognostic value in these circumstances were identified. The proposed models demonstrate the great heterogeneity within this group of patients.
The value of serial bone scanning in operable breast cancer
Authors: Monypenny I J , Grieve R J , Howell A , Morrison J M 
Published: March 2007

Abstract
The value of initial and serial isotope bone scans was assessed in 685 patients with operable primary breast cancer. Nineteen (2·8 per cent) patients had a positive initial scan and negative skeletal radiographs; only nine of these developed other evidence of metastatic disease after a mean follow up of 21 months. Five hundred and ten patients had serial scans up to five years after simple mastectomy; 51 (10 per cent) had scan conversion, of whom 37 developed clinical or radiological confirmation of recurrent disease at a mean follow-up of 13 months. Compared with clinical or radiological methods for the detection of first metastases serial bone scans gave a mean lead time of five months in 15 patients and no lead time in the remaining 22 patients. Twelve of forty-five patients with radiologically proven bone metastases had negative scans. Neither initial or serial bone scanning is clinically useful or economically viable as a routine screening or follow-up procedure for patients with operable breast cancer.
The uses and abuses of life-table methods in vascular surgery
Authors: Underwood C J , Faragher E B , Charlesworth D 
Published: March 2007

Abstract
This paper details the calculations involved in a life-table analysis and appraises the current use of this technique in vascular research. We suggest that the presentation of patency curves should be standardized and recommend that: curves are presented as step rather than continuous graphs;the number of patients remaining in a study are shown at intervals along patency curves;the length of time for which a curve is claimed to hold is more rigorously defined;an attempt is made to increase, where possible, the frequency of patient review, particularly in the immediate postoperative period;ways of increasing the total sample size (e.g. multicentre studies) are investigated.
We also recommend that a set of definitive guidelines on the presentation of graft patency data acceptable to all the major vascular journals be sought.
Prostaglandin E1 in severe lower limb ischaemia: A double-blind controlled trial
Authors: Telles G S , Campbell W B , Wood R F M , Collin J , Baird R N , Morris P J 
Published: March 2007

Abstract
Thirty patients with ischaemic ulceration or rest pain due to lower limb atherosclerosis were treated with intravenous prostaglandin E1 (PGE1) or placebo in a prospective double-blind controlled trial. There was no significant improvement of rest pain, nor was PGE1 effective in promoting ulcer healing. This study provides no support for the use of intravenous PGE1 in the treatment of end-stage lower limb atherosclerotic disease.
The demonstration of saphenofemoral incompetence; Doppler ultrasound compared with standard clinical tests
Authors: McIrvine A J , Corbett C R R , Aston N O , Sherriff E A , Wiseman P A , Jamieson C W 
Published: March 2007

Abstract
Patients with primary varicose veins were examined by a combination of the standard tourniquet test with detection of reflux by Doppler ultrasound. Results were compared with standard clinical tests: impulse or thrill at the saphenous opening on coughing, tap impulse at the groin, and the ‘Trendelenburg’ tourniquet test. The state of competence of the saphenofemoral junction was noted at operation. One hundred and sixty-one limbs of 105 patients were studied. The saphenofemoral junction was incompetent in 132/161 limbs (82 per cent) and was judged competent in 29/161 limbs (18 per cent). The combined Doppler and tourniquet test assessed the saphenofemoral junction correctly in 82 per cent of limbs and was more accurate than all the other tests. The test had good sensitivity (0·9) but poor specificity (0·45). Poor specificity was a feature of all the tests except for thrill which was a highly insensitive test. The combined Doppler and tourniquet test appears to be the most simple, rapid and accurate means of detecting saphenofemoral incompetence.
Computer aided diagnosis in acute testicular pain
Authors: Goulbourne I A , Nixon S J , MacIntyre I M C 
Published: March 2007

