bluuebunny/crossref_metadata_2025_split huggingface dataset:
Pancreatitis and hyperparathyroidism
Authors: Sitges-Serra A , Alonso M , De Lecea C , Gores P F , Sutherland D E R 
Published: March 2007

Abstract
Hypercalcaemia is considered to be a rare cause of pancreatitis but the true cause-and-effect relationship between hyperparathyroidism and pancreatic inflammatory disease remains controversial. Over 100 patients have been reported in whom both processes have occurred concurrently, but doubts have been expressed as to whether or not this association is due to chance. We report 10 new cases of hypercalcaemic hyperparathyroidism associated with different types of pancreatitis. Seven patients had primary hyperparathyroidism and three had hyperparathyroidism after renal transplantation. Two experienced acute pancreatitis after parathyroidectomy. of the remaining eight patients, five had hypercalcaemia equal to or above 120 mg/l. The prevalence of pancreatitis in our series of 86 cases of primary hyperparathyroidism is 8 per cent. Acute and chronic calcifying types of pancreatitis were observed. Three patients died of the disease, two of them after renal transplantation. It is suggested that pancreatitis may complicate the clinical course of hyperparathyroidism, particularly when hypercalcaemia is moderate to severe and/or there are other risk factors such as treatment with steroids and azathioprine after renal transplantation.
Approach to ingrowing toenails: The wedge resection/segmental phenolization combination treatment
Authors: Issa M M , Tanner W A 
Published: March 2007

Abstract
One hundred and seventy procedures were performed on one hundred and forty patients with ingrowing toenails. Each patient was randomly allocated to one of three treatment groups. There were 55 wedge resections (WR), 53 segmental phenolizations (SP) and 62 wedge resection/segmental phenolization combination treatments (WR/SP). All patients were followed up for 6 months. The duration and intensity of postoperative pain was assessed and the recurrence rate monitored. Postoperative pain was less in the WR/SP group (9.4 ± 13.5 h) than in the WR group (30.0 ± 37.6 h, P&lt;0.001). There were seven recurrences in the WR group, four in the SP group, and none in the WR/SP group. The results in the WR/SP group were statistically significant when compared with the WR group (P&lt;0.01) and with the SP group (P&lt;0.05). We conclude that the WR/SP combination procedure is a superior form of treatment for ingrowing toenails.
Smooth muscle tumours of the digestive tract: Report of 160 cases
Authors: He L-J , Wang B-S , Chen C-C 
Published: March 2007

Abstract
Of 160 patients seen in the period 1951–84 with smooth muscle tumours of the digestive tract, 71 proved to have leiomyomas, 87 had leiomyosarcomas and 2 had leiomyoblastomas. Tumour diameter was frequently greater in patients with leiomyosarcoma. The surgical mortality was 2.8 per cent after treatment of leiomyoma and 10.3 per cent after treatment of leiomyosarcoma. After resection of leiomyosarcoma the 2-year survival rate was 86 per cent and the 5-year survival rate was 43 per cent. The only hope of cure of these malignant lesions lies in surgical resection but, even when the lesion is incurable, resection may allow worthwhile palliation.
Surgical approaches to vertebral artery injuries
Authors: Hatzitheofilou C , Demetriades D , Melissas J , Stewart M , Franklin J 
Published: March 2007

Abstract
Twenty patients with penetrating injuries of the vertebral artery who were treated as emergencies were subjected to the following operative approaches: five cases, Henry's approach (posterior) and modified Henry's approach (anterior); five cases, limited exposure and application of metal clips; four cases, plugging of the arterial defect with Oxycell or crushed muscle; three cases, control with ligatures and non-conventional exposure of the artery; one case, inflation of a balloon catheter within the vertebral canal; one case, repair of the lacerated first extraosseous part of the vertebral artery. One patient died from exsanguination on the operating table, before any repair was possible. The overall mortality was 20 per cent and the mean hospital stay 6·1 days. Thirty-five per cent of the patients presented with neurological complications, and 55 per cent left the hospital well. No advantage of Henry's classical approach over limited exposure and control with metal clips was shown, when mortality, hospital stay and long-term problems were compared. Because of its relative simplicity we suggest that the metal clipping of the vertebral artery, above and below the site of injury, is an effective technique that can be used to stop the bleeding. One case presented as a false aneurysm of the vertebral artery, following a stab wound. This was successfully treated with excision of the aneurysm and vertebrovertebral artery bypass, using a saphenous vein graft.
Angiodysplasia of the colon: Endoscopic diagnosis and treatment
Authors: Santos J C M , Aprilli F , Guimarães A S , Rocha J J R 
Published: March 2007

