bluuebunny/crossref_metadata_2025_split huggingface dataset:
A controlled trial of plasma lipid reduction in peripheral atherosclerosis—an interim report
Authors: Duffield R G M , Miller N E , Jamieson C W , Lewis B 
Published: March 2007

Abstract
The effects of plasma lipid reduction on the progression of femoral atherosclerosis have been studied in 24 hyperlipidaemic patients with stable intermittent claudication. The patients were randomized into treatment or ‘usual-care’ groups, the former receiving lipid-lowering therapy by diet and drugs, and the latter no such treatment. Biplanar femoral arteriography was performed before and after a mean period of 19 months. In the treatment group plasma total cholesterol was decreased by a mean of 25 per cent and plasma triglyceride by more than 40 per cent. Plasma lipids were unchanged in the usual-care group. Significantly fewer arterial segments showed detectable progression in the treatment group (P &lt; 0·01). In addition, the mean increment in plaque area (mm2 per segment per year) in the treatment group was only 34 per cent of that in the usual-care group (P = 0.06).
Increased penile perfusion and reversal of vasculogenic impotence following femoro-femoral bypass
Authors: Schuler J J , Gray B , Flanigan D P , Williams L R 
Published: March 2007

Abstract
This study assessed the effect of femoro-femoral bypass on penile perfusion and impotence. Twelve patients with femoro-femoral grafts had Doppler pressure measurements and penile/brachial indices (PBI) recorded at both dorsal penile arteries, first with the graft open and then with the inflow portion of the graft temporarily occluded by manual external compression.
Doppler pressure measurements and PBI did not change significantly in the dorsal penile artery on the donor (inflow) side of the graft when the graft was temporarily occluded. Patients who were potent both pre- and postoperatively (n - 5) had no significant change in pressure or PBI on the recipient (outflow) side of the graft with graft occlusion. In those patients who experienced reversal of impotence following bypass (n = 4) the mean dorsal penile artery pressure on the recipient side decreased from 101 mmHg with the graft open to 30 mmHg with the graft occluded (P &lt; 0·05).
Review of arteriograms revealed that patients most likely to experience increases in penile perfusion have either (a) recipient side common iliac artery occlusion and a patent internal iliac system which is perfused in a retrograde fashion or (b) recipient side proximal internal iliac occlusion with well-developed collateral circulation between the profunda femoris and the distal internal iliac arterial systems.
Femoro-femoral bypass can increase penile perfusion and alleviate vasculogenic impotence in selected patients.
Impotence in vascular disease: relationship to vascular surgery
Authors: Depalma R G 
Published: March 2007

Abstract
This review considers diagnosis and treatment of vasculogenic impotence. It describes current information related to normal mechanisms of penile erection and pathophysiology of organic impotence, methods of preoperative diagnosis, quantitative evaluation of penile blood flow and operative techniques to be employed in aneurysmal or occlusive aorto-iliac disease. The importance of preserving internal iliac flow and neural fibres enervating the genitalia is stressed. Large vessel reconstructions have proved practical in maintaining or restoring normal erectile function, but at present reconstructions of isolated pudendal or penile artery occlusions are experimental. Medical therapy can be effective in certain marginal cases of small vessel occlusion.
Prevention of fatal postoperative pulmonary embolism by heparin dihydroergotamine or Dextran 70
Authors: Gruber U F 
Published: March 2007

Abstract
Eight thousand and one patients were admitted to a prospective, randomized multicentre trial comparing the prophylactic efficacy of heparin-dihydroergotamine (DHE) and Dextran 70 against fatal pulmonary embolism after emergency or elective orthopaedic surgery. Of the 7413 patients correctly admitted to the trial, 3698 were allocated to receive heparin-DHE and 3715 to receive Dextran 70. Twenty-eight patients in the heparin-DHE and 27 in the dextran group died within 40 days of operation. Necropsy was performed in 19 cases in each group. In 6 patients in the heparin-DHE and in 9 in the dextran group pulmonary embolism was the sole or a contributory cause of death (n.s.). In the dextran group there were more diffuse intraoperative bleeding complications (P &lt; 0·01), more massive postoperative haemorrhages (P &lt; 0·01), more small wound haematomas (P &lt; 0·05) and more allergic reactions (P &lt; 0·05). This is the first large multicentre trial dealing with elective and emergency procedures in orthopaedic patients.
Human umbilical vein and polytetrafluorethylene arterial grafts compared in an artificial circulation
Authors: Goldman M , Gunson B , Hawker R J , McCollum C N 
Published: March 2007