Abstract
Over an 11-year period in Edinburgh, 495 patients with a proven diagnosis of testicular torsion or acute epididymo-orchitis were admitted to hospital. The final diagnosis in 227 was epididymitis, in 236 torsion of the testis and in 32 torsion of a testicular appendage. The immediate salvage rate from torsion of the testis was 67 per cent. To try to improve diagnostic accuracy in these three conditions, a computer program was constructed using a data base derived from the literature. On retrospective analysis of the 495 patients, the program achieved a 92·3 per cent accuracy in differentiating torsion from epididymitis. If the computer's diagnosis had been followed it would have reduced the exploration rate in epididymitis from 18 to 1·8 per cent. It would further have increased the diagnostic accuracy of a junior doctor to that of a senior colleague, but the number of torsions ‘missed’ by the computer and senior doctor would have been similar. The technique is inexpensive, rapid, immediately available, non-invasive and easy to use. It is suggested that such a program will increase diagnostic accuracy in acute testicular pain and, hopefully, the salvage rate from torsion of the testis.
Colostomy irrigation with prostaglandin E2 and bisacodyl. A double-blind cross-over study
Authors: Kjærgaard J , Christensen U , Stadil F , Anderson B 
Published: March 2007

AbstractThe emptying of the colon and the side-effects after intraluminal application of prostaglandin E2 and of bisacodyl in 14 patients was studied by employing colostomy irrigation. The design was double-blind with cross-over. the irrigation was one litre of tap water to which was added in randomized sequence placebo, prostaglandin *2 (350, 700 and 1400 μg) or bisacodyl (1·25, 2·5 and 5 mg). Neither prostaglandin E2 nor bisacodyl had any significant effect.
Abnormalities of muscle metabolism and histology in malnourished patients awaiting surgery: Effects of a course of intravenous nutrition
Authors: Church J M , Choong S Y , Hill G L 
Published: March 2007

Abstract
Malnourished surgical patients have metabolic and functional abnormalities of skeletal muscle and it has been suggested that these are due to reduced activities of glycolytic enzymes associated with abnormalities of muscle fibres. We have measured the activities of four key enzymes of glucose utilization and the size and distribution of muscle fibre types in vastus lateralis biopsies from 14 undernourished patients awaiting surgery (mean weight loss 24 ± 10 per cent). These results were compared with those from 14 normally nourished controls, comparable in age, sex, race and habitual activity. Fructose bisphosphatase activity was reduced in undernourished patients by 44 per cent (P &lt; 0·01), phosphofructokinase by 40 per cent (P = 0·005) and hexokinase by 37 per cent (P &lt; 0·001). Both fibre types were smaller in patients than controls (area I, 41·4 μm2 × 10−2 ± 0·4 vs. 73·3 μm2 × 10−2 ± 0·6, P &lt; 0·001; area II, 27·7 μm2 × 10−2 ± 0·4 vs. 72·5 μm2 × 10−2 ± 0·5, P &lt; 0·001), and there was a smaller proportional number of type II fibres in patients (35 per cent vs. 65 per cent, P &lt; 0·01). This loss of type II fibre numbers and preferential type II atrophy may account for the enzyme depression associated with it and could produce the syndrome of impaired glucose tolerance, muscle weakness and fatigue seen in undernourished patients. In a subgroup of 11 patients, biopsy was repeated after 14 days of intravenous nutrition. Only phosphofructokinase activity rose significantly (19·62 ± 1·85 to 30·74 ± 2·99 μmol min−1 g−1, P &lt; 0·01) and both type II fibre size (40·6 ± 18·5 to 47·4 μm2 ± 20·3 × 10−2, P &lt; 0·05) and number (42 per cent ± 6 to 56 per cent ± 5, P &lt; 0·05) also rose. Intravenous nutrition may therefore increase maximum glycolytic rate and improve muscle function in undernourished surgical patients.
Prospective controlled vagotomy trial for duodenal ulcer: Results after five years
Authors: Hoffmann J , Jensen H-E , Schulze S , Poulsen P E , Christiansen J 
Published: March 2007

