bluuebunny/crossref_metadata_2025_split huggingface dataset:
Neoplasia and ureterosigmoidostomy: A colonoscopy survey
Authors: Stewart M , Macrae F A , Williams C B 
Published: March 2007

Abstract
Patients who have undergone implantation of ureters into the sigmoid colon (ureterosigmoidostomy) are known to be at high risk of developing cancer of the colon many years later. The operation is often performed in infancy for congenital abnormalities of the bladder, thus creating a long term surveillance problem.
Six of 34 patients (17·6 per cent) who had undergone ureterosigmoidostomy were found at a screening fibresigmoidoscopy to have adenomas of the left colon or severe dysplasia of the stoma, a mean interval of 22 years after their urinary diversion. Four other patients had previously had a sigmoid adenoma or cancer; thus, 29 per cent overall had developed colonic neoplasms, almost all closely related to their stomas. Another patient who, by error, was excluded from the surveillance, died of metastatic cancer of the sigmoid colon within the study period.
Regular surveillance by fibresigmoidoscopy of patients who have had urinary diversion affords the opportunity to detect and remove potentially malignant sigmoid lesions. In addition to its clinical importance, it allows a closer study of this unique model of colon carcinogenesis.
Control of malignant ascites with spironolactone
Authors: Greenway B , Johnson P J , Williams R 
Published: March 2007

Abstract
Thirteen of 15 patients with malignant ascites ashieved an excellent response to spironolactone, with an increase in urinary sodium excretion rates from less than 35 mEq/d before treatment to between 50 and 245 mEq/d after treatment. Plasma renin activity was raised in all of 5 patients in whom it was measured, whereas aldosterone was raised in only 3; these results are similar to those found in ascites due to cirrhosis.
The effect of gastrointestinal malignancy on resting metabolic expenditure
Authors: Macfie John , Burkinshaw L , Oxby C , Holmfield J H M , Hill G L 
Published: March 2007

Abstract
It is unclear whether or not the presence of a malignancy causes an increased energy demand in the patient. As energy expenditure is normally related to body cell mass, it might be expected that an alteration in the relationship between body cell mass and energy expenditure would be observed in patients with malignant disease. This study aimed to investigate this possibility and to attempt to quantify any change in order to determine its clinical relevance.
Three groups of patients were studied: a control group (group I), consisting of healthy volunteers and patients awaiting minor elective surgery for benign conditions, and two groups of patients with malignant disease the extent of which was assessed at laparotomy; group II comprised those with local disease and group III those with metastatic disease. Resting metabolic expenditure (RME) was measured by indirect calorimetry and the total body potassium (TBK) was measured as an indicator of body cell mass. The results show a close correlation between RME and TBK in all groups. The RME at a given potassium content was greatest in those patients with metastatic disease. The magnitude of the difference was small, however, amounting to a mean elevation of 289 kcal/d in this group compared to control subjects.
It is concluded that malignancy may result in an increased energy demand, particularly in patients with metastatic disease. The magnitude of the increase is small and probably of little consequence when planning nutritional support, although its cumulative effect over many months may be significant.
Angiodysplasia and Meckel's diverticulum: A congenital association?
Authors: Hemingway A P , Allison D J 
Published: March 2007

Abstract
Five patients under the age of 21 years are described in whom a Meckel's diverticulum was found in association with angiodysplasia of the caecum or ascending colon. Angiodysplasia has only been observed previously in patients over the age of 35 years and its demonstration in 5 young patients with Meckel's diverticulum points not only to an association between the two disorders, but suggests that angiodysplasia may have a congenital aetiology.
A trial of preoperative radiotherapy in the management of operable rectal cancer
Authors:   First Report of an MRC Working Party, Duncan W , Smith A N , Freedman L S , Alderson M R , Arnott S J , Bleehen N M , Bond W H , Crowther D , Deeley T J , Duthie H L , Dykes P W , Fielding L P , Flatman G E , Goligher J C , Hawley P R , Hughes L E , Joslin C A F , Koriech O M , Morson B C , Oates G D , Peckham M J , Sandland M R , Schofield P F , Slack W , Slaney G , Smith J A R , Stewart Scott J , Whitehouse J M A , Wrigley P F M , York-Mason A 
Published: March 2007