Abstract
Of 34 patients with massive lower intestinal bleeding, 17 (11 men and 6 women, age range 33–85 years; mean 64·8 years) were diagnosed as having angiodysplasia of the colon. The diagnosis was made by colonoscopy and the lesions were treated successfully by fulguration in 13 (86·6 per cent) of 15 patients. Two of the 17 patients underwent surgical resection of the involved intestinal segment. One patient still has sporadic intestinal haemorrhage, and another patient died from bleeding of the left colon after blind right colectomy. The remaining 13 patients have had no further bleeding in the 1–7 years following colonoscopic fulguration. Colonoscopy is a useful method of diagnosing angiodysplasia of the colon and affords the possibility of treatment.
Recurrent inguinal hernia: A personal study
Authors: Marsden A J 
Published: March 2007

Abstract
A personal series of 287 recurrent inguinal hernias repaired by a single consultant surgeon is presented. Four techniques of repair were employed in the series: Bassini operation; a posterior ‘lace repair’; complete closure of the canal after division of the spermatic cord and local repair of isolated defects. The overall recurrence rate, 27 failures in 287 operations (9 per cent) is disappointing. The best technique is excision of the cord and canal closure, two failures in 43 operations (5 per cent). Cord excision does carry a risk of testicular complications.
Gastric outlet loss and enterogastric reflux after gastrectomy
Authors: Iici T , Whitfield P F , Boulos P B , Hobsley M 
Published: March 2007

Abstract
The relationship of gastric secretion in response to a single injection of insulin and in response to a histamine infusion, before and after partial gastrectomy, was analysed in 58 patients. The aspirated gastric juice was corrected for gastric outlet loss and enterogastric reflux. Gastrectomy drastically reduced the stimulated gastric secretion by a similar proportion for the two secretagogues, thereby implying that antral gastrin plays no greater part in one than in the other. Gastric outlet losses were also reduced after gastrectomy, but as a fraction of gastric contents, both gastric outlet loss and enterogastric reflux more than doubled; the possible relationship of these findings to the aetiology of gastric ulcer is discussed.
Treatment policy for the management of carcinoma of the oesophagus
Authors: Desa L , Raghunath A S , Chawla S L , Peel A L G , Dellipiani A W 
Published: March 2007

Abstract
The management of 120 consecutive patients with carcinoma of the oesophagus, treated in a district general hospital over a 10-year period is reviewed. The treatment options were by endoscopic methods, radiotherapy, surgery or a combination of these. Adenocarcinoma was the most frequent histological type (51 per cent) and 41 per cent of patients had squamous carcinoma. In addition to survival the quality of swallowing and the incidence of late complications following the treatment options was assessed. Primary surgery was carried out in 21 cases (operability rate 17·5 per cent) and 81 per cent of these cases were resectable. The overall operative mortality rate was 14·3 per cent (6 per cent in resected cases) and the 5-year survival rate was 9·5 per cent. After primary radiotherapy only 5 per cent of patients survived 2 years. The majority of patients were treated by endoscopic intubation with an overall mortality of 16·6 per cent and a mean survival of 5·5 months. Patients treated surgically experienced the best symptomatic relief and had the lowest incidence of late complications, when compared with those treated differently. However the overall results of surgery were poor and there remains the need to compare the results of surgery and radiotherapy in similar groups of patients.
Comparison of colonic reservoir and straight colo-anal reconstruction after rectal excision
Authors: Nicholls R J , Lubowski D Z , Donaldson D R 
Published: March 2007