Abstract
The relative merits of gluteraldehyde tanned human umbilical vein (HUV) and polytetrafluorethylene (PTFE) as alternative arterial grafts have yet to be distinguished in clinical practice. A direct comparison between the thrombogenicity of these rival materials using human blood in an artificial circulation has therefore been made. Eight volunteers each donated 600ml of blood. The heparinized blood, now containing autologous 113Inm labelled platelets, was divided equally into paired artificial circulations incorporating 15 cm lengths of either 6 mm PTFE or HUV. The grafts were perfused for 45 min with a pulsatile flow mimicking the superficial femoral artery. Platelet deposition on the graft (graft activity) was expressed as the ratio of counts from the graft over those per millilitre of blood. The fall in platelet count over the 45-min period and change in threshold aggregation responses were also measured. Platelet deposition was consistently greater on HUV with a mean (±s.e.) graft activity of 5·59±0·9 markedly exceeding that in the PTFE group of 1·16±0·1 (P &lt;0·01). This increased consumption of platelets by HUV was demonstrated by a mean fall in platelet count in the circulating blood of 46·7±8·4 × 109/l compared to a fall of 18·2 ± 6·2 × 109/l in the PTFE group (P &lt;0·01). Furthermore, aggregation thresholds increased more after exposure to HUV compared to PTFE. The flow surface platelet deposition was confirmed by scanning electron microscopy and in addition patchy subintimal dissection was found in all the HUV grafts. HUV is markedly more thrombogenic than PTFE when examined in an artificial circulation under flow conditions similar to the human femoropopliteal segment.
Randomized controlled trial of injection sclerotherapy for bleeding oesophageal varices—an interim report
Authors: Yassin Y M , Sherif S M 
Published: March 2007

Abstract
Oesophageal varices are the commonest cause of acute upper gastrointestinal bleeding in Egypt, due to the prevalence not only of schistosomiasis but also chronic hepatitis. Poor results of conventional treatment and shunt surgery led us to evaluate injection sclerotherapy, using fibreoptic endoscopy. In a controlled trial, 108 patients were randomly allocated to injection sclerotherapy or to conventional treatment (medical measures, with modified splenectomy and oesophagogastric devascularization in selected cases). We report the results in the first 108 patients, with a follow-up of 1·35 months. Fifty-three patients received injection sclerotherapy; 5 died (2 of recurrent bleeding) and 5 others had recurrent bleeding but were controlled by further injections. Thirty-six of the 55 control patients underwent surgery; 5 died (2 of recurrent bleeding) and 2 others developed recurrent bleeding. Further bleeding occurred in 12 of the 19 patients who were managed by medical measures alone, with 7 dying. These early results indicate that injection sclerotherapy can be effective in urgent and elective situations and that it appears to have advantages over conventional medical and surgical treatments.
The diagnostic yield of ERCP in the investigation of unexplained abdominal pain
Authors: Ruddell W S J , Lintott D J , Axon A T R 
Published: March 2007

Abstract
One hundred and forty patients with undiagnosed severe chronic abdominal pain who had not undergone previous biliary surgery were investigated by ERCP. A diagnosis was achieved in 34 patients (24 per cent) including 8 with previously undiagnosed peptic ulceration and 5 with gallstones. Twenty-five patients (18 per cent) had an abnormal pancreatogram, including 1 with pancreatic cancer. The incidence of pancreatogram abnormalities suggestive or diagnostic of pancreatitis was particularly high (60 per cent) in patients with a history of alcohol abuse. ERCP has a valuable role in the investigation of patients with ‘obscure’ abdominal pain.
Postanal repair for neuropathic faecal incontinence: Correlation of clinical result and anal canal pressures
Authors: Browning G G P , Parks A G 
Published: March 2007