Abstract
In a multicentre study, 824 patients with operable rectal cancer were randomized to receive surgery alone, surgery plus a single fraction of 500 rad (5 Gy) and surgery plus 2000 rad (20 Gy) in 10 equal daily, i.e. multiple, fractions. The ratio of abdominoperineal excision to anterior restorative operations was 3:1. There was no evidence of an increased morbidity or mortality following irradiation. The multiple fraction 2000 rad group had tumours which were significantly smaller than those of the other groups. There was also a reduction in the Dukes' C cases in the multiple fraction group. Neither the tumour size nor the lymph node status was altered in the single fraction group.
Conservative surgery for peptic oesophageal strictures
Authors: Cabré-Martínez C A , Sierra-Gil E , Miquel-Collell J M , Curto-Cardús J A 
Published: March 2007

Abstract
Vagal denervation of the stomach and, in most cases, intermittent dilatation for a limited time after the operation have been employed in the treatment of 14 patients with fibrous stricture and shortening of the oesophagus due to chronic gastro-oesophageal reflux. In 2 patients the stricture was widened by means of a gastric patch at the same operation.
The results have been quite encouraging, all patients being able to swallow solid food, most of them normally, and the improvement appears to be permanent. The change in the quality of the refluxed fluid brought about by gastric denervation seems to play a leading role in improving local oesophageal conditions and rendering the stricture amenable to dilatation by bougies or by ingested solid food.
Linear ulcers of the greater curvature of the stomach in patients with mucosal pyloric stenosis
Authors: Gough M J , Savage P T 
Published: March 2007

Abstract
Two patients with linear ulcers of the greater curvature of the stomach are reported. These patients formed part of a series of 18 patients with mucosal pyloric stenosis seen between 1963 and 1981. The mechanisms that may be important in the pathogenesis of these unusual ulcers are discussed.
Dumping symptoms after vagotomy treated by reversal of pyloroplasty
Authors: Ebied F H , Ralphs D N L , Hobsley M , Le Quesne L P 
Published: March 2007

Abstract
Eight patients with intractable dumping symptoms following truncal vagotomy and Heineke–Mikulicz pyloroplasty for duodenal ulcer had the pyloroplasty reversed. These patients were assessed, both clinically and by a dumping provocation test, before operation, within 3 months of reversal of the pyloroplasty, and again at 1 year postoperatively. Six of them had no symptoms during the year and results of their dumping provocation tests have reverted to normal. Five have been followed up for a further year and in all the clinical improvement is maintained. Two patients developed recurrent dumping symptoms within 6 months of the reversal procedure.
The Hartmann procedure
Authors: Bakker F C , Hoitsma H F W , Den Otter G 
Published: March 2007

Abstract
During a 10-year period, 59 patients had a Hartmann operation for diverticular disease (n = 19), carcinoma (n = 21), anastomotic disruption (n = 5), injury (n = 3) and various other conditions (n = 11). Twenty-two patients (37·3 per cent) died postoperatively. Wound infection or wound dehiscence occurred in 26 patients. Other complications inherent in this operation were colostomy necrosis or retraction (n = 12) and leakage of the rectal stump (n = 3). The mean hospital stay of the surviving patients was 28·4 days. Colorectal continuity was subsequently restored in 12 patients (32·4 per cent) and no difficulties were encountered with this procedure.
The identification of patients at high risk following curative resection for colorectal carcinoma
Authors: Finlay I G , McArdle C S 
Published: March 2007

Abstract
Thirty-five consecutive patients undergoing apparently curative resection for colorectal carcinoma were staged by conventional methods (Dukes', degree of tumour differentiation and pre- and postoperative CEA). In addition, the presence or absence of occult hepatic metastases at the time of surgery was determined by sequential CT scanning.
Thirteen patients died within 30 months of surgery. Conventional prognostic indices failed to define clearly those patients who died. In contrast, the presence or absence of occult hepatic metastases at the time of surgery clearly defined two groups of patients. Only 9 per cent of patients who possessed occult hepatic metastases survived 30 months compared with 88 per cent of patients in whom these metastases were not detected. The clinical implications of these results are discussed.
Results of highly selective vagotomy in a non-university teaching hospital
Authors: Busman D C , Munting J D K 
Published: March 2007