Abstract
A prospective, randomized, controlled trial was performed to study truncal vagotomy and drainage (TV), selective vagotomy and drainage (SV) and parietal cell vagotomy (PCV) as elective treatment for duodenal ulcer. Five years postoperatively, 233 patients were available for study: 73 TV, 81 SV and 79 PCV. The ulcer recurrence rates were 13.6, 19.8 and 30.4 per cent respectively. The incidence of severe dumping was 4.9, 10.9 and 1.9 per cent; of severe diarrhoea 4.9, 6.3 and 1.9 per cent; of severe pain/dyspepsia 3.3, 6.3 and 3.8 per cent and of severe nausea/vomiting 0, 1.6 and 0 per cent respectively. Women suffered more postvagotomy symptoms than men. After treatment of recurrences and postvagotomy symptoms, more patients after PCV achieved excellent results than after TV and SV, as recurrences were easier to treat than severe postvagotomy symptoms. The only factor found contributing to the high ulcer recurrence following PCV was the large number of surgical trainees operating in the trial.
Duodenal ulcer perforation whilst on cimetidine therapy
Authors: Sherlock D J , Holl-Allen R T J 
Published: March 2007

Abstract
Nine cases of perforation whilst patients received cimetidine therapy were identified and followed prospectively. There was a high correlation with the other major complications of duodenal ulceration: pyloric stenosis and haemorrhage. Initially, three of the nine patients had simple suture of the perforation, but eventually all required truncal vagotomy and a drainage procedure. The follow-up ranges from 6 months to 2.5 years and the results in the surviving patients are good. The pre-operative identification of this group, being established medical failures with the high probability of requiring necessary definitive surgery, will aid the surgical management of this condition.
Fine needle aspiration cytology, in relationships to clinical examination and mammography in the diagnosis of a solid breast mass
Authors: Dixon J M , Anderson T J , Lamb J , Nixon S J , Forrest A P M 
Published: March 2007

Abstract
The accuracy of clinical examination, mammography and fine needle aspiration cytology in identifying malignancy has been assessed in 1655 breast masses from two time periods. Clinical examination and mammography remained consistent at identifying malignancy but 9 per cent of all breast carcinomas were considered benign by both techniques (sensitivity 91 per cent). Fine needle aspiration cytology, when performed by multiple aspirators in the first study period, had a sensitivity of only 66 per cent for malignancy. During the second period of study, when all aspirates were performed by a single aspirator, sensitivity rose to 99 per cent. The two patients with false negative cytology in this latter period had both clinical and mammographic evidence of malignancy. No patient with malignant cytology was subsequently shown to have benign disease. It is concluded that a combination of clinical examination and mammography, with fine needle aspiration cytology performed by committed individuals with aptitude for the technique and interpreted by experienced pathologists, can identify all patients with breast cancer before surgery.
Inhibition of experimental colorectal cancer by razoxane (ICRF-159)
Authors: Gilbert J M , Thompson E M , Slavin G , Kark A E 
Published: March 2007

Abstract
Large bowel cancer induced in rats by dimethylhydrazine (DMH) closely resembles human disease both histologically and clinically. In this study it has been used to assess the antimitotic drug razoxane (ICRF-159). Dimethylhydrazine induced benign colorectal tumours after 20 weeks and adenocarcinomas from 30 weeks. Razoxane was given from week 25 until the end of experiment (week 35) to see if this drug could inhibit the development of tumours. Animals were randomly allocated to four groups: DMH + razoxane (26), DMH + control (26), control + razoxane (25), control + control (25). There were fewer malignant colorectal tumours in rats receiving razoxane than in the controls (10 vs. 24; P = 0.04). Some animals developed malignant tumours of the small intestine as well as the large bowel and the number of malignant tumours for the whole intestinal tract was also reduced in animals receiving razoxane (15 vs. 32; P = 0.025). This study demonstrates inhibition of the development of malignant tumours in rats by razoxane. This finding may have relevance to colorectal cancer in man where razoxane has been used in disseminated disease and as an adjuvant to surgery.
Return to work following ileostomy
Authors: Whates P D , Irving M 
Published: March 2007

Abstract
The experiences of 1033 members of the 51 English divisions of the Ileostomy Association of Great Britain and Ireland have been analysed in respect of their return to work after construction of an ileostomy. Although there was a fall in the number of patients returning to work after operation this was often for reasons unrelated to surgery. The majority of those returning to work resumed work with the same employer and usually in the same post. Fifty-nine (5.7 per cent) patients began work for the first time after operation, including 33 (3.2 per cent) who were previously inactive although of working age. Analysis of occupational class shows that, although a number of patients initially resumed work within a lower class, once established in employment successful career advancement was possible. Problems in the gaining or resumption of employment were reported by 56 (5.4 per cent) patients. In 22 (2.1 per cent) patients, almost all approaching or above retirement age, successful surgery resulted in a decision not to return to employment. An ileostomy is no barrier to successful return to work in nearly all occupations, and is accomplished by the majority of patients without major difficulty.
Incidence of pathogenic bacteria from mesenteric lymph nodes and ileal serosa during Crohn's disease surgery
Authors: Ambrose N S , Johnson Margaret , Burdon D W , Keighley M R B 
Published: March 2007