Abstract
The clinical and physiological results in 13 patients having a colonic J reservoir-anal anastomosis (CR) and 15 consecutive patients having a straight colo-anal reconstruction (SC) have been compared. The groups were matched for age, sex, level of tumour and proximal and distal resection margins. The incidence of postoperative complications was similar in each group. The mean follow-up in CR patients was 7 ± 4 months and 47 ± 23 months in SC patients. Stool frequency per 24 h was ⩽ 2 in all CR patients while it was &gt; 2 in 40 per cent of the SC patients (P &lt; 0·05). Three CR patients and six SC patients had minor incontinence, all but one of the rest were fully continent. One patient had a major leak. There was no significant difference in mean resting anal voluntary contraction pressure in the two groups, with mean values within the normal range. The mean rectal sensitivity threshold volume in CR patients (83 ± 30 ml) and SC patients (52 ± 22 ml) was significantly different (P &lt; 0·05) as was the mean maximum tolerable volume (317 ± 122 ml and 174 ± 83 ml respectively, P&lt;0·01). There was no significant difference in balloon expulsion testing, defaecating proctography or methyl cellulose evacuation in the two groups. The addition of a colonic reservoir appears to avoid the high stool frequency occurring in some patients after straight colo-anal anastomosis.
Clinical and functional results after restorative proctocolectomy
Authors: Pescatori M , Mattana C , Castagneto M 
Published: March 2007

AbstractOf 84 patients who underwent restorative proctocolectomy with an ileoanal reservoir in 21 Italian departments of surgery, 51 had ulcerative colitis, 32 familial polyposis and 1 intractable constipation. Follow-up information is available for all 58 patients who had their ileostomy closed, the length of follow-up ranging between 2 and 78 months. There were no operative deaths. A failure rate (i.e. excision of the pouch) of 3 per cent was observed. Sepsis was the most common postoperative complication, and was most often related to ileoanal anastomosis dehiscence (15 per cent), followed by small-bowel obstruction requiring laparotomy (10 per cent). Clinical ‘pouchitis’ occurred in 14 per cent of patients after ileostomy closure. The average frequency of defaecation was four motions per 24 h; evacuation was spontaneous in all patients and only 5 per cent complained of troublesome faecal soiling while 34 per cent had occasional incontinence to flatus and mucus. Patients with a short or absent rectal cuff had a lower rate of incontinence (30 versus 48 per cent, difference not statistically significant) without any increase in the frequency of genito-urinary disorders. None of the two most used reservoirs, the J (n = 40) and S pouch (n = 17) showed significant superiority in terms of bowel frequency and continence. Incontinence was more likely in patients whose ileostomy closure had been delayed for more than one year.
Growth-promoting action of gastrin on human colonic and gastric tumour cells cultured in vitro
Authors: Watson S A , Durrant L G , Morris D L 
Published: March 2007

Abstract
The gastrointestinal hormone, gastrin, was examined for its trophic effect on the growth of colorectal and gastric tumour cells. All of the freshly disaggregated colorectal and gastric human adenocarcinomas responded to pentagastrin in 24 hcultures in vitro. Two newly established adenocarcinoma cell lines showed a response to pentagastrin at passage 2 but not at passage 6. Long-established cell lines did not respond to pentagastrin; however, upon synchronization of the human gastric cell line, MKN45, a trophic growth response with gastrin-17 was observed. This response was enchanced when the same cell line was grown as a xenograft in nude mice and then examined in vitro for gastrin dependence; this dependence was gradually reduced on further in vitro passaging. These results indicate that trophic responses to gastrin are lost during in vitro culture and may be underestimated by using long-established tumour cell lines. However, as all of the early cultures of colorectal and gastric tumours respond trophically to gastrin, perhaps gastrin-receptor blockers may be an important therapeutic modality for these patients.
Influence of age on the mortality from acute pancreatitis
Authors: Fan S T , Choi T K , Lai C S , Wong J 
Published: March 2007

Abstract
The influence of age on the mortality rate of 268 patients with acute pancreatitis was studied. The hospital mortality rate for patients aged below 50 years was 5·9 per cent. The figure increased to 21·3 per cent in patients aged over 75; the high mortality was accounted for by a higher incidence of deaths related to concomitant medical or surgical diseases in the same hospital admission rather than to complications resulting directly from the pathological process of acute pancreatitis. When only deaths due to complications of acute pancreatitis were analysed, the mortality rate was not significantly different between the young and elderly groups. Moreover, the complication rate and the proportion of patients having severe disease (judged by the number of prognostic signs) were not higher in the elderly. Thus acute pancreatitis was intrinsically not more serious were it not for the presence of concomitant diseases with advanced age.
Continuous enteral nutrition during the early adaptive stage of the short bowel syndrome
Authors: Levy E , Frileux P , Sandrucci S , Ollivier J M , Masini J P , Cosnes J , Hannoun L , Parc R 
Published: March 2007