Abstract
Clinical and laboratory results are presented of 229 patients treated by highly selective vagotomy for duodenal ulcer in a non-university teaching hospital. Sixty-two per cent of the operations were performed by residents as part of their training. After 1–8 years follow-up (97 per cent complete) there were 22 recurrences (9·6 per cent). The residents had fewer recurrences than the consultants, but their patient follow-up was shorter. The usual Visick grading is presented (1, 2: 83·5 per cent; 3, 4: 16·5 per cent) as well as an additional way of grading described by Visick in 1948 which suggests that 4 per cent appear to be permanent failures. Mortality rate was 0·4 per cent, complications rate was low and side effects were in general of minor importance. Laboratory results are presented showing that the basal acid output (BAO) was reduced permanently by 65 per cent, and the PAO by 50 per cent. In patients with recurrences BAO was not reduced and the PAO was less reduced than in the non-recurrence group. Metabolic parameters did not deteriorate. Basal serum gastrin rose after operation while serum vitamin B12 remained constant with a minimal tendency to decrease.
Endotoxin, prostaglandins and renal fibrin deposition in obstructive jaundice
Authors: Fletcher M S , Westwick J , Kakkar V V 
Published: March 2007

Abstract
The delayed clearance of endotoxins in obstructive jaundice may cause renal impairment by inducing renal vasoconstriction and glomerular fibrin deposition as a consequence of intravascular coagulation. As endotoxins activate arachidonic acid metabolism we have examined the effects of selective inhibitors on mortality, plasma TxB2 and 6-oxo-PGF1α production and renal fibrin deposition in rats with obstructive jaundice following endotoxin administration. Jaundiced rats had a high mortality following endotoxin—58 per cent at 4 h and 83 per cent at 24 h. Pretreatment with indomethacin 3 mg/kg i.p., dazoxiben 3 mg i.p. or prostacyclin 300 ng/kg i.v. produced significant improvements in survival. Endotoxaemia was associated with significant elevations of plasma TxB2 and early inhibition of plasma 6-oxo-PGF1α generation. Renal fibrin deposition, assessed using indirect immunofluorescence and a 125I-labelled fibrinogen uptake ratio, occurred in jaundiced kidneys following endotoxin and could be prevented using indomethacin, dazoxiben and prostacylin. These results suggest that endotoxin-induced TxA2 production can cause renal fibrin deposition in obstructive jaundice, thus contributing in the pathogenesis of the renal impairment.
Nadolol and potassium iodide in combination in the surgical treatment of thyrotoxicosis
Authors: Peden N R , Gunn A , Browning M C K , Crooks J , Forrest A L , Hamilton W F , Isles T E 
Published: March 2007

Abstract
With the two aims of rapidly reducing circulating thyroid hormone levels and controlling the symptoms of thyrotoxicosis, we have prepared 17 thyrotoxic patients for subtotal thyroidectomy, using a combination of potassium iodide administered for 10 days and the long acting beta-adrenoceptor antagonist nadolol. All 17 patients had normal serum thyroxine levels after 10 days of such treatment although 10 still showed elevation of serum tri-iodothyronine and considerable elevation in the most severely toxic patient. All patients were, however, clinically euthyroid preoperatively.
Nadolol was adminstered once daily, hence avoiding the problems of drug administration in the immediate postoperative period, and plasma nadolol concentrations were high throughout the perioperative period. Serum thyroxine and tri-iodothyronine levels were significantly lower and reverse tri-iodothyronine levels higher 24 h postoperatively than before operation. All patients remained stable throughout the perioperative period.
We conclude that this regimen has a number of advantages in the preparation of patients for thyroidectomy, in reducing the degree of thyrotoxicosis, in convenience of drug administration and in ensuring adequate circulating concentrations of beta-adrenoceptor antagonist whilst still retaining a relatively short preoperative phase of drug treatment.
Urinary stones in subjects with a permanent ileostomy
Authors: Kennedy H J , Fletcher E W L , Truelove S C 
Published: March 2007