Abstract
Neuropathic faecal incontinence is associated with low anal pressures and shortening of the anal canal. The operation of postanal repair has been shown to result in the return of acceptable continence in over 80 per cent of such patients. This paper examines the effect of the operation on anal canal pressures. Forty-two patients with primary faecal incontinence and electrophysiological evidence of neuropathy affecting the external anal sphincter and pelvic floor musculature were studied. Anal pressures were measured before operation and not less than 1 month afterwards. Two groups were chosen according to the clinical result. Group 1 consisted of 34 patients who regained continence and group 2 comprised 8 patients judged as having had an unsatisfactory result. In group 1 there was an increase in anal canal length (1.4 ± 0.2 cm, mean ± s.e.m., paired t test, P &lt; 0.001), resting pressure (19 ± 3 cm H2O, P &lt; 0.001) and voluntary contraction pressure (13 ± 3 cm H2O, P &lt; 0.001). In group 2 there was some increase in anal canal length (1.0 ± 0.2 cm P &lt; 0.01) but no increase in mean resting pressure or mean voluntary contraction pressure. The results show that postanal repair effectively lengthens the anal canal and increases anal pressures in patients with a successful clinical outcome.
Attenuation of adrenocortical response to upper abdominal surgery with epidural blockade
Authors: Tsuji H , Asoh T , Takeuchi Y , Shirasaka C 
Published: March 2007

Abstract
Plasma cortisol concentrations and urinary 17-OHCS excretion were measured in two groups of 15 patients receiving elective gastrectomy under either general anaesthesia or epidural blockade. In another 15 patients receiving epidural blockade, the vagus nerve was blocked by injection of local anaesthetics or by truncal vagotomy, and their cortisol response to gastrectomy was compared with the other two groups. Gastrectomy under general anaesthesia caused a marked increase in plasma cortisol concentrations and in urinary excretion of 17-OHCS. These adrenocortical responses to gastrectomy were significantly inhibited in patients operated upon under epidural blockade extending from T3–4 to L1–2 and continuing for 48 h postoperatively. In patients receiving both epidural and vagus nerve blockade, the plasma cortisol response was the same as in those receiving epidural blockade alone. The results indicated that the adrenocortical response to upper abdominal surgery was safely attenuated, though not abolished, with high spinal epidural blockade continuing for 48 h postoperatively. The vagus nerve was not likely to be playing an important role in the adrenocortical response to gastrectomy.
Bile acids and post-vagotomy diarrhoea
Authors: Blake G , Kennedy T L , McKelvey S T D 
Published: March 2007

Abstract
Cholecystectomy increases the risk of post-vagotomy diarrhoea and bile acid binding agents may relieve it, suggesting a role for bile acids in its pathogenesis. The faecal bile acid loss in 15 patients with episodic diarrhoea after vagotomy and drainage was not raised when compared with 12 normal subjects, except on days when diarrhoea occurred. This elevation was caused by an increase in stool weight rather than bile acid concentration, suggesting that the increased bile acid loss during attacks was not causally related. Asymptomatic vagotomy patients excreted normal amounts of bile acids. Seven patients with episodic diarrhoea after vagotomy and drainage with cholecystectomy continuously excreted excessive amounts of bile acids when compared with normal subjects and asymptomatic patients. The concentration of bile acid in their stools was higher than that observed in symptomatic patients after vagotomy and drainage alone. The continuous presence of excess bile acid may prime the colon to react more readily to stimuli caused by disturbed gastric emptying and rapid small bowel transit, without being the main factor in causing the condition. These findings may explain the increased risk of diarrhoea when cholecystectomy is combined with vagotomy.
The reasons for persistent hypercalcaemia after cervical exploration for presumed primary hyperparathyroidism
Authors: Russell C F , Edis A J , Purnell D C 
Published: March 2007

Abstract
Of 500 consecutive patients who underwent cervical exploration for presumed primary hyperparathyroidism, 461 (92·2 per cent) were cured, as judged by an immediate return of serum calcium levels to normal. Thirty-nine patients (7·8 per cent) had persistent hypercalcaemia after the initial operation. The clinical profiles, operative and pathologic findings, surgical procedures performed and subsequent management of these 39 patients were reviewed. At re-evaluation, 4 patients were noted to have been cured of their hyperparathyroidism: Twenty-one patients had persistent hyperparathyroidism: in 6, all 4 parathyroid glands had not been identified at the initial operation and in 15, hypercalcaemia persisted after the identification of 4 glands. One patient had recurrent hyperparathyroidism after the removal of a 720 mg adenoma and the identification of 3 normal parathyroid glands. Nine patients had non-parathyroid causes for the hypercalcaemia: 2 had occult malignant neoplasms, 6 had benign familial hypocalciuric hypercalcaemia and 1 had immobilization hypercalcaemia. In 4 patients the reason for the persistent hypercalcaemia remained unclear. We suggest a schema that may be used as a guideline in the investigation and management of patients with persistent hypercalcaemia after primary neck exploration for presumed hyperparathyroidism.
Calcium excretion (CaE) in metastatic breast cancer
Authors: Campbell F C , Blamey R W , Woolfson A M J , Elston C W , Hosking D J 
Published: March 2007