AbstractSixty-two patients with the short bowel syndrome (30–150 cm) were managed by continuous enteral nutrition (CEN) in the early adaptive phase. In all, 82 per cent were referrals from other units and 85 per cent of referrals had failure of one or more organ systems on admission. There were intra-abdominal abscesses in 41 per cent of patients and 37 per cent had an enterocutaneous fistula. The diet included polysaccharides, medium chain triglycerides and protein hydrolysates, mixed with a high-viscosity tapioca suspension. An elemental diet was used initially in 15 per cent of patients. Thirty-three patients had an interruption of the gastrointestinal tract by a temporary enterostomy. Chyme was re-infused into the distal intestine in 20 cases. ‘Zero-time’ was taken as the time of operation or, for referred patients treated conservatively, the date of admission. CEN was commenced at a mean of 14 days from zero-time. Total parenteral nutrition could be discontinued at a mean of 36 days and exclusive oral alimentation was resumed at a mean of 87 days. Patients with small bowel longer than 80 cm attained enteral autonomy earlier than patients with a shorter length. Mean faecal volume did not increase following institution of CEN, suggesting tolerance to the high-viscosity diet. In cases with re-infusion of enteric content, the distal circuit (length of distal small intestine 46 cm) was able to absorb 70 per cent of the volume re-infused (mean volume 2700 ml). Body weight and nutritional markers increased significantly during the course of CEN. This study suggests that enteral autonomy can be attained early in the short bowel syndrome, even under challenging conditions. Elemental formulae do not appear to offer a benefit over polymeric diets.
Effect of epidural analgesia on postoperative insulin resistance as evaluated by insulin clamp technique
Authors: Uchida I , Asoh T , Shirasaka C , Tsuji H 
Published: March 2007

Abstract
The influence of epidural neural blockade on postoperative insulin resistance was studied using the euglycaemic insulin clamp technique. Eighteen patients undergoing elective upper abdominal surgery of moderate severity were allocated to two groups: group G patients underwent operation under general anaesthesia, and postoperative pain was relieved by systemic administration of analgesia; and group E patients received epidural analgesia during surgery and epidural morphine postoperatively. In each patient the euglycaemic insulin clamp test was performed twice: several days before surgery and on postoperative day 1. Peroperative catecholamine and cortisol responses were also measured to investigate possible endocrine mechanisms of the insulin resistance. Glucose disposal (M) decreased in both groups on postoperative day 1 at plasma insulin concentrations ranging from 1.2 to 10.0 milliunits ml−1, resulting in the downward shift of dose-response curves. However, this downward shift was significantly smaller in group E than in group G patients. Urinary adrenaline excretion increased markedly on the day of operation in group G, but was significantly inhibited in group E. Urinary noradrenaline excretion increased mainly on postoperative day 1 in group G, but was significantly inhibited in group E. Plasma cortisol response was lower in group E than in group G during and shortly after operation, and was significantly inhibited in group E on postoperative day 1. These results indicate that insulin resistance after elective abdominal surgery is due to a postreceptor deficit in glucose utilization, as indicated by the downward shift of the dose-response curves. This disturbance in glucose metabolism was reduced by epidural analgesia, the results being associated with inhibited catecholamine and cortisol responses.
Renal transplantation: The nonstarters
Authors: Lennard T W J , Parrott N R , Wilson R G , Proud G , Farndon J R , Simpson Judy M , Taylor R M R 
Published: March 2007

Abstract
Renal transplants do not always function immediately and this non-function may be related to poor long-term graft survival. The causes of this primary non-function (PNF) are poorly understood. The incidence of PNF in 106 consecutive renal transplants was found to be 57 per cent. Using stepwise logistic regression analysis of 20 prospectively collected variables for each transplant two have been found to be positively associated with PNF of the transplant: (1) the use of cyclosporin as an immunosuppressant and (2) a second warm ischaemia (anastomosis) time of more than 30 min. It is proposed that the use of cyclosporin be restricted in the early post-transplant period until initial function of the transplant is established. The surgical procedure of kidney transplantation should be planned to minimize the anastomosis time prior to recirculation of the graft.
Role of constipation and anal hypertonia in the pathogenesis of haemorrhoids
Authors: Gibbons C P , Bannister J J , Read N W 
Published: March 2007