Abstract
The prevalence of urinary stones in a group of subjects living with a permanent ileostomy has been determined by intravenous urography. Thirty-nine of the ileostomists had previously suffered from ulcerative colitis, while the remaining 12 suffered from Crohn's disease. Four of the ileostomists who had had ulcerative colitis had urinary stones (10·3 per cent). These four subjects were all male, so that among the 23 male ileostomists who had had ulcerative colitis 17·4 per cent had urinary stones. No urinary stones were found in the ileostomists with Crohn's disease. Various factors thought to be associated with a liability to urolithiasis have been examined in the ileostomists and also in a control group of 39 healthy subjects matched for age and sex with the ileostomists who had had ulcerative colitis. The ileostomists commonly showed a reduced urinary volume, a low urinary sodium and magnesium content and low urinary pH. The ileostomists were much more prone to be hyperuricaemic than the controls, and hyperuricaemia was strongly associated with the presence of urinary stones.
The ultrasonic demonstration of portacaval and interposition mesocaval shunts
Authors: Holmin T , Alwmark A , Forsberg L 
Published: March 2007

Abstract
This study demonstrates direct as well as indirect ultrasonic signs of shunt patency in 11 patients with end-to-side portacaval or prosthetic interposition mesocaval shunts. The shunt was visualized in 8 of the 11 patients. Dilation of the inferior vena cava was demonstrated in 7 out of 11 patients, and an increased diameter of the superior mesenteric vein was observed in all of the 7 patients with a mesocaval shunt.
The effect of preoperative bile salt administration on postoperative renal function in patients with obstructive jaundice
Authors: Evans H J R , Torrealba V , Hudd C , Knight M 
Published: March 2007

Abstract
We have studied the effect of the preoperative administration of bile salts on postoperative renal function in jaundiced patients undergoing surgery. Nine patients did not receive bile salts and in this group there were 2 cases of acute renal failure in the postoperative period. Furthermore, creatinine clearance values fell in this group from a mean value of 85 ml/min preoperatively to a mean postoperative value of 55 ml/min. Nine patients received preoperative bile salts with no case of renal failure. Creatinine clearance values increased in all but 2 patients from a mean preoperative value for the group of 79 ml/min to a mean postoperative value for the group of 99 ml/min. The difference between the changes in creatinine clearance in the two groups was statistically significant (P &lt; 0·01). The results of this study suggest that the oral administration of bile salts to jaundiced patients in the preoperative period prevents deterioration in renal function postoperatively and also reduces the incidence of postoperative renal failure.
Bleeding patterns in colorectal cancer: The effect of aspirin and the implications for faecal occult blood testing
Authors: Doran J , Hardcastle J D 
Published: March 2007

Abstract
Faecal occult blood testing for 3 consecutive days is recommended for the detection of colorectal cancer. Is this adequate? Haemoccult tests were performed for 6 days on the faeces of 50 patients with colorectal cancer. Enteric-coated aspirin was given during the final 3 days to see if its systemic effect on coagulation would increase tumour bleeding. In 25 patients blood loss was quantified by radiochromium assay. Bleeding was slight and intermittent with large daily fluctuations in individual patients. Median daily loss before aspirin was 1·2 ml and after aspirin 2·5 ml. Thirty per cent of the tumours were Haemoccult negative using the standard 3-day regimen and 18 per cent were negative after aspirin. Over the 6-day period, 10 per cent were persistently negative. We conclude that new methods are required to improve the diagnostic yield from faecal occult blood tests.
The water soluble contrast enema after rectal anastomosis
Authors: Shorthouse A J , Bartram C I , Eyers A A , Thomson J P S 
Published: March 2007

Abstract
A retrospective study of 135 consecutive postoperative water soluble contrast enemas has been performed to establish the safety of the technique and indications for its use. Normal and abnormal appearances at various levels of rectal anastomsis have been described. Postrectal fluid collections are associated with anastomotic dehiscence and may be a cause rather than effect. One low colorectal anastomosis was disrupted during administration of the enema; the procedure was otherwise safe and free from complication. The postoperative water soluble contrast enema is presented primarily as a research tool to define the true anastomotic leak rate, but may be useful in the diagnosis of a postrectal collection and to define the extent of an established leak.
Conservative treatment of inoperable arterial occlusions of the lower extremities with intra-arterial prostaglandin E1
Authors: Gruss J D , Bartels D , Ohta T , MacHado J L , Schlechtweg B 
Published: March 2007