Abstract
In 51 women with metastatic breast cancer calcium excretion per litre of glomerular filtrate (CaE) values were persistently higher in those with bone secondaries than in those with only soft tissue involvement despite a normal range of serum calcium in both groups. Measurement of CaE in 8 further patients who were severely hypercalcaemic as a result of their advanced breast cancer revealed the degree to which calcium resorption from bone secondaries and renal dysfunction contributed to the hypercalcaemia. Thus, in patients with breast cancer, CaE provides a reliable indicator of early changes of calcium homeostasis. It may provide an objective indication of progression of bone secondaries and also has important therapeutic implications in established hypercalcaemia.
The causes, management and outcome of upper gastrointestinal haemorrhage in an Indian hospital
Authors: Anand C S , Tandon B N , Nundy S 
Published: March 2007

Abstract
Four hundred and eight consecutive patients with upper gastrointestinal haemorrhage, admitted to a large hospital in India over the 5-year period 1976–81, were studied prospectively. The mean age was 41 years, the male: female ratio was 3:1, causes of bleeding were oesophageal varices in 45·5 per cent, duodenal ulcer in 25 per cent, gastric ulcer in 5 per cent and gastritis in 8·5 per cent. One hundred and twelve patients had operations with an overall mortality of 20 (18 per cent). Thirty-three (11 per cent) of the unoperated patients died. Eighty-seven per cent of patients left hospital alive and 76 per cent returned to their former way of life. Patients with upper gastrointestinal bleeding in North India are mainly young males, nearly half bleeding from oesophageal varices, and have a moderately good prognosis.
Results of transurethral resection of the benign prostate
Authors: Habib N A , Luck R J 
Published: March 2007

Abstract
This retrospective study reviews the results of 200 consecutive transurethral resections of prostate (TURP) for benign disease performed in two small district general hospitals. There was 1 postoperative death (0·5 per cent). Ninety-five per cent of the patients were discharged from follow-up with satisfactory results. Nine patients (4·5 per cent) are still under review either for postoperative complications or persistent symptoms.
Results of Marlex mesh abdominal rectopexy for rectal prolapse in 100 consecutive patients
Authors: Keighley M R B , Fielding J W L , Alexander-Williams J 
Published: March 2007

AbstractOne hundred and six consecutive patients were seen between January 1973 and January 1982 with a circumferential full thickness rectal prolapse. One hundred were treated by abdominal rectopexy using a rectangular sling of monofilament knitted polypropylene (Marlex) mesh sutured to the sacrum and to the lateral ligaments of the mobilized rectum. There were only 9 men in the series and 23 per cent of the patients were over the age of 80 years. Sixty-seven of the patients gave a history of faecal incontinence. Previous unsuccessful treatment for rectal prolapse included a Thiersch wire or a Silastic perianal sling in 19, electrical therapy in 12, rectopexy with polyvinyl alcohol sponge (Ivalon) in 5 and pelvic floor repair in 2. There were no operative deaths following Marlex mesh rectopexy. Twelve patients had their operation performed under spinal anaesthesia because they were considered unfit for general anaesthesia. No patient developed a recurrent rectal prolapse, but 24 of the 67 patients who had incontinence experienced persistent incontinence after rectopexy (36 per cent); 10 of these patients subsequently had a postanal repair with good results. Rectopexy had no influence on anal canal pressures. Marlex mesh rectopexy is a safe and effective operation for rectal prolapse. It appears to be superior to other operations in that, so far, there has been no recurrence.
E-rosette inhibition and tumour recurrence in early breast cancer
Authors: Haffejee A A , Webster D J T , Paterson A G , Whitehead R H , Thatcher J , Hughes L E , Angorn I B 
Published: March 2007