Abstract
Samples of ileal serosa and mesenteric lymph nodes have been harvested before antibiotic administration during 46 non-contaminated operations for Crohn's disease and compared with 43 operations for conditions other than Crohn's. Potentially pathogenic bacteria were isolated from the serosa in 12 (27 per cent) Crohn's patients, compared with 6 (15 per cent) controls (P = 0.04). Intestinal bacteria were recovered from mesenteric nodes in 15 (33 per cent) Crohn's patients compared with 2 (5 per cent) controls (P = 0.006). These findings suggest that bacteria leak from the small bowel lumen in a high proportion of Crohn's disease patients. This may explain the pathogenesis of abscess and fistula in this disorder as well as the high rate of sepsis following elective surgery even in the absence of macroscopic contamination.
Intraperitoneal antiseptics in experimental bacterial peritonitis
Authors: Platt J , Jones R A , Bucknall R A 
Published: March 2007

Abstract
A model of bacterial peritonitis, using mice infected with Escherichia coli, has been used to assess the protective effects of intraperitoneal treatment with antiseptics. Of the five antiseptics tested, only chlorhexidine gluconate had any protective effect, concentrations of 0.05 and 0.02 per cent reducing the mortality to 14 and 50 per cent respectively. The other antiseptics, taurolin, noxytiolin, povidone iodine and hypochlorite were all ineffective. Delayed treatment with chlorhexidine was not as effective as instillation immediately postinfection.
The effect of pre-operative glucose loading on postoperative nitrogen metabolism
Authors: Crowe P J , Dennison A , Royle G T 
Published: March 2007

Abstract
The nitrogen sparing effect of glucose loading at either 1 mg kg−1 min−1 or 5 mg kg−1 min−1 from the evening before surgery was compared with similar glucose infusions commenced after elective surgery. Thirty-two patients undergoing abdominal surgery of moderate severity were studied. Glucose at 5 mg kg−1 min−1 reduced urea excretion compared with glucose at 1 mg kg−1 min−1. The timing of the carbohydrate infusion was not critical in altering the overall extent of the protein sparing at either rate. High dose glucose infusions markedly reduced overall urea and 3-methylhistidine excretion. This implies a reduction in protein breakdown. A pre-operative high dose infusion of glucose may in particular improve protein synthesis for the first 24 h after surgery.
The effect of resection of the distal ileum on gastric emptying, small bowel transit and absorption after proctocolectomy
Authors: Neal D E , Williams N S , Barker M C J , King R F G J 
Published: March 2007

Abstract
Patients who had undergone proctocolectomy and ileostomy for ulcerative colitis have been studied. One group (contrast group) had undergone resection of only small amounts of terminal ileum (median = 4 cm), the other group of patients (study group) had undergone resection of greater lengths of small bowel (median = 60 cm). Gastric emptying and transit of a standard meal through the small bowel were estimated, whilst the amounts of fat, nitrogen, glucose, sodium and potassium excreted by the ileostomy were simultaneously determined. Significantly greater amounts of fat, nitrogen, sodium, potassium and water were excreted by patients who had undergone resection compared with contrast patients (P &lt;0·01). The rate of gastric emptying was not increased in patients who had undergone ileal resection compared with contrast patients but small bowel transit within 4 hours of ingestion of the meal was significantly faster. A significant correlation between transit times and excretion of fat was also noted in patients (P &lt;0·02). Thus, quite modest ileal resection in addition to proctocolectomy leads to rapid small bowel transit and marked malabsorption of nutrients as well as water and electrolytes.
Hyperlipidaemia, alcohol abuse and acute pancreatitis
Authors: Dickson A P , Neill J O , Imrie C W 
Published: March 2007