Abstract
Prostaglandin E1 has a strong vasodilator effect, it inhibits the aggregation of platelets and improves the microcirculation. The hormone is synthesized from arachidonic acid and 80–90 per cent is eliminated in the first transit of the pulmonary circulation. From 1 January 1978 to 30 June 1981 100 patients suffering from inoperable occlusion of the arteries of the lower limbs and facing amputation were treated with intra-arterial PGE1 by prolonged perfusion over an average period of 34 days. PGE1 0·1–0·2ng kg−1 body weight min−1 was administered. Forty-even of 100 legs were saved; 22 of 29 patients suffering from diabetes requiring insulin had to undergo amputation, but only 1 of 18 patients suffering from thromboangiitis obliterans had to have an amputation. The results of treatment in the 52 cases of uncomplicated arteriosclerosis lie in between, with 18 amputations. The complications that followed treatment were haemorrhage, arterial thrombosis, infection and mycotic aneurysms.
Can drugs help patients with lower limb ischaemia?
Authors: Boobis L H , Bell P R F 
Published: March 2007

Abstract
The prevalence of symptomatic arterial disease of the lower limbs is 2 per cent of the population aged 45–60, but it has a relatively benign course, with 70 per cent of patients requiring no therapy. Of the numerous drugs used in the treatment of the disease, there is no evidence to suggest that antilipaemic drugs, anticoagulants, vasodilators or rheological agents confer any benefit to the patient. The initial use of antiplatelet drugs and prostaglandins has been disappointing despite the undoubted importance of the platelet/endothelial interaction in the aetiology of atherosclerosis. As it is unlikely that we can reverse advanced disease, this is hardly surprising. Long term use of these drugs may prevent deterioration in those patients with progressive disease, and controlled trials on this aspect of treatment are now required. Symptomatic relief in the claudicant may perhaps be obtained with naftidrofuryl and suloctodil and with the former in more severe ischaemia, but their use should not replace the beneficial effects of exercise and cessation of smoking.
Transaxillary sympathectomy—is a one-stage bilateral procedure safe?
Authors: Campbell W B , Cooper M J , Sponsel W E , Baird R N , Peacock J H 
Published: March 2007

Abstract
During an 11-year period, 80 transaxillary sympathectomies were performed on 51 patients (hyperhidrosis 24, Raynaud's syndrome 18, Buerger's disease 4, others 5).
Bilateral procedures under one anaesthetic were performed in contrast with previous reports which advocated unilateral operations only. The advantages of the transaxillary route over other operative approaches are discussed.
Extrathoracic management of aortic arch syndrome
Authors: Criado F J 
Published: March 2007

Abstract
The English literature on extrathoracic procedures for aortic arch syndrome spanning the 19-year period 1962–1980 has been reviewed. Fifty publications reporting on 787 operations were selected for analysis. The overall results were excellent in terms of safety and long term symptomatic relief. Unilateral carotid-based operations appear preferable to longer crossover bypasses in the majority of patients. It is suggested that transthoracic reconstruction remain the approach of choice for innominate artery disease and multiple bilateral arch branch occlusions in good-risk patients.
The early diagnosis of massive acute intestinal ischaemia
Authors: Jamieson W G , Marchuk S , Rowsom J , Durand D 
Published: March 2007

Abstract
Intestinal ischaemia with ensuing gangrene has been a serious clinical problem. Delay in diagnosis has inevitably led to either massive gut resection or death.
It has been shown that the bowel contains high concentrations of both organic and inorganic phosphate. With gut ischaemia, phosphate is released from the bowel and elevated concentrations may be measured in peripheral blood, peritoneal fluid and urine. Associated leucocytosis and acidosis constitute a diagnostic laboratory triad.
The alteration in gut phosphate metabolism has been studied extensively in dogs and humans. Under hypoxic conditions, a time period exists before irretrievable gut necrosis ensues. During this vital interval serum phosphate is elevated.
In 20 clinical cases an accurate diagnosis of bowel ischaemia was made utilizing phosphate measurements. Three cases had an early diagnosis which led to embolectomy with no loss of gut.
Elevated serum phosphate is an accurate diagnostic finding in early cases of massive gut ischaemia. It is hoped that this simple test may help lower the staggering mortality and morbidity associated with massive intestinal ischaemia.