Abstract
The relationship of serum blocking activity and susceptibility to tumour recurrence using E-rosette inhibition by normal allogenic lymphocytes was evaluated before and after operation in 20 patients with early breast cancer. Preoperative serum inhibition levels did not predict recurrent tumour. The mean postoperative inhibition in patients with recurrence was significantly greater than in those without recurrence. Postoperative testing only in a group of 124 patients showed that the development of local tumour recurrence was preceded by significantly greater inhibition of E-rosetting than occurred in patients without recurrence. The application of a threshold level of serum inhibition of 15 per cent distinguishes patients who are unlikely to develop tumour recurrence over a 4-year follow-up period. Serial measurements of serum inhibition at 6-monthly intervals over 2 years did not add to the predictive value of this test.
The diagnosis and treatment of peri-aortic fibrosis (‘inflammatory’ aneurysms)
Authors: Baskerville P A , Blakeney C G , Young A E , Browse N L 
Published: March 2007

Abstract
A proportion of abdominal aortic aneurysms are found at laparotomy to have thick white walls and extensive peri-aneurysmal adhesions. Graft replacement in these patients is often difficult and associated with an increase in morbidity and mortality. In this study 103 patients with a clinical diagnosis of aortic aneurysm were scanned with computerized tomography to determine whether this condition could be diagnosed preoperatively. Of these, 15 showed diagnostic radiological criteria of peri-aortic fibrosis. Laparotomy revealed no false negatives and only one false positive. Clinical, serological and pathological findings have been compared to those with ‘normal’ aneurysms.
In view of the similarities between this condition and retroperitoneal fibrosis, 5 patients were treated with Prednisone 5 mg twice daily for up to 18 months and a CAT scan technique developed to monitor the degree of thickening quantitatively. Abdominal pain disappeared rapidly, and sequential scanning showed a decrease in peri-aortic fibrosis. Measurements showed the fibrosis only to disappear, with no increase in the diameter of the aortic lumen. In some cases, the lumen was only minimally dilated, although clinical examination suggested an aneurysm. Consequently we suggest that the term peri-aortic fibrosis is a better description of this condition whose aetiology is still obscure, and in which aneurysm formation, when present, may simply be consequent upon the fibrotic reaction in the wall.
Bile acid and lysolecithin concentrations in the stomach of patients with gastric ulcer: Before operation and after treatment by highly selective vagotomy, Billroth I partial gastrectomy and truncal vagotomy and pyloroplasty
Authors: Dewar E P , King R F G , Johnston D 
Published: March 2007

AbstractBile acid and lysolecithin concentrations in the stomach were measured in normal subjects and in patients with gastric ulcer (GU) before operation and more than 1 year after highly selective vagotomy, Billroth I partial gastrectomy (PG) and truncal vagotomy and pyloroplasty. Before operation, patients with GU had significantly (P&lt;0·001) higher bile acid concentrations in the stomach than normal people. After highly selective vagotomy, bile acid concentrations were significantly lower than in preoperative GU patients and were also significantly lower than in patients after PG, but were still higher than in normal people. Postprandial and peak lysolecithin concentrations after highly selective vagotomy were significantly lower than after partial gastrectomy. The therapeutic effect of highly selective vagotomy in the surgical treatment of GU may be due not only to reduced acid-peptic ‘attack’ on the gastric mucosa, but also to reduced duodenogastric reflux of ‘bile’.
Lymphadenopathy as a primary presenting sign: A clinico-pathological study of 228 cases
Authors: Anthony P P , Knowles S A S 
Published: March 2007

Abstract
A total of 228 cases of lymphadenopathy as a primary presenting sign are reported. Tissue diagnoses were divided into: metastatic carcinoma (41 per cent), lymphoma (19 per cent), a specific non-neoplastic condition (10 per cent) and non-specific hyperplasia and inflammation (30 per cent); thus the overall yield of positive tissue diagnosis was 70 per cent. Just 5 primary sites: breast, lung, gastrointestinal and genito-urinary tracts and skin (mainly melanomas) accounted for all but one case. Hodgkin's and non-Hodgkin's lymphomas were evenly distributed. In those with generalized malignant lymphadenopathy a surprisingly even proportion of 1 to 1·5 was found between carcinoma and lymphoma. In those with localized malignant disease metastatic carcinoma predominated. The overall incidence of primary lymphadenopathy increased with age, due to an increase in malignancy. Less than half of patients with carcinomatous lymphadenopathy had symptoms and these tended to be organ specific, whereas three-quarters of patients with lymphoma had symptoms which were usually non-specific. A haematological screen, liver function tests and chest X-ray were frequently abnormal but were not diagnostic.