Abstract
The hypothesis that haemorrhoids result from chronic constipation was investigated by studying bowel habit, anal pressure profiles and anal compliance in 13 men and 10 women with prolapsing haemorrhoids. 12 women with severe constipation and 14 male and 11 female control subjects. Defaecation was less frequent in women than in men (P &lt; 0·01) but was independent of the presence of haemorrhoids. Patients with haemorrhoids and control subjects reported similar stool consistency and rarely admitted to straining. Severely constipated women complained of infrequent defaecation, straining at stool and hard motions, but none had prolapsing haemorrhoids. Haemorrhoids were associated with significantly longer anal high-pressure zones and significantly greater maximum resting pressures at all levels of anal distension (P &lt; 0·01), but minimum residual pressure during rectal distension and maximum squeeze pressure were not significantly different from control subjects. Maximum resting pressure was increased in patients of both sexes with haemorrhoids, but this reached statistical significance only in men (P &lt; 0·001). Constipated women had normal anal pressure profiles and maximum anal pressures. These data show that patients with haemorrhoids are not necessarily constipated but tend to have abnormal anal pressure profiles and anal compliance. Chronically constipated women do not necessarily have haemorrhoids but have normal anal pressure profiles and compliance. This casts doubt upon the hypothesis that haemorrhoids are caused by constipation.
Lateral division of the puborectalis muscle in the management of severe constipation
Authors: Kamm M A , Hawley P R , Lennard-Jones J E 
Published: March 2007

Abstract
Patients with severe constipation often do not ‘relax’ their pelvic floor during defaecation. Electromyography of the pelvic floor may reveal inappropriate contraction during defaecation straining, and balloon expulsion, a test of rectal evacuation, may be impaired. Fifteen patients with severe idiopathic constipation and three patients with a megarectum underwent lateral division of the puborectalis muscle and upper half of the external sphincter muscle. Twelve patients had a unilateral division and six patients had both sides divided. Surgery caused a marked reduction in the maximum voluntary squeeze pressure in the anal canal from a pre-operative mean of 90 ± 49 (s.d.) cmH2O to a postoperative mean of 40 ± 29 cmH2O (P &lt; 0·0001). Four patients, three with idiopathic constipation and one with megarectum, experienced symptomatic improvement. Three of these patients had a bilateral division. Improvement did not correlate with a change in the puborectalis electromyography or the ability to expel a balloon. Three patients experienced mild mucus or urge incontinence, but no patient was incontinent for solid stool.
Heparin/dihydroergotamine for venous thrombosis prophylaxis: comparison of low-dose heparin and low molecular weight heparin in hip surgery
Authors: Lassen M R , Borris L C , Christiansen H M , Møller-Larsen F , Knudsen V E , Borist P , Nehen A-M , De Carvalho A , Jurik A-G , Nielsen B W , Lucht U 
Published: March 2007

Abstract
In a prospective, double-blind controlled study we have compared the prophylactic efficacy against deep vein thrombosis of low-dose heparin + dihydroergotamine (A), low molecular weight heparin + dihydro-ergotamine (B) and placebo (C). A total of three hundred and fifty-six patients undergoing total hip replacement were randomized into three groups and 316 patients were analysed. All thrombi were verified by ascending phlebography. One-third of the patients developed deep vein thrombosis in group A and B, differing significantly from group C. The operative blood loss in group B was higher than that in groups A and C. However, the number of patients transfused and their transfusion requirements did not differ. Severe bleeding occurred in one patient in each group. No deaths were registered during the study. Our study indicates that prophylactic treatment against postoperative deep vein thrombosis with low molecular weight heparin + dihydroergotamine once daily is as effective and safe as conventional low-dose heparin + dihydroergotamine twice daily in patients undergoing total hip replacement. The once-daily regimen has the advantage of better patient acceptance and less nursing time.