Abstract
Of 311 patients with primary acute pancreatitis, seven revealed major and seven minor lipid abnormalities on hospital admission. One pregnant woman suffered acute pancreatitis associated with Fredrickson type I hyperlipoproteinaemia. Twelve of the 13 men with types IV and V hyperlipoproteinaemia suffered alcohol abuse pancreatitis and represented 13·2 per cnt of this aetiological group. However, only one of the 157 patients (0·6 per cnt) with biliary disease had lipid abnormalities. Two of the 13 men died—the oldest, who had gallstones, and one with alcohol related disease. The remaining 11 were subject to follo-up (5–10 years). Six who had improvement of their lipid abnormalities, had abstained from alcohol. The other five had a persistent lipid disorder, and all admitted continuing heavy alcohol ingestion. The clilnical diagnosis of acute pancreatitis was supported by serum amylase elevation in only nine of the fourteen patients Urinary amylase levels were consistent with the diagnosis in 11 of the 12 patients. Estimation of both serum and urinary amlylase gave 100 per cnt support to the clinical diagnosis of acute pancreatitis Hyperlipidaemia associated with acute pancreatitis may be secondary to alcohol abuse but the possible role of HLP cannot be discounted. Urinary amylase is useful in diagnosing acute pancreatitis in the presence of hyperlipidaemia.
The management of acute cholecystitis in the elderly
Authors: van Rensburg L C J 
Published: March 2007

Abstract
This paper assesses the value of hepatobiliary scanning and surgical treatment of acute cholecystitis in patients above the age of 60 years over a 3 year period (1980–1982). During this period 382 cholecystectomies for biliary disease were performed in 257 women and 125 men with mean ages of 55·6 and 61·1 years respectively. Of the 382, 208 were older than 60, with a female to male ratio of 1·3:1. Acute cholecystitis occurred in 74 of the 208 patients; they were subjected to early cholecystectomy. Biliary tract imaging using 99 m technetium-labelled diisopropyl-IDA (DISIDA) proved valuable in confirming the diagnosis of acute cholecystitis. Of 85 patients over 60 years who underwent hepatobiliary scanning with a presumptive diagnosis of acute cholecystitis, 74 had positive scans and acute cholecystitis was confirmed at subsequent operation in these cases. There were two false positive and nine negative scans showing that biliary scintigraphy proved to be a rapid non-invasive and sensitive method of diagnosing acute cholecystitis. The advent of hepatobiliary scanning has strengthened our surgical strategy in the management of acute cholecystitis in the elderly and allows early elective surgery with an acceptable morbidity and in this series no mortality.
Cutaneous seeding of malignant tumours after insertion of percutaneous prosthesis for obstructive jaundice
Authors: Shorvon P J , Leung J W C , Corcoran M , Mason R R , Cotton P B 
Published: March 2007

Abstract
Three cases of cutaneous malignant deposits at the site of skin puncture for insertion of percutaneous biliary prosthesis are described. Tumour dissemination casts doubts on the value of percutaneous intubation of the biliary tree when preparing patients for curative resection of pancreatic or biliary tumours.
Bilateral primary breast cancer: A prospective study of disease incidence
Authors: Chaudary M A , Millis R R , Hoskins E O L , Halder M , Bulbrook R D , Cuzick J , Hayward J L 
Published: March 2007

Abstract
A prospective study was carried out, between January 1980 and March 1982, of all women who presented to the Breast Cancer Unit, Guy's Hospital, with a second primary breast cancer. The percentage of new simultaneous tumours detected clinically or by mammography was approximately 3 per cent. Routine mammographic screening of the contralateral breasts of patients with unilateral disease increased the rate of detection, fivefold, of simultaneous bilateral cancers. The incidence of nonsimultaneous bilateral disease was 7·6 second cancers per thousand patients at risk per year. The annual rate of occurrence of second primary cancers was a constant event and showed no trend either to increase or to decrease with follow-up. However, the risk of a nonsimultaneous second cancer was strongly correlated with age at first primary. Women who developed their first breast cancers under the age of 40 years had three times the risk of developing a second breast cancer compared with those who developed their first cancer after the age of 40. The risk of a second nonsimultaneous primary was 5·9 times that of the risk of occurrence of cancer in the first breast in the general